The other Copenhagen Consensus
A small and quiet launch of a new and bright organisation took place in Copenhagen last week. Global Doctors is led by an enthusiastic team of young Danish physicians, including its prime mover, Caecilie Buhmann. It is ably supported by Torben Kitaj, editor-in-chief of the Danish Medical Journal, and Jens Winther Jensen, president of the Danish Medical Association. Global Doctors aims not only to put global health on the medical and political agenda in Denmark. It also hopes to convince Danish doctors that they cannot practise medicine to full eﬀect without an understanding of the global context of disease. The strategies Global Doctors will use are familiar to any successful group: to inform, network, debate, and research, within the medical community and beyond. Two speciﬁc workstreams are already in hand. One, Travel to Teach, is beginning to build sustainable postgraduate medical education in Africa (eg, Rwanda) by organising exchange schemes between doctors. A second is an international congress on violence, conﬂict, and health, planned for 2009 or 2010.
Elsewhere in Copenhagen last week, Bjørn Lomborg, the infamous sceptical environmentalist, was completing his second global policy Olympiad. Lomborg had somehow persuaded a slew of respected economists, including ﬁve Nobel laureates, to take part in a dismal competitive sport—to choose who mattered more, starving children or uneducated girls, those with cardiovascular disease or women who urgently needed access to reproductive health services. Not surprisingly, given Lomborg’s track record, climate change ranked low in his list of global priorities. It was the same in 2004 when he ﬁrst launched his socalled Copenhagen Consensus. It ﬂies in the face of the best science (the Intergovernmental Panel on Climate Change) and the best economics (the Stern Report). The launch of Global Doctors contrasted sharply with Lomborg’s high-proﬁle media event. But over the next decade, The Lancet’s guess is that the cause of creating a world where health is taken more seriously will have been better served by Global Doctors than by Lomborg’s ill-judged and false consensus. ■ The Lancet
Overcoming barriers to early dementia diagnosis
For more on the Alzheimer’s Society campaign see http:// www.alzheimers.org.uk/site/ scripts/news_article. php?newsID=282 For the King’s Fund report see http://www.kingsfund.org.uk/ publications/kings_fund_ publications/paying_the_price. html For the National Audit Oﬃce report see http://www.nao.org. uk/publications/nao_reports/ 06-07/0607604.pdf
Last week, the UK Alzheimer’s Society launched a public information campaign to raise awareness about the early signs of dementia. As part of this new initiative, every general practitioner (GP) in England will receive an educational tool in the form of a CD-ROM to help with the diagnosis and management of this range of diseases. The Society is right to include support for GPs as an element of their campaign. Dementia is set to become an increasing part of GPs’ caseloads. A new King’s Fund report, released last week, estimates that the number of people with dementia in the UK will increase by 61% by 2026, from 582 830 to 937 640 cases. Currently, however, only a third to a half of people with dementia receive a formal diagnosis. And a National Audit Oﬃce (NAO) report, published in July last year, found that only 30% of a 1000 GPs surveyed felt they have enough training to diagnose dementia. Dementia diagnosis can be a particular anxiety area for doctors because of the diﬃculty separating normal ageing from disease. Research has shown that some
educational interventions can be beneﬁcial in improving detection rates. But even with this additional support, GPs’ negative attitudes about the beneﬁts of an early dementia diagnosis also need to be challenged. The NAO report found that less than two thirds of GPs thought it was important to actively look for early symptoms. Those surveyed also felt there is little that can be done for dementia. This therapeutic nihilism is worrying since early diagnosis and intervention can, in some cases, help delay admission to a nursing home and it also gives patients and their families time to plan their futures. The UK’s ﬁrst National Dementia Strategy, which launches later this year, should help address this negativity. It will focus on raising awareness, early diagnosis and intervention, and improving the quality of care. The success of this strategy will be key in closing the diagnosis gap. With more resources and political attention being directed to dementia, GPs should feel more optimistic about the support their patients can receive once an early diagnosis is made. ■ The Lancet www.thelancet.com Vol 371 June 7, 2008