Home-based therapy with ready-to-use therapeutic food (RUTF) for the treatment of malnutrition has better outcomes in the research setting than standard therapy. This study examined outcomes of malnourished children aged 6-60 months enrolled in operational home-based therapy with RUTF. Children enrolled in 12 rural centres in southern Malawi were diagnosed with moderate or severe malnutrition according to the World Health Organization guidelines. They were treated with 733 kJ kg(-1) day(-1) of RUTF and followed fortnightly for up to 8 weeks. Staff at each centre followed one of three models: medical professionals administered treatment (5 centres), patients were referred by medical professionals and treated by community health aids (4 centres), or community health aids administered treatment (3 centres). The primary outcome of the study was clinical status, defined as recovered, failed, died or dropped out. Regression modelling was conducted to determine what aspects of the centre (formal training of staff, location along a main road) contributed to the outcome. Of 2131 severely malnourished children and 806 moderately malnourished, 89% and 85% recovered, respectively. Thirty-four (4%) of the moderately malnourished children failed, with 20 (2%) deaths, and 61 (3%) of the severely malnourished children failed, with 29 (1%) deaths. Centre location along a road was associated with a poor outcome. Outcomes for severely malnourished children were acceptable with respect to both the Sphere guidelines and the Prudhon case fatality index. Home-based therapy with RUTF yields acceptable results without requiring formally medically trained personnel; further implementation in comparable settings should be considered.

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The Nobel Prize in Physiology or Medicine is a prestigious award given every year for ostensibly the most important discovery in the field. Prizes in Medicine have typically gone to honor foundational knowledge rather than measurable impact. Two recent examples from global health (a rotavirus vaccine, child growth standards) offer alternatives for what might be lauded in medicine. These two examples and historical achievements regarding cholera and smallpox are worthy but do not fall within the scope of Nobel awards for Peace or Economics. The COVID-19 pandemic gives a new context for the idea that discovery and implementation are both keys to medicine. New patterns that redefine achievement in medicine could emerge by Nobel Prize precedent to promote greater health equity and international collaboration.

The following 3 scenes from Catch-22, A Novel, illuminate medicine. Each centers on a human being who is ill or injured. The climax of the book is the death of a young boy named Snowden. In that scene, the author makes a notable allusion to Shakespeare's King Lear; some original text from that play is provided for context.Scene 1: The Soldier in White (pp. 9-10)The soldier in white was encased from head to toe in plaster and gauze… Sewn into the bandages over the insides of both elbows were zippered lips through which he was fed clear fluid from a clear jar. A silent zinc pipe rose from the cement on his groin and was coupled to a slim rubber hose that carried waste from his kidneys and dripped it efficiently into a clear, stoppered jar on the floor. When the jar on the floor was full, the jar feeding his elbow was empty, and the two were simply switched quickly so that the stuff could drip back into him.Scene 2: The Pain in Yossarian's Liver (p. 7)Yossarian was in the hospital with a pain in his liver that fell just short of being jaundice. The doctors were puzzled by the fact that it wasn't quite jaundice. If it became jaundice they could treat it. If it didn't become jaundice and went away they could discharge him. But this being short of jaundice all the time confused them… They read the chart at the foot of the bed and asked impatiently about the pain. They seemed irritated when he told them it was exactly the same. Scene 3: Snowden's Secret (p. 440)"I'm cold, " Snowden whimpered. "I'm cold. " "There, there, " Yossarian mumbled mechanically in a voice too low to be heard. "There, there. " Yossarian was cold, too, and shivering uncontrollably. He felt goose pimples clacking all over him as he gazed down despondently at the grim secret Snowden had spilled all over the messy floor. It was easy to read the message in his entrails. Man was matter, that was Snowden's secret. Drop him out a window and he'll fall. Set fire to him and he'll burn. Bury him and he'll rot, like other kinds of garbage. The spirit gone, man is garbage. That was Snowden's secret. Ripeness was all."I'm cold, " Snowden said. "I'm cold. " "There, there, " said Yossarian. "There, there. " He pulled the rip cord of Snowden's parachute and covered his body with the white nylon sheets.