Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Exit the Editor
- John S Dowden (27 May 2004)
-
CHEERFUL YESTERDAYS AND CONFIDENT TOMORROWS.
- BM Hegde (28 May 2004)
-
Windmills and heroic martyrdom
- John Hopkins (28 May 2004)
-
Thank you Richard
- John P O'Keefe (28 May 2004)
-
Global Warming
- Ediriweera B.R., Desapriya (28 May 2004)
-
American leadership and the threat to health
- Mark Struthers (29 May 2004)
-
Best wishes Richard
- Parthasarathy K S (30 May 2004)
-
Nature's tolerance has limits?
- Dr.Naseem A. Qureshi MD, IMAPA, LMIPS (30 May 2004)
-
Making a Difference
- Jenny Firth-Cozens (30 May 2004)
-
From the bed-side to the bench: Your future duty!
- Friedrich Flachsbart (31 May 2004)
-
But she'll look sweet upon the seat of a bicycle built for two
- Dr. Herbert H. Nehrlich (1 June 2004)
-
The NHS, American style
- Trisha Greenhalgh, Barbara Starfield, Professor of Family Medicine, Johns Hopkins University, USA (8 June 2004)
-
The BMJ's future is threatened by the BMA: Act now to protect the journal
- R Beddows (10 June 2004)
-
Modernisation of NHS needs genuine rearrangement of relationships and services
- susanne McCabe (14 June 2004)
-
A chorus of fond farewell to a great medical editor from the ‘patients’
- Hilda Bastian (17 June 2004)
|
|
|||
|
John S Dowden, Medical Editor, Australian Prescriber Australia
Send response to journal:
|
No doubt there will be many tributes from around the UK to Richard Smith's 25 years at the BMJ, but I would like to thank him for his influence on medical editors around the world. Under his leadership the BMJ has set high standards of publication, particularly in the field of electronic publishing. These are standards that other medical journals can aspire to reach and thereby improve the service to their readers. Richard has always been willing to share his expertise on editing and peer review with other editors. Although you might not agree with his opinion, he will certainly give you one! I suspect resigning to work for a multinational corporation will not be Smith's last surprise. Competing interests: None declared |
|||
|
|
|||
|
BM Hegde, Retired Vice Chancellor Mangalore 575004, India
Send response to journal:
|
Dear Richard, Wordsworth must have had you in mind when he wrote:"A man he seems of cheerful yesterdays and confident tomorrows." You will be missed for ever in the BMJ. One would find it difficult to get into your large shoes. "Every man" said Channing "is a volume, if you know how to read him." We have enjoyed reading your volume in the last quarter of a century. While it is good to be repotted at 52, it is great to leave when you are most wanted. That taste will linger for ever in your mouth. Congratulations and God speed. I am happy that you are getting into another vital area where the hapless
old elderly need someone of your courage and stature to give them hope.
Let me end this by quoting William Shakespeare in Much Ado About Nothing:
Hope to see you before you leave, God willing.
Competing interests: None declared |
|||
|
|
|||
|
John Hopkins, GP Newton Aycliffe DL5 4SE
Send response to journal:
|
Dear Dr Smith, After spending the last several years seeking to change the BMJ from a technical medical journal to a general interest health based newspaper it is perhaps a sign of the failure of that strategy that Richard Smith is moving to pastures new. On a personal level, fair minded readers must wish him well in his new career. Some of those readers share his love of John Milton. In a phrase from Paradise Lost, that might equally have applied to Don Quixote, he said: 'With long and tedious havock fabled knights
Yours sincerely, John Hopkins Competing interests: None declared |
|||
|
|
|||
|
John P O'Keefe, Editor in chief, Canadian Dental Association 1815 Alta Vista Drive, Ottawa, Ontario, Canada K1G 3Y6
Send response to journal:
|
I "discovered" Richard Smith's leadership when I became an editor almost 7 years ago. I particularly appreciated the development of bmj.com and the introduction of the Electronic Long / Paper Short (ELPS) articles. I have shamelessly followed Richard's lead with these initiatives. Our "paper short" versions in the Journal of the Canadian Dental Association are comprised of one-page summaries, tailored for the busy general practitioner who tells me that he is interested in reading only an abstract. Thank you sincerely for your wonderful leadership. Your influence goes beyond medicine. Competing interests: None declared |
|||
|
|
|||
|
Ediriweera B.R., Desapriya, Research Associate-Department of Pediatrics Centre for Community child Health Research, 4480 Oak Street Vancouver BC V6H 3V4
Send response to journal:
|
A serious response to global warming needed American leadership (1). Recent report submitted to the United Nations, the U.S. Environmental Protection Agency (EPA) admitted that human activities are the primary cause of global warming. Human activities related primarily to the burning of fossil fuels and changes in land cover such as deforestation are changing the concentration of atmospheric constituents or properties of the earth's surface that help to absorb or scatter radiant energy (2). Higher average ambient air temperatures are likely to induce more vigorous cycles of evaporation and precipitation. Indeed, a trend of increasing climate variability and extreme precipitation events has been observed over the past century, and recent models strongly correlate this trend with anthropogenic production of greenhouse gases (2). Climate change during the next century and beyond may exacerbate many of the health threats faced by human populations, especially in resource- poor countries. These threats include disruption of water and food supplies by extreme weather events and the enhanced spread of vector-borne diseases by increasing air and water temperatures(3). The primary international response to global climate change was the 1992 United Nations Framework Convention on Climate Change (UNFCCC), which has been ratified by 186 nations (4). The United States produces about 25 percent of the world's carbon dioxide emissions, making it the greatest producer of greenhouse gases. Unless it seriously tackles emissions reduction, it would be difficult to prevent global warming (4). This would demand immense political will on the part of both industrialized and industrializing countries to fundamentally restructure many sectors of their societies. Effective mitigation of climate change will ultimately require the participation of the United States and its realization that the adoption of alternatives to fossil fuels is not only compatible with economic growth (5) but is also a public health measure supported by a large body of empirical research. (1). Smith R., Cataclysm and Departure. BMJ 2004; 328 (2). Milly PC, Wetherald RT, Dunne KA, Delworth TL. Increasing risk of great floods in a changing climate. Nature. 2002; 415:514-517. (3). Patz JA, Engelberg D, Last J. The effects of changing weather on public health. Annu Rev Public Health. 2000;21:271-307. (4). Report of the Conference of the Parties on Its Third Session, Kyoto, Japan, 10 December 1997. Kyoto, Japan: UNFCCC; 1997. Available at: unfccc.int/resource/docs/cop3. Accessed May 28, 2004. (5). Barrett JP, Hoerner JA, Bernow S, Dougherty B. Clean Energy and Jobs: A Comprehensive Approach to Climate Change and Energy Policy. Washington, DC: Economic Policy Institute; 2002. Competing interests: None declared |
|||
|
|
|||
|
Mark Struthers, GP Bedfordshire, UK
Send response to journal:
|
Perhaps your correspondent was really serious about the threat to global health. America and the values Americans export are a dangerous theme indeed. Donald Rumsfeld and his people may only comprise 5 per cent of the world’s population but without doubt, they pose the greatest threat to life on this planet. Richard Smith has been a fine leader of the BMJ for 13 years and I don’t write this facetiously or without sincerity. It will be sad to see him go and even sadder to know where he’s going. The same could also be said of Tony Blair and the way to disaster his leadership is headed. And of a certain age, these fine British gentlemen are bedazzled by power and riches from overseas and that creativity and flair that is a sexy siren song to both. Good night, good night, departure is such sweet sorrow and bitter too, that I shall say good night till it be the day after tomorrow. As Henry Kissinger once said, “Nothing is more difficult for Americans to understand than the possibility of tragedy.” Competing interests: worry that the possible departure of Donald Rumsfeld will make no difference to the world. |
|||
|
|
|||
|
Parthasarathy K S, Formerly Secretary, Atomic Energy regulatory Board Mumbai 400094
Send response to journal:
|
Dear Richard, The readers of BMJ will miss you. I used to eagerly wait for the "EDITOR'S CHOICE" week after week. I admired your style, though not some of your views! I appreciated your courage of conviction when you resigned an academic post when the University you served decided to accept funds for research from tobacco companies.It was an admirable decision arrived at by, if my memory is correct, an opinion poll among your readers. I could not accept the brazen way you lost your guard and published a paper which, with glaring limitations, tried to prove that passive smoking is after all not as harmful as was thought of! Many readers felt that that issue of BMJ followed a "tabloid style". You may recall that I published a critical article on this aberration of BMJ in the "Science & Technology" feature of the Hindu, one of the most popular Indian news papers.I had some correspondence with you on that topic.You volunteered to respond to the Hindu.But did not.You felt that I was less objective in my approach. Best wishes to you Richard, for success in your new assignment.I am sure that you will carry on your activities creditably.You may be very busy then, but when time permits,please pen down your experiences for the benefit of the BMJ readers.I am sure the new Editor of the BMJ will find some slot in the journal to accommodate the notes from one who served the BMJ so well for so long. Competing interests: None declared |
|||
|
|
|||
|
Dr.Naseem A. Qureshi MD, IMAPA, LMIPS, Medical Director(A), Director CME&R Buraidah Mental Health Hospital, Postcode:2292, Saudi Arabia
Send response to journal:
|
Sir: The editor's choice of BMJ theme ,i.e., global warming and health (1) and significantly related accompanying editorials (2,3), news (4) and reviews (5,6) for this week is highly relevant from many perspectives such as biological, social, psychological, economic, ecological environment, and political. All the authors have contributed substantially to the growing, worrying data about climate global warming and its devastating consequences such as droughts, floods, heat waves, storms and hurricanes, death tolls, spread of infectious and water born diseases, famine and hunger, displacement of masses across international boundires, amplificatiuon of poverty and malnutrition, and others. I would like to inform the readers that psychiatric problems such as PTSD, depressions, psychosis, and somatoform disorders will increase globally tremendously. Thus, this BMJ issue certainly spreads seriously the message across the world people that global warming should be taken seriously and preventive measures are crucially more important now than ever before. The production of greenhouse gases is directly related to global warming and its unimaginable and also unbearable disasters. The USA alone produces 25% of greenhouse gases while the rest of world produces 75% of greenhouse gases and hence all are tempering the nature's working mechanisms for the survival of humans. Nature's beauty will not be realized and sensed if humans are not around and so the nature will also die. Nature has its limits and overcrossing them by nurture will result in total destruction both of humans and other living creatures on this beautiful planet. It is implored that the world climatologists and political leaders must seriously devise plans to prevent global warming and looking at its urgency and immediacy it is the prime duty of each nation including the USA and its people to act now, as two decades will pass very quickly. References: 1. Richard Smith. Cataclysm and departure. BMJ 2004; 328: 0-g 2. Jonathan A Patz. Global warming.BMJ 2004 328: 1269-1270. 3. Peter Drahos and David Henry. The free trade agreement between Australia and the United States. BMJ 2004 328: 1271-1272. 4. Zosia Kmietowicz. Editor of the BMJ to take up new post. BMJ 2004 328: 1276. 5. Shakoor Hajat. The Day After Tomorrow. BMJ 2004 328: 1323. 6. Cathy Read. Climate Change and Human Health: Risks and Responses. BMJ 2004 328: 1324. Competing interests: Pro-nature conservationist. |
|||
|
|
|||
|
Jenny Firth-Cozens, Consultant Hillside, Garth Row, Kendal, LA89AT, Cumbria.
Send response to journal:
|
What a loss to us all! Richard has made the BMJ an accessible and even enjoyable read, not just to doctors but to non-medics like me as well. He has kept central the idea that medicine is for the public good, and that has meant being a politically critical voice at times - another welcomed change but one which must sometimes have taken courage too. As an assistant editor, he also published my first paper on doctors’ stress and I heard later that he’d had to fight hard to take a paper that looked at the under-side of medicine, and from a psychologist too. Thank you Richard for going out on a limb then and since! We will greatly miss his expertise at making medicine and health so accessible, but also his wonderful humour. Undoubtedly had he not taken this job, he could equally have seen an alternative career on the comedy circuit. Perhaps he still will? So many people will miss you, Richard, but also will wish you well. You’ve made a difference for the better, and that’s the best most of us can do. Jenny Firth-Cozens. Competing interests: None declared |
|||
|
|
|||
|
Friedrich Flachsbart, General Medicine Praxis 37085 Göttingen
Send response to journal:
|
Dear Editor, if You now try to change the world of medicine: Good luck. But do not forget Sir Fleming and his streptococci. Common cold and streptococci are the main killer in our society. You should start a bed-side study - there is no way to test it at the bench: Penicillin versus placebo in all cases of possible post-streptococcal-reactive-diseases in man. From the bed-side to the bench: Only this study could help to show the correlations of chronic strep- infection with psoriasis, asthma, diabetes, arthritis, hypertension, cardiomyopathy, restless leg .. Good luck and never forget Sir Alexander Fleming! Sincerily Yours Friedrich Flachsbart Competing interests: None declared |
|||
|
|
|||
|
Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
Send response to journal:
|
It is with a significant amount of dismay that I read about Dr. Smith's leaving this journal for greener pastures. This is not altogether unselfish reasoning, the thought of a stuffy shirt or an iron-fisted new editor is constantly crossing my mind. I recently responded to one of Richard's questions concerning his chances of surviving another few years, if he continued to cycle to work. Being a sometimes ignorant foreigner I mistook this voiture to be a motorised version of cycle, thus a motorcycle and had visions of Harley Davidson (that would at least be PRO-AMERICAN) or BMW. I even made the suggestion that he trade in his motorbike and get the vehicle he wanted, needed and deserved: A Mercedes Benz 6.9 ! Dr. Smith must still be laughing about this occasionally, but I am convinced that NOW is the time to repeat the suggestion. Just think of the size of your new employer, the expansive shape of your new employer's country and the awesome power and influence of your new position. All are attributes of the 6.9 ! And remember that your wife (is there one?) will be far more comfortable on those Sunday drives! With the single exception of the Polypill fiasco, I have appreciated and liked most of your comments and will join the masses of people who will miss you. Could we have Professor Monappa Hegde as your replacement? (I think he drives a yellow GOGGOMOBILE ) Competing interests: None declared |
|||
|
|
|||
|
Trisha Greenhalgh, Professor of Primary Health Care University College London, Barbara Starfield, Professor of Family Medicine, Johns Hopkins University, USA
Send response to journal:
|
We wish Richard Smith every success as he moves from editing the BMJ to his new post as Chief Executive of an American-based private health care company whose mission is to expand into the European market and "speed modernisation of the NHS" (1). We urge him to bear three points in mind: 1. There is as yet no evidence that the ‘Americanisation’ of the UK National Health Service through measures such as public-private partnerships (2), ‘walk-in centres’ (3), increased choice of secondary care provider (4) and ‘payment by results’ (5) has led to significant improvements in health for the most vulnerable groups in society. Starting from a position in which health outcomes in the UK were generally superior to those in the US (6), health inequalities in the UK have if anything increased in recent years (7-9). Comparisons demonstrating the superiority of one of the few effective forms of American 'managed care’ (the Kaiser health care system) over standard NHS care (10) ring hollow considering that these exemplary models operate with self-selected doctors and systematically exclude the working poor without health insurance. Furthermore, the perils of using guideline adherence to develop performance indicators are increasingly recognized (11). 2. When Richard was still a junior editor, the BMJ published a survey of primary care patients, which identified their three top priorities as "Doctor listens to me", "Doctor sorts out my problems", and "I usually see the same doctor" (12). The three least highly valued options were health education, being able to change doctor easily, and convenient premises. In the 15 years since that paper was published, a primary care system based on personal relationships, responsiveness to patients' concerns, and continuity of care has been eroded in favour of one based on the management of doctor-defined disease entities using standardised protocols and procedures. 3. Modernisation initiatives in the NHS are increasingly couched in the consumerist rhetoric of 'quality', 'efficiency', and 'choice'. Whilst we strongly support efforts to improve healthcare quality, we believe there is a danger that private-sector values will drive primary health care further towards defining itself at its margins and devaluing its core business (13). We urge Richard to bear in mind the Orwellian nightmare of an Americanised and private-sector modeled NHS – efficient, equitable, evidence-based, and brimming with choice – in which the elusive elements of good family doctoring have been successfully purged from our consciousness in favour of a neater, cleaner, more technological, and less equitable health system. References (1) Smith R. Cataclysm and departure. BMJ 2004; 328: 1266. (2) Gesler W, Bell M, Curtis S, Hubbard P, Francis S. Therapy by design: evaluating the UK hospital building program. Health Place. 2004;10:117-28. (3) Chapman JL, Zechel A, Carter YH, Abbott S. Systematic review of recent innovations in service provision to improve access to primary care. Br.J Gen.Pract. 2004; 54: 374-81. (4) Appleby J, Harrison A, Dewar S. Patients choosing their hospital. BMJ 2003; 326: 407-8. (5) Dixon J. Payment by results – new financial flows in the NHS. BMJ 2004; 328: 969-970. (6) Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, Oxford University Press, 1998. (7) Coleman MP, Rachet B, Woods LM, Mitry E, Riga M, Cooper N, Quinn MJ, Brenner H, Esteve J. Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001. British J Cancer 2004; 90: 1367- 73 (8) Ferrie JE, Shipley MJ, Davey SG, Stansfeld SA, Marmot MG. Change in health inequalities among British civil servants: the Whitehall II study. J Epidemiol Community Health 2002;56:922-6. (9) Moser K, Li L, Power C. Social inequalities in low birth weight in England and Wales: trends and implications for future population health. J Epidemiol Community Health 2003; 57: 687-91. (10) Ham C, York N, Sutch S, Shaw R. Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data. BMJ 2003;327: 1257. (11) Walter LC, Davidowitz N, Heineken P, Covinsky K. Pitfalls of converting practice guidelines into quality measures: lessons learned from a VA performance measure. JAMA 2004; 291:2466-70. (12) Smith CH, Armstrong D. Comparison of criteria derived by government and patients for evaluating general practitioner services. BMJ 1989; 299: 494-6. (13) McWhinney IR. Primary care: core values Core values in a changing world. BMJ 1998; 316: 1807-1809. --- Competing interests: None declared |
|||
|
|
|||
|
R Beddows, Writer Flat 1, 16 Princes Avenue, London N10 3NR
Send response to journal:
|
Today, June 9, an announcement was made about interim arrangements once Richard Smith leaves the BMJ on July 30. His role will be split in two, dividing his Chief Executive and Editor-in-Chief functions between two colleagues, Stella Dutton and Kamran Abbasi. Strangely, this statement makes no mention of how a new Editor is to be selected. No details are given about the constitutional arrangements for protecting the BMJ's managerial autonomy and editorial independence within the BMA. These silences are disturbing. There are basic questions about Richard Smith's succession that have yet to be answered. The lack of transparency over how the new Editor will be chosen is troubling given that it is now several weeks since the present Editor announced his decision to leave. How will the selection process proceed? Who will be on the selection committee? And how will this panel themselves be chosen? How can readers of the BMJ be assured that the BMA will now not take advantage of this time of uncertainty to put in place a person more suited to the BMA's own aims and objectives? (It is well known that the journal is currently locked in battle with the BMA over its future management and autonomy - Richard Smith leaves at a time of particular tribulation in the journal's history - why, for example, did the BMA commission management consultants to deliver an externally imposed structure on the BMJ's organisation with no serious input from the journal's own staff?) The BMJ is owned, in spirit at least, by its readers. The BMA is simply its temporary guardian. It would be wholly wrong for the BMA to have majority decision making power in the selection of the journal's next editor. The BMJ is bigger than the BMA and this fact should be reflected in an international panel of individuals, drawn from the present editorial board, perhaps past boards, and possibly its leading authors, to choose the next editor. The BMA could have courtesy observer status at each stage of the selection procedure but no more. The lesson of the editorial departures at the New England Journal of Medicine and JAMA is that the more the owners interfere in the editor's decisions and appointment, the less credible the journal becomes. The greatest service the BMA could now provide to the BMJ is to withdraw from the selection process of the next Editor. Will the BMA's leadership make such a commitment, thereby asserting their belief in the independence of an important and much needed international institution? Or will they put their short-term self-interest before the global good? Readers should vote now on which path they wish the BMA to take. Competing interests: None declared |
|||
|
|
|||
|
susanne McCabe, gardener cardiff cf24 3pf
Send response to journal:
|
Tricia's response will ring a bit hollow with the thousands of people who have neither the idealised relationship described with 'Doctor' nor the best technologically informed treatments available to the better off in UK society already. Giving people a list of options does not necessarily mean those choices located on on the lower end are unimportant it should be said. Many people do not want a cosy relationship with a GP for example, although they do need a good working relationship of course. What ongoing studies over the past fifteen years show more clearly is that people have diverse wishes regarding relationships and services from health carers. And not all health carers wish to provide emotional support to those who consult them. Averaging out lists of priorities can obscure this diversity. The NHS desperately needs modernising. Some of the most basic information about changes already introduced has not even been conveyed to people using both primary and secondary services. Hopefully organisations such as Richard Smith is joining will be more proactive and rigorous in promoting ideas of the right to choose treatments,services, practitioners and right to information about them. People on low incomes are often at a disadvantage because they are not being properly informed, are often not given the same quality consultion, as those who are quite rightly more demanding, know how to use the NHS, or who the practitioner relates to more easily. But is not just the consequence of being well off or'poor'. Some of the most articulate individuals come from low income backgrounds. Much does though depend on the well off in every respect being willing to share more generously.Very little proactive work in empowering all sections of out communities is being carried out.There are also other factors involved than income or educational attainment, such as personality, what one may be needing to press for, for oneself or others,the attitude of the health practitioner. If a sugery is overrunning who is rushed through the door most quickly ......Wales has one of the highest uses of presciption drugs, including anti-depressants,in Europe, most significantly in areas of chronic deprivation. This has been known for decades.It is more than time for a new approach. Competing interests: None declared |
|||
|
|
|||
|
Hilda Bastian, Editor, Informed Health Online www.informedhealthonline.org, Melbourne Australia
Send response to journal:
|
It’s not often that a doctor leading a medical institution encourages a chorus of opinionated patient advocates to chime in from the sidelines. Richard Smith did that and went further, ensuring the voices of patients were increasingly heard within the BMJ as well. Today we’re speaking with one voice though – we’re grateful, and we’ll miss you, Richard! Thanks for having the courage of your convictions on important public interest issues, and for your commitment to a better doctor-patient dialogue. Cheers for experimenting with patient-centred innovations – and yes, we liked the notorious patient issue! We’re sad to see you go, but thankful for the opportunity to work with you and your wonderful team. We look forward to seeing the BMJ build on your achievements – and to your next ones as well. Members of the BMJ Patient Advisory Group - Hilda Bastian (Informed Health Online, Melbourne Australia) John Bowis (London, UK) Audrey Craven (Migraine Association, Ireland) Carol D'Souza (The Indian Epilepsy Association, Mumbai, India) Jean Georges (Alzheimer Europe) Peter Lapsley (Skin Care Campaign, UK) Alastair Newton (European Dystonia Federation) Asa’ah Nkohkwo (Sickle Cell Society, UK) James Partridge (Changing Faces, UK) Joanne Shaw (Medicines Partnership) Evelyn Sipido (Firenze, Italy) Competing interests: None declared |
|||