Remembering Edmund Klein: the Father of Immunotherapy

Edmund Klein’s seminal research in oncology transformed medicine. He would now be 100 years old. This extraordinary physician–scientist has been dubbed the Father of Immunotherapy and was honored with the highest American recognition in medicine, the Lasker Award, often a prelude to the Nobel Prize (AU)

Basic Sanitation Policy in Brazil: ideas, institutions and challenges in the Twenty-first Century. / Política Pública de Saneamento Básico no Brasil: ideias, instituições e desafios no Século XXI.

This paper describes the challenges currently facing Brazil's basic sanitation sector. The sector's characteristic profitability and dynamism have brought State-run Water & Sewage (W&S) services into the spotlight of the structural reform agenda on the argument that governments do not have the resources necessary to universalize coverage. There is a pattern of W&S services' operating with a surplus, which helps explain the intense dispute in recent years in favour of legal changes to the market position of CESBs and local providers to favour an expanding role for private agents. Converging with the structural reform agenda, Law 14,026, sanctioned on 15 July 2020, made far-reaching changes to the legal framework for sanitation and provided for the State's complete withdrawal from the sector. The new regulatory framework prohibited programme contracts, required tender processes for sanitation service contracts, encouraged regionalization without CESBs, set out national guidelines for States and municipalities to access federal funding and introduced a national regulation regime under the National Waters and Basic Sanitation Agency. The model of cooperation that operates in the SUS could serve as a reference for constructing a social pact in the sector.

Este trabalho aborda os desafios contemporâneos do setor de saneamento básico brasileiro. As características de rentabilidade e dinamismo setorial puseram os serviços estatais de A & E no foco da agenda das reformas estruturais sob o argumento de que os governos não dispõem de recursos necessários para universalizar a cobertura. A agenda da reforma dos serviços de A & E advoga a concessão a empresas privadas da comercialização do abastecimento de água e do tratamento do esgotamento sanitário. Em convergência com esta agenda de reforma estrutural, a aprovação em 15 de julho de 2020 da Lei 14.026 alterou em profundidade o marco legal do saneamento, adotando integralmente a pauta da desestatização do setor. O novo marco regulatório veta o contrato de programa, torna obrigatória a licitação para contratação do serviço de saneamento, estabelece diretrizes nacionais para que estados e municípios acessem recursos federais e institui o regime de regulação nacional por meio da Agência Nacional de Águas e Saneamento Básico. O modelo cooperativo praticado no Sistema Único de Saúde (SUS) pode servir como referência para a construção de um pacto social no setor.

Adventures With Parasites, Metabolism, Inborn Errors, and Cancer: The 2023 Lasker-Koshland Special Achievement Award in Medical Science.

In this Viewpoint, Lasker Award winner Piet Borst looks back over a 50-year career in scientific research, including work with trypanosomatids, mechanisms of drug resistance in cancer cells, and inborn errors of metabolism.

Olikoye O. Ransome-Kuti: A testimony of his achievements in health reforms and public health governance.

The late Professor Olikoye Ransome-Kuti, Nigeria's longest-serving Health Minister since independence to date, has been variedly referred to as a distinguished academic, professional, public servant, technocrat, reformer, change agent, and mentor. His name is widely known not only within Nigeria but in Africa and, indeed, globally. Based on my knowledge of him as a result of working and interacting very closely with him in various capacities during the last twenty-seven (27) years of his life (1976-2003), I have highlighted in this paper some of his efforts and achievements for which he will forever be remembered.

Forced changes in the Pacific Walker circulation over the past millennium.

The Pacific Walker circulation (PWC) has an outsized influence on weather and climate worldwide. Yet the PWC response to external forcings is unclear1,2, with empirical data and model simulations often disagreeing on the magnitude and sign of these responses3. Most climate models predict that the PWC will ultimately weaken in response to global warming4. However, the PWC strengthened from 1992 to 2011, suggesting a significant role for anthropogenic and/or volcanic aerosol forcing5, or internal variability. Here we use a new annually resolved, multi-method, palaeoproxy-derived PWC reconstruction ensemble (1200-2000) to show that the 1992-2011 PWC strengthening is anomalous but not unprecedented in the context of the past 800 years. The 1992-2011 PWC strengthening was unlikely to have been a consequence of volcanic forcing and may therefore have resulted from anthropogenic aerosol forcing or natural variability. We find no significant industrial-era (1850-2000) PWC trend, contrasting the PWC weakening simulated by most climate models3. However, an industrial-era shift to lower-frequency variability suggests a subtle anthropogenic influence. The reconstruction also suggests that volcanic eruptions trigger El Niño-like PWC weakening, similar to the response simulated by climate models.

Fennoscandian tree-ring anatomy shows a warmer modern than medieval climate.

Earth system models and various climate proxy sources indicate global warming is unprecedented during at least the Common Era1. However, tree-ring proxies often estimate temperatures during the Medieval Climate Anomaly (950-1250 CE) that are similar to, or exceed, those recorded for the past century2,3, in contrast to simulation experiments at regional scales4. This not only calls into question the reliability of models and proxies but also contributes to uncertainty in future climate projections5. Here we show that the current climate of the Fennoscandian Peninsula is substantially warmer than that of the medieval period. This highlights the dominant role of anthropogenic forcing in climate warming even at the regional scale, thereby reconciling inconsistencies between reconstructions and model simulations. We used an annually resolved 1,170-year-long tree-ring record that relies exclusively on tracheid anatomical measurements from Pinus sylvestris trees, providing high-fidelity measurements of instrumental temperature variability during the warm season. We therefore call for the construction of more such millennia-long records to further improve our understanding and reduce uncertainties around historical and future climate change at inter-regional and eventually global scales.

Evolución de la deontología española (1978-2022) qué ha cambiado en los últimos 40 años? / Evolution of spanish deontology (1978-2022). What has changed in the last 40 years?

El artículo repasa la evolución de la deontología de la Organización Médica Colegial a través de cómo se ha plasmado en los Códigos de Deontología aprobados por esta institución. Tras una aproximación al espíritu y contenidos del primer Código de Deontología de 1978, nacido tras la Constitución Española, aprobada ese mismo año, que estableció el reconocimiento y la necesidad de regular los colegios profesionales y el ejerci cio de los profesionales titulados. Se compara Código de 1978 con el recientemente aprobado en diciembre del 2022, utilizando como puente el segundo Código de 1990. En la comparación encontramos muchas cuestiones bioéticas sobre las que, a través de las últimas décadas, se ha reflexionado y se han introducido respuestas que responden a los numerosos cambios sociales y tecnológicos que se han producido. Se hace es pecial referencia al concepto de respeto, plasmado en la relación entre el médico y el paciente. Se trata de una relación que, con frecuencia, no es simétrica porque quien sufre puede sentir o soportar una extrema vulnerabilidad. Se reflexiona también sobre la evolución de temas relevantes o que pueden plantear más controversias, como el respeto a la vida inicial y final. La síntesis del actual Código de Deontología médica de 2022 se puede hacer en tres palabras: Respeto y Derechos Humanos (AU)

The article reviews the evolution of the deontology of the Spanish Medical Organization through how it has been reflected in the diverse codes of deontology approved by this institution. After an approxima tion to the spirit and contents of the first Code of ethics approved in 1978, born after the Spanish Cons titution, passed that same year, which established the recognition and the need to regulate professional associations and the exercise of qualified professionals. The 1978 Code is compared with the one recently approved in December 2022, using the second 1990 Code as a bridge. In the comparison we find many bioethical issues on which, through the last decades, reflections have been made and answers have been introduced that respond to the many social and technological changes that have occurred. Special referen ce is made to the concept of respect, embodied in the relationship between the doctor and the patient. It is a relationship that is often not symmetrical because the sufferer may feel or endure extreme vulnerability. The article also reflects on the evolution of relevant issues or those that may raise more controversies, such as respect for initial and final life. The synthesis of the current 2022 Code of Medical Ethics can be done in three words: Respect and Human Rights (AU)