BMJ  2003;327 (25 October), doi:10.1136/bmj.327.7421.0-g

Editor's choice

Emotional among friends

"What our age lacks," wrote Soren Kierkegaard, "is not reflection but passion." The staple of medical journals is reason. We cling to the fiction of the enlightenment and are nervous of passion. But we know that it is passion that drives the world, and medicine—dealing daily with birth, sickness, pain, and death—might be the most emotional of all the intellectual disciplines. Usually it isn't, but this issue contains much emotion.

Zulfiqar Bhutta, Samiran Nundy, and Kamran Abbasi are launching the BMJ into something very special—a theme issue on the health problems of South Asia edited by South Asians (p 941). "South Asia," wrote a former Pakistani minister of finance, "is fast emerging as the poorest, the most illiterate, the most malnourished... the most deprived region in the world." Almost 40% of deaths in children under 5 years occur in its four largest countries. Yet it invests more in arms than in the health and education of its people—and conflict and disorder are virtually continuous.

We have high hopes for the issue, which will concentrate on solutions not problems. The very fact that doctors from all the countries of South Asia—and particularly India and Pakistan—are working together on the project is important. The "grander ambition" of the editors is to "promote peace and unity in a part of the world crippled by religious, social, and nationalist divides." To edit such an issue demands not just hard work and passion but also bravery.

Other friends have been working to understand the exploitation in Britain of "trust doctors," many of them from South Asia. These are junior doctors who are not in formal training positions but who keep the health service going. They are exploited and uncounted—and constitute an underclass. BMJ colleagues had to work extraordinarily hard to study these doctors—because trusts did not want to answer their questions (p 961). An editorial (p 943) and articles in Career Focus discuss how the health service should respond, but one voice is missing—that of the doctors themselves. Despite strenuous efforts we couldn't get them to speak. They may be too scared.

Will this be yet another problem where Britain fails to act? Stephen Lock, my predecessor and mentor, reflects on why it is that Britain is good on talk but poor on action (p 940). Stephen drew attention to the problem of research misconduct in the early 1980s, but 20 years later Britain still has no adequate response—despite many meetings and reports. We may still have years to wait. In his splendid polemic Stephen castigates the British for taking centuries to ban slavery, clean up the air and the rivers, introduce proper freedom of information, and reform the House of Lords.

The most emotional event for us at the BMJ has been the death of Roger Robinson—a leading paediatric neurologist, expert on the Scottish poet James Beattie, and one of our editors for the past dozen years (p 992). Roger was unusually wise, gentle, and insightful—and we will miss him badly.

(rsmith{at}bmj.com)

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Relevant Articles

Britain prefers talk to action

Stephen Lock
BMJ 2003 327: 940-941. [Extract] [Full Text] [PDF]

Why a special issue of the BMJ on South Asia?

Zulfiqar Bhutta, Samiran Nundy, and Kamran Abbasi
BMJ 2003 327: 941-942. [Extract] [Full Text] [PDF]

The rise of trust doctors

Nicola Cooper and William Burr
BMJ 2003 327: 943-944. [Extract] [Full Text] [PDF]

Recruitment of doctors to non-standard grades in the NHS: analysis of job advertisements and survey of advertisers

Sabina Dosani, Sara Schroter, Rhona MacDonald, and Jackie Connor
BMJ 2003 327: 961-964. [Abstract] [Full Text] [PDF]

Roger Robinson

Harvey Marcovitch and Richard Smith
BMJ 2003 327: 992. [Extract] [Full Text] [PDF]

Rapid Responses:

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Not just an issue, series needed!

Vikas Dhikav
bmj.com, 27 Oct 2003 [Full text]

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