Using kitchen scales, carefully weight out 4 kilograms of rice and pour it into a deep saucepan. Now put your hands into the rice and let the grains run between your fingers.Contemplate carefully each grain. The number of grains (about 140,000) is approximately the number of lives that could be saved each year world-wide if all hospitalized trauma patients with significant bleeding were treated with tranexamic acid (TXA) within 3 hours of injury. TXA is cheap and widely available. All that is needed to reap these human benefits is that doctors use it.That TXA is a potent inhibitor of fibrinolysis was first reported by Shosuke and Utako Okamoto in The Keio Journal of Medicine in September 1962.Since then TXA has been widely used to treat heavy menstrual bleeding and to reduce blood loss in elective surgery where it reduces blood transfusion by about one third.2 The CRASH-2 collaborators hypothesized that TXA might also reduce bleeding in trauma patients. The CRASH-2 trial was a UK government funded randomized trial of the effects of the early administration of TXA on death, vascular occlusive events and blood transfusion in bleeding trauma patients.

Using kitchen scales, carefully weight out four kilograms of rice and pour it into a deep saucepan. Now put your hands into the rice and let the grains run between your fingers. Contemplate carefully each grain. The number of grains (about 140 000) is approximately the number of lives that could be saved each year world-wide if all hospitalized trauma patients with significant bleeding were treated with tranexamic acid (TXA) within three hours of injury. TXA is cheap and widely available. All that is needed to reap these human benefits is that doctors use it.

As evidence mounts that corporate actor engagement in United Nations (UN) policy-making processes leads to weaker and shallower public health commitments, greater attention is being paid to how to minimise undue interference and manage conflicts of interest (CoI). While we welcome efforts to develop normative guidance on managing such conflicts, we argue that there is the need to go further. In particular, we propose that an index be developed that would assess the health impacts of individual corporate actors, and those actors who fail to achieve a set benchmark would not have engagement privileges. We further propose the establishment of an independent panel of experts to advise on corporate actor engagement as well as on ambiguous and potentially health-harming commitments in text under negotiation in the UN. Recognising that the implementation of such measures will be contested, we recommend a number of practical steps to make their implementation more politically palatable.