For healthcare professionals only

Editor's Choice

Cataclysm and departure

BMJ 2004; 328 doi: (Published 27 May 2004) Cite this as: BMJ 2004;328:0-g
  1. Richard Smith, editor (rsmith{at}

    You ought to have a theme issue on “America as a global threat to health” suggested one of our correspondents, perhaps facetiously. Imagining the downcast face of our North American editor, the plummeting circulation of BMJUSA, and the wagging finger and circumlocutions of Donald Rumsfeld, we promptly decided against. But this issue could have provided the beginnings for such a theme.

    A serious response to global warming needed American leadership. Instead, we got the opposite. The United States, which produces a quarter of the world's greenhouse gases, turned its back on the Kyoto agreement. As a result we are not responding adequately to global warming, and our grandchildren will find themselves in an increasingly degraded world. Now the American creativity and flair, which most of us admire, has produced not a solution to the problem but a film to scare us witless.

    Our cover picture, taken from the film The Day After Tomorrow, shows New York under water. Global warming is causing disasters. New Delhi is snow covered, and Britain is in the grip of an ice age because the Gulf Stream has switched off. Shakoor Hajat writes that the film presents “the worst case scenario” (p 1323), but Jonathan Patz tells us that global warming means not just a gradual climb in temperature but also an increased frequency and intensity of extreme climatic events—heat waves, droughts, floods, and storms (p 1269). It is also likely to increase the number of hungry people by 90 million this century (p 1324).

    Peter Drahos and David Henry are upset by the United States because it is using its trade powers to undermine rational drug policies in Australia (p 1271). The Australians have a tough policy on subsidising only drugs that are cost effective, but a new trade agreement creates a body to dispute decisions of the committee that decides on subsidies. This agreement, argue the editorialists, is one of several that is diluting the Doha declaration of the World Trade Organisation that aimed “to protect public health and, in particular, to promote access to medicines for all.”

    Before I'm accused of being “anti-American” I must tell you that I will be leaving the BMJ to become chief executive of a European company being created by the UnitedHealth Group, the largest health and wellbeing company in the United States, to work with European public health systems, including the NHS (p 1276). The company will be aiming to help speed modernisation of the NHS.

    My main reason for leaving is that a quarter of a century is enough. I've had a wonderful time, and, like Woody Allen sweeping the floors in a strip club, I would have paid for the privilege of editing the BMJ. I hope that I hand the journal on in as a good a shape as I found it, and I thank the BMJ staff, authors, and readers for tolerating my eccentricities for so long. (PS. I'm not going just yet.)


    • Embedded Image Richard Smith's resignation letter and letter to staff appear on

    View Abstract