They served in the armed forces medical services, and then came back to start both the National Health Service and the specialties which we now recognise. They probably contributed more to the health of the population and to health care in general than any other generation of doctors before or since. The effect of contributions they made to the health of the community can be seen in the huge increase in the number of older people, most of whom have spent the greater part of their lives in good health. It may be that medical historians will see the second half of the twentieth century as a golden age of medicine when huge advances in prevention and treatment were not only developed, but were widely available, and when modern systems of health care were devised.

Training
The other thought I had is that, while these doctors of course undertook postgraduate training, there were no NTNs, CCSTs, SACs, JCHMTs or STAs. Training was less formal and less structured and much more based on gaining wide experience. Many established the specialties in which they worked, training themselves. They then set up training schemes for their successors. While it is certainly better to be trained than untrained, (as a former Chairman of the SAC in Geriatric Medicine I have to say this!), I am concerned that training is becoming so bureaucratic and rigid that we may be disadvantaging our speciality as well as others.

Health care of older people has benefited greatly by the arrival into our specialty, of doctors who have trained first in other medical specialties. Such movement should be encouraged and should continue, and we must ensure that we do not create unnecessary barriers which will disadvantage our specialty and our patients. Similarly, we must welcome those who have spent a significant amount of time in high quality research or who have worked in other countries. They all add to the wide experience which is necessary for a general and rapidly developing specialty such as ours.

Tough decisions
A recent special issue of the British Medical Journal dealt with the relationship between doctors and the pharmaceutical industry. While nobody doubts the huge contribution that the pharmaceutical industry makes to health care, and the need for the industry to make reasonable profits in order to pay for research and development, the journal suggested that in some cases the relationship between the medical profession and the pharmaceutical industry is too close and too cosy. It cannot be healthy that so much postgraduate medical training depends on funding from the pharmaceutical industry. As a Society we need to take these points seriously and consider our own position.

When you receive your copy of the annual accounts for 2002/3, you will see that the income from our bi-annual conferences and sponsorship is a very important source of funding for the Society; 59% of total income. This income largely arises from the pharmaceutical exhibitions which are such a prominent part of our spring and autumn meetings. You will also be aware that this source of income is far from secure. Mergers in the pharmaceutical industry have resulted in a reduction in the number of companies, and hence in the number of exhibition spaces that are taken at our meetings. Sponsorship for a number of activities is becoming more difficult to obtain.

As part of its strategic thinking, I believe that the Society needs to consider whether it ought to be so dependent on the pharmaceutical industry to balance its books, or whether it would be both financially healthier and ethically sounder if we covered our core activities from the income from the membership. In 1989/90 subscriptions accounted for 56% of income, compared to just 24% now. To move back in this direction might require some tough decisions about our subscription levels, but geriatricians are well used to making tough decisions.

Beyond our shores
The Society quite rightly spends much of its time and effort in considering the care of older people within the United Kingdom, the policies, both of the UK Government and of the devolved Administrations, and its own business. It is important that we also look beyond our own needs and problems. Ageing is a worldwide phenomenon and in the next few decades will probably have most impact in the developing world.

Some of the problems are similar to ours but some are different. Unlike sub-Saharan Africa, in this country we are not faced with the ‘missing generation’ in which younger adults, particularly those who are parents, have succumbed to HIV/AIDs and the older generation find themselves bringing up their grandchildren. I hope that at one of our Spring or Autumn meetings in the near future, we might devote a session to ageing in the developing world.

Prof Robert Stout
President