Several international organisations
have been engaged in North Korea
for many years, and still there are
grave, morally unacceptable, health
inequities in the country. To ensure
the right to health for all people of
North Korea, increased academic
collaboration could be a small step on
the way to success. Reliable knowledge
of a state’s health challenges and
health system could help planning
of health services, interventions, and
humanitarian aid programmes.
Department of Community Medicine, Institute of
Health and Society, University of Oslo, 0318 Oslo,
more responsible and positive part in
dealing with this issue instead of simply
rejecting this accusation or opposing
the politicisation of such issues.3
First, it is necessary to distinguish
refugees from citizens who have
entered China illegally for economic
reasons. China must protect refugees’
basic rights, treat them with dignity,
and stop repatriating them too
easily. Second, China should take the
comments and suggestions from
the international community more
seriously, working together, not
only to contribute to humanitarian
relief, but also to work to end the
undeniable and unacceptable suffering
of North Korea’s people. It is China’s
responsibility and duty.
We declare that we have no competing interests.
We declare that we have no competing interests.
*Espen Bjertness, Ahmed Ali Madar
[email protected]
The Lancet. North Korea: evidence of
intolerable human rights violations. Lancet
2014; 383: 756.
Ottersen OP, Dasgupta J, Blouin C, et al. The
political origins of health inequity: prospects
for change. Lancet 2014; 383: 630–67.
Yo Han Lee, Seok-Jun Yoon, Young Ae Kim,
Ji Won Yeom, In-Hwan Oh. Overview of the
burden of diseases in North Korea.
J Prev Med Public Health 2013; 46: 111–17.
United Nations Children’s Fund. Levels and
trends in child mortality: report 2012. http://
Report_2012.pdf (accessed March 13, 2014).
WHO. Levels and trends in child malnutrition:
UNICEF-WHO-The World Bank joint child
malnutrition estimates.
(accessed March 13, 2014).
WHO. Noncommunicable disease country
profiles: Democratic People’s Republic of
prk_en.pdf?ua=1 (accessed March 13, 2014).
WHO. Tuberculosis county profiles: Democratic
People’s Republic of Korea. http://www.who.
int/tb/country/en/index.html (accessed
March 13, 2014).
We read with interest The Lancet’s
Editorial on North Korea and evidence
of intolerable human rights violations.1
As Chinese health-care professionals,
we share The Lancet’s concerns about
the situation in our neighbouring
country, North Korea. Only a few people
know what exactly happens there due
to extremely limited news coverage.
Since the evidence is solid after a
year-long investigation into systematic
human rights violations in North
Korea,2 it is urgent that China plays a
Cai-Yue Liu, An-Tang Liu,
Hua-Peng Guan, *Hua Jiang
[email protected]
Department of Plastic and Reconstructive Surgery,
Changzheng Hospital, Second Military Medical
University, Shanghai 200003, China (C-YL, A-TL, HJ);
and Department of Orthopedics, Changzheng
Hospital, Second Military Medical University,
Shanghai, China (H-PG)
The Lancet. North Korea: evidence of
intolerable human rights violations. Lancet
2014; 383: 756.
UN’s Human Rights Council. Commission of
Inquiry on human rights in the Democratic
People’s Republic of Korea, UN’s Human Rights
CommissionofInquiryDPRK.aspx (accessed
Feb 17, 2014).
Agence France-Press. China rejects complicity
in North Korea human rights violations.
The Globalpost, Feb 18, 2014. http://www.
(accessed Feb 18, 2014).
Treatment of
paracetamol overdose
We read with interest David Bateman
and colleagues’ report (Feb 22, p 697)1
regarding reduction of adverse effects
during treatment with intravenous
acetylcysteine for paracetamol
poisoning. Acute ingestions of
para cetamol are common and
consequently it has become one of
the most frequent causes of acute
liver failure in the USA. As such, efforts
to reduce treatment-related adverse
events and the overall costs of care
are greatly needed. However, we are
concerned about the generalisability
of the protocol used by Bateman and
A new acetylcysteine protocol
that reduces the minimum duration
of treatment from 21 h to 12 h is
appealing in the common setting
of hospital overcrowding. While
deserving of investigation, this
justification alone is insufficient
to advocate for the widespread
adoption of this protocol. Although
the present study effectively
evaluates adverse events related to
treatment, it was not powered for
efficacy. We are specifically concerned
about the use of shortened protocols
in patients who either present later
than 8 h after ingestion or with very
high paracetamol concentrations
such that substantial amounts of
paracetamol would remain at the end
of 12 h of therapy.
We commend the authors for their
elegant first step but caution that
without efficacy data the risks of
reducing care might outweigh the
benefits. We agree that shortened
therapeutic courses seem reasonable
in patients who present early
with paracetamol concentrations
minimally above the treatment
threshold, but strongly caution against
abandonment of a treatment protocol
that has been proven to be largely safe
and effective until sound efficacy data
are obtained.
We declare that we have no competing interests.
*Benjamin Kessler, Robert Hoffman
[email protected]
Department of Emergency Medicine, North Shore
University Hospital, Manhasset, NY 11030, USA
(BK); and Division of Medical Toxicology,
Department of Emergency Medicine, NYU School of
Medicine, New York, NY, USA (RH)
Bateman DN, Dear DW, Thanacoody HKR, et al.
Reduction of adverse effects from intravenous
acetylcysteine treatment for paracetamol
poisoning: a randomised controlled trial.
Lancet 2014; 383: 697–704. Vol 383 April 19, 2014