Caring for the carers

fgodlee@bmj.com

Months of hard work and tense negotiation have concluded this week with world leaders and senior ministers signing the UN declaration on non-communicable diseases. As Rebecca Coombes reports, it falls short on setting targets but puts NCDs firmly on the global agenda (doi:10.1136/bmj.d6034). WHO’s director general Margaret Chan calls them "the diseases that break the bank" and there are now calls to include them in the Millennium Development Goals. As for measures to contain them, the declaration is fierce on tobacco control, good on trans fats and salt reduction, but much weaker on alcohol pricing.
As well as blogs from the UN summit (http://blogs.bmj.com/bmj), you can read Tony Delamothe’s letter urging an unknown health minister to go beyond the "diluted and downgraded" declaration (doi:10.1136/bmj.d6004). "There’s nothing to stop you from acting on the evidence that has been amassed in the run up to the summit," he says. "Doing that would more than justify your trip."
Acting on the evidence is what we aim to help you do. Last week we published the third article in our series on assessing older people, focusing on falls assessment and accompanied by four short videos showing assessment in different settings (doi:10.1136/bmj.d5153). This week, the final article turns our attention to the people who care for older people (doi:10.1136/bmj.d5202). More and more family members are facing this challenge as our populations age, and their emotional and physical health are key to keeping the show on the road. But as I D Cameron and colleagues explain, many won’t think of themselves as carers and won’t ask for help. Your time may be limited, but they suggest asking how burdened the carer feels, and if possible establishing a therapeutic relationship.
Carers are important in other ways. As David Grelotti and Ted Kaptchuk explain, a carer’s views about a treatment can influence how a its effectiveness is judged (doi:10.1136/bmj.d4345). "Placebo effect by proxy" occurs where family members (and clinicians) believe a treatment will work and transmit this feeling to the patient. Optimism about the outcome can make the patient’s environment less stressful and more supportive. But placebo by proxy can also do harm—encouraging overprescription of antibiotics and antipsychotics, for example, as well as exaggerating the benefits of treatment in clinical trials.
Doctors are carers too, and are not always good at looking after themselves. So here are two books that will lift your spirits. The 19th century friendship between pioneering surgeon Theodor Billroth and the composer Johannes Brahms resulted in an extraordinary series of letters. First published in 1957, Letters from a Musical Friendship charts 29 years of what Michael Kelly calls "a symbiotic and brotherly relationship" through conversations about music, art, life, and death (doi:10.1136/bmj.d5903). Equally extraordinary is the simple but forceful testimony of Izzeldin Abuelaish, a Palestinian doctor working in an Israeli hospital, whose three daughters were killed in 2009 during the Israeli incursion into Gaza. Faced with this tragedy, his response has been to liken hate to disease and communication to cure. The book resounds with his conviction that the medical profession is a force for good.

Cite this as: BMJ 2011;343:d6048