Jianwen Guo and colleagues1 conducted a large, randomised, placebo-controlled, double-blind trial and reported that the traditional Chinese medicine (TCM) compound FYTF-919 had no effect on functional recovery, survival, or health-related quality of life in patients with moderate to severe intracerebral haemorrhage. However, this trial—running from Nov 24, 2021, to Dec 28, 2023—did not adhere to the CONSORT Extension for Chinese Herbal Medicine Formulas 2017, which suggested reporting TCM-specific patterns for recruited participants.

President Donald Trump has promised a new golden age of scientific progress and innovation. In a letter to Michael Kratsios, Director of the White House Office of Science and Technology Policy, Trump invoked the USA's post-war scientific boom as a guide: “As World War II drew towards a close, President Franklin D Roosevelt wrote a letter like this one to his science and technology advisor, Vannevar Bush, charging him to explore new frontiers of the mind for the sake of national greatness and pioneer science in peacetime.

Jianwen Guo and colleagues’ trial1 on using FYTF-919 for acute intracerebral haemorrhage has sparked considerable discussion across China's medical community and social media. Although many commend the rigorous methodology of this multicentre, randomised, placebo-controlled, double-blind trial, others argue that the personalised, syndrome-based approach of traditional Chinese medicine (TCM) is incompatible with such standardisation, raising questions on how traditional remedies should be validated.

Jianwen Guo and colleagues’ randomised controlled trial on FYTF-919 for acute intracerebral haemorrhage has attracted extensive attention from researchers in China.1 Guo and colleagues found that FYTF-919 did not affect the utility-weighted modified Rankin Scale at 90 days and found no differences in secondary outcomes or serious adverse events. However, their analysis and conclusions have raised several concerns.

The results of Jianwen Guo and colleagues’ trial shed light on the efficacy and safety of FYTF-919 in the treatment of intracerebral haemorrhage.1 However, their trial might have several detailed errors and questions that raise concerns.

We commend Jianwen Guo and colleagues’ study reporting the clinical trial results of the traditional Chinese medicine (TCM) compound FYTF-919 in the treatment of acute intracerebral haemorrhage.1 However, there are aspects of the study design that warrant further discussion.

Stoop TF, Javed AA, Oba A, et al. Pancreatic cancer. Lancet 2025; 405: 1182–202—In this Seminar, several references cited in the text and non-text items have been corrected. These corrections have been made to the online version as of May 15, 2025.

We appreciate the feedback on and constructive criticism of the CHAIN trial,1 where, as in all complex projects, there were various challenges, many of which were unforeseen. The result—an overall neutral effect of the traditional Chinese medicine (TCM) compound FYTF-919 on the primary outcome of utility-weighted functional recovery in patients with moderate to severe intracerebral haemorrhage—was unexpected and has led to reverberations in the Chinese community. As Renqi Luo and colleagues note, the trial is a crucial step for clinical research on TCM.

Colombia's progressive drug policy reforms include the prioritisation of harm reduction, but campaigners fear advances are at risk. Jacqui Thornton reports.

New health data regulations promise to empower patients and help research, but can they overcome difficulties in harmonisation and implementation? Ferry Biedermann reports.

Molijn C. After release, another struggle: Syria's ex-detainees. Lancet 2025; 405: 1326–27—In this World Report, Alessandra Lenner's name was misspelled. This correction has been made to the online version as of May 15, 2025.

One in five of the population lives with chronic pain. Psychological interventions for pain reveal core principles that can be used to create opportunities for chronic pain self-management in primary practice, across health-care settings, and at home. We highlight the different types of chronic pain and illustrate the psychoneurobiological mechanisms involved. We review core principles for psychological pain management, evaluate the evidence, and illustrate the underlying neurobiology involved. We provide practical advice for how to facilitate pain self-management in clinical practice.

The CHAIN trial evaluating FYTF-919 for acute intracerebral haemorrhage by Jianwen Guo and colleagues1 marks an advancement in assessing traditional therapies while raising important methodological considerations.

Jianwen Guo and colleagues studied patients with intracerebral haemorrhage receiving FYTF-919 or placebo, and found no significant differences in clinical outcomes or serious adverse events.1 However, this conclusion is inconsistent with a previous multicentre trial, which used a similar study design and reported that FYTF-919 significantly improved the 90-day modified Rankin Scale score.2 We hypothesise that the key reason for this discrepancy might lie in differences in the baseline characteristics of the population.

Sofosbuvir–daclatasvir was non-inferior to sofosbuvir–velpatasvir. High efficacy was seen with novel strategies, which might help to inform approaches to treatment for harder-to-reach populations.

As of 2022, an estimated 50 million people globally were infected with chronic hepatitis C virus (HCV), with an estimated 1 million new infections annually. Of these 50 million people, only 36% were aware of their diagnosis, and only 20% of those diagnosed had been treated with direct-acting antivirals (DAAs).1 Inspired by highly efficacious and well tolerated DAAs, WHO set an ambitious target of HCV elimination by 2030.2 However, only a few countries are on target to reach this goal, and it is estimated that the number of people treated annually needs to increase from 754 000 to 7·2 million to achieve this target.

Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, with atherosclerotic cardiovascular disease (ASCVD) contributing substantially to this burden.1,2 Given the well-established association between LDL cholesterol and the risk of developing ASCVD, reducing LDL cholesterol concentrations represents a cornerstone for management of patients with ASCVD or populations at elevated risk, including those with heterozygous familial hypercholesterolaemia (HeFH). The 2019 European Society of Cardiology/European Atherosclerosis Society guidelines on lipid management classify those with ASCVD as a very high-risk population and strongly recommend that these patients reach at least a 50% reduction from their baseline LDL cholesterol concentration while maintaining levels below 55 mg/dL.

Combination therapy of obicetrapib and ezetimibe significantly reduced LDL cholesterol. This oral, single-pill therapy could improve LDL cholesterol management in patients with pre-existing or high risk for ASCVD.

American civil rights activist Maya Angelou once wrote, “prejudice is a burden that confuses the past, threatens the future, and renders the present inaccessible”.1 At a time of unprecedented nationalist and far-right politics in some countries, many people working in global health increasingly encounter an unsafe environment for meetings and conferences, especially those who are considered as others, such as citizens of the Global South, immigrants, refugees and Indigenous, LGBTQ+, and racialised minorities.

On April 16, 2025, the UK Supreme Court ruled that only those who are what it terms as biologically female can be defined as women.1 This has wide implications for medicine as well as for people who are transgender. The Court's document runs to 88 pages. The Court's position on sex is set out several times. For example, on page 50:

For decades, the US Agency for International Development (USAID) has been vital in combating HIV across the Asia–Pacific region, where nearly 7 million people live with the virus amid persistent stigma. In countries such as India, Indonesia, Myanmar, Nepal, Papua New Guinea, the Philippines, and Vietnam, USAID's support has expanded access to HIV testing, immediate antiretroviral treatment (ART), and pre-exposure prophylaxis.1 Beyond treatment, USAID has strengthened psychosocial services, legal aid, and capacity-building, ensuring care reaches marginalised communities.

No significant difference in incidence of shoulder dystocia was found between trial groups in the ITT analysis, probably due to the high proportion of earlier-than-expected deliveries in the standard care group reducing the intended between-group differences in gestational age and birthweight. However, in the per-protocol analysis, compared with all deliveries after 38+0 weeks' gestation, induction of labour between 38+0 weeks' gestation and 38+0 weeks' gestation did show a significant reduction in shoulder dystocia.

The death of Pope Francis1 marks not only the end of a papacy, but also the loss of a global voice who persistently bridged science, compassion, and ethics in one of the most influential roles in the modern world. In an age of misinformation, polarisation, and public health crises, his moral authority was frequently aligned with scientific reason and evidence-based action.

Shoulder dystocia is a rare but potentially serious obstetric emergency. Although many cases of shoulder dystocia are mild, risks include newborn brachial plexus injury, bony fractures, hypoxic encephalopathy, maternal perineal lacerations, and postpartum haemorrhage.1 Risk factors for shoulder dystocia include high birthweight and maternal diabetes,2,3 but it is an unpredictable event that complicates prevention efforts. In the Big Baby trial, Jason Gardosi and colleagues assessed whether shoulder dystocia rates could be reduced with induction of labour between 38 weeks' and 0 days' (38+0) gestation and 38+4 weeks of gestation compared with standard care when a fetus was suspected to be large for gestational age.

The United States Congress has proposed cuts to Medicaid, reversing the Affordable Care Act expansion.1 These cuts could increase mortality and financial hardship for enrollees while straining health-care providers, especially in rural and underserved areas. Here, we estimate the potential effect on mortality and catastrophic health-care expenditures, defined as out-of-pocket costs exceeding 30% of household income.