BMJ  2005;331 (12 November), doi:10.1136/bmj.331.7525.0-f

Editor's choice

Nervous laughter

"`Tsunami not our problem,' say top docs." So ran the spoof headline at our strategy day last week. David Tovey, head of the BMJ's Clinical Evidence, was drawing his vision of a worst case tabloid future for the BMJ. (Other headlines on his flipchart masterpiece were "Name that rash and win an iPod," and "Cox 6 inhibitors work for everyone.")

We were laughing at the time, if somewhat nervously, but the tsunami-rejecting, insular view within medicine is real (we have heard it from readers at focus groups). It is also to some extent understandable. After all, what can we as individuals do about natural disasters in far off places? Even those who are there to help, like Richard Villar writing in this week's journal, express feelings of hopelessness (p 1151). So what's the point of reading about healthcare challenges in developing countries? How does it help us practise better medicine and lead better lives?

Our answer is that medicine cannot be practised in isolation. As the world becomes smaller, health care around the world has more, not less, in common. All healthcare systems struggle with the challenges of limited resources and growing demand. As well as providing clinically practical information (this week Caroline Mitchell and colleagues present a comprehensive review of the diagnosis and management of shoulder pain (p 1124)), we think the BMJ has a role in presenting an international perspective on health care.

So we are proud this week to publish an important group of articles about health in the developing world. The authors—David Evans, Tessa Tan-Torres Edejer, and colleagues at WHO—use a uniquely systematic approach to examine the cost effectiveness of strategies to achieve the millennium development goals. All eight articles are published online this week and the first three appear in this week's journal (pp 1197, 1133, 1137).

Of course, doctors in the UK have their own problems closer to home. The NHS is going through what Nick Timmins, in the first of two articles published this week, calls "the biggest revolution in the way its services are delivered since its foundation in 1948" (p 1141). His lucid account of how private health care has developed within the NHS launches a series of articles on the NHS revolution and health care in the market place.

The BMJ's terrible tabloid future was not the only worst case scenario drawn at our strategy day. The other, from deputy editor Tony Delamothe, was a picture of an ivory tower muffled from external intrusion by thick shrubs, behind the comfortable walls of which the BMJ's editors sit and occasionally lob packages of stuff to whoever might be passing. The tag line was "From complacence to irrelevance." Fear is a terrific motivator. We came out of the meeting inspired with new purpose and a plan of action. We'll tell you all about it soon.

Fiona Godlee, editor

(fgodlee{at}bmj.com)

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Rapid Responses:

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Fear and Loathing in Las Vegas
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