Cosmeceuticals lurk in the shadowy ground between drugs and cosmetics. Allergan’s Botox, which flattens furrowed foreheads, is one example. Merck’s Propecia for balding pates is another, as are off-the-shelf skin creams with active biological ingredients.

Those who add a prescription cosmeceutical to their morning routine can have real hope of seeing results. But the enticing skincare aisles of your local drugstore tell a different story: dermatologists confess that some 90% of ingredients in anti-ageing creams are little more than overpriced petroleum jelly.

Cosmeceutical manufacturers must shoulder much of the blame, for trying to sidestep drug regulations. The US Food and Drug Administration (FDA) defines drugs as agents intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease, or that affect the structure or function of the body. Cosmetics escape the rigorous trials demanded of a drug because they are assumed only to alter our appearance. But the system falls down for cosmeceuticals, because it is the manufacturers – not the FDA – who decide whether a product is classed as drug or cosmetic. A cream that claims to cure eczema is a drug; if it claims to promote healthy skin, it is a cosmetic. This bizarre situation means that, although some cosmetics companies have excellent R&D arms, many are dissuaded from finding genuinely active ingredients, or advertising their properties if they do, for fear of having to undergo expensive drug trials.

Bill Gates, Microsoft’s founder, travelled to Mozambique to announce the donation of $168m to fight malaria, ushering in what some call a new era of philanthropy.

He almost doubled what the rest of the world – governments, the UN and charities – spend on a disease that kills a million people every year, 90% of them in Africa.

Some of the money will boost research on malaria prevention and new drugs to fight drug-resistant strains. Most will go into a quest for a vaccine which, if successful, could transform the continent. ‘It is time to treat Africa’s malaria epidemic like the crisis it is,’ Mr Gates said. ‘It is unacceptable that 3000 African children die every day from a largely preventable and treatable disease.’

The World Health Organization and the government of Mozambique hailed the donation as a humanitarian gesture that partly filled a huge gap in funding for malaria research.

The announcement came just days after Forbes Magazine published a rich list topped for the tenth consecutive year by Mr Gates and his $45bn fortune. Mr Gates is fascinated with biology and scientific advances such as mapping the genome of the mosquito, believing that the insights can benefit the poor and sick.

For many years, groin hernia repair has been one of the most common operations worldwide. Yet, there is still no consensus about the best choice of anaesthesia. The present day surgeon faces almost the same choice as did his or her predecessors – the choice between local, regional, or general anaesthesia. Local anaesthesia is preferred at most centres where there is a special interest in hernia repair, whereas in other settings, such as general surgical units, regional or general anaesthesia is more often used.

In a recently reported trial, 616 patients at 10 hospitals in Sweden were randomly assigned to have either local, regional, or general anaesthesia. Primary endpoints were early and late post-operative complications. Secondary endpoints were duration of surgery and anaesthesia, length of post-operative hospital stay, and time to normal activity.

Intra-operative tolerance of local anaesthesia was high. In the early post-operative period, local anaesthesia was superior to the other two types with respect to almost all endpoints. At 8 days’ and 30 days’ follow up, there were no significant differences between the three groups. Local anaesthesia has substantial advantages compared with regional or general anaesthesia, such as shorter duration of admission, less post-operative pain, and fewer micturition difficulties. The favourable results obtained with local anaesthesia in specialised hernia centres can, to a great extent, be reproduced by general surgeons in routine surgical practice.

Bicycle helmet standards have a design flaw that could leave cyclists vulnerable to serious head injuries, say researchers in Belgium. The current standards fail to protect one of the most vulnerable parts of the human head – the temple. Yet the researchers have shown that the temple is a common impact site.

Bart Depreitere, Carl Van Lierde and their colleagues at the biomechanics lab of the University Hospital Gasthuisberg Leuven and the Catholic University of Leuven studied head injuries in 86 cyclists who had been involved in accidents. They found that 57% of them had suffered impacts to the side of the head, and a further 27% had suffered impacts to the front (Accident Analysis and Prevention, in press).

Helmets do protect against some of these injuries, but most current helmet designs leave the temple unprotected, says Depreitere. ‘The temple area is a critical site, because the bone is thin. There is a high incidence of brain injuries from impacts in this area.’

A simple tweak to helmet design would do the trick, says Depreitere. ‘I think that an extra piece just in front of the ear, a couple of centimetres or so, would protect the temple.’