Kamran Abbasi

War on the roads

The last thing the world needs is another war. Nevertheless, this week the BMJ exposes one more—the war on the worlds roads. But to what extent can the global road trauma epidemic be likened to war? War is often waged by the powerful on the weak. In this case, the interests of pedestrians, cyclists, and other vulnerable road users are pitted against the powers that stand to profit from increasing global motorisation. And there are many millions of casualties. Every day about 3000 people die and 30 000 people are seriously injured on the worlds roads.1 In this issue Nantulya and Reich point out that over 85% of the deaths and 90% of disability adjusted life years lost from road traffic injuries are in low and middle income countries, with pedestrians, cyclists, and bus passengers bearing most of the burden.2 Most of the victims will never own a car, and many are children. Even in the high income countries, poor children are at greatest risk. The existence …

Doctors and managers: a problem without a solution?

In preparing this theme issue on doctors and managers we were offered many sophisticated descriptions of the origin and nature of the tension between doctors and managers but fewer credible solutions. The fundamental problem is a paradox between calls for a common set of values and the need to recognise that doctors and managers do and should think differently. If managers suddenly became preoccupied with the needs of an individual patient, irrespective of the consequences for others or for their budget, then the health system would collapse. If doctors decided that their principal concern was to ensure the smooth running of the system and the delivery of policy irrespective of the consequences for the patient in front of them, then both the quality of care and public support would collapse. Doctors worry about patient outcomes. Managers worry about patient experience (which includes outcomes, but only as part of a mix to be met out of finite resources). Patients are, again, best served by a tension between the two. Admitting that this paradox …

Corruption: medicine’s dirty open secret

Doctors must fight back against kickbacks

Medical journals and industry ties

Zero tolerance on education articles with financial links to industry

Protecting children from armed conflict. The UN convention needs an enforcing arm

Once wars and other conflicts begin, children suffer abuse—physical, sexual, and emotional. This is despite international laws to protect them.1 Recent studies on the psychological consequences of armed conflict have shown that the resultant unhappiness and mental disturbance is so great in children that it can rarely be repaired.2 4 The answer therefore has to be prevention, and, if that fails, the international community needs to act rapidly to protect vulnerable children. In conflicts over the past 10 years 90% of casualties have been civilians. Two million children have been killed and 4–5 million seriously injured (usually without analgesia, anaesthesia, or surgical facilities to treat them). Twelve million children have been made homeless, over one million orphaned, and countless psychologically traumatised. Three quarters of deaths from antipersonnel mines are among children. #### United Nations Convention on the Rights of the Child (International Law in 1990) In accordance with their obligations under International Humanitarian laws in armed conflicts, States Parties shall take all feasible measures to ensure protection and care of children who are affected by an armed conflict.—Article 38, pt 4 Inequalities in health care, and the poverty in which a …

The World Bank and world health: Under fire

of soybean oligosaccharides on human faecal microflora. Microb Ecology Health Dis 1990;3:293-303. 27 McBain AJ, Macfarlane GT. Investigations of bifidobacterial ecology and oligosaccharide metabolism in a three-stage compound continuous culture system. Scand J Gastroenterol 1997;32:32-40. 28 Ito M, Deguchi Y, Miyamori A, Matsumoto K, Kikuch H. Effects of administration of galactooligosaccharides on the human faecal microflora, stool weight and abdominal sensation. Microb Ecology Health Dis 1990;3: 285-92. 29 Zang XB, Ohta Y, Hosono A. Antimutagenicity and binding of lactic bacteria from a Chinese cheese to mutagenic pyrolyzates. J Dairy Sci 1990;73:2702-10. 30 Rowland IR, Grasso P. Degradation of N-nitrosamines by intestinal bacteria. Appl Microbiol 1975;29:7-12. 31 Challa A, Ramkishan Rao D, Chawa CB, Shackleford L. Bifidobacterium longum and lactulose suppress azoxymethane-induced colonic aberrant crypt foci in rats. Carcinogenesis 1997;18:517-21. 32 Sekine K, Watanabe-Sekine E, Ohta J, Toida T, Tatsuki T, Kawashima T. Induction and activation of tumoricidal cells in vitro and in vivo by the bacterial cell wall of Bifidobacterium infantis. Bifidobacteria and Microflora 1994;13:65-77. 33 Koo OM, Rao AV. Long-term effect of bifidobacteria and Neosugar on precursor lesions of colonic cancer in CF1 mice. Nutr Rev 1991;51:137-46. 34 Reddy BS, Rivenson A. Inhibitory effect of Bifidobacterium longum on colon, mammary, and liver carcinogenesis induced by 2-amino-3methylimidazo [4,5-f] quinoline, a food mutagen. Cancer Res 1993;53:3914-18. 35 Buddington RK, Williams CH, Chen S-C, Witherly SA. Dietary supplement of Neosugar alters the fecal flora and decreases activities of some reductive enzymes in human subjects. Am J Clin Nutr 1996;63: 709-16. 36 Famularo G, Moretti S, Marcellini S, De Simone C. Stimulation of immunity by probiotics. In: Fuller R, ed. Probiotics: therapeutic and other beneficial effects. London: Chapman and Hall, 1997:133-61. 37 Schiffrin EJ, Brassart D, Servin AL, Rochat F, Donnet-Hughes A. Immune modulation of blood leukocytes in humans by lactic acid bacteria: criteria for strain selection. Am J Clin Nutr 1997;66(suppl):15-20S. 38 Standiford TK, Arenberg DA, Danforth JM, Kunkel SL, VanOtteren GM, Strieter RM. Lipoteichoic acid induces secretion of interleukin-8 from human blood monocytes: a cellular and molecular analysis. Infect Immun 1994;62:119-25. 39 Op den Camp HJM, Oosterhof A, Veerkamp JH. Interaction of bifidobacterial lipoteichoic acid with human intestinal epithelial cells. Infect Immun 1984;47:332-4. 40 Kleeman EG, Klaenhammet TR. Adherence of Lactobacillus species to human fetal intestinal cells. J Dairy Sci 1982;65:2063-9. 41 Perdigon G, Nader De Macios, ME, Alvarez S Oliver G, Pesce AA, Ruiz Holgado AAP. Effect of perorally administered lactobacilli on macrophage activation in mice. Infect Immun 1986;53:404-10. 42 Matsumara K, Kitazawa H, Itoh T, Yamaguchi T. Interferon induction by murine peritoneal macrophage stimulated with Lactobacillus gasseri. Animal Sci Technol (Jpn) 1992;63:1157-9. 43 Solis Pereyra B, Lemmonier D. Induction of human cytokines to bacteria used in dairy foods. Nutr Res 1993;13:1127-40. 44 Yasui H, Ohwaki M. Enhancement of immune response in Peyer’s patch cells cultured with Bifidobacterium breve. J Dairy Sci 1991;74:1187-95. 45 Yasui H, Nagaoka N, Mike A, Hayakawa K, Ohwaki M. Detection of bifidobacterium strains that induce large quantities of IgA. Microb Ecology Health Dis 1992;5:155-62. 46 De Simone C, Ciardi A, Grassi A, Lambert Gardini S, Tzantzoglou S, Trinchieri V. Effect of Bifidobacterium bifidum and Lactobacillus acidophilus on gut mucosa and peripheral blood B lymphocytes. Immunopharmacol Immunotoxicol 1992;14:331-40. 47 Majamaa H, Isolaurie E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997;99:179-85. 48 Hopkins MJ, Cummings JH, Macfarlane GT. Interspecies differences in maximum specific growth rates and cell yields of bifidobacteria cultured on oligosaccharides and other simple carbon sources. J Appl Microbiol 1998;85:381-86.

The World Bank and world health. Healthcare strategy.

the double standard of sexual behaviour (the acceptability of men’s sexual activity versus the disease consequences of women’s) still prevails. The relatively small part that men will be required to play in the screening process not only disadvantages women but fosters the continuing lack of recognition that men also suffer the consequences of gender inequalities in the maintenance of their health. Full consideration of these issues is important if we are to develop health education programmes that will increase the acceptability of any future screening programme and ensure that it does not impact negatively on perceptions of female sexuality. Competing interests: None declared.

Is there hope for South Asia

Yes, if we can replicate the models of Kerala and Sri Lanka Two years turned the Indian subcontinent into South Asia. Between 14 August 1947 and 4 February 1948, India, Pakistan (its eastern part would later become Bangladesh), and Sri Lanka all gained independence from the British Empire. Amid the optimism of independence, the new states were comparable in population health and development indicators. Their progress since has been different. This issue of the BMJ maps out the extent of the regions myriad difficulties. Non-communicable and communicable diseases ravage South Asia (see pp 781, 794, 807, 811). Tobacco and pharmaceutical industries are exploiting weak legislation to nurture new markets (pp 778, 780, 801). There is little pride in the progress of surgery (p 782), health research (p 826), or postgraduate education (p 779). Yet one challenge dwarfs all these: the desperate state of maternal and child health. Several articles reinforce the message that the scale of morbidity and mortality caused by neglect of mothers and children …

Accelerating achievement of the sustainable development goals.

A game changer in global health

Europe’s refugee crisis: an urgent call for moral leadership

Offering asylum is a minimum standard of civilised society