Conflicts and catastrophes: Lessons for medicine

War—what is it good for? You will be excused for believing that war has broken out in the pages of the JRSM this month. Alan Maynard's—some might say—unprovoked attack on the Medical Royal Colleges in the July issue JRSM 2007; 100; 306-8) prompted a swift reply in defence of their purpose and relevance to their memberships JRSM 2007;100;410-11). Ian Roberts’ target in July was the involvement of Formula One and motoring organizations in road safety, an involvement that makes little sense to him JRSM 2007;100;360-2). How much control would you allow to the pharmaceutical industry in deciding on the safety of drugs? Or the tobacco industry on the safety of cigarettes? In this issue David Ward, from the FIA Foundation, argues that Roberts misses the point, and possibly several more JRSM 2007;100;412-13). You decide.

Battles sit comfortably in an issue dominated by conflicts and catastrophes. This month's journal evaluates the effects of Chernobyl's nuclear catastrophe with an inside view on the internal politics around the measurement of harms JRSM 2007; 100:407-9), and ends with lessons on how we might respond better to a similar nuclear incident. Other pieces review the drivers of conflict (JRSM 2007;100;403— 6) and the links between conflict, climate change, and poverty JRSM 2007;100;399-402). Jack Piachaud, who coordinated these submissions, which relate to the RSM's October 2007 conference on ‘Nuclear Weapons; The Final Pandemic. Preventing Proliferation and Achieving Abolition’, reminds us that the futures of Iraqi children are forgotten casualties in the current conflict (JRSM 2007;100;394-5).

The consequence of war on human health reaches its most devastating form in the shape of nuclear weapons, as observed in Hiroshima and Nagasaki, and described by the BMA Board of Science and Education in 1983; ‘The NHS could not deal with the casualties that might be expected following the detonation of a single one megaton weapon over the UK.’ Continued development and proliferation of these weapons and the risks of a ‘dirty bomb’ make the threat, which seemed to subside following the end of the Cold War, live again. Prevention is complex because of fears and distrust between nations. As the Canberra Commission on the Elimination of Nuclear Weapons observed; ‘The proposition that nuclear weapons can be retained in perpetuity and never used, accidentally or by design, defies credibility.’

Whenever a medical journal strays into matters of war, the editor usually takes hits for meddling in politics. But medical journals are about improving health and health care; hence preventing conflicts and limiting their harms have to be considerations for all healthcare professionals. Indeed, the public are usually horrified to discover that healthcare professionals might be involved in bringing about death, as they have been over the past months at the involvement of doctors in bomb attacks. Yet the healthcare professions have always contained their fair share of murderers and villains—abhorrent though it may seem. Medical journals are as familiar—perhaps more so—with discussing death as they are with debating health, and conflict produces death and disability on a scale without parallel. It is an essential debate for doctors to be engaged with, like the debates on the Medical Royal Colleges, road safety, minimally invasive surgery for pneumothorax (JRSM 2007;100;419—22), and the media's misuse of the term ‘schizophrenia’ JRSM 2007;100;423-6).

But if we learn nothing else from this issue of the JRSM, we must learn that we overuse the term ‘we’ as a profession. We are not Royal, so we must be arrogant or impersonal or lacking in confidence. Andrew Papanikitas, we thank you for this important observation (JRSM 2007;100;436—7), which we also consider to be a medical catastrophe of sorts.