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EDITOR'S CHOICE: Fiona Godlee Health is a human right BMJ 2009; 338: b136 [Full text]

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Brilliant Concept but, a qualified success

BM Hegde   (16 January 2009)

Gaza - the duty of the medical profession

Paquita de Zulueta   (17 January 2009)

No human right to health.

George Y. Caldwell., Sinapore 259858.   (18 January 2009)

Health is not a human right

François Burnier   (20 January 2009)

BMA's work on human rights

Vivienne Nathanson, Ann Sommerville   (2 February 2009)

Contemporary Homework For All People.

Emilio Polo Ledezma, Carlos Polo Rivera – Sixth Semester Medical Student.   (24 February 2009)

Brilliant Concept but, a qualified success 16 January 2009
BM Hegde, Editor in Chief, Journal of the Sciecne of Healing Outcomes. Mangalore-575 004, India. Send response to journal: Re: Brilliant Concept but, a qualified success	Dear Fiona Godlee, While I appreciate your concern for the hapless majority in countries where human rights are non existent vis-à-vis their health with special reference to war casualties, I am wondering why your editorial excludes those affluent countries where "so called" human rights are upheld but human health is being destroyed, thanks to the governmental efforts to encourage industries that are meant to generate wealth for them even if they pollute the environment? (1) Guns kill more people in the US compared to road accidents but, there is no gun control there! Arms lobby is so powerful all over the world that if there is no conflict anywhere they will not thrive. Even in the war ravaged countries no one is bothering about the malnourished poor people. Why is it that your contributors never thought of the millions that die due to pollution of our environment, drinking water and even our food that is genetically modified? Terminator seeds make life miserable for farmers in many poor countries where they have to be at the mercy of multinationals for their next crop! Large scale farmer suicides are due to poverty resulting from faulty policies of the governments. Even science gets twisted to help the powers that be in preference to the powerless in this world. Global warming would result in exponential increase in vascular diseases. Who contributes maximum carbon dioxide to the environment? Warming up of Europe might bring back the scary Black Death epidemics there. Rattus rattus, the black rats, will reappear in warmer Europe bringing with them pasturella pestis. Why are we not serious about energy from wind and sun and, even, from water, as is shown by some scientists, while we are bending over backwards to encourage nuclear energy? Polluting industries are being encouraged. Efforts are being made to legislate, in some parts of the world, to ban healthy natural nutrients being sold. MSG obesity is an epidemic in some parts. This food additive is known to stimulate leptin with resultant obesity even in children. (2) All kinds of dangerous chemicals are being permitted in cosmetics, foods, cleaning agents and other house hold necessities. The pro- oestrogens in some make up materials are known to produce changes in breast size and possibly increase the risk of breast cancers in future. (3) How good are dried powdered milk products? Cow's milk itself could be a health hazard! Do human beings have any enzyme to digest milk after weaning? Isn't cow's milk a foreign protein? Does not milk provoke anti- body production in our system? Are some of these antibodies known to destroy the beta cells in the pancreas? Isn’t there evidence to point to the possibility of these antibodies playing a role in the predicted epidemic of type II diabetes in the world? (4, 5, 6) While the war casualties look glaringly significant, and your new definition of health is a briiliant concept in that context, it is only a partial success, as the above mentioned excluded health risks tend to endanger health of the population all over the world to a greater extent than all the war casualties together. The Lancet idea of making all doctors as health givers might go against the finding that whenever doctors went on strike during peace times(Saskatchewan, Los Angles County, Bogota in the past and recently in Israel) death and disability rates went down only to level up after the doctors came back to work! (7) Does the medical profession keep society healthy? Is more always better than less? Is hi-tech better than low tech? (8) Why was the per capita mortality of the grievously injured soldiers in Falklands as good, if not slightly better, than Vietnam, despite the fact that the latter had a five-star hospital almost next door to the war theatre? To me the ideal definition of health seems to be “the capacity to do what one wants to do with enthusiasm to work and enthusiasm to be compassionate to others in a hostile environment. I have borrowed some parts of this new definition from Richard Smith. Man’s greatest enemy is man himself, whether it is in affluent west or in the sub-Saharan Africa. Man, whether in the palace or pad; castle or cottage, Zimbabwe or London, is governed by the same passions and emotions. With his proclivity for comfort and his greed, man will eventually destroy all nature given resources in this world to make all of us unhealthy. The recent economic meltdown of the global economy is proof enough. While technology has shrunk this world into a neighbourhood, mankind is yet to broaden its horizon to make it a large and healthy brotherhood. Health expectancy is the number of years a new born child could expect to live without the help of drugs and doctors! Science should learn from nature instead of trying to teach nature a thing or two. Nature has healthy living tips which might help us to live well. If we depend purely on our present interventional methods for every deviation from the statistical normal the “last well person” would be extinct soon. (9) The “disease” concept had its time. We do not need it anymore. (10) Yours ever, Bmhegde References: 1) Godlee F. Health is a human right. BMJ 2009;338:b136. 2) CMatyšková R, Maletínská L, Maixnerová J, Pirník Z, Kiss A, Zelezná B. Comparison of obesity phenotypes related to monosodium glutamate effects on arcuate nucleus and/or the high fat diet feeding in C 57 B1/6 and NMRI rats. Physiol Res. 2007; October 11. 3) 3 Karlsruhe Nutrition Symposium European Research towards Safer foods: Tumours found in hormone dependent organs (breast, prostate) www.mri.bund.de/nn_971894/SharedDocs/Publikationen/Berichte/bfe-r-98- 02__pt3,templateId...pdf/bfe-r-98-02_pt3.pdf 4) Vaarala O, et al. Cow Milk Feeding Induces Antibodies to Insulin in Children-A Link Between Cow Milk and Insulin-Dependent Diabetes Mellitus? Scandinavian Journal of Immunology. 1998; 47: 131-135. 5) Vaarala O, et al. Cow Milk Feeding Induces Primary Immunization to Insulin in Infants at Genetic Risk for Type 1 Diabetes. Diabetes. 1999; 48: 1389-1394. 6) Paronen J, et al. The Effect of Cow Milk Exposure and Maternal Type 1 Diabetes on Cellular and Humoral Immunization to Dietary Insulin in Infants at Genetic Risk for Type 1 Diabetes. Diabetes. 2000; 49: 1657- 1665. 7) Siegel-Itzkovich J. Doctors’ strike in Israel may be good health. BMJ 2000; 320:1561. 8) Starfield B. Is US medicine the best in the world? JAMA 2000; 248: 483- 485. 9) Hadler NM. The last well person. 2007, McGill Queen’s University Press. 10) Tinnetti M & Fried T. The end of the disease era. Am. J. Med 2004; 116: 179-183. Competing interests: None declared
Gaza - the duty of the medical profession 17 January 2009
Paquita de Zulueta, General Practioner, Hon Senior lecturer medical ethics and law Imperial College Send response to journal: Re: Gaza - the duty of the medical profession	I also agree with the editorial of the Lancet that proposed that all members of the medical profession carry the responsibility for ensuring that the health needs of civilians are safeguarded in conflicts and wars.But where is the response of our leaders to the invasion of Gaza and to the 18 month blockade prior to this? There has been virtual silence from the BMA apart from a bland statement on its website. To my knowledge there has been no public condemnation from our leaders of this collective punishment - a clear breach of the Geneva Convention - no heading of a petition, no open letter from the heads of the royal colleges, no speeches at the last public rally, no overt medical presence at the vigil, and no call for an urgent debate. Aside innocent civilians, our healthcare colleagues are being killed. Hospitals, ambulances, and designated medical and relief centres are being deliberately bombed (some probably with white Phosphorus), and access to essential medical treatment is being prevented. Children are left to languish for over 48hours with no food or water by the bodies of their dead mother whilst Israeli soldiers deny them access to healthcare workers. The profession has a clear moral imperative to speak out and to condemn these outrageous acts as well as to provide support to those who are treating the civilians at this time. A brave Norwegian doctor working in Gaza, struggling to save lives against impossible odds, reminded us that the people of Gaza are voiceless and that he, as a doctor, had a duty to speak out on their behalf. Is it not our turn now? Competing interests: None declared
No human right to health. 18 January 2009
George Y. Caldwell., General Practitioner 31 Balmoral Park, #18-33, Sinapore 259858. Send response to journal: Re: No human right to health.	Indeed health is not a human right. It is something that God gives us, more or less. It is a human right, however, to deal with what is our lot as we see fit. To neglect our health, as most people do, or to improve upon it. That is that. We have no right whatsoever to perfect health. Competing interests: None declared
Health is not a human right 20 January 2009
François Burnier, GP 1142 Pampigny Switzerland Send response to journal: Re: Health is not a human right	Health is not a human right. No more than fine weather. Health should not be confused with care, nor fine weather with an umbrella. Competing interests: None declared
BMA's work on human rights 2 February 2009
Vivienne Nathanson, Head of Professional division BMA, Ann Sommerville Send response to journal: Re: BMA's work on human rights	Regarding the letter from Dr Pacquita de Zulueta, it is disheartening to see letters from BMA members saying that the Association does nothing about the duties of the medical profession in terms of human rights. In the wider human rights community and among doctors who join organisations such as Physicians for Human Rights or the medical group of Amnesty International, there is more recognition of the role that the BMA has consistently played over the past 25 years. Within the World Medical Association too, the BMA strongly encourages other medical organisations to have the confidence to take action within their own countries. It is for politicians, however, rather than doctors to take a political stance. The BMA has consistently and publicly condemned breaches of medical neutrality around the world, in its publications and in correspondence with political figures. It has written repeatedly to governments, health ministers and medical associations in countries where doctors are clearly involved in human rights abuses – either as victims or perpetrators. [1] The BMA’s books “Medicine Betrayed” and “The Medical Profession and Human Rights” set out in considerable detail the continuing role the BMA plays when colleagues or their patients are caught up in breaches of international law and human rights. Professor Vivienne Nathanson Head of BMA’s Professional Division, BMA delegate to the World Medical Association, and a member of the executive of the International Rehabilitation Council for Torture Survivors (IRCT). Ann Sommerville, Head of Ethics Competing interests: We are both responsible for the BMA's work on human rights. 1 BMA statement on the humanitarian crisis in Gaza. 9 January 2009. http://www.bma.org.uk/ethics/MENULINKgaza2009.jsp
Contemporary Homework For All People. 24 February 2009
Emilio Polo Ledezma, Teacher Researcher Health's Faculty of the Surcolombiana University - Paca Research Group, Neiva –Huila -Colombia, Carlos Polo Rivera – Sixth Semester Medical Student. Send response to journal: Re: Contemporary Homework For All People.	Although for me, the WHO definition of health, proposed in 1948, is incomplete, what was wrong during these sixty years of hard work wasn’t the organizational structure of this sector in each country, neither the wonderful primer WHO definition, but the dynamics of all health processes daily taking place in this sector around the world. The problem is: there isn’t correspondence between what is written, in health, and what is done in practice. Dynamical forces driving and managing health resources develop activities directed more toward personal enrichment than towards a collectively solving of the major and most relevant health problems affecting people, especially to the most vulnerable population. A large percentage of the health budget is used for educational activities of prevention at secondary or tertiary level, in a strategy designed mainly to legally extract economical resources of this sector to exponentially increase the incomes of mayors, governors, health directors at municipal, departmental, regional and national levels. There are not activities, absolutely nothing, for promoting health prevention at primary level. Everything is geared in order to invest in palliative pharmacological care and in surgical treatments to patients with incurable diseases, a dynamics which generates good economical returns. At the moment, the health business is very lucrative. The big latinamerican cities are filling up with official and private hospitals, financially profitable clinics. Proliferates business of renting stretchers, oxygen tanks, crutches, parenteral solutions supporters, walkers, wheelchairs, drugstores centers of formal and alternative medicine, care shelters for helping patients in terminal state, aesthetics and massage centers, day’s hospitals, abortions clinics, garages for immediate ambulance service ... Daily the states and governments, violate the most fundamental human right, the right to life. In several countries the state does not guarantee good living for people. Daily they must struggle hard to find the necessary way to achieve the resources necessary for living. Many of these people activities lead to procedures that generate dishonest acts of violence and corruption, which characterize the dynamics of poorest countries around the world. In Colombian cities, for instance, 54% of people are living in misery conditions, in absolute poverty. Most people, who enjoy the privilege of having a job, on average, earn only about six dollars a day. Much of these incomes are used for payment of educational services, health, housing, home services, energy, aqueduct and telephone. The people often pay to entities whose owners are members of the richest country’s families. The remnant money is used for buying meals of low biological value, with low digestibility and therefore of very low nutritional quality. Five factors determine the individual health status: Sixty percent of it depends on the quality and quantity of daily food ration and personal lifestyle, 20% of the environmental features surrounding each individual, 15% depends of his genome and the remaining 5% of the metabolic state that he has at any given time. Very few true restaurants remain in the cities; most of these so called businesses are degradants, instead of helping the individual to restore his organic structure, they, increasingly contribute to the individual corporal deterioration. The enormous growth of the automotive industry, the big cities’ congestion and the world economical globalization processes, which seriously attempt the people’s health, have introduced profound changes at people behavior. Day by day they are consuming more and more, contaminated and of poor quality, street rambler foods. Many people prefer to feed in the cities’ commercial sector and not in their own house, because of high transport costs and low prices for rolled tortillas, staffed maize pies, bread, pocket’s food, cereals, snacks, candies, colored and odored sugar’s waters, parboiled soups, low quality appetizers, fermented beverages of poor quality, pasta, beans, lentils, bananas ... All of this, is contributing to the development of a new people’s culture, that is creating a lot of health problems among the latinamericans. Between the main ones, generated by this new culture are: protein malnutrition, excessive carbohydrates consumption, mainly in the form of cereals and platano’s flours, poor quality alcohol intake, lack of vitamins and other essential nutrients, in the daily diet, mainly those which form the, so called, human antioxidant system. Through radio broadcasting, TV, internet and other mass communication media, are promoting a sedentary lifestyle, accompanied with pleasant recreational sex life. Everywhere in the cities, there are houses, hostels, motels. It’s not difficult to meet sexual workers, homosexuals. Sexual education is more used to promote the distribution and sale of chemical contraceptives, intrauterine devices, patches, injections, implants, aphrodisiac beverages, sildenafil derivatives, papaverine, apomorphine, marijuana, bazuco, cocaine, and other psychoactive substances. Unscrupulous people, socially, spread and promote the idea that, in order to live better and to feel very well, it’s essential a permanent sexual intercourse. As logical consequence of this, have increased the number of indigent people, in the Colombian cities. The central parks are full of antisocial, drug addicts and promiscuous sexual people. To ensure health for latinamerican people it’s necessary to: globalize wages, to reduce the large economical gap that exists between those who have much money and the poor and misery people, radically to modify cultural patterns related with sexual recreational life. Additionally, it’s necessary to remind everyone who wants to be a candidate representative of a country, that this position not only generates the right to occupy the post for a predetermined period, but honestly to accomplish the responsibilities that this position requires. Remind to him that his duty is to preserve public order, to respect and to enforce all the national, regional, departmental and municipal, governmental rules. Every political leader must be specially trained to understand the true structure of public authority and he should be fully aware that the social safety, good education and public health depend, at the end from the success of his management. He must ensure that the regulations would dictate a rational and orderly growth of human settlements. He must well legislate for maintaining free public spaces in the city; well, clean circulatable ways, and a permanent looking of parks and recreation areas. If a candidate does not know the true concept of life’s quality, it’s better for him to dedicate his forces to do something else, because every common citizen has the right to protest the leader decisions, when the environmental conditions of the country, region, department, or city deteriorate. Every day he ever should be worried about economic development, about how to reduce unemployment levels, to ensure the existence of good roads and to ensure the country's competitiveness. The last justification of authority in the modern world lies in ensuring the efficient provision of public services for communities. Who wants to be a public leader, before that he must carry a self- examination on their skills in these matters, about the credibility that he can weak up between the managers of services for the community and about his leadership capacity for coordinate social activities as diverse but complementary. We can not put personal interests above the people´s or communities interests. This is one of the main keys to ensure health for all individuals around the world. We must eliminate the predators of our health and political institutions worldwide. Competing interests: None declared