This paper, co-authored by Paul Newton of the Mahosot Hospital in Laos — who has collaborated closely with INTERPOL in its anti-counterfeiting operations — summarises evidence on the prevalence of counterfeit drugs, and details their medical and economic impact on poor countries. It outlines how the international community can tackle the problem, which the authors say needs to be taken more seriously. Although the trade in counterfeit drugs has obvious health impacts, its indirect effects are no less significant and include a loss of confidence in health systems and health workers.

This study documents the chemical composition of drugs randomly sampled from pharmacies in Delhi and Chennai in India, and aims to offer the government guidance on improving drug regulation. India is a major producer and consumer of pharmaceuticals but, with quality control standards varying significantly between states, the country has high levels of counterfeit drugs. The study shows that 12 per cent of Delhi samples and 5 per cent of Chennai samples collected in 2008 and 2009 did not meet international quality standards. Although these numbers roughly match the government's estimates, there were differences between pharmacies in the types of drugs commonly counterfeited. And while some had no fake drugs, others had up to 30 per cent.

Ensuring that traditional medicines are safe and effective is a major challenge. This study uses mathematical models to show that the treatments that become popular through communities and get passed down through generations are not necessarily the most efficacious. Often, ineffective treatments that are based on superstition can spread because, the authors say, their very ineffectiveness means that patients use the treatment for longer than medicine that actually works.

This article argues that unless the modernisation of traditional medicine in Nepal is treated with care, it could create gender inequalities and the increased social marginalisation of women. Healthcare in Nepal is slowly being modernised to fit more with a model of Western medicine than with traditional Ayurveda. Ayurveda attracts many female practitioners since it is one of the few professions in this patriarchal society in which women are accorded high status.

This series of commentaries and research articles — published by The Lancet, the Peking University Health Sciences Centre and the China Medical Board — addresses China's major health challenges, strategies and future. It has been produced by a group of 63 scientists from 10 countries with Chinese scientists making up two-thirds of the authors.

The research papers give scientific evidence on key health issues including the emergence and control of both infectious and chronic non-infectious diseases in China as well as the performance of China's healthcare system.

Authors of the series' commentaries further discuss a range of topical issues affecting China's health system, including the state of biomedical science and technology (see 'Progress in Chinese biomedicine a massive challenge'), medical research ethics, the lessons learnt from China's schistosomiasis control programme and the challenges the country faces in controlling HIV/AIDS.

This series of five articles outlines new challenges and unsolved problems since the journal's last series in 2005. The first article ([189kB]) predicts the disease burden and economic losses that developing countries would face from chronic diseases such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes. In the 23 countries that the authors incorporated into a model, chronic disease was responsible for 50% of the disease burden in 2005. If no action is taken, they say, about US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015. The second article ([105kB]) looks at how to scale-up strategies to fight chronic diseases in developing countries. The authors review evidence to identify which methods are cost-effective and financially feasible, and therefore ready to be scaled-up.

Tobacco control, salt reduction (both of which are detailed in the series' third paper ([177kB])), and a multidrug strategy to treat individuals with high-risk cardiovascular disease (see an in-depth look in paper four ([220kB])) are prime candidates for scaling-up. What effect improving health systems has on the level of chronic diseases should be properly evaluated, say the authors. For some health interventions, such as preventing or controlling diabetes, there is little cost-effectiveness data for low or middle-income countries, but their scientific effectiveness is so compelling that countries should consider how best to incorporate them. The final paper ([92kB]) is a call to action to incorporate existing interventions into healthcare programmes, which in 2005 was costed at US$5.8 billion.

1990 saw the first major effort to estimate the main causes of illness and the biggest killer diseases in different countries. The data are important for public-health officials to allocate their resources wisely but also for feeding into estimates to plan for the future. Importantly, these need to be regularly updated to ensure that health programmes are still going in the right direction. This paper updates the 1990 study and offer predictions up to 2030.

The most forceful change in disease trends is in developing countries, with the proportion of people affected by non-communicable diseases set to increase. Proportionally, the number of people with infectious diseases is set to fall, though not when it comes to HIV/AIDS.

Because the authors also rely on predicting socio-economic development trends, they created best-case and worst-case scenarios for economic growth. In the pessimistic scenario, by 2030, the three leading causes of illness will be HIV/AIDS, depression, and ischaemic heart disease; in the optimistic scenario, road-traffic accidents will replace heart disease as the third leading cause.

Cardiovascular diseases are set to rise dramatically in developing countries, partly because of an increase in risk factors for the diseases, which include diet, physical activity, smoking. The authors looked at cardiovascular disease risks such as being overweight or obese, systolic blood pressure, and total cholesterol, and related them to national income, food purchase constraints, and urbanisation. Body mass index (BMI) and cholesterol increased as national income increased, then flattened, and eventually declined. BMI also rose with increasing urbanisation.

The authors suggest that cardiovascular disease risks will increasingly be concentrated in low-income and middle-income countries. Thus, preventing obesity should be considered a priority in these countries, along with measures to control blood pressure, cholesterol, and tobacco use.