Bmj Usa: Editor's Choice

We are the world

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E95

This article originally appeared in BMJ USA

“I deeply believe we are one world, and all humankind are connected,” Donald Berwick emailed a reader of the Washington Post who had responded to a guest editorial originally published in that newspaper. The reader responded, “Where did you get that idea?” (BMJ USA p 165).

We Americans tend to think that little matters unless it matters to us. The fallacy in such thinking became evident on September 11, when the plight of a distant people erupted in our skies and streets with ghastly consequences. Our government now invests billions on the war on terrorism, a longstanding world crisis that now gets attention because it has touched us.

How interesting that we so frequently entice interest in humanitarian crises by emphasizing that the problems of others are our own. It is as if self-interest is the precondition for caring. In his editorial (which is reprinted in BMJ USA p 165), Berwick must argue that “we all have AIDS,” as if the 36 million lives affected is not reason enough. He challenged the CEOs of drug companies to offer HIV medications for free, reasoning that the profits they sought in Africa were never likely, and “they would [thereby] gain the trust and gratitude of the entire world. They would have created a story to be told for a millennium …”

In a companion article that accompanies his editorial, Berwick recounts why he wrote it, how readers reacted, and how his uplifting proposal met with deafening silence from many CEOs (BMJ USA p 165). One exception, the chairman of GlaxoSmithKline (which has lowered the price of its antiretrovirals in Africa by 90%), says that making HIV drugs free will do little good because health care systems in Africa are inadequate (BMJ USA p 168). Zackie Achmat, a South African activist infected with HIV who refuses to take antiretroviral drugs in protest, asks why Pfizer sells fluconazole in South Africa at 10 times the price of the generic in Thailand (BMJ USA p 168). Meanwhile, sagging drug company profits mean that prices are more likely to rise than fall (BMJ USA p 175).

One hope is that our humanitarian passions might be stirred even without a business argument and even if the problems are not our own. Any parent should be disturbed by the warning of Matshalaga and Powell that a third of Africa's children will be orphans by 2010 (BMJ USA p 139). They note that the $1.9 billion required to finance African children's education, thereby providing self-sufficiency and the knowledge required to prevent infection, is what wealthy nations spend each year on Sony Playstations for their children.

American doctors might wonder why they should care about this. The BMJ's January 26 theme issue on the global impact of AIDS, from which the Berwick and orphanhood articles have been taken, is easily pushed aside for more “relevant” articles about HIPAA regulations and the newest cephalosporin. But what is left of professionalism (BMJ USA p 176), and of our humanity, when caring for others ends at the water's edge?

Berwick (BMJ USA p 165),

Sykes (BMJ USA p 168),

Achmat (BMJ USA p 168),

Drug companies face pressure on profits (BMJ USA p 175),

Matshalaga (BMJ USA p 139),

Doctors are called on to renew their professionalism (BMJ USA p 176),

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