The Lancet

Global efforts to strengthen rehabilitation systems are urgently needed. The WHO Rehabilitation 2030 initiative and its work to develop standardised rehabilitation indicators1 are therefore important steps towards improving rehabilitation services and advancing the aims of the UN Convention on the Rights of Persons with Disabilities. However, Wouter de Groote and colleagues’2 expectation that these indicators can ensure “a measurable path to independence and participation” risks overlooking structural and social inequalities in access to rehabilitation.

More than 260 million people worldwide live with asthma, and more than 400 000 die of the disease each year. 5–10% of people with asthma live with severe asthma, but it has an outsized effect—frequent disease exacerbations, poor lung function, and a widespread dependence on corticosteroids. Despite serious symptoms, asthma is often underdiagnosed and mismanaged, which—in the worst-case scenarios—can be fatal.

Epidemiologist and leading HIV specialist in Russia. Born on Jan 17, 1955, in Moscow, Russia, he died on May 20, 2026, in Moscow, aged 71 years.

We thank Tim Kambič and colleagues for their Correspondence regarding the importance of exercise and physical activity for patients with heart failure with reduced ejection fraction (HFrEF).

We thank Stanislas Quesada and colleagues for their thoughtful comments and for recognising the clinically meaningful benefit of pembrolizumab plus weekly paclitaxel, with or without bevacizumab, in platinum-resistant ovarian cancer.1 Because ENGOT-ov65/KEYNOTE-B96 was not designed to support unplanned subgroup analyses, we have limited our response to prespecified analyses and results that can be interpreted within the trial design.

We highly commend Isabelle Ray-Coquard and colleagues for their Comment announcing the Lancet Commission on Ovarian Cancer,1 emphasising equity-driven reform. However, we believe they overlook a crucial barrier to improving population-level survival: emergency presentations.

Hatter L, Holliday M, Oldfield K, et al. Budesonide–formoterol versus salbutamol as reliever therapy in children with mild asthma (CARE): a 52-week, open-label, multicentre, superiority, randomised controlled trial. Lancet 2025; 406: 1473–83—In this Article, the percentage of participants in the salbutamol group with at least one serious adverse event has been corrected in table 3. A clarification has also been added to table 3 that the data included within are unadjusted raw count results. These changes have been made to the online version as of Sept 17, 2026.

The starting point for medicine is accurate knowledge of the body. These words belong to the renowned 2nd-century physician Galen. However, as revealed by the title of their text, The Best Physician is Also a Philosopher, Galen argued that a true follower of Hippocrates also needs philosophy. For Galen, what distinguished a druggist from a physician is that the latter is practised in logic, ethics, and natural philosophy (the study of the natural world). Galen himself was both physician and philosopher.

We congratulate Nicoletta Colombo and colleagues for the practice changing results of the ENGOT-ov65/KEYNOTE-B96 trial in platinum-resistant ovarian cancer.1 Their study reports clinically significant improvement in progression-free survival and clinically meaningful improvement in overall survival with pembrolizumab plus weekly paclitaxel, with or without bevacizumab, in patients who had received no more than two previous lines of systemic therapies (for platinum-resistant ovarian cancer).1 These findings are notable in a setting of historically poor prognosis.

In 1974, as the Brazilian student resistance movement strengthened against repression by the country's authoritarian government, Waleska Teixeira Caiaffa became a medical student at the Federal University of Minas Gerais in Brazil. The university was located in Belo Horizonte, Brazil's first planned modern city. Caiaffa witnessed “many student protests during which the military would come in and arrest students”, alongside the city's rapid but inequitable urban expansion. Although “the city was designed as a ‘healthy city’”, she explains, Black informal workers who had either been forcibly displaced from the city centre or migrated from rural areas settled in unplanned, precarious “favela” settlements, expanding racial segregation.

When I was in my late 20s I stood on a bridge for a very long time. I was there, for many reasons. Fatigue being the greatest among them. This tiredness was not only caused by lack of sleep but also from exhaustion linked to 2 years spent as a Black woman in the majority white space of an elite UK academic institution. It was during my doctorate and I was seeking to elevate women's voices. I was exhausted by having to justify my methodological choices and conceptual frameworks to allow the complexity of these women's lives and their mental health needs to be seen.

We thank Rui Wu and colleagues for their thoughtful commentary on the outlined objectives for the Lancet Commission on Ovarian Cancer.1 The authors have provided intriguing data regarding the percentage of women who are first diagnosed in emergency room settings (up to 50% in some jurisdictions) and the associated prognostic implications of this presentation. Wu and colleagues raise important findings: these patients are far more likely to be older, frailer, and to have inequities in access to stable health care (for a variety of complex reasons that vary by country) and thus might be excluded from optimised diagnostic pathways (inclusive of genetics and molecular profiling), surgical intervention, access to novel therapeutics, and optimised survivorship plans.

We read with great interest the Seminar by Antonio Cannata and colleagues1 on novel diagnosis and management approaches to heart failure with reduced ejection fraction (HFrEF). We were surprised by the omission of recent guideline-recommended regular physical activity counselling and supervised exercise training;2,3 therefore, we highlight here its benefits combined with pharmacotherapy.

Byung-Chul Han's short book, Psychopolitics: Neoliberalism and New Technologies of Power (2025, first published in German in 2014), opens with a line that should make us all pause: “Freedom will prove to have been merely an interlude.” End-of arguments have not fared well in recent years. The end of history? We can only wish. But Han's case deserves a hearing because his critique attacks some of health science's most cherished principles. He claims that the era of ever-larger quantities of data is reducing human freedoms.

As President of the Mario Robles Ossio Foundation, a Mexican patient organisation, I strongly support the focus on implementation in the Health Policy by Tonelli and colleagues.1 Mexico has one of the highest burdens of kidney disease worldwide. In March, 2025, chronic kidney disease was included within the National Medical Care Protocols.2 However, as the paper highlights, the real challenge begins after policy adoption: translating those commitments into actions that reach people in their daily lives.

Tonelli and colleagues should be commended for their recently published Health Policy.1 This advocacy paper will indeed profoundly change the vision of nephrology practice on chronic kidney disease (CKD). The paper itemises the major steps towards a major paradigm shift, that is, the transition from replacing kidney function by means of dialysis and transplantation to preserving kidney function through conservative kidney management, which reflects the original mission of the specialty.

On Aug 26, 2026, glacial lake outburst floods affecting Rasuwa, Nuwakot, and Dhading districts in Nepal swept away entire communities, killing 1204 people (as established by recovery of deceased bodies and body parts), with around 4216 people reported missing (as of Sept 2, 2026).1 Global media reported this catastrophic disaster as a Himalayan tsunami.2 Nestled in the Himalayas, Nepal faces an ongoing climate threat and is further vulnerable due to settlements along riverbanks. There are thousands of glacial lakes storing meltwater, and their number is increasing as global temperatures rise, making them akin to ticking time bombs.

Perioperative durvalumab plus FLOT improved overall survival versus placebo plus FLOT and is a new standard treatment option for patients with resectable gastric or gastro-oesophageal junction adenocarcinoma.

Gastric and gastro-oesophageal junction cancers are among the most common causes of cancer-related deaths.1 In patients with operable tumours, several phase 3 trials established the value of perioperative chemotherapy.2–4 In parallel, phase 3 studies in advanced disease confirmed a survival advantage for anti-PD-1 and anti-PD-L1 immune checkpoint inhibitors in combination with platinum doublet chemotherapy, particularly in PD-L1 expressing tumours.5 Thus, examination of whether immune checkpoint inhibitors could improve outcomes in patients who are non-metastatic was warranted.

Founded only in 2009 but central to the Ebola response in DR Congo, ALIMA brings local leadership to humanitarian action. Andrei Popoviciu reports.

In the era of climate change, numerous regions worldwide are facing a surge in both the frequency and unprecedented scale of wildfires. Exposure to wildfire smoke poses substantial risks to health, especially for vulnerable populations. Although previous studies have shed light on health effects of wildfire smoke, crucial research gaps persist, including long-term health effects, interactions with pre-existing health conditions, and health disparities. Closing these gaps is vital to enhancing the ability to safeguard public health during wildfire events and to formulate effective strategies for prevention, mitigation, and response.

Oral administration of OM-85 in early life did not decrease the incidence of wheezing lower respiratory tract illness in this high-risk population. Bacterial lysates are not efficacious for the primary prevention of asthma-like symptoms during the preschool years.

Asthma-related symptoms, such as wheezing, are highly prevalent among preschool children. Asthma is a complex disease and originates from genetic susceptibility combined with different environmental exposures. Early life is a specific critical period for development of later-life asthma.1 Population studies have identified various fetal and early-childhood risk factors for asthma, including early-life respiratory tract infections.1 Early-life respiratory tract infections have not only short-term consequences, but seem also to affect the development of both the respiratory and immune systems, and subsequently predispose individuals to chronic respiratory diseases in later life.

Infectious disease outbreaks expose weaknesses that are overlooked between crises. The ongoing Ebola virus disease outbreak caused by Bundibugyo virus (Orthoebolavirus bundibugyoense; BDBV) in the Democratic Republic of the Congo, during which there has been cross-border transmission into Uganda, has brought together governments, regional and multilateral organisations, manufacturers, research institutions, and financing partners. These actors are accelerating the development, evaluation, and deployment of medical countermeasures (MCMs), including diagnostics, vaccines, therapeutics, and personal protective equipment (PPE).

In stable patients with previous myocardial infarction, left ventricular ejection fraction ≥40%, no heart failure, and no other indication for β-blocker therapy, discontinuation met the non-inferiority criteria for the primary and key secondary endpoints. Interpretation of the primary endpoint is limited by its hospitalisation-heavy and trial-dependent composition.

Few areas of cardiovascular pharmacotherapy have changed as much as β-blocker use after myocardial infarction. For decades, β-blockers were prescribed routinely and often indefinitely after myocardial infarction, a practice based on trials from the early 1980s showing reductions in mortality and recurrent events.1 However, those trials preceded routine reperfusion, invasive management, statins, and dual antiplatelet therapy; therefore, their relevance to contemporary post-myocardial infarction patients is uncertain.

From constructing cell-like systems to creating genomes from scratch, synthetic biology is having a moment. What will it mean for health? Talha Burki reports.

Most high-income countries, including those whose populations are ageing and shrinking, are reorganising their health and long-term care systems for efficiency, without fully integrating disaster resilience into that redesign. Japan is no exception. On July 3, 2026, Japan's Ministry of Health, Labour, and Welfare issued a formulation guideline for the 2040 Regional Medical Care Vision, encouraging prefectures to concentrate resource-intensive acute functions into regional hub hospitals as the workforce contracts.

Meta-analysis, from Greek μετά (meta, after) and ἀνά-λυσις (ana-lysis, breaking up), refers to the analysis of analyses. Meta-analyses address what existing studies collectively allow to be inferred, rather than answering a primary research question. The use of meta-analysis has expanded rapidly, with more than 400 000 meta-analyses indexed in PubMed between 1980 and 2025 (appendix p 9). Yet the trustworthiness of meta-analyses varies widely. Some have reshaped clinical practice and policy; others have added noise or conveyed false certainty.

The health and wellbeing of women, newborns, children, and adolescents are a fundamental human right and a cornerstone of global socioeconomic development. The 2030 Sustainable Development Goal (SDG) era is approaching its conclusion, with progress towards several targets still elusive and the geopolitical landscape highly fragmented. Against this background, we, as three UN agencies with a primary focus on health, together with the Partnership for Maternal, Newborn and Child Health, are beginning to review the evidence on what it will take to protect and advance sexual, reproductive, maternal, newborn, child, and adolescent health and wellbeing beyond 2030.