Editorial

778 www.thelancet.com Vol 379 March 3, 2012

89% of Fellows who attended an Extraordinary General Meeting (EGM) of the Royal College of Physicians of London this week voted yes to the motion that the UK Government’s Health and Social Care Bill would damage the health of the public in England. 79% called on the College to demand complete withdrawal of the Bill.

Although these votes were non-binding on the College, and despite the vote being held among only 189 Fellows, the mood of the meeting was abundantly clear. Fellows of the College were deeply hostile to the Bill and they wanted their College—one of the most senior Colleges among all the Royal Colleges—to speak forcefully about the threat it posed. Within a matter of days, Fellows and Members will be surveyed about their views on the Health Bill, providing a democratic mandate for the President, Sir Richard Thompson, to pursue the College’s next steps.

This EGM was a historic occasion. The College is at its best when recognising and relying on its independence, its commitment to science, its defence of the highest clinical and ethical standards of practice, and its trusted

public voice. The meeting this week exemplifi ed all of these attributes. Rarely has a Royal College brought its Fellows together to take part in such thoughtful refl ection over such a momentous issue of the day.

The President underlined the “sense of urgency” facing the College. It is an urgency that faces the country too. There is an almost daily thickening in the atmosphere of panic around the Coalition Government’s health policy. Politicians across all parties acknowledge that this Bill is not good. It will cause unnecessary disruption to health services and add to the bureaucracy of the NHS. What began as a ham-fi sted attempt to modernise the NHS has become a grotesque political disaster for government.

Can the Royal College of Physicians translate the views of its Fellows and Members into an eff ective policy that achieves the desired goal—the defeat of this Bill? On its own, almost certainly not. But if it now works in concert with other respected medical bodies, this toxic legislation may prove just too much of a liability for the government to protect and defend. The Lancet

The Royal College of Physicians of London roars

Drug control in marginalised communitiesThe history of drug control achieved a milestone last week with the launch of the International Narcotics Control Board’s annual report, 100 years after the International Opium Convention of The Hague in 1912. The signing of the 1912 Convention signalled that international cooperation and shared responsibility were essential to drug control. A century on, much has been achieved, but many challenges remain.

Success stories in drug control include governmental adherence to international conventions, prevention of licit to illicit drug diversion, and improved control of some precursor chemicals. However, at the public health level, debate continues over whether international drug conventions and global solutions are needed, or whether national policies aligned with the risks of diff erent drugs would be more eff ective.

One challenge highlighted by the new International Narcotics Control Board’s report is the problem of drug misuse in marginalised societies. In many countries, whether developed or less developed, communities with high rates of violence, social disintegration, and organised

crime have endemic drug misuse. Limited education, unemployment, and poor health are the norm in these communities, and drug addiction combined with lack of access to health services fuels ill health. The Narcotics Control Board emphasises the need to prevent young people living in such communities from turning to illegal drug use or drug traffi cking by provision of community- based interventions including policing, education, employment and leisure opportunities, and promotion of positive role models.

Drug treatment and rehabilitation services are poorly accessed by those most in need, who, in addition, neglect other physical and mental health problems they may have. “Drug addicts have as much right as anyone else to have access to health services”, Hamid Ghodse, President of the International Narcotics Control Board, commented at the launch of the report. But ensuring equitable access to health services, appropriate treatment, and continued follow-up for illicit drug users in marginalised communities is a challenge yet to be met by most governments. The Lancet

For the International Narcotics Control Board report see http://

www.incb.org

For more on the public health debate see Series Lancet 2012;

379: 55, 71, and 84

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