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OBSERVATIONS: Tessa Richards An age old problem BMJ 2007; 335: 698 [Full text]

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Apologies to Tomji Tanabe

Tessa J Richards   (8 October 2007)

Right to die?

Peter Bruggen   (12 October 2007)

Self Management :An age old solution to an age old problem

Arun K Chopra   (13 October 2007)

Apologies to Tomji Tanabe 8 October 2007
Tessa J Richards, Assistant Editor BMJ, WC1H 9JR Send response to journal: Re: Apologies to Tomji Tanabe	Counting the number of rapid responses an article generates is one of the yardsticks by which the BMJ assesses its impact - for better or worse. In this instance, however,I am not seeking to generate debate but simply to say sorry to Tomji Tanabe, and you gentle reader, for a misquote. As a result of an editorial gremlin, views I express later in the article about how a society treats its elderly people, are incorrectly attributed to him in the opening sentence. We apologise for this and wish him well. Competing interests: None declared
Right to die? 12 October 2007
Peter Bruggen, retired psychiatrist 21 Mackeson Road NW3 2LU Send response to journal: Re: Right to die?	Yes, as far as you go, but I am sorry that you duck consideration of a right to die. I am pleased at your concern for dignity and rights of the elderly, but what if our wishes are to die? We talk of rights to freedom to health care, to justice, to being treated with respect and not abused. But, what if, at the end I simply want to die? I do not mean if I am suffering from a treatable depressive disorder. Treat that and I might try again. I mean if, at the end, with ‘all said and done’, all treatments tried, I am still in more pain, more discomfort, or with more memory loss than I want or want those caring for me to endure; and if I am not able physically to kill myself (no illegality there). Then what about helping me? I know it is not legal in this country, but it is in some. Is not denying me that help an ‘indignity’, a ‘neglect’ or indeed even a ‘cruelty’. It does sound as if a supported suicide bill or a euthanasia bill would have public support. It does sound as if the feared-for abuses have not occurred in Oregon, Holland or Switzerland. At least let’s talk about it. Peter Bruggen Retired psychiatrist Competing interests: None declared
Self Management :An age old solution to an age old problem 13 October 2007
Arun K Chopra, Special Lecturer,Nottingham University QMC,Derby Road,Nottingham,NG7 2UH Send response to journal: Re: Self Management :An age old solution to an age old problem	Dear editor, There is no doubt that the demographic changes which we are currently living through will have a major impact on health and social policy in the years to come. An increasingly older population will be more likely to suffer from one or more chronic diseases. Coupled with this, is the rise of depression which is projected to be the largest cause of morbidity by 2020 and which has recently been shown to cause the greatest decrement in health as compared to other chronic diseases, asthma, angina,arthritis and diabetes. The combination of depression with any of these illnesses leads to a greater health decrement than any other combination amongst these illnesses (Moussavi et al,2007). One possible solution to this increasingly complicated scenario is strenghtening the position of self management of chronic illness through models of healthcare delivery such as the collaborative care model. (www.improvingchroniccare.org-accessed 11/10/07)This model has demonstrated effectiveness in both physical and mental ill-health, although its application outside of research trials remains limited. More recently, concerns have been expressed over the value of self monitoring in Diabetes, with researchers reporting no significant gains from such practice(Farmer et al, 2007). In order to bring this possible solution to bear, professionals need to be supportive of patients who collaboratively self manage, there needs to an improved response to problems identified through self management and research is needed to elucidate the patient pathways to self management in order to ensure that the appropriate self management package is provided to a patient at the right stage of their illness course and tailored to the degree of psychological readiness they have to tackle the challenges of living with a chronic illness. References Farmer,A. et al (2007)Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial.BMJ ;335: 132 Moussavi,S. et al (2007)Depression, chronic diseases, and decrements in health: results from the World Health Surveys.The Lancet;370:851-858 Competing interests: None declared