The Lancet

Duchenne muscular dystrophy (DMD) is a severe genetic neuromuscular disease caused by the absence of functional dystrophin, a large structural protein encoded by the X-chromosomal DMD gene. It is typically diagnosed in boys during early childhood and leads to progressive muscle degeneration, resulting in loss of ambulation, respiratory insufficiency requiring non-invasive ventilation, cardiomyopathy, and premature death in early adulthood.1 Glucocorticoids remain the cornerstone of pharmacological treatment.

Coronary artery bypass grafting (CABG) remains the standard of care for many patients with complex multivessel coronary artery disease because of its proven durability and long-term survival benefit.1 Yet conventional median sternotomy continues to dominate surgical practice despite decades of efforts to reduce surgical trauma. Minimally invasive cardiac surgery (MICS) CABG has long promised faster recovery and improved patient satisfaction, but widespread adoption has been limited by concerns that a smaller incision might compromise the quality, completeness, or durability of surgical revascularisation.

We thank Egbert F Smit and Anne-Marie C Dingemans for their Comment1 on our Article2 that reported outcomes from the KRYSTAL-12 trial and welcome their emphasis on the importance of patient-reported outcomes in contextualising treatment benefit for patients with KRASG12C-mutated non-small-cell lung cancer.1 Smit and Dingemans note that, although an in-depth analysis of quality-of-life measures was not provided in the primary publication,2 EQ-5D-5L scores appeared similar between treatment groups despite higher gastrointestinal toxicity with adagrasib.

Seeded protein misfolding and aggregation are relevant to many neurodegenerative diseases. The archetype are prions: protein-only infectious agents that cause fatal neurodegenerative diseases including Creutzfeldt–Jakob disease (CJD). The recent recognition of iatrogenic amyloid β cerebral amyloid angiopathy (CAA) and Alzheimer's disease, caused by inadvertent seeding of amyloid β pathology following historical medical procedures, raises concerns that these conditions might also be transmitted via blood components and products, as was the case in rare instances for variant CJD.

We appreciate the thoughtful Correspondence by Shaun Khanna and colleagues regarding our recent paper published in The Lancet.1 The authors have raised very important fundamental aspects of long-term secondary prevention that merit further elaboration.

The health of LGBTQ+ people has long been an indicator of wider advances in human rights and health equity. Modern LGBTQ+ liberation movements have achieved substantial progress towards the decriminalisation and depathologisation of LGBTQ+ identities. Yet hard-won gains are easily lost, and many parts of the world see no such gains at all, with LGBTQ+ people denied even the most basic human rights.

A controversial court case is bringing renewed attention to gender-based violence towards pregnant women in the country's health system. Sharmila Devi reports.

Narumi Harada-Shoji and colleagues report extended follow-up of the J-START trial and show that adjunctive ultrasonography plus mammography reduced the cumulative incidence of stage 2 and later breast cancer in women aged 40–49 years.1 Yet, the absolute difference at 180 months was small (1·08% vs 1·14%), breast-cancer mortality was identical (21 deaths in each group), and the benefit was time-limited (49–96 months), yielding a restricted mean survival time gain of 0·18 months per participant.

The 10-year follow-up of the HOST-EXAM trial by Jeehoon Kang and colleagues1 provides the longest randomised comparison of clopidogrel and aspirin monotherapy after percutaneous coronary intervention, demonstrating sustained reductions in composite ischaemic and bleeding outcomes with clopidogrel without a mortality signal. These findings extend previous observations from trials such as HOST-EXAM,2 SMART-CHOICE 3,3 and STOPDAPT-2,4 as well as individual patient-level meta-analyses,5 collectively challenging the long-standing primacy of aspirin in chronic secondary prevention.

Trachtman H, Kretzler M, Gesualdo L, et al. TRPC6 inhibition for the treatment of focal segmental glomerulosclerosis: a randomised, placebo-controlled, phase 2 trial of BI 764198. Lancet 2026; 407: 587–98—In table 1 of this Article, the BI764198 20 mg 24 h median TPE and all BI764198 median serum albumin level IQR have been updated. These corrections have been made to the online version as of Aug 20, 2026.

Eder L, Perez-Chada L, Liao W, Merola JF. Psoriasis. Lancet 2026; 408: 734–52—In this Seminar, the first sentence in the Introduction has been updated to “more than 40 million individuals”. The second sentence of the Epidemiology section has also been updated to “more than 40 million individuals”. These corrections have been made to the online version as of Aug 20, 2026, and will be made to the printed version.

The management of advanced hepatocellular carcinoma, defined by the presence of vascular invasion, extrahepatic spread, and cancer-related symptoms according to the Barcelona Clinic Liver Cancer staging system,1 has evolved since 2020 with the emergence of immunotherapy. Sorafenib remained as the single option showing a survival benefit2 until the publication of the positive results of the IMbrave 150 trial,3 which demonstrated superiority of the combination of atezolizumab and bevacizumab compared with sorafenib.

In patients with advanced hepatocellular carcinoma with macrovascular invasion after systemic therapy, time to treatment failure was longer in those who had liver resection than in those who received maintenance therapy.

Desai AC, Maalouf NM, Harper JD, et al. Prevention of urinary stones with hydration: a randomised clinical trial of an adherence intervention. Lancet 2026; 407: 1171–81—In figure 3 of this Article, the values for adherence based on 2·5 L criteria have been corrected. These corrections have been made as of Aug 20, 2026.

“My doctor told me to lose weight.” As a paediatrician and adolescent medicine specialist practising in the USA with a specialty in eating disorders, I hear a version of this sentence frequently when I ask young people struggling with eating disorders what first started a shift in their eating behaviours. They often share that it was at their appointment for a check-up or a sports physical when their doctor indicated concern that their weight or BMI was “too high”. This comment generally comes from a physician whom they have known a long time and trust.

Child psychiatrist, award-winning author, and academic. Born on Oct 12, 1928 in Boston, MA, USA, he died on June 4, 2026 in Lincoln, MA, aged 97 years.

It has been 40 years since Purdue Pharma released OxyContin in the USA and—through its aggressive marketing, lobbying, and legal strategies—launched an epidemic of addiction, overdoses, and deaths among patients taking the prescription opioid. This large increase in prescription opioid addiction was exploited by illicit drug producers and traffickers and led to escalating consumption of heroin, then to fentanyl, and to the current polydrug use involving opioids, stimulants, and sedatives. Total annual fatal overdoses in the USA peaked at 108 000 in 2022.

“We call it le Vidal”, Alexandre Loupy says. “It's a 4000-page book that my mother had, with all the medications…I said, okay, I’m going to learn it.” These days, computers crunch the information for Loupy, Professor of Nephrology and Epidemiology at the Necker Hospital of the Assistance Publique–Hôpitaux de Paris, France, and the Director of the Paris Institute for Transplantation and Organ Regeneration (PITOR). But growing up on Réunion Island, the son of a travel agent and a pharmacist (hence the presence of le Vidal), the 12-year-old Alexandre attempted to learn every drug in the book.

Serious shortages of fuel and medical supplies have plunged the health system into chaos. Joe Parkin Daniels reports.

Narumi Harada-Shoji and colleagues report that adjunctive ultrasonography reduced the cumulative incidence of advanced breast cancer (stage 2 or higher) in women aged 40–49 years (hazard ratio 0·83, 95·6% CI 0·70–0·98) in the J-START trial.1 As a breast surgeon involved in population-based screening in Japan, I recognise this landmark achievement. However, the clinical trial conditions enabling this result might not be reproducible at scale.

In September, 2026, UN member states are expected to adopt a Political Declaration at the UN General Assembly's second High-Level Meeting on pandemic prevention, preparedness, and response.1 This is a vital opportunity to bolster commitments and resources to address the upstream drivers of spillovers of the next epidemic or pandemic.2 To advance these goals and solidify its own standing, the declaration must affirm recent legal milestones connecting human rights with spillover and pandemic prevention.

We thank Anna Macios and colleagues, Saisai Jing and Jiazhao Song, and Atsushi Fushimi for their important comments on the long-term follow-up analysis of the J-START trial.1 We clarify how the reduction in advanced breast cancer should be interpreted, and how it should inform screening policy and implementation.

We write in response to Patricia J Garcia and colleagues’ Comment, which mischaracterises the 2026 MV Hondius hantavirus outbreak as indicative of “weak surveillance and coordinated response capacities in Latin America”.1 We agree that regional preparedness should be strengthened. However, this outbreak did not reveal institutional weakness; rather, it showcased the response capacity and cross-border collaboration already developed in South America.

GBD 2023 Mental Disorder Collaborators. Updated trends in the global prevalence and burden of mental disorders, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet 2026; 407: 2040–64—Appendix 2 of this Article has been corrected as of Aug 20, 2026.

Narumi Harada-Shoji and colleagues’ claim that adding ultrasonography to mammography screening reduces the incidence of advanced breast cancer because the percentage of such cancers out of all cancers is lower in the ultrasound group than in the mammography-only group, is incorrect.1

More than 1 billion people—around 15% of the global population—are estimated to have a disability.1 Yet, people with disabilities are under-represented in health research and continue to experience huge health-care inequities. Disability is an important determinant of access to services and health outcomes, but it is often overlooked.

On July 28, 2026, a magnitude 7·1 earthquake struck Kumamoto Prefecture in southern Japan.1 By the next morning, at least 13 people were confirmed dead; more than 30 000 households remained without power, more than 80 000 without water, and damage or utility outages were reported at 46 health-care facilities.1 In 2016, the same region was struck by successive magnitude 6·5 and 7·3 earthquakes.2 A large shopping mall, which was damaged in 2016 and reopened in June 2026, partly collapsed before an explosion, exposing the fragility of rebuilt infrastructure.

For selected patients with multivessel coronary artery disease, MICS CABG performed by experienced teams improved patient-reported physical recovery at 1 month compared with sternotomy CABG, with no apparent safety penalty through to 12 months. These findings support consideration of MICS CABG in appropriately selected patients treated by experienced teams, and further studies of implementation, recovery pathways, and long-term outcomes.

Psoriasis is a common, chronic, immune-mediated skin disease affecting more than 40 million individuals worldwide. Psoriasis, along with psoriatic arthritis, are part of a broader psoriatic disease spectrum, and present with inflammatory skin and musculoskeletal manifestations driven by shared genetic, environmental, and immunological mechanisms. Skin psoriasis presents with diverse clinical phenotypes, including chronic plaque psoriasis, guttate, palmoplantar, erythrodermic, and pustular forms.

Deramiocel safely slows disease progression in advanced DMD, preserving skeletal muscle function. Administered quarterly in a simple outpatient regimen, deramiocel is a promising treatment for DMD, agnostic to the precise underlying genetic lesion.

In the context of worsening geopolitical turmoil, attacks on multilateralism, expanding emergency demands, declining financial resources for global health, and a reforming international system, it is timely for WHO to reassess its mandate, priorities, and comparative advantage in emergencies such as outbreaks, natural disasters, conflicts, and technological emergencies. The Accra Reset, UN80, Humanitarian Reset, the growth of regional public health institutions, and review of the global health architecture provide precisely these opportunities.

50 years ago during a US election year marked by post-Vietnam war disillusionment, post-Watergate cynicism, and bicentennial optimism, three new infectious threats stress-tested the US public health system. Throughout 1976, a series of challenges emerged: an outbreak of swine influenza A (H1N1) among US troops in New Jersey, NJ, USA; a lethal pneumonia cluster tied to the American Legion Convention in Philadelphia, PA, USA; and an unexplained haemorrhagic fever outbreak in Africa. Although the pathogens and locations were different, the challenge was the same: making sound public health decisions under uncertainty without losing trust or inadvertently causing harm.