Intended for healthcare professionals

Editor's Choice

Taking a stand

BMJ 2006; 332 doi: (Published 25 May 2006) Cite this as: BMJ 2006;332:0-f
  1. Fiona Godlee, editor (fgodlee{at}

    The World Health Organization has had good and bad leaders. Dr Lee Jong-wook, who died last week just three years into his first term as WHO's director general, was one of the better ones (p 1234). He died just before the opening session of WHO's annual assembly and only days after the successful resolution of a cause he had championed—the registration of clinical trials (p 1232). His support, both moral and financial, for trial registration showed his willingness to resist pressure from powerful industry lobbies. Because of this, WHO's stance on trial registration should take its place alongside the organisation's earlier triumphs, most famously its stance against the producers of infant formula milk in the 1980s.

    Dr Lee said that his success in office would be defined by the fight against HIV and AIDS. His tenure can be judged a success in that treatment for HIV and AIDS is at the centre of the international health agenda partly thanks to WHO's “3 by 5” initiative—to treat 3 million people by 2005. But HIV has not been vanquished. In most of the developing world, the epidemic and its impact on society is steadily worsening, with incidences reaching nearly 50% among adults in some parts of Africa. Elinor Moore's hospital in Malawi now admits about 40 patients a day, compared with about a dozen 10 years ago, with the increase mostly due to HIV infection (p 1280). Diagnostic services are struggling to keep up, she writes, and, in the absence of accurate diagnosis, polypharmacy is rife with all its attendant risks. The focus on HIV also means that non-HIV related conditions, such as diabetic ketoacidosis, are increasingly poorly managed, she warns. As for access to treatment, Amnesty International's annual report says that only 20% of adults and 10% of children in South Africa who need treatment are getting it.

    Launching the report last week (p 1231), Amnesty's secretary general, Irene Khan, warned that the security agenda of powerful and privileged countries has diverted attention from human rights violations elsewhere. Principles have been sacrificed in the name of the war on terror, she said, resulting in “enormous damage done to the lives and livelihoods of ordinary people.”

    Amnesty's report went to press before the recent escalation of events in the Palestinian Territories, where Israel's response to legitimate concerns about security after the election of the Hamas government is now pushing the Palestinians into a health and humanitarian crisis (p 1231). Under international pressure, Israel says it will now release funds directly to Palestinian health services, but it is not clear how this will work. Physicians for Human Rights-Israel has put out an urgent appeal for donations of medicines and equipment for hospitals in Gaza and the West Bank ( And in a letter this week (p 1276), Derek Summerfield calls on the world's medical associations to speak out against these “grotesque events” or be seen by their silence to collude with them. This is, by any other name, an embargo that endangers health (BMJ1997;315: 1393-4) and as such it should be opposed.

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