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Reflections from the PLOS Medicine Team: PLOS Medicine 15th Anniversary

Wrapping up the 15th Anniversary Collection, PLOS Medicine team members choose our favorite and most impactful articles from our time on the journal.

To celebrate 15 years of PLOS Medicine, the journal team joined some of our academic editors in identifying our favorite or most impactful articles over our time on the journal. Below are the choices made by our staff editors, editorial operations team, and our partners on the production team.

Though each of us has different reasons for choosing our favorite articles, we are all united by our belief in PLOS Medicine’s strengths as a medical journal and in the influential research we usher through to publication. It’s an honor to be able to serve our communities throughout the peer-review and publication process. 

 

Clare Stone, Acting Editor-in-Chief

At the time of handling this paper on the Yazidi genocide, I’d been on the PLOS Medicine team for a year or so. My background was clinical genomics and I continued in this after joining PLOS Medicine. This 2017 Cetorelli et al paper was such a shock to read when I handled it and had a complete otherworldliness from profiling cancers and predicting outcomes or remission. 

The Yazidis are an ancient ethnic and religious minority who lived primarily in the Nineveh Province of Northern Iraq. ISIS tried to eliminate them to cleanse non-Islamic religions from the region. It was harrowing and deeply disturbing to know that within days in August 2014, nearly 10,000 Yazidis were killed or captured by ISIS; up to 4,000 of those were killed immediately, either by bullet or be-heading or being set on fire. Many others fled up Mount Sinjar – where they remained trapped by ISIS forces – to face a different death of dehydration, starvation or succumbing to the elements. Of the deaths on the mountain, 93% were children. Those who were captured were either raped and tortured or forced to fight for ISIS, and nearly all witnessed the brutal killing of family members. 

I chose this paper to highlight in our blog as it had a deep impact on me at the time of reading and has shaped in me a desire to continue to highlight stories and studies from humanitarian, crises, refugee and migrant settings. This paper was the first survey of the extent of the genocide and was an important paper to highlight what happened, to raise awareness that rescue in some instances was still needed, and support is needed for survivors. It also aimed to provide some framework in moving forward to when a formal genocide investigation is underway that may bring perpetrators to justice. 

 

Richard Turner, Senior Editor

Do we need to re-learn the lessons of HIV/AIDS? Безусловно.

Many of us have read accounts of the tragic history of the HIV/AIDS epidemic in medical journals and elsewhere, with its famous (and infamous) steps and missteps, including the contentious discovery of the virus, the exacerbating role of stigma, the important role of activism in bringing treatment to those in desperate need of it, and the painfully slow emergence of effective therapies for people able to access them. The current UNAIDS targets imagine a world where diagnosis of 90% of people with HIV is widespread, with 90% of those people treated and in turn 90% virally suppressed, seeking to minimize onward viral transmission and AIDS deaths.

As part of PLOS Medicine’s 2017 Special Issue on Advances in HIV Prevention, Treatment and Cure, Chris Beyrer and co-authors contributed a Perspective piece on the HIV epidemic in the Russian Federation. By analysing contemporary data from Russia, the authors drew attention to alarming regionally concentrated increases in HIV diagnoses and AIDS deaths, highlighting injection drug use and poor availability of treatments among the contributing factors. The authors concluded that: “The continuous growth of the Russian HIV epidemic is a failure of public policy and practice”.

This short article shows the power of analysing and reporting country and regional data so as to identify future public health crises, and illustrates the broader dimensions of medicine in helping to pinpoint specific cultural and political factors that may prevent viable disease prevention and treatment. Similar situations involving restrictive laws and policies are far from unknown in other countries even in 2019 and, although laudable intentions have since been expressed, much work will remain to be done to bring the HIV/AIDS epidemic in Russia under control.

 

Thomas McBride, Senior Editor

Dirty tricks to sell more treats

Noncommunicable diseases add up to kill 41 million people each year, equivalent to 71% of all deaths globally. Key to the WHO’s global action plan for reducing NCD burden is reducing demand and use of tobacco and alcohol, as well as unhealthy foods known to lead to many of the leading NCDs like lung cancer, cardiovascular disease, and diabetes. At many levels of government, from local to national, legislation such as labeling requirements, advertising restrictions, and taxes on these products seek to encourage healthier choices among consumers. But as it turns out, alcohol, tobacco, and junk foods are actually extremely profitable, and these regulations usually don’t enjoy universal support of the businesses that sell them. We are familiar with the political battles that play out on the local level over new legislation as interested parties seek to guard their profits. And as a PLOS Medicine research article from 2018 found, these battlegrounds often extend all the way to the international stage. 

In a rather unique study for a medical journal, Pepita Barlow and colleagues investigated whether the rules set up by the World Trade Organization are used by WTO member states to limit food, beverage, or tobacco regulations in other countries. Despite health exceptions in trade rules meant to protect these policies, challenges to food, beverage, and tobacco regulations were common (93 between 1995 and 2016) and frequently involved a power asymmetry (over three-quarters of challenges made towards low- and middle-income countries raised by high-income countries). While challenges rarely reached the level of formally adjudicated disputes, the delays, costs, and threats of formal disputes may achieve the goals of the challenging country and often defanged the proposed regulations. The authors describe separate cases in which regulations proposed by Indonesia, Chile, Colombia, and Saudi Arabia were postponed and weakened following challenges. 

Though the authors were not able to identify what proportion of challenges were valid or identify the factors that influence who challenges who, this study was important in quantifying tactics that were known to occur but typically only reported in case studies. Particularly unsettling was the image of large economies throwing their weight around on a global stage to disrupt efforts of LMICs, where 80% of “premature” NCD deaths (deaths occurring between 30 and 69 years old) occur, to improve the health of their citizens. Let’s hope that shedding a light on these tactics will allow well-meaning policymakers to more effectively guard the health of their citizens.

Adya Misra, Senior Editor

Supermarket checkout policies and changing consumer behaviours: has the war on obesity finally begun?

We have all been there: standing at the supermarket check out, tired after a day’s work and looking longingly at something sugary to get us through the evening. Changing eating behaviours is one of the cornerstones of obesity prevention at an individual level, but unless these changes are incorporated into our lifestyles, these can be hard to maintain. The WHO response to the obesity crisis has always been focussed on prevention, calling for action to change our so called “obesogenic” environment that encourages unhealthy eating/drinking behaviours. 

While supermarkets have been criticised for promoting less than healthy food items by offering discounts, between 2014-2016 several supermarkets implemented policies to remove less than healthy foods from their checkout, replacing them with other healthier versions or non food items. Chocolates, sugary drinks and potato crisps were replaced by dried fruit, nuts and water in some supermarket  checkouts. 

This 2018 article by Katrine T Ejlerskov and colleagues studied data from 30,000 UK households to find out what food they brought home between 2013-2017. Using an interrupted time series analysis, authors observed a 17% decrease in purchases including small packs of sugary sweets, chocolates and potato crisps immediately after changes in checkout policies. This change appeared to stay stable, with a 16% decrease noticed after a year of the policy implementation. The authors also looked at how many purchases involved buying less healthy snacks that were not brought home, suggesting that these were consumed at or shortly after leaving the supermarket. Around a 76% decrease in these “on the go” purchases was reported in 2016-2017, suggesting some long term effects of the implementation of such policies. 

This type of study shows us that voluntary action from supermarkets can have huge effects on our food purchasing behaviours and in turn affect our health. While the authors didn’t measure the direct health effects of these checkout policies, we can hope that more such endeavours will help tackle the rising incidence of obesity around the globe. 

 

Caitlin Moyer, Associate Editor

Air pollutants associated with automobile emissions related to alterations in childrens’ neurodevelopment

The development of brain structures and cognitive abilities continues throughout childhood and adolescence.  This protracted nature of neurodevelopment may leave children particularly vulnerable to insult from exposure to environmental toxins, raising the possibility that exposures to these factors may impact cognitive function.  Given the increasingly ubiquitous presence of pollutants derived from sources such as automobile traffic exhaust, it is important to conduct studies that enable us to determine if a relationship exists between exposure to higher pollutant levels and changes in cognitive outcomes in children.  

In a 2015 study, Sunyer and colleagues investigated whether there is any association between children’s cognitive development and exposure to traffic related air pollutants at school.  Researchers measured levels of air pollutants associated with traffic emissions in and around schools located in both high- and low-traffic areas of Barcelona, Spain, and evaluated school children’s memory and attention over the course of a year.  The results suggested that children attending schools where levels of traffic-associated air pollutants were higher exhibited reduced cognitive growth over this period compared to children at lower-pollution schools.  

These findings illustrate how air pollution is associated with cognitive abilities in children, and that air quality in the vicinity of school environments could potentially have implications for academic achievement.  Results from studies such as this one also demonstrate the potential children’s health consequences of government and industry policy changes concerning the development of more progressive vehicle emissions standards to mitigate the release of traffic-associated pollutants into the environment.

 

Krystal Farmer, Development Editor

With the proliferation of camera-enabled smartphones it’s more possible than ever to document our own behavior and the behavior of those around us as we move through the world. And, with videos captured by those smartphone cameras now regularly sprinkled throughout the 24-hour news cycle, in recent years it often feels as though we’re being inundated with viral images of death at the hands of law enforcement officers. This 2017 PLOS Medicine article shows that, for as much law-enforcement related death we often feel we’re taking in via the media, some portion of those deaths are still officially underreported, unrecorded or misclassified in official government data.  

Here, Feldman and colleagues hypothesized that the number of deaths due to injuries inflicted by US law enforcement officials was being undercounted by the National Vital Statistics System (NVSS) when compared to law-enforcement related deaths reported in The Guardian’s The Counted database of police killings. To test their theory, using capture-recapture analysis the authors created a database that estimated that there were a total of 1,166 law-enforcement-related deaths in 2015. When they looked at the number of 2015 deaths captured by NVSS and The Counted respectively, they found that The Counted captured more of those deaths than NVSS (93.1% vs. 44.9%). Feldman and colleagues also found that if the deaths were the result of some means other than a gunshot or if they happened in a low-income county, they were more likely to be incorrectly categorized as not involving law enforcement..

I chose this paper because we know that gun injuries and deaths, including those caused by police, are a public health issue in the US, especially for marginalized groups. As such, it’s imperative that government agencies accurately and adequately track this data in order to 1) study it and discover whether and why certain populations are more or less affected, 2) develop effective policies and laws to determine and tackle the underlying problems leading to the injuries and deaths, and 3) measure whether or not instances of police injury or death actually increase or decrease over time. This article proves we still have a long way to go before we get there and that media reporting may ultimately help us get where we need to be. Until then, we may want to keep our smartphone cameras at the ready and our eyes peeled for breaking news.

 

Vita Usova, Senior Publications Assistant

With the Extinction Rebellion and Greta Thunberg featuring heavily in the news around the world, we can no longer ignore the threat that environmental crisis is posing to us all. I chose this paper because women’s health and the climate change crisis are close to my heart. The Policy Forum by Dr Sorensen and colleagues highlights how rapid change in climate threatens the most vulnerable societies in the world at disproportionate rates. The lack of segregation of genders at policy levels has led to women suffering the brunt of climate change-related illnesses such as anemia and malnutrition, respiratory and cardiovascular disease, and suffering increased mortality during climate-related disasters. 

 

The good news is that gender is being factored into climate policy, albeit slower than this crisis demands, and we are making strides forward. I pride myself on being a strong woman and reading this made me realise how even the strongest women put in an impossible situation are extremely vulnerable and prey to violence, poor health and loss of their children.  Papers like this are invaluable tools for furthering the cause and raising the profile of these incredibly urgent issues. 

 

Erin O’Loughlin, Senior Publications Assistant

On June 4, 2014, the Islamic State group (IS) invaded Mosul, Iraq’s second-largest city. After 29 months of continuous occupation by IS, Iraqi and coalition forces began taking the city back in October 2016. Nine months of fighting led to the liberation of Mosul on June 29, 2017. Throughout the occupation and liberation, civilians living in the city were at risk of death, injury and kidnapping, but official data on those casualties were not available. In this 2018 study, Gilbert Burnham et al revealed that the civilian mortality rate in Mosul was higher during the months of its liberation than during IS occupation. 

 

The researchers surveyed Mosul households as soon the military allowed them access to the area following its liberation, asking residents to report how many deaths, injuries or kidnappings had happened within the household during IS occupation and during the liberation. According to the results, more civilian casualties occurred during the nine months of liberation than during the 29 months of IS occupation, with the majority of deaths attributable to airstrikes (201 deaths) and explosions (172 deaths).

 

This study stood out to me as a fantastic example of the broad scope of PLOS Medicine, as well as the high impact of the research we aim to publish. As a non-scientist with a background in history, it was remarkable to me to see quantitative analysis of a political and societal issue framed as a public health problem. It highlights the changing landscape of warfare itself, as more and more conflict takes place within occupied cities with high risks to civilians. In particular, the fact that more casualties occurred during the liberation than during the occupation highlights the failures of “precision” airstrikes to protect civilians, and helps to explain the widespread and worsening refugee crisis as a result of displaced people from active warzones. 

Eric Cain, Production Editor

A 2018 research article by Cedeño Laurent and colleagues sought to “evaluate the differential impact of having air conditioning (AC) on cognitive function during a HW [heatwave] among residents of AC and non-AC buildings” using a prospective observational cohort study design in Boston, Massachusetts, using university students. The study involved two cognitive tests among a group indoors with AC and a group without, attempting to document “the effects of temperature on cognitive function… [as] no field studies have observed how indoor temperatures during HWs impact cognition, even though adults in the United States spend upwards of 90% of their time indoors.”

 

The study found that students living without air conditioned spaces scored lower on cognitive test performance metrics, suggesting that lower performance may be related to the thermal burden of higher temperature. While one might alleviate the physical and cognitive burden of a heatwave event with localized air conditioning, novel building materials and design present potential long-term solutions, whereas the use of most artificial cooling systems only provides temporary comfort and introduces more greenhouse gases into the environment. 

 

With Earth’s warming average temperature, impacts of human activity causing climate warming appear certain to add further stress on human health, not only during acute heatwave events, but as a macro-level trend change. If a heatwave event indeed contributes to human cognitive underperformance through an increased thermal burden, then major steps must be taken to reduce large-scale thermal burden and avoid “significant implications on educational attainment, economic productivity, and workplace safety” among an increasingly at-risk public.

 

 

Image Credit: geralt, Pixabay (CC0)

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