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Jeffrey I Mechanick is Clinical Professor of Medicine and Director of Metabolic Support in the Division of Endocrinology, Diabetes, and Bone Diseases at the Mount Sinai School of Medicine, New York. He is currently Treasurer and Vice President of the American Association of Clinical Endocrinology, Secretary/Treasurer of the American College of Endocrinology, and a member of the President’s Council on Fitness, Sports, and Nutrition–Science Board. Dr Mechanick is Past President of the American Board of Physician Nutrition Specialists and author of several books on nutrition, diabetes, thyroid cancer and metabolic bone disease. His research interests are in critical illness endocrinology, thyroid cancer and nutrition. He is in private practice in endocrinology and metabolic support in New York City.

linical endocrinology has witnessed many surges in activity over the past year. Many events have been exciting and responsive to innovations and discoveries destined to improve healthcare, but many events have also posed tough challenges to the way patient care can be practised. For instance, the recent UN resolution 64/265 drawing attention to global problems of unhealthy diets, diminished physical activity, type 2 diabetes and cardiovascular risk expanded the scale of the metabolic disease problem. The global and domestic problems of overnutrition co-exist with problems of undernutrition and cachexia, commonly encountered in hospitals and impoverished areas. This UN resolution underscores the mandate for more physicians to become experts in nutritional medicine and resonates with the emerging epidemics of obesity and diabetes. How can this shortage of physician nutrition experts be addressed? Education, professional society collaboration and standardisation of clinical practice are key factors to the solution. Clinical endocrinologists have also sensed the explosion of biotechnologic advances with the advent of novel biological and small molecule therapies. These interventions target metabolic disorders, including osteoporosis, cachexia and thyroid disease, at the cellular and molecular levels.


On the other hand, the accelerating science and translation of findings to patient care are throttled down by intensified governmental regulatory efforts and economic pressures for cost-savings. The reduced availability of new anti-obesity and anti-diabetes drugs is incongruous with the epidemiology of these disorders. Physician–industry relationships are subjected to greater scrutiny, impacting the format and accessibility of continuing medical education. Physician frustration with learning new and multiple electronic health record products and functions, reduced reimbursements and administrative hurdles to deliver state-of-the-art care to their patients compounds the problem.

It is ultimately the complex interplay between scientific discovery, clinical practice, socioeconomic factors and political forces that will dictate the healthcare system of the future. The use of clinical practice guidelines can assist physicians in this arena with efficient and effective decision-making. This is especially true of those guidelines that incorporate a transparent evidence base, credentialed expert opinions, socioeconomic and other subjective factors, diligent review processes and facile implementation tools. This edition of European Endocrinology provides perspectives on all of these issues.

European Endocrinology would like to take this opportunity to thank all contributors to this edition. From organisations to individuals, all support and participation is gratefully acknowledged. European Endocrinology expresses its continuing gratitude to the members of the Editorial Board, an invaluable source of guidance and wisdom, and special thanks goes to the experts who have contributed this insightful selection of articles and thrown a spotlight on these pertinent issues. n



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