World Medical Association Inaugural Address

Tokyo, Japan
9th October 2004

Today, I feel especially privileged to become your President of our World Medical Association.

I thank you -- the physician members -- for electing me to this office last year in Helsinki.

I thank the American Medical Association and the AMA Delegation -- Doctors Palmisano, Nelson and Hill.

I thank Dr. Delon Human, our Secretary-General -- whose service has been extraordinary -- and the WMA Staff, who have been so helpful.

I would like to thank Dr. Appleyard for his superb year as president. I would also like to thank our fellow officers, Drs. Myllymaki, Blachar, Moon and Villmar along with our hard working council members.

And I thank my predecessors from the United States: Doctors Johnson, and Smoak -- and my esteemed colleague here from Florida, Dr. Robert Windom, former U.S. Deputy Secretary for Health.

I thank the Japanese Medical Association -- who have been such gracious hosts -- and who have provided such an outstanding educational, social and business meeting.

All of you have given me opportunities to work hard for a worthy cause: to seek -- and to strive for -- the best health care -- for the people of the world -- through the pursuit of the highest standards of medical care, medical education, medical ethics, and medical science.

These things form the intellectual foundation -- and the creative spark -- of the art of medicine.

And they are ingrained in the charter of the World Medical Association. They are our mission -- and our charge. Caring -- ethics -- science -- the three fundamental, enduring traditions.

Fulfilling this mission -- living out these ideals -- is what gives us the power to be strong, effective advocates for patients -- and for our profession -- The world over.

Through changes in governments and changes in policies -- through changes in public opinion -- through changes in economics and through changes in medical science and methods -- we will flourish.

At this moment in history, the wealth of nations is not the most pressing issue -- rather, it is the health of nations.

Indeed, one of the most pressing issues facing nations -- be they first world or third; post-industrial or developing, is access to care -- how to deliver medical and health care of high quality -- including public health and preventative medicine -- to the greatest number of their citizens -- with the most efficiency possible.

This at a time when the quality of medical care -- and the good health of our patients -- face unprecedented challenges -- both locally -- and globally. Natural -- and man-made.

AIDS. SARS. Resistant tuberculosis. Malaria. The threat of bioterrorism. Bureaucratic meddling. Changing health care policies. An unprecedented number of aging citizens. An unprecedented migration of physicians. And the need -- in many lands -- if not most -- for health care system reform.

All of these things make global cooperation essential -- if we as physicians are to protect the public health. Our increasingly open borders -- and our increasingly mobile populations -- are creating a rich environment for infectious agents -- posing a serious threat to human health and international security.

New infectious diseases such as SARS can emerge -- and travel swiftly around the globe -- mutating -- and infecting less-resilient hosts. These microbes respect no international borders -- or the landscape's physical barriers.

Our weapons against these microbes -- are becoming less effective -- as they develop resistance to the drugs -- that once kept them at bay.

For medicine to survive these threats, it must continue to push the boundaries of science and technology. By so doing, we make longer, better lives available to all humankind.

And from these challenges -- from adversity of all kinds -- we can learn as we overcome. Learn because we overcome.

Recently, I was in a country where physicians offered a candid admission -- that their government delayed the medical community from releasing what they knew about SARS -- when they knew it.

Because of this, valuable time was lost addressing the epidemic and identifying the disease.

This country's scientists knew the structure of SARS -- knew what it was -- how dangerous it was ---for two months before it could be reported.

Ultimately, this silence cost lives -- and cost the country's economy $80 billion.

But because of physician inspired public pressure, there has been a change. Physicians and other scientists in this country can now freely report their findings.

This provided clear evidence of the value of disclosure -- and cooperation -- and the transparency of science. Not only for the health of a country -- but for its economy -- it's wealth.

From adversity has come knowledge -- and progress -- in the global fight against contagion.

In an African nation, a physician was discharged from his duties as a hospital superintendent in early 2002 for "insubordination" -- because he allowed a public health organization to use space in his facility to administer HIV prophylaxis to rape victims.

At the time he was fired, the nation's Health Ministry prohibited the use of HIV drugs as a method of prevention and treatment after HIV exposure.

Because of the international pressure brought to bear -- in part because of this physician's case -- this government changed its policy on HIV treatment.

Through the adversity suffered by these brave physicians, medicine has advanced. These are the type of obstacles we face as a community - and which we must overcome -- together.

The traditions of medicine are what enable physicians to work together under difficult conditions.

Consider the Addis Ababa Fistula Hospital in Ethiopia, where -- in one of the world's most impoverished regions -- physicians treat women suffering from obstetric fistula, a debilitating childbirth injury -- still common in the developing world.

Or Dr. Paul Farmer, who for 20 years has worked to develop a community-based health network in Haiti. He helped implement one of the first AIDS treatment programs in the developing world - and an innovative treatment for patients with multi-drug-resistant tuberculosis.

I've seen adversity - and a common goal - unite physicians - with my own two eyes.

In Nigeria before the Biafran War, I helped work on a nutrition survey of the entire country - a cooperative effort with physicians from America and Nigeria -- Ibo, Yoruba, Housa and Fulani - all working together.

At the London School of Tropical Medicine - at the time of the 6-Day War in 1967 - I watched Christian, Jewish, Muslim and Hindu physicians work side by side - for the betterment of all nations, all faiths, and all peoples.

Through adversity, we find cooperation, and innovation. We learn from each other. Take inspiration from each other. Because we are all in this -- together.

We must delight in our diversity, but remember always the danger of discord. There is power only in unity.

With enthusiasm -- hard work -- and hope -- we can take the challenges we face in medicine and turn them into opportunities for better health.

But only if we remain responsible for our traditions of ethics, caring and science. Only if we work with our patients and others to topple the barriers to quality medical care. Only if we are active, united members of our profession.

Without science -- and its application -- ethics and caring alone are merely good intentions -- only well intentioned kindness.

It is our commitment to science -- and the life-long process of learning that science -- that directs -- and expands -- and that makes unique -- what we as physicians do. We must not permit others to diminish our scientific standards.

Ethics is what compels us to put the interests of the patient first -- or in some instances, the public.

That is the heart of my message today -- that everything we do -- we do for our patients.

The sick, the infirm, the elderly -- those most vulnerable among us -- throughout the world. Those who most need physicians -- and our traditions -- and our advocacy and our autonomy.

Sir William Osler said, "caring is the most important thing -- so do it first. For it is the caring physician who most inspires hope and trust."

In that spirit, I would like the members of the World Medical Association to be known as "The Caring Physicians of the World."

Toward that end, we are asking that each of our national medical associations nominate one to three of their physician members -- who best reflect the principles of caring, ethics and science.

We will select from 50 to 80 of these physicians -- and feature them in a publication to be distributed at our annual meeting in Santiago, Chile, in October, 2005.

We are most fortunate to have the generous support of the Pfizer Medical Humanities Initiative in this publication effort, and I offer them special thanks today.

This publication will be disseminated around the world to national medical associations, governments, foundations and other interested groups. This activity will also include a dedicated website, a series of regional meetings and bridges to other opportunities.

We seek the most caring physicians of the world -- and we want the world to know who they are. And we want the world to know who we are at the World Medical Association. What we do. What we stand for. And the values we embrace. In the service of our patients -- and the public health.

Caring. Ethics. Science.

Our caring is evident in our everyday work and in the millions of hours of charity care we provide in the four corners of the globe.

Our ethics guide not only our practice of medicine, but also the practice of international physician organizations.

Our medical science is evident -- in our growing success -- at treating -- and curing -- diseases and conditions -- once thought fatal.

The miracles of organ transplants -- vaccines -- chemotherapy -- medical genetics -- and advanced technology.

International efforts - such as our work to combat AIDS in Uganda - and save countless lives.

Caring. Ethics. Science.

These are the watchwords of our profession. But everywhere I go -- around the world -- physicians are being subjected to ever greater pressures. Subjected to forces that make it more and more difficult to live out the credo of our calling.

The elimination of patient choice -- and the erosion of appropriate physician autonomy -- puts the sacred patient physician relationship in jeopardy.

So it falls to us -- we who represent international medicine -- to help restore pride, passion, enthusiasm and optimism among our colleagues -- wherever they practice -- wherever they are challenged.

The irony is that we are small -- but our power to do good -- and to wield influence -- is great.

We will reach out -- and encourage national medical associations to form -- where none exist today.

We will reach out -- to assist in the development of quality care -- and to enhance safety.

We will reach out -- and focus attention on developing world issues -- HIV/AIDS, hunger, and infectious diseases. Violence, terrorism and torture. Obesity -- diabetes -- and cardiovascular disease.

We will reach out with regional meetings of our WMA -- and in the houses of parliament, the legislatures, and the board rooms, in partnership with our sister and brother organizations.

And we will reach out -- with a strong, authoritative voice -- as a fierce guardian of ethics and human rights on the international stage. Because we remain -- the global voice of medicine.

It is a voice I have continually heard -- in the years since I embarked on my course of study in international research -- a journey that took me to Egypt, Nigeria and London.

Since then, I have visited health care, education and research facilities in more than 60 countries. These travels have given me unconditional respect for our global profession of medicine -- and a deep sense of awe -- at the remarkable trust and hope our calling commands and inspires.

I've witnessed the work of physicians like you more extensively than I could have imagined. I've seen your skill and caring and compassion -- in settings from the most advanced hospital to the most remote clinic -- and how you manage the expectations created by innovations in medicine.

In these 40 years, I have seen much suffering. But also I have seen much relief of suffering.

I have seen how good health leads to more literacy, more equality of opportunity in political and economic matters and environmental improvements. When health improves, all other aspects of life improve.

And while health experts and economists may differ on how to go about it, the goal is the same. And the rewards tremendous.

Politicians and governments tend to think of medical care and research as a cost -- an expense. But we know that medical care and research is an investment, a value -- one with a tremendous return.

In some countries, there is a need for basics such as clean water, edible food and reliable electricity. But in these places -- they still know and respect their doctor.

Our patients value medical research and innovation. They value medical care. They do not want their care undermined -- or withheld.

We must make sure our patients understand -- how the problems we face as physicians undermine our ability to deliver that care.

We need to continue to communicate the value of our work -- the importance of our work -- to our patients, to the media and to our governments.

And we need to continue to communicate the value of our work -- to each other.

Few things are as central to the development of science and medicine -- as the exchange of information.

By sharing information -- either in journals, or text books, or in international conferences such as these -- we reaffirm what we understand about the art and science of medicine and broaden our base of knowledge.

These are gifts that we bring back to our patients and our communities -- gifts we can use to make medical practice in our respective nations -- better, stronger than ever before.

And experiences such as this gathering -- are also gifts -- to us, as physicians.

They present opportunities -- for friendship. For greater understanding -- not only of science and health policy, but also of culture and history. They challenge us to see our profession and ourselves from a new perspective -- and change us for the better.

No one better understands the obstacles to quality health care -- than physicians and their patients. That's why, as WMA President, I will take my cue from the people on the frontlines and make your agenda -- your individual country's health care agenda -- and your patients' agenda -- my agenda. Our agenda.

To fulfill this mission -- we have to be determined, and stay that way. We can't give up -- or give in.

This is a time of excitement and anticipation -- for me, a time of wonder and expectation.

I look forward to working together -- as we shepherd the spirit of international medicine -- boldly into this 21st century. I can only hope that my time as president will strengthen the bonds that unite us all.

Bonds such as our shared commitment to the best science -- to caring and compassion -- and to excellence in every aspect of medicine.

Bonds such as our commitment to professional integrity -- and to the ethic that requires us to put our patients first. Our commitment -- to the values we share.

As physicians, we can do much on our own -- we can do even more together.

The WMA and its members are -- and will continue to be -- an ethical beacon -- and a force of endless possibilities.

So let us continue to build bridges among our national associations -- and among the individual physicians in this room --

And continue to share our dreams of better health for all.

As I look ahead to the next year, it occurs to me that there is no greater gift than this: To see medicine's traditions lived to the fullest and to work to protect those traditions from harm.

How can we not be enthusiastic and optimistic about our profession with such enduring traditions - about our opportunity to be useful and of value every day -- and about the marvels of modern medicine.

There is an old Japanese proverb, "The go-between wears out a thousand sandals." We must be willing to wear out a thousand sandals - or more - in our advocacy for our patients and our profession.

Together, the family of medicine -- will bring its agenda to the global stage.

We will encourage - and lead -- patients and other partners to stand beside us. We will tear down the barriers that stand between us and our patients - and between us and quality medical care. We will be "The Caring Physicians of the World." Thank you.

Yank D. Coble, Jr., MD