Richard Smith: What do you do these days?

Richard SmithAbout twice a week somebody asks me: “What exactly do you do these days?” Many doctors knew me as the editor of the BMJ, and they have a vague memory that I left to do something disreputable. My brother advises me to answer: “I’m back laying pavements for the council.” That stops further inquiries, he guarantees.

Sometimes I answer: “Lots of things. I have about eight jobs, some paid, most not.” Then I move away.

But more often I take a deep breath and begin my well rehearsed speech. “I run a philanthropic programme to create centres in low and middle income countries to counter chronic disease, meaning cardiovascular disease, diabetes, chronic obstructive pulmonary disease. I do this on behalf of the UnitedHealth Group, and we are working with the National Heart, Lung, and Blood Institute, one of the National Institutes for Health.”

If people aren’t bored, I continue: “So far almost all aid has gone to AIDS, TB, malaria, and maternal and child health, but chronic disease kills most people everywhere apart from SubSaharan Africa: there is a pandemic sweeping through the developing world. We have 11 centres in 28 countries including China, Bangladesh, India, Pakistan, Tunisia, Kenya, Tunisia, South Africa, Argentina, Peru, Central America, and the US Mexico Border, a remarkable place.”

I thought of my little speech as we all met together last week in Bethesda, home of NIH. The people from the centres have come to feel like family to me – just like people did at the BMJ. But this is a much more diverse family, and I’m conscious of – and very excited by – the changing relationship between people from the developed and developing world. Perhaps it didn’t feel like that in Copenhagen last week, but for me we are very much equals, in it together; 20 years ago it didn’t feel like that.

WHO produced its first report on the need to counter chronic disease in the developing world in 2000 but then took eight years to develop an action plan. And the sad truth is that there hasn’t so far been much action – but simply lots of talk. We are almost the first people to put resources – some $50m between us – into countering chronic disease. We fund research, mostly implementation research, and the creation of capacity – people, institutions, and communities equipped to counter chronic disease through research, advocacy, and policy making. Capacity will be vital when larger resources are forthcoming – as they undoubtedly will be.

As we held our energetic meeting last week, I thought of Margaret Mead’s famous quote: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” I learnt that quote when preparing a talk on social movements and in particular studying how the campaign to abolish slavery had achieved what seemed impossible in just 20 years. When 12 men met in a printer’s shop in London in 1787 slavery was normal, the British economy depended on it, and many powerful institutions and people, including the Church of England and members of parliament, owned plantations worked by slaves. Yet within 20 years a bill was passed abolishing slave trading in the British Empire.

We face what may be a bigger challenge, but we have the advantage over the 12 men that we are much more diverse. I felt in that meeting as if we too could do the impossible, a very different feeling than what must have prevailed in Copenhagen. But importantly what is good for us as individuals – using motorized transport less, exercising more, and eating less meat and more vegetables – is also good for the planet. The deep pessimism I felt about the outcome of the Copenhagen meeting is thus blunted by the optimism I felt among my new family.

Richard Smith is a former editor of the BMJ.