{"id":3633,"date":"2017-01-19T17:02:38","date_gmt":"2017-01-19T17:02:38","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/wmj38.pdf"},"modified":"2017-01-19T17:02:38","modified_gmt":"2017-01-19T17:02:38","slug":"wmj38-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/es\/publicaciones\/world-medical-journal\/wmj38-2\/","title":{"rendered":"wmj38"},"author":2,"comment_status":"open","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

wmj38<\/a><\/p>\n

COUNTRY
\n\u2022 191st
\nWMA Council Meetingt
\n\u2022 In Memoriam Alan Rowe
\nvol. 58
\nMedicalWorld
\nJournalJournal
\nOfficial Journal of the World Medical Association, INC
\nG20438
\nNr. 2, May 2012
\nCover picture from Turkey
\nEditor in Chief
\nDr. P\u0113teris Apinis
\nLatvian Medical Association
\nSkolas iela 3, Riga, Latvia
\nPhone +371 67 220 661
\npeteris@arstubiedriba.lv
\neditorin-chief@wma.net
\nCo-Editor
\nDr. Alan J. Rowe \u2020
\nCo-Editor
\nProf. Dr. med. Elmar Doppelfeld
\nDeutscher \u00c4rzte-Verlag
\nDieselstr. 2, D-50859 K\u00f6ln, Germany
\nAssistant Editor Velta Poz\u0146aka
\nwmj-editor@wma.net
\nJournal design and
\ncover design by P\u0113teris Gricenko
\nLayout and Artwork
\nThe Latvian Medical Publisher \u201cMedic\u012bnas
\napg\u0101ds\u201d, President Dr. Maija \u0160etlere,
\nKatr\u012bnas iela 2, Riga, Latvia
\nCover painting:
\nPainting by Nuri Iyem (Turkish, 1915\u20132005)
\nOil on canvas
\nPublisher
\nThe World Medical Association, Inc. BP 63
\n01212 Ferney-Voltaire Cedex, France
\nPublishing House
\nPublishing House
\nDeutscher-\u00c4rzte Verlag GmbH,
\nDieselstr. 2, P.O.Box 40 02 65
\n50832 Cologne\/Germany
\nPhone (0 22 34) 70 11-0
\nFax (0 22 34) 70 11-2 55
\nProducer
\nAlexander Krauth
\nBusiness Managers J. F\u00fchrer, N. Froitzheim
\n50859 K\u00f6ln, Dieselstr. 2, Germany
\nIBAN: DE83370100500019250506
\nBIC: PBNKDEFF
\nBank: Deutsche Apotheker- und \u00c4rztebank,
\nIBAN: DE28300606010101107410
\nBIC: DAAEDEDD
\n50670 Cologne, No. 01 011 07410
\nAdvertising rates available on request
\nThe magazine is published bi-mounthly.
\nSubscriptions will be accepted by
\nDeutscher \u00c4rzte-Verlag or
\nthe World Medical Association
\nSubscription fee \u20ac 22,80 per annum (incl. 7%
\nMwSt.). For members of the World Medical
\nAssociation and for Associate members the
\nsubscription fee is settled by the membership
\nor associate payment. Details of Associate
\nMembership may be found at the World
\nMedical Association website
\nwww.wma.net
\nPrinted by
\nDeutscher \u00c4rzte-Verlag
\nCologne, Germany
\nISSN: 0049-8122
\nDr. Jos\u00e9 Luiz
\nGOMES DO AMARAL
\nWMA President
\nAssocia\u00e7ao M\u00e9dica Brasileira
\nRua Sao Carlos do Pinhal 324
\nBela Vista, CEP 01333-903
\nSao Paulo, SP Brazil
\nDr. Leonid EIDELMAN
\nWMA Chairperson of the Finance
\nand Planning Committee
\nIsrael Medical Asociation
\n2 Twin Towers, 35 Jabotinsky St.
\nP.O.Box 3566, Ramat-Gan 52136
\nIsrael
\nDr. Masami ISHII
\nWMA Vice-Chairman of Council
\nJapan Medical Assn
\n2-28-16 Honkomagome
\nBunkyo-ku
\nTokyo 113-8621
\nJapan
\nDr. Wonchat SUBHACHATURAS
\nWMA Immediate Past-President
\nThai Health Professional Alliance
\nAgainst Tobacco (THPAAT)
\nRoyal Golden Jubilee, 2 Soi
\nSoonvijai, New Petchburi Rd.
\nBangkok,Thailand
\nSir Michael MARMOT
\nWMA Chairperson of the Socio-
\nMedical-Affairs Committee
\nBritish Medical Association
\nBMA House,Tavistock Square
\nLondon WC1H 9JP
\nUnited Kingdom
\nDr. Guy DUMONT
\nWMA Chairperson of the Associate
\nMembers
\n14 rue des Tiennes
\n1380 Lasne
\nBelgium
\nDr. Cecil B. WILSON
\nWMA President-Elect
\nAmerican Medical Association
\n515 North State Street
\n60654 Chicago, Illinois
\nUnited States
\nDr.Torunn JANBU
\nWMA Chairperson of the Medical
\nEthics Committee
\nNorwegian Medical Association
\nP.O. Box 1152 sentrum
\n0107 Oslo
\nNorway
\nDr.Frank Ulrich MONTGOMERY
\nWMA Treasurer
\nHerbert-Lewin-Platz 1
\n(Wegelystrasse)
\n10623 Berlin
\nGermany
\nDr. Mukesh HAIKERWAL
\nWMA Chairperson of Council
\n58 Victoria Street
\nWilliamstown, VIC 3016
\nAustralia
\nDr. Otmar KLOIBER
\nWMA Secretary General
\n13 chemin du Levant
\nFrance 01212 Ferney-Voltaire
\nFrance
\nWorld Medical Association Officers, Chairpersons and Officials
\nOfficial Journal of the World Medical Association
\nOpinions expressed in this journal\u00a0\u2013 especially those in authored contributions\u00a0\u2013 do not necessarily reflect WMA policy or positions
\nwww.wma.net
\n41
\nMy first meeting with Alan Rowe was at the German Annual As-
\nsembly in Dresden, 1992. He explained me his plans for the Eu-
\nropean Forum of Medical Associations and WHO (EFMA), for
\nwhich he was Secretary from 1984 to 2001. With the fall of com-
\nmunism in East Europe, the Forum should take on a new role and
\nhe was very clear about the importance of reaching out to the medi-
\ncal communities of the new democracies.
\nMy first meeting with Alan Rowe was, in a way, a disappointment,
\nI thought. He would not argue with me. Whatever I criticized, he
\nreflected my criticism and did not oppose any point. My arguments
\nweren\u2019t that good,I knew.So was he an opportunist? The impression
\nof him as a passive man stayed with me all day. But in the follow-
\ning days, I observed a man who was driven by a cause, a mission: a
\nunified Europe. One that was more than the Europe of the rich, or
\nthe European Economic Community as it was called then. He was
\nlooking for all of Europe and actually beyond. Very soon it became
\nclear that my first impression was wrong and that Alan Rowe was
\na true philanthropist constantly searching for harmony and under-
\nstanding. A very rare species in this world.
\nThe humble General Practitioner from the east of England was his
\nouter appearance, but in his portfolio was a number of important
\npositions he held and filled during his long career. He was rooted
\nin a very thorough and traditional education. After his basic medi-
\ncal education in London, he studied pathology and then became a
\nGeneral Practitioner in 1954. He served in this capacity in Ixworth
\nSuffolk, during what others would consider a full work life until
\n1988. It would be unfair, however, to describe his medical inter-
\nest strictly by his role as a family physician. He engaged as well in
\nspecialised fields of medicine such as rheumatology and oncology,
\nas well as in general fields, such as medical education and, most
\nimportant, public health.The latter found him cooperating with the
\nWorld Health Organization, to whose European Branch in Copen-
\nhagen he always stayed closely connected.
\nHis work brought him respect and recognition in many countries
\nof Europe and there are probably not many other physicians who
\nhave been recognized and awarded in so many countrie \u2013 and in
\nsome even several times! Aside from his home country, which made
\nhim an Officer of the British Empire, he received honours in Italy,
\nFrance, Portugal, Germany, Poland, Kazakhstan, Georgia, Romania,
\nand Macedonia. (This list is probably not exhaustive.)
\nAlan Rowe engaged in organized medicine and volunteered for
\nmany duties in the British Medical Association, the European
\nUnion of General Practitioners, the Standing Committee of Eu-
\nropean Doctors, the European Forum of Medical Associations and
\nWHO,and neither last nor least,the World Medical Association.In
\n2003 he joined and volunteered to edit the World Medical Journal
\nand he reviewed it from a mere existence to being a real membership
\njournal.He only promised to do it for a year or two and when finally
\nPeteris Apinis took over as Editor in 2007, he remained committed
\nand continued to volunteer as a co-editor.
\nOn a few occasions he treated us with his special gift as a musician.
\nWhenever there was an opportunity he gave us \u2013 sometimes spon-
\ntaneously \u2013 an organ concert.
\nHis health limited him during his last years of life more and more,but
\nhe still participated in our European meetings and collaborated en-
\nthustiastically over the phone and by e-mail until the very last weeks.
\nOn April 30th
\nAlan peacefully passed away and many of us have
\nlost a good friend, a kind and gentle colleague, an artist and a great
\nEuropean spirit. And while my first encounter with him appeared
\nto be disappointing for a moment, the rest was a wonderful friend-
\nship.
\nDr. Otmar Kloiber
\nSecretary General, WMA
\nEditorial
\nIn Memoriam Alan J. Rowe
\n42
\nWMA news
\nIn the last six months,a full working agenda
\nhas been accomplished by the Presidency of
\nthe World Medical Association (WMA).
\nAfter taking the Office in Montevideo
\n(Uruguay), in October last year, the Brazil-
\nian Dr. Jos\u00e9 Luiz Gomes do Amaral, hold
\na debate on Social Determinants of Health
\nas his first commitment at the International
\nConference in Rio de Janeiro in the same
\nmonth.
\nAt that time,having the opportunity to rep-
\nresent physicians from a hundred Nations,
\nhe expressed the importance of finding a
\nsolution for social inequalities, observed in
\nboth the rich and the developing countries.
\nThese inequalities are the main responsible
\nfor the health level populations are facing.
\nThey refer to the conditions people are born
\nand grow up, to the differences in educa-
\ntion, opportunities and working conditions
\nand to the conditions people age. Physi-
\ncians play an important role in this field,
\nsince, besides assisting people in need, the
\nprofession comprehends the intervention in
\nthe factors that give rise to poor health. For
\ninstance, tobacco and excessive alcohol con-
\nsumption are causes of several diseases. And
\nthe question arises what makes us smoke
\nand drink excessively? The \u201ccauses of causes\u201d
\nof diseases, i.e., their social determinants,
\nrequire analysis and intervention. Increased
\ntaxation on tobacco, sale of alcoholic bever-
\nages to the underaged made cumbersome,
\ntobacco and alcohol advertisements banned
\nare examples to deeply impact the access
\nand consumption of these products.
\nIn Chihuahua, Mexico, last November, the
\nPresident of the WMA offered solidarity
\nto the Mexican colleagues at the Assembly
\nof Mexican Medical College, where the is-
\nsue was a response to the violence against
\nhealth professionals fighting drug traf-
\nficking, mainly in the city of Juarez. Vari-
\nous aspects of insecurity doctors in many
\nareas around the world have to face were
\nrevealed.
\nOn November 19th
\n, in Panama, several
\nNMAs from Latin-American nations met.
\nAmong the problems that threaten the
\nquality of medical services and particularly,
\nthe Medicine, there were brought out the
\nrepeated political interferences in doctor
\norganizations, mainly in Bolivia and Ven-
\nezuela. In Bolivia today, the government
\ntries to disassemble the medical profession
\nand regulate it, as well as decide on ethi-
\ncal issues and technical competences which
\nqualify different specialties.The objective of
\nthe government is to take total control of
\nthe profession. Still, on 25\u201326 November,
\nPortuguese medical students met to debate
\nthe European economic crisis viewing it
\nfrom the professional perspective of young
\ndoctors in a continent that is going through
\nmajor challenges.
\nFrom January 30th
\nthrough February 1, in
\nS\u00e3o Paulo, at the headquarters of the Medi-
\ncal Association of the State of S\u00e3o Paulo
\nand in Rio de Janeiro, doctors announced
\nthe worldwide campaign for 2012 \u2013 \u201cGlobal
\nappeal\u201d against the discrimination faced by
\npersons affected by leprosy.
\nOne year after the earthquake followed by
\na tsunami and nuclear accident in Japan, on
\nMarch 11th
\n, 2012, the \u201cMontevideo State-
\nment\u201d was presented, which deals with the
\nrole of medical association and physicians
\nin response to disaster situations. At the
\nJapanese Medical Association, in Tokyo, the
\nsuccessful mobilization of Japanese physi-
\ncians around this key issue, sharing such
\nexperience, carry enormous benefits for
\ndiminishing the impact upon the lives of
\npeople of the less and less infrequent cata-
\nstrophic events.
\nIn April this year, in Taiwan, at the open-
\ning of the 20th
\nInternational Conference
\non Health Promoting Hospitals, the op-
\nportunity to approach the role of hospitals
\nand health services for the promotion of
\nhealth and tackling social determinants of
\nhealth was underlined. The experience of
\ntwo hospitals from the city of S\u00e3o Paulo
\nwas presented. One of them was Pirajussara
\nGeneral Hospital which was built 13 years
\nago in a poor area of the city and which has
\nsuccessfully contributed to the improve-
\nment of local social conditions. Similarly,
\nthe experience of Hospital Israelita Albert
\nEinstein was presented, demonstrating rel-
\nevant social actions to the community of
\nParais\u00f3polis, a poor community with almost
\n60 thousand inhabitants. At the same event,
\nthe meeting for \u201cHealth without Danger\u201d
\ntook place, which is oriented to manage-
\nment processes of health institutions and
\npreservation of the environment. The envi-
\nronmental impact of modern hospitals has
\nbeen capturing more and more the atten-
\ntion of society.
\nAlso past April in Ankara and Istanbul,
\nTurkey, the WMA was represented by the
\nPresident and the Council Chair for the
\nintermediation of physicians and parlia-
\nmentary group of that country because of
\nthe crisis caused by a decree recently pro-
\nActivities of WMA since October 2011
\nJose Luiz Gomes do Amaral
\n43
\nWMA news
\nmulgated and brutally restricting the inde-
\npendence and authority of doctors concern-
\ning their professional, ethical and technical
\nself-regulation. The growing animosity of
\nthe Turkish government against medical
\nprofession, creating a hostile environment
\nagainst health professionals, has gener-
\nated serious situations: physicians have been
\nblamed responsible for the consequences of
\nan erroneous public system; dissemination
\nof false information on the lack of doctors
\nas a justification for \u201cimporting\u201d physicians
\nfrom the neighboring countries or other
\nparts of the world and which, to a great ex-
\ntent, has been influenced by the crisis. The
\ncrisis culminated in the murdering of a 30-
\nyear old doctor, followed by a great demon-
\nstration throughout the country. In Istanbul
\nthe President of the WMA participated in
\nthe demonstration of more than 20 thou-
\nsand doctors, bringing the city of Istanbul
\ninto a halt and raising a popular outcry as a
\nresponse to this tragedy.
\nIn April 23, the President of the WMA
\nand its Council participated in the meet-
\ning of \u201cHealth Care in Danger\u201d, an initia-
\ntive, convening such organizations as the
\nWorld and the British Medical Associa-
\ntion, the International Red Cross\/Crescent
\nand Doctors without Borders to discuss the
\ngrowing violence wave against health pro-
\nfessionals in several regions of the world,
\ne.g. Somalia, Libya, Egypt, Bahrain, Syria,
\nIraq, Afghanistan, Israel, Mexico, Colom-
\nbia, the civil and military conflicts. Using
\nthe opportunity, the WMA presented its
\nposition in the field of ethics and medical
\nneutrality in conflict situations. Physicians
\nand other medical professionals have been
\narrested, kidnapped, tortured and murdered
\nin retaliation for assisting people that even-
\ntually belong to an opponent group. Hospi-
\ntals have been bombed and invaded. Such
\nincidents have interrupted humanitarian
\nactions, causing the withdrawal of volun-
\ntary teams whose security could not be en-
\nsured and, thus, leaving a great amount of
\nunassisted people behind.
\nAt the end of April, namely April 24\u201329,
\na Council Meeting of the World Medical
\nAssociation took place in Prague,the Czech
\nRepublic. In addition to the problems men-
\ntioned above, other important issues were
\ntackled as well, such as opening of one more
\nrevising of the Declaration of Helsinki,
\nan initiative started by Dr.Urban Wiesing
\nfrom Tubingen University and Dr.Ramin
\nParsa-Parsi from the German Medical As-
\nsociation. The Meeting also dealt with the
\nprohibition of physician participation in
\ndeath penalty and the repudiation of the
\norgan use from sentenced prisoners-donors
\nfor transplanting, which is unacceptable,
\nsince it contradicts the professional ethical
\nfoundations of medicine.
\nDr.Jos\u00e9 Luiz Gomes do Amaral,
\nPresident of WMA
\nThe 191st
\nCouncil meeting of the World
\nMedical Association opened with
\nDr.\u00a0 Mukesh Haikerwal, Chair of the
\nCouncil, presiding. Almost 150 delegates
\nfrom 40 National Medical Associations
\nattended the meeting, which was held at
\nthe Marriott Hotel in Prague, the Czech
\nRepublic.
\nThe President Dr. Jos\u00e9 Gomes do Amaral
\nbegan by giving an oral report on his activi-
\nties and the many meetings he had attended.
\nHe said that he and Dr. Haikerwal had been
\nable to give particular support to the Turkish
\nMedical Association on their recent visit to
\nIstanbul, joining a demonstration of doctors
\nafter the death of a young Turkish physician.
\nThe Secretary General Dr. Otmar Kloiber
\npresented a detailed report on his activities
\nand the activities of the WMA staff.He said
\nthe WMA was still being asked to do more
\nthan it could do. However, the organisation
\nwas growing in its networking activity and
\npartnership with other organisations.
\n191st
\nWMA Council Meeting
\nPrague, the Czech Republic (April 26\u201328, 2012)
\n44
\nWMA news
\nDeclaration of Helsinki
\nDr. Ramin Parsa-Parsi (Germany), Chair
\nof the Workgroup on the revision of the
\nDeclaration of Helsinki, reported on the
\npreparation for two conferences, the first in
\nRotterdam in June and the second in Cape
\nTown in December, Prof. Urban Wiesing,
\nthe WMA\u2019s ethics adviser on the Declara-
\ntion, gave an oral report on the Workgroup\u2019s
\nprogress.
\nThe committee agreed to recommend to the
\nCouncil that an invitation for a public con-
\nsultation be sent out after the Council had
\napproved a draft version of a revised Dec-
\nlaration, possibly as early as Spring 2013;
\nthat National Medical Associations should
\nbe asked to put forward suggested topics
\nfor the revision process; and that the Work-
\ngroup be authorised to continue planning
\nthe two conferences.
\nFinance and planning\u00a0
\nDr. Leonid Eidelman (Israel), Chair of the
\nFinance and Planning Committee, pre-
\nsided.
\nMembership Dues
\nMr Addy H\u00e4llmyer, the WMA\u2019s Financial
\nAdviser, said that there were still substan-
\ntial amounts of dues outstanding for 2012
\nmembership payments.\u00a0 He thanked all
\nthose NMAs who had paid their dues.
\nFinancial Report
\nPresenting the financial report,Mr H\u00e4llmy-
\ner said that 2011 had been another year of
\nfinancial turbulence. But despite this the
\nWMA had not suffered any loss in its fi-
\nnancial assets. Dr. Frank Montgomery
\n(Germany),the Treasurer,assured the meet-
\ning that the Association was financially in
\ngood standing.
\nBusiness Development
\nMr Tony Bourne (United Kingdom), Chair
\nof the Business Development Group, said
\nthe main topic of discussion at the Group\u2019s
\nlatest meeting was the idea of setting up a
\nround table of outside organisations. But
\nthe proposal now was for it to be a non-rev-
\nenue raising forum.There would be no spe-
\ncific fees derived from these organisations.
\nWhat would be required from them would
\nbe a registration fee designed to cover the
\ncosts of administering a round table.\u00a0 The
\nidea for the composition of a round table
\nwould be that it should be a mixture of non-
\ngovernmental organisations, multilateral
\norganisations and commercial companies.
\nIdeally it would meet initially once a year\u00a0at
\nthe time of the WMA General Assembly.
\nHe said the British Medical Association
\nhad undertaken to draft a charter or memo-
\nrandum of understanding about the rules of
\nengagement.This would be circulated to the
\nCouncil Executive. He hoped that between
\nten and fifteen organisations would be ap-
\nproached in a pilot scheme over the next
\none to two months.\u00a0
\nDisaster Preparedness
\nDr.Miguel Jorge (Brazil) gave an oral report
\nfrom the Workgroup on Disaster Prepared-
\nness and Medical Response. The group was
\ncontinuing to work with other bodies, such
\nas the Red Cross and the World Health
\nProfessional Alliance,and it was now think-
\n45
\nWMA news
\ning of conducting a survey among NMAs
\nto identify their programmes and activities.
\nIt was also considering an online course for
\nthe WMA\u2019s website. To do this he asked
\nthat the Workgroup\u2019s mandate should be
\nextended.
\nThe committee agreed to recommend this
\nto the Council.
\nFuture WMA Meetings
\nDr. Kloiber said there had been many appli-
\ncations from NMAs to host future General
\nAssemblies. Applications had been received
\nfrom Argentina, Columbia, Indonesia, Lat-
\nvia, Russia, South Africa and Taiwan.
\nShort oral presentations were then given by
\neach NMA to the meeting, and after a vote
\nit was decided to hold the 2014 Assembly in
\nDurban, South Africa.
\nStrategic Plan
\nDr. Robert Ouellet (Canada), Chair of the
\nStrategic Planning Group, reported on
\nprogress of the three-year rolling strategic
\nplan that had been discussed at the last
\nGeneral Assembly. He introduced Emman-
\nuelle Morin from the Canadian Medical
\nAssociation who said they had now moved
\nto the stage of preparing a final strategic
\nplan. She spoke about the results of the sur-
\nvey of members and stakeholders. This had
\nidentified the core business areas of ethics
\nand guidance, advocacy and representation,
\nand networking and outreach. What now
\nhad to be decided were the priority strategic
\nobjectives, such as operational excellence,
\nand partnership and collaborations. Mem-
\nbers had to ask themselves whether this
\nplan would provide the direction needed for
\nthe WMA over the next 3\u20135 years.
\nThe committee decided that the latest doc-
\nument on the strategic plan should be cir-
\nculated to NMAs for further consideration.
\nMembership
\nJunior Doctors Network
\nDr. Xaviour Walker, Chair of the Network,
\ngave an oral report about the Network\u2019s
\nactivities. He said the Network had been
\nin existence now for two years as the first
\nglobal organisation of its kind. It was plan-
\nning to network with other junior doctors\u2019
\norganisations and to work with NMAs that
\ndid not have junior representation.The Net-
\nwork was involved in developing two papers
\nfor the WMA, one on physician wellbeing
\nand the other on ethical global health train-
\ning.
\nMembership\u00a0
\nApplications for membership were received
\nfrom the Myanmar Medical Association
\nand from the Sri Lanka Medical Associa-
\ntion.The committee decided to recommend
\nthe Council to forward the applications to
\nthe General Assembly for acceptance
\nFrance
\nAn application for membership was re-
\nceived from the Conseil de l\u2019Ordre Na-
\ntional des Medecins to replace the French
\nMedical Association. Dr. Michel Legmann
\n(Conseil de l\u2019Ordre National des Medecins)
\nsaid that the 270,000 French physicians had
\nto be registered with the Conseil in order to
\nbe able to practice.\u00a0
\nThe committee recommended the Council
\nto forward the request to the General As-
\nsembly for adoption.
\nElection Procedure
\nDr. Ouellet proposed an amendment to
\nthe WMA\u2019s election and voting procedures,
\nstating that in order to be elected a candi-
\ndate must be present at the time of the elec-
\ntion.This would be in line with the election
\nrequirements of most national medical as-
\nsociations.
\nIn the debate that followed, a number of
\nconcerns were identified, and Dr. Ouellet
\ndecided to withdraw the amendment for
\nfurther consideration.
\nWMA Awards
\nA proposal was considered for a new WMA
\nawards scheme to recognise physicians and
\nlay persons who had helped to improve
\nmedical care. The idea was put forward by
\nDr. Peteris Apinis (Latvia), but after the de-
\ntails were explained, it was decided that the
\nidea should not be pursued.
\nWorld Medical Journal
\nDr. Peteris Apinis, editor in chief of the
\nJournal, said the WMJ had been published
\nfor 58 years. Since 2010 it had been pub-
\nlished bi-monthly. He said he would like to
\npublish the Journal 12 times a year, but this
\nwould be financially challenging. His ideas
\nfor developing a scientific edition would
\nalso depend on finding the necessary re-
\nsources.
\nSocio-Medical Affairs
\nCommittee\u00a0
\nSocial Determinants
\nSir Michael Marmot (United Kingdom),
\nChair of the Socio-Medical Affairs Com-
\nmittee, opened the proceedings of his com-
\nmittee, by giving a report on social determi-
\nnants. He said he was conducting a review
\nof social determinants and the health divide
\nin the European region and there would be
\na report to the WHO later this year. The
\nWMA had an important role to play about
\n46
\nWMA news
\nwhat doctors and other health professionals
\ncould do in this arena.
\nHealth and the Environment
\nDr.Dongchun Shin (Korea) gave an oral re-
\nport about the UN Climate Change Sum-
\nmit which he attended in Durban, South
\nAfrica last year and the parallel Global Cli-
\nmate and Health Summit. These brought
\ntogether key health sector people to dis-
\ncuss the impact of climate change on pub-
\nlic health and solutions to promote greater
\nhealth. The WMA was one of the partners
\nin the event.
\nDr.Vivienne Nathanson (United Kingdom)
\nsaid she had attended a follow up Health
\nSector Climate Strategy discussion held
\nto build\u00a0on the work of the Durban Sum-
\nmit. She said there was a worrying trend of
\nhealth repeatedly slipping from the agenda
\nwhen talking about climate change. There
\nwas a need to produce a resource which
\nidentified what the health environmental
\nand economic cases were for averting cli-
\nmate change.
\nSir Michael Marmot\u00a0referred to the forth-
\ncoming UN Conference on Sustainable
\nDevelopment in June and expressed his
\nconcern that there was almost no health
\ncomponent in it. People were going to dis-
\ncuss climate change without looking at the
\nimpact of health.
\nHealth and Mercury
\nDr. Peter Orris (USA) reported on the UN
\nMercury Treaty negotiations which he had
\nbeen following for the WMA. Although
\nthe process was moving forward slowly, a
\nhealth perspective was missing from this
\ndiscussion and delegates from Environment
\nMinistries had little understanding of the
\ntopic. However, there had been tremendous
\nprogress in phasing out mercury thermom-
\neters.
\nProtection of Health Personnel
\nThe committee considered the proposed re-
\nvision of the WMA Regulations in Times
\nof Armed Conflict and Other Situations of
\nViolence.
\nDr. Vivienne Nathanson reported on the
\nproject \u201cHealthcare in Danger\u201d launched
\nby the International Committee of the
\nRed Cross to raise public awareness about
\nattacks on health care personnel and insti-
\ntutions and find solutions to the problem.
\nThe ICRC had carried out research on
\nthe extent of the problem in a selection of
\ncountries. The aim of the project was to try
\nto get a global movement to push hard at
\ngovernments to give to those institutions,
\ntheir workers and patients legal protections.
\nShe also spoke about a conference organised
\nthat week jointly by the ICRC, the WMA
\nand the British Medical Association on the
\nissue. The key message of the conference
\nwas that every time a doctor was kidnapped,
\ninjured or killed it was patients, often the
\npoorest and most vulnerable, who suffered.
\nIt was often the case that healthcare provi-
\nsion was withdrawn.
\nThe committee considered the revised poli-
\ncy on Regulations in Times of Armed
\nConflict and decided to forward it to the
\nCouncil for sending it to the General As-
\nsembly for adoption.
\nThe committee also considered a Resolu-
\ntion on Danger in Health Care in Syria and
\nBahrain which it agreed should go to the
\nCouncil for (see p. 55) approval.
\nEthical Implications of
\nPhysician Strikes
\nLeah Wapner (Israel)\u00a0spoke about the pro-
\nposed Statement on Physician Strikes, pre-
\nsented by the Israeli Medical Association
\nlast year after the physicians\u2019 strike in Is-
\nrael. She said there was a lot of controversy
\nsurrounding the issue and the role that the
\nWMA should have in this area. As a re-
\nsult it was clear that the Statement needed
\nfurther discussion. She\u00a0 proposed that a
\nWorkgroup should be set up to consider
\nthe whole issue.
\nThe committee agreed to recommend this
\nto the Council.
\nElectronic Cigarettes
\nThe committee considered the proposed
\nStatement on Electronic Cigarettes.
\nDr.\u00a0 Jeremy Lazarus (USA) introduced
\nthe paper and said it had undergone some
\namendments since the last discussion in
\nMontevideo.
\nDr.Vivienne Nathanson said that some to-
\nbacco companies in the United Kingdom
\nwere branding their electronic cigarettes
\nwith the brand names of high selling ciga-
\nrettes, hoping that people would switch
\nbetween the two. She wanted to see the
\nWMA deplore the idea of brand stretch-
\ning.
\nIt was agreed to amend the document ac-
\ncordingly and forward it to the Council
\nwith the recommendation that it should go
\nto the General Assembly for adoption.
\nViolence in the Health Sector
\nMalke Borrow (Israel) introduced the pro-
\nposed Statement on Violence in the Health
\nSector paper which was first presented in
\n2010 and had since been amended to ad-
\ndress the issue of mental health.
\nThe committee decided to recommend to
\nthe Council that the document be sent to
\nthe General assembly for adoption.\u00a0
\nForced Sterilisation
\nDr. Vivienne Nathanson introduced\u00a0a new
\nproposal for a Statement on Forced and
\nCoerced Sterilisation that had arisen out of
\n47
\nWMA news
\ndiscussions with the International Health
\nand Human Rights Organisations. Around
\nthe world, forced sterilisation was extremely
\ncommon, and this was not an issue that ap-
\nplied only to women. Men were also sub-
\nject to it. She said the proposed Statement
\ndeclared that no-one should be sterilised
\nwithout their consent and she asked that
\nthe document be circulated to NMAs for
\nconsideration.
\nThe committee agreed to recommend this
\nto the Council.\u00a0
\nTurkish Medical Association
\nThe meeting heard a plea for help from the
\nTurkish Medical Association. Dr. Feride
\nTanik (Turkey) said that as a result of a
\ndecree from the Turkish Government last
\nyear the medical association was facing fi-
\nnancial and political pressures. The author-
\nity of the association on self-regulation had
\nbeen transferred into a new bureaucratic
\nbody of the Ministry of Health. As a result
\nthe association no longer had the authority
\nto establish and issue ethical guidelines for
\nphysicians, conduct investigations about al-
\nleged malpractice by physicians, determine
\ndisciplinary sanctions against physicians or
\ndevelop core curricula for medical educa-
\ntion, post-graduate medical education.
\nThey were particularly concerned that the
\nGovernment had removed from the medi-
\ncal association\u2019s mandate the words to en-
\nsure \u201cthat the medical profession is prac-
\nticed and promoted in line with public and
\nindividual well-being and benefit\u201d. As a
\nresult of this, the association could no lon-
\nger challenge actions that adversely affected
\nthe right to health, the provision of health
\ncare, public health, and individual patient
\nwell-being. This diminished the indepen-
\ndence of physicians, as well as the health of
\ntheir patients.
\nThe committee considered a Resolution
\nexpressing concern about the Turkish Gov-
\nernment\u2019s action and urging it to restore
\nto the Turkish Medical Association the
\nresponsibilities for professional autonomy
\nand self-regulation that it took from them.
\nIt called on all physician members of the
\nTurkish Parliament to remember their du-
\nties as physician leaders and to support the
\nright of the medical profession to autono-
\nmy and self-regulation. And it commend-
\ned the Turkish Medical Association and
\nthose members of the Turkish Parliament
\nwho had challenged their Government.
\nIt was agreed to forward the Resolution to
\nthe Council for approval.
\nAutonomy of Professional
\nOrders in West Africa
\nA proposed Resolution was submitted by
\nthe Medical Association of Senegal re-
\nquesting that the professional autonomy
\nand self-regulation be guaranteed within
\nthe countries of the Economic and Mon-
\netary Union of West Africa, which brought
\ntogether eight countries of West Africa.
\nIt was agreed to forward the Resolution to
\nthe Council for approval.
\nVaccination
\nDr. Jon Snaedal (Iceland) introduced a
\nproposed new Statement on the Prioriti-
\nsation of Vaccination that had come from
\nthe Iceland and Irish Medical Associations.
\nHe said the WMA had a multitude of poli-
\ncies on public health but nothing on vac-
\ncination which was one of the most effec-
\ntive interventions. The proposed Statement
\nendorsed the global vision on vaccination
\nof the World Health Organisation and
\nUNICEF and emphasised the importance
\nand effectiveness of vaccination. But it also
\npointed to the dangers arising from many
\nill thought out ideas about the risks, leading
\nto a decrease in vaccination in some parts of
\nthe world, thereby increasing the prevalence
\nof diseases.
\nIt was agreed that the paper should be cir-
\nculated to NMAs for consideration.
\nCounterfeit, Falsified and
\nSubstandard Medicines
\nThe Secretary General, Dr. Kloiber, intro-
\nduced a paper, entitled \u201cHow to Achieve
\nInternational Action on Falsified Medicine:
\nA Consensus Statement\u201d, that had been
\nreceived by the WMA for endorsement
\nfrom outside the organisation. The paper
\nhad been written against the background
\nof the large amount of substandard, fake
\nand counterfeit medicines that existed in
\nthe world. But Dr. Kloiber said the issue
\nwas dominated by questions of intellectual
\nproperty rights which were a minefield and
\nhe doubted whether it would be helpful for
\nthe WMA to endorse the paper.
\nAfter a debate, during which delegates ex-
\npressed strong reservations about the docu-
\nment, it was agreed that no further action
\nshould be taken.
\nAdvocacy\u00a0
\nPaul Emile-Cloutier (Canada), newly ap-
\npointed Chair of the Advocacy Advisory
\nWorkgroup, highlighted some of the advo-
\ncacy developments of the WMA which he
\nsaid were reaping some positive results. The
\nGroup had discussed some of the challenges
\nthe WMA was facing, such as how to bet-
\nter align the strategy on advocacy with the
\nstrategic plan and how to assist the NMAs
\nwith their advocacy by providing them with
\nthe necessary tools.The Group would even-
\ntually come forward with some concrete
\nproposals.
\nHealth Care in Danger
\nDr. Jorge (Brazil) said that given the in-
\ncreasing concern about doctors being
\nthreatened around the world and the new
\nICRC campaign \u201cHealth Care in Danger\u201d
\nthat a WMA Workgroup should be set up
\nto identify and follow up events in this area.
\nThis was agreed and the proposal was for-
\nwarded to the Council for approval.
\n48
\nWMA news
\nBolivia
\nThe committee heard a plea from CON-
\nFEMEL (the Medical Confederation of
\nLatin America and the Caribbean) for doctors
\nin Bolivia to be supported by the WMA in a
\ndispute with their Government.It was report-
\ned that doctors\u2019 leaders in the country were
\ncurrently involved in a hunger strike in pro-
\ntest at recent Government actions to change
\nthe laws governing the practice of medicine.
\nThese included changing the presumption of
\ninnocence in cases of malpractice. In addition
\ndoctors\u2019salaries and income had been reduced,
\ntheirworkinghoursincreasedandworkcondi-
\ntions had deteriorated.The WMA was urged
\nto send a letter of support to the Bolivian doc-
\ntors.The proposal was deferred to the Council.
\nMedical ethics committee
\nDr. Torunn Janbu (Norway), Chair of the
\nMedical Ethics Committee, presided.
\nEthical Organ Procurement
\nDr. Vivienne\u00a0Nathanson, Chair of a Work-
\ngroup on the issue, presented a revised ver-
\nsion of the proposed Statement on Organ
\nand Tissue Donation. Significant amend-
\nments had been made about prisoners being
\norgan donors with a prohibition on organs
\nbeing taken from executed prisoners. A new
\nsection had also been added about living
\ndonors, the biggest increasing section in
\nmany countries.
\nThe committee debated the document at
\nsome length and made a number of amend-
\nments relating to the description that should
\nbe given to decision makers, on transplant
\nco-ordinators and the wording on oppos-
\ning the commercialisation of donation and
\ntransplantation.
\nIt then agreed to send the amended State-
\nment to the Council for forwarding to the
\nGeneral Assembly for adoption.
\nEthics in Palliative Medicine
\nDr. Fernando Rivas (Spain), Chair of the
\nWorgroup on Ethics and Palliative Seda-
\ntion, said the Group had concluded that
\nthe WMA\u2019s existing Declarations on Eu-
\nthanasia, Terminal Illness and End-of-Life
\nMedical Care were sufficiently relevant and
\nthat no new Declaration was required. The
\nSpanish Medical Association had offered to
\ncirculate guidelines to help NMAs promote
\neducation on palliative care and relation-
\nships between physicians and patients, and
\nto write an article in the World Medical
\nJournal on this topic.
\nDr. Marco Gomez Sancho (Spain) said
\nthe purpose of suggesting a new Declara-
\ntion had been to allow members to make a
\ndistinction between two things that were
\ntotally different \u2013 palliative sedation, which
\nwas a medical process that was universally
\naccepted all over the world and euthanasia
\nwhich was a process that was absolutely
\nrejected by a strong majority of doctors,
\nthough not all of them.
\nThe committee thanked the Workgroup for
\ntheir work.
\nCapital Punishment
\nDr. Cecil Wilson (USA)\u00a0 presented a new
\nResolution on Capital Punishment reaf-
\nfirming the WMA\u2019s prohibition on physi-
\ncians participating in capital punishment.
\nHe reminded the committee that the Work-
\ngroup had been set up to evaluate whether
\nthe WMA should have a mandate to exam-
\nine the options for developing a Statement
\nopposing capital punishment.
\nThe proposed Resolution,including a prohi-
\nbition on physicians facilitating the impor-
\ntation or prescription of drugs for execution,
\nwas debated and after several amendments
\nwere agreed it was decided to send the doc-
\nument to the Council for forwarding to the
\nGeneral Assembly for adoption.
\nHuman Rights
\nMs Clarisse Delorme, the WMA\u2019s advocacy
\nadviser,updated the meeting on the situation
\nin Bahrain of the trial of a number of physi-
\ncians and on the continuing conflict in Syria.
\nPerson Centered Medicine
\nDr. Jon Snaedal (Iceland) introduced a pro-
\nposed new Statement on Person Centred
\nMedicine. He said one reason for this was
\nthe fragmentation of health which tended
\nto be more and more organ specific. The
\nWMA was now involved in various initia-
\ntives on person centred medicine and it was
\ntime the Association developed policy on
\nthe issue.
\nThe committee decided to circulate the doc-
\nument to NMAs for consideration.
\nCouncil
\nThe third and final day of the meeting was
\ntaken up with the Council considering the
\nreports from the three committees.
\nIt approved three Resolutions: on Threats to
\nProfessional Autonomy and Self-Regula-
\ntion in Turkey,on Danger in Health Care in
\nSyria and Bahrain, and on the Autonomy of
\nProfessional Orders in West Africa.
\nFrom the Socio-Medical Affairs Commit-
\ntee it decided to forward to the General
\nAssembly for adoption the following docu-
\nments:
\n\u2022 Revised Regulations in Times of Armed
\nConflict.
\n\u2022 Statement on Electronic Cigarettes.
\n\u2022 Statement on Violence in the Health
\nSector.
\nThe Council agreed to the setting up of a
\nWorkgroup on physician strikes and to cir-
\nculating to NMAs papers on forced sterili-
\nsation and vaccination.
\n49
\nWMA news
\nFrom the Medical Ethics Committee it de-
\ncided to forward to the General Assembly
\nfor adoption:
\n\u2022 Revised Statement on Organ and Tissue
\nDonation.
\n\u2022 Resolution on Capital Punishment.
\nThe Council also agreed to the idea of a
\npublic consultation on the revision of the
\nDeclaration of Helsinki after the Council
\nhad approved a draft proposal and to circu-
\nlating a paper to NMAs on person centred
\nmedicine
\nFrom the Finance and Planning Commit-
\ntee it decided to forward to the General As-
\nsembly for adoption:
\n\u2022 Membership applications from the
\nMyanmar and Sri Lankan Medical As-
\nsociations.
\n\u2022 Membership of the Conseil de l\u2019Ordre
\nNational des Medecins to replace the
\nFrench Medical Association.
\nThe Council also agreed to extend the
\nmandate of the Workgroup on disaster pre-
\nparedness and to circulate to NMAs the
\namended paper on the strategic plan.
\nBolivia
\nCONFEMEL proposed an emergency
\nResolution urging the WMA to express its
\nsupport for the doctors in Bolivia who were
\non hunger strike in protest at the actions
\nthat the Bolivian Government had taken
\nagainst the Bolivian Medical Association.
\nOne suggestion was that the WMA should
\nhelp to mediate between the two sides.
\nThe Council decided that this issue should
\nbe sent to the Council Executive to take
\nforward.
\nWorld Veterinary Association
\nDr. Tjeerd Jorna, Past President of the
\nWorld Veterinary Association, addressed
\nthe meeting about the history and work
\nof his association. Its mission was to en-
\nsure animal health and animal welfare at
\na global level and to protect public health.
\nHe said he hoped the WMA and the WVA
\ncould co-operate more on issues such as
\nanti-microbial resistance and the control of
\nzoonotic diseases, such as rabies and avian
\ninfluenza. He hoped the two organisations
\ncould agree a memorandum of understand-
\ning and he had sent a draft memorandum to
\nthe WMA\u2019s Secretary General.
\nDisaster Preparedness
\nThe Council agreed to extend the mandate
\nof the Workgroup to explore developments
\nin terms of specialisation and online train-
\ning courses and other possibilities by sur-
\nveying constituent members.
\nPrimary Care Conference
\nThe Chair, Dr. Haikerwal said it was hoped
\nto have a primary care conference early in
\n2013.
\nWorld Health Assembly
\nDr. Kloiber said that the forthcoming
\nWorld Health Assembly would give the
\nWMA the chance for some advocacy ac-
\ntivities. One topic coming up at the WHA
\nwas a report on intellectual property which
\nin part called for the lifting of patents
\nfor drugs for poor countries. He said the
\nWMA had a tradition of asking for equi-
\ntable access to drugs which was extremely
\nimportant for the provision of drugs to
\npatients in poor countries. However, the
\nway the report was being proposed was
\nquestionable because a lifting of patents
\nwould lead immediately to a production of
\ndrugs which would flood the market.There
\nwould be no more protection for produc-
\ning new drugs. This was something the
\nWMA would have to monitor closely and
\nhe suggested that the WMA might even-
\ntually have to consider policy on the whole
\narea of the sustainability of the pharma-
\nceutical supply in the world, equitable ac-
\ncess to drugs and how innovations would
\nbe financed in the future.
\nElection Procedure
\nDr. Ouellet put forward a revised amend-
\nment to the WMA\u2019s election and voting
\nprocedures, having taken into consideration
\nconcerns expressed in the Finance Com-
\nmittee.
\nThe new amendment read that \u201cIn cases of
\nofficers elected by the Council and commit-
\ntee chairs elected by committee, candidates
\nmust to the degree possible be present at
\nthe time of the election, except in circum-
\nstances deemed acceptable by the electing
\nbody. Candidates will have the opportunity
\nto speak to their candidacy\u201d.The Council
\naccepted the proposal.
\nThe Council meeting ended with thanks
\nto the Czech Medical Association for their
\nhospitality.
\n50
\nWMA news
\nSecretary General\u2019s Report
\nNon-communicable diseases
\nNon-communicable diseases have emerged as one of the most
\nimportant topics on the public health agenda. The WMA has
\nconcerns regarding the WHO\u2019s identification of four specific
\nNCDs\u00a0\u2013 cardiovascular disease, cancer, lung and respiratory dis-
\nease, and diabetes \u2013 as a focus of the initiative. The risk of this is
\nreturning to a silo-based approach to public health. If govern-
\nments concentrate only on improving health outcomes in these
\nidentified areas, other critical NCD threats will not receive ad-
\nequate attention. Therefore the WMA, together with the other
\nhealth professionals, has been lobbying to revise the WHO\u2019s ap-
\nproach to make it more holistic and suggesting that targets should
\naddress the elimination of inequalities in health care.
\nTogether with our partners in the World Health Professions Al-
\nliance (WHPA) the WMA has participated in the development
\nof the NCD toolkit to assess the risk level in life style behaviours
\nand bio measures in form of NCD indicators.The Brazilian Med-
\nical Association has translated this into Portuguese.
\nMulti drug resistant tuberculosis project
\nThe WMA has launched the revised MDR-TB online course, up-
\ndating the original 2006 course.Printed courses have been translat-
\ned into Azeri,Chinese,French,Georgian,Russian and Spanish.All
\ncourses can be accessed free of charge from the WMA webpage.
\nThe printed TB refresher course has been nominated by the Unit-
\ned States Center for Disease Control (CDC) as an educational
\nhighlight and has received an award.
\nTobacco project
\nThe WMA was involved in the implementation process of the
\nWHO Framework Convention on Tobacco Control (FCTC)
\nhttp:\/\/www.who.int\/tobacco\/framework\/en,the international treaty
\ncondemning tobacco as an addictive substance and imposing bans
\non the advertising and promotion of tobacco.
\nThe WMA is also cooperating with the public private partnership
\n\u201cQuitNowTXT program\u201dto develop information for tobacco ces-
\nsation via mobile phones to reach people at risk for preventable
\nNCDs.
\nAlcohol
\nThe WMA continues to monitor activities relating to the Global
\nStrategy to Reduce the Harmful Use of Alcohol. This requires
\nconcerted action by countries, effective global governance, and
\nappropriate engagement of all relevant stakeholders, including
\nhealth actors.The WMA Secretariat has monitored the process in
\nthis direction, so that medical associations at national and global
\nlevels continue to be engaged in this area.
\nCounterfeit medical products
\nThe WMA and the members of the WHPA have stepped up their
\nactivities on counterfeit medical issues and developed an Anti-
\nCounterfeit campaign with an educational grant from Pfizer Inc.
\nand Eli Lilly. The basis of the campaign is the \u2018Be Aware\u2019 toolkit
\nfor health professionals and patients to increase awareness of this
\ntopic and provide practical advice for actions to take in case of a
\nsuspected counterfeit medical product.
\nHealth and the environment
\nClimate change
\nThe WMA had had observer status to the UN Climate Change
\nConference in Durban in December 2011, which brought to-
\ngether representatives of the world\u2019s governments, international
\norganizations and civil society.\u00a0The discussions aimed to advance
\nthe implementation of the Climate Change Convention and the
\nKyoto Protocol. The WMA Secretariat has been able to facilitate
\nthe participation of medical associations interested in the Summit.
\nThe Association also agreed to be a partner for a Global Climate
\nand Health Summit in December 2011 organised by Health Care
\nWithout Harm, the Climate and Health Council, the World
\nFederation of Public Health Associations and Nelson R. Man-
\ndela School of Medicine (University of KwaZulu-Natal). The
\npurpose of the event was to galvanize health sector work around
\nclimate change. A Declaration and Plan of Action were adopted
\nby all partners. Prof. Dong Chun Shin (Korean Medical Associa-
\ntion), a member of the former WMA working group on health
\nand the environment represented the WMA at the Summit. As
\na follow-up to the Durban Summit, a Health Sector Climate
\nStrategy discussion of the partners was held in London in March
\nto build on the success of the work achieved in Durban. Professor
\nVivienne Nathanson represented the WMA at the meeting. The
\nWMA had also continued its work in the areas of mercury and
\nchemicals.
\n51
\nWMA news
\nSocial determinants of health
\nCouncil Member,Sir Michael Marmot (British Medical Associa-
\ntion), was a member of the advisory Committee for the World
\nConference on Social Determinants of Health in Rio de Janeiro.
\nThe goal of the Conference was to bring Member States and oth-
\ner actors together and engage high-level political support to make
\nprogress on national policies that address social determinants of
\nhealth, with the objective of reducing health inequities.The Con-
\nference adopted the Rio Declaration at the end of the meeting,
\nwhich emphasized the role of the health sector in reducing health
\ninequities.
\nHealth systems
\nGlobal health systems face the challenges of delivering high qual-
\nity, accessible care under increasing budgetary pressure. Health
\ndata has a critical role to play in improving the quality, accessibil-
\nity and efficiency of health services and, therefore, an important
\nrole in ensuring that health systems continue to improve.Howev-
\ner, across all health systems there are situations in which accurate
\nhealth data are not available. The lack of availability and access
\nto health data can result in unsafe or ineffective services or lead
\nto a waste of resources.The World Economic Forum organized a
\nworking group to develop and define the principles of a Global
\nCharter on Health Data. The WMA represented the physicians\u2019
\nperspective in this working group and demanded the anonymity
\nand aggregation of data and the right of the patient\u2019s ownership
\nof the data.
\nPositive Practice Environment Campaign (PPE)
\nThe WMA has continued its close involvement in this global
\n5-year campaign, which aims to ensure high-quality health work-
\nplaces for quality care. Activities are taking place in Uganda, Mo-
\nrocco and Zambia, which are among the fifty-seven countries
\nworldwide suffering from a critical shortage of health care work-
\ners. The PPE Partners and Secretariat are working with nation-
\nal health professional and hospital organisations in these three
\ncountries to develop country projects and improve their practice
\nenvironments.
\nMigration and retention
\nThe WHO has developed the Guidelines on Retention Strategies
\nfor Health Professionals in Rural Areas and the WMA took part
\nin the drafting process. The guidelines are based on three pillars:
\neducational and regulatory incentives, monetary incentives and
\nmanagement, and environment and social support.
\nWorkplace Violence in the Health Sector
\nPreparations for the 3rd
\nConference on Workplace Violence in the
\nHealth Sector (24\u201326 October,2012,Vancouver) have started and
\nthe WMA is a member of the planning committee.The Chair of
\nCouncil, Dr. Mukesh Haikerwal, will be opening the conference
\nwith a keynote speech.
\nEducation and Research
\nThe World Federation for Medical Education (WFME) has
\nstarted a discussion process about the future role of the physician,
\nin which the WMA will be involved. There will be a WFME
\nWorld Conference on medical education in Malm\u00f6,Sweden from
\nNovember 14\u201316, 2012 and all medical associations are invited to
\nattend and participate.
\nThe WMA participated as a member of steering groups in two
\nprojects commissioned by the European Union on the Mobility
\nand Migration of Health Professionals, one led by the European
\nHealth Care Management Association and the other by the Re-
\nsearch Institute of the German Hartmann Bund, a private physi-
\ncians\u2019 organization.The objective of the projects was to assess the
\ncurrent trends of mobility and migration of health professionals
\nto, from, and within the European Union, including their reasons
\nfor moving. Research will also be conducted in non-European
\nsending and receiving countries, but the focus lies within the EU.
\nIn December, the two research projects came to an end and an
\nInternational Conference, \u201cEnsuring Tomorrow\u2019s Health: Work-
\nforce Planning and Mobility\u201d, was held 7\u20139 December, 2011 to-
\ngether with the launch of the final research publication: \u2018Health
\nProfessional Mobility and Health Systems \u2013 Evidence from 17
\nEuropean Countries. The WMA presented the physicians\u2019 per-
\nspective on this topic and actively took part in the workshop or-
\nganisation.
\nPatient safety
\nThe WMA had been involved in the issue of patient safety and
\nwas a member of the WHO reviewing committee for the multi-
\nprofessional guidelines.
\nCaring physicians of the world
\ninitiative leadership course
\nThe CPW Project, which began with the Caring Physicians of
\nthe World book, published in October 2005 in English and in
\n52
\nWMA news
\nSpanish, has continued with regional conferences and leadership
\ncourses organized by the INSEAD Business School.
\nSpeaking book
\nThe speaking book on clinical trials, a collaborative effort with
\nthe South African Medical Association, the SADAG (South
\nAfrican Depression & Anxiety Group) and the Steve Biko
\nCenter for Bioethics in Johannesburg and the publisher \u201cBooks
\nof Hope\u201d, had been launched during the General Assembly in
\nSeoul, 2008. In 2010, Books of Hope, with the support of Pfizer,
\nthe Chinese Center of Disease Control, the Chinese Medical
\nDoctors Association, the Chinese Association on Tobacco Con-
\ntrol and the WMA, presented a speaking book on the dangers
\nof smoking.
\nHealth politics
\nThe WMA has intervened several times on health politics matter
\nat the request of member associations:
\nIn Slovakia the government put hospitals in a state of emergency
\nin order to stop protests and industrial action by physicians fight-
\ning for better working conditions and against the privatisation
\nof public hospitals. In consultation with the Slovak Medical As-
\nsociation, the WMA wrote to the Prime Minister and the Presi-
\ndent of the Republic to ensure proper working conditions and
\nfair payment.
\nIn Poland the physicians were made liable for managing the reim-
\nbursement entitlements for the insured. All people in Poland are
\ninsured under a state insurance scheme which gives various en-
\ntitlements for reimbursement. These different entitlements were
\nat least in part non-transparent to the physicians, who should not
\nbe held liable for wrongly assigning reimbursement statuses for
\ndrug on prescriptions.Together with the Polish Chamber of Phy-
\nsicians and Dentists the WMA protested against this measure,
\nwhich later was revoked.
\nAt the end of 2011, the Turkish Government removed from the
\nTurkish Medical Associations and other self-governing institu-
\ntions key functions such as supervision of physicians and the
\nregulation of post graduate education. Interestingly, these insti-
\ntutional rights were assigned by law and the government is trying
\nto lift them by a government order. Together with the Turkish
\nMedical Association the WMA will stage public events in An-
\nkara and Istanbul April 16th
\nand 17th
\nrespectively to fight for re-
\ntaining these critical rights of physician self-governance.
\nHuman rights
\nIn January 2011, the Special Rapporteur launched a public con-
\nsultation on the right to health of older persons, and the WMA
\nSecretariat coordinated the consultation with national medical
\nassociations, encouraging them to contribute to the process and
\nincrease the visibility of medical associations\u2019action in the area of
\nhealth and human rights.
\nBahrain
\nFor more than a year the WMA Secretariat and its members have
\nbeen monitoring the situation in Bahrain, where assaults by secu-
\nrity forces on health professionals were reported by Amnesty In-
\nternational. Several letters were sent to the authorities of Bahrain
\nexpressing deep concerns on the access to appropriate healthcare
\nfor victims, as well as on health professionals\u2019 independence. The
\nWMA Secretariat and its members have been closely following
\nthe trial of physicians.
\nSyria
\nThe Association has also issued press releases about the situation
\nin Syria and are closely watching the situation.
\nProtection of health professionals in armed-conflicts
\nareas
\nThe growing threats to health personnel in armed conflicts areas
\nand other situations of violence had been the subject of increasing
\nglobal debate and actions over the last year, in which the WMA
\nhad been closely involved. The Association was now supporting
\nthe International Committee of the Red Cross four-year cam-
\npaign \u201cHealthcare in Danger\u201d about the security and delivery\u00a0of
\neffective and impartial health care in\u00a0armed conflict and other\u00a0sit-
\nuations of violence.
\nDetention
\nAs an elected member of the Executive Committee (ExCo) of
\nthe IRCT, Clarisse Delorme attended the ExCo meeting which
\ntook place last November in London. Issues discussed included
\nthe preparations for the coming General Assembly (November
\n2012, Copenhagen) as well as the activities of the UN Subcom-
\nmittee on Prevention of Torture (SPT) and more generally the
\nHuman Rights Council.
\n53
\nWMA news
\nThe WMA Secretariat had contacted the United Nations Of-
\nfice on Drugs and Crime about the possible revision of the UN
\nStandard Minimum Rules for the Treatment of Prisoners with
\nsuggestions for recommendations and these were welcomed by
\nthe UN office.
\nWoman and children, and health
\nA joint press release has been issued with the International Fed-
\neration of Human Rights and Health Organisations in which the
\npractice of forced\/coerced sterilization was denounced and con-
\ndemned.
\nIn 2009, the WMA amended its Declaration of Ottawa to foster
\nthe protection of children. With the \u2018Fit for School\u2019 project, the
\nWMA had an implementation activity to increase the health sta-
\ntus of children. Currently, the German Development Aid Agency
\nGIZ together with the South East Asian Ministers of Educa-
\ntion Organisation (SEAMEO) and the WMA are developing
\nthe \u2018fit for school course\u2019, which aims to promote and facilitate
\neffective school health programmes worldwide through build-
\ning conceptual, implementation, and management capacity with
\ngovernments, international organisations and NGOs in low and
\nmiddle-income countries.
\nThe course will be developed in a comprehensive yet modular way
\nallowing for adaptation to different target audiences and country
\nsettings. It will cover a broad range of topics related to effective
\nschool health programmes, including concept development to
\nimplementation, child health, evidence-based interventions, day-
\nto-day management, and to evaluation and monitoring\u2013all with a
\nstrong practical approach.
\nEthics
\nThe WMA Workgroup on the Declaration of Helsinki was con-
\ntinuing to examine ways in which the Declaration might be re-
\nvised.
\nThe Chair of the WMA Medical Ethics Committee, Dr.Torunn
\nJanbu, had participated as the WMA representative in a work-
\nshop organised by the Council for International Organisations of
\nMedical Science on the ethical aspects of clinical research con-
\nducted in developing countries and community consultation in
\nthe preparation of research. The workshop covered areas such as
\ncommunity customs and codes,community engagement,multiple
\ncommunities, traditional knowledge, authority structures and the
\nrole of elders.
\nMedical and health policy development
\nThe Center for the Study of International Medical Policies and
\nPractices, George-Mason-University, which is one of the WMA\u2019s
\nCooperating Centers, has studied the need for educational sup-
\nport in the field of policy creation. The surveys performed with
\ncooperation of the WMA found a demand for education and ex-
\nchange. The Center invited the WMA to participate in the cre-
\nation of a scientific platform for international exchange on medi-
\ncal and health policy development. In the fall of 2009, the first
\nissue of a scientific journal, the World Medical & Health Policy,
\nwas published by Berkeley Electronic Press as an online journal.
\nIn the meantime Berkley Electronic Press has been obtained by
\nDe Gruiter. The World Medical & Health Policy Journal can be
\naccessed at: http:\/\/www.psocommons.org\/wmhp.
\nWorld health professions alliance
\nTogether with the other members of WHPA,the WMA launched
\nthe WHPA NCD campaign, the core of which is a simple, uni-
\nversal educational tool allowing everyone to assess and record
\ntheir lifestyle\/behavioural and biometric risk factors. The infor-
\nmation obtained through using the Health Improvement Card
\ncan help the individual and health professional develop specific
\ninterventions to address individuals risk factors and actively im-
\nprove health and well-being.
\nIn a second phase, the card will be piloted and evaluated.The ob-
\njective of the project is to develop a tool that is usable in all health
\ncare settings throughout the world and that increases awareness
\nof the individual responsibility of each person for their health,
\nand serves as an advocacy tool for improved health care systems.
\nMembership
\nThe Medical Association of Myanmar and the Sri Lanka Medical
\nAssociation have both applied to join the WMA and the Italian
\nOrder of Physicians has also indicated its intention to rejoin.
\nDr. Otmar Kloiber
\n54
\nWMA news
\nIntroduction
\nThe WMA is extremely concerned about recent actions by the
\nTurkish government that drastically reduce the self-governing au-
\nthority and professional autonomy of the medical profession in
\nTurkey. In particular, the newly enacted Government Decree 663
\non the Organization and Duties of the Ministry of Health and its
\nAssociated Organizations establishes a Health Professions Board,
\ncontrolled by the Ministry of Health, and delegates authority to
\nthis Board for certain critical functions that should remain with
\nthe Turkish Medical Association in keeping with the principles of
\nprofessional autonomy and physician self governance.The Turkish
\nMedical Association was established by the Turkish Parliament in
\n1953,while Decree 663 was passed by the government ministers of
\nTurkey in an extraordinary process that bypassed the Parliament.
\nOf grave concern is the fact that the Turkish Medical Association
\nno longer has the authority to:
\n\u2022 Establish and issue ethical guidelines concerning physician
\nconduct
\n\u2022 Conduct investigations regarding alleged malpractice by physi-
\ncians
\n\u2022 Determine disciplinary sanctions again=st physicians in cases
\nof malpractice
\n\u2022 Develop core curricula for medical education, post-graduate
\nmedical specialty curricula, and content and accreditation for
\ncontinuing medical education (all of which were previously
\ndone in partnership between the TMA and universities)
\nIn addition, Decree 663 amends Article 1 of the Constituting
\nLaw of the Turkish Medical Association (originally drafted and
\nadopted by the Parliament) by removing the following language
\nin the TMA\u2019s mandate: \u201censuring that medical profession is prac-
\nticed and promoted in line with public and individual well-being
\nand benefit\u201d. As a result of this restriction of its mandate, the
\nTMA no longer has the right to legally challenge actions and
\nregulations that adversely affect the right to health, the provision
\nof health care, public health, and individual patient well-being.
\nExamples might include, for instance, efforts against restrictions
\non which medical procedures would be reimbursed under the
\nnational health system or initiation of action to address public
\nhealth hazards such as the use of cyanide in silver and gold min-
\ning and processing. The narrowing of the TMA\u2019s mandate in this
\nregard not only diminishes the independence of physicians, but
\nalso jeopardizes the health of their patients.
\nTherefore
\nReaffirming its unequivocal commitment to the independence
\nand professional self-governance of the medical profession, as
\ndefined in the WMA Declaration of Madrid on Professional
\nAutonomy and Self-Regulation, and the WMA Resolution on
\nthe Independence of National Medical Associations, the WMA
\nCouncil:
\n1. Urges the Turkish government to rescind Decree 663 and
\nrestore to the Turkish Medical Association its duties and re-
\nsponsibilities for professional autonomy and self regulation,
\nproperly established by the Parliament in 1953 through the
\nlegitimate and transparent national democratic process.
\n2. Urges all physician members of Parliament, regardless of po-
\nlitical affiliation, to recall their duties as physician leaders and
\nsupport the right of the medical profession to autonomy and
\nself-regulation.
\n3. Supports and commends the Turkish Medical Association
\nand those members of the Turkish Parliament who have chal-
\nlenged these recent actions and requested a legal review of this
\nDecree by the Constitutional Court.
\n4. Calls on all physicians in Turkey and around the world to join
\nactively in advocacy efforts to promote and support profes-
\nsional independence, the right to health, and the health of the
\npeople of Turkey.
\nWMA Council Resolution on Threats to Professional
\nAutonomy and Self-Regulation in Turkey
\nAdopted by the\u00a0191st
\n\u00a0WMA Council Session, Prague, April 2012
\n55
\nWMA news
\nPreamble
\nThe Economic and Monetary Union of West Africa (Union
\nEconomique et Mon\u00e9taire Ouest Africaine; UEMOA) brings
\ntogether eight countries of West Africa using CFA Franc as a
\ncurrency.This tool of integration advocates for the free circulation
\nand settlement of physicians in the countries of UEMOA.
\nThere is a College of the Orders of Physicians, bringing together
\nthe Orders of member countries of the Union. The Orders are
\noften under the supervision of the health ministries. This situ-
\nation often confines the technical and administrative autonomy
\nand impedes the good management of the medical mapping of
\nthe region, undermining access to health care for the populations.
\nRecommendation
\nReiterating its\u00a0Declaration of Madrid on Professional Autonomy
\nand Self-Regulation\u00a0and its\u00a0Resolution on the Independence of
\nNational Medical Associations,the WMA requests that the inde-
\npendence, professional autonomy and self-regulation be guaran-
\nteed within the countries of the Economic and Monetary Union
\nof West Africa
\nWMA Council Resolution on the Autonomy
\nof Professional Orders in West Africa
\nAdopted by the\u00a0191st
\n\u00a0WMA Council Session, Prague, April 2012
\nThe WMA recognises that attacks on health care facilities, health
\ncare workers and patients are an increasingly common problem
\nand the WMA Council denounces all such attacks in any country.
\nThese often occur during armed conflict and also in other situations
\nof violence, including protests against the state.\u00a0 Patients, including
\nthose injured during protests,often come from the poorest and most
\nmarginalised parts of the community and suffer a higher proportion
\nof serious health problems than those from wealthier backgrounds.
\nGovernments have an obligation to ensure that health care facili-
\nties and those working in them can operate in safety and without
\ninterference either from state or non-state actors, and to protect
\nthose receiving care.
\nWhere services are not available to patients due to government
\naction or inaction, the government, not the health practitioners,
\nshould be held responsible. Noting that recent and ongoing con-
\nflicts in Bahrain and Syria have seen physicians, other health care
\npersonnel and their patients attacked while in health care facili-
\nties, the WMA demands:
\n1. That states fulfill their obligations to all their citizens and resi-
\ndents, including political protestors, patients and health care
\nworkers, and protect health care facilities and their occupants
\nfrom interference, intimidation or attack.
\n2. That governments enter into meaningful negotiations wher-
\never such attacks are possible, likely or already occurring to
\nstop the attacks and protect the institutions and their occu-
\npants, and
\n3. That governments consider how they can contribute posi-
\ntively to the work of the International Committee of the
\nRed Cross on promoting the safety of health care provision
\nthrough awareness of the concepts within their project Health
\nCare in Danger.
\nWMA Council Resolution on Danger in Health Care
\nin Syria and Bahrain
\nAdopted by the\u00a0191st
\n\u00a0WMA Council Session, Prague, April 2012
\n56
\nWMA news
\nThe first ever consultative event on the
\nproblem of safely and effectively delivering
\nhealthcare to people in situations of conflict
\nand violence took place in London in April.
\nA symposium at BMA House, jointly or-
\nganised by the International Committee
\nof the Red Cross (ICRC), the British Red
\nCross, the World Medical Association and
\nthe British Medical Association, was held
\nto discuss the ICRC\u2019s project \u2018Health Care
\nin Danger\u2019 that was launched last year.
\nIt was the first of a series of global work-
\nshops, attended by health care workers and
\nkey stakeholders from around the world,
\nto brainstorm solutions and possible ways
\nforward for the project. As part of the
\nproject, the ICRC is also running a public
\ncampaign, \u2018It\u2019s a Matter of Life and Death\u2019,
\nwhich seeks to raise public awareness of
\nthe problem and mobilise a community of
\nconcern among health care workers, armed
\nforces, states and weapons carriers.
\nThe conference was opened by Geoff Loane,
\nHead of Mission for the ICRC, who said
\nthe threat to health personnel, to ambu-
\nlances, hospitals and clinics from direct at-
\ntacks and kidnapping in armed conflicts was
\none of the biggest and most unacknowl-
\nedged humanitarian challenges today. This
\nwas particularly the case in North Africa
\nand the Middle East. The ICRC\u2019s recent
\n16-country study had analysed 655 inci-
\ndents of attacks against health care between
\nmid 2008 and late 2010, leading to 1,834
\npeople being killed or injured. The analysis
\ngave them a clearer picture of the type of
\nactivities causing health care to be impeded
\nas well as who was doing this and how it
\nwas happening. The purpose of the ICRC\u2019s
\ncampaign was to ensure the security of the
\ndelivery of effective and impartial health
\ncare in armed conflict.
\nHe said the conference was a call for action,
\nalthough at the moment the action that
\nwas required was not entirely obvious. The
\nsolution did not lie with the health com-
\nmunity alone.The responsibility for security
\nlay with governments, military bodies, po-
\nlice forces and local communities and the
\npurpose of the conference was to examine
\npossible solutions and actions.
\nMr Paul-Henri Arni, the head of the ICRC
\nproject, said the symposium was the first
\nof several planned conferences to look for
\npractical recommendations. Some sugges-
\ntions included urging the states to develop
\nappropriate military and police practices
\nfor managing checkpoints for ambulances
\nand other vehicles evacuating the wounded
\nand for entering health facilities. Another
\nwas for states to develop domestic law to
\nassure greater security of health care and
\na third idea was for the health community
\nto extend research and to develop teaching
\nmodules on the implications of insecurity
\nfor health care.
\nDr. Unni Karunakara, International Presi-
\ndent of M\u00e9decins Sans Fronti\u00e8res, gave
\nseveral examples of the effects of attacks on
\nmedical personnel on the delivery of health
\ncare. MSF staff had been kidnapped and
\nattacked in several countries, leading the
\norganisation having to scale back or even
\nevacuate its work in refugee camps. Medical
\nteams had had to be withdrawn in a number
\nof places resulting in thousands of consul-
\ntations with patients not taking place. He
\nexplained how his organisation had had to
\nsuspend services in its recently opened ma-
\nternity hospital in Khost, Afghanistan, af-
\nter an explosion in the hospital compound.
\nAnd in Somalia alone since 1979 there had
\nbeen more than one thousand incidents
\nagainst MSF teams.
\nCarolyn Miller, chief executive of the medi-
\ncal charity Merlin, set three challenges to
\nthe meeting, calling on health professionals
\nand the NGO community to take practical
\naction quickly, for local people to be given a
\nstrong voice in fashioning responses and for
\ncharities to work in forgotten and under-
\nserved places, such as the Central African
\nRepublic. She said that Merlin had cam-
\npaigned vigorously on the risks to health
\ncare, and she expressed the hope that build-
\ning sets of \u2018communities of concern\u2019 would
\ndeliver the critical mass of attention that
\nwas needed for policy makers to be per-
\nsuaded to respond.
\nProfessor Sir Michael Marmot, chair of the
\nWMA\u2019s Social and Medical affairs commit-
\ntee, spoke about insecurity in health and
\ninequality. He said conflicts could cause
\ndeprivation and deprivation could cause
\nconflict. Conflict disempowered people. He
\ngave examples of maternal mortality rates
\nin Afghanistan and death rates in Russia
\nresulting from social disruption and con-
\nflict. While only one in 46,500 women in
\nEurope died during childbirth, the figure in
\nAfghanistan was one in ten. So, when a ma-
\nternity hospital had to close the loss could
\nbe devastating.
\nHe said it was also vital to examine the
\ncauses of the causes of ill health, includ-
\nHealth Care in Danger Symposium
\nNigel Duncan
\n57
\nWMA news
\ning education, deprivation and general in-
\nequity. The issue of the social determinants
\nof health was now being taken up in many
\ncountries throughout the world.
\nSir Michael suggested that the Red Cross
\nwas such a highly admired organisation
\nworldwide that it could and should play a
\ngreater role in dealing with the wider issue
\nof health in the population.
\nNick Young, Chief Executive of the Brit-
\nish Red Cross, said the aim of the confer-
\nence was to raise awareness throughout the
\nworld. What was needed was a united and
\ncoherent voice to mobilise action, more evi-
\ndence about the extent of violence against
\nhealth that was going on throughout the
\nworld and then a set of practical recom-
\nmendations that could be actioned. He em-
\nphasised that this was not just a case of \u201ca
\nlaunch, a lunch and a logo\u201d.
\nProfessor Sir Andrew Haines, Professor
\nof Public Health and Primary Care at the
\nLondon School of Hygiene and Tropical
\nMedicine, said there was a need for the sys-
\ntematic collection of data on this subject.
\nHe urged academic institutions to get in-
\nvolved in this issue and for the subject to
\nbe incorporated in medical school curricula.
\nCarolyn Miller, Chief Executive of Merlin,
\nspoke of her organisation\u2019s work in this area,
\nin particular the need to create a commu-
\nnity of concern around the issue of health
\nworkers.
\nMs Mohini Ghai Kramer, Head of Corpo-
\nrate Communication at the ICRC, said that
\nthe target audiences for the ICRC\u2019s cam-
\npaign were political authorities and arms
\ncarriers, public opinion and affected popu-
\nlations.She said they wanted to focus on the
\nvictims of violence rather than presenting
\nmedical personnel as heroes.
\nPanel discussions were held throughout the
\nday to follow up the speeches with ideas
\nfor practical action. Speakers from the floor
\nemphasised the current lack of awareness
\nof the problem among non-governmental
\norganisations, the fact that there were too
\nmany initiatives and also the need to target
\narms suppliers.
\nThe conference heard from Gilles Thai
\nLarsen, International Law Adviser with the
\nBritish Red Cross, about the legal frame-
\nwork governing military hostilities and he
\nsaid there already was a legal framework for
\nprotecting healthcare workers and patients.
\nThis derived from international humanitar-
\nian law and international human rights law,
\nand was often also addressed in domestic
\nlaw.The rules declared that measures should
\nbe taken to provide health care to the
\nwounded and sick on a non-discretionary
\nbasis and that access to health care facilities
\nshould not be denied or limited. The rules
\nalso stated that health care personnel should
\nnot be hindered in the performance of their
\nmedical tasks and that the wounded, the
\nsick and health care personnel should be
\nprotected against interference by third par-
\nties.
\nDr. Peter Hill, Associate Professor from
\nthe Australian Centre for International
\nand Tropical Health at the University of
\nQueensland, spoke about the impact on
\nhealth systems of violence against health
\npersonnel. This included the effect on the
\nsupply of drugs and vaccine and on tech-
\nnology. Dr. Rudi Coninx, from the World
\nHealth Organisation, said one of the most
\nfrequently asked questions put to him on
\nthis subject was \u201cIs the WHO doing any-
\nthing?\u201d His reply was that the WHO was
\ndoing many things \u2013 expressing concern
\npublicly, documenting evidence and get-
\nting involved in diplomacy. There was also
\na resolution requiring the organisation to
\ndevelop methodologies for collecting health
\nattack data. But he emphasised that health
\nfacilities must be treated as neutral premises
\nand should not be used by one side or the
\nother in conflicts.
\nProfessor Len Rubenstein, from the Cen-
\ntre for Public Health and Human Rights
\nat the Johns Hopkins Bloomberg School
\nof Public Health, said there was only epi-
\nsodic reporting by human rights groups on
\nhealth attacks and there was limited sharing
\nof internal security information among hu-
\nmanitarian organisations. However, the US
\nState Department was now collecting data
\nfor annual country reports on human rights
\npractices of attacks on health care and there
\nwas the WHO resolution on the need for
\nassuming leadership in this field.
\nHe said that despite the current lack of evi-
\ndence, the lack of integration and the rarity
\nof prosecutions, there had been promising
\ndevelopments. But what was needed now
\nwas a global coalition, an integrated and
\ncollaborative approach to this whole prob-
\nlem from international bodies.
\nDr. Jose Gomes do Amaral, President of the
\nWMA, spoke about the Association\u2019s policy
\non the protection of medical personnel in
\narmed conflicts, emphasising the impor-
\ntance of the Declaration of Geneva. He said
\nthe WMA had been active in condemning
\ndocumented attacks on medical person-
\nnel. Surgeon Rear Admiral Lionel Jarvis,
\nMedical Director General for the UK Navy,
\nspoke about the role of the medical defence
\nservices and the ethical challenges faced by
\nmilitary personnel in Afghanistan. He said
\nthe medical defence service was absolutely
\ncommitted to treating only on the basis of
\nprioritisation by clinical need, with total
\nimpartiality and without any discrimina-
\ntion whatsoever.And he added that those in
\nthe medical defence services must know the
\nlaws of armed conflict and to this end they
\nunderwent training in medical ethics.
\nHe said that the 21st
\ncentury conflict was
\nvery different from the situation in the two
\nworld wars. There was now rapid electronic
\ncommunication, enhanced media inter-
\nest and increasing multinational coalitions.
\nDilemmas for medics on the front line in-
\ncluded self defence, protection of comrades
\nand casualties, triage, disposal of casualties
\nand the use of protective emblems.
\n58
\nVeterinary Medicine
\nDr. Vivienne Nathanson, from the British
\nMedical Association, who chaired the final
\nsession, emphasised the importance of the
\nWMA\u2019s statement that medical ethics in
\ntime of war were the same as medical ethics
\nin peace.
\nSumming up the day\u2019s discussion, Dr.
\nRobin Coupland, medical adviser at the
\nICRC, said the main points he drew from
\nthe day were the need to gather more data
\nabout violence against health care, the need
\nto raise awareness of the problem, getting
\ngreater academic attention to the problem
\nand improving co-ordination between all
\nthose involved. He said it was important to
\navoid competition between different agen-
\ncies. A mosaic of measures was needed, but
\nwhat was critical now was to build aware-
\nness of the threats to health care. Without
\nawareness nothing would be done by poli-
\ncymakers.
\nAlthough he said it was clear there was no
\nneed for the development of international
\nhuman rights law, since it already existed, it
\nmight now be time for the appointment of a
\nspecial rapporteur on the security of health
\ncare.
\nDr. Coupland ended by saying that the
\nresults of the conference would eventually
\nbe summarised in a public document that
\nwould be posted on the website of the four
\norganising associations and would form the
\nbasis of a dialogue with policy makers.
\nNigel Duncan
\nWMA Public Relations consultant
\nAntimicrobial resistance is a problem that
\nthreatens both animal health and public health.
\nResistance to antimicrobials has the potential
\nto take away this tool to protect animal health
\nin two ways: 1) loss of effectiveness due to the
\ndevelopment of resistance to antimicrobials by
\nanimal pathogens, and 2) through the loss of
\napproval to use important antimicrobials in
\nanimals in order to preserve their use in hu-
\nman medicine. Therefore to protect the ef-
\nfectiveness of antimicrobials to treat animal
\nand human diseases, the World Veterinary
\nAssociation (WVA) has developed responsible
\nuse guidelines for veterinarians. The WVA be-
\nlieves that the use of the guidelines will lessen
\nthe development and spread of antimicrobial
\nresistance. The guidelines recognize and ac-
\nknowledge the fact that veterinarians must
\nbalance the sometimes competing needs of ani-
\nmal health and public health. Human medical
\nproviders are not challenged with achieving
\nthat balance. Instead they only need to con-
\ncern themselves with protecting the health of
\nhumans. Decisions must be science-based and
\nrisk-based. Risk analysis needs to consider both
\nthe benefits and the risks to human health that
\nare created through the use of antimicrobials to
\ntreat, control and prevent diseases in animals.
\nThe use of the risk analysis process (risk assess-
\nment, risk communication, and risk manage-
\nment) can result in different risk management
\ndecisions in different countries or regions in the
\nworld because of differences in risk tolerances
\nTjeerd Jorna
\nResponsible Use of Antimicrobials \u2013 World
\nVeterinary Association Perspective
\nLyle Vogel
\nWVA members
\nWVA is an umbrella organisation for:
\n– national veterinary associations
\n– international assocations of veteri-
\nnarians working in different areas of
\nveterinary medicine
\n59
\nVeterinary Medicine
\nand in the respective importance given to hu-
\nman health over animal health. For example,
\nin the United States, the previously approved
\nuse of fluoroquinolones to treat colibacillosis in
\npoultry has been withdrawn while other coun-
\ntries and regions continue to use fluoroquino-
\nlones. Similarly, Europe and other regions have
\nbanned the use of antimicrobials to promote
\nfeed efficiency and growth in animals while
\nother countries and regions have not.These dif-
\nferences are due to a multitude of factors such as
\ndiffering animal production systems, different
\npatterns of antimicrobial use in animals and
\nhumans, differing acceptance of risk by differ-
\nent cultures, different values placed on the im-
\nportance of animal health, different recognition
\nof the benefits to human health from the use of
\nantimicrobials in animals.
\nAntimicrobial resistance is a growing pub-
\nlic health concern worldwide. Antimicro-
\nbial resistance creates problems for animal
\nhealth as well. Infections caused by antimi-
\ncrobial-resistant microorganisms can fail
\nto respond to standard treatments, thereby
\nreducing the possibilities of effective treat-
\nment and increasing the risk of morbidity
\nand mortality in serious diseases. Both the
\npublic health and animal health concern is
\nthe response to the loss of effectiveness of
\nantimicrobials because of resistance.But the
\nanimal health concern is also the response
\nto the existing or proposed restrictions on
\nthe use of effective antimicrobials by veteri-
\nnarians. For example, in the United States
\nveterinarians are no longer allowed to use
\nthe previously approved fluoroquinolone to
\ntreat colibacillosis in poultry because of sus-
\npicion that this use was the cause of resis-
\ntant Campylobacter infections in humans.
\nIn Europe there is a total ban on growth
\npromoters to prevent the development of
\nantimicrobial resistance.
\nThe reason for growing problems with anti-
\nmicrobial resistance can be explained easily.
\nIt is a fact of nature that bacteria may mu-
\ntate or acquire genetic material from other
\nbacteria and develop the ability to survive
\ntreatment. Through selective pressure im-
\nposed by the use of antimicrobials, these
\nbacteria, starting as a tiny fraction of the
\noverall population, may become an increas-
\ningly dominant part of the population over
\ntime.
\nBut not all bacteria are the same.The likeli-
\nhood of developing resistance varies among
\nthe different genus and species of bacteria.
\nThere are also differences in the likelihood
\nof certain antimicrobials to cause the devel-
\nopment of resistance. There are also differ-
\nences in the importance of specific classes
\nof antimicrobials for both animals and hu-
\nmans. There is also a variety in the way the
\nantimicrobials are used, such as the reason
\nfor the use for treatment,prevention or con-
\ntrol of disease, as well as in the frequency of
\nuse, the length of use, and the total quanti-
\nties that are used over time.
\nThese differences cause difficulties in de-
\ntermining the appropriate risk manage-
\nment actions that are effective in protecting
\npublic health without unnecessarily elimi-
\nnating a valuable tool for protecting ani-
\nmal health. Actions to eliminate or restrict
\ncertain antimicrobials or certain classes of
\nantimicrobials from use in animals may
\nsacrifice the health of animals. And public
\nhealth may not be improved. For example,
\nthe previously mentioned ban in the United
\nStates in 2005 on the use by veterinarians
\nof a fluoroquinolone to treat colibacillosis in
\npoultry has not improved public health.The
\nsurveillance data show that the ban has not
\ndecreased the prevalence of resistant infec-
\ntions in humans. In fact, the prevalence has
\nincreased since the ban.
\nFor a long time, the World Veterinary As-
\nsociation has addressed the problem of an-
\ntimicrobial resistance in multiple ways, such
\nas participation in international working
\ngroups that were working on solutions in
\norder to protect public health and animal
\nhealth. For example, the president of the
\nWVA at that time, Dr. Herbert Schneider,
\nchaired the World Organization for Ani-
\nmal Health\/OIE Ad Hoc Working Group
\non Antimicrobial Resistance. That group
\ndeveloped the list of antimicrobials that
\nare important in veterinary medicine. The
\nlist was approved by the OIE in 2007. The
\nWVA also participated in the Codex Ali-
\nmentarius Commission Intergovernmental
\nTask Force on Antimicrobial Resistance.
\nOver the last 3 years, Past President Leon
\nRussell and current president Dr.Jorna,rep-
\nresented the WVA in the discussions that
\nresulted in Guidelines for Risk Analysis of
\nFoodborne Antimicrobial Resistance. The
\nGuidelines for Risk Analysis were approved
\nearlier this year.
\nPreviously, in about 1998, the WVA devel-
\noped policies that addressed antimicrobial
\nresistance to guide both the organization
\nand the veterinary profession. The policies
\nincluded a position statement on responsi-
\nble use of antimicrobials. More recently the
\nWVA decided it was time to review those
\npolicies and update them as necessary. The
\nreview and update was carried out during
\nthe last 18 months.It included development
\nof a policy, proposed by the members of the
\nEXCOM and the Council and the publica-
\ntion of the draft policy on the WVA Web
\nsite with a request for review and input from
\nthe WVA members and other interested or-
\nganizations. The process has resulted in the
\ncurrent policy, the WVA Position on Re-
\nsponsible Use of Antimicrobials.
\nAs explained in the introduction to the re-
\nsponsible use principles, the policy incorpo-
\nrates several premises or ideas that form the
\nbasis of the principles:
\n1. Good animal health and welfare always
\nstarts with good care and management.
\nThe animals must be provided with a
\nproper diet, clean water, and sufficient
\nspace.Stress must be minimized includ-
\ning minimizing exposure to adverse en-
\nvironmental factors.
\n2. Prevention, control and treatment of
\nanimal diseases are necessary parts of
\nsuccessful animal husbandry.
\n3. The availability and use of a variety of
\nantimicrobials for animals is essential
\n60
\nto assure animal health and welfare.
\nProtecting animal health, through the
\nprevention and relief of conditions that
\ncause animal suffering, is an essential
\npart of ensuring good animal welfare.
\n4. However, there is a risk that the use of
\nantimicrobials in animals can result in
\nresistance to antimicrobials which nega-
\ntively affects public and animal health.
\n5. Therefore, the availability and use of
\nantimicrobials in animals must be bal-
\nanced to achieve both good animal
\nhealth and public health.
\n6. Veterinarians must consider both hu-
\nman and animal health when deciding
\non the use of antimicrobials. Neither
\nhuman health nor animal health and
\nwelfare can be ignored. It differs from
\nhuman health practitioners who do not
\nconsider animal health when they advo-
\ncate for restrictions on veterinary medi-
\ncines.
\n7. Decisions on how to manage the risk
\nof antimicrobial resistance must be
\nbased on risk analysis. The three com-
\nponents of risk analysis are risk assess-
\nment, risk communication and risk
\nmanagement. All three components
\nmust be incorporated into the decision
\nprocess.Through the process of risk as-
\nsessment the available scientific infor-
\nmation can be gathered and evaluated.
\nThen risk communication is applied
\nto inform all of the stakeholders of
\nthe results of the risk assessment. Risk
\ncommunication must occur among all
\nof the affected stakeholders including
\npublic health officials, veterinarians,
\nphysicians, farmers, the general public,
\nand officials responsible for regulation
\nof veterinary medicines. This should
\nlead to discussions regarding the levels
\nof expected risk compared to the lev-
\nels of acceptable risk among the vari-
\nous stakeholders. Decisions regarding
\nwhether to take or impose risk man-
\nagement actions and the extent of the
\nrisk management actions, if imposed,
\nmust be based on risk assessment and
\nrisk communication. Then, if neces-
\nsary, risk management techniques can
\nbe applied that balance the appropriate
\nmeasures for public health and animal
\nhealth. Because of the importance of
\nantimicrobials for both animal health
\nand public health, risk analysis must be
\ncomprehensive. The risk analysis must
\ninclude evaluations of the risk to both
\nanimal health and public health, as well
\nas the benefits to public health, animal
\nhealth and animal welfare from the use
\nof antimicrobials in animals. Healthy
\nanimals create healthy food and conse-
\nquently improved public health.
\n8. The WVA recognizes that different
\ncountries and regions have chosen dif-
\nferent risk management actions based
\non risk analysis. For example, some
\ncountries license certain antimicrobials
\nto be used in food-producing animals
\nto enhance production through growth
\npromotion and feed efficiency, although
\nsuch use is prohibited in other countries
\nand regions. And as previously men-
\ntioned, the United States has chosen to
\nban the use of enrofloxacin by veterinar-
\nians to treat colibacillosis in chickens
\nand turkeys. These differences between
\ncountries and regions can occur because
\nof cultural differences in the level of risk
\nacceptance or tolerance, and as well as
\nbecause of differences on the emphasis
\nplaced on risks versus benefits to public
\nhealth from the use of antimicrobials in
\nanimals.
\n9. Risk analysis cannot be generalized to
\nevaluate broad categories, such as the
\nreason for use, prevention of disease,
\ncontrol of disease, or growth promo-
\ntion. Instead, the particulars such as
\nclass of antimicrobial, ability to confer
\nresistance, frequency of use, method of
\nadministration, and importance in vet-
\nerinary and human medicine need to be
\nconsidered.
\n10. Responsible use of antimicrobials by
\nveterinarians plays an important role
\nin protecting public health. Veterinar-
\nians play a key role in helping to mini-
\nmize and prevent the development
\nand spread of antimicrobial resistance.
\nTherefore, veterinarians need to be in-
\nvolved in antimicrobial use decisions as
\nwell as policy and regulatory decisions.
\nThe foregoing premises form the basis of
\nprinciples of the WVA position on respon-
\nsible use of antimicrobials. The following
\nare the 12 principles:
\n1. In case of animal disease, the animals
\nshould be examined by a veterinarian,
\nwho makes a diagnosis, and recom-
\nmends and plans an effective treatment
\nprogramme. If a decision is reached
\nto use antimicrobials for therapy, vet-
\nerinarians should strive to optimize
\ntherapeutic effectiveness and minimize
\nresistance to antimicrobials in order to
\nprotect public and animal health.
\n2. Antimicrobials used for therapy are
\nhealth management tools that are li-
\ncensed to be used for the purposes of:
\na. disease treatment;
\nb. disease control;
\nc. disease prevention.
\n3. Codes of good veterinary practice, qual-
\nity assurance programmes, herd health
\ncontrol and surveillance programmes,
\nand education programmes should pro-
\nmote responsible and prudent use of
\nantimicrobials. Veterinarians must as-
\nsume responsibility to possess current
\ninformation on resistance because they
\nare accountable for safe and effective use
\nof these medicines.
\n4. Antimicrobials should be used only
\nwith veterinary involvement. Regular,
\nclose veterinary involvement is essential
\nfor informed advice concerning the ef-
\nfective use of antimicrobials. Regardless
\nof the distribution system available in
\nthe country, the use of antimicrobials
\nshould be subject to appropriate profes-
\nsional advice of a veterinarian.
\n5. The availability of effective antimicro-
\nbials should be based on risk analysis
\nthat considers the OIE list of Antimi-
\ncrobials of Veterinary Importance. The
\nOIE International Committee adopted
\nthe list of Antimicrobials of Veterinary
\nVeterinary Medicine
\n61
\nImportance in May, 2007. Veterinary
\nantimicrobials are classified according
\nto their importance as critical, highly
\nimportant or important. Risk analysis
\nshould consider the OIE list, as well as
\nthe list developed by the World Health
\nOrganization, that classifies the impor-
\ntance of human antimicrobials.
\n6. Therapeutic antimicrobials may be used
\nwhen it is known or suspected that an
\ninfectious agent is present which will be
\nsusceptible to therapy. It is the respon-
\nsibility of the veterinarian to choose
\nthe antimicrobial product, based on
\nhis or her informed professional judg-
\nment balancing the risks and benefits
\nfor humans and animals. The veterinar-
\nian shall have due regard to the public
\nhealth risks because of using veterinary
\nmedicines. At the same time, benefits
\nshall be taken into account, such as pro-
\nmoting the health and welfare of ani-
\nmals, assuring safe and affordable food
\nfrom healthy animals, while reducing
\nhuman exposure to bacteria of animal
\norigin.
\n7. When antimicrobials need to be used
\nfor therapy, bacteriological diagnosis
\nwith antimicrobial sensitivity testing
\nshould, whenever possible, be part of
\nthe informed professional clinical judg-
\nment. Ideally, the antimicrobial sensi-
\ntivity of the causal organism should be
\ndetermined before therapy is started.
\nHowever, in disease outbreaks involv-
\ning rapid transmission of disease among
\ncontact animals or with high case mor-
\ntality rates, treatment may be started on
\nthe basis of clinical diagnosis. But even
\nin this case, the antimicrobial sensitivity
\nshould be determined so that, if treat-
\nment fails, the regimen can be changed
\nin the light of the results of sensitivity
\ntesting. Surveillance or monitoring sys-
\ntems should be established to measure
\nantimicrobial sensitivity trends over
\ntime so that the trends can guide clini-
\ncal judgment on antimicrobial use.
\n8. Label instructions should be carefully
\nfollowed and due attention paid to spe-
\ncies and disease indications and contra-
\nindications, dosage regimen, withdrawal
\nperiods, storage instructions, and expi-
\nration dates for products. Off label or
\nextra-label use of antimicrobials should
\nbe exceptional and under the profes-
\nsional responsibility of a veterinarian,
\nwith careful justification, written pre-
\nscription or instructions, and in accord
\nwith the governmental regulations and
\nguidance.
\n9. Antimicrobials used for therapy should
\nbe used for as long as needed, over as
\nshort a dosage period as possible, and
\nat the appropriate dosage regimen. It is
\nessential to administer the antimicrobial
\nin accordance with the recommended
\ndosage regimen. This will minimize
\ntherapy failures and exploit fully the ef-
\nfective potential of the product. Insuf-
\nficient duration of administration can
\nallow the infection to break out again.
\nThis may increase the likelihood of
\nselecting bacteria with reduced anti-
\nmicrobial sensitivity. But limiting the
\nduration of use to only that required
\nfor therapeutic effect will minimize the
\nexposure of the bacterial population to
\nthe antimicrobial.The adverse effects on
\nthe surviving commensal microflora are
\nminimized. Theoretically, antimicrobial
\nuse should be stopped as soon as the
\nanimal\u2019s own host defense system can
\ncontrol the infection itself.
\n10. Records should be kept of all antimicro-
\nbial administrations.
\n11. Coordinated susceptibility monitoring
\nand surveillance should be conducted
\nand the results should be provided to
\nthe prescriber\/supervising veterinarian
\nand other relevant parties. Monitoring
\nand surveillance should target micro-
\norganisms of both veterinary and pub-
\nlic health importance. Data should be
\nquickly provided to allow timely modi-
\nfication of veterinary recommendations
\nfor treatment in order to balance the
\nbenefits with the risks.
\n12. Efficacious, scientifically proven alter-
\nnatives to antimicrobials are needed as
\nan important part of good husbandry
\npractices. Some of the potential alterna-
\ntives include vaccines, probiotics, com-
\npetitive exclusion products, nutrition,
\nand improved livestock management.
\nResearch is needed to further develop
\nthese alternatives and to evaluate the
\nimpact of these alternatives on selection
\nfor resistance.
\nContinued availability of all classes of effec-
\ntive antimicrobials for veterinary medicine
\nis a critical component of safe food supply
\nand optimal animal health and welfare.
\nSafeguarding animal health is of paramount
\nimportance to the economic welfare, pub-
\nlic health, and food supply of nations and
\nstates. Animal and human health are inex-
\ntricably linked.
\nResponsible use of antimicrobials by veteri-
\nnarians is in the best interests of both ani-
\nmal health and public health.The WVA be-
\nlieves that the implementation of the WVA
\nprinciples for responsible use will decrease
\nthe selective pressures that cause the spread
\nof antimicrobial resistance and will help re-
\ntain both the effectiveness and the availabil-
\nity of veterinary antimicrobials.
\nDr.Tjeerd Jorna,
\nImmediate Past President, WVA
\nDr. Lyle Vogel,
\nCouncillor, WVA
\ne-mail: t.jorna3@upcmail.nl
\nVeterinary Medicine
\n62
\nDuring the 191st
\nCouncil Session of the
\nWMA Dr.\u00a0Tjeerd Jorna, Past-President of
\nthe WVA, presents his global organisation:
\nOn a global scale the World Veterinary As-
\nsociation (WVA) is a small organisation
\nand therefore it has to be presented as one
\nprofession with one vision and one voice in
\nthe perspective of veterinary medicine and
\nanimal and public health.
\nIn 2011 the veterinary profession marked
\nits 250 years of activity and that was a good
\nreason to look back and evaluate what has
\nbeen achieved and even a better reason to
\nbecome inspired and look ahead. Therefore,
\nthe slogan Vet for Health-Vet for Food-
\nVet for the Planet.
\nThe WVA is an umbrella organisation for
\nnational veterinary organisations and in-
\nternational associations of veterinarians
\nworking in different areas of veterinary
\nmedicine. The structure of the WVA in-
\ncludes Presidential Assembly represented
\nby all members; the Council represented
\nby elected representatives of six regions
\n[the five continents and North Africa and
\nthe Middle East]; the Associate members
\nand the WVA EXCOM, consisting of an
\nelected President, two Vice Presidents and
\nPast-President.
\nThe WVA sees its Mission in cooperation
\nof its member organisations for the sup-
\nport of veterinarians of different positions
\nand all over the world for promoting the
\nhealth and welfare of animals and people,
\nbecause Healthy Animals mean Healthy
\nPeople. The Vision of the WVA is to be
\nthe global voice for veterinarians in order
\nto strengthen their position in promoting
\nanimal health and well-being and protect-
\ning public health.
\nIn 2013 the WVA will celebrate its 150th
\nanniversary as in 1863 Dr. John Gamgee
\norganized an international veterinary con-
\ngress, a body that was professionalized in
\n1959 bearing the new name WVA. The
\nthemes discussed at the first congresses did
\nnot differ much from those of today: zoo-
\nnoses, food safety, veterinary law, education
\nand the application of veterinary medicines.
\nThe main goals of WVA include the follow-
\ning: to be recognized as the global veterinary
\nvoice, to promote high quality veterinary ed-
\nucation, to win recognition of the veterinary
\nprofession as Global Public Good,to support
\nveterinarians in delivering their responsibili-
\nties by optimising the preconditions required
\nfor full filling their tasks and to ensure and
\nsafeguard long-term viability of the WVA.
\nVeterinary medicine rests on three pillars:
\nanimal health, animal welfare and public
\nhealth,and if to draw a parallel with a build-
\ning, be it a temple, a church or a mosque,
\nany building needs to have a good founda-
\ntion, and in our case the foundation is high
\nquality veterinary education. The veterinar-
\nian is the mediator between the animals,
\nthe animal owners and society and his\/her
\nperformance should be science based, using
\nknowledge and skills accompanied with the
\nproper attitude and ethical principles. He\/
\nshe has to work objectively, independently
\nand impartially. The veterinarian\u2019s roles are
\ndifferent for a practitioner,a hygienist (meat
\ninspection), a state veterinary officer (policy
\ncontrol and public health inspector), in in-
\ndustry and institutes, in education (Veteri-
\nnary faculties and Agricultural schools), in
\nmilitary and in environment and climate
\nchange disease monitoring.
\nThe responsibilities of veterinarians include
\nmeeting the requirements set by society,
\ncontrolling animal health, animal welfare
\nand public health [including zoonoses]
\nand participating in environmental and
\neco-system health. The veterinary duties
\nare to prevent and early detect outbreaks
\nof animal diseases and zoonotic diseases; to
\ncertify healthy animals for trade; to ensure
\nthe safety of products of animal origin; to
\ninvestigate and diagnose animal diseases
\nand to decide upon correct intervention and
\ntreatment.
\nTo perform this duties by veterinarians
\nall over the globe and in all countries the
\nWVA has to strengthen the veterinary
\nprofession by encouraging all countries to
\ndevelop robust veterinary legislation and
\nan autonomous statutory body, encourag-
\ning the veterinary profession to establish
\na representative well-organized veterinary
\nAssociation and to adopt and act upon a
\nveterinary act and a code of conduct, pro-
\nmoting public-private collaboration and
\ncontinuously creating preconditions aimed
\nat the vets meeting their responsibilities in
\nthe best possible way. As regards Animal
\nHealth it implies promoting of prevention
\nwhich is better than cure; encouraging vets
\nto perform monitoring, surveillance, early
\ndiagnosis and reporting of animal and zoo-
\nnotic diseases; supporting of global disease
\ncontrol programs and promotion of avail-
\nability of veterinary medicines [drugs] ,en-
\ncouraging responsible use and preventing
\nantimicrobial resistance. Regarding Public
\nHealth it means to continuously emphasise
\nthe role vets play in food safety; to maintain
\ncontrol of zoonotic diseases; to control food
\nWorld Veterinary Association meets World
\nMedical Association
\nVeterinary Medicine
\n63
\nsecurity and food safety and to support the
\nstructure of National Veterinary Services.
\nAs already mentioned above, the veterinary
\nmedicine needs a good foundation that is
\nensured by Veterinary Education and Life
\nLong Learning. The WVA has to develop
\nand implement a strategy for enhancing vet-
\nerinary education and skills development;
\nto analyse the accreditation\/evaluation sys-
\ntems; to work towards all newly graduates
\nacquiring the necessary \u201cDay-One Compe-
\ntences\u201d; to promote institutionalisation of
\nLife Long Learning programs and to be an
\nactive partner in global veterinary education
\nprojects. The definition of Day-One Com-
\npetences are the combination of knowledge,
\nskills\/experience, attitude and aptitude that
\nveterinary graduates need to possess for safe
\nentering the veterinary profession and en-
\nabling them to perform most of their duties.
\nThe expectations of society include the fol-
\nlowing: the veterinarian has to act as a link
\nbetween animals,animal owners and society
\nin the interests of society that needs to have
\nconfidence and trust in the high standards
\nof veterinary education and professional
\nimplementation. Thereby we have to ensure
\nthat society knows the practitioner and is
\naware of all his\/her public health-related
\nduties.To meet the expectations of the Vet-
\nerinary Profession there is required a level
\nof education\/training provided by schools
\nthat ensure that the young graduates have
\nacquired solid Day-One Competences to
\nstart real professional independent activities
\nby performing the various daily duties of
\nvets, at the same time being aware that the
\nDay-One Competences are only the start-
\ning competences.
\nThe collaboration between veterinarians
\nand physicians is promoted by the ONE
\nHEALTH concept that means a unified
\napproach between veterinary and human
\nmedicine to improve Global Health. This
\nconcept is not new as the founder of the
\nfirst veterinary school in Lyon [France] in
\n1761 cooperated with the physicians of that
\ntime. Later this concept was renewed by
\nVirchow and in the new millenium by Rog-
\ner Mahr [the former president of AVMA]
\nin North America. Cooperation can be of
\ngreat importance in the control of zoonoses
\nand the prevention of antimicrobial resis-
\ntance. Examples of physicians and vets co-
\noperating nowadays is the control of rabies,
\na very severe disease in Africa and India,
\ntaking more than 60.000 deaths per year
\nand most of them being children; or the
\ncontrol of avian influenza and all kinds of
\nfood poisonings by salmonellosis or campy-
\nlobacteriosis.The WVA likes to confirm this
\ncollaboration with the WMA in a Memo-
\nrandum of Understanding and the WVA
\nhas submitted the first draft to the board
\nof WMA. Your President Elect will make
\nthe first comments helping to reach the fi-
\nnal draft in the nearest future. The Memo-
\nrandum focuses on the control of zoonoses,
\nfood safety and security and the prevention
\nof antimicrobial resistance. The use of anti-
\nmicrobials cannot be only risk-based, but it
\ncould be that we have to separate antimi-
\ncrobials for the use in humans. The WVA
\nhas written a position paper about the re-
\nsponsible use of antimicrobials that reflects
\nits meaning on a global level in 2011. In the
\nWorld Veterinary Congress 2011 in Cape
\nTown the WVA, supported by WHO, FAO
\nand OIE [the World Animal Health Or-
\nganization in Paris], organized the Global
\nSummit \u201cLessons Learned and Future Ap-
\nproaches on the Use of Antimicrobials\u201d.
\nThe WVA is communicating its policies
\nthrough its website www.worldvet.org and
\nthrough newsletters by website and mail.
\nNew is our communication through direct
\nmail of short WVA news and by organiz-
\ning regional meetings as on-site meetings
\nof congresses and symposia\/conferences
\norganized even by related organizations.
\nOur experience has revealed that many
\nvets in the world do not read websites or
\nnewsletters and cannot afford the congress-
\nrelated expenses in expensive venues. It is
\nmore beneficial if the WVA board visits the
\nmembers in their own region.
\nI would like to finish by inviting the WMA
\nto visit our Assembly and Congress next
\nyear, the year of our 150th
\nanniversary, and
\nI would like to cooperate fruitfully in the
\nfuture and thank everybody for your hos-
\npitality.
\nDr.Tjeerd Jorna,
\nImmediate Past President, WVA
\nVeterinary Medicine
\n64
\nRegional and NMA news
\nThe International Health Economics As-
\nsociation (iHEA) www.healtheconomics.org
\nis an academic society of 2,600 health econ-
\nomists in 73 countries worldwide that has
\nbecome the central source for professional
\nactivity and critical evaluation of health
\neconomic research. iHEA focuses on the
\ncolleagueship and advancement of indi-
\nvidual health economics scholars, students,
\nand researchers, with a mission \u201cto increase
\ncommunication among health economists across
\nthe globe, foster a higher standard of debate in
\nthe application of economics to health and to
\nhealthcare systems, and to assist young health
\neconomists conduct high quality researcher at
\nthe start of their careers.\u201d
\nBackground
\nAlthough as early as the 1920s economists
\nbegan getting together to review each oth-
\ner\u2019s work in the area of health and to trade
\nideas on the subject, there was no formal
\nfield of health economics until the 1970s.
\nOver the years various regional and na-
\ntional health economics associations were
\nstarted, many of those in Europe and An-
\nglophone countries following the Health
\nEconomics Study Group (HESG) model
\nin the UK. There were discussions among
\nhealth economists about the need for cre-
\nating an international membership society
\nto encourage communication among health
\neconomics worldwide, and in 1994 the In-
\nternational Health Economics Association
\n(iHEA) was established following meeting
\nin Zurich and Boston.
\nRegional and National Affiliates of iHEA
\n\u2022 African Health Economics and Policy
\nAssociation (AfHEA)
\n\u2022 American Society of Health Economists
\n(ASHEcon)
\n\u2022 Asociacion de Economia de la Salud
\nLatinoamerica y Caribe (AES LAC)
\n\u2022 Australian Health Economics Society
\n(AHES)
\n\u2022 China Health Economics Association
\n(CHEA)
\n\u2022 Coll\u00e8ge des Economistes de la Sant\u00e9
\n(CES)
\n\u2022 Colombian Health Economics Associa-
\ntion (ACOES)
\n\u2022 Croatian Society for Pharmacoeconomics
\nand Health Economics (CSPHE)
\n\u2022 European Committee on Health Eco-
\nnomics (ECHE)
\n\u2022 Finnish Society for Health Economics
\n(TTTS)
\n\u2022 German Association for Health Eco-
\nnomics (DGGOE)
\n\u2022 Health Economics Study Group (HESG)
\n\u2022 Indian Health Economics and Policy As-
\nsociation (IHEPA)
\n\u2022 Health Economics Association of India
\n(HEAI)
\n\u2022 Italian Association of Health Economics
\n(AIES)
\n\u2022 Japan Health Economics Association
\n(JHEA)
\n\u2022 Portuguese Health Economics Associa-
\ntion (APES)
\n\u2022 Spanish Health Economics Association
\n(AES)
\n\u2022 Swedish Health Economics Association
\n(SHEA)
\n\u2022 Swiss Association for Health Economics
\n(SAG)
\n\u2022 Taiwan Society of Health Economics
\n(TaiSHE)
\n\u2022 Turkish Health Economics and Policy
\nAssociation (THEPA);
\n\u2022 Young Researchers in Health (YRH)
\nFunding and Organizational
\nStructure
\nThe International Health Economics As-
\nsociation (iHEA) is a charitable non-profit
\norganization largely self-funded through
\nindividual dues and fees, which helps it to
\nmaintain independence from the specific
\ninterests of industry, government agencies
\nor medical organizations. Its organizational
\nstructure consists of: an executive director;
\na president, who is elected by the member-
\nship; a secretary\/treasurer; a board of direc-
\ntors; program chairs for the biennial meet-
\ning; and the association\u2019s operational staff,
\nwhich consists of three individuals. Mem-
\nbers of the board of directors serve four-year
\noverlapping terms.
\nInternational Health Economics Association
\n(iHEA)
\nThomas E. Getzen Anne Mills
\n65
\nRegional and NMA news
\nIn March 2012 the International Federa-
\ntion of Pharmaceutical Manufacturers and
\nAssociations (IFPMA) expanded the IF-
\nPMA Code of Practice which governs how
\nmember companies interact with health-
\ncare professionals, medical institutions and
\npatient organizations. IFPMA requires all
\nmembers, which comprise the research-
\nbased pharmaceutical industry, to adopt and
\nimplement this Code around the world.
\nAdvancing medical knowledge and improv-
\ning public health depend on information-
\nsharing interactions by the entire medical
\ncommunity \u2013 from researcher to attending
\nphysician, nurse, pharmacist and patient \u2013
\nand integrity is essential to these exchanges.
\nIn these interactions, it is vital that health-
\ncare providers, patients, and governments
\nare confident that pharmaceutical compa-
\nnies act in an ethical and professional man-
\nner wherever they operate in the world.
\nSuch ethical practices should apply not only
\nto the promotion of medicines, but more
\nbroadly to all interactions with the health-
\ncare community.The Code is a public state-
\nment of the standards of practice to which
\nthe healthcare community and others can
\nexpect our industry to adhere.
\nConcerning our industry\u2019s interactions with
\nhealthcare professionals, the IFPMA Code
\nof Practice clarifies which promotional aids
\nand medical products, such as pharmaceuti-
\ncal product samples, are permitted while re-
\nconfirming that personal and cash gifts are
\nnot.\u00a0 It prohibits pre-approval promotional
\nactivities for pharmaceutical products while
\nproviding clear guidance for supporting
\ncontinuing medical education.This includes
\nensuring that meetings are held in appro-
\npriate venues that are conducive to scientific
\nor educational objectives.
\nBeyond interactions, the Code now also
\nincludes high-level guiding principles for
\npractice, a requirement for member com-
\npanies to train employees, a provision on
\ndisclosure of clinical trial information, and
\nclear guidance for filing complaints.
\nThe research-based pharmaceutical indus-
\ntry highly values trust in interactions with
\nhealthcare professionals and others.
\nEnsuring trust promotes high quality ex-
\nchanges of medical information which, in
\nturn, benefit patients\u2019 health. This expanded
\nIFPMA Code of Practice is one more ele-
\nment of our commitment to patients and
\nhealthcare professionals.
\nBy September 2012, IFPMA members will
\nhave implemented this Code wherever they
\noperate in the world. This includes align-
\ning national industry codes and ensuring
\nthat employees receive training and adhere
\nto these high ethical and professional stan-
\ndards.
\nWe encourage others \u2013 doctors, nurses,
\npharmacists, academics, patients and con-
\nsumers \u2013 to not only be aware of this ex-
\npanded Code, but also to ensure equally
\nhigh ethical and practice standards across
\nthe healthcare sector. By working together,
\nwe can continue to improve the lives of peo-
\nple around the world.
\nThe Research-Based Pharmaceutical Industry Expands its Code of
\nPractice Governing Interactions with the Healthcare Community
\nEduardo Pisani
\nMain Activities
\nThe Association\u2019s main activities include:
\npresenting the annual Kenneth J. Arrow
\nAward in Health Economics for the best
\npublished paper in health economics; edit-
\ning and maintaining HEN-the Health Eco-
\nnomic Network electronic archive in col-
\nlaboration with the Social Science Research
\nNetwork at SSRN.com; distributing health
\neconomics related information to its mem-
\nbers including a weekly online newsletter;
\nmaintaining a world directory of health
\neconomics; and conducting the World
\nCongress of Health Economists. The first
\n\u201ciHEA Congress\u201d was held in Vancouver,
\nB.C., Canada in 1996. Subsequent confer-
\nences were held in Rotterdam, Holland in
\n1999; York, England 2001; San Francisco,
\nCalifornia 2003; Barcelona, Spain 2005;
\nand Copenhagen, Denmark 2007; Beijing,
\nChina 2009; and Toronto, Canada 2011.
\nUpcoming Congresses are scheduled for
\nSydney, Australia in 2013; Dublin, Ireland
\nin 2014, and Milan, Italy in 2015.
\nProf. Thomas E. Getzen,
\nExecutive Director
\nProf. Anne Mills,
\nPresident 2012\u20132013
\n66
\nThe International Federation of Biomedical
\nLaboratory Science (IFBLS) is an indepen-
\ndent non-governmental association of na-
\ntional societies in 40 countries, representing
\nmore than 185,000 biomedical laboratory
\nscientists, technologists and technicians
\nworldwide. Providing a critical service as-
\nsisting physicians in the diagnosis and
\ntreatment of human diseases, these health
\nprofessionals serve as key personnel by
\nmaintaining medical laboratories and pro-
\nviding needed medical laboratory services.
\nIn a recent report the Institute of Medicine
\nin the United States has documented an
\nexcess of 70 percent of the information in
\na typical patient\u2019s chart in hospital at any
\ntime is information generated by the bio-
\nmedical laboratory from testing performed
\nby biomedical laboratory scientists.
\nThe IFBLS (originally called the Inter-
\nnational Association of Medical Labora-
\ntory Technologists \u2013 IAMLT) was founded
\nin 1954 when Ms. Elizabeth Pletscher
\nand her Swiss colleagues invited national
\nmedical technology associations, from a
\nnumber of countries, to meet in Zurich,
\nThe International Federation of Biomedical
\nLaboratory Science (IFBLS)
\nAbout IFPMA:
\nIFPMA represents the research-based phar-
\nmaceutical companies and associations across
\nthe globe. The research-based pharmaceuti-
\ncal industry\u2019s 1.3 million employees research,
\ndevelop and provide medicines and vaccines
\nthat improve the life of patients worldwide.
\nBased in Geneva, IFPMA has official rela-
\ntions with the United Nations and contrib-
\nutes industry expertise to help the global
\nhealth community find solutions that im-
\nprove global health.
\nIFPMA manages several global initia-
\ntives including: the IFPMA Developing
\nWorld Health Partnerships which stud-
\nies and identifies trends for the research-
\nbased pharmaceutical industry\u2019s long-term
\npartnership programs to improve health in
\ndeveloping countries; the IFPMA Code of
\nPractice (http:\/\/www.ifpma.org\/ethics\/ifp-
\nma-code-of-practice\/ifpma-code-of-practice.
\nhtml) which sets unsurpassed standards for
\ninteractions with the healthcare commu-
\nnity; and the IFPMA Clinical Trials Portal
\nhelps patients and health professionals learn
\nout about clinical trials and trial results.
\nIFPMA Guiding Principles on
\nEthical Conduct and Promotion
\nThe International Federation of Pharmaceu-
\ntical Manufacturers and Associations (IFP-
\nMA) member companies engage in medical
\nand biopharmaceutical research in order to
\nbenefit patients and support high-quality
\npatient care. Pharmaceutical companies,
\nrepresented by IFPMA, promote, sell and
\ndistribute their products in an ethical man-
\nner and in accordance with all the rules and
\nregulations for medicines and healthcare.
\nThe following Guiding Principles set out
\nthe basic standards to inform on the 2012
\nIFPMA Code of Practice which applies to
\nthe conduct of IFPMA Member Compa-
\nnies and their agents.This helps ensure that
\ntheir interactions with stakeholders are ap-
\npropriate.
\n1. The healthcare and well-being of pa-
\ntients are the first priority for pharma-
\nceutical companies.
\n2. Pharmaceutical companies will conform
\nto high standards of quality, safety and
\nefficacy as determined by regulatory au-
\nthorities.
\n3. Pharmaceutical companies\u2019 interactions
\nwith stakeholders at all times must be
\nethical, appropriate and professional.
\nNothing should be offered or provided
\nby a company in a manner or on condi-
\ntions that would have an inappropriate
\ninfluence.
\n4. Pharmaceutical companies are respon-
\nsible for providing accurate, balanced,
\nand scientifically valid data on products.
\n5. Promotion must be ethical, accurate,
\nbalanced and must not be misleading.
\nInformation in promotional materials
\nmust support proper assessment of the
\nrisks and benefits of the product and its
\nappropriate use.
\n6. Pharmaceutical companies will respect
\nthe privacy and personal information of
\npatients.
\n7. All clinical trials and scientific research
\nsponsored or supported by compa-
\nnies will be conducted with the intent
\nto develop knowledge that will ben-
\nefit patients and advance science and
\nmedicine. Pharmaceutical companies
\nare committed to the transparency of
\nindustry sponsored clinical trials in pa-
\ntients.
\n8. Pharmaceutical companies should ad-
\nhere to both the spirit and the letter of
\napplicable industry codes. To achieve
\nthis, pharmaceutical companies will en-
\nsure that all relevant personnel are ap-
\npropriately trained.
\nEduardo Pisani, Director General
\nInternational Federation of Pharmaceutical
\nManufacturers and Associations
\nRegional and NMA news
\n67
\nSwitzerland. The response to the invita-
\ntion was so great that the decision was
\nmade to create an international association.
\nMs. Pletscher became the first Secretary
\nand later the Honorary Executive Secre-
\ntary and was in office from 1954 to 1973.
\nAt the Triennial Conference of the Insti-
\ntute of Medical Laboratory Technology
\n(now the Institute of Biomedical Science)
\nin Nottingham, United Kingdom, in 1955,
\na meeting was held and the first draft con-
\nstitution of the future International Asso-
\nciation was discussed. A further meeting
\nwas held on the occasion of the first Inter-
\nAmerican Convention in Quebec, Canada,
\nthe following year.
\nIn 1957 a delegates meeting was held in
\nAmsterdam, Holland, when study groups
\nwere formed by different nations to make
\nenquiries on the situation of medical labo-
\nratory technologists all over the world. In
\naddition, the legal status of the Association
\nwas discussed.\u00a0On the occasion of the Tri-
\nennial Conference of the IFBLS in Bristol,
\nUnited Kingdom, in 1958, the draft stat-
\nutes were discussed and the first Council
\nwas elected. Mr. R. J. Broomfield from the
\nUnited Kingdom became the first Presi-
\ndent.
\nThe following year a General Assembly of
\nDelegates (GAD) was held in Hamburg,
\nGermany; the statutes were finally adopted
\nand the preliminary reports of the study
\ngroups were discussed. In 1960 the Ameri-
\ncan Society of Medical Technologists and
\nthe Canadian Association joined IFBLS,
\nmaking it truly a \u201cWorld\u201d organization.
\nThe first week-long international Congress,
\nwith a large participation from all over the
\nworld, was held in Stockholm, Sweden, in
\n1961.Two years later saw the publication of
\nthe first Newsletter of the IFBLS. 1964 saw
\nthe 10th
\nanniversary Congress being held in
\nLausanne, Switzerland. Over 400 delegates
\nfrom 16 countries attended. For the future a
\ndecision was reached to hold the Congress
\nbiennially.
\nCongress was held in Berlin, Germany in
\n1966; Helsinki, Finland 1968; Copenha-
\ngen, Denmark 1970; Vienna, Austria 1972;
\nParis, France 1974; Chicago, USA 1976;
\nEdinburgh, Scotland 1978; Durban, South
\nAfrica 1980; Amsterdam, The Netherlands
\n1982; Perth, Australia 1984; Stockholm,
\nSweden 1986; Kobe, Japan 1988; Geneva,
\nSwitzerland 1990, Dublin, Ireland 1992;
\nHong Kong 1994; Oslo, Norway 1996;
\nSingapore 1998; Vancouver, Canada 2000.
\nOrlando, USA 2002; Stockholm, Sweden
\n2004; Seoul,South Korea 2006; New Delhi,
\nIndia 2008; Nairobi, Kenya 2010; and will
\ntake place in Berlin, Germany later in 2012.
\nIn 1965 the IFBLS became a consultative
\nmember of the Council of Europe in Stras-
\nbourg. A resolution was introduced to the
\nSecretary General of the Council of Europe
\nin 1966, asking for a committee of experts
\nto be formed to investigate the standardiza-
\ntion of training, in order to issue diplomas
\nacceptable to other countries.The resolution
\nwas accepted and the committee of experts
\nformed. In the same year the IFBLS News-
\nletter (Med Tech International \u2013 MTI) be-
\ngan twice yearly publication.
\nThe IFBLS was approved as a non-gov-
\nernmental organization in official relation-
\nship with the World Health Organization
\n(WHO) in 1972. On her retirement, at the
\nVienna Congress, Elizabeth Pletscher was
\nawarded the first Honorary Membership of
\nthe Association, having served 19 years as
\nExecutive Secretary.
\nAt the World Congress in Orlando in
\n2002 the General Assembly of Delegates\u00a0\u2013
\nGAD\u00a0 \u2013 voted to change the name of the
\norganization from IAMLT to IFBLS, this
\nlatter title being more reflective of the educa-
\ntional standards and role of the members of
\nthe profession.It was also agreed to move the
\nregistered office from Stockholm to Hamil-
\nton, Canada where it is presently located.
\nThe Mission of IFBLS is:
\n\u2022 To support, advance and promote good
\nlaboratory practice through the develop-
\nment and adherence to high quality stan-
\ndards in diverse environments through-
\nout the world;
\n\u2022 To support, advance and promote the
\neducation, training and professional de-
\nvelopment of Biomedical Laboratory
\nScientists and technologists;
\n\u2022 To support, advance and promote ethical
\nand professional values in the biomedical
\nlaboratory profession;
\n\u2022 To promote the exchange of ideas and the
\nactive participation of biomedical labora-
\ntory professionals through seminars, re-
\nsearch and educational forums;
\n\u2022 To promote the coordination of activi-
\nties within the healthcare and biomedical
\nlaboratory professions through the devel-
\nopment of international partnerships and
\nprograms and;
\n\u2022 To support, promote and advance such
\nactivities of IFBLS as are incidental and
\nancillary to the foregoing objects.
\nFor more information on IFBLS please
\ncontact our website at www.ifbls.org
\nVincent S. Gallicchio,
\nPhD, Dp (hon), MT(ASCP),
\nFRSA, FASAHP
\nPresident, IFBLS
\nVincent S. Gallicchio
\nRegional and NMA news
\n68
\nMission: To promote, among all peoples and
\nnations, the highest possible level of mental
\nhealth in its broadest biological, medical, edu-
\ncational and social aspects.
\nThe Federation was founded in 1948 as an
\ninternational multi-disciplinary organization
\nto bring together health professions to work
\nfor the improved treatment of mental illness-
\nes. The founders saw a great need to expand
\nunderstanding of mental illnesses at govern-
\nment level and with the general public. The
\nneed for advocacy is real, and it can change
\nattitudes.Mental illnesses are not rare,yet in-
\ndividuals and families are often reluctant to
\nspeak about them. According to the World
\nHealth Organization just one of these dis-
\norders, unipolar depression, is the third lead-
\ning cause of the global burden of disease\u2013and
\nwill rise to the first place by 2030.
\nEvidence-based treatments are available,
\nbut even in developed countries many peo-
\nple who could benefit do not receive them
\nfor various reasons. In low- and middle-in-
\ncome countries the situation is much worse.
\nIn low-income countries public knowledge
\nof mental disorders is often lacking and
\ngovernment spending on their treatment
\nwithin the health budget is very limited,
\neven although low-cost treatments exist.
\nThe Federation believes in fostering positive
\nmental health as well as improving care for ill-
\nness.WFMH believes that good mental health
\nis a valuable asset for individuals and their
\ncommunitiesandshouldbesupportedanden-
\ncouraged in society. For every age group good
\nmental health is a part of overall well-being.
\nThe goals of the Federation are:
\n\u2022 To heighten public awareness about the
\nimportance of mental health, and to gain
\nunderstanding and improve attitudes
\nabout mental disorders.
\n\u2022 To promote mental health and optimal
\nfunctioning.
\n\u2022 To prevent mental, neurological and psy-
\nchosocial disorders.
\n\u2022 To improve the care and treatment of
\nthose with mental, neurological and psy-
\nchosocial disorders.
\nThe Federation\u2019s Board of Directors
\nWFMH currently has a Board of 22 Direc-
\ntors from 16 countries, headed by the Presi-
\ndent, Deborah Wan of Hong Kong. The
\nExecutive Committee consists of 8 Officers
\nfrom 6 countries. The Board members have
\nextensive, varied experience in the mental
\nhealth field and offer broad international
\nperspectives from their regional viewpoints.
\nThey consult by email, Skype, and confer-
\nence calls and confer once a year in person.
\nAdvocacy
\nWFMH maintains a strong role in civil so-
\nciety advocacy. It founded World Mental
\nHealth Day (10 October),which is celebrat-
\ning its 20th
\nanniversary in 2012. Each year
\nthe WFMH Board selects a theme,material
\nis developed and translations are made into
\na number of languages. The information is
\ncirculated via email and post to organiza-
\ntions and individuals who arrange their own
\nlocal events of many kinds for public educa-
\ntion.The flexible campaign format has been
\nsuccessful in reaching many levels from
\nvillages to government ministries, as it can
\nbe easily adapted to suit requirements. For
\n2012 the theme is \u201cDepression\u201dand the ma-
\nterial will provide basic information about
\nthis common illness.
\nThe WFMH Congress held every two years
\nin a different part of the world also promotes
\npublic attention for mental health issues,with
\na diverse program of presentations by inter-
\nnational speakers together with numerous
\nparallel sessions and additional activities.The
\nCongress in 2011 was held in Cape Town,
\nSouth Africa. In 2013 it will be in Buenos
\nAires, Argentina, and in 2015 in Singapore.
\nThe \u201cGreat Push for Mental Health\u201d pro-
\ngram has built up a network of over 500
\norganizations from 110 countries that have
\nindicated their support for this new advo-
\ncacy program (including individuals, the
\nnetwork currently numbers 1,428 contacts).
\nThe \u201cGreat Push\u201d has adopted a slogan of
\n\u201cunity, visibility, rights and recovery\u201d with
\nthe aim of providing a platform for the
\nviews of civil society. It is planning to use
\na survey this year to obtain the opinions of
\nthe organizations about priorities for the
\nWorld Health Organization\u2019s proposed Ac-
\ntion Plan for Mental Health.
\nRecent Activities at the United Nations
\nand World Health Organization
\nWFMH is a non-profit organization with
\nConsultative Status at the United Nations
\nand maintains official relations with the
\nWorld Health Organization.Volunteer rep-
\nresentatives participate in NGO activities
\nDeborah Wan
\nThe World Federation for Mental Health
\n(WFMH)
\nRegional and NMA news
\n69
\nThe Mozambican
\nMedical Association
\nHow do you protect the legal, judicial and fi-
\nnancial interests of your colleagues?
\nMost of the Mozambican physicians work
\nfor the government and they are protected
\nby the General Statute of the agents and
\npublic workers.
\nDo you have a legal counsel?
\nAt the Mozambican Medical Association
\n(AMM) we do have a legal counsel that
\nadvises on different matters needing legal
\ncounselling.
\nAre the rights to protect your colleagues includ-
\ned in your countries\u2019 legislation?
\nYes. In Chapter II Article 3 and Article 5g)
\nof the Mozambican Medical Association
\nand it reads as follows: Article 3 \u2013 AMM
\npromotes, with independence and responsi-
\nbility,the defense of its associates\u2019legitimate
\ninterests, fights for the dignification of the
\nmedical class, and assumes an active posi-
\ntion regarding all issues that affect or may
\naffect the health condition of the popula-
\ntion in the Country, the Continent or the
\nWorld. Article 5g) \u2013 Care for the full com-
\npliance with the law and respective regula-
\ntions, namely in what concerns the doctor\u2019s
\ntitle and profession.
\nHave you organised strikes, rallies and other
\nactivities?
\nThe AMM had never had the need to orga-
\nnize strikes. Sometimes it makes statements
\nin the public and private newspapers about
\nmatters that need a position from the medi-
\ncal class.
\nDo you turn to the government?
\nWe turn to the government for matters that
\nare of interest to the AMM, for support to
\nsome issues (like the Physicians Statute),
\nto advise on some law proposals (e.g., the
\nTransplant Law) and as a partner in some
\nactivities, such as the continuous medical
\neducation.
\nThe Slovak Medical
\nAssociation
\nHow do you protect the legal, judicial and fi-
\nnancial interests of your colleagues?
\nThe Slovak Medical Association (SkMA) is
\na non-profit, non-governmental organisa-
\ntion with voluntary membership. We pro-
\ntect the interests of our organization and
\nour members, if their activity is related to
\nthe subject of our activities.
\nThe mission of the SkMA is to make broad
\nmedical circles aware of the latest scien-
\ntific findings and professional observations
\nthrough organised scientific events and
\nother professional meetings, to support the
\ninvolvement of our own experts in similar
\nevents abroad and to publish and support
\nthe issue of professional magazines and
\npublications.
\nDo you have a legal counsel?
\nYes, one of the employees of the Secretariat
\nof the SkMA is a lawyer.
\nAre the rights to protect your colleagues includ-
\ned in your countries\u2019 legislation?
\nYes
\nHave you organised strikes, rallies and other
\nactivities?
\nNo, but last year we supported the strike of
\nhealth workers.
\nDo you turn to the government?
\nYes
\nThe Macedonian
\nMedical Association
\nHow do you protect the legal, judicial and fi-
\nnancial interests of your colleagues?
\nIn general, issues arising from legal and ju-
\nridical regulations are left to be solved by
\nthe individuals themselves, the physicians
\nand other health personnel.
\nExemptions are the rights arising from col-
\nlective agreements that are coordinated and
\nsigned by trade unions and employers, i.e.
\nthe minister of health.These are issues from
\nwork-related legislation. Physicians can ap-
\nply to the Administrative Court for legal
\nacts arising from legal and juridical regula-
\ntions and approved by the managing bodies
\nor organs of the state.
\nThere is another possibility, which is very
\noften used by individuals. Physicians and
\ncitizens use the Supreme Court for explor-
\ning the constitutionality of legal decisions
\nProtecting the Rights and Interests of Physicians
\nin New York and Geneva, and work with
\nBoard members and staff to monitor UN
\nand WHO developments related to mental
\nhealth. In 2011 WFMH participated in ef-
\nforts to have mental health included in the
\ninternational discussion on non-commu-
\nnicable diseases which led to a UN High-
\nLevel Meeting on the topic.The Federation
\nsucceeded in organizing a symposium for
\nan invited audience in New York just before
\nthe High-Level Meeting, where key gov-
\nernment officials from Brazil, India, Guy-
\nana and the United States stated the case
\nfor the inclusion of mental health.
\nTo read more about our other important
\nactivities and programs, please, go to our
\nwebsite at www.wfmh.org.
\nDr.\u00a0Deborah Wan,
\nBoard President
\nRegional and NMA news
\n70
\nthat refer to the rights of the physicians and
\ntheir work.
\nTrade Unions and their institutions and
\nbodies play the key role in financial mat-
\nters. Attorneys are being engaged to repre-
\nsent the interests of trade union members
\nin front of the Administrative and regular
\ncourts.
\nDo you have a legal counsel?
\nThere is no legal advice although gen-
\neral practitioners or the Society of Private
\nPhysicians has its attorney with restricted\/
\nlimited rights. For example, he\/she is not
\nallowed to be present at debates about sign-
\ning contracts between the Fund for Health
\nCare and physicians. In this context the
\nMedical Chamber is not involved, and as a
\nrule, the Chamber represents the rights of
\nthe physicians not only verbally but in front
\nof legitimate and state institutions.
\nAre the rights to protect your colleagues includ-
\ned in your countries\u2019 legislation?
\nThere is no legal or any other obligation for
\nprotection of the rights included or deter-
\nmined in the state laws.
\nHave you organised strikes, rallies and other
\nactivities?
\nOver the last two decades there was one
\nstrike interrupting the work for several
\nhours. A few demonstrations and similar
\nactivities, mostly manifested by interrup-
\ntion of the work, have taken place, but they
\nreferred to the work organization and not to
\nthe rights of the employed.
\nDo you turn to the government?
\nCommunication with the Government has
\nbeen initiated,although still without any re-
\nsults. Suggestions from the doctors\u2019associa-
\ntions, representing the interests of the phy-
\nsicians, are not accepted in most instances.
\nIt has also to be emphasized that physicians
\nwho are members of the State Parliament\/
\nRepublic\u2019s Assembly represent the interests
\nof the political parties and not of the pro-
\nfession.
\nThe Hong Kong Medical
\nAssociation
\nHow do you protect the legal, judicial and fi-
\nnancial interests of your colleagues?
\nPartnering with the Medical Protection
\nSociety in the UK, we help our colleagues
\ndefend professional negligence and mis-
\nconduct cases. All expenses and compensa-
\ntions for damages are paid out of the funds
\npooled in this Society so that colleagues can
\npractice medicine having peace of mind.
\nOur Duty Council Member scheme helps
\nanswer questions from colleagues who have
\nproblems in their daily practice.
\nDo you have a legal counsel?
\nTo advise us on legal matters, several legal
\ncounsels are retained by the Association on
\na pro bono basis.
\nAre the rights to protect your colleagues includ-
\ned in your countries\u2019 legislation?
\nThe rights to practice medicine are mainly
\nwritten in the Medical Registration Ordi-
\nnance.Others include the Pharmacy & Poi-
\nsons Ordinance, the Supplementary Medi-
\ncal Professions Ordinance, the Medical
\nClinics Ordinance and related ordinances
\nand regulations.
\nHave you organised strikes, rallies and other
\nactivities?
\nOne of the main objectives of the Hong
\nKong Medical Association is to promote
\nthe welfare and protect the lawful interests
\nof the medical profession.
\nAt times, we have to resort to strikes, ral-
\nlies or sit-in demonstrations to get ourselves
\nheard or turn to the government if required.
\nIn 2007,we had a sit-in protest and a march
\nagainst the \u201cunequal pay for equal work\u201d
\nwage scale of the junior doctors working in
\npublic hospitals. In 2008, we had another
\nmarch against the sharp increase in rents of
\nclinics in public housing estates.
\nDo you turn to the government?
\nWe collect views of the profession by con-
\nducting surveys and then present them to
\nthe authorities via the media or via our rep-
\nresentatives in the respective government
\nand non-governmental organizations.
\nFMH Swiss Medical
\nAssociation
\nHow do you protect the legal, judicial and fi-
\nnancial interests of your colleagues?
\nThe Swiss legislation on social insurance
\nasks for collective tariffs (http:\/\/www.admin
\n.ch\/ch\/f\/rs\/832_10\/a46.html) which gives
\nsome protection to the practitioner.
\nFMH can asssit members in financing legal
\nprocedures of general interest to the medi-
\ncal community.
\nDo you have a legal counsel?
\nFMH has a legal department.
\nAre the rights to protect your colleagues includ-
\ned in your countries\u2019 legislation?
\nThe Swiss legislation grants its inhabit-
\nants the right to found private associa-
\ntions. FMH as a private association is free
\nto define its aims. SIWF-ISFM as a part
\nof FMH which regulates the postgraduate
\ntraining (http:\/\/www.fmh.ch\/bildung-siwf.
\nhtml) has a mandate of the state and does
\nnot interfere with the political branches of
\nFMH.
\nHave you organised strikes, rallies and other
\nactivities?
\nThe FMH is currently, like it already did in
\n2008, taking a leading role in federal refer-
\nendums (see referendum on managed care
\nlegislation of June 17th
\n, 2012, http:\/\/www.
\nparlament.ch\/f\/dokumentation\/dossiers\/care\/
\npages\/default.aspx).
\nDo you turn to the government?
\nFMH has regular contacts with members of
\nthe government and the public administra-
\ntion
\nRegional and NMA news
\n71
\nThe Serbian Medical Chamber
\nHow do you protect the legal, judicial and fi-
\nnancial interests of your colleagues?
\nThe legal interests of our colleagues are
\nprotected in health system via proposed
\nlaws and bylaws that the Serbian Medical
\nChamber suggests or in some cases disputes
\nin front of the Constitutional Court of the
\nRepublic of Serbia. Financial interests of
\nmedical doctors in Serbia are protected by
\nhealth care trade unions.Currently there are
\nsix medicine trade unions in Serbia. We are
\nnot pleased with this sort of disunion.
\nDo you have a legal counsel?Are the rights to
\nprotect your colleagues included in your coun-
\ntries\u2019 legislation?
\nReferring to the judicial protection of Ser-
\nbian physicians,the Serbian Medical Cham-
\nber takes actions via an official lawyer and le-
\ngal adviser. Furthermore, the Ethical Board
\nworks on the Serbian Medical Chamber
\nLitigation Rule Book. The Serbian Medical
\nChamber,therefore,has its legal counsel and,
\nat the same time,the legal team that consists
\nof 16 lawyers. The rights to protect medical
\ndoctors in Serbia are defined in the Serbian
\nMedical Chamber Statute and in the Law
\non Health Care Professionals Chambers of
\nthe Republic of Serbia.
\nHave you organised strikes, rallies and other
\nactivities?
\nWe have not organized strikes and rallies.
\nHowever, the Serbian Medical Chamber
\nofficials very often meet with Government
\nand Ministry of Health representatives.
\nDo you turn to the government?
\nThose meetings result with variable out-
\ncomes.
\nThe Icelandic Medical
\nAssociation
\nBackground information
\nIceland is a small country with the popula-
\ntion of approx. 320,000. In 2010 there were
\naround 1070 practicing medical doctors in
\nthe country, thereof 860 with specialist li-
\ncences. Approx. \u00be of the medical workforce
\nworked full time or part time in the public
\nhealth sector; in hospitals, health care cen-
\ntres and health institutions. Over 90% of
\nthe doctors are members of the Icelandic
\nMedical Association (IMA), established in
\n1918.
\nLegal Provisions on Icelandic Medical Doctors
\nFor decades there has been in force a spe-
\ncial legislation on doctors, defining their
\nobligations and basic rights. The legislation
\ndoes not give IMA any legal role, neither
\nto protect nor assist its members when legal
\nmatters arise.
\nHowever, IMA has from early on given its
\nmembers legal advice and in some instances
\nprovided legal assistance to them. IMA
\nhas a lawyer among its staff members and
\nwhen needed attorneys are engaged to bring
\ncases to court. Most such cases are due to
\nthe employers\u2018 failure to comply with wage
\ncontracts or other work related agreements.
\nWorking Conditions and the Right to Strike
\nOne of the roles of IMA is to negotiate
\nwage agreements. A legislation on wage
\nagreements within the public sector stipu-
\nlates that all salaried employees,who receive
\nsalaries based on wage agreements reached
\nby their association, are either obliged to be
\na member of their association or pay a yearly
\nfee to it. Consequently, doctors who receive
\nsalaries based on IMA\u2018s wage agreements
\nneed either be a member of IMA or pay a
\nfee to it.
\nWithin IMA a negotiating committee is
\nresponsible for the negotiation process
\nand other work related matters within the
\npublic health care sector. If the negotiating
\nparties do not reach an agreement IMA has
\nthe legal right to call for a general strike of
\ndoctors. However, this happens very rarely,
\nmainly due to very extensive legal exemp-
\ntions to the right of doctors to strike. Fur-
\nthermore, many Icelandic doctors believe it
\nis unethical to strike and are of the opinion
\nthat other measures are to be used to raise
\nwages, shorten working hours and improve
\nworking conditions.
\nIMA continuously has a dialogue with the
\nrelevant health authorities on issues relating
\nto health and the situation of doctors.
\nBelgium
\nThe Belgian Association of Medical Trade
\nUnions has been set up in 1963.
\nThe Belgian Medical Body wanted to be a
\nliberal profession and had to fight against
\nthe government\u2019s will to nationalize health
\ncare.
\nAfter a 3 week\u2019s medical strike, the gov-
\nernment withdrew the law. Medical prac-
\ntice would remain liberal and every year
\na mutual agreement would be made be-
\ntween doctors and insurance companies,
\nabout medical fare in order to insure fare
\nsecurity for the patient in a social funded
\nsystem.
\nSince then,we have set up a complex system
\nof concertation which allows us to give our
\nopinion on any medical matter or on public
\nhealth.This system gives us a real power but,
\nif we achieve a reasonable consensus, and it
\nhas happened very often, we take action
\nagainst such measures as strikes, demon-
\nstrations, etc.
\nOf course,to have a fair balance between ac-
\ntions and negotiations we need to have legal
\nadvisors. It is more difficult to come to the
\nsame opinion in the whole medical body.
\nEvery speciality often sees to its own inter-
\nests. We have to conciliate the two commu-
\nnities (the Flemish and French speaking)
\nhospitals and ambulatory care, etc.
\nBut, up to now, we manage to keep a strong
\nsolidarity. And, anyway, don\u2019t forget that the
\ngovernment decides eventually.
\nRegional and NMA news
\n72
\nThe Royal Dutch Medical
\nAssociation (KNMG)
\nKNMG is a federation of associations of
\ndoctors: GPs, medical specialists (consul-
\ntants), occupational health doctors, nursing
\nhome doctors and doctors working in the
\npublic health domain. KNMG represents
\nabout 60% of all doctors in the country.The
\nfederation defends the so-called immaterial
\ninterests of all doctors, in the fields of qual-
\nity and safety of care,professional behaviour
\nstandards, medical ethics, legal and judicial
\naspects, education, lifelong learning, career
\nplanning, prevention and public health.
\nKNMG has 25 policy advisors working on
\nthese issues, among whom 5 legal advisors.
\nKNMG intensively lobbies stakeholders,
\nministries and parliament in order to realize
\nits objectives. High KNMG officials regu-
\nlarly meet with government officials, the
\nminister of health and members of parlia-
\nment. We have a high profile in the media
\ndue to a very active media policy.
\nMaterial interests (wages, fees, insurance
\nrates) are looked after by the separate profes-
\nsional associations, which also cover the spe-
\ncific quality aspects for their own profession-
\nal communities. There is close cooperation
\nbetween KNMG and its federation partners
\nto take joint action wherever possible, and
\nin case of common interests to jointly move
\ntoward stakeholders, government and parlia-
\nment and thus reinforce the message.
\nThe Canadian Medical
\nAssociation
\nThe Canadian Medical Association is a vol-
\nuntary, member-driven physician represen-
\ntative organization.We advocate actively on
\nbehalf of our members with the government
\nand other important stakeholders at the na-
\ntional level and through our Provincial and
\nTerritorial Medical Associations (PTMA\u2019s)
\nat the provincial and territorial level. In
\nCanada, health care provision and fund-
\ning is a provincial and territorial obligation,
\nalthough the federal government plays an
\nimportant role in transfer funding, care of
\ncertain populations (such as Canadian Ab-
\noriginals) and policy setting.
\nPhysician malpractice insurance is provid-
\ned mainly through the Canadian Medical
\nProtective Association (CMPA). This asso-
\nciation is separate from the CMA, although
\nwe share close ties. Members receive legal
\nadvice and representation through their
\nmembership in the CMPA. Further infor-
\nmation is available at www.cmpa-acpm.ca.
\nFinancial interests are primarily addressed
\nby the PTMA\u2019s through their negotiations
\nfor physician fee schedules and billing codes
\nwith their respective provincial govern-
\nments. On occasion, PTMA\u2019s have had to
\norganize targeted strikes and job actions in
\nthe past although this has thankfully been
\nquite rare.
\nCyprus Medical Association
\nThe Cyprus Medical Association was es-
\ntablished in 1967 and represents all practic-
\ning physicians in Cyprus. According to the
\nCypriot legislation, a physician who is prac-
\nticing in the island is obliged to become a
\nmember of the Association. At present, the
\nCyprus Medical Association has approxi-
\nmately 2650 members.
\nThe main aims of the Association are to unite
\nall members of the medical profession who
\nare practicing in Cyprus and to safeguard
\ntheir interests.Furthermore,CyMA provides
\nconsultation and assistance to its members in
\ntheir mutual relations, in their relations with
\nthe State or other authorities and organisa-
\ntions. Additionally to that, CyMA cooper-
\nates with other national and international
\nbodies in order to foster its aims.
\nMoreover, the Cyprus Medical Association
\nis not only a professional body but also acts
\nin various ways for the benefit of patients
\nand the general. public The Association
\naims at the protection of medical ethics, the
\ndevelopment of a health care system so that
\nevery patient enjoys the right to adequate
\ntreatment, enhancement of its members
\nprofessional training and advancement op-
\nportunities, introduction of new legislation
\nand regulations governing health issues and
\nthe management of its members\u2019 pension
\nfund and life insurance schemes.
\nThe Association has an administrative board
\nof 24 members. It meets once a month and
\nappoints its eight sub-committees. These
\nsub-committees are the Ethics Committee,
\nthe Continuing Medical Education Com-
\nmittee, the Scientific Committee, the Law
\nand Regulations Committee, the Commu-
\nnication Committee, the National Health
\nInsurance Scheme Committee, the Trade-
\nUnion Committee for the Private sector
\nand the Trade-Union Committee for the
\nPublic sector.
\nThe Cyprus Medical Association secures the
\nlegal and judicial interests of its members
\nthrough a multilayered and coherent policy
\nthat is based on the one hand, on full imple-
\nmentation of the Cypriot Law in relation to
\nthe physician profession, and on the other
\nhand on intensive cooperation and dialogue
\nwith the Cypriot Government and Parlia-
\nment. Moreover, the Cyprus Medical Asso-
\nciation buys services from a legal counsel and,
\nin close cooperation with him, the members
\nof the Law and Regulations Committee par-
\nticipate in open discussions at the Cypriot
\nParliament concerning healthcare issues.
\nThe financial interests of the CyMA mem-
\nbers are secured through the operation of
\ntwo Committees, the Trade-Union Com-
\nmittee for the Private sector and the Trade-
\nUnion Committee for the Public sector.The
\nTrade-Union Committee for the Private
\nsector organizes and coordinates all of the
\nlocal medical specialities boards and every
\ntwo years on behalf of its members negoti-
\nates with insurances companies and specific
\nemployers insurance funds the price of med-
\nical acts. It has to be noted that according to
\nRegional and NMA news
\n73
\nthe Cypriot Law all the bilateral contracts
\nare signed between each individual doctor
\nand the insurance companies. CyMA acts
\nas the representative of the physicians dur-
\ning the negotiations for the content of the
\nbilateral agreement.
\nSince the establishment of CyMA and until
\ntoday the Association has not organised a
\nstrike or rallies as there has been no need for
\nit. The main diachronic philosophy of the
\nAssociation is to maintain excellent rela-
\ntions with the state decision makers in order
\nto secure the interests of its members. Until
\ntoday, any problems the medical profession
\nhas been facing were resolved through dia-
\nlogue and lobbying.
\nNevertheless, CyMA supported a number
\nof strikes that were organised by the Union
\nof the Public Doctors aiming to improve
\ntheir rights at work. During those strikes
\nCyMA had a constructive role in the reso-
\nlution of the problems due to the strikes by
\ntransferring patients from the public to the
\nprivate sector.
\nAccording to the World Health Organiza-
\ntion, health care in Cyprus meets high stan-
\ndards. Today CyMA has a leading role and
\nsupports the creation and establishment of
\na National Health Plan that will combine
\nall the medical services from the private
\nand public sector. It will further improve
\nthe service provided to the patients of the
\nisland.
\nIntroduction
\nThe CPME spring meetings in Brussels on
\n3\u20135 May saw many new developments:
\nFirstly, the CPME together with the
\nECDC (European Centre for Disease
\nPrevention and Control) hold a joint con-
\nference on vaccination and prevention, en-
\ntitled: \u201cPrevention through Childhood Vac-
\ncination \u2013 Defining Doctors\u2019 Roles in the
\nStakeholder Debate\u201d.
\nOn the following day, at its Board meeting
\nin Brussels on 5 May 2012, the CPME ad-
\nopted policies concerning professional regu-
\nlation as well as public health which demon-
\nstrates the variety of health policy of interest
\nto the European Medical Profession.
\nThe General Assembly on the same day
\nelected the new Executive Committee for
\nthe period 2013\u20132015.
\nCPME\/ECDC conference
\non childhood vaccination
\nThe half day conference gathered together
\nspeakers from ECDC, WHO-Europe,
\nthe European Commission, M\u00e9decins du
\nMonde, the European Patients Forum and
\ndelegates from the National Medical Asso-
\nciations. European Doctors and policy mak-
\ners agreed that high quality, evidence-based
\ninformation and good communication be-
\ntween doctors and patients\/parents as well
\nas modern media tools are key for preven-
\ntion and form part of the recommendations
\nfor future policy actions and joint action. In
\nconclusion, it was stated that doctors should
\nengage more in supporting vaccination pro-
\ngrams for children. Special emphasis was
\nput on the importance of vaccination against
\nmeasles which is a condition for near eradi-
\ncation of this disease in the world.
\nOutcome of CPME\u2019s Board
\nand Executive Committee
\nmeeting in May 2012
\nProfessional Qualifications Directive
\nAs previously reported,the CPME is very ac-
\ntive on the revision of the professional quali-
\nfication directive (Dir.2005\/36 EC)1
\nto which
\n1 http:\/\/eurlex.europa.eu\/LexUriServ\/LexUriServ.
\ndo?uri=OJ:L:2005:255:0022:0142:en:PDF
\nthe Commission in December 2011 pub-
\nlished its proposal COM (2011) 883 final2
\n.
\nTheCPMEBoardendorsedtheamendments
\nof the Executive Committee to the Europe-
\nan Commission\u2019s proposal to revise the Pro-
\nfessional Qualification\u2019s Directive (PQD)3
\n.
\nThe main issues of concern in a nutshell
\nare that competent authorities must not be
\nrestricted in the capacity to grant recogni-
\ntion of qualifications; for the sake of legal
\ncertainty and patient safety \u201ctacit recogni-
\ntion\u201d cannot be accepted. Partial access (ac-
\ncess without fulfilling the minimum train-
\ning requirements) is not appropriate for the
\nmedical profession, otherwise patient safety
\nand quality of care is at high risk. While
\nalert mechanisms should apply to all health
\ncare professionals, data protection standards
\nand the principle of the presumption of in-
\nnocence must be respected. There should
\nbe no change to the minimum training re-
\nquirement of basic medical training as set
\nout in the current directive (stipulating 6
\nyears or 5500 hours) in order to safeguard
\nthe quality of the increasingly complex
\neducation and training. Initiatives to de-
\nvelop and elaborate the minimum training
\nrequirements must be driven by the medi-
\n2 http:\/\/ec.europa.eu\/internal_market\/qualifica-
\ntions\/docs\/policy_developments\/modernising\/
\nCOM2011_883_en.pdf
\n3 http:\/\/cpme.dyndns.org:591\/adopted\/2012\/
\nCPME_AD_EC_27032012_009_Final_EN.pdf
\nNews from the Standing Committee of
\nEuropean Doctors (CPME)
\nRegional and NMA news
\n74
\ncal profession, in particular the competent
\nauthorities.
\nDoctors\u2019 knowledge of the language must
\nbe sufficient to safely communicate with
\npatients as well as consult with their profes-
\nsional, regulatory, administrative and com-
\nmercial infrastructure. Language verifica-
\ntions shall not be used as barriers to mobility.
\nApart from its own amendments, the
\nCPME also adopted a draft statement on
\nPQD to be signed together with all main
\nEuropean Medical Organisations.
\nMedical devices
\nThe Board approved also a statement on
\nmedical devices1
\nin which CPME welcomes
\nthe statement of the European Health and
\nConsumer Policy Commissioner John Dalli
\nmade on 9 February 2012 where he called on
\nEU Member States for immediate action to
\nbe taken at national level to ensure full and
\nstringent implementation of the current legis-
\nlation on medical devices. Going further than
\nthis,CPME calls for legislation which follows
\nthe same principles as Pharmacovigilance,
\nsince medical devices have reached a degree of
\ncomplexity that easily compares with the one
\nin use in the pharmaceutical industry. Also, a
\ncentralised monitoring mechanism to ensure
\nthe highest safety standards of the notified
\nbodies across the EU is considered desirable.
\nAlcohol and Youth policy
\nThe new CPME statement reaffirms Euro-
\npean doctors\u2019 commitment to actively con-
\ntributing to the prevention of alcohol-related
\nharm to this vulnerable group. One of the
\nactions highlighted is the pro-active engage-
\nment with children and young people on the
\ntopic of alcohol. These \u2018brief interventions\u2019
\n1 http:\/\/cpme.dyndns.org:591\/database\/2012\/
\nEC_2012_026%20CPME.FOR.BOARD.
\nStatement.Medical.Devices.pdf
\nby doctors have been proven a highly effec-
\ntive tool in preventing harm. Also, doctors
\nup-hold their call for regulatory action to be
\ntaken both on maximum blood alcohol levels
\nfor drivers and on the advertising of alcohol
\nproducts. In addition, the statement address-
\nes the need for more effective enforcement
\nof legislation on alcohol sales to minors and
\nhighlights the importance of choosing a par-
\nticipatory approach in school-based training
\nprogrammes on alcohol related harm.
\nEthical and fair patents
\nAt its Executive Committee meeting on 3
\nMay, the CPME adopted a policy which
\ncalls for ethical and fair patents2
\n. While the
\nregulation implementing enhanced coop-
\neration in the area of the creation of unitary
\npatent protection is currently blocked in the
\nCouncil of Ministers,since there is no agree-
\nment as to whether the future European
\nPatent court shall be established in London,
\nMunich or Paris, in the view of European
\nDoctors a clearer defined exemption in the
\nregulation on the human genome is of high
\nimportance. Also, development as well as
\nfair pricing of new treatment should not be
\nimpeded by the regulation; otherwise health
\ncare itself will be endangered in the future.
\nNew CPME Executive
\nCommittee and Internal
\nAuditor for 2013\u20132015
\nThe CPME members at their General As-
\nsembly on 5 May 2012 elected the new
\nCPME Executive Committee 2013\u20132015
\n\u2022 CPME President:
\nDr. Katr\u00edn Fjeldsted
\nDr. Fjeldsted completed her general prac-
\ntice training in 1979 in London, United
\n2 http:\/\/cpme.dyndns.org:591\/database\/2012\/
\nEC_2012_053.Draft.CPME_Statement_Pat-
\nenting.Human.Genome.pdf
\nKingdom after receiving her Medical De-
\ngree from the University of Iceland in 1973.
\nShe has been a family physician at the Ef-
\nstaleiti Health Centre since 1980 and was
\nthe medical director from 1980 to 1982
\nand again from 1997 to 2003. She has fur-
\nthermore held inter alias the following of-
\nfices: Chairman of the Icelandic College
\nof Family Physicians 1995\u20131999, Member
\nof National Parliament from 1999\u20132003,
\nMember of the Icelandic parliamentary
\ndelegation to the United Nations General
\nAssembly in 1999 and 2000, CPME Vice
\nPresident for 2006\u20132007 and 2008\u20132009
\nand CPME Treasurer for 2010\u20132012. At
\nthe CPME General Assembly in May 2012,
\nDr. Fjeldsted was elected CPME President
\nfor 2013\u20132015.
\n\u2022 Vice-President 2013\u20132015:
\nDr. Heikki P\u00e4lve (Finland)
\n\u2022 Vice-President 2013\u20132015:
\nDr. Milan Kubek (Czech Republic)
\n\u2022 Vice-President 2013\u20132015:
\nDr. Jacques de Haller (Switzerland)
\n\u2022 Vice-President 2013\u20132015:
\nDr. Istvan \u00c9ger (Hungary)
\n\u2022 CPME Treasurer:
\nDr. Frank Ulrich Montgomery (Ger-
\nmany)
\n\u2022 CPME Immediate Past President:
\nDr. Konstanty Radziwill (Poland)
\nInternal Auditor
\nDr. Gordana Kalan-\u017div\u010dec (Slovenia) was
\nelected CPME Internal Auditor 2013\u2013
\n2015.
\nNext CPME general meetings
\nThe next CPME general meetings will take
\nplace in Limassol (Cyprus) on 23\u201324 No-
\nvember 2012.
\nDr. Konstanty Radziwill
\nCPME President
\nBirgit Beger
\nCPME Secretary General
\nRegional and NMA news
\n75
\nWMA newsCOUNTRY
\nEducated
\nHaughley Grange Stowmarket Suffolk IP
\n14 QT
\nBrentwood School
\nKings College,University of London (Vice-
\nPresident Union Society)
\nCharing Cross Hospital
\nLMSSA(Lond) 1950 MRCGP 1968: FR-
\nCGP 1988
\nOccupation
\nConsultant European Health Affairs
\nHon. Editor in Chief World Medical Jour-
\nnal 2004\u20132008,
\nHon. Co-Editor 2009\u20132012
\nJHO\/SHO Royal East Sussex Hospital
\n1950\u20131951
\nMedical Registrar Royal East Suffolk Hos-
\npital 1953
\nJunior Specialist in Pathology RAMC
\n(DADP War Office 1952\/1953) 2 I\/C No 1
\nBlood Transfusion Unit, (Reserve) RAMC
\n1993\u20131999)
\nMedical Registrar Hastings and Bexhill
\nGroup 1953\u20131954
\nGeneral Practitioner, Ixworth, Suffolk
\nl954\u20131988
\nHospital Practitioner Rheumatology & Re-
\nhabilitation
\nAddenbrooke\u2019s Hospital, Cambridge 1960\u2013
\n1986
\nConsultant DG V European Commission
\n1988\u20131992
\nAdviser in General Practice, Course Direc-
\ntor, European School of Oncology 1988\u2013
\n1998
\nSecretary Suffolk Local Medical Commit-
\ntee 1992\u20131996
\nFounding Editor Oncology in Practice
\n1991\u20131994
\nSecretary-General EFMA\/WHO 1984\u2013
\n2001 (see below)
\nConsultant WHO (see below)
\nTemp. Adviser WHO (see below)
\nHonours
\nOfficer of the British Empire (OBE) 1976
\nGold Medal Giornata Nazionale del Med-
\nico (Italy) 1978
\nHippocrates Medal (S.I.M.G.) 1986
\nFellow British Medical Association 1986
\nMedaille de M\u00e9rit\u00e9 Europ\u00e9en (Gold)1993
\nSilver (1988)
\nHon. Member Ordern dos Medicos (Por-
\ntugal) 1988
\nHartmann-Thieding Medal (Hartmann-
\nbund, Germany) 1988
\nHon.Specialist Clinica Geral (Portugal) 1988
\nVice-President, British Medical Associa-
\ntion 1998\u20132012
\nPapal Bene Merente Medal 1999
\nBereinstein Medal, Polish Medical Cham-
\nber 1999
\nEhrenzeichen der Deutschen \u00c4rzteschaft
\n(Medal of Merit of theGerman Medical
\nAssociation) 2000
\nHon Member: Medical Association of Ka-
\nzakhstan 2000
\nHon. Member: European Forum of Medi-
\ncal Associations &WHO 2001
\nHon Member: Romanian Medical Associa-
\ntion 2001
\nKaspar Roos Ehrenmedaille, NAV-Yir-
\nchowbundes 2002
\nMacedonian Medical Chamber for service
\nto Macedonia Health Services\u00a0\u2013 2004
\nAppointments
\n\u2022 Member Jury (National Secretary) Prix
\n\u201cEurope et Medecine\u201d 1992\u20132004
\n\u2022 Member of Livery, Worshipful Society of
\nApothecaries,
\n\u2022 Freeman of City of London
\nMedical Defence Union
\n\u2022 Member of Council, Medical Defence
\nUnion 1986\u20131996
\n\u2022 Member of Cases Committee 1986\u20131996
\n\u2022 Adviser on EEC 1980\u20131990
\nNational Health Service (UK)
\n\u2022 Member Executive (Health) Council,
\nWest Suffolk 1962\u2013
\n\u2022 Suffolk \u201cDHSS Best Buy Hospital\u201dPlan-
\nning Group
\n\u2022 Member Clothier Committee on Rural
\nDispensing (DHSS) 1979\u20131983
\n\u2022 Member of East Anglia Regional Health
\nAuthority (DHSS) 1974\u20131982
\n\u2022 Chairman Rural Practice Payments
\nCommittee 1980\u20131982 (DHSS)
\n\u2022 Member East Anglia RHA General
\nPractice Advisory Committee 1984\u20131988
\n\u2022 Member RHA\/Cambridge University
\nLiaison Committee
\n\u2022 Member General Practice Postgraduate
\nMedical Training Committee (RHA)
\n1987\u20131993
\n\u2022 Black Interprofessional Working Group
\non Data Protection and access to medical
\nrecords 1984\u20131990 Dept. Health & Soc.
\nServ. (DHSS)
\n\u2022 Member UK Council for Postgraduate
\nMedical Education 1978\u20131986
\n\u2022 Member C.M.O\u2019s (DHSS) Working
\nGroup on Specialist Training) (Liaison
\nwith EEC group) 1999
\nUK Government and European Parliament
\n\u2022 1975 Adviser to H. M. Government Op-
\nposition on Draft Doctors\u2019 Directives
\n(EEC\/75\/362\/363) on Mutual Recogni-
\ntion of Medical Qualifications
\n\u2022 Expert to H M Opposition Rapporteur,
\nHouse of Commons, Alan Tyrell
\n\u2022 Expert to Amedee Turner MEP Euro-
\npean Parliament Rapporteur on Directive
\nGeneral Practice (86\/457\/EEC) (see also
\nEuropean Community)
\nEurope
\nMedical Profession
\nChairman BMA Committee on European
\nEconomic Community (EEC) 1971\u201373,
\n1975\u20131990, (Vice-Chairman 1974\u20135).
\nStanding Committee of Doctors (CPME)
\n\u2022 Head of UK Delegation 1971\u20131990
\n(Observer 1968\u201371)
\n\u2022 Chairman \u201cHealth Professions\u201dCommit-
\ntee
\nIn memoriam Alan John Rowe
\n3 February 1926 \u2013 30 April 2012
\n76
\nWMA news COUNTRY
\n\u2022 Vice-Chairman Ethics Committee 1980\u2013
\n1985
\n\u2022 Member Juristes Committeel971\u20131990,
\nEducation Committee 1972\u20131990, So-
\ncial Security 1975\u201390 General Practice
\n(1971\u20131988)
\n\u2022 Rapporteur various topics including
\nPharmaceutical Directives, Liability for
\nDefective Products, Radiological Safety,
\nthe Elderly population in the EEC etc.
\n\u2022 UEMO Liaison Officer to CP (vide infra)
\nEuropean Union of General Practitioners
\n(UEMO)
\n\u2022 President 1982\u20131986 (adoption of EU
\nDirective Specific Training for General
\nPractice 1986)
\n\u2022 Head of UK delegation 1971\u20131990 (Ob-
\nserver 1969\u201371)
\n\u2022 Liaison Officer with the European Com-
\nmission, Council of Europe & the World
\nHealth Organisation (1972\u20131982; 1986\u2013
\n1990), Standing Committee of Doctors
\nof EEC 1974\u2013 1982;1986\u20131990
\n\u2022 Chairman various working groups
\nEuropean Community (EU)
\nEuropean Commission
\n\u2022 Consultant DGV 1988\u20131992); (Europe
\nagainst Cancer Programme);
\n\u2022 Member GP Organisations\u2019 Representa-
\ntives Group DGV 1992\u2013 98;
\n\u2022 Member Advisory Committee on Medi-
\ncal Training (ACMT) 1983\u201393: Chair-
\nman Working Group \u201cACMT visiting
\nsystem for Medical Schools & Faculties\u201d
\n\u2022 Consultant Europe against Cancer Gen-
\neral Practice Strategy 1994
\nAIM Programme DGXIII
\n\u2022 Member of Committee on \u201cComputer
\nSecurity and Legal issues in Medical In-
\nformation\u201d
\n\u2022 Presentation on Medical Confidentiality\u201d
\nAIM European
\n\u2022 Parliamentary Hearing on Confidential-
\nity 1989
\nEconomic and Social Committee (EEC)
\n\u2022 Rapporteur\u2019s Expert various health top-
\nics\u00a0\u2013 consolidation of directives on mutual
\nrecognition of professional qualifications,
\nproduct liability, Drug consumption etc.
\nEuropean Parliament
\n\u2022 Consultant to Rapporteur (Amedee
\nTurner EMP) on G. P. Directive (457\/86
\nEC) 1985\u201386
\nWorld Health Organisation
\n\u2022 General Secretary, European Forum of
\nMedical Associations & WHO 1991\u2013
\n2001, Secretary General 1984\u20131991
\n\u2022 Organisation of Oncology Services (Pri-
\nmary Care) in Bulgaria
\n\u2022 Consultant: Health Professionals\u2019 recogni-
\ntion,licensing&regulationinKosovo(1999)
\n\u2022 Consultant-Organisation of PHC On-
\ncology Services in Bulgaria
\n\u2022 Consultant\u00a0\u2013 Relations between WHO &
\nHealth Professions NGOs (Geneva\u00a0\u2013 2000)
\n\u2022 Consultant\u00a0 \u2013 Regulation and Licensing
\nof Physicians in Europe 2001\u20132002 (see
\nbibiliography 46)
\n\u2022 Temporary Adviser\u00a0\u2013 various topics, CIN-
\nDI, Appropriate Health Care Technology,
\nGeneral Practice,CME,Cancer Prevention
\nand Control, Tobacco Control(various),
\nYouth & Alcohol, Inter-ministerial Con-
\nference on Tobacco 2001, Family Medi-
\ncine\/GP- definition and future develop-
\nment,Patient empowerment,etc.
\n\u2022 Member European Tobacco Partnership
\nGroup EURO 1998\u20132002
\n\u2022 Inter-Ministerial Conf. Tobacco and
\nHealth, \u201cDoctors and Tobacco\u201d Work-
\nshop, Stockholm, Sweden
\n\u2022 Consultant TCRC Symposium (E. U.,
\nWHO TCRC.) Edinburgh 2004
\nOther European
\n\u2022 Director European Seminars on Specific
\nTraining for General Practice (Oncology)
\nSEMG Florence 1993
\n\u2022 Director European Seminars on Specific
\nTraining for General Practice-Florence
\n1994 (Eng\/Fr)
\n\u2022 Director ESO\/EEC French and English
\nWorkshops for GP Trainers on Oncology
\nin General Practice Training-Venice, Orta,
\nFlorence, Coimbra, Antwerp. 1990\u201396
\n\u2022 Consultant Workshop Primary Preven-
\ntion of Cancer in Genffi\u00aek Practice, Uni-
\nversity of Southampton 1993
\n\u2022 BIS\/World Bank Consultant on Reform
\nof Health Care Law- Macedonia 2001\u2013
\n2002.
\nBritish Medical Association
\n\u2022 Vice-President 1997\u20132012
\n\u2022 Fellow 1988
\n\u2022 Member of BMA Council 1971\u20131990
\n\u2022 Past President Suffolk Branch
\n\u2022 Past President West Suffolk Division
\n\u2022 Chairman East Anglian Regional Council
\n\u2022 Chairman EEC Committee 1971\u20131974,
\n1976\u20131990 (vice-chairman1975\u20131976)
\n\u2022 Member Central Ethical Committee
\n1971\u20131990 (vice-chairman 1978\u20131990)
\n\u2022 Chair Working Party and contributor
\nHandbook of Medical Ethics (1984\u2013
\n1988)
\n\u2022 Member(Chair) BMA\/Life Offices Assn.
\nCommittee
\n\u2022 Member General Medical Services
\nCommittee 1965\u20131990 (Negotiator
\n1968\u20131973)
\n\u2022 Chairman Rural Practices Committee
\nUK 1968\u20131974
\n\u2022 Chairman ABPI\/BMA Liaison Com-
\nmittee 1986\u20131990
\n\u2022 Member:
\nHealth Services Financing Advisory Pan-
\nel 1967\u20131970; Review Body Joint Evi-
\ndence Committee 1968\u20131973; Medicines\u2019
\nLegislation Working Party (Tunbridge)
\n1968\u20131970; In-vitro Fertilisation Commit-
\ntee: various, other committees and work-
\ning parties; National Joint Committee on
\nDispensing (BMA\/R Pharm Soc); Clothier
\nCommittee on Rural Dispensing; GMS
\nEducation Committee
\n\u2022 Member Interprofessional Working
\nGroup on Access to Personal Health
\nInformation Black Committee (Dept..
\nof Health\/BMA) Chairman Handbook
\nWorking Party \u201cPhilosophy & Practice of
\nMedical Ethics\u201d\u00a0\u2013 BMA 1988
\n\u2022 BMA representative Presidency of Pro-
\nfessions 1976, 1979, 1980
\n\u2022 Founding Member Board,Tobacco Con-
\ntrol Resource Centre 1997\u20132012
\n\u2022 Consultant 2002\u20132005 (Editorial body
\n\u201cDoctors and Tobacco\u201d 2004\u20132005
\n77
\nWMA newsCOUNTRY
\nRoyal College of General
\nPractitioners
\n\u2022 Fellow 1982
\n\u2022 Observer on Council
\n\u2022 Member of GMSC\/RCGP Liaison Com-
\nmittee
\n\u2022 UK Representative, European Commis-
\nsion. \u201cEurope against Cancer\u201d
\n\u2022 GP committee 1994\u201395
\nWorld Medical Association
\n\u2022 HonEditorWorldMedicalJournal2003\u2013
\n2008
\n\u2022 Member BMA delegation General As-
\nsemblies Honolulu, Venice, Lisbon, Ma-
\ndrid:
\n\u2022 EFMA\/WHO Observer General As-
\nsembly, Edinburgh, Hamburg, Helsinki;
\n\u2022 Observer various Council meetings
\n\u2022 Expert Adviser Ethics Committee
\n\u2022 Past Chairman Associates Group
\nOther
\n\u2022 Member Interprofessional Group on
\nEEC (Law Society) 1978\u20131982
\n\u2022 World Congress on Medical Law 1979
\n\u2022 Member of UK Cancer Co-ordinating
\nCommittee,EuropeagainstCancer1994\u2013
\n2002
\n\u2022 Member of Council, Queen\u2019s Institute of
\nDistrict Nursing
\n\u2022 Member of Advisory Group on SEN
\nrole in local authority nursing services
\n(Q.I.D.N)
\n\u2022 Member Advisory Panel, Association of
\nOccupational Therapists 1989\u20131991
\n\u2022 Member of Jury (UK National Secretary)
\n\u201cPrix Medicine Europeene\u201d (Institut Sci-
\nences de la Sante) Paris 1980\u20132005
\n\u2022 Member of Livery, Worshipful Society of
\nApothecaries of London. Freeman City
\nof London
\nSocieties
\n\u2022 Ethics in Health Care Forum
\n\u2022 Medico-Legal Society
\n\u2022 Fellow Royal Society of Medicine
\n\u2022 Past Fellow Royal Society Tropical Medi-
\ncine and Hygiene
\nPublications\/Reports\/Lectures
\n\u2022 EpidemicHaemorrhagic Fever Lancet,
\nNov 15, 980.1952
\n\u2022 Memorandum on Immunological Proce-
\ndures (edit)\u00a0\u2013 HMSO (1953)
\n\u2022 Epidemic Haemorrhagic Fever\u00a0\u2013 R.Soc.
\nTrop.Med.& Hyg 1953
\n\u2022 \u201cImplications for general practice of Brit-
\nain\u2019s entering the Common Market\u201d,
\nBMA Junior Members Forum, Cam-
\nbridge 1971, BMA
\n\u2022 \u201cGeneral Practice and the Common Mar-
\nket\u201d, Proc.Roy.Soc.Med. 65,927\u20139,1972
\n\u2022 \u201cPsychosomatic factor in Rheumatoid Ar-
\nthritis\u201dThe Practitioner 1972,208,81\u201385
\n\u2022 \u201cLibre Circulation des M\u00e9decins\u201d\u00a0\u2013 Ca-
\nhiers de Droit Europ\u00e9ene 1976 Nos
\n5\u20136,733\u201366
\n\u2022 \u201cThe EEC Commission,Health and Med-
\nicine\u00a0\u2013 a new Directorate General for Yt-
\nedX\u00d9f!\u201d.summary in BMJ 1977,12th
\nMarch
\n\u2022 \u201cInstitutions of the European Communi-
\nty & Occupational Health\u201dRoyal Society
\nof Medicine 1977
\n\u2022 \u201cCollaboration and cooperation between
\nthe professions in the EEC\u201dInternational
\nSeminar \u201cBackground to nursing in the
\nEEC\u201dRoyal College of Nursing,UK 1977
\n\u2022 \u201cFormazione complementare del medico
\ngenerico nel Paesi d\u00e9lia CEE\u201d Inter-
\nnational Conference \u201cEuropa Bianco\u201d,
\nFNOOM, Naples, 20 May 1978
\n\u2022 \u201cPrimary health care in Europe\u201d\u00a0\u2013 Bristol
\nPostgraduate Centre 1978
\n\u2022 \u201cLocal Ethics Research Committees\u201d
\nRutgers University USA1979
\n\u2022 \u201cProblems of Ethics & Research\u00a0\u2013 Local
\nEthical Research Committees\u201d. National
\nAcademy of Medical Sciences, Washing-
\nton, DC, US A, April 3rd
\n1980
\n\u2022 Local Ethical Research Committees
\n\u201cPresentation\u201d Institutional Review
\nBoards Symposium-Rutgers University,
\nUSA, 11 April 1980.
\n\u2022 \u201cWhy Social Policy in the EEC?\u201d Wil-
\nson School of Political Science, Princeton
\nUniversity, USA
\n\u2022 \u201cThe UK National Health Service\u201d,Hast-
\nings on Hudson Ethics Centre USA,^10
\nApril 1980
\n\u2022 \u201cMedicina General y Salud Publica en
\nEuropa\u201d Congresso Nacional de Medi-
\ncos Titulares Espagnole, Torremolinos.
\nSpain. 1988
\n\u2022 \u201cQuelle v\u00e9rit\u00e9 faut il dire au malade?\u201d\u00a0\u2013
\nLigue Nationale Fran\u00e7aise contre le Can-
\ncer, Paris, 1983
\n\u2022 \u201dTechnological, Scientific Progress and
\nHuman Rights: Genetic Engineering\u201d
\nWMJ 31,25-26,1984\u201d
\n\u2022 \u201cFormation continue aux Royaumme
\nUni\u201d Europe Blanche, Inst des Sciences
\nde la Sant\u00e9, Paris 1985
\n\u2022 \u201cRole et Formation Sp\u00e9cifique du Mede-
\ncin Generaliste selon le le CEE\u00a0\u2013 Col-
\nloque International de l\u2019Universite de
\nBobigny, Paris.
\n\u2022 \u201cL\u2019organisation de la formation Medical
\nContinue\u00a0\u2013 Angleterre\u201d l\u2019Institut des Sci-
\nences de la Sant\u00e9, Paris 1986
\n\u2022 \u201cContinuing Medical Education in the
\nUnited Kingdom\u201d, Europe Blanche (Par-
\nis) 1988.
\n\u2022 \u201cLa jurisdiction professionelle en Grand
\nBretagne\u201d\u00a0\u2013 Colloque \u201cOrdre des M\u00e9de-
\ncins et son devenir\u201d, Ordre des M\u00e9decins,
\nOct 1981
\n\u2022 \u201cHealth and the European Community\u201d
\nWHO (EUR\/ICP\/ Cor.010103) 1986
\n\u2022 \u201cRaising Standards through Common
\nAction\u00a0\u2013 The Battle for Health\u201d The Eu-
\nropean, 1 No 6,1987
\n\u2022 \u201cLes syst\u00e8mes de Soins \u00e9trangers\u201d\u00a0 \u2013
\nPays du Nord-Syst\u00e8mes Nationalis\u00e9es\u201d
\nl\u2019Institut d\u2019\u00c9tudes Politiques, Paris, 1991
\n\u2022 \u201cThe EEC and the Internal Market in
\nMedicine\u201d, Postgraduate Centre, Col-
\nchester, 1991
\n\u2022 Europe against Cancer\u00a0\u2013 the role of gen-
\neral Practitioners. Europe Social, Euro-
\npean Communities 1\/1991
\n\u2022 \u201cThe EEC and Medicine\u201d\u00a0 \u2013 European
\nSociety of Parkinsons Organisations,
\nGlasgow 1991
\n\u2022 \u201cSpecific Training in Family Medicine
\nand the European CommunityHealth
\nServices\u201d\u00a0\u2013 Ministry of Health Sympo-
\nsium, Madrid 1991
\n\u2022 \u201cRole of G. P\u2019s in Female Cancer Screen-
\ning\u201d\u00a0\u2013 SIMG\/EEC Florence 1991
\n78
\nWMA news COUNTRY
\n\u2022 \u201cMedicine in the European Union and
\nGreater Europe\u201d\u2013 Hertford Postgraduate
\nCentre 1991
\n\u2022 \u201cOverview of EEC Professional Direc-
\ntives\u201d in Standards of Excellence (Health
\nCare delivery in the European Commu-
\nnity) NHS Training Directorate. 1992
\n\u2022 \u201cLa Medicine de Famille dans les Pays du
\nNord\u201d\u00a0\u2013 l\u2019Institut d\u2019\u00c9tudes Sciences Poli-
\ntiques, Paris 1993.
\n\u2022 \u201cRegard sur d\u2019autres syst\u00e8mes de sant\u00e9\u00a0\u2013
\nSysteme de Sant\u00e9 Anglais\u201d l\u2019Institut
\nd\u2019Etudes Politiques Paris 20 June 1993
\n\u2022 \u201cHealth and the European Commu-
\nnity\u201d\u00a0 \u2013 EFMA\/WHO Meeting 1988-
\nWHO Copenhagen E 65564 pp 67\u201370
\n\u2022 \u201cEurope against Cancer Programme\u00a0\u2013 an
\noverview\u201d UEMO Handbook 199
\n\u2022 Reports of Annual meetings of Eu-
\nropean Forum of Medical Associa-
\ntions and the World Health Organisa-
\ntion, 1986,1987,1988, 1990,1991,1992,
\n1993,1994, 1995,1996, 1997, 1998,1999,
\n2000, 2001\u00a0\u2013 WHO European Regional
\nOffice\/ICP\/EXM 019
\n\u2022 \u201cLe Cancer et les styles de vie\u201d\u00a0\u2013 III ieme
\nCours Europ\u00e9en d\u2019Oncologie pour les
\nMaitres de Stage M\u00e9decins Generali-
\nstes\u00a0\u2013 Univ. Coimbra 1995
\n\u2022 \u201cEurope against Cancer GP Strategy\u201d
\nUEMO Handbook 1999,115\u2013118
\n\u2022 \u201cThe General Practice Directive 86\/457\/
\nEEC\u00a0 \u2013 the end of 30 years struggle?\u201d
\nUEMO Handbook Kensington Publica-
\ntions 1994
\n\u2022 \u201cCore content of cancer in specific train-
\ning for general practice\u201d\u00a0\u2013 Proceedings of
\nConsensus Conference on cancer train-
\ning for General Practitioners Copenha-
\ngen 1991 EEC\/UEMO
\n\u2022 \u201cRole of General Practitioners in Tobacco
\nControl\u201d\u00a0\u2013 Europe against Cancer, Ath-
\nens 1992
\n\u2022 \u201cCancer\u201d, UEMO Handbook, Kensing-
\nton Publications 1993
\n\u2022 \u201cPrimary and Secondary Cancer Preven-
\ntion in General Practice\u201d\u00a0 \u2013 European
\nCommission Symposium, Brussels 1990
\n\u2022 \u201cMedical Education in the EEC\u201d\u00a0\u2013 Karo-
\nlinska Managers\u00a0\u2013 Univ. Sussex 1982
\n\u2022 \u201cMedicine and the EEC\u201d Karolinska
\nManagers\u00a0\u2013 Univ. Sussex 1983
\n\u2022 \u201cLes Personnes Ag\u00e9es dans la Commu-
\nnaut\u00e9 Europ\u00e9ene\u00a0 \u2013 present et l\u2019avenir\u201d\u2013
\nBonnel, Hennigan & Rowe IPSEN 1990
\n\u2022 \u201cEurope against cancer\u00a0\u2013 the role of general
\npractitioners\u201d\u00a0\u2013 Social Europe 1\/91,p94\u201395.
\nEuropean Commission ISSN 0255-9776
\n\u2022 \u201cEuropean Code against Cancer\u00a0 \u2013 a
\nbooklet for general practitioners\u201d Scand.
\nJ. Prim. Health Care 1994 Suppl. 1 (and
\n3M first version of Code) 1993)
\n\u2022 \u201cTitle IV of the E.U. Council Directive:
\nSpecific training in General Medical
\nPractice\u201dUEMO Handbook, Kensington
\nPublications l995
\n\u2022 \u201cDispensing of Medicines by General
\nPractitioners\u201d\u00a0 \u2013 an overview of trends
\nin the European Union\u00a0\u2013 Austrian Arz-
\ntekammer, Vienna-1995
\n\u2022 \u201cThe European Medical Profession\u00a0 \u2013
\nproblems, challenges and opportunities
\nat the beginning of the 21st
\ncentury.\u201d Bull
\n2\/02 Soci\u00e9t\u00e9 des Sciences M\u00e9dicales du
\nGrand-Duche de Luxembourg 2002.p
\n\u2022 \u201cEuropean Legislation\u201d in \u201cThe Law and
\nGeneral Practice\u201d 1992, Radcliffe Press.
\n\u2022 \u201cInternational Partnerships for Health\u201d,
\nWHO address General Assembly, Polish
\nMedical Chamber, Warsaw 1997
\n\u2022 Editorials in World Medical Journal
\n50 (1\u20134), 2004, 51 (l\u20134)\u20132005,52 (1\u20134),
\n2006, 5J-(1\u20134), 2007.
\n\u2022 Licensing and Regulation of Physicians in
\ntheWHOWorld Health European Region
\nCopenhagen. EUR\/05\/5051794C 2005
\n\u2022 Licensing and Regulation of Physicians
\nEuroMed, Barcelona 2005
\n\u2022 Handbook European Forum of National
\nMedical Associations & WHO(Rowe &
\nVigen) 1981\u20132001
\n\u2022 Clinica Geral, 1985
\nOther activities
\nKings College, University of London Vice
\nPresident Union Society
\nMusic
\n\u2022 Organist St Michael\u2019s Church, Gidea
\nPark 1941\u20131944
\n\u2022 Organ Scholar, Kings College, London,
\n1945\u20131947, President and Conductor
\n\u2022 Music & Dramatic Society
\n\u2022 Sub-Organist St. Martins in the Fields
\n1947\u20131950
\n\u2022 Organ recitals in UK & abroad, includ-
\ning, St. David\u2019s Cathedral, St. Margaret\u2019s
\nWestminster, Oude Kirke Amsterdam,
\nBasilica Wilten, Innsbrook, St., Inns-
\nbrook, Cathedrals in Santiago da Com-
\npostella, Toledo and Lisbon, San\u2019 Gior-
\ngio Basilica Venice, Wilten Innsbruck
\nBasilica, Du PresConcert Hall Meudon,
\nParis:, Ljubljana and Chapel, Princeton
\nUniversity
\nHarpsichord \/Organ Continuo
\n\u2022 Ipswich Bach Choir-harpsichord con-
\ntinuo Bach Matthew & John Passions,
\nChristmas Oratorio, Magnificat, Mozart
\nRequiem, Monteverdi Vespers
\n\u2022 Cheltenham Bach Choir-harpsichord
\n& organ continuo (Christmas Oratorio)
\nKidderminster Bach Choir-harpsichord
\ncontinuo
\n\u2022 Eye Bach Choir-organ continuo
\nHaydn\u201dSpazen Messe\u201d,\u201cMesse de Minu-
\nit, Messiah. (many) Clerambaut etc.
\n\u2022 Various orchestral works Handel\u2019 Messi-
\nah, Israel in Egypt, Hoist Hymn of Jesus
\n\u2022 Organist Gustav Holst Centenary Me-
\nmorial Service Aldborough with Aldbor-
\nough Festival Choir.
\n\u2022 Holst Hymn of Jesus,(keyboard) St Mar-
\ntin in the Field
\nConducting
\n\u2022 Appointed conductor Ipswich Orchestral
\nsociety
\n\u2022 Other conducting Handel, Acis and
\nGalatea, J. S, Bach B minor Mass, Haydn
\nHarpsichord concerto in D, etc.. Cantata
\n51, Mozart 12th
\nMass and Mozart Re-
\nquiem, Haydn \u201cNelson\u201d, \u201cHarmonie\u201d and
\n\u201cSparrow\u201d Masses, Schultz Passion etc.
\nVaughan Williams Coronation Te Deum
\n\u2022 Director of Music St Edmunds Church,
\nBury St. Edmunds 1958\u20131993
\n\u2022 Organist l958\u20132011
\n79
\nMedical profession
\n(WMJ 2007, Vol 53. Nr 1)
\nWherever one looks the medical profes-
\nsion it seems to be facing more and more
\nproblems despite, or sometimes due to,
\nadvances in medical science and their in-
\ntroduction into medical practice. They
\nrange from the global problems of human
\nresources and health professionals includ-
\ning physicians, inequities in their distribu-
\ntion across the world, continuing efforts to
\nmaintain standards for professional prac-
\ntice and ensuring maximum patient safety,
\nthe changing face of medical practice with
\nincreasing emphasis on prevention, huge
\nincreases in the intrusion of management
\nand administrative bureaucracy associated
\nwith medical practice both in hospitals and
\nthe communities.
\nAs these problems are addressed, it is vital
\nthat the profession in each country is seen
\nto have considered them and prepared its
\nown position, rather than reacting to short
\nterm policies proposed by others which
\nmay be neither in the best interests of the
\ncommunity, of individuals, or of the pro-
\nfession.
\nThe contents of this issue of WMJ reflects
\nthe diversity of both the positive develop-
\nments in medicine, science and in disease
\ncontrol, strategic plans and health policy
\ndevelopments, as well as some of the prob-
\nlems which still need to be solved.
\nIt includes some further WMA policy state-
\nments,one of which,that on medical educa-
\ntion, is also the subject of a report on a new
\nstrategic partnership between the World
\nHealth Organisation and the World Fed-
\neration of Medical Education. There is also
\na report on the first meeting of the Task-
\nforce of the Global Health Workforce Al-
\nliance (GHWA) to seek practical solutions
\nto the health workforce problems, including
\ninvestment in education and training of all
\nhealthcare workers. The WMA Secretary
\nGeneral comments on one particular effort
\nseeking to persuade physicians who have
\nemigrated to return to practice in their own
\ncountry where there is a grave shortage of
\nphysicians. Another article addresses the
\nproblems of medical research ethics posing
\na question as to whether or not there are
\nlimits to the possible har- monisation of ac-
\ntivities of ethical research committees. Two
\npapers given at the WMA scientific meet-
\ning in South Africa address the important
\ntopic of \u201cHealth as an investment\u201d
\nIn the context of the problems of shortage
\nof physicians it is interesting to note the
\nresults of a ten year cohort study of 545 of
\ndoctors who graduated in one country in
\n1995 1
\n. Of approximately 1400 of the final
\nyear students who expressed willingness to
\nparticipate in the survey, a sample of 600
\nwere drawn and of these 545 participated
\nin the questionnaire which was sent to all
\nparticipants each year for ten years. This
\nwas combined with focus groups which
\nwere random sub-samples each year, where
\nquestions could be more deeply examined.
\nApart from information on type of work,
\ncareer choice and training, questions were
\nasked about working conditions and about
\nparticipants\u2019 attitudes to medicine as a ca-
\nreer, in the light of their experience year by
\nyear.
\nWhile all the results of this study are inter-
\nesting, as will be those of the next ten year
\ncohort study, in the context of the debate
\non human health resources (particularly re-
\ncruitment and retention of physicians), it is
\ninteresting to note that in this study
\n\u2022 2 in every 5 doctors in the cohort study
\n(40%) found that the reality of a career
\n1 BMA Cohort Study W report 2005
\nin medicine was very different from that
\nenvisaged on graduation in 1995;
\n\u2022 While three quarters (75%) of the co-
\nhort doctors ten years after graduating
\nwere satisfied with practising medicine, a
\nfifth (20%) reported a lukewarm desire to
\npractice medicine.
\n\u2022 The rest (5%) had little or no desire to
\npractise medicine. (3% of the cohort had
\nleft medicine during the 10 years of the
\nstudy, the most common reason being
\ndissatisfaction with medicine as a career.
\n\u2022 15% had changed their career choice dur-
\ning the study period, a key factor in this
\nbeing \u201chours of work and working con-
\nditions\u201d followed by working\/pay condi-
\ntions.
\nWhile these findings are disturbing (20%
\nhaving a weak desire to practice medicine
\nafter 10 years), when planning to educate
\nmore physicians to meet needs it is unfor-
\ntunate that no other countries have carried
\nout comparable extensive cohort studies.
\nIf the profession is to address its future in
\nthe light of the problems it faces, then such
\nstudies could contribute valuable informa-
\ntion in the formulation of such plans.
\nMedical professionalism
\n(WMJ 2007, Vol 53. Nr 3)
\nThe second half of the 20th
\ncentury and
\nthe beginning of this one have experienced
\nunprecedented and ever increasing rapid-
\nity of technological development, scientific
\ndiscovery, research and the production of
\ninnovative diagnostic tools and therapeu-
\ntic agents. All have had enormous impact
\non medical practice, some have posed ma-
\njor ethical problems and \u2013 not to be disre-
\ngarded\u00a0 \u2013 increased public expectations of
\nscientific discoveries and their application
\nin medicine, together with calls for, and
\nthe need of consequent changes in medical
\npractice.
\nIn parallel, the huge expansion in the avail-
\nability and accessibility of information
\nPublications by Alan J. Rowe in WMJ
\nIn Memoriam
\n80
\nabout medicine, medicines and medical
\nresearch through the growth of communi-
\ncation via the mass media and IT develop-
\nment, has played a major role in changes
\ntaking place in the organisation and the
\nconduct of medical practice. At the same
\ntime it has also, through the instant avail-
\nability on information via the media (both
\nTV and the web) supplied compelling in-
\nformation about the increasing instances
\nof natural disasters and their consequences.
\nThe instant availability of information has
\nalso highlighted to a wider public the prob-
\nlems of disparity in the provision of health
\ncare in differing parts of the world.The im-
\npact of information about the incidence of
\ninfectious diseases and the reality of the role
\nof poverty in disease, relayed through media
\nreadily accessible in the home, conveys an
\neven more realistic and compelling image of
\ncatastrophes, diseases and poverty, than that
\npreviously available through the spoken or
\nwritten word.
\nThe impact of these developments has had
\nsubstantial political, social and economic
\neffects in both developed and developing
\ncountries, leading to consequent changes
\nin medical practice and its organisation, as
\nwell as challenges to the nature of the role
\nof physicians in health care.
\nThese developments have had far reach-
\ning impacts on the medical profession, in-
\ncluding effects on basic medical education,
\npostgraduate education, licensing and regu-
\nlation,continuing professional development
\nand re-accreditation,not to mention the na-
\nture of health care and the delivery of medi-
\ncal care. All of this has been accompanied
\nby the increasing burden of administrative,
\nmanagerial functions and economic con-
\nstraints.
\nOn a number of occasions in these columns
\nwe have commented on these trends, the
\nchallenges which they are producing and
\nthe increasing need for the medical profes-
\nsion to address them. Indeed, some of the
\nissues have already been addressed in vari-
\nous parts of the world1,2
\n, and a Charter3
\nen-
\ndorsed by a number of organisations in at
\nleast 28 countries.
\nAt its next meeting in October, the WMA
\nCouncil will be considering these issues
\nand with this in mind , the current issue
\nof WMJ is substantially devoted to a pa-
\nper on the issue of Medical Professional-
\nism, in particular the role of the National
\nMedical Associations. As will be seen, this
\npaper highlights important problems which
\nshould be considered urgently by individual
\nphysicians in whatever aspect of medical
\npractice as well as NMA\u2019s.
\nThe inclusion of this substantial paper has
\nsubstantial constraints on the normal contents
\nof the journal which we will include in the
\nnext issue. While this topic has already been
\naddressed in some parts of the world,we hope
\nthat it will stimulate further debate and con-
\ntribute, to a clear-affirmation of the qualities
\nof medical professionalism in the 21st
\ncentury.
\nThe challenge to medical care
\n(WMJ 2007, vol 53 Nr. 4)
\nThe Tobacco Control Resource Centre, a
\nresource supported by the British Medi-
\ncal Association, the European Commis-
\nsion and the European Regional Office of
\nthe World Health Organisation, published
\nin 2000 a report in the context of Tobacco
\nControl Programme under the title \u201cTo-
\nbacco \u2013 Medicine\u2019s Big Challenge.\u201d Now at
\nthe end of 2007, while Tobacco remains a
\nproblem and the great scourges of disease
\n1 Royal College of Physicians \u201cDoctors\u2019 in Society:
\nMedical Professionalism in a changing World.
\nReport of a Working Party of the Royal College
\nof Physicians, London: RCP 2005
\n2 Rosen R, Dewar S., On being a doctor Medical
\nProfessionalism in a changing world Kings Fund
\nPublications 2004
\n3 Medical Professional Project. Medical Profes-
\nsionalism in the new millennium. A physician
\ncharter. Ann. Intern. Med 2002 136 (3) 243-246
\nstill challenge medicine, a huge challenge
\n(possibly \u201cThe Challenge\u201d for the medical
\nprofession) faces the health professionals
\nproviding medical care, namely the problem
\nof the supply and distribution of health care
\nworkers. The 2006 World Health Report of
\nWHO4
\nhighlighted the problem, notably
\nthe huge discrepancies in the distribution
\nof Physicians, Dentists, Nurses, Midwives
\nand other Health care workers, not only
\nwithin countries but more significantly be-
\ntween countries. Scientific advances have
\nmade great contributions in our knowledge
\nof the nature and causes of many diseases,
\naccompanied by discovery and development
\nof many new drugs to cure or ameliorate the
\neffects of disease.All of these call for increas-
\ning skills and increased demands on all sec-
\ntors of the medical workforce in developed
\ncountries It places increased demands on
\nthe sparse, sometimes almost non-existent
\nsupply of health care workers in underdevel-
\noped countries,where healthcare was already
\nminimal, obstructing any implementation of
\nadvances in healthcare available elsewhere.
\nHitherto the limited attempts to address
\nmanpower problems in the healthcare work-
\nforce had, unsurprisingly, concentrated on
\nworkforce problems within national health
\ncare systems, substantially disregarding the
\nhuge disparities between countries, regions
\nand even continents. At the same time con-
\ncern has been expressed by both the profes-
\nsion and by some other authorities about the
\nrecruiting of physicians in developed coun-
\ntries from developing countries who are al-
\nready under-doctored, Codes of practice and
\nstatements of policy to change this have been
\nissued by the World Medical Association5
\nand by some governments and authorities.
\nWhile a great tribute should be paid to those
\norganisations and governments who, in one
\nway or another have, over many years, en-
\n4 \u201cWorking together for health\u201d The World Health
\nReport 2006 WHO,Geneva,ISBN 92-4-156317-6
\n5 WMA Statement on Ethical Guidelines for the
\nRecruitment of Physicians, Helsinki 2003
\nIn Memoriam
\ncouraged the provision of doctors, nurses and
\nother medical assistance to those countries in
\nneed, and to those health professionals who
\nundertook to meet the needs,it was effectively
\nonly with the arrival of HIV\/AIDS and,more
\nrecently the risk of pandemic disease, coupled
\nwith increasing political awareness of the need
\nto deal with poverty, inequity and human
\nrights, that the need to address the problems
\nassociated with the global health workforce
\nhave been forced to the forefront of discussion.
\nIn previous editorials in the World Medical
\nJournal, WMJ 52 (1) and (2) we have drawn
\nattention to emerging trends not only in the
\nchanging or expanding role of individual
\nhealth professions, but also to problems of
\ntraining, mobility and availability of health
\nprofessionals. Further problems complicat-
\ning the whole issue relate to the changes in
\nrole and functions of health professionals,
\nreflecting not only the increasing aspira-
\ntions of the individual health professional,
\nbut also the increasing specialisation within
\nindividual health professions.
\nIn the first part of 2008 at least two con-
\nferences will address some of the issues
\ninvolved. The first is a World Health Or-
\nganisation Global Conference to be held
\nin Addis Ababa Ethiopia in January 2008,
\nwhen the conference will address the topic
\nof Task Shifting. \u201cTask Shifting\u201d is de-
\nfined in a number of WHO documents as
\n\u201cthe name given to a process of delegation
\nwhereby tasks are moved, where appropri-
\nate, to less specialised health workers\u201d.
\nThe second conference, organised by the
\nWorld Health Professions Alliance in the
\nweek preceding the WHO Assembly, is the
\nFirst World Conference the Role and Reg-
\nulation of Health Professions which will be
\nheld in Geneva. Both Conferences are of
\nhuge importance in relation to the provi-
\nsion of health care across the globe in both
\ndeveloped and developing countries.
\nThe conferences have great relevance to
\nthe future role and functions of the Medi-
\ncal Profession. Whereas previously, physi-
\ncians, when recognised for full registration
\nas a medical practitioner, held the sole li-
\ncence to carry out certain specific acts such
\nas the right to prescribe and to engage in
\nthe practice of medicine, in an increasingly
\nsophisticated and technical world it is clear
\nthat some of these reserved functions can
\nbe carried out by other health professionals
\nunder regulation, after appropriate techni-
\ncal specialist training. This has substantial
\nimplications for changes in the protected
\nrole that physicians have previously held
\nin certain areas, while possibly calling for
\nnew roles in other areas, essentially calling
\nfor a reassessment of the role and functions
\nof physicians in society. In some countries
\nsuch changes have already occurred in areas
\nsuch as the extension of limited prescribing
\nrights to other health professionals such as
\nnurses, and extending the acts carried out
\nby other health professionals By enhancing
\nthe role of some health professionals, such
\nchanges increase the provision of certain
\nhealth services to a much wider population
\nin both developed and developing countries.
\nNevertheless, as indicated earlier, if there is
\na basic shortage of health care workers in
\nall the health professions, the world is faced
\nwith a major problem. This shortage does
\nnot only apply to underdeveloped coun-
\ntries. In more developed countries as scien-
\ntific and technical knowledge and develop-
\nment have increased there is also increased
\ndemand for the implementation of these
\ndiscoveries and a consequent demand for
\nmore health workers. Thus the USA esti-
\nmates that by 2020 they will require at least
\n200,000 physicians to meet their needs,
\nmore than the current need of the rest of
\nthe world!
\nThe WMA Secretary General in his column
\nrefers to another problem associated with
\nthe changes in role and functions of physi-
\ncians, namely the need for clarity in identi-
\nfying the roles of health professionals and
\nthe titles used to identify them to the public.
\nThe differences in titles used for physicians
\nacross the world are illustrated in an article
\nby Dr. Doren, to which Dr. Kloiber refers.
\nThe Health Workforce problem which the
\n2006World Health Report highlighted is now
\nbeing actively pursued and it is essential that,
\nas indicated in the editorials referred to above,
\nboth individual physicians and their repre-
\nsentative organisations actively address these
\nissues. The distribution of certain diseases has
\nbeen radically changed as a result of greatly in-
\ncreased international travel, with the potential
\nfor wider dissemination of communicable dis-
\neases including newly emerging diseases, and
\nthe risk of major pandemics need to be bal-
\nanced with attention to the global problems
\nof inequitable distribution of physicians, with
\nsuch huge conditions.On this list a number of
\nexistingmedicinesarehoweverlackingbecause
\nthey have not been adapted for childrens use.
\nIt has been known for a long time that there
\nis a substantial gap between the availability
\ntheir distribution. With the calls for \u201ctask
\nshifting\u201das part of the solution, this may also
\ncall for radical changes in the career cycle of
\nphysicians, nurses, pharmacists, including
\nprofessional practice in foreign countries as a
\nnormal part of the professional career struc-
\nture. All of these considerations require ur-
\ngent attention at a time when the very nature
\nof the regulation of the health professions
\nin also under review, including the ques-
\ntion of the degree to which the professions
\nthemselves should play a role in regulation, a
\nmatter of major concern to those professions
\nwhose proud role has for millennia been that
\nof \u201cCarmg Professions\u201d. It is to this end that
\nthe medical profession defends its position
\nin self-regulation of standards of care and
\nits ethical code of conduct in the interests of
\nboth patients and profession.All of this must
\nbe urgently considered both in discussions at
\nindividual, at national level and in the glob-
\nal conferences referred to above. There is no
\ntime to be lost. Just as the profession has
\ntaken a stand on Tobacco so it must face up
\nto this Big Challenge to the profession itself.
\nBoth individual physicians and their leaders
\nmust act.Time waits for no man!
\nIn Memoriam
\nIV
\nContents
\nA Brief History
\nFounded in 1978 by \u201cLe Quotidien du
\nMedecin\u201d (a magazine for the medical
\nprofessions) and initiated by the journalist
\nLiliane Laplaine-Montheard, the Medi-
\ncine and Health World Games (aka Me-
\ndigames) have become the most important
\ninternational athletic event exclusively for
\nhealth professionals. The World Medical
\nand Health Games (WMHG) gather more
\nthan 2000 participants from 40 countries.
\nThey are open to all health professionals:
\ndoctors, dentists, pharmacists, nurses, vet-
\nerinarians and students in those fields. The
\ngames offer a unique ambiance where the
\nparticipants can exchange both their pro-
\nfessional ideas and life experiences as well
\nas compete in their favourite sports.
\n23 Sports, one Rallying Philosophy…
\nFor the baron Pierre de Coubertin, found-
\ner of the modern Olympic Games, the
\nbeauty of sports and the pure joy in the
\nathletic effort was paramount. It is in this
\n\u201cOlympic\u201d spirit that every year the par-
\nticipants meet in the Medigames. There is
\na choice of individual sports (tennis, judo,
\nswimming, half marathon, squash, golf,
\nathletics…) or team sports (volley-ball,
\nbeach volley, soccer, basket-ball…). As in
\nthe Olympics the Medigames tradition-
\nally start with a \u201cparade of nations\u201d and an
\n\u201copening ceremony\u201d. The week that fol-
\nlows not only offers many athletic compe-
\ntitions but also a variety of entertainments.
\nIt ends with a \u201cclosing ceremony\u201d in hon-
\nour of the Games.
\nSport… For the Neurons
\nEvery year since their creation, and beyond
\nthe focus on sports, the Medigames have
\nalways been a international forum where
\nseveral medical themes are studied and
\ndiscussed, thus allowing the participants to
\nally sport with a furthering of their profes-
\nsional expertise.This year it will presided by
\nDr.\u00a0Andr\u00e9 Monroche (France). Finally, the
\nMedigames offer an opportunity to discov-
\ner a new part of the world every year. After
\nGermany (2008), Spain (2009), Croatia
\n(2010) and Las Palmas-Spain (2011), it is
\nnow the turn of Antalya to host the games.
\nAntalya, real pearl of the Turkish Riviera,
\nis a really nice seaside city. Its charming
\nlittle port, Mediterranean weather, warm
\nwelcome from its habitants, as well as great
\nsport facilities, will make the participants
\nhave a wonderful stay in this city.
\nThe rendez-vous is set from July 7th
\ntill July
\n14th
\nin Antalya!
\nPress Contact:
\nJ\u00e9r\u00e9mie ROUALET
\nMarketing & Communication Manager
\nTel : +33 (0)1 777 065 23\/Fax : +33 (0)1
\n777 065 14
\nEmail : roualet@medigames.com
\nSite Internet : www.medigames.com
\n33rd
\nWorld Medical and Health Games from July 7th
\nto July 14th
\n2012 in Antalya!
\nEditorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
\nActivities of WMA since October 2011 . . . . . . . . . . . . . . . 42
\n191st
\nWMA Council Meeting . . . . . . . . . . . . . . . . . . . . . . 43
\nSecretary General\u2019s Report . . . . . . . . . . . . . . . . . . . . . . . . . 50
\nWMA Council Resolution on Threats to Professional
\nAutonomy and Self-Regulation in Turkey . . . . . . . . . . . . . 54
\nWMA Council Resolution on the Autonomy
\nof Professional Orders in West Africa . . . . . . . . . . . . . . . . 55
\nWMA Council Resolution on Danger in Health Care
\nin Syria and Bahrain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
\nHealth Care in Danger Symposium . . . . . . . . . . . . . . . . . . 56
\nResponsible Use of Antimicrobials \u2013 World Veterinary
\nAssociation Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
\nWorld Veterinary Association meets World Medical
\nAssociation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
\nInternational Health Economics Association (iHEA) . . . . 64
\nThe Research-Based Pharmaceutical Industry Expands
\nits Code of Practice Governing Interactions with the
\nHealthcare Community . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
\nThe International Federation of Biomedical Laboratory
\nScience (IFBLS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
\nThe World Federation for Mental Health (WFMH) . . . . . 68
\nProtecting the Rights and Interests of Physicians . . . . . . . 69
\nNews from the Standing Committee of European
\nDoctors (CPME) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
\nIn Memoriam Alan John Rowe . . . . . . . . . . . . . . . . . . . . . 75
\nPublications by Alan J. Rowe in WMJ . . . . . . . . . . . . . . . . 79<\/p>\n"},"caption":{"rendered":"

wmj38 COUNTRY \u2022 191st WMA Council Meetingt \u2022 In Memoriam Alan Rowe vol. 58 MedicalWorld JournalJournal Official Journal of the World Medical Association, INC G20438 Nr. 2, May 2012 Cover picture from Turkey Editor in Chief Dr. P\u0113teris Apinis Latvian Medical Association Skolas iela 3, Riga, Latvia Phone +371 67 220 661 peteris@arstubiedriba.lv editorin-chief@wma.net Co-Editor […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":940,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/wmj38.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/3633"}],"collection":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/comments?post=3633"}]}}