Addressing the 49th WMA General Assembly in Hamburg, Dr Azwar said that health care services around the world had become big business and had developed into a health care industry. "As a result, the soul and spirit of providing health care services are already changed dramatically. The provision of health care services is no longer one hundred per cent for the good of the people but has become an avenue for achieving a big income. At the present time, in almost every country, the motivation for the provision of health care services is more the profit motive than people's health. While the rich very much enjoy good health care services, the poor often receive minimal care or can only suffer."

Solutions to health care problems were now coming mainly from third parties and not from the medical profession. Ministries of health, legislators, insurance companies and others were all attempting to have an impact on health care services and attempting to create systems to solve the problems.

"This must end. This must stop. It is time for us, the medical profession, to resume the leadership in the pursuit of global health. We must become proactive and involved in the development of new health care systems. These systems should provide rewards for the diligent pursuit of good health and the fulfilment of our professional obligation and ethics.

"This is the ultimate challenge! If we do not rise to meet this challenge, it will be a signal of a future where we float helplessly, blown like leaves in the wind, powerless to do what we should do to meet our professional obligations. We cannot be that weak, we cannot be this uncertain of our abilities. The time is now and the place is here. We must stand, organise and provide the necessary leadership."

Dr Azwar called for the strengthening of national medical associations and of all international medical associations and urged the WMA to assert the medical profession's leadership as we approach the 21st century.