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wmj201601<\/a><\/p>\n

COUNTRY
\nvol. 62
\nMedicalWorld
\nJournal
\nOfficial Journal of The World Medical Association, Inc.
\nISSN 2256-0580
\nNr. 1, March 2016
\nContents
\nHealth Databases and Biobanks \u2014 Ethical Dilemmas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t1
\nAgeing and Ageism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t2
\n\u2018Show Doctors\u2019 and Korean Medical Association\u2019s Efforts for Self-Regulation . . . . . . . . . . . . \t5
\nMedical School Numbers and Career Choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t7
\nMedical Education in the Postmodern Era . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t10
\nSocial Determinants of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t11
\nSolving the Climate Crisis will Make us Healthier and More Prosperous . . . . . . . . . . . . . . . . \t13
\nPunching to Fortune or to the Grave? Scrutiny on Boxing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t14
\nCarte Blanche on Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t18
\nEuropean Countries Moving Towards Digital Prescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t19
\n\u201cThis Year Our Office Will Go Green\u201d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t23
\nOn the International Public Coordination Health Committee . . . . . . . . . . . . . . . . . . . . . . . . . \t25
\nAustralian Medical Association (AMA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t26
\nAustrian Medical Chamber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t26
\nAssociation Belge des Syndicats M\u00e9dicaux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t27
\nBrazilian Medical Association (AMB) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t28
\nFrench Medical Council. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t28
\nBundes\u00e4rztekammer\/German Medical Association (GMA) . . . . . . . . . . . . . . . . . . . . . . . . . . . \t29
\nIndian Medical Association (IMA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t30
\nKuwait Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t32
\nNew Zealand Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t32
\nNigerian Medical Association (NMA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t33
\nNorwegian Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t34
\nPanhellenic Medical Association (PhMA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t35
\nPolish Supreme Chamber of Physicians and Dentists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t36
\nPortuguese Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t37
\nRoyal Dutch Medical Association (KNMG). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t38
\nRomanian College of Physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t39
\nSingapore Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t40
\nSpanish General Medical Council (OMC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \tiii
\nEditor in Chief
\nDr. P\u0113teris Apinis, Latvian Medical Association, Skolas iela 3, Riga, Latvia
\nPhone +371 67 220 661
\npeteris@arstubiedriba.lv, editorin-chief@wma.net
\nCo-Editor
\nProf. Dr. med. Elmar Doppelfeld, Deutscher \u00c4rzte-Verlag, Dieselstr. 2, D-50859 K\u00f6ln, Germany
\nAssistant Editor
\nMaira Sudraba, Velta Poz\u0146aka; lma@arstubiedriba.lv
\nJournal design and
\ncover design by
\nP\u0113teris Gricenko
\nLayout and Artwork
\nThe Latvian Medical Publisher, \u201cMedic\u012bnas apg\u0101ds\u201d, President Dr. Maija \u0160etlere, Skolas street 3, Riga, Latvia
\nPublisher
\nThe Latvian Medical Association, \u201cLatvijas \u0100rstu biedr\u012bba\u201d,
\nSkolas street 3, Riga, Latvia.
\nISSN: 2256-0580
\nSir Michael MARMOT
\nWMA President
\nBritish Medical Association
\nBMA House,Tavistock Square
\nLondon WC1H 9JP
\nUnited Kingdom
\nDr. Donchun SHIN
\nWMA Chairperson of the Finance
\nand Planning Committee
\nKorean Medical Association
\n46-gil Ichon-ro
\nYongsan-gu, Seoul 140-721
\nKorea
\nProf. Dr. Frank Ulrich
\nMONTGOMERY
\nWMA Vice-Chairperson of Council
\nBundes\u00e4rztekammer
\nHerbert-Lewin-Platz 1 (Wegelystrasse)
\n10623 Berlin
\nGermany
\nDr. Xavier DEAU
\nWMA Immediate Past-President
\nConseil National de l\u2019Ordre des
\nM\u00e9decins (CNOM)
\n180, Blvd. Haussmann
\n75389 Paris Cedex 08
\nFrance
\nDr. Joseph HEYMAN
\nWMA Chairperson
\nof the Associate Members
\n163 Middle Street
\nWest Newbury, Massachusetts 01985
\nUnited States
\nDr. Masami ISHII
\nWMA Treasurer
\nJapan Medical Assn
\n2-28-16 Honkomagome
\nBunkyo-ku
\nTokyo 113-8621
\nJapan
\nDr. Heikki P\u00c4LVE
\nWMA Chairperson of the Medical
\nEthics Committee
\nFinnish Medical Association
\nP.O. Box 49
\n00501 Helsinki
\nFinland
\nDr. Miguel Roberto JORGE
\nWMA Chairperson of the Socio-
\nMedical Affairs Committee
\nBrazilian Medical Association
\nRua-Sao Carlos do Pinhal 324,
\nCEP-01333-903 Sao Paulo-SP
\nBrazil
\nDr. Ardis D. HOVEN
\nWMA Chairperson of Council
\nAmerican Medical Association
\nAMA Plaza, 330 N. Wabash,
\nSuite 39300
\n60611-5885 Chicago, Illinois
\nUnited States
\nDr. Otmar KLOIBER
\nSecretary General
\nWorld Medical Association
\n13 chemin du Levant
\n01212 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
\n1
\nBACK TO CONTENTS
\nThe electronic environment of medical service and research has in-
\ncreased immensely the possibilities of connecting information but
\nat the same time it poses various new ethical aspects to physicians.
\nThe electronic medical record is one of these welcomed novelties
\nas it helps physicians and other health care workers in their daily
\npractice. It is a practical solution that makes it possible to have all
\ninformation on a given individual easily accessible.The main ethical
\nissues are security of data and who is having access but apart from
\nthat there are few difficult dilemmas. On the other hand, informa-
\ntion for secondary use creates multiple ethical issues.The WMA has
\nfor a long time been aware of these possible problems, but a specific
\ninitiative in Iceland in the last years of the 20th century spurred a
\nlively dialogue, not only inside the country but internationally as
\nwell. It was an eye opener on how data can be used on a higher level
\nas all information from medical records was supposed to be linked
\nto a genealogical database of a whole population as well as to a third
\ndatabase on genetic information. The main \u201cselling point\u201d was to
\ncreate new knowledge, but the intention was also to sell informa-
\ntion to various buyers such as insurance companies. The issue was
\nbrought to the WMA who subsequently made a policy statement
\non the secondary use of medical data, adopted in 2002. This policy
\nwas up for revision in 2012 and a prolonged process started, most
\nlikely coming to an end this year.
\nThe revision policy has in many aspects been unique for the WMA
\nonly to be compared to the policy making for the Document of
\nHelsinki (DoH). This is not a coincidence as the policy on Health
\nData and Biobanks is to some extent an extension of the DoH with
\nthe addition that is not only directed to research on humans but for
\nother secondary use as well. One of the main dilemmas has been
\nthe rights of individuals on the one hand and the interest of the
\nholders of data on the other hand. To guard the rights of patients
\nand healthy individuals in their dealings with the health system has
\nbeen one of the cornerstones of the work of the WMA, evident
\nby many of its policies such as the DoH and the Declaration of
\nLisbon on the rights of patients. In the case of the use of health
\ndata and human biological material, consent is one of main ethi-
\ncal issues. Individuals should have the right to decide on the use of
\ndata of themselves. On the other hand, when planning for the use
\nof data from millions of individuals, it is not practical to ask each
\nand everyone to consent. This has been solved in many ways. One
\nis simply to use data without consent of any kind but that is unac-
\nceptable. Another solution is the so-called open consent when an
\nindividual accepts that his\/her data can be used for any purpose at
\na later time. This is also unacceptable, at least to the WMA. Other
\nterms have been coined such as broad consent or even mega consent,
\nmeaning that the individual is to some extent informed of later use.
\nIn the current draft of the revised policy this is solved in a rather
\ncomplex way but that is unavoidable. Just to mention some of the
\nrequirements for consent, individuals should be well informed of
\nthe purpose of keeping the data or material, the rules of access to
\ndata, the governance arrangements, commercial use, if applicable,
\nand benefit sharing. Many other ethical aspects are addressed as
\nwell in the draft that now has been sent formally to the Secretariat
\nof the WMA for processing.
\nThis has been the work of many. Foremost, the representatives of
\nnine National Member Associations of the WMA forming a work
\ngroup that has had this topic in its hands for the last four years. In
\ntwo mini-conferences in Copenhagen and Seoul, external experts
\nhave been invited to explain various aspects of the use of data and
\nmaterial and they have participated in a dialogue with the work-
\ngroup members.The participation in an open consultation was over-
\nwhelming as around 90 different partners commented and brought
\nforward various ideas.
\nAs a chair of the workgroup I would like to extend special thanks to
\nall of the work group members, to the Danish and Korean Medical
\nAssociations for hosting the meetings with external experts and to
\nthe German Medical Association for hosting a smaller work group
\nmeeting. Thanks are also due to our special experts at many of our
\nmeetings, professors Urban Wiesing from T\u00fcbingen in Germany
\nand Dominique Sprumont from Neuchatel in Switzerland.
\nLast but not least, the help of the Secretariat has been absolutely
\ninstrumental in making the whole process possible.
\nJon Snaedal
\nRepresentative of the Icelandic Medical Association and
\nChair of the Work Group on Health Data and Biobanks
\nHealth Databases and Biobanks \u2014 Ethical Dilemmas
\n2
\nAgeism
\nLife expectancy and longevity
\nLife expectancy is a statistical measure of
\nhow long a person may live, based on the
\nyear of his\/her birth. The term is, however,
\nmore frequently used for whole popula-
\ntions and is one of the terms used to es-
\ntimate the overall health of a population.
\nThe term equals average number of years
\na person born today is expected to live, if
\nmortality rate for each age remains the
\nsame in the future. Life expectancy of hu-
\nman populations has been increasing for
\nat least a century and there is no plateau
\nin sight. Inequality in life expectancy is,
\nhowever, immense and seems not to be
\ndiminishing, neither between countries
\nnor inside countries. This is in some cases
\nthe result of population unrest and armed
\nconflicts that have been shaping the life of
\nentire populations such as in Syria, Yemen
\nand Sudan just to mention the few most
\nrecent and apparent cases. The inequality
\nbetween countries becomes apparent when
\nlooking at the UN population prospects
\nshowing life expectancy of lower than 45
\nyears in some sub-Saharan Africa but more
\nthan 85 years in Japanese women. This fol-
\nlows very closely the economic state of re-
\nspective countries (Figure 1).
\nWhen looking at the numbers and how
\nthey have been changing, it is amazing to
\nsee that the average lifespan in high-income
\ncountries has increased by almost three
\nmonths every year since 1840. For the first
\nmany decades, this increase was due to de-
\ncreasing mortality among the new-born and
\nyoung children but during the last decades,
\nthe life expectancy of the >65 years of age
\nhas increased the most.
\nThe causes of increased longevity are mani-
\nfold but public health initiatives have had
\nmore impact than direct medical interven-
\ntion but there is an overlap between these
\ntwo types of measures such in the case of
\ngeneral vaccination. Of medical interven-
\ntion, vaccination of children is the single
\nmost effective intervention leading to lower
\ninfant mortality and by that, increased lon-
\ngevity. Taking this fact into account, it is
\nreally sad to witness some misguided ideas
\nof possible side effects of vaccination that
\nhave lead to lower proportion of individu-
\nals being vaccinated and in turn increased
\nsusceptibility of children and vulnerable
\npopulations to communicable diseases. This
\nhas been much debated and is tackled in
\nmany ways. One is to inform and educate,
\nexemplified by the American Academy of
\nPediatrics [1], another to dictate by laws.
\nThe WMA addressed this in a policy docu-
\nment of 2012 \u201cWMA Statement on Priori-
\ntization of Immunization\u201d[2]. Another very
\nsuccessful medical intervention, accounting
\nfor a very low maternal and infant mortal-
\nity in high-income countries, is prophylac-
\ntic health care in pregnancy and for infants
\nin the first year of life. It is a sad reminder
\nof inequality of the world that even simple
\ninterventions, with very well documented
\nresults, are not provided for in many low-
\nincome countries. We know better and we
\ncan do better.
\nYet another medical intervention leading
\nto increased longevity of individuals and
\nincreased life expectancy is antibiotic treat-
\nment for communicable diseases. This has
\nbenefited adults as well as children and has
\nlead to very low mortality of infections that
\nbefore were deleterious.
\nMore complicated interventions such
\nas treatment of cardiovascular diseases
\nor cancer have had some effect, not least
\nto increase longevity of middle aged and
\nolder individuals. As a consequence of all
\nthis, more and more are living to older age
\nand as fertility rate has been decreasing,
\nthe proportion of older people has been
\nincreasing drastically during the last few
\ndecades leading to ageing populations,
\na development with no definite end in
\nsight\u00a0[3].
\nAs mentioned before, inequality is evident
\nand seems not to be generally decreasing.
\nThis leads to differences in life expectancy
\nrelated to different social classes and educa-
\ntion.This has been addressed in the Marmot
\nreview [4] and in the WMA policy docu-
\nment \u201cWMA Declaration of Oslo on Social
\nDeterminants of Health in 2012\u201d[5]. Some
\nexamples from the first Marmot review: In
\nEngland, premature death caused by health
\ninequalities amounts totally to between 1.3
\nand 2.5 million extra years of life. Another
\nexample: if those without a university de-
\ngree would live as long as those with degree,
\nmore than 200.000 premature deaths would
\nbe prevented each year.
\nLife extension
\nSome attention has been put on the pos-
\nsible biological increase in life expectancy.
\nAgeing and Ageism
\nBased on a plenary presentation at the 3rd
\nInternational Congress of Person Centered
\nMedicine in London, October 2015
\nJon Snaedal
\n3
\nAgeism
\nBACK TO CONTENTS
\nFigure 1.\u2002 Life expectancy and economic state
\nEven though life expectancy has been
\nincreasing generally and the number of
\ncentenarians has been rising, there is yet
\nno direct evidence of increased absolute
\nmaximum life span of humans that seems
\nto be around 120 years. The attention has
\nbeen focused on the genetics of ageing and
\nmany have been dreaming of some kind of
\nmanipulation of longevity genes in order to
\nincrease life expectancy. The term \u201cLife ex-
\ntension science\u201d has been created, address-
\ning possible intervention with the aim to
\nextend both maximal and average life span.
\nThe ideas are many: to use molecular repair,
\nstem cell therapy or by use of simple anti-
\nageing products. Specific organizations
\nhave been established to further research
\nin this field\u00a0[6]. This has been widely criti-
\ncized in the medical and lay press [7] and
\nvery few established scientists have been
\nactive in this field. It came therefore as a
\nsurprise when the FDA in the US decided
\nto allow for a trial for age prolonging by
\nan old medication for diabetes, metformin.
\nThis trial is both based on evidence from
\nanimal research [8] and compelling evi-
\ndence from epidemiological studies on hu-
\nmans with type 2 diabetes [9]. This study
\nused observational data from the UK Clini-
\ncal Practice Research Datalink (CPRD)
\nwith information from almost 80 thousand
\nsubjects treated with metformin, 12\u00a0 000
\ntreated with sulphonylurea drugs, and
\n90\u00a0000 matched subjects without diabetes
\nwith a total, censored follow-up period of
\nmore than 500 000 years. Patients with
\ntype 2 diabetes treated with metformin
\nmonotherapy had longer survival than did
\nmatched, non-diabetic controls. However,
\nthose treated with sulphonylurea drugs had
\nmarkedly reduced survival compared with
\nthe other groups. The planned metformin
\ntrial, which is called Targeting Aging with
\nMetformin, or TAME, is scheduled to start
\nin 2016 and participants are currently be-
\ning recruited. It is of course interesting to
\nsee if individuals can live a healthier life by
\nsimple intervention but to prolong life be-
\nyond maximal life span creates many ethi-
\ncal dilemmas.
\nSocial aspects of ageing
\nWith ageing comes less ability to work and
\nto earn for living. This has, of course, been
\nknown for centuries but it was not legally
\naddressed until the Prussian authorities ad-
\nopted \u201cThe Old Age Pension Program\u201d in
\n1889 designed to provide a pension annuity
\nfor workers who reached age 70. This is the
\nfirst legislation containing social action to
\nsecure income for the oldest in society. At
\nthat time, the average life span was less than
\n60 years and thus the proportion of those
\nolder than 70 was low. In most middle in-
\ncome and high-income societies, schemes
\nof old age pension have now been in place
\nfor decades but the age limit for pension has
\nbeen lowered to 60-65 years in most coun-
\ntries in spite of increased longevity of popu-
\nlations. The scenario is, however, changing
\nrapidly and the financial burden has now
\nincreased to the level that this is not longer
\nsustainable. One country after another is
\nnow taken actions to try to lessen the finan-
\ncial burden and the most influential act is to
\nincrease the pension age. For example in the
\nUK, the state pension age for men has been
\n65 years and for women 60 years.According
\nto the Pension Acts of 2011 and 2014 [10],
\nthere will be a stepwise increase, steeper for
\nwomen, up to 67 years in the coming years.
\nBut when do we get old? For practi-
\ncal purposes, ageing is often divided into
\n\u201cyounger old\u201d (65\u201380 years) and \u201colder
\nold\u201d (>80\u00a0years) but this distinction is not
\nuniversal and biological age is not equal to
\nchronologic age. Generally, individual nor-
\nmal variation increases with age and to that
\nis added the effect of intrinsic and extrinsic
\nfactors. Therefore, the difference in \u201cage ap-
\npearance\u201d increases with age. In line with
\nincreased longevity, more aged individuals
\nthan ever enjoy healthy life without diseas-
\nes and disabilities and to some extent, the
\ngoal of \u201ccompression of morbidity\u201d is being
\n4
\nAgeism
\nmet as described in a landmark article in
\n1980\u00a0[11]. By that is meant that the time
\nspent with ill health, functional disability
\nand frailty before death is being shortened.
\nIn every discussion on the effect of age-
\ning of societies, old people are considered
\na financial burden and when looking at the
\nincreasing proportion of older individuals
\ntowards people in working age it is evident
\nthat there is an ever increasing burden in
\nsociety. The International Labour Orga-
\nnization has discussed this frequently and
\nhas provided some advice [12]. However,
\nolder individuals need not to be a financial
\nburden in society. Actually, in Iceland, it
\nhas been calculated that in a decade or two
\nfrom now,those older than 65 years will be a
\nfinancial asset instead of burden for the so-
\nciety. The reasons are mainly twofold. One
\nis the high level of employment in the ages
\n65-75 years. Another reason is that pension
\nfunds outside the state pension system have
\nbeen created and form now a good deal of
\nthe income of older individuals. Currently,
\nthe pension funds are little less than 150%
\nof GDP of the country, the second highest
\nlevel in the world.On top of this comes that
\nolder individuals are becoming healthier.
\nThe increased proportion of the aged in
\nsociety has many consequences other than
\nfinancial. The constant focus on the burden
\nof the aged creates a negative view of the in-
\ndividuals and groups and is to some extent
\nthe cause of what we call Ageism.
\nAgeism
\nThe term \u201cageism\u201d was coined in 1969 by
\nRobert N. Butler [13]. The term is used for
\nprejudice or discrimination and involves
\nholding negative stereotypes of individu-
\nals and groups based on age. Ageism has
\nmainly been used for individuals in old
\nage but can also be used for other ages,
\nfor example, teenagers that feel they are
\nnot respected because of their immaturity.
\nAgeism towards the elderly involves often
\nhow younger people expect older people to
\nbehave but the concept is broader and ex-
\nists in all aspects of society. Ageism can be
\ncategorized such as:
\nSuccession: younger people assume that
\nolder people have \u201chad their turn\u201d and
\nshould make way for younger generations.
\nConsumption: there are limited resources
\nin society and younger people feel they
\nshould be spent on them (education, etc.)
\nrather than on the older generation.
\nIdentity: older people should \u201cact their age\u201d
\nrather than \u201csteal\u201dfrom younger people such
\nas in clothing and manner.
\nAgeism leads to discrimination and in a
\nstudy by University of Kent [14], age was
\nthe single most prevalent basis for dis-
\ncrimination, more than those based on
\ngender, religion or sexual orientation even
\nthough the latter ones have created more
\nheadlines (Fig 2). Ageism can also been
\ncategorized in terms of intention or if it is
\ndirected at persons or is institutionalized.
\nAgeism can also be evident or hidden.
\nIntentional ageism is when attitudes and
\nlanguage is used with purpose, taking ad-
\nvantage of older people vulnerability. This
\nincludes missions, rules and practices that
\ndiscriminate against individuals or groups
\nbased on their age. An upper age limit for
\npolls is one such example indicating that
\nthe views of older individuals are not in-
\nteresting or important. Another example is
\nhow individuals are chosen for interviews
\nin official media. Unintentional ageism is
\npossibly more prevalent.These are descrip-
\ntions and practices that include bias due
\nto age by those unaware of the bias. The
\nuse of language is throwing a light on this.
\nIn a survey carried out in students partici-
\npating in senior mentoring program, 12%
\nof tweeds they used contained remarks
\nthat were considered discriminating [15].
\nSometimes this is done by the best of in-
\ntentions, to avoid putting responsibility
\non individuals based on their age without
\nrecognizing that the same individuals wel-
\ncome this responsibility.
\n% Reporting experience of predjudice or
\nunfair treatment in the past year
\nAge
\nSexual
\norientation
\nDisability
\nReligion
\nEthnic
\nBackground
\nGender
\nSource: Ago Concom\/University of Kent
\n40
\n30
\n0
\n10
\n20
\nFigure 2. \u0007Discrimination based on age,
\ngender etc.
\nAgeism is evident in working life such as
\nin legislation, in advertising, in attitudes in
\nthe workplace and when cut downs are per-
\nformed. Ageism is prevalent in the health
\ncare and often unintentionally. Upper age
\nlimits based on chronological ageing has
\nbeen prevalent but increasingly, consider-
\nations based on biological ageing are used.
\nOlder individuals referred to emergency
\nunits are sometimes termed \u201csocial refer-
\nrals\u201d when an obvious medical reason is not
\nfound. The reason in these cases is most of-
\nten multi-morbidity in an individual that
\nhas experienced a deterioration, small to
\noutsiders but immense in his or her own
\nexperience. Another term used for older in-
\ndividuals in hospital wards is \u201cbed blockers\u201d,
\na hugely degrading term.
\nBut how is ageism felt by older individuals?
\nFrom data derived from the fifth wave of
\nthe English Longitudinal Study of Ageing
\n(ELSA) it seems evident that a third of the
\nrespondents experienced age discrimination
\nand this increased with the age of the re-
\nspondents. Discrimination was associated
\nwith older age, higher education, lower lev-
\nels of household wealth and being retired
\n[16].
\n5
\nBACK TO CONTENTS
\nShow DoctorsKOREA
\nInitiated by the Brazilian Medical Asso-
\nciation, the WMA is currently developing
\na policy document on ageing that is now
\nbeing considered by the National Member
\nAssociations.In this comprehensive draft to
\na statement, an advice is given to appropri-
\nately train all health care professionals, es-
\npecially physicians, to deal with the health
\nproblems of older people, which imply not
\nonly training geriatricians but also main-
\nstreaming aspects of ageing into the medi-
\ncal curriculum.This draft to a policy will be
\ndiscussed and debated at the next Council
\nmeeting in Buenos Aires.
\nReferences
\n1.\t Diekema DS, American Academy of Pediatrics
\nCommittee on Bioethics. Responding to paren-
\ntal refusals of immunization of children. Pediat-
\nrics.2005; 115(5):1428\u20131431
\n2.\t World Medical Association. WMA State-
\nment on the Prioritisation of Immunisation.
\nWMA[Internet] [cited 2015 Nov\u00a022]. Available
\nfrom: https:\/\/www.wma.net\/en\/30publications\/
\n10policies\/v4\/index.html
\n3.\t United Nations, Department of Economic and
\nSocial Affairs, Population Division (2013).World
\nPopulation Ageing 2013. ST\/ESA\/SER.A\/348.
\n4.\t Fair Society,Healthy Lives.The Marmot Review
\n2010.[Internet] [cited 2015 Nov 22]. Available
\nfrom: http:\/\/www.instituteofhealthequity.org\/
\nprojects\/fair-society-healthy-lives-the-marmot-
\nreview
\n5.\t World Medical Association. WMA Dec-
\nlaration of Oslo on Social Determinants
\nof Health. WMA[Internet] [cited 2015
\nNov\u00a020]. Available from: https:\/\/www.wma.net\/
\nen\/30publications\/10policies\/s2\/index.html
\n6.\t About Life Extension. Life Extension Foun\u00ad
\ndation[Internet] [cited 2015 Nov 22]. Available
\nfrom: http:\/\/www.lifeextensionfoundation.org\/
\n7.\t Lucke JC, Wayne Hall W.Who wants to live
\nforever? EMBO Rep. 2005 Feb; 6(2): 98\u2013102.
\nAvailable from: http:\/\/www.ncbi.nlm.nih.gov\/
\npmc\/articles\/PMC1299249\/
\n8.\t Martin-Montalvo A, Mercken EM, Mitchell SJ,
\net al. Metformin improves healthspan and lifes-
\npan in mice. Nat Commun. 2013;4:2192.
\n9.\t Bannister CA, Holden SE, Jenkins-Jones S, et
\nal. Can people with type 2 diabetes live longer
\nthan those without? A comparison of mortality
\nin people initiated with metformin or sulphony-
\nlurea monotherapy and matched, non-diabetic
\ncontrols. Diabetes Obes Metab. 2014; 16 (11):
\n1165-1173.
\n10.\tPensions ACT 2014. The National Archives
\n[Internet] [cited 2015 Nov 22].Available from:
\nhttp:\/\/www.legislation.gov.uk\/ukpga\/2014\/19\/
\ncontents.
\n11.\tFries JF. Ageing, natural death and compression
\nof morbidity. N Engl J Med. 1980;303(3):245-
\n50.
\n12.\tAgeing societies: The benefits, and the costs of
\nliving longer. World of Work 2009;67:9-12.
\n13.\tButler, RN. Age-ism: Another form of bigotry.
\nThe Gerontologist 1969;9(4):243\u2013246.
\n14.\tHow ageist is Britain? Age concern Report
\n2000. The Age UK network [Internet] [cited
\n2015 Nov 23]. Available from: http:\/\/www.
\nageconcern.org.uk
\n15.\tGendron TL, Welleford EA, Inker J and White
\nJT. The Language of Ageism: Why We Need to
\nUse Words Carefully. Gerontologist. 2015 Jul 16.
\n16.\tRippon I, Kneale D, de Oliveira C, et al. Per-
\nceived age discrimination in older adults. Age
\nAgeing. 2014 May; 43(3):379-86.
\nProf. Jon Snaedal,
\nFormer President of the WMA
\nE-mail: jsnaedal@landspitali.is
\nTV Appearances by Physicians
\nand \u2018Show Doctors\u2019
\nKMA strongly recommends that physi-
\ncians contribute to public health by de-
\nlivering correct health information to the
\npublic as professionals through broadcast-
\ning media. However, recently many medical
\ninformation programs have grown beyond
\na platform for simply providing medical
\ninformation and have increasingly become
\nentertainment programs, leading to issues
\nof being too sensational and including dis-
\ntorted and exaggerated content.
\nOf course, most of the physicians who ap-
\npear on these shows are respected experts
\nin their relevant fields and conduct them-
\nselves properly on TV in line with their
\nprofessional honor and integrity by provid-
\ning the public with evidence-based health
\ninformation in an easy-to-understand
\nmanner. However, some physicians have
\neither abused TV appearances as a means
\nof commercial marketing or have provided
\nunclear information to viewers which di-
\nrectly harms not only the public but also
\nother physicians who conduct themselves
\nproperly on TV. As a result, KMA came to
\nestablish guidelines regarding TV appear-
\nances by physicians.
\nWhat are \u2018Show Doctors\u2019?
\nAccording to KMA\u2019s definition, a show
\ndoctor is a physician who appears on broad-
\ncasting media as a physician and either
\npromotes procedures not medically recog-
\nnized or frequently carries out indirect, ex-
\naggerated or false advertisement including\u00ad
\n\u2018Show Doctors\u2019 and Korean Medical
\nAssociation\u2019s Efforts for Self-Regulation
\nHyun-Young Deborah Shin
\n6
\nShow Doctors KOREA
\nendorsement of specific health foods or
\nsupplements.
\nBirth of Show Doctors and
\nShow Doctor Cases
\nNos. 1 and 2
\nLate last year, a famous Korean singer in his
\nlate 40s suddenly passed away after receiv-
\ning surgery. The singer had already received
\ngastric banding surgery and underwent
\nanother round of surgery from the same
\nsurgeon after complaining of abdominal
\npain, but died during post-operative pe-
\nriod. As a part of legal proceedings aimed
\nat determining whether medical negligence
\nwas involved, it was discovered that the sur-
\ngeon in question had appeared on a health
\nand medical information program regu-
\nlarly, which led to some media to speculate
\nwhether the surgeon may have been negli-
\ngent of patient care because of his frequent
\nmedia appearances.
\nAlso, late last year, a physician appeared on
\na health information program related with
\nhair loss and said that Houttuynia cordata
\nThunb, a herb, was effective in treating hair
\nloss, and also sold products containing the
\nsame herb through on-line shopping sites.
\nThis led to a sudden increase in prices of
\nthe herb, and a patient who had received
\nhair transplant surgery strongly protested
\nto his doctor after watching this program.
\nThe doctor described above has been des-
\nignated as the first show doctor by KMA
\nand is currently pending a decision by the
\nKMA\u2019s Central Ethics Committee.The sec-
\nond show doctor case involves another doc-
\ntor who appeared on a TV health program
\nand said that after taking lactic acid bacteria
\nper oral infertility patients became preg-
\nnant, people who used to wear glasses no
\nlonger had to and patients on medication
\nfor chronic diseases such as diabetes and
\nrheumatoid arthritis stopped medication.
\nAt the same time, the physician appeared
\non home-shopping channels and sold lactic
\nacid bacteria products, which triggered seri-
\nous social controversy.
\nReasons for Show Doctors
\n1.\t Excessive competition over ratings
\ndue to increase in medical information
\nprograms.
\n2.\t TV channels need cast members and
\nphysicians want to appear on TV.
\n3.\t Black market regarding payment for
\nappearances by TV companies.
\nTypes of Show Doctors
\n1.\t Physicians who appear on TV to pro-
\nmote products or to market his\/her
\nhospital.
\n2.\t Physicians who want to become celeb-
\nrities or TV personalities.
\n3.\t Physicians who participate in health
\nfood businesses.
\n4.\t Physicians who place ungrounded
\ntrust on efficacy of foods or health
\nsupplements.
\n5.\t Physicians who place strong belief in
\nalternative medicine rather than mod-
\nern medicine.
\nKMA\u2019s Adoption of Guideline
\non Show Doctors
\nKMA referenced various sources including
\nthe regulations of the Korea Communica-
\ntions Standards Commission, related provi-
\nsions of the Broadcasting Act, regulations
\non broadcasting program review, regula-
\ntions on review of programs that introduce
\nor sell products, regulations of the KMA\u2019s
\nCentral Ethics Committee, Article 56 of
\nthe Medical Services Act on prohibition
\nof medical advertisement and Article 23
\nof the Enforcement Decree of the Medical
\nServices Act on standards for prohibition of
\nmedical advertisement in order to create the
\nbasic framework for the guideline, which
\nwas then finalized by having the Show
\nDoctor Taskforce revise and supplement
\nthe framework according to ethics regula-
\ntions.The Medical Services Director, Public
\nRelation Director, Legal Affairs Director
\nof KMA and the Director of the Medical
\nPolicy Research Institute participated in
\nthe Show Doctor Taskforce to share ex-
\npert knowledge on experiences of reviewing
\nmedical advertisement and ethics regula-
\ntions of other countries. KMA\u2019s Guideline
\non Broadcasting Appearances by Physicians
\nversion 1.0 was distributed on March 26,
\n2015 after receiving feedback from medical
\njournalists and the Korean Society of Medi-
\ncal Ethics.
\nUsed as Guideline for
\nPhysician TV Appearances
\nKMA distributed the guideline to its
\nphysician members and broadcasting re-
\nlated personnel and asked for their active
\nparticipation. The Korean Association of
\nProducers, the Korean Communications
\nStandards Commission, the Ministry of
\nHealth and Welfare and various health and
\nmedical organizations responded positively
\nand MOUs were signed to promote the
\nproduction of proper health information
\nprograms in the future. Also the broadcast-
\ning review standard was recently amended
\nand supplemented according to the KMA
\nguideline, and even the press extensively
\ncovered the guideline which has increased
\npublic support for KMA for its efforts to
\nself-regulate.
\nEthics Guideline and
\nControversy over Adoption
\nas Legal Obligation
\nThe Ministry of Health and Welfare newly
\nadded regulations on administrative penal-
\nties against show doctors to the Enforce-
\nment Decree of the Medical Services Act
\nfor \u201cactions that harm the dignity of medi-
\ncal professionals\u201d (up to 1 year of license
\nsuspension).
\nRegarding this, KMA\u2019s position is that any
\nguideline on broadcasting appearances by
\n7
\nBACK TO CONTENTS
\nMedical Education
\nphysicians should be approached as a rec-
\nommendation and ethical norm, and KMA
\nis against the adoption of any compulsory
\nlegal measure against physicians. However,
\nthe issue of show doctors is not limited to
\njust physicians and involves all health-relat-
\ned professionals such as traditional medi-
\ncine doctors, dentists, pharmacists, nurses
\nand nutritionists. In particular, Korea has a
\ntwo-tracked medical system that recognizes
\ntraditional medicine doctors who practice
\nempirical alternative medicine as a separate
\nprofessional group, apart from physicians
\nwho practice modern medicine. As a result,
\nthere is greater concern of medical profes-
\nsionals appearing on TV and transmitting
\nwrong medical information to the public
\nwithout any or proper evidence. Accord-
\ningly, the medical authority has insisted
\nthat penalties against show doctors should
\nmaintain equity among different medical
\nprofessions, and adopted the amended en-
\nforcement decree which is expected to be
\napplied to all medical and health profes-
\nsionals.
\nFuture KMA Plans
\nagainst Show Doctors
\nKMA created the Show Doctor Review
\nCommittee on May 20, 2015 to restart its
\nactivities regarding sanctions against show
\ndoctors. The Review Committee expressed
\nits commitment to consider the issue of
\nshow doctors from a more fair and profes-
\nsional perspective by appointing KMA of-
\nficers who had been members of the Show
\nDoctor Taskforce as well as journalists and
\nethics experts as members. Also, the Re-
\nview Committee is planning to strengthen
\nits exchange with the Korean Communi-
\ncations Standards Commission and broad-
\ncasting producers to prevent TV programs
\nfrom violating the guideline and to prepare
\nfollow-up measures regarding any future
\nviolations. The Committee also plans to
\nexpand the guideline to cover appearances
\nby physicians in all forms of mass media.
\nKMA is greatly encouraged by the fact
\nthat the Guideline on Broadcasting Ap-
\npearances by Physicians proposed by KMA
\nwas adopted as a WMA resolution at the
\nWMA General Assembly held in Russia
\nin October 2015 and promises to continue
\nits efforts to provide correct health infor-
\nmation to the public.
\nHyun-Young Deborah Shin, MD
\nExecutive Board Member of Public
\nRelations and Spokesperson,
\nKorean Medical Association
\nClinical Assistant Professor,
\nMyongji Hospital,
\nDepartment of Family Medicine,
\nSeonam University
\nFormer JDN Communication\/
\nPublication director
\nE-mail: shy801117@gmail.com
\nIt is generally agreed that there has been
\nprogress in recent years in many of the as-
\npects of medical education, but a particular
\nproblem is that we do not have good in-
\nformation on the numbers of new medical
\nschools, and their quality. How do we de-
\ncide how many medical schools are needed?
\nHow do we decide which standards these
\nschools as well as long-established schools
\nshould use, and how do we assess their per-
\nformance in meeting those standards? We
\nalso need a better understanding of the pro-
\ncesses that decide entry of newly qualified
\ndoctors into specialist training. How are
\ntheir choices influenced and managed, and
\nhow do they meet the needs of the health
\ncare system?
\nThe development of new medical schools is
\nan uncertain process [1,2]. Very broadly, in
\nfirst-world countries, the approximate fig-
\nure of new medical students required was
\nthat, for each million of the population,
\nthere should be 100 new medical students
\neach year [3]. This figure is probably now
\nMedical School Numbers and Career
\nChoices: Current Problems in Medical
\nEducation
\nDavid Gordon Line Engelbrecht Jensen
\n8
\nMedical Education
\n0
\n500
\n1000
\n1500
\n2000
\n2500
\n3000
\n1940 1950 1960 1970 1980 1990 2000 2010 2020
\nNumber of
\nMedical
\nSchools
\nYear
\nFigure 1.
\n\u00adsignificantly higher for a number of rea-
\nsons\u00a0 \u2013 the increased feminisation of the
\nmedical workforce [4] and the increasing
\ncomplexity [1] of medical practice being
\nimportant factors. However, in many coun-
\ntries, a new medical school may be agreed
\nfor reasons that are political [5] or commer-
\ncial rather than rational, for example \u201cfor
\nprofit\u201d medical schools[6].
\nAn interesting example of a planned process
\nfor the development of new medical schools
\ncomes from the early history of the USSR.
\nLeaving aside the long-established medi-
\ncal schools of Russia and Ukraine (and also
\nthe special case of the three Baltic states),
\nin each republic of the former USSR, the
\nfirst ever medical school was always set
\nup within 10 years of the republic joining
\nthe USSR. This is a remarkable example of
\nplanning of the health medical workforce
\nto meet the needs of the population in na-
\ntions that had been neglected by the Czar-
\nist Russian empire, and contrasts with the
\nmany failures of planned Soviet economies
\nin other walks of life [7].
\nSince 2013, the World Federation for
\nMedical Education (WFME) [8] and the
\nFoundation for the Advancement of In-
\nternational Medical Education and Re-
\nsearch (FAIMER)[9] have jointly managed
\nthe World Directory of Medical Schools,
\nWDMS[10], the only authoritative list of
\nall the medical schools in the world.In 2015,
\nWDMS lists over 2700 medical schools,
\nbut there is a supplementary list of about
\n600 additional schools that are believed to
\nexist. This supplementary list was created
\nusing information obtained from a num-
\nber of sources. However, verification that
\nthese additional schools actually exist, and
\nmeet the criteria for inclusion in WDMS,
\nis difficult to obtain, because reliable official
\nsources are slow, and sometimes unwilling,
\nto provide information.
\nThe number of medical schools in the world
\nis growing rapidly and much of this growth
\nis without good reason\u00a0\u2013 national govern-
\nments failing to take, or ignoring, expert
\nadvice, or subject to corrupt practices; or
\ncommercial organisations establishing un-
\nnecessary schools solely for profit. However,
\nmany new medical schools are undoubtedly
\nfounded for worthy reasons: the health care
\nsystem that will benefit from the new school
\nneeds more doctors.
\nYet, even if there is a good reason for a new
\nschool or schools, exact decisions are not
\nalways made on the best evidence. Predict-
\ning the future is logically not easy, but many
\ncountries do work actively with workforce
\nplanning [1,11]. These predictions are obvi-
\nously not the exact truth but may be the best
\nevidence available. However, these efforts to
\npredict future demand as well as understand
\nfluctuations of supply of doctors have been
\nseen to be ignored when decisions on chang-
\nes in medical student numbers and open-
\ning of new schools are taken. This tends to
\nhappen when current political \u201cgut feelings\u201d,
\noften related to election years, take priority
\nover best evidence with politicians acting
\nprimarily in response to current political, de-
\nmographic and economic pressures [5].
\nThese decisions naturally carry implications
\nfar into the future. Another flaw is the fail-
\nure to consider the careers and career choic-
\nes of doctors after obtaining their primary
\nmedical qualification. A potentially large
\nincrease in number of medical students
\nneeds to be matched by additional numbers
\nof postgraduate training positions and un-
\nwanted, rushed, educational reforms can be
\nthe result when the lack of postgraduate ca-
\npacity is realised too late, as seen in the UK
\n[12]. This led to disruption of many careers
\nand loss of doctors overseas from the UK.
\nAnother risk is to educate doctors with little
\nprospect apart from unemployment, a per-
\nsonal problem for the unemployed doctor, a
\npotential financial problem for society and
\na stimulus for further rushed reforms [11].
\nRegarding the quality of new as well as
\nalready existing medical schools, the stan-
\ndards for medical education have been a
\nconcern of WFME for many years [13].Al-
\nthough WFME standards for basic medi-
\ncal education have been extensively adopted
\nworld-wide, with appropriate adjustment
\nto meet the local context of medical educa-
\ntion, the process of systematically assessing
\nwhether or not a medical school is actually
\nmeeting the standards has been patchy.This
\nprocess\u00a0 \u2013 the accreditation of educational
\nprogrammes, the certification of the suit-
\nability of medical education programmes,
\nand of the competence of medical schools
\n9
\nBACK TO CONTENTS
\nMedical Education
\nin the delivery of medical education\u00a0\u2013 is of
\nthe highest importance.
\nAfter WFME had completed its programme
\nof developing standards for medical educa-
\ntion, including standards for basic medical
\neducation, for postgraduate medical educa-
\ntion, and for continuing professional de-
\nvelopment of medical doctors, it turned to
\nconsideration of the use of these standards
\nin accreditation. The outcome was a joint
\nWorld Health Organization\u2013WFME state-
\nment on the promotion of accreditation, and
\na WHO\u2013WFME policy paper on the pro-
\ncesses of accreditation [14]. That policy pa-
\nper remains the definitive statement of how
\nthe accreditation of medical education pro-
\ngrammes should be carried out.
\nAccreditation has a cost in money and staff
\ntime, but it is a cost that must be accepted.
\nTo run the teaching programmes of a medi-
\ncal school without assessing how well they
\nare performing their function is as illogical as
\nflying an aeroplane without making sure the
\naircraft is mechanically sound, regularly ser-
\nviced, and supplied with fuel. The evidence
\nfor the efficacy of accreditation is limited
\n[15] but is often seen most clearly when ac-
\ncreditation is introduced for the first time to
\na long-established education system [16].
\nThe implicit value of accreditation was
\nacknowledged by the Educational Com-
\nmission for Foreign Medical Graduates
\n(ECFMG) of the USA when it announced
\nthe policy that, with effect from 2023, over-
\nseas medical graduates wishing to work in
\nthe USA will only be accepted for assess-
\nment if they have graduated from a school
\nthat meets North American or WFME
\nstandards for accreditation [17]. This re-
\nquires that we must be certain that ac-
\ncrediting agencies are meeting accepted
\ninternational standards, to verify that the
\nassessment of medical schools within the
\nremit of each accrediting agency are work-
\ning to the right standard. The outcome is
\nthe WFME Recognition of Accreditation
\nProgramme, in which official accrediting
\nagencies are evaluated in their performance
\nin a transparent and rigorous process to en-
\nsure that accreditation of medical schools is
\nalways at an internationally accepted and
\nhigh standard, meeting the agreed WHO\u2013
\nWFME policy [14].
\nThe new ECFMG policy has undoubtedly
\nbeen a powerful stimulus to the accredita-
\ntion of medical education, world-wide.
\nHowever, international recognition of ac-
\ncreditation of medical schools is much more
\nimportant than simply a permit to apply
\nto work in another country. It is important
\nthat it verifies the standard of education for
\nall medical graduates, to the future benefit
\nof society and the patients of these doctors
\nof the future.
\nWe therefore call for a coherent system: stu-
\ndent numbers and (where necessary) new
\nmedical schools determined by rational and
\nevidence-based data; postgraduate service
\nand training posts aligned to the needs of
\nthe health care system and to the number of
\nemerging graduates; medical schools deliv-
\nering programmes of education to contex-
\ntually relevant standards; the performance
\nof medical schools being evaluated and
\nenhanced by accreditation; and accredit-
\ning agencies being evaluated to ensure that
\nthey are also at the required standard. If all
\nelements of this system work together, and
\nwith the best motives, then the problems of
\nmedical education will be many fewer.
\nReferences
\n1.\t Planning the Medical Workforce – Third Report
\nof the Medical Manpower Standing Advisory
\nCommittee: Department of Health, London,
\nUK, December 1997.
\n2.\t Norris, Tom E. Coombs, John B. House, Peter,
\nMoore, Sylvia; Wenrich, Marjorie D.; Ramsey,
\nPaul G. Regional Solutions to the Physician
\nWorkforce Shortage: The WWAMI Experience.
\nAcademic Medicine: October 2006; 81: 857-862.
\n3.\t Data presented to the Association of Medical
\nSchools in Europe in 2001 by V Grabauskas.
\n4.\t Elston M A, Lee D W The Impact of Increas-
\ning Numbers of Women Doctors in the Medical
\nWorkforce \u2013 A Report for the Medical Work-
\nforce Standing Advisory Committee: Royal
\nHolloway, University of London, March 1996.
\n5.\t Nielsen K, Gregersen H, G\u00f8tzsche C-O.L\u00e6-
\ngeuddannelse p\u00e5 Aalborg Sygehus [Internet]
\n[cited 2015 Nov 30]. Available from: http:\/\/
\nwww.ft.dk\/samling\/20061\/almdel\/udu\/bi-
\nlag\/418\/394865.pdf
\n6.\t Karle H. How do we Define a Medical School?:
\nReflections on the occasion of the centennial of
\nthe Flexner Report. Sultan Qaboos Univ Med J.
\n2010 Aug; 10(2):160-8. Epub 2010 Jul 19.
\n7.\t World Medical Association.WMA General
\nAssembly, Moscow 2015[Internet] [cited 2015
\nNov 30].Available from: https:\/\/www.wma.net\/
\nen\/40news\/20archives\/2015\/2015_38\/
\n8.\t World Federation for Medical Education [In-
\nternet] [cited 2015 Nov 30].Available from:
\nhttp:\/\/wfme.org\/
\n9.\t Foundation for Advancement of International
\nMedical Education and Research [Internet]
\n[cited 2015 Nov 30]. Available from: http:\/\/
\nwww.faimer.org\/
\n10.\tWorld Directory of Medical Schools\u00a0 [Internet]
\n[cited 2015 Nov 30].Available from: http:\/\/
\nwww.wdoms.org\/
\n11.\tL\u00e6geprognose\u00a0\u2013 Udbuddet af l\u00e6ger 2000-2025,
\nSundhedsstyrelsen Copenhagen 2003.
\n12.\tModernising Medical Careers, The next steps,
\nThe future shape of Foundation, Specialist and
\nGeneral Practice Training Programmes, Depart-
\nment of Health, London, April 2004.
\n13.\tWorld Federation for Medical Education.
\nStandarts [Internet] [cited 2015 Nov 30]. Avail-
\nable from: http:\/\/wfme.org\/standards
\n14.\tWorld Federation for Medical Education.
\nWHO\/WFME Policy [Internet] [cited 2015
\nNov 30].Available from: http:\/\/wfme.org\/ac-
\ncreditation\/whowfme-policy
\n15.\tvan Zanten M, Boulet JR. The association be-
\ntween medical education accreditation and
\nexamination performance of internationally
\neducated physicians seeking certification in the
\nUnited States. Quality in Higher Education 2013;
\n19:3, 283-299.
\n16.\tGeneral Medical Council. UK primary legisla-
\ntion [Internet] [cited 2015 Nov 30]. Available
\nfrom: http:\/\/www.gmc-uk.org\/about\/legisla-
\ntion\/uk_primary_legislation.asp
\n17.\tEducational Commission for Foreign Medi-
\ncal Graduates [Internet] [cited 2015 Nov 30].
\nAvailable from:www.ecfmg.org\/accreditation\/
\nindex.html
\nDavid Gordon, President,
\nWorld Federation for Medical Education
\nE-mail: president@wfme.org
\nLine Engelbrecht Jensen,
\nSurgical resident, Region Zealand, Denmark
\nE-mail: lineengelbrecht@gmail.com
\n10
\nMedical Education
\nOne generation passeth away, and another
\ngeneration cometh; and the earth abideth for
\never. (Ecclesiastes 1:4)
\nHow do you know something is fine art in
\nthe postmodern era? Because the museum
\ncurator said it is.
\nIn the postmodern era, characterized by a
\ndemocratization of opinion and influence,
\nanyone can be an art critic, anyone can be
\na politic pundit and anyone can be a medi-
\ncal expert. In today\u2019s \u201cflat world,\u201d truth
\nis supposed to be relative. Information is
\nnow crowd-sourced and diversified. Medi-
\ncal opinions that were once taken at face
\nvalue from one\u2019s own doctor are now parsed
\nthrough the internet, dissected in online fo-
\nrums with other laypersons. The question is
\nnot whether this evolution is good or bad;
\nthe question is how traditional systems and
\nstructures \u2013 such as medical education \u2013 will
\nevolve to remain relevant and at their best.
\nWe are now more than half a century into
\nthe postmodern era, which introduced mul-
\nticulturalism and relativism into a world of
\ncertainty and hierarchy. In 1966 the artist
\nCarl Andre debuted with Equivalent VIII,
\nknown colloquially as the Bricks. Andre\u2019s
\npiece comprised 120 bricks that were \u201cplaced
\nin meticulous rectilinear relationship within
\nthe gallery space\u201d[1] making a new use of the
\nenvironment as part of an art display.Stacked
\nfirebricks became art when a museum bought
\nand displayed them.Not long after,a non-or-
\nchestral performance with a sound mixer and
\nno plot became an opera when its director
\ncalled it an opera. In 1967 Jacques Derrida\u2019s
\nOf Grammatology was published, creating the
\nconcept of deconstructive criticism and effec-
\ntively reinventing literary theory.
\nPostmodernism differs from modernity in
\nits questioning of reason, rejection of great
\nnarratives and emphasis on subcultures.
\nRather than searching for one ultimate
\ntruth that could explain all of history, post-
\nmodernism focuses on contingency, con-
\ntext and diversity. The postmodern world is
\ncharacterized by the coexistence of various
\nnarratives in one global village.
\nAmid these changes in philosophy, cultures
\nand values contracted and expanded, and
\nmedicine, once an absolute, began its trans-
\nformation. Modernism had venerated doc-
\ntors as educated authority figures, experts
\non medicine whose knowledge could be
\ntaken for granted; postmodernism emerged
\nand questioned reason, rejected overarching
\nnarratives and respected alternative back-
\ngrounds and approaches.
\nFifty years later, medical schools and resi-
\ndency programs are made up of the second
\npostmodern generation, millennials [2].
\nThis generation approaches medical school
\nwith a wholly new set of expectations, needs
\nand learning styles. When millennials enter
\nmedical school, they are older than medical
\nstudents have traditionally been, and their
\nbackgrounds more varied. They have needs
\nthat will not be met within a traditional
\nprogram. Millennial students have expecta-
\ntions of a less formal relationship with their
\nprofessors; they crave mentors and inter-
\naction, rather than lectures and authority.
\nThey prefer team learning as much as team
\nworking. They place much less emphasis on
\nprofessional formalities and much more on
\ntheir individual impacts and purposes within
\nmedicine.They are accustomed to digital for-
\nmats and interactive learning,and resistant to
\nthe traditional podium-audience model [3].
\nThe medical world is very different from the
\none in which the more traditional teaching
\nformat was developed, and the distinction
\nbetween modern and postmodern theory
\nhas been amplified by the digital age. Medi-
\ncal students and residents, like everyone in
\nthe developed world, live a reality of en-
\ntirely new forms of communication. They
\nhave been habituated to visual learning and
\nprompt gratification, accustomed to having
\nanswers always at their fingertips. There is
\nan information explosion: no longer do we
\nlive in a world in which information is cen-
\ntralized. \u201cTruth\u201d and \u201cexpertise\u201d are more
\ndemocratic than ever before, and with the
\nperseverance of postmodern theory, there is
\nan ongoing focus on the diversity of ideas
\nand a rejection of absolute truth.
\nMillennial learning practices are the new-
\nest iteration of the postmodern movement.
\nWhen burnout and job dissatisfaction
\namong physicians are at record highs, the
\nprobable conclusion is that the old system
\ndoes not suit contemporary needs.The only
\noption now is to make adjustments and sync
\nup postmodern needs and desires with a
\npostmodern learning environment.
\nMillennials begin their training with the
\nsame excitement and same good intentions
\nas medical students always have, but they suf-
\nfer burnout increasingly early in their careers:
\n45% of physicians have symptoms of burnout,
\nand 46% of interns experience symptoms of
\ndepression in their first year [4]. According
\nto Richard Schwartzstein,\u201cWe have [medical
\nMedical Education in the Postmodern Era
\nLeonid A. Eidelman
\n11
\nBACK TO CONTENTS
\nNMA and Regional News
\nThe Medical Association of Malta (MAM)
\norganised a satellite meeting for the Com-
\nmonwealth People\u2019s Forum during the Com-
\nmonwealth Heads of Government Meeting
\n(CHOGM) held in Malta in November 2015.
\nMr. Gordon Caruana Dingli, President of
\nMAM, introduced the topic of social deter-
\nminants of health and argued that these are
\nnot only significant in less developed coun-
\ntries since social gradients exist even in af-
\nfluent societies. His main message was that
\nmeasures to reduce inequities require com-
\nmitment at all levels: political, social, and
\nindividual healthcare professionals.
\nThe conference was
\nopened by the Hon.
\nParliamentary Sec-
\nretary Mr. Chris
\nFearne who de-
\nscribed social deter-
\nminants of health as
\nbeing the area where
\npolitics and health
\ninteract. He be-
\nlieves that politicians
\nshould work together in a whole-of-gov-
\nernment approach and take policy decisions
\nthat would improve
\nthese social factors,
\nto ultimately lead to
\nan improvement in
\npublic health.
\nDr.Solaiman Juman,
\nPresident of the
\nCommonwealth
\nMedical Associa-
\nSocial Determinants of Health
\nReport from Satellite Meeting Commonwealth People\u2019s Forum
\nSascha Reiff Gordon Caruana
\nChris Fearne
\nSolaiman Juman
\nstudents] memorize long lists of facts, delay
\ntheir involvement with patients, and expose
\nthem to frustrated and overwhelmed faculty
\nmembers who are under increasing pressure
\nto generate greater clinical revenue. And stu-
\ndents\u2019empathy diminishes [5].\u201d
\nIt is imperative, therefore, that the medical
\nestablishment makes adjustments to insure
\nthat medical students are taught in the envi-
\nronments in which they will learn most ef-
\nfectively and be content in their chosen pro-
\nfession. Physician dissatisfaction is strongly
\nassociated with medical errors, prescribing
\nhabits, patient compliance, patient dis-
\nsatisfaction and medical malpractice suits.
\nLearning styles are just one component of
\nkeeping students and residents on track. To
\npreempt burnout, the medical community
\nmust encourage \u201chappiness\u201damong medical
\nstudents and young doctors. Young doctors
\nshould be given the skills, time and space to
\ncreate healthy lifestyles. Medical programs
\nshould use their platforms to emphasize
\na work-life balance, and remind students
\nthat they will be better doctors \u2013 and more
\nfulfilled individuals \u2013 if they regularly re-
\nmember to take care of themselves as well
\nas their patients.
\nToday, medical students are well-educated,
\ntechnology-oriented and empathetic. They
\nhave expectations that should be considered
\nand valued,and the postmodern era calls for
\nrecognition of the evolution of learning.The
\nmedical establishment can, by adjusting to
\nthe new styles of the millennial generation,
\ncreate better working conditions and better
\npatient care, delay burnout, enhance resil-
\nience and ultimately lead to professional
\nfulfillment.
\nReferences
\n1.\t Alle, R. Catalogue of the Tate Gallery\u2019s Collection
\nof Modern Art other than Works by British Artists,
\nTate Gallery and Sotheby Parke-Bernet, Lon-
\ndon 1980, pp11-12
\n2.\t Strauss Wd Howe N. Millennials Rising:The Next
\nGreat Generation.New York:Vintage Books,2000
\n3.\t Ullma, K. Medical Education needs of the Mil-
\nlennial Generation. ENTtoday. January 13, 2015
\n4.\t Oaklande, M. Doctors on life support. Time.
\nSeptember 7-14, 2015, p.47
\n5.\t Schwartzstei, RM. Getting the right medical
\nstudents \u2013 nature versus nurture. N Engl J Med.
\n2015;372(17):1586-7
\nDr. Leonid A. Eidelman, MD
\n12
\nNMA and Regional News
\ntion described social determinants of health
\nas being the root causes of the causes of ill
\nhealth and argued for investment in areas
\nother than healthcare, to indirectly improve
\npublic health. His main message was that
\ncountries should aim to improve empower-
\nment and health literacy of their population,
\nmainly through education.
\nDr. Natasha Az-
\nzopardi Muscat,
\nPresident Elect of
\nthe European Pub-
\nlic Health Associa-
\ntion presented sta-
\ntistics which clearly
\nshow that Malta
\nis not immune to
\nsocial gradients.
\nDifferences in edu-
\ncational level, gender, ethnicity, household
\nincome and even living in certain regions
\nare associated with differences in rates of
\nmortality, health, level of physical activity,
\nBMI, and presence of certain diseases. She
\nalso argued the case that general socioeco-
\nnomic, cultural and environmental condi-
\ntions influence outcomes in health as much
\nas, if not more than, individual lifestyle fac-
\ntors. The former is causing social gradients
\nto increase, especially post-financial cri-
\nsis, and is due to the non-implementation
\nof preventive interventions. Countering
\nthis trend requires the will and the means
\nto make change happen. Further research,
\nimplementing effective policies and sharing
\nof best practice across the EU and Com-
\nmonwealth are key to reducing health in-
\nequalities.
\nMr. Duncan Sel-
\nbie, CEO of Public
\nHealth England
\nfollowed up on Dr.
\nAzzopardi Muscat\u2019s
\nrecommendations
\nby listing the most
\nimportant contri-
\nbutions to reducing
\ninequity in health:
\nemployment and housing.These would pro-
\nvide a positive feedback by decreasing risks
\nto health, and increasing income, access to
\nhealthcare, education and ultimately better
\nhealth.
\nSir Michael Mar-
\nmot, who chaired
\nthe WHO Com-
\nmission on Social
\nDeterminants of
\nHealth and is now
\nPresident of the
\nWorld Medical As-
\nsociation, present-
\ned evidence that
\nshowed how inter-
\nventions in early childhood can help chil-
\ndren in the lowest quintile of development
\nto catch up with their peers who are in the
\nhighest quintile of development if placed
\nwithin a better socioeconomic environment.
\nSimilarly, countries which have high levels
\nof social mobility have less income inequali-
\nties. Inequities in the current generation are
\ndamaging the chances of future generations,
\nfurther perpetuating the problems. He ar-
\ngued for giving children the best start in life
\npossible,creating fair employment and good
\nwork, ensuring a healthy standard of living
\nand growing old healthily. Inequalities are
\ninevitable but it is up to us to change the
\nmagnitude of inequalities. Do something,
\ndo more, do better!
\nMs. Mary Ann Sant
\nFournier, Presi-
\ndent of the Malta
\nChamber of Phar-
\nmacists introduced
\nMr. Raymond An-
\nderson, President of
\nthe Commonwealth
\nPharmaceutical As-
\nsociation who reit-
\nerated the message
\nthat we should follow the social model of
\ncare which is based on the understanding
\nthat in order for health gains to occur,social,
\neconomic and environmental determinants
\nmust be addressed. He believes resources
\nshould be channelled towards building so-
\ncial capital\u00a0\u2013 interventions which increase
\ncommunity awareness, connections and re-
\nlations. He presented a programme (Build-
\ning the Community- Pharmacy Partner-
\nship) which takes advantage of the close
\ncontact that community pharmacists have
\nwith their communities, to create a partner-
\nship between them, encourage community
\nactivity and empower people. This could
\nlead to a reduction in health inequalities.
\nFinally, the Rt Hon. the Lord Kakkar con-
\ncluded that the
\ntrue underlying fac-
\ntors for improving
\nhealth are not the
\ntechnology and
\nprocedures that are
\navailable in special-
\nist institutions, but
\nthe general socio-
\neconomic, cultural
\nand environmental
\nconditions within our society. We need to
\nturn our attention to these determinants of
\nhealth and work towards equity in our soci-
\neties.This requires action at all levels.
\nDr. Sascha Reiff, Specialist Trainee
\nin Public Health Medicine;
\nDept. of Health, Malta; Council member
\nof the Medical Association of Malta;
\nPresident of the European Junior Doctors;
\nPermanent Working Group (EJD).
\nE-mail: sascha.reiff@gov.mt
\nDr. Gordon Caruana Dingli, Consultant
\nSurgeon and Head of Breast Clinic;
\nDeputy Chairman Department of
\nSurgery; Mater Dei Hospital;
\nPresident of the Medical Association of Malta.
\nE-mail: gordon.caruana-dingli@gov.mt
\nSir Michael Marmot
\nRaymond Anderson
\nLord Kakkar
\nDuncan Selbie
\nNatasha Azzopardi
\n13
\nClimate Change
\nBACK TO CONTENTS
\nUNATED STATES OF AMERICA
\nScientists and medical professionals have
\nwarned for decades that climate change
\nwill create unprecedented challenges to
\npublic health, especially among impover-
\nished communities. According to recent
\nresearch published in the scientific journal,
\nLancet, climate change \u201cthreatens to un-
\ndermine the last half century of gains in
\ndevelopment and global health.\u201dWe are al-
\nready observing some of those consequenc-
\nes. Parts of Asia and Latin America that
\nwere previously immune are experienc-
\ning unprecedented levels of insect-borne
\ndisease such as malaria and dengue fever,
\nwhile drought and famine have wreaked
\nhavoc on a massive scale across the Middle
\nEast and Africa, in some cases prompting
\nor exacerbating violent conflict.There is no
\nquestion, addressing climate change is an
\nissue of human rights and civil rights\u00a0\u2013 of
\nlife and death.
\nFortunately, it is not too late to slow or pre-
\nvent altogether many of the worst impacts of
\na warming planet.Based on what the science
\nis telling us,it is no overstatement to say that
\ntackling climate change could be the great-
\nest global health opportunity of this century.
\nThe Paris agreement establishes ambitious
\ngoals that, if met, would go a long way to
\navert a global health catastrophe. But it is up
\nto each and every nation, and to the subna-
\ntional governments at every level, to see to
\nit that we meet those goals. Ultimately, this
\nfight will be won or lost nation by nation,
\nstate by state, city by city.
\nNow the truly difficult work begins. We
\nneed to ensure that our transition to a clean
\nenergy economy protects our most vulner-
\nable and disproportionately impacted com-
\nmunities, both globally and locally, includ-
\ning the poor, sick, and elderly, who bear the
\ndisproportionate impacts of air pollution,
\nextreme weather, and other impacts associ-
\nated with climate change.
\nIn the United States, pollution from free-
\nways, power plants, refineries, ports and
\nother sources disproportionately harm the
\npoor and people of color. A recent study by
\nthe national NAACP found that 40% of the
\n6 million Americans living in close proxim-
\nity to coal-fired power plants are people of
\ncolor.
\nAs President Obama has noted, \u201cToday, an
\nAfrican-American child is more than twice
\nas likely to be hospitalized from asthma; a
\nLatino child is 40 percent more likely to die
\nfrom asthma.\u201d So, the President continued,
\n\u201cif you care about low-income, minority
\ncommunities, start protecting the air that
\nthey breathe.\u201d (Remarks by the President,
\nAugust 3, 2015).
\nMy home state of California is no stranger
\nto the costs of air pollution and extreme
\nweather patterns. According to the Ameri-
\ncan Lung Association, California is home
\nto the five most polluted cities in the na-
\ntion for ozone and particulate matter, which
\ncome primarily from vehicle tailpipe emis-
\nsions. 8 in 10 Californians currently live
\nin areas with unhealthy air. Twice as many
\nCalifornians die early deaths from the
\nhealth impacts of vehicular pollution than
\nfrom motor vehicle accidents every year. To
\nmake matters worse, we have endured near-
\nly five consecutive years of record drought,
\nalong with devastating wildfires, both of
\nwhich have harmed our economy and the
\nhealth of our communities.
\nMaking clean energy and low-carbon trans-
\nportation options available to all, regardless
\nof socioeconomic background, is critical not
\nonly because it is the right thing to do, but
\nbecause it accelerates our transition to a
\nmore sustainable economy.
\nWhen electric vehicles, solar panels, and
\nother clean energy technologies are avail-
\nable only to the wealthy and privileged, we
\nare not achieving the reductions in emis-
\nsions and improvements in air quality that
\nwe need to achieve to make a difference for
\nthe climate or for the health of our com-
\nmunities.
\nThe voice of health professionals is vitally
\nimportant in this debate. From the per-
\nspective of legislators trying to advance
\nequitable solutions to this monumental
\nchallenge, we need you to be engaged in
\nthe policy trenches. We need you to edu-
\ncate your communities, colleagues, and
\npolicymakers at every level of government
\nabout why climate change is the health eq-
\nuity issue of this century: what\u2019s at stake,
\nand the health co-benefits of strong cli-
\nmate action.
\nI urge you: use your voice to support climate
\npolicy solutions that bring health and equity
\nco-benefits to the communities that need
\nthem most.
\nSenator Kevin de Le\u00f3n (D-Los Angeles),
\nPresident pro Tempore of the
\nCalifornia State Senate
\nSolving the Climate Crisis will Make us
\nHealthier and More Prosperous
\nKevin de Le\u00f3n
\n14
\nBoxing Safety UNITED STATES\/SOUTH AFRICA
\nIntroduction
\nStudies prove that boxing is a dangerous
\nsport associated with devastating injuries
\nand chronic neurological damage to its
\nparticipants. Despite this, boxing still has
\na huge following worldwide and concerned
\nhealth bodies have expressed serious con-
\ncern about the dangers associated with the
\nsport.
\nDeep in the Eastern Cape (EC) province
\nof South Africa, in a local township called
\nMdantsane\u00a0 \u2013 the second largest township
\nin South Africa\u00a0\u2013 thousands of youngsters
\nare raised up in a boxing climate of almost
\nreligious proportions. In that township,
\nramshackle and overcrowded gymnasiums
\nand boxing clubs flourish, to which scores
\nof youths daily flock for training sessions
\nunder the tutelage of home-grown trainers.
\nDoubtless, many of the youngsters are lured
\nby the prospect of fame and fortune, some
\nby genuine love of the \u2018sport\u2019. A handful of
\nschools in the area offer boxing as an extra-
\ncurricular activity.
\nLocated in the same province as the home
\nof the illustrious, once amateur boxer and
\nformer president of South Africa, Nelson
\nMandela, Mdantsane has earned itself the
\nname \u201cthe Boxing Mecca of South Af-
\nrica\u201d. It is where boxing world champions
\nlike Nkosana \u2018Happyboy\u2019 Mgxaji, Welcome
\nNcita and Vuyani Bungu hail from.It is also
\nwhere the shock of a native hero\u2019s death hits
\nthe most,such as when the boxer Mzwanele
\nKompolo died in 2015 following a fatal
\nblow to the head during a match.
\nAbout 1500 kilometres from Mdantsane,
\nin the north-lying South African prov-
\nince of Limpopo, a rural Venda village has
\nalso earned its title of \u201cthe Mecca of bare-
\nknuckle fighting\u201d. The indigenous tradition
\nof Musangwe\u00a0 \u2013 characterised by extreme,
\nunsupervised, open field fist fighting\u00a0 \u2013 is
\na common Venda cultural event believed
\nto have been handed down to the genera-
\ntions by ancestors since as early as the 18th
\ncentury. At a traditional Musangwe boxing
\ntournament, only male villagers qualify as
\nspectators and participants. High profile
\ntraditional leaders, tribesman and organis-
\ners fiercely defend the practice, which they
\nclaim helps young men build their courage
\nand prepare them for life\u2019s challenges.
\nTo the participants, the treacherous punch-
\nes, dangerous knockouts, loss of teeth, and
\nother unseen bodily harms are a fair price
\nfor the personal and tribal glory that ac-
\ncompanies the conquest. Unlike Mdantsane
\nthough, Musangwe fighters are not in the
\ngame for money, and there has never been
\na world champion from that area.
\nSuch is the character of boxing in certain
\nplaces in South Africa.There could be simi-
\nlar\u00a0\u2013 or worse\u00a0\u2013 versions of this sort of in-
\nformal brutal activity in other countries in
\nAfrica or across the globe. Unsupervised or
\nunderground boxing competitions put at
\nrisk the lives and health of many athletes,
\nespecially naive youngsters who are enticed
\nby money. On the whole, South Africa has
\na relatively well established formal boxing
\nregime which has significant spectatorship,
\nover 500 licensed boxers, and 9 interna-
\ntional title holders in 2012 [1]. Further, the
\nexistence of the South African Boxing Act
\n2001 as well as formal boxing authorities,
\nsuch as Boxing South Africa and the South
\nAfrican National Amateur Boxing Organ-
\nisation, facilitate the control and regulation
\nof the sport, although lacking emphasis on
\nhealth and safety of boxers.
\nFigure 1. \u0007Mdantsane township, South
\nAfrica
\nArguments against boxing
\nBoxing is a collision sport. While partici-
\npating in any sporting activity entails the
\nrisk of catastrophic or fatal injury, boxing is
\nunique in its intent on inflicting deliberate
\nphysical harm on the opponent; this is the
\nhallmark of boxing criticism. As knocking
\nthe opponent down is a principal motiva-
\nPunching to Fortune or to the Grave? Scrutiny on Boxing
\nBernard Mutsago Mzukisi GrootboomSelaelo Mametja
\n15
\nBACK TO CONTENTS
\nBoxing SafetyUNITED STATES\/SOUTH AFRICA
\ntion in boxing,the head region is specifically
\ntargeted, producing an alarming incidence
\nof chronic brain injury [2]. Calling for the
\nabolishment of boxing, the then Secretary
\nGeneral of the World Medical Association
\nin 2000, Dr. Delon Human, described box-
\ning in strong terms: \u201cIt [boxing] cannot fairly
\nbe described as a sport; it is simply a barbaric
\npractice\u201d (emphasis mine) [3].
\nExamination of the available literature
\nshows that repeated trauma to the head re-
\nsults in minor to serious head injuries and
\nassociated neurological complications lead-
\ning to long term neurodegenerative diseases
\nsuch as Parkinson\u2019s and Alzheimer\u2019s diseas-
\nes. For example, study findings published in
\nthe British Journal of Sports Medicine [4]
\nshow that the most commonly injured body
\nregion was the head\/neck\/face (89.8%), fol-
\nlowed by the upper extremities (7.4%). Spe-
\ncifically, injuries to the eye region (45.8%)
\nand concussion (15.9%) were the most
\ncommon. Another study found that 51%
\nof injuries were to the facial area, 17% to
\nthe hands, 14% to the eyes, and 5% to the
\nnose\u00a0[5].
\nSustained blows to the head lead to acute
\nand sub-acute neurological consequences
\nthat include cerebral concussions (\u201cknock
\nouts\u201d), headaches, tinnitus, forgetfulness,
\nimpaired hearing, dizziness, nausea, im-
\npaired gait, cognitive deficits and acute
\nneuronal and astroglial cell lesions associ-
\nated with Alzheimer\u2019s disease. The most
\nthreatening of long term consequences of
\nhead blows\/injuries is chronic traumatic en-
\ncephalopathy (CTE) also known as chronic
\ntraumatic brain injury (CTBI), dementia
\npugilistica and \u2018punch drunk\u2019[6]. Other
\nconsequences include tremors, dysarthria,
\nParkinson\u2019s disease, ataxia spasticity, de-
\nmentia, memory disorders, depression, ad-
\ndiction and irritability [2, 5, 7].
\nNot only do boxing injuries affect the head
\nbut many other areas of the body, such as
\nthe upper and lower extremities as well as
\nthe thorax and back [8].
\nBoxing risks for children and adolescents
\nhave particularly attracted great attention.
\nMany young boys and girls around the
\nworld take part in the dangerous sport of
\nboxing despite the attendant risks. For ex-
\nample,an excess of 18 000 youngsters below
\n19 years of age were registered with USA
\nBoxing in 2008 [9]. Although amateur box-
\ning is considered safer than professional
\nboxing, injuries still occur [10]. Medical or-
\nganisations such as the American Academy
\nof Paediatrics, the Australian Medical As-
\nsociation and the Canadian Paediatric So-
\nciety oppose boxing as a sport for children
\nand adolescents [9].
\nNot only do injuries occur during competi-
\ntion but also during training. A prospective
\ncohort study published in 2006 found 57%
\nof injuries occurring during competition,
\nversus 43% occurring in training. Intensity
\nof the physical combat was found to be a
\nstronger risk factor than exposure time.The
\nstudy also found that although training
\ntook 99% of the time, only 43% of injuries
\noccurred during training and 92% of the in-
\njuries sustained by the cohort during com-
\npetition were to the head [10].
\nOther arguments in condemnation of box-
\ning border on the moral, ethical and legal
\ngrounds.These include observed association
\nwith aggression and criminality [5] as well
\nas the discreditable demonstration of inter-
\npersonal violence through the media. The
\nlater sparks calls for censorship by authori-
\nties such as the Australian Medical Associa-
\ntion which recommends that media cover-
\nage of boxing should be subject to control
\ncodes similar to those which apply to televi-
\nsion screening of violence [11]. It is argued
\nthat the courage and discipline purported to
\nbe provided by boxing can be obtained from
\nother safer sports.
\nBoxing fatalities
\nWhile surveillance data is generally poor,
\nboxing fatalities are reported in various
\nsources, including the media. The cause of
\nsudden death in the ring is either cardiac or
\nneurological [12],with subdural haematoma
\nbeing the leading cause of death in sports-
\nrelated traumatic brain injury [2]. Annually,
\nabout 10 boxers die due to a knockout in
\nmost cases [13]. There were 339 mortalities
\nbetween 1950 and 2007 (mean age, 24 \u00b1 3.8
\nyears); 64% were associated with knockouts
\nand 15% with technical knockouts [14].
\nThere has been a string of boxer fatalities
\nin South Africa, including the deaths of
\nPhindile Mwalase and Mswanele Kom-
\npolo who both died directly as a result of
\na blow to the head in 2014 and 2015 re-
\nspectively. Unfortunately most local boxers
\nare not well funded and end up seeking
\nhealthcare in public health facilities. Glob-
\nally, some deaths have not been mere sta-
\ntistics but incendiary events that changed
\nthe history of boxing. In 1994 the British
\nMedical Association made calls for the ban
\nof boxing following the death of a 23 years
\nold professional boxer, hours after a box-
\ning fight. A blood clot was removed from
\nhis brain. In March 2015, the Australian
\nMedical Association also called for a ban
\nfollowing the death of a 23 years old pro-
\nfessional boxer
\nThe fortune factor
\nBoxing was never initially intended for
\nphysical fitness, but for the amusement of
\nancient nobles and crowds, against the will
\nof participants who were often slaves. To-
\nday, boxers have autonomy and they partake
\nin boxing for a variety of reasons. A certain
\nnational boxing authority identifies fitness
\nmerely as an \u2018additional benefit\u2019 of boxing
\n[1]. It is highly unlikely that many modern
\nfighters climb into the ring just to entertain
\nspectators.
\nThere is something else phenomenal lurk-
\ning behind the craze of boxing. Although
\nfew of them reach the level of better-paying
\nprofessional boxing, \u201cfor young men, in this
\n16
\nBoxing Safety UNITED STATES\/SOUTH AFRICA
\nplace [Eastern Cape Province, South Africa],
\nboxing is the only way out of poverty\u201d (em-
\nphasis mine) [15]. This telling expression
\nreveals the power of the lucrativeness of this
\n\u2018sweet science\u2019 to many aspiring boxers in
\ndeprived circumstances in various parts of
\nthe world. Not surprisingly, needy parents
\nof such ambitious youngsters seem to accept
\nand encourage the pursuit of a boxing career
\nas a straight route out of poverty.
\nUnder the fortune proposition, it becomes
\neasy to explain boxers\u2019 tendency to hide
\ntheir unfitness or previous injuries. Noh et
\nal. found that \u201cof the athletes who returned
\nto training following injury, only 19.33%
\nof them had completed their full treat-
\nment. Most returned to training early due
\nto greed\u201d [16]. Some sources also note that
\nthe pressure to participate while injured or
\nnot having fully recovered may come from
\ncoaches and managers [17].
\nOne wonders how many youngsters go
\ninto the boxing sport without fully under-
\nstanding the risks. Ironically, many box-
\ners, most probably in the African milieu,
\ndie bankrupt. In the article Whores, Slaves
\nand Stallions: Languages of Exploitation and
\nAccommodation among Boxers [18], Wac-
\nquant eloquently elucidates the \u2018corporeal
\nexploitation\u2019 and manipulation of boxers
\nby \u201cflesh peddlers\u201d, i.e. the promoters and
\nmatchmakers who further their financial
\ninterest at the expense of boxers\u2019 safety and
\ndignity. Against the constant plea by box-
\ners and boxing structures for more boxing
\nsponsorship, the British Medical Associa-
\ntion, one of the most ardent opponents of
\nboxing, criticises increased funding for
\nboxing [19].
\nBoxing legality in various
\ncountries and the banning-
\nunbanning \u2018seesaw\u2019
\nWhile boxing participation and spectator-
\nship continues to be huge and permitted
\nin many countries, in other countries it is
\neither outright untolerated \u2014 as in Ice-
\nland, Iran and North Korea \u2014 or has been
\non a legal pendulum. For example, Albania
\nbanned boxing in 1960 only to unban it
\nin 1991. In Sweden, boxing was forbidden
\nfrom 1970 until 2007, when the country
\namended boxing conditions. Recently, two
\nmore countries, Cuba and Norway, joined
\nthe unbanning bandwagon in 2013 and
\n2014 respectively. The ongoing wave of un-
\nbanning in countries appears to be based
\non considerations not quite allied to boxers\u2019
\nsafety.
\nClearly, boxing has failed to garner attrac-
\ntiveness among medical bodies, a number
\nof whom possesses official positions con-
\ndemning boxing or some forms of it on
\nthe basis of scientific evidence. The World
\nMedical Association (WMA), a represen-
\ntative body for 112 national medical asso-
\nciations and about 10 million physicians,
\nissued a statement recommending the ul-
\ntimate banning of boxing [20]. Among the
\nmedical associations supporting banning
\nof boxing are the Australian, American,
\nBritish, Canadian, Irish, Danish, Finnish,
\nPortuguese, German and Belgian medical
\nassociations [21,\u00a04]. Other medical bodies,
\nsuch as the South African Medical Asso-
\nciation, currently do not have official posi-
\ntions on boxing.
\nRole of the ringside physician
\nTo the medical fraternity, the boxer\u2019s health
\nand safety is the first concern. Many medi-
\ncal professionals serve as sports physicians
\nrendering medical services in various capac-
\nities at sporting events. In the 2012 London
\nOlympic Games, 5000 medical volunteers
\nwere involved. Such roles require physi-
\ncians to possess appropriate skills, educate
\nboxers or parents about the risks of box-
\ning, be cognisant of possible litigation [22],
\nand exercise personal choice on whether or
\nnot to provide care in boxing events [17].
\nThe ringside physician, as part of an inte-
\ngral multidisciplinary boxing team, plays
\na part at each stage of the boxer\u2019s career,
\nsuch as issuing of boxing licences; pre- and
\npost- contest examinations; involvement in
\ntraining; attending to boxers during com-
\npetition; and performing annual medical
\nevaluations [23].
\nThe relationship between the boxing referee
\nand the ringside physician is a contentious
\nsubject that is discussed elsewhere [12]. By
\nvirtue of their training, ringside physicians
\nare uniquely positioned to assess boxers\u2019
\nhealth risks and to avert catastrophic inju-
\nries and deaths in the ring. Calls have been
\nmade (for example, by the World Medical
\nAssociation and the Australian Medical
\nAssociation, among others) for ringside
\nTable 1. Medical Organisations\u2019 Position Statements on Boxing Ban
\nOrganization Position Organization Position
\nAmerican Medical Association
\n(2007)
\nRecommends that until boxing is banned, head
\nblows should be prohibited
\nAmerican Academy of Paediatrics
\n(1997)
\nOpposes boxing as a sport for any child, adolescent,
\nor young adult
\nAustralian Medical Association
\n(2007)
\nOpposes all forms of boxing; recommends the pro-
\nhibition of all forms of boxing for people younger
\nthan 18 years
\nBritish Medical Association
\n(2007)
\nOpposes amateur and professional boxing; calls for
\ncomplete ban on boxing; recommends banning box-
\ning for those younger than 16 years
\nCanadian Medical Association
\n(2002)
\nRecommends that all boxing be banned in Canada
\nWorld Medical Association (2005) Recommends that boxing be banned
\n17
\nBACK TO CONTENTS
\nBoxing SafetyUNITED STATES\/SOUTH AFRICA
\nphysicians to be given the power to termi-
\nnate a bout [20, 11].
\nBoxing safety standards
\nInterventions to enhance boxing safety dif-
\nfer from country to country. Although a
\nseries of vital amendments to boxing rules,
\nstandards and equipment that were gradu-
\nally implemented since the 20th
\ncentury have
\nminimised the risks in boxing, neurological
\nand non-neurological injuries have contin-
\nued with this sport [24]. This demonstrates
\nthat the intervention measures may not be
\nadequate. As with any other sports, boxing
\ninjury risk cannot be totally eliminated, but
\nlessened. Risk to the head remains. Even in
\namateur boxing, where a knockout is less
\ncommon, there is still a risk of concussion
\nfrom blows to the head [22]. Although in
\nmost countries, including South Africa,
\nboxing is regulated, the health and safety
\nof boxers is not adequately emphasized. In
\na number of countries, the governments or
\nboxers carry the costs of health care and in-
\nsurance companies do not usually provide
\ncover for health care or disability amongst
\nboxers.The boxers are at risk of catastrophic
\nhealth expenditure. Boxers often rely on
\ngovernments for social security grants in
\ncase of disability. The current WMA state-
\nment, inter alia, is propounding an injury
\npreventive approach that includes: strict
\nmedical evaluation of boxers,education,im-
\nprovement and use of safety equipment,and
\nthe active role of ringside physicians.
\nConclusion
\nWhilst banning boxing will be an ideal pre-
\nvention strategy, in the absence of banning,
\ninternational boxing bodies, governments
\nand local boxing bodies must develop ev-
\nidence-based injury prevention measures
\namongst boxers. The medical surveillance
\nshould be implemented starting at the be-
\nginning of boxer\u2019s careers and to the grave.
\nThis will provide information on long term
\nsequelae of boxing and risk reduction strat-
\negies.The boxers must have access to quality
\nhealth care services and be protected against
\nfinancial catastrophe. Doctors looking after
\nboxers must promote evidence-based pre-
\nvention, treatment and rehabilitation of
\nboxers.
\nReferences
\n1.\t Boxing South Africa. 2012\/2013\u00a0 \u2013 2016\/17
\nStrategic Plan. 2012
\n2.\t Ling H, Hardy J, Zetterberg H. Neurologi-
\ncal consequences of traumatic brain injuries in
\nsports. Mol Cell Neurosci. 2015; 66:114\u2013122.
\n3.\t World Medical Association. WMA Calls
\nFor Ban On Boxing. 2000. Available from:
\nhttps:\/\/www.wma.net\/en\/40news\/20archiv
\nes\/2000\/2000_02\/
\n4.\t Zazryn T R, Finch C F, McCrory P. A 16 year
\nstudy of injuries to professional boxers in the
\nstate of Victoria, Australia. Br J Sports Med.
\n2003;37:321\u2013324
\n5.\t F\u00f6rstl H, Haass C, Hemmer B, Meyer B, Halle
\nM. Boxing\u2014Acute Complications and Late Se-
\nquelae, from Concussion to Dementia. Dtsch Ar-
\nztebl Int. 2010; 107(47): 835\u20139. DOI:10.3238\/
\narztebl.2010.0835
\n6.\t Ann C. McKee AC, Cantu RC, Nowinski JE,
\nHedley-Whyte T, Gavett BE, Budson AE, et al.
\nChronic Traumatic Encephalopathy in Athletes:
\nProgressive Tauopathy following Repetitive
\nHead Injury. J Neuropathol Exp Neurol. 2009;
\n68(7): [cited 2015 Nov 19 ]; 709\u2013735. Available
\nfrom: doi:10.1097\/NEN.0b013e3181a9d503.
\n7.\t Stiller JW, Yu SS, Brenner LA, Langenberg P,
\nScrofani P, Pannella P, et al. Sparring and neu-
\nrological function in professional boxers. Front.
\nPublic Health. 2014; 2:69 [cited 2015 Nov 19].
\nAvailable from: doi: 10.3389\/fpubh.2014.00069
\n8.\t Siewe J, Rudat J, Zarghooni K, Sobottke R, Ey-
\nsel P, Herren C, et al. Injuries in Competitive
\nBoxing. A Prospective Study. Int J Sports Med.
\n2014. [Internet] [cited 2015 Nov 19 ], Available
\nfrom: doi: 10.1055\/s-0034-1387764.
\n9.\t American Academy of Pediatrics. Policy State-
\nment\u2014Boxing Participation by Children and
\nAdolescents. Pediatrics. 2011;128:617\u2013623
\n10.\tZazryn T, Cameron P, McCrory P. A prospec-
\ntive cohort study of injury in amateur and pro-
\nfessional boxing. Br J Sports Med. 2006; 40:670\u2013
\n674.
\n11.\tAustralian Medical Association (AMA) Posi-
\ntion Statement on Boxing. 1997. Reaffirmed
\n2007
\n12.\tSethi N K. Boxer safety, and the relationship
\nbetween the referee and the ringside physician.
\nS Afr J Sports Med. 2015; 27(1):3; [cited 2015
\nOct\u00a0 6]. Available from: DOI:10.7196\/SA-
\nJSM.595
\n13.\tSvinth, Joseph R. Death under the Spotlight:
\nThe Manuel Velazquez Boxing Fatality Col-
\nlection. Journal of Combative Sport .2007 [cited
\n2015 Oct 22 ] Available from: http:\/\/ejmas.com\/
\njcs\/jcsart_svinth_a_0700.htm.
\n14.\tBaird LC, Newman CB, Volk H, Svinth JR,
\nConklin J, Levy ML. Mortality resulting from
\nhead injury in professional boxing. Neurosurgery.
\n2010; 67(5):1444-50.
\n15.\tMedia Club South Africa. From Mdantsane to
\nthe world: The Eastern Cape\u2019s champion box-
\ners. [cited 2015 Nov 15 ] Available from: http:\/\/
\nwww.mediaclubsouthafrica.com\/sport\/3666-
\neast-london-boxing-capital-of-south-africa.
\n16.\tNoh JW , Park BS, Kim MY, Lee LK,Yang SM,
\nLee WD, et al. Analysis of combat sports play-
\ners\u2019 injuries according to playing style for sports
\nphysiotherapy research. J Phys Ther Sci. 2015; 27:
\n2425\u20132430.
\n17.\tBritish Medical Association Science and Edu-
\ncation department and the Board of Science.
\nAn information resource for doctors providing
\nmedical care at sporting events. 2014.
\n18.\tWacquant L. Whores, Slaves and Stallions:
\nLanguages of Exploitation and Accommoda-
\ntion among Boxers. Body & Society. 2001.Vol 7
\n(2 – 3): [Cited 2015 Nov 23];181 – 94. Available
\nfrom: http:\/\/loicwacquant.net\/assets\/Papers\/
\nWHORESLAVESTALLIONS.
\n19.\tHawkes N. BMA criticises increased funding
\nfor boxing. BMJ. 2012; 345.
\n20.\tWorld Medical Association. Statement on Box-
\ning. Adopted 1983, editorially revised 2005
\n21.\tBritish Medical Association Scientific Depart-
\nment. The Boxing Debate. 1993
\n22.\tLecrerc S, Herrera CD. Sport medicine and the
\nethics of boxing. West J Med. 2000 Jun; 172(6):
\n396\u2013398.
\n23.\tSA Journal of Sports Medicine; Issue 10, Special
\nFeature: Boxing.1982
\n24.\tLoosemore M, Lightfoot J, Beardsley C. Box-
\ning injuries by anatomical location: a systematic
\nreview. Journal of the Romanian Sports Medicine
\nSociety. 2015; vol. XI( 2): 2583-2590
\nBernard Mutsago, Health Policy Researcher,
\nSouth African Medical Association.
\nSelaelo Mametja,Head: Knowledge
\nManagement and Research Department,
\nSouth African Medical Association
\nMzukisi Grootboom,Chairman, South
\nAfrican Medical Association
\nE- mail: BernardM@samedical.org
\n18
\nTobacco Smoking BELGIUM
\nMedia regularly mention the measures to
\nreduce the number of smokers and tobacco
\nconsumption in general. Such measures are
\nsporadically but begrudgingly taken. Nev-
\nertheless, tobacco consumption is a real
\npledge for health and deserves to mobilize
\nall efforts.
\nAdult smokers have to leave public places
\nto satisfy their bad habit but people still
\nhave to go through the smoky cloud.
\nSmokers jeopardize not only their own
\nhealth but first and foremost other people\u2019s
\nhealth.
\nStill the main victims are children, particu-
\nlarly in the private sphere. They have not
\nchosen it, but they are prejudiced twice.
\nFirst of all because of the passive smok-
\ning whose harmfulness is well known. It
\nseems it is even worse than active smoking
\nin open spaces. Secondly, they are under
\nthe influence of adults\u2019 example (parents in
\nparticular) who give them a positive im-
\nage of smoking. We all know that most
\nchildren whose parents smoke also become
\nsmokers.
\nIt is of paramount importance to protect
\nchildren. Small infants run more risk of
\nsuffering from respiratory infections when
\nsubmitted to a smoky environment. In such
\ncases, infections are more severe.
\nTeenagers under the influence of their
\nparents and adults in general are tempted
\nto smoke and start at a very young age.
\nTherefore, they are one of the favorite target
\ngroups for tobacco companies. Since these
\nare killing their customers, they have to
\nreplace them on a more regular basis. To-
\nbacco is impregnated and treated to make
\ncigarettes more enjoyable but above all to
\nspeed up the addiction process. They de-
\nvelop commercial and advertising strategies
\nin order to interest as many people as pos-
\nsible\u00a0\u2013 the younger, the better.
\nKeeping our children away from this pledge
\nshould be a priority. Smoking kills more
\nthan terrorism.
\nWith this in mind, children should live in a
\ntobacco-free environment from a very early
\nage: without smoke and without any relat-
\ned waste product. They also should evolve
\nwithout any advertising message which
\ncould give a positive image of smoking.
\nIt is up to the legislator to take measures
\nconcerning those advertising messages.
\nAs far as the non-smoking environment is
\nconcerned, many initiatives have already
\nbeen taken but the legislators,wherever they
\ncome from, are afraid of interfering in the
\nprivate sphere. This is wrong. One person\u203as
\nfreedom ends where another\u203as begins and it
\nis the same about private life, in particular
\nwhen it concerns children.
\nThe first step should consist of introducing
\nin children\u2019s rights the right to live in a non-
\nsmoking environment. This way, this right
\nwill naturally extend to the private sphere.
\nEvery house, common area or kid\u2019s bed-
\nroom (at least the one where he\/she sleeps)
\nmust be smokeless.The same applies to cars
\nin which children are transported.
\nIs this an invasion of privacy? Is this objec-
\ntive impossible to achieve?
\nI do believe it is possible. Most countries
\nlegislated to make corporal punishments
\nillegal. This prohibition applies to both the
\nfamily framework and the family home.
\nEven if we know that the aim has not been
\ntotally achieved, it has had an unprecedent-
\ned influence on society.
\nIn Belgium, plenty of social workers are
\nvisiting families to check on feeding and
\ncare babies or infants receive. Their work
\nis mostly educational but can also include
\nmore coercive guidance.Social workers have
\nmeans of action in case mistreatments, for
\nexample, are observed. Smoking in a child\u2019s
\nenvironment is a kind of mistreatment. We
\nmust consider it as an abuse. We must do
\nsomething!
\nMaybe legislators will take measures. If
\nso, they will act reluctantly, as usual. They
\nshould feel the moral pressure of the whole
\nsociety on their shoulders.
\nMay everyone feel responsible for this issue!
\nDr. Roland Lemye
\nVice-president
\nBelgium Association
\nof Medical Unions
\nE-mail: info@absym-bvas.be
\nCarte Blanche on Smoking
\nRoland Lemye
\n19
\nBACK TO CONTENTS
\nE-healthESTONIA
\nIntroduction
\nDigital prescription or ePrescription is un-
\nderstood as the process of electronic trans-
\nfer of a prescription by a healthcare provid-
\ner in a primary care or community health
\ncentre setting to a pharmacy for retrieval
\nof the drug by the patient [1, p.\u00a0 36]. In
\n2010 only a few European countries used
\ne-prescription system in full\u00a0 \u2013 electronic
\nprescribing was possible in 15 countries,
\nelectronic transfer to the pharmacy\u00a0\u2013 in 9
\ncountries, and dispensation data were re-
\ncorded in 7 countries [1, p.\u00a07].
\nIn Estonia, e-prescription was launched on
\n1 January, 2010 as a complete nation-wide
\nsystem. According to the data of the Es-
\ntonian Health Insurance Fund (EHIF) in
\n2014, 98.5% of all prescriptions in Estonia
\nwere issued in the format of e-prescription.
\nThe authors\u2019 aim was to study the current
\ne-prescription related experiences of fam-
\nily physicians in other European countries
\nin 2014.
\nMethods
\nThe survey was done and reflects the data of
\n2014.To gather the relevant data a question-
\nnaire consisting of 14 multiple-choice ques-
\ntions with a space for free text commentary
\nwas sent to representatives of pan-European
\nquality and safety promoting organization
\n(EQuiP) member countries and to experts
\nin non-EQuiP countries Latvia and Lithu-
\nania. In 2014 representatives of 23 European
\ncountries belonged to EQuiP. Altogether we
\nreceived answers from representatives of 25
\ncountries and the current analysis is based
\non these answers except for Greece where
\nmajor inconsistency was found between the
\nanswers from the expert and international
\nreports, according to which the answers
\nwere corrected [2]. Representatives of Croa-
\ntia, United Kingdom, Belgium, Denmark,
\nGermany, Norway, Slovenia, Spain, Turkey,
\nAustria, Czech Republic, Estonia, Finland,
\nFrance, Greece, Hungary, Ireland, Italy, Lat-
\nvia, Lithuania, the Netherlands, Portugal,
\nPoland, Sweden, and Switzerland completed
\nthe questionnaire. All respondents were ex-
\nperts whose jobs were related to the field
\nof family medicine\u00a0\u2013 practicing GPs, those
\ninvolved in training of GPs, scientists or
\nhealthcare managers of family medicine.
\nResults
\nOut of the 25 participating countries, a na-
\ntion-wide e-prescription system existed in
\nnine countries: Estonia, Finland, Sweden,
\nthe Netherlands, Denmark, Turkey, United
\nKingdom, Croatia, and Greece. Region-
\nally functioning e-prescription system was
\nin Spain and Italy, and it was organized be-
\ntween some partners\u00a0\u2013 insurance providers,
\nhealthcare providers, and pharmacies\u00a0 \u2013 in
\nthree countries: Belgium (ongoing pilot proj-
\nect), the Czech Republic and Norway. Digi-
\nEuropean Countries Moving Towards
\nDigital Prescription
\nLe Vallikivi
\nFigure 1. Existence of digital prescription system in the responding countries (01.07.2014)
\n20
\nE-health ESTONIA
\ntal prescription did not exist in eleven coun-
\ntries: Austria, France, Germany, Hungary,
\nIreland, Latvia, Lithuania, Poland, Portugal,
\nSlovenia, and Switzerland. In the countries
\nwhere digital prescribing was available (Fig-
\nure 1), around 90\u2013100% of the prescriptions
\nwere issued using the digital system.
\nThere was no digital prescription system or
\nit existed only between selected partners in
\n14 countries altogether. In most of these
\ncountries there were ongoing discussions
\nabout digital prescription or such a system
\nwas about to be launched in the near future.
\nAccording to the opinion of the representa-
\ntives of Ireland and Switzerland there had
\nbeen no discussions about implementing a
\nnation-wide digital prescription system in
\nthese countries, however, according to the
\nSwiss e-health strategy report [3] such dis-
\ncussions have been held.
\nIn European countries, the systems for han-
\ndling prescriptions had diverse structures
\nfor collecting various data at various levels.
\nA nation-wide prescription database ex-
\nisted in eleven of the responding countries;
\nin two countries, the database existed at the
\nregional level and in four countries, there
\nwas a database between certain partners.
\nA\u00a0 healthcare provider based database ex-
\nisted in two countries. No database existed
\nin Lithuania (Table 2).
\nSeventeen countries used the database to
\nmanage various medication-related data
\n(Figure 2). The database usually contained
\ninformation about the active substance, trade
\nname of the medicament, prescribed dosage,
\npatient and doctor writing out the prescrip-
\ntion.In several countries,the database also in-
\ncluded information about the purchase made
\naccording to the prescription (Figure\u00a02).
\nIn all countries, the doctor could obtain in-
\nformation about the treatment the patient
\nwas receiving as reported orally by the pa-
\ntient or in written form from the doctor.
\nMedication data were available to the doctor
\nin the form of electronic interaction in eight
\ncountries; in three countries, this informa-
\ntion was available in the regional database
\nand in four countries only within the re-
\nspective healthcare institution. Experts from
\nseveral countries (Norway, Belgium, United
\nKingdom) indicated that family doctors and
\nother specialists differed in their possibili-
\nties to access the prescription data, e.g. the
\nsystems allowed to follow the prescriptions
\nissued by GPs but not by other specialists.
\nIn many countries, various data sets to as-
\nsist in prescribing were available (Figure 3).
\nSupported by linking different e-solutions
\nthe system provided pre-filled information
\nof the prescribing doctor, healthcare pro-
\nvider and patient, thereby diminishing both
\nmanual input and error, influencing sig-
\nnificantly both quality and safety. No e-pre-
\nscribing system gave a possibility to assess
\nthe use of over-the-counter medication yet.
\nThe exact definition of clinical decision sup-
\nport system was not given before asking the
\nTable 1. Discussions on nation-wide digital prescription system as future perspective.
\nYes, digital prescription system will be
\nimplemented in the near future
\nYes, but different parties have
\ndifferent opinions
\nNo discussion
\nBelgium
\nPortugal
\nLatvia
\nHungary
\nSlovenia
\nSpain
\nAustria
\nCzech Republic
\nFrance
\nGermany
\nNorway
\nPoland
\nIreland
\nSwitzerland
\nTable 2. Existence of central prescription database in responding European countries.
\nNation-wide
\ncentral database
\nRegional
\ndatabase
\nDatabase between
\ncertain partners
\nHealth care
\nprovide database
\nNo database
\nBelgium
\nCroatia
\nDenmark
\nEstonia
\nFinland
\nHungary
\nPortugal
\nSlovenia
\nGreece
\nSweden
\nTurkey
\nSpain
\nItaly
\nCzech Republic
\nLatvia
\nFrance
\nNorway
\nSwitzerland
\nNetherlands
\nGermany
\nAustria
\nPoland
\nIreland
\nUnited Kingdom
\nLithuania
\nTrade name and substance name
\nDosage
\nPatient\u2019s personal information
\nPrescribing physician\u2019s data
\nMedical service provider\u2019s data
\nInsurance and reimbursement
\nData about dispensing the drug
\nDiagnosis
\nDrug\u2019s interactions and side e\ufb00ects
\n0 1412108642 16
\nFigure 2. Information in central database, number of countries
\n21
\nBACK TO CONTENTS
\nE-healthESTONIA
\nexperts about its existence and functionality.
\nThe answers indicated that no decision sup-
\nport existed in 11 countries out of 25, in the
\nrest of the countries there was some level
\nof clinical decision support. There was no
\ncountry with 100% decision-making support
\nsystem coverage for all the doctors. The ex-
\ntent of the decision support application was
\ndifferent between countries. For example, in
\nFinland around 40% of GPs and 50% of hos-
\npital based doctors used the EbMed decision
\nsupport system, while in Belgium there were
\ncertain support modules in only one or two
\nparts of the medical software out of 17.
\nThe nature and content of decision support
\ndepended on the software used by the par-
\nticular GP. In some countries, for example
\nGermany, optional software supplements
\nfor decision support were available at an ex-
\ntra cost. The most extensive functionalities
\nof the decision support system have been
\ndeveloped in Finland.
\nThe most often encountered ways of deci-
\nsion support dealt with pharmacological
\ndata of the medication, drug interactions,
\nadverse reactions, warning about patient\u2019s
\nallergies, concurrent diagnosis, gender and
\nage-based warnings and helped with correct
\ndosage in accordance with the treatment
\nguidelines (Figure 4).
\nRenewals and prescribing
\nout of office
\nIn eight countries the only way to renew a
\nprescription was by visiting the doctor. In the
\nremaining 17 countries, there were various
\nalternatives: a phone contact with the doc-
\ntor, visit to the nurse, phone contact with the
\nnurse, and electronic prescription request or
\nprescription renewal by the pharmacologist.
\nIn some countries it was possible to request
\nmedication electronically either by sending an
\ne-mail to the practice or using its homepage.
\nIn 11 countries out of 25 only paper pre-
\nscription could be issued outside of the doc-
\ntor\u2019s office. In Denmark, Sweden, the Neth-
\nerlands, and with some software versions
\nin Turkey there was a smartphone\/tablet
\nsolution for browser based remote desktop.
\nIn Denmark,the Netherlands,Finland,UK,
\nand Ireland it was possible to order a pre-
\nscription from the pharmacy by phone. In
\nPortugal, Greece, Finland, UK and Den-
\nmark it was possible to prescribe over the
\ninternet. In Switzerland, France and Den-
\nmark it was possible to send a prescription
\nto the pharmacy by fax.
\nFeedback about prescribing
\nDoctors received systematic feedback on
\nprescriptions in 16 countries. Surpris-
\ningly there was no feedback system in well
\ndigitalized Finland and Norway. Doctors
\ndid not receive systematic feedback on the
\nmedications they had prescribed also in It-
\naly, Ireland, Latvia, Switzerland, Germany,
\nPoland and Slovenia. The most common
\nkind of feedback dealt with the prescrip-
\ntion\u2019s compliance with clinical guidelines
\n(15 countries), and also with cost control by
\nencouraging prescription of generic medi-
\ncations (10 countries). Usually the institu-
\ntions giving feedback were insurance com-
\npanies or healthcare regulating institutions.
\nBenefits and harms of
\ndigital prescribing
\nAccording to the respondents\u2019 responses,
\nthe benefits of the digital prescription sys-
\ntem from the doctors\u2019 points of view were
\nthe following: complete overview of the
\npatient\u2019s medication, indirect information
\nabout the treatment compliance with the
\ndispensation data. Issuing the prescription
\nwas easier, faster, and safer for the patient
\nData of reimbursement
\nData about the medical service provider
\nPrescriptions prescribed by other doctors
\nData about patient\u2019s medical insurance
\nDrug interactions database
\nDrug information database (SPC)
\nPossibility to copy previous prescriptions
\nPatient\u2019s personal data
\nNone, doctor \ufb01lls out all the \ufb01elds manually
\n0 2015105
\nFigure 3. E-health solutions to help the prescribing doctor, number of countries
\nWarnings about patient\u2019s allergies
\nDrug interactions
\nAccess to pharmacological information
\nHelp determining the dosage
\nIntercurrent diagnosis
\nSide e\ufb00ects of the drug
\nCompliance with clinical guidelines
\nAge-based warnings (e.g. children)
\nRenal malfunction and drug dosage
\nGender-based warnings
\n0 10642 8 12
\nFigure 4. Functions of clinical support systems, number of countries
\n22
\nE-health ESTONIA
\n(decision support assisted, for example, in
\ndosing, selecting the most suitable medi-
\ncation, and selecting applicable discount).
\nThe experts presumed that from patient\u2019s
\npoint of view receiving the prescribed medi-
\ncation got faster, easier and safer, the pre-
\nscription could be requested over the inter-
\nnet or by phone; the patient could not lose
\nthe prescription.
\nAs concerns pharmacists, the main benefit
\nwas that prescriptions were 100% readable,
\nand handling was fast and safe\u00a0\u2013 there were
\nfewer errors due to misreading or typing.
\nPharmacists needed less time to enter the
\nprescription; in addition, a pharmacist was
\nbetter informed when advising the patient
\nif there was access to the information about
\nall the medications prescribed.
\nThe experts saw simplicity and safety of
\nthe system as its most important benefit
\nfor society: a patient, healthcare provider
\nand pharmacist could save time. There was
\na good overview of both: the prescribing
\npractice and dispensation giving a possi-
\nbility to analyze the treatment quality and
\ntreatment costs, there was timely and accu-
\nrate overview available for different partners
\nin the system.
\nAccording to the respondents\u2019 responses, the
\ntransit to digital prescription has not been
\nflawless and has caused problems unknown
\nduring the paper-prescription era. Episodic
\ndisturbances in the internet, prescription cen-
\ntre\u2019s or GP\u2019s software were causing occasional
\ndisruptions in the functioning of the system.
\nFrom the doctors\u2019 point of view, there was
\noccasionally insufficient systematic control
\nover repeat prescriptions and the patient
\nmight get the medication for a long time
\nwithout meeting the doctor even if it was
\nneeded.There is apprehension that the doc-
\ntor-patient relationship was transforming
\nto be even more computer-centred.
\nFrom the patient\u2019s point of view the concern
\nwas most often related to a patient loosing
\ncontact with the doctor.It was sometimes dif-
\nficult for a patient to understand the prescrip-
\ntions, and there was a need to turn to a phar-
\nmacy or the GP office to check the details.
\nThe experts presumed that for pharmacists
\nthe digital prescription system required
\nmore IT knowledge and IT equipment in
\nthe pharmacy.
\nAs concerns society the experts saw as po-
\ntential problematic areas the security of sen-
\nsitive personal data as well as weakening of
\nthe relationship between the doctor and the
\npatient.
\nSummary
\nThe purpose of this study was to get an
\noverview how widely the digital prescribing
\nis used in European countries, how the sys-
\ntems work and whether they are connected
\nto nation-wide or regional databases, and
\nwhether there are supporting mechanisms
\nfor safe prescribing.
\nFrom the quality and safety aspect, digital
\nprescription provides an excellent opportu-
\nnity to prevent treatment errors and support
\nthe compliance of clinical practices with the
\ncurrent treatment guidelines through the
\ndecision support system. The central da-
\ntabase provides an opportunity to analyze
\nprescribing on the whole and at the level
\nof single practitioner\u2019s practice. Adequate
\nfeedback mechanisms enable to introduce
\nchanges into the prescribing practice.
\nThe dream of pan-European digital pre-
\nscriptions may remain a dream for a long
\nperiod of time. There are large differences
\nin the digital prescription systems in Eu-
\nropean countries. Still, the benefits of the
\nsystem outweigh the difficulties. The ex-
\nperience of developing and implementing
\nthe digital prescribing system in different
\ncountries provides all partners with valuable
\ninformation on developing novel combined
\nIT-services for healthcare and a possibility
\nto avoid mistakes made in other countries.
\nKatrin Martinson
\n23
\nGreen Health
\nBACK TO CONTENTS
\nUNITED STATES
\n\u201cThis year our office will go green.\u201d Have
\nyou said or thought this? Has this been a
\ngoal for your office, clinic or outpatient fa-
\ncility that you have not accomplished? The
\nWorld Medical Association now offers to
\nits members a new free service, My Green
\nDoctor, which can make this possible.
\nMy Green Doctor is located on the web at
\nwww.mygreendoctor.org. This practice man-
\nagement tool has demonstrated that it can
\nsave offices money as they learn environ-
\nmental sustainability. One large group in the
\nUnited States began saving money in the first
\nmonth of using this system and continues to
\nsave more than $2000 US per doctor annually.
\nMy Green Doctor is a complete, simple-to-
\nfollow program that is used by those who
\nwork in the office. They learn how to create
\nand manage an office Green Team, and how
\nto make changes in the office that make the
\noffice healthier and more efficient. The of-
\nfice also learns ways to teach these ideas to
\nthe patients. This is another way in which
\nyour practice improves community health
\noutcomes. My Green Doctor will make
\nyour colleagues and you truly proud.
\nWhy Go \u201cGreen\u201d?
\nFirst of all, what do we mean by \u201cgreen\u201dand
\nwhy should this be a goal for your office?
\n\u201cGreen\u201d means to become an office that has
\nreached established benchmarks in man-
\naging its environmental impact. With My
\nGreen Doctor, each office decides which
\ntopics are important to and relevant to its
\nsituation. An office might consider how
\nenergy, water, paper products, chemicals or
\nother resources are used. It might consider
\nhow office staff members and patients travel
\nto and from the office since our transpor-
\ntation decisions have an environmental
\nimpact. It might mean changing the foods
\nwe choose to have in the office. My Green
\nDoctor offers more than 140 Action Steps
\nand Education Steps to pick from.
\nBecoming a green doctor office is not dif-
\nficult; your Green Teams simply meet over
\nlunch to make changes according to the
\nplans provided by My Green Doctor. In
\nthis manner, the office can look forwards to
\nmaking gradual improvements that over six
\nto twelve months provide significant satis-
\nfaction.
\nThe benefits are real and nearly immedi-
\nate. Your office is likely to save electricity
\nand water, which is real money. For ex-
\nample, a five-office practice in Pensacola,
\nFlorida is saving more than $14,000 US
\neach year on its electric bill. In addition,
\nthe people who join your office \u201cGreen
\nTeam\u201d will enjoy it because each person
\nis contributing to making their workplace
\nsafer, cleaner and healthier.This builds of-
\nfice morale and a team approach to prob-
\nlem-solving.
\nYour patients will see the improvements:
\nrecycling bins in your waiting room, bro-
\nchures or posters for them to read, a \u201cGreen
\nDoctor Recognition\u201d certificate from the
\n\u201cThis Year Our Office Will Go Green\u201d:
\nAnnouncing a New Free Service for
\nWMA Member Countries
\nTodd L Sack
\nReferences
\n1.\t Stroetmann K, Artmann J, Stroetmann V, Prot-
\nti\u00a0D, Dumortier J, Giest S, et al. European coun-
\ntries on their journey towards national eHealth
\ninfrastructures\u00a0\u2013 evidence on progress and rec-
\nommendations for cooperative actions. Final
\nEuropean progress report [Internet ]. ehstrate-
\ngies_final_report.pdf. 2011 [cited 15 January
\n2016]. Available from: http:\/\/www.ehealthnews.
\neu\/images\/stories\/pdf\/ehstrategies_final_report.
\npdf
\n2.\t Papanikolaou C. Implementation of ePrescrip-
\ntion in Greece [Internet ]. [Cited 12 January
\n2016]. Available from: http:\/\/ehealth2014.org\/
\nwpcontent\/uploads\/2014\/02\/Papanikolaou_
\nKiruna_Sw_4-5_02_2014.pdf
\n3.\t Schmid A, Wyss S, Giest S. E-Health Strate-
\ngies Country Brief: Switzerland [Internet ]. 1st
\ned. Bonn, Brussels: European Commission, DG
\nInformation Society and Media, ICT for Health
\nUnit; 2010 [cited 14 January 2016]. Avail-
\nable from: https:\/\/www.academia.edu\/869241\/
\nCountry_Brief_Switzerland
\nThe authors are thankful to all EQuiP As-
\nsembly members and Dr.\u00a0 Dana Mishina,
\nDr.\u00a0 Evelin Hanikat, Dr.\u00a0 Siiri Johanson,
\nProfessor Vytautas Kasulievicius, Professor
\nChristos Lionis for their contribution.
\nKatrin Martinson, Family doctor,
\nLinnam\u00f5isa Family Medicine Center,
\nEQuiP Estonian representative
\nLe Vallikivi, Family doctor,
\nMedicum Family Medicine Center Ltd,
\nEQuiP Estonian representative
\nE-mail: perearst.martinson@gmail.com
\n24
\nGreen Health UNITED STATES
\nWorld Medical Association on your wall,
\nand likely other measures that will tell them
\nthat yours\u2019 is a modern, progressive office
\nwith a broad interest in their health. My
\nGreen Doctor is designed for doctor offices,
\nis peer-written, peer-reviewed, non-parti-
\nsan, based on solid science, and is written
\nto be understood by anyone working in a
\nmedical office.
\nText box idea: \u201cWww.mygreendoctor.org is
\na free, non-profit site that is based on solid
\nscience and is managed by physicians. It is
\neasy to use and confidential, plus no ads, pop-
\nups, banners, or passwords.\u201d
\nGetting Started
\nStart by talking with your practice\u2019s manag-
\ning physicians, owners or Board of Direc-
\ntors. They should agree to adopt environ-
\nmental sustainability as a core value for your
\ncompany and to choose My Green Doctor
\nto guide the process.My Green Doctor pro-
\nvides a sample company environmental sus-
\ntainability policy and a ten-minute Power
\nPoint talk to introduce these ideas. If you
\nare a large practice, your company will want
\nto appoint an Environmental Sustainability
\nCommittee that will meet monthly to coor-
\ndinate your progress.
\nEach office will learn how to initiate and
\nmanage an office Green Team. The Team
\nconsists of members of the office staff who
\nare willing to meet monthly over lunch.
\nThe best teams draw volunteers from many
\nsectors of the office\u2014nurses, front office
\nstaff, cleaning personnel, managers, phy-
\nsicians, etc. At these meetings, the Team
\nmembers will consider Action Steps to
\nadopt for the office. At subsequent meet-
\nings, the Team will review the progress
\nmade as well as the setbacks, and will con-
\nsider other Action Steps to pursue. Along
\nthe way, the Team decides how to share
\nthis information with other staff members,
\nwith their families and the patients. These
\nare the Education Steps.
\nA key early step is to find someone to be
\nthe Green Team Leader. This might be a
\nphysician, an office manager, or anyone who
\nwants to help out. The leader will sched-
\nule the Team meetings, send reminders to
\nmembers, and manage the meetings to be
\nsure that each Action Step has a Champion
\nwho takes responsibility for reporting back
\nat the next Team meeting. The position of
\nTeam leader can rotate every few months.
\nThe Team will report its progress quarterly
\nto your Environmental Sustainability Com-
\nmittee or to the Board of Directors.
\nSix Tips for Green Team Success:
\n1.\t Declare environmental sustainability
\nto be a core value.
\n2.\t Adopt an environmental sustainabil-
\nity policy for your practice.*
\n3.\t Require Green Teams to meet month-
\nly in every office.
\n4.\t Make small, steady steps with one
\nnew Action Step each month.
\n5.\t Teach: use email, brochures, green
\ntips, posters, & meetings.*
\n6.\t Reward your Team with thanks,praise,
\nand more.
\n\u2003 *\u2002 available at www.mygreendoctor.org\/resources
\nA Green Team\u2019s First Meeting
\nYour Green Team will not need experts,
\noutside consultants, or prior knowledge
\nof environmental management. Ask office
\nmembers to join you for your first meeting
\nover lunch and to register at www.mygreen-
\ndoctor.org (no passwords are needed). They
\ncan bring their laptops or you might pho-
\ntocopy the one-page \u201cQuick Start, Now!\u201d
\nguide and the \u201cQuick Start, Now!\u201d Action
\nSteps from one of the Workbooks.
\nAt the first meeting, the Green Team will
\nchoose one or two Action Steps from any
\nof the seven Workbooks. It is easiest to pick
\nfrom \u201cEnergy Efficiency\u201d, \u201cSolid Waste &
\nRecycling\u201d, or \u201cDrug Disposal & Chemi-
\ncals\u201d. Each of these workbooks has an
\n\u201cIntroduction\u201d section, a \u201cBackground In-
\nformation\u201d section, and an \u201cAction Steps\u201d
\nsection.
\nA good place to start is the \u201cEnergy Ef-
\nficiency\u201d Workbook. You might adopt the
\npolicy to turn machines off at night or
\nto adjust the thermostats to save money.
\nFor each Action Step, discuss how it will
\nbe implemented, how you will share your
\nplans with the entire office, pick a cham-
\npion from the Team to oversee the Step,
\nand set a date for completion. Someone
\nshould record your decisions on the Green
\nTeam Notes form provided by My Green
\nDoctor, and be sure to set the date for the
\nnext meeting.
\nYour Next Meetings
\nPlan for your Green Team to meet month-
\nly. At each meeting, review the progress
\nand setbacks experienced with the Action
\nSteps that you have adopted. Look at other
\nWorkbooks, starting with those that have
\nthe easy \u201cQuick Start, Now!\u201d steps. Read
\ntogether the \u201cIntroduction\u201d and \u201cBack-
\nground Information\u201d sections because
\nthese sections provide the knowledge base
\nthat will engage and empower each mem-
\nber of your Team.
\nAfter a few months, consider some of the
\nmore ambitious but interesting options for
\nyour office. For example, you might build a
\ncomprehensive energy plan to save big mon-
\ney, or reconfigure people\u2019s work schedules\u00adto
\nminimize their transportation environmen-
\ntal impacts, or eliminate Styrofoam, bottled
\nwater or hazardous cleaning chemicals.
\nYou could agree to use the \u201cHealthy Foods\u201d
\nguidelines for food gifts that are brought to
\nyour office by salespeople. You could spon-
\nsor a community garden or start one your-
\nselves. You could install a solar hot water
\nheater or simply turn off your hot water
\nheater forever as a few offices have done.
\nYou can purchase renewable energy credits
\n(REC\u2019s) to offset the carbon dioxide pollu-
\ntion from your office\u2019s energy use.
\n25
\nGreen Health
\nBACK TO CONTENTS
\nUNITED STATES
\nEducation Steps: Your
\nBiggest Impact
\nWhatever your office does, you will want to
\ntalk about it,perhaps even to brag a bit.Www.
\nmygreendoctor.org offers dozens of Educa-
\ntion Steps. These can be a powerful part of
\neach Green Team meeting. An Education
\nStep could be a short text message or memo
\nto co-workers, a brief report at each staff
\nmeeting, or an item in each office newsletter.
\nFor patients, they can be a poster in the wait-
\ning room or a sticker on light switches such
\nas \u201cPlease Turn Me Off\u201d. The website offers
\nmany free, downloadable brochures that you
\ncan print and place in your waiting rooms
\nfor your patients to take home (click the Re-
\nsources tab). Your Green Team will only be
\ntruly effective if you educate those around you.
\nGreen Team members take ideas home to
\ntheir families and neighbors. These include
\nideas about energy efficiency, wise water
\nand chemicals uses, healthy food choices,
\nand healthy transportation decisions. Peo-
\nple look to health providers and doctors as
\nrole models; when we recycle, keep organic
\ngardens, bicycle to work or drive energy-ef-
\nficient cars, our patients and neighbors pay
\nattention. The exchange of information is a
\ntwo-way street with Green Team members
\noften bringing green ideas to the office that
\nthey learn from their children.
\nText box idea: \u201cA Green Team\u2019s greatest im-
\npact comes from teaching others.\u201d
\nGreen Doctor Office Recognition
\nMonthly meetings can earn your office the
\nGreen Doctor Office Recognition certificate
\nwithin six months. The office must meet the
\nstandards established and maintained by
\nMy Green Doctor physicians. These include
\ncompleting five Green Team Meetings, im-
\nplementing five Action Steps, and complet-
\ning five Education Steps.The \u201cNuts & Bolts\u201d
\ntab of www.mygreendoctor.org describes
\nhow to record your Green Team Notes and
\nhow to submit your documentation.
\nGoing Green, For Good
\nBusinesses large and small have been \u201cgo-
\ning green\u201d for decades. Their motivations
\nare as diverse as their business plans and
\nprofit margins. Like doctor offices, most
\nstart because they want to save money
\nand most accomplish that. But many busi-
\nnesses report that the non-monetary ad-
\nvantages are the most rewarding and are
\ngained when businesses not only \u201cgo green\u201d
\nbut also stay green \u201cfor good\u201d.These offices
\nhave used the greening process to foster a
\nculture of teamwork, resources conserva-
\ntion and mutual respect. The World Medi-
\ncal Association is proud to offer My Green
\nDoctor to its members without a fee and
\nurges you to register your office today.
\nTodd L Sack,
\nMD, Florida physician in private
\npractice for more than twenty years;
\neditor My Green Doctor for the WMA.
\nE-mail: tsack8@gmail.com
\nOn the International Public
\nCoordination Health Committee
\nThe International Public Coordination
\nHealth Committee was established on
\nMay 15, 2015, in Almaty, Kazakhstan, at
\nthe initiative of the National Medical As-
\nsociation of the Republic of Kazakhstan
\nand the non-commercial partnership the
\nNational Medical Chamber of the Russian
\nFederation. The purpose of the Commit-
\ntee is to create a dialogue platform for the
\nmedical community from different coun-
\ntries and various medical organizations
\nand associations whose activities are aimed at improving the quality
\nindicators of health and preservation of human life.
\nThe Headquarters of the International Coordination Public Health
\nCommittee is at the office of the National Medical Association in
\nAlmaty, 117\/1 Kazybek bi str.
\nOn October 13, 2015, in Moscow the first meeting of the Inter-
\nnational Public Coordination Health Committee was held which
\ntook place at the Research Institute of Emergency Children\u2019s Sur-
\ngery and Traumatology. The meeting was attended by representa-
\ntives of Belarus, Bulgaria, Greece, Kazakhstan, Latvia, the Prid-
\nnestrovian Moldavian Republic, Russia and Finland.
\nThe meeting adopted Regulations on the International Public Co-
\nordination Health Committee and regulations on the following
\nstructural units: Eurasian Council on Bioethics, Eurasian Council
\non Mediation in Healthcare, International Committee on Infor-
\nmatization of Health and International Committee on Indepen-
\ndent Expertise of Treatment Quality. The Heads of the units were
\nnominated and approved.
\nThe Committee welcomes further cooperation through Memoran-
\ndum of International Cooperation and Mutual Understanding in
\nHealth Sector which now is open for signing to all organizations.
\nAddress: Kazakhstan, 050\u00a0000 Almaty,
\n117\/1 Kazybek bi str
\nE-mail: doctor_sadykova@mail.ru
\nFax\/tel: +7\u00a0727 2 331890
\nAizhan Sadykova
\n26
\nAustralian Medical Association
\n(AMA)
\nOffice Bearers:
\nPresident: Professor Brian Owler, a Neuro-
\nsurgeon based in Sydney, Australia
\nVice President: Dr. Stephen Parnis, an
\nEmergency Physician based in Melbourne,
\nAustralia
\nThe AMA is the peak representative and
\nadvocacy body for all registered medical
\npractitioners and medical students in Aus-
\ntralia.
\nMedical students can join the AMA for free and are supported with
\nadvocacy, lobbying and mentoring.
\nAMA membership provides political representation, political and
\nprofessional lobbying, media commentary, public health advocacy,
\nworkplace representation and advice, career advice and support, in-
\ndustrial relations expertise and craft group representation.
\nMembers shape and debate current issues facing the medical work-
\nforce and patients. Policies are developed at the association\u2019s annual
\nNational Conference.
\nThe AMA publishes two magazines that are distributed to all mem-
\nbers and which contribute to national information and debate on
\nmedical research and health policy.
\nThe prestigious Medical Journal of Australia, which celebrated its
\ncentenary in 2014, publishes peer reviewed medical research papers
\nand provides a forum for debate on pressing clinical issues.
\nIn addition, the AMA publishes a fortnightly national news
\nmagazine, Australian Medicine, which keeps members informed
\nabout national and international developments affecting health
\npolicy, as well as updates on the Association\u2019s policy and advocacy
\nwork.
\nThe AMA has a strong presence in national health policy debates.
\nIt is one of the nation\u2019s most active lobby groups, and maintains a
\nstrong network of contacts among Government Ministers, Federal
\npoliticians and political parties.
\nIt frequently presents submissions to, and appears before, parlia-
\nmentary inquiries into health issues, and is also represented on
\nmany government committees, advisory bodies and instrumentali-
\nties, ensuring that the voice of the profession is heard well before
\ndecisions are made.
\nThe AMA keeps politicians informed about the views of the profes-
\nsion in order to help achieve better health outcomes for all Austra-
\nlians.
\nThe AMA frequently runs campaigns to influence government de-
\ncisions and policies.
\nAll policies and advocacy by the AMA is conducted in the interests
\nof patients and the medical profession.
\nAMA House, 42 Macquarie Street, Barton, ACT, Australia, 2600
\nSecretary General Anne Trimmer
\nPh: 61 2 6270 5460; Fx: 61 2 6270 5499
\nE-mail: atrimmer@ama.com.au
\nWebsite: www.ama.com.au
\nAustrian Medical Chamber
\n(\u00d6\u00c4K\u00a0\u2013 \u00d6sterreichische \u00c4rztekammer)
\nOffice Bearers:
\nPresident: Dr. Artur Wechselberger
\nVice Presidents: Dr. Karl Forstner,
\nDr.\u00a0Harald Mayer
\nInternational Affairs: Dr. Johannes
\nSteinhart, Dr. Reiner Brettenthaler
\nDirectors: Dr. Lukas St\u00e4rker, Dr. Johannes
\nZahrl
\nMembership: According to the Austrian
\nMedical Act, the Austrian Medical Cham-
\nber represents the professional, social and economic interests of all
\ndoctors engaged in medical activities in Austria.Furthermore,it acts
\nas umbrella association under public law for its nine members, the
\nmedical chambers in the Austrian provinces. Membership is obliga-
\ntory for every doctor wishing to pursue medical activities in Austria.
\nActivities and Services:Legal responsibilities of the Austrian Medical
\nChamber include, besides others, admission to and administration of
\nthe medical register, as well as recognizing foreign medical qualifica-
\ntions. Furthermore, the Austrian Medical Chamber is the competent
\nauthority for issuing medical diplomas and for conducting specialist
\nand GP qualifying exams.The elaboration of concepts,expert opinions
\nand proposals regarding the Austrian health care system, including the
\nright to comment on draft bills or enacting guidelines on medical fees,
\non the medical code of conduct etc., as well as concluding contracts
\nwith social insurance institutions and collective agreements, and exe-
\ncuting disciplinary legislation and arbitration also belong to the respon-
\nsibilities of the Austrian Medical Chamber. Moreover, the Chamber
\nis involved in the elaboration of specialist and GP training programs,
\nand it also has its own institution offering CME\/CPD for Austrian
\nmedical doctors. The Chamber provides counselling for its members
\nin issues relating to professional law and in international matters. In-
\nformation for members is provided on the website and in the journal
\nof the Austrian Medical Chamber (\u00d6sterreichische \u00c4rztezeitung).
\nBrian Owler
\nArtur Wechselberger
\nNMA news
\n27
\nBACK TO CONTENTS
\nInternational collaboration: Besides its WMA membership, the
\nAustrian Medical Chamber is also a member of AEMH, CEOM,
\nCPME, EANA, EFMA\/WHO, EJD, FEMS, UEMO, UEMS and
\nZEVA. The Austrian Medical Chamber actively participates in the
\nwork of these organisations and regularly attends meetings.
\nVision:The Austrian Medical Chamber aims at achieving a positive
\nframework for medical practice in Austria.This includes in particu-
\nlar the improvement of the specific working conditions for doctors.
\nThereby, the work of the Austrian Medical Chamber constitutes a
\nmajor contribution to the wellbeing of the patients and the Austrian
\nhealthcare system in general.
\nWeihburggasse 10-12
\n1010 Wien
\nAustria
\nE-mail: post@aerztekammer.at
\nWebsite: www.aerztekammer.at
\nAssociation Belge des Syndicats
\nM\u00e9dicaux
\nOffice Bearers:
\nPresident: Dr. J. de Toeuf
\nVice-President: Drs. M. Moens \u2013
\nL.\u00a0De\u00a0Clercq \u2013 R. Lemye \u2013 M.\u00a0Vermeylen
\nSecretary General: Drs. M. Masson \u2013
\nY.\u00a0Louis
\nTreasurer: Dr. L. Herry
\nHead of International Affairs:
\nDr.\u00a0B.\u00a0Maillet
\nActivities: The ABSyM\/BVAS (Belgian Association of Medical
\nUnions) was created in 1963 as a reaction to the decision of the
\ngovernment to oblige the medical profession to be regulated by the
\nBelgian State. Belgian physicians thought that this system could
\nnot match their medical ethics which is based on a doctor-patient
\nrelationship of trust implying free choice of a doctor by a patient,
\ndoctor\u2019s therapeutic freedom as well as secrecy.The rules and legisla-
\ntion established by the State affected those principles.
\nQuite rapidly, physicians from all over the country get organized
\nand created doctor\u2019s associations on the ground. Those associations
\nfederated and developed necessary means to deal with conflicting
\nsituations. This association that is presently called ABSyM\/BVAS
\nwas the successor of the former Belgian Medical Federation (F\u00e9-
\nd\u00e9ration m\u00e9dicale belge – FMB) which was unable to organize a
\nresistance movement.The conflict raised the year after,in 1964,with
\na medical strike that lasted nearly one month and had been very
\nwell planned.The medical corps, organized as an emergency doctor
\nservice, then proposed nothing more than depersonalized care, ac-
\ncording to the modalities and procedures the government wanted to
\nestablish. As the conflict got worse and since the government had
\ndecided to requisition physicians, the ABSyM\/BVAS launched a
\n\u201cluggage\u201d operation. Most of the physicians went abroad to escape
\nthe potential requisitions.This operation brought the government to
\ngive in on this issue. The conflict led to some agreements that fore-
\nsaw an annual collaboration system between the ministry of public
\nhealth and social affairs, mutual companies and physicians which
\nallowed the coexistence of a medical private practice and a social
\nfinancing.This annual or biennial agreements\u2019system is still ongoing
\nalthough it has been dealing with many problems and had to tackle
\nthe evolution of the medical profession in which it is often diffi-
\ncult to fully preserve the Hippocratic principles. Let\u2019s think about
\nthe control over expenditure, the necessity of teamwork but also the
\nexchange of data which is the inevitable consequence to reach the
\nnecessary balance.
\nThe ABSyM\/BVAS did not only focus on union defense. It has
\nbeen firmly committed in the defense of patients\u2019 interests and dia-
\nlogue with them, who have also formed associations. The ABSyM\/
\nBVAS has been committed in the quality of care thanks to an incen-
\ntive system rather than restraints and sanctions. Furthermore, the
\nABSyM\/BVAS gives priority to security and patients\u2019 rights and
\nalso organizes direct dialogue with other health care professionals
\n(pharmacists, dentists, nurses, physiotherapists\u2026). It also takes care
\nof the working conditions of physicians and their health. Its sphere
\nof activity is as extended as the one of associations but in the mean-
\ntime, it also preserves means of action when the negotiation shows
\nno signs of good results.The Belgian \u201cdefederalization\u201dwhich is cur-
\nrently ongoing gives the ABSyM\/BVAS new concerns, especially
\nsince it remains one of the few unitary organizations in the country.
\nNevertheless, the strongly professionalized ABSyM\/BVAS is look-
\ning to the future with confidence.
\nMember of CPME, UEMO, ARMH, EANA, EFMA and WMA.
\nThe ABSyM\/BVAS is active in many organs of the INAMI\/RIZIV
\n(Belgian Federal Institute for Health Insurance), such as the Gen-
\neral Council,the Insurance Committee,the Assessment Committee
\nof Medical Practices with regard to Medicines, the Drug Reim-
\nbursement Commission, etc. and is also represented into work-
\ngroups of the Public Health Ministry.
\nChauss\u00e9e de la Hulpe 150
\nB \u2013 1170 Brussels
\nPhone: +32 2\/644 12 88
\nE-mail: info@absym-bvas.be
\nWebsite: www.absym-bvas.be
\nJ. de Toeuf
\nNMA news
\n28
\nBrazilian Medical Association
\n(AMB)
\nOffice Bearers (2014\u20132017):
\nPresident: Florentino de Araujo Cardoso
\n1st Vice-President: Eleuses Vieira de Paiva
\n2nd Vice-President: Lincon Lopes Ferreira
\nSecretary General: Ant\u00f4nio Jorge Salom\u00e3o
\n1st Secretary: Aldemir Humberto Soares
\n1st Tresurer: Jos\u00e9 Luiz Bonamigo Filho
\n2nd Treasurer: Miguel Roberto Jorge
\nDirector of International Affairs: Nivio
\nLemos Moreira Junior
\nMembership:Any medical doctor from any
\nState in the country can join the Brazilian Medical Association as
\na regular member if he\/she is a regular member of his\/hers State
\nMedical Association which are Affiliated to the AMB. Medical
\nStudents can join as associate member and has its representation
\nthrough the Young Doctor Committee.
\nServices provided:The main services provided by the AMB to their
\nmembers are: Board Certification along with the respective Spe-
\ncialty Society, the Brazilian Hierarchical Classification of Medical
\nProcedures which defines the minimum cost of medical procedures
\nshould be, news and scientific publications, representation of their
\ninterests in national and international forums.
\nActivities:
\n\u2022\t for Members: a Continuing Medical Education Program,the Evi-
\ndence Based Medical Guidelines Project,cultural activities,Medi-
\ncal Meetings, Members Benefits Club and Leadership Program.
\n\u2022\t for the Public: Salve Sa\u00fade (Cheers Health) – Campaign to pro-
\nmote healthy habits and the prevention of Non Communicable
\nChronic Diseases. Caixa Preta da Saude ( Health Black Box) –
\nCampaing to encourage the population to denounce precarius
\nconditions of health services. Patient Safety Commission . Elec-
\ntronic Prescription.
\nWith the Government: a Law Proposal to increase yearly fund-
\ning for health to a minimum of 10% of the GDP, lobby at the
\nMinistry of Education for quality control when approving new
\nand inspecting existent medical schools and Medical Residents
\nTraining Program , lobby at the Ministry of Health for adoption
\nof a medical career in the public services, and improve the quality
\nof Public Health Care.
\nWith the Media: press releases related to health issues of public
\ninterest, promotion of debates related to health policies, educa-
\ntion on health related issues, Social Media and Digital Comu-
\nnication.
\nWith Strategic Partners: special programs with pharmaceutical and
\nhealth insurance companies, and financial institutions aiming to
\npromote health information to the public as well as to provide free
\naccess to scientific publications to Brazilian physicians. Exchange of
\ninformation and activities with others National Medical Associa-
\ntions and International Health Organizations.
\nRua Sao Carlos do Pinhal 324,
\nCEP 01333-903, S\u00e3o Paulo-SP, Brazil
\nPhone: +55 11 31786800
\nEmail: internacional@amb.org.br
\nWebsite: www.amb.org.br
\nFrench Medical Council
\nOffice Bearers:
\nPresident: Dr. Patrick Bouet
\nSecretary General: Dr. Walter Vorhauer
\nPresident of the International Relations
\nDelegations: Dr. Xavier Deau, Immediate
\nPast-President of the WMA.
\nThe French Medical Council in a nutshell
\nThe French Medical Council brings togeth-
\ner all doctors in France whatever their spe-
\ncialty and their mode of practice, defends
\nthe honor, protects the independence and represents the medical
\nprofession. By taking on a moral, administrative, consultative, me-
\ndiation and jurisdictional role, the French Medical Council is the
\nguarantor of the doctor\/patient relationship. The commitment of
\nthe French Medical Council in its everyday activities is being at the
\nservice of doctors in the best interest of patients.
\n\u2022\t The French Medical Council is a private body charged with a
\npublic service obligation whose existence is established in the
\nFrench Code of Public Health.
\n\u2022\t In France, doctors must be registered to be allowed to provide
\nitems of medical service.According to the French Law,the French
\nMedical Council is the one managing the whole process of regis-
\ntration of doctors (including the establishment and maintenance
\nof the official register of doctors), monitoring their conditions of
\npractice as well as taking care of the recognition of their profes-
\nsional qualifications.
\n\u2022\t The French Medical Council consists of one Departmental Coun-
\ncil per French Department (95 in total), one Regional Council
\nper French Region (22 in total). The French National Council
\nis made up of 54 members (from each Region), elected by the
\nFlorentino de
\nAraujo Cardoso
\nPatrick Bouet
\nNMA news
\n29
\nBACK TO CONTENTS
\nDepartmental Councils, a member appointed by the Academy of
\nMedicine, and a Councilor of State appointed by the Minister of
\nJustice.
\n\u2022\t Members of the National Council meet in four different sections:
\nEthics and good medical practice, Professional practice, Medical
\ntraining and competence and Public health and medical demog-
\nraphy.
\n\u2022\t The Council writes and updates the French Code of Medical
\nEthics, which is an integral part of the French National Code of
\nPublic Health.
\n\u2022\t The French Medical Council also acts as a disciplinary body for
\ndoctors
\n\u2022\t The Council has set up 2 Delegations: one for internal affairs (to
\nsupport and oversee the Departmental and Regional Councils)
\nand one for European and International Affairs (DAEI) (to work
\nwith other European and international bodies).
\nEuropean and International Commitments
\n\u2022\t Since 2012, the French Medical Council is an official member of
\nthe World Medical Association
\n\u2022\t The French Medical Council runs the General Secretariat of:
\n— The European Council of Medical Orders (CEOM) which
\nbrings together Medical Councils and regulatory bodies from
\n16 European countries. It aims at promoting the practice at
\nEuropean level of high quality medicine respectful of patients\u2019
\nneeds
\n— The Conference of Medical Councils from French-speaking
\ncountries (CFOM) which is a collegial forum for discussion
\namong medical regulatory bodies from French-speaking coun-
\ntries.
\nBrussels representative office
\nThe French Medical Council opened in 2008 a representative office
\nto the European Institutions in Brussels in order to closely monitor
\nEuropean legislation on health.
\nConseil national de l\u2019Ordre des m\u00e9decins
\n180 boulevard Haussmann
\n75389 Paris Cedex 08
\nE-mail: conseil-national@cn.medecin.fr;
\ninternational@cn.medecin.fr
\nWebsite: www.conseil-national.medecin.fr
\nBundes\u00e4rztekammer\/
\nGerman Medical Association
\n(GMA)
\nOffice Bearers and Representatives:
\nPresident: Prof. Dr. Frank Ulrich
\nMontgomery
\nVice-President: Dr. Martina Wenker,
\nVice-President: Dr. Max Kaplan,
\nHonorary President: Prof. Dr. Karsten
\nVilmar,
\nSecretary General: Tobias Nowoczyn,
\nHead of Department for International
\nAffairs: Dr. Ramin Parsa-Parsi, MD MPH,
\nPolicy Advisor: Domen Podnar,
\nDepartment for International Affairs
\nThe German Medical Association (Bunde\u00ads\u00e4rz\u00adtekammer) is the joint
\nassociation of the State Chambers of Physicians (Landes\u00e4rztekam-
\nmer) in Germany. It represents the interests of all 481,174 physi-
\ncians in Germany (as of 31\/12\/2014) in matters relating to profes-
\nsional policy and plays an active role in opinion-forming processes
\nwith regard to health and social policy and in legislative procedures.
\nIn addition to in-house committees focused on specific topics rel-
\nevant to the medical profession, separate bodies such as the Scien-
\ntific Advisory Board and the Drug Commission are housed within
\nthe GMA, but have their own statutes and rules of procedure.Their
\nmembers are elected by the Executive Board of the German Medi-
\ncal Association or the German Medical Assembly \u2013 the annual par-
\nliament of the German medical profession.
\nThe GMA is also home to the Office for Transplantation Medi-
\ncine (Gesch\u00e4ftsstelle Transplantationsmedizin), which advises on and
\nmonitors compliance with transplantation regulations.
\nActivities
\nThe activities of the German Medical Association include:
\n\u2022\t Developing and maintaining the
\n— (Model) Professional Code ((Muster-)Berufsordnung), used by
\nthe State Chambers of Physicians as a basis for their own le-
\ngally binding Professional Codes, which outline the ethical and
\nprofessional obligations of physicians among themselves and
\nvis-\u00e0-vis patients.
\n— (Model) Specialty Training Regulations ((Muster-)Weiterbil-
\ndungsordnung), used by the State Chambers of Physicians as a
\nbasis for their own legally binding Specialty Training Regula-
\ntions, which define the content, duration and objectives of spe-
\ncialty training and specialist designations.
\nFrank Ulrich
\nMontgomery
\nNMA news
\n30
\n— (Model) Regulations on Continuing Medical Education
\n((Muster-)Fortbildungsordnung), used by the State Chambers of
\nPhysicians as a basis for their own legally binding Regulations
\non Continuing Medical Education.
\n\u2022\t Ensuring quality medical care by coordinating exchange among
\nthe 17 State Chambers of Physicians.
\n\u2022\t Cultivating a sense of unity among all physicians practising in
\nGermany by advising and informing them of all important pro-
\ncesses and activities relevant to their profession.
\n\u2022\t Achieving the most uniform possible regulation of professional
\nduties and principles for medical practise in all fields.
\n\u2022\t Safeguarding the professional interests of physicians in matters
\nbeyond state jurisdiction through exchanges with the Federal
\nGovernment, the Bundestag and the Bundesrat (the two houses of
\nparliament) and political parties.
\n\u2022\t Communicating the position of the medical profession on mat-
\nters relating to health policy and medicine.
\n\u2022\t Promoting continuing medical education.
\n\u2022\t Promoting quality assurance.
\n\u2022\t Establishing and maintaining good relations with the global
\nmedical community.
\nMembership
\nMembership in one of the 17 State Chambers of Physicians is
\ncompulsory for all physicians practising medicine in Germany. In-
\ndividual physicians are therefore indirectly members of the German
\nMedical Association.
\nInternational commitment
\nThe GMA represents the interests of the German medical profes-
\nsion on the international stage through its membership in numer-
\nous international organisations and bilateral relations with medical
\norganisations abroad.
\nIn its work with the World Medical Association (WMA), the
\nStanding Committee of European Physicians (CPME), the Eu-
\nropean Forum of Medical Associations (EFMA), the European
\nConference of Medical Chambers (CEOM), the European Net-
\nwork of Medical Competent Authorities (ENMCA) and the an-
\nnual ZEVA Symposium of the Central and Eastern European
\nChambers of Physicians, the GMA contributes to the dialogue on
\nimportant social and ethical issues that impact the global medical
\ncommunity.
\nHerbert-Lewin Platz 1
\nD-10623 Berlin
\nGERMANY
\nTelephone: + 49 30 400 456 361
\nTelefax: + 49 30 400 456 384
\nE-mail: international@baek.de
\nWebsite: www.bundesaerztekammer.de
\nIndian Medical Association
\n(IMA)
\nOffice Bearers:
\nPresident: Dr. S S Agarwal
\nNational Hon Secretary General:
\nDr. K K Aggarwal
\nIndian Medical Association (IMA) is the
\nonly representative, national voluntary or-
\nganization of Doctors of Modern Scientific
\nSystem of Medicine in India, which looks
\nafter the interest of doctors and the well-
\nbeing of the community at large with the
\nfollowing objectives:
\n1.\t To promote and advance medical and allied sciences in all their
\ndifferent branches and to promote the improvement of public
\nhealth and medical education in India.
\n2.\t To maintain the honour and dignity and to uphold the interest
\nof the medical profession and to promote co-operation amongst
\nthe members thereof;
\n3.\t To work for the abolition of compartmentalism in medical edu-
\ncation, medical services and registration in the country and thus
\nto achieve equality among all members of the profession.
\nThe founding fathers way back in 1928, felt the need of a national
\norganization of the Medical Profession. Before that, some members
\nof the profession \u2013 a selected few \u2013 were members of the British
\nMedical Association, which had opened branches in India to cater
\nto the local needs. These stalwarts, ultimately succeeded in forma-
\ntion of Indian Medical Association and reached an agreement with
\nthe British Medical Association that they will have no branch in
\nIndia and got mutually affiliated which relationship continues till
\ntoday.
\nIndian Medical Association, in the year 1946, helped in the orga-
\nnization of the World Medical Association and thus became one of
\nits founder members. As an organization, it has been and continues
\nto play an important role in its deliberations.
\nDr. R.V.Sathe, the then President, IMA held the chair of the Presi-
\ndent of WMA when the WMA met in New Delhi in 1962. It\u2019s
\na matter of pride that another illustrious Past President of IMA
\nDr.\u00a0A.K.N. Sinha also held the office of the WMA and now an-
\nother eminent Past President Dr. Ketan Desai will take over this
\npost in 2016.
\nThe IMA has been playing an important role in the deliberations
\nof the World Medical Association at New Delhi since its inception.
\nIMA, withdrew from World Medical Association in 1985, since the
\norganization refused to expel South Africa despite its dismal record
\nS S Agarwal
\nNMA news
\n31
\nBACK TO CONTENTS
\nof racial discrimination. IMA later in February, 1993 decided again
\nto become its member. 45th General Assembly of the World Medi-
\ncal Association at its meeting held on October 2-5, 1993 approved
\nIMA\u2019s membership of the WMA.
\nToday, IMA is a pan-India voluntary organization of practitio-
\nners of modern system of medicine. It has a membership of over
\n2,56,000 doctors spread over 30 state branches & 1700 local
\nbranches in almost all the districts of India. IMA is reaching to
\napproximately 33 crores (330 million) of people every month and
\nensuring affordable & quality treatment.
\nThe vast human resources and infrastructure at the command of
\nIMA is a national health asset.IMA members have been involved in
\nvarious programmes which are aimed mainly for the benefit of the
\ncommunity organized by various national and international agen-
\ncies.
\nIMA has complemented many Government Programmes like
\nRevised National Tuberculosis Control Programme (RNTCP),
\nAnaemia-Free India, Leprosy Eradication Programme, Child
\nSurvival & Reduction of Infant Mortalities and has provided all
\nassistance and expertise, whenever required, to ensure making
\nhealthcare accessible, affordable, qualitative and available timely
\nfor all.
\nIMA branches run Blood Banks, Bio-medical waste dispos-
\nal units, Palliative care units for cancer and Reproductive &
\nChild Health (RCH) centres besides imparting training to its
\nmembers in meeting various health challenges. IMA also ar-
\nticulates its views on policy matters and legislations pertaining
\nto health.
\nNational Headquarters
\nThe National Headquarter of the IMA is situated at New Delhi. It
\npublishes a monthly Journal \u201cJournal of Indian Medical Associa-
\ntion\u201d as an academic feast to all its members.
\nThe leadership of all IMA consists of Office-bearers Headquar-
\nters, of State & Local Branches, Working Committee and Central
\nCouncil Members.
\nIMA has three Academic Wings
\n\u2022\t IMA College of General Practitioners
\n\u2022\t IMA Academy of Medical Specialties
\n\u2022\t IMA AKN Sinha Institute of Continuing Medical & Health
\nEducation and Research
\nIMA has the following wings & Schemes running for the benefit
\nof its members:
\n\u2022\t IMA National Social Security Scheme
\n\u2022\t IMA National Professional Protection Scheme
\n\u2022\t IMA Hospitals Board of India
\n\u2022\t IMA National Health Scheme
\n\u2022\t IMA National Pension Scheme
\nIMA leadership communicates to each and every member through
\nvirtual Team IMA Group & through eIMA News & SMSes on a
\ndaily basis. We also communicate to the public through IMA PR
\nand communication department on a daily basis.
\nIMA also organizes Press Conferences in every State on regular
\nbasis and conducts similar Press Conference simultaneously in 100
\nBranches at the time.
\nIMA has trained 100% operational PCR staff of Delhi Police on
\nCPR-10 in a record time. The same is now being replicated at a
\nnational level.
\nIMA projects include awareness regarding Child Sexual Abuse,
\nStandards of TB Care, Violence against medical establishments,
\nsealing of charges during national calamity & availability of emer-
\ngent medical care to everybody in time.
\nIMA\u2019s Swacch Bharat Swastha Bharat Initiative (Clean India
\nHealthy India Initiative) spreads awareness about safe water, food
\nhygiene and control of vector borne diseases.
\nUnder Aao Gaon Chalen (Let\u2019s Go to Villages), IMA has adopted
\nmore than 100 villages and provides them free treatment on a regu-
\nlar basis. Over 10,000 free surgeries have already been done through
\nthis Project.
\nIMA is represented on various Government and Semi-Gov-
\nernment bodies of the Central and State Governments and on
\nother national institutions and thus contributes its view at these
\nforums and renders active cooperation within its policy frame
\nwork. As a voluntary body, the Association has been drawing the
\nattention of the Government and others concerned, to the spe-
\ncific areas in the field of health care in which the voluntary agen-
\ncies could play a leading role particularly in the implementation
\nof national health programs for achieving the goal of \u201cHealth for
\nAll\u201d. It has been organizing International and National Confer-
\nences, Seminars and Conventions on subjects of topical interest
\nfrom time to time.
\nThe official representatives of the Association have also been par-
\nticipating in International Conferences abroad and in the General
\nAssembly and Council Meetings of the World Medical Association,
\nthe Commonwealth Medical Association & WONCA etc.
\nAs a part of our commitment to public health, Indian Medical
\nAssociation has undertaken a large number of projects related
\nto the health of the general masses and the social practices of
\nthe Indian community. To name a few others, IMA has success-
\nfully undertaken projects related to Polio, Tuberculosis, Anaemia
\nFree India, HIV\/AIDS, Hepatitis, Prostrate Diseases, Avian and
\nSwine Flu and many other. We have collaborated with many In-
\nternational agencies and organizations like UNICEF, UNFPA,
\nPLAN International and Clinton Foundation etc. and Govt. de-
\npartments in our other projects related to Child Trafficking, Sex
\nSelection, Baby Friendly Hospitals Initiative where breastfeeding
\nis promoted, Infant mortality, Adolescent Health and Pharmaco
\nVigilance etc.
\nNMA news
\n32
\nIt is desirable for various National Medical Associations to ex-
\nchange study programmes, e-connect through video conferences
\nand conduct medical educational programmes and faculty exchange
\nwith Indian Medical Association.
\nIMA can also provide consultancy services from Indian doctors to
\npatients from other countries.
\nIMA helps in providing regular medical updates and updating med-
\nical journals of various NMAs. We can even issue joint advisories
\nfrom time to time during any infection outbreaks.
\nIMA House, Indraprastha Marg
\nNew Delhi (India)
\nMobile: +91-9811090206
\nE-mail: np@ima-india.org
\nE-mail: hsgima@gmail.com
\nWebsite: www.ima-india.org\/ima
\nKuwait Medical
\nAssociation
\nOffice Bearers (2014\u20132016):
\nPresident: Dr. Mohammad AlMutairi
\nVice President: Dr. AbdulMehsen
\nAlKandari
\nGeneral Secretary: Dr. Mohammad Faisal
\nAl-Qenai
\nTreasurer: Dr. Mohammad Abdullah
\nAlObaidan
\nExecutive Board Member: Dr. Laila Saud
\nAlEneizi
\nExecutive Board Member: Dr. Aseel O A AlSabbrei
\nExecutive Board Member: Dr. Nawaf F S Dehrab
\nMembership: All physicians in Kuwait from different specialties
\nincluding newly graduates are members of Kuwait Medical Asso-
\nciation (KMA).
\nServices provided:
\n1.\t Issuance of Kuwaiti Medical Journal since 1967
\n2.\t Establishment of Health Studies Centers such as Late Mo-
\nhamed Abdul Mohsen Al-Kharafi Center for Medical Infor-
\nmation
\n3.\t Training sessions for medical practice related-skills (e.g. writing
\nmedical articles)
\n4.\t Establishment and strengthening the collective solidarity fund
\nfor the members of the medical professions associations
\n5.\t Regulation of seasonal Association Group tours inside Kuwait
\nand abroad regularly
\n6.\t Association provides its professional consults for the National
\nAssembly, the Amiri Diwan and the Council of Ministers upon
\ntheir request
\n7.\t Playing a role in fortifying the health development in the com-
\nmunity advocacy and awareness campaigns in relation to diabe-
\ntes, heart disease, AIDS and others
\nVision:
\n1.\t Improving health and healthcare services in Kuwait
\n2.\t Encouraging cooperation , support and exchange of experiences
\nbetween the Arab physicians
\n3.\t Cooperating with similar foreign professional bodies , interna-
\ntional and regional organizations to serve the objectives of the
\nassociation.
\nInternational collaboration
\nKuwait Medical Association is currently collaborating with several
\ninternational organizations including:
\n1.\t Doctors Without Borders (MSF)
\n2.\t Healthcare Without Harm
\n3.\t World Medical Association
\n4.\t Arab Medical Union
\nKuwait Medical Association
\nP.O.Box 1202 Safat 13013
\nState of Kuwait
\nE-mail: kma@kma.org.kw
\nWebsite: www.kma.org.kw
\nNew Zealand
\nMedical Association
\nOffice Bearers (2013\u20132015):
\nPresident: Branko Sijnja
\nChair: Stephen Child
\nDeputy Chair: Kate Baddock
\nGeneral Practitioners Council Chair: Kate
\nBaddock
\nSpecialists Council Chair: Harvey White
\nDoctors-in-Training Council Chair: Marise Stuart
\nMembership: The New Zealand Medical Association (NZMA)
\nis the country\u2019s foremost pan-professional medical organisation in
\nNew Zealand representing the collective interests of all doctors.The
\nMohammad AlMutairi
\nBranko Sijnja
\nNMA news
\n33
\nBACK TO CONTENTS
\nNZMA\u2019s members come from all disciplines within the medical
\nprofession, and include specialists, general practitioners, doctors-
\nintraining and medical students.
\nServices provided: The NZMA is a strong advocate on medicopo-
\nlitical issues, with a strategic programme of advocacy with politi-
\ncians and offi cials at the highest levels.
\nThe key roles of the NZMA are:
\n\u2022\t to provide advocacy on behalf of doctors and their patients
\n\u2022\t to provide support and services to members and their practices
\n\u2022\t to publish and maintain the Code of Ethics for the profession
\n\u2022\t to publish the New Zealand Medical Journal.
\nThe NZMA works closely with many other medical and health
\norganisations, and provides forums that consider pan-professional
\nissues and policies. The NZMA has a close relationship with, and
\nprovides support to, the New Zealand Medical Students Associa-
\ntion (NZMSA).
\nThe NZMA provides administrative, advocacy and communica-
\ntions activities for the New Zealand Branch of the Royal Austra-
\nlian and New Zealand College of Ophthalmologists (RANZCO).
\nIt also provides support services to the Medical Benevolent So-
\nciety.
\nActivities (some examples)
\n\u2022\t With Members:
\n— Revision of the profession\u2019s Code of Ethics, which lays down
\nprinciples of ethical behaviour, applicable to all doctors. It also
\nincludes recommendations for ethical practice.
\n— Representing member practices in employment negotiations
\nwith the nurses\u2019 union.
\n— Providing advisory services for both employer and employee
\ndoctors on professional and business matters
\n\u2022\t With the Public: Reducing alcohol-related harm: a policy briefing \u2013
\nthis publication recommended a suite of measure to be considered
\nas part of an approach to tackling the harm caused by alcohol
\nabuse.This was a major piece of work for the NZMA,with several
\nmonths\u2019 research into the latest evidence of the harms associated
\nwith alcohol and on the successful ways in which these can be
\naddressed.
\n\u2022\t With local and central Government: Advocacy on: Physician as-
\nsisted dying; National Health Strategy; Pharmacy Action Plan;
\nlocal alcohol policies; New Zealand\u2019s climate change target; free
\ntrade agreements; health literacy; support for plain packaging for
\ntobacco products; eliminating illicit trade in tobacco products; a
\nnew national drug policy; non-medical prescribing; health equity
\nand social determinants ; health structure and funding, with par-
\nticular reference to primary care.
\n\u2022\t With the Media: Responsiveness to media and release of media
\nreleases related to health issues of public interest (obesity etc);
\npromotion of debates related to health policies (Trans Pacific
\nPartnership Agreement; tobacco packaging; refugee support; al-
\ncohol policies etc).
\n\u2022\t With Strategic Partners: Submissions to the Medical Council
\nof New Zealand on good prescribing, better data, registration of
\nforeign-trained doctors. Advocacy to the national funding agency
\nfor pharmaceuticals (PHARMAC) on proposals for procure-
\nment of medical devices for hospitals; prescribing by different
\noccupational groups; and various individual drug funding pro-
\nposals; advocacy to the Pharmaceutical Society on the draft Na-
\ntional Pharmacist Services Framework; workforce planning and
\nsustainability (with Health Workforce New Zealand and other
\nagencies).
\nPO Box 156, Wellington 6140,
\nNew Zealand
\nE-mail: nzma@nzma.org.nz
\nWebsite: www.nzma.org.nz
\nNigerian Medical Association
\n(NMA)
\nOffice Bearers (2014\u20132016):
\nPresident: Dr. Kayode Obembe
\n1st
\nVice President: Dr.Titus Ibekwe
\n2nd
\nVice President: Dr. Barthy
\nOkorochukwu
\nSecretary General: Dr. Adewunmi Alayaki
\nDeputy Secretary General: Dr. Chuks
\nossai- Abaninwa
\nNational Treasurer: Dr. Abdulrahman
\nAbubakar
\nEditor NMJ: Dr. Francis Uba
\nMembership: All medical and dental practioners in Nigeria are
\nmembers of the Nigerian Medical Association on induction as a
\nmedical practioner and fulfilling the necessary provisions as stipu-
\nlated by the Medical and Dental Council of Nigeria. Membership
\ncuts across members in Nigeria and those in the Diaspora.
\nAims and Objecitves:
\n1.\t To ensure that Medical and Dental Practioners in the country
\nuphold the physicians oath
\n2.\t To promote the advancement of health and allied sciences
\nKayode Obembe
\nNMA news
\n34
\n3.\t To assist thr government and people of the federal Republic of
\nNigeria is the provision of smooth,efficient and effective health-
\ncare delivery system in the country.
\n4.\t Tp promote the welfare and interaction of all medical and den-
\ntal practioners in the country
\n5.\t To cooperate with organizations anywhere in the world wich
\nhave similar aims and objectives
\nTo consider and Express views on all proposed legislations and na-
\ntional issues especially those affecting healthcare delivery system
\nand medical and dental education in Nigeria.
\nVision: A formidable professional body committed to fostering ef-
\nfective and efficient health care delivery, high ethical standarts and
\nthe interest of its members.
\nCore Values:
\n\u2022\t High ethical standarts of practice
\n\u2022\t welfare of members
\n\u2022\t compassionate service
\n\u2022\t integrity
\nMission:To build a sustainable proffesional Association of Medical
\nand Dental proffessionals that will advance the delivery pf qualita-
\ntive health care services through continuing Professional develop-
\nment, advocacy and policy development. knowledge management
\nand public\u0113 education, in collaboration with ither relevant stake-
\nholders.
\nInternational collaboration: The NMA is in collaboration with
\nseveral International oganisations, among these includes:
\nWorld Medical Association,African Medical Association,Collabo-
\nration is ongoing with svereal national medical associations, United
\nNations organisations, USAID, DFID etc.
\n8 Benghazi Street, Off Addis Ababa Crescent, Wuse Zone 4,
\nAbuja, FCT, Nigeria
\nP.O. Box: 8829, Wuse Abuja
\ntel: +2348035870494, +2348066102538
\nE-mail: nationalnma@yahoo.com
\nE-mail: k_obembe@yahoo.co.uk
\nWebsite: www.nationalnma.org
\nNorwegian Medical
\nAssociation
\nOffice Bearers:
\nPresident: Dr. Marit Hermansen
\nVice-president: Dr. Jon Helle
\nSecretary General: Dr.Geir Riise
\nThe Medical Ethics Committee:
\nchairperson: Dr.Svein Aarseth
\nOrganisation and membership: The Nor-
\nwegian Medical Association (NMA), was
\nfounded in 1886 as the professional asso-
\nciation and trade union for Norwegian physicians. Membership is
\nvoluntary, and approximately 96 % of the Norwegian physicians are
\nmembers. The main aims of the NMA are to protect and develop
\nthe professional, social and financial interests of its members, to
\npromote their interests in matters concerning medical education,
\nprofessional development and scientific activities, and to advance
\nthe quality of the Norwegian health care system.
\nMain bodies of the Norwegian Medical Association: The Annual
\nRepresentative Meeting (ARM) is the chief decision-making body
\nand elects the Central Board of 9 members, including the president
\nand vice-president. The election period for the board is two years.
\nARM also elects the Medical Ethics Committee
\nThe NMA consists of 19 local branches (one in each county), 7 oc-
\ncupational branches, 45 speciality branches, one for retired doctors
\nand one student organisation.
\nThe seven occupational branches organise members that share occu-
\npational interests: junior doctors, consultants, general practitioners,
\nresearchers, occupational health doctors, private practicing special-
\nists and public health doctors.The occupational branches have their
\nmain interests in salaries and working conditions, while the spe-
\ncialty branches are engaged in scientific and professional activities
\nlike education, quality improvement etc.
\nThe secretariat: The secretariat has six departments: Dep. of Pro-
\nfessional Affairs, Dep. of Communication and Politics, Dep. of Fi-
\nnance and Administration, Dep. of Law and Working Life, Insti-
\ntute for Studies of Medical Profession and The Norwegian Medical
\nJournal.The number of full-time staff members is 140.
\nThe role of The Norwegian Medical Association
\nThe Norwegian Medical Association is the only medical association
\nfor doctors in Norway.The NMA has two main responsibilities:
\n1.\t Negotiating salaries and working conditions for the members
\n2.\t Taking care of the members professional and scientific interests
\nMarit Hermansen
\nNMA news
\n35
\nBACK TO CONTENTS
\nIn addition the NMA is responsible for much of the post-graduate
\nspecialist education.
\nAreas of priority
\nThe Norwegian Medical Association will for the next two years
\n(2015\u201317) particularly work for:
\n\u2022\t Confident physicians \u2013 safe patients
\n\u2022\t Improve governance, organization and leadership of the specialist
\nhealth care sector
\n\u2022\t Improve the leadership of the medical profession in the primary
\nhealth care sector
\n\u2022\t Secure quality and capacity in the specialist education
\nSome data about Norway
\nNorway has a population of 5 160 000 and is situated in the
\nnorthern part of Europe and has borders to Sweden, Finland and
\nRussia.
\nHealthcare and services are financed by taxation and are designed
\nto be equally accessible to all residents, independent of social status.
\nWith its 220 000 employees, the health sector is one of the largest
\nsectors in Norwegian society.
\nThe healthcare system is under the jurisdiction of the Ministry of
\nHealth and Care services, which is responsible for planning and
\nmonitoring national health policy. Responsibility for provision of
\nservices is decentralized to the municipal and regional level. The
\nmunicipalities are in charge of providing primary healthcare ser-
\nvices, while the four Health regions provide the specialized medical
\nservices, mainly hospital care.
\nGeneral practice is organised through a list patient system. The
\nlist-patient system is a national system organised and run through
\nagreements between the NMA and the health authorities where the
\ngeneral practitioners are mainly self-employed.
\nThere are some specialist practices working under agreements with
\nthe Health regions.
\nNorway only has a few numbers of authorized private hospitals and
\nhealth services in addition to the public facilities.
\nThe number of doctors, including students and retired doctors, are
\nabout 32 262. In relation to inhabitants we have among the highest
\nnumber of doctors in Europe, in 2014 the ratio was one doctor per
\n218 inhabitants.
\nThe Journal of The Norwegian Medical Association is issued ev-
\nery second week (22\u201324 per year).
\nPost-graduate medical education: There are 45 recognised medi-
\ncal specialities in Norway of which eight are sub-specialities under
\ninternal medicine and five are sub-specialities under general surgery.
\nThe majority of the specialities relate to health services in institu-
\ntions (hospitals).Specialities i primary health care are general medi-
\ncine, community medicine and occupational medicine.
\nHealth politics: The NMA is involved in many of the activities run
\nby the health authorities through meetings, working groups and
\npolitical work. The NMA also appoints members to participate in
\ndifferent task groups, and meetings with the political parties in the
\nParliament.
\nInternational collaboration: The Norwegian Medical Association
\nmeets twice a year with the other Nordic medical associations to
\ndiscuss areas of common interest. We cooperate with the Chinese
\nPsychiatric Association on human rights and ethics in psychiatry
\nand Human Rights Foundation of Turkey on torture and rehabili-
\ntation of torture survivors. We also have a project in Malawi, to
\nsupport the Society of Medical Doctors of Malawi establishing a
\nwell-functioning secretariat.
\nThe Norwegian Medical Association
\nP.O.Box 1152 Sentrum
\nNO-0107 Oslo
\nPhone +47 23 10 90 00
\nTelefax +47 23 10 90 10
\nE-mail: legeforeningen@legeforeningen.no
\nWebsite: www.legeforeningen.no
\nPanhellenic Medical Association
\n(PhMA)
\nOffice Bearers:
\nPresident: Dr. Michail Vlastarakos,
\n1st
\nVice-President: Dr. Constantinos
\nGiannakopoulos
\n2nd
\nVice-President: Dr. Constantinos
\nKoutsopoulos
\nSecretary General: Dr. Dimitris Varnavas
\nTreasurer: Dr. Vladimiros Panagiotidis
\nMembers of the Board: Drs Anastasios
\nVasiadis, Athanasios Exadactylos, Pavlos
\nKapsambelis, Anna Mastorakou, Christos Papazoglou, Grigorios
\nRokadakis, Ioannis Chronopoulos, Michalis Psaltakos, Panagiotis
\nPsycharis.
\nThe Panhellenic Medical Association, the national Medical Asso-
\nciation of Greece, is an independent public legal entity, established
\nby the Legislative Decree of 1923 (OJ 309 A\/1923), having its reg-
\nistered offices in Athens. It is the central coordinative body and the
\nsupervisory organisation of all Greek physicians and country\u2019s local
\nMedical Associations.
\nMarit Hermansen
\nNMA news
\n36
\nWithin the Panhellenic Medical Association, the Supreme Disci-
\nplinary Board is constituted, with 6 regular members and 4 surro-
\ngate members, elected by the General Assembly, as well.The Disci-
\nplinary Board is empowered to hear doctors\u2019appeals of the decisions
\nof the local medical associations\u2019 disciplinary board.
\nPresident of the Supreme Disciplinary Board of PhMA: Dr.Matina
\nPagoni
\nVice-President: Dr. Stavros Fotopoulos
\nMembers:Members of the PhMA are the 60 local medical associa-
\ntions of the country. Doctors\u2019 registration within the local medical
\nassociation of the region where they practice medicine is mandatory.
\nThe Panhellenic Medical Association\u2019s bodies are the General As-
\nsembly, which is consisted of elected delegates from the local medi-
\ncal associations and the Board, consisted of 15 members elected by
\nthe General Assembly.
\nAims and objectives: The Panhellenic Medical Association is an
\ninstitutional consultant of the State on health issues, and it covers
\ncompetences of medical trade unions. It participates in the nego-
\ntiations on issues such as, the remuneration of physicians\u2019 salaries,
\nworking conditions of doctors, medical fees for self-employed phy-
\nsicians, pension issues, etc., and is represented at competent govern-
\nmental expert committees.At the same time,it is in regular dialogue
\nwith other national bodies in the health field, making every effort to
\nresolve problems that arise.
\nSince April 2016, the PhMA has been legislated to grant medical
\nspecialty titles and medical practice licenses, which are issued by the
\nlocal Regions, so far.
\nThe PhMA, having signed a Cooperation Agreement with the
\nUEMS-EACCME, accredits scientific educational events related
\nto lifelong learning of physicians and continuing professional de-
\nvelopment.
\nRecently, the Institute of Scientific Research of the PhMA is es-
\ntablished, dealing with issues of Healthcare, pharmaceutical policy,
\nmedical tourism, international affairs, etc.
\nInternational membership: The PhMa represents Greek phy-
\nsicians, as a member, to: Standing Committee of European
\nDoctors (C.P.M.E.), European Union of Medical Specialists
\n(U.E.M.S.), European Association of Senior Hospital Physi-
\ncians (A.E.M.H), Conseil Europ\u00e9en des Ordres de M\u00e9decins
\n(CEOM) and since October 2015, the PhMA is the 112 mem-
\nber of the WMA.
\nPanhellenic Medical Association
\nPloutarchou 3, GR-106 75 Athens, Greece
\nTel. +30 210 72 58 660-662 (ext.3)\/F. +30 210 72 58 663
\nE-mail: pisinter1@pis.gr
\nWebsite: www.pis.gr
\nPolish Supreme Chamber
\nof Physicians and Dentists
\n(Naczelna Izba Lekarska)
\nOffice Bearers (2014\u20132018):
\nPresident: Maciej Hamankiewicz
\nVice-Presidents: Romuald Krajewski,
\nZyta Ka\u017amierczak-Zag\u00f3rska, Agnieszka
\nRucha\u0142a-Tyszler (dental practitioner)
\nSecretary: Marek Jod\u0142owski
\nDeputy Secretary: Anna Lella (dental
\npractitioner)
\nTreasurer: Wojciech Marquardt
\nThe Polish (Supreme) Chamber of Phy-
\nsicians and Dentists (Naczelna Izba Lekarska) and the regional
\nchambers of physicians and dentists (okr\u0119gowe izby lekarskie) are
\nthe organizational bodies of the professional self-government of
\nphysicians and dental practitioners in Poland who are associated in
\nthe chambers with equal status.The professional self-government of
\nphysicians and dental practitioners in Poland was founded in 1922,
\ndissolved in 1952 and reestablished in 1989. There are 23 regional
\nchambers and a separate chamber of military physicians and dentists
\nthat has legal status of the regional chamber although it is active in
\nthe entire country. Every physician and every dental practitioner
\nwho holds the right to practice the profession in Poland is a member
\nof one of the regional chambers by virtue of the law. Currently the
\njoint self-government associates 178 000 physicians and dentists in
\nPoland, including approximately 125 000 practicing physicians.The
\nhighest authority of the Supreme Chamber of Physicians and Den-
\ntists is the General Medical Assembly whereas the regional medical
\nassemblies are the highest authorities of the regional chambers. In
\nthe period between assemblies \u2013 the Supreme Medical Council and
\nregional medical councils respectively.The Supreme Medical Coun-
\ncil represents the medical and dental professions at the state level,
\nand regional councils at regional levels.
\nScope of activity
\nThe field of activities of the self-government of physicians and den-
\ntists, as laid down in the Law of 2 December 2009 on Chambers of
\nPhysicians and Dentists, include:
\n\u2022\t supervising the proper and conscientious exercise of the medical
\nprofessions;
\n\u2022\t determining the principles of professional ethics and deontology bind-
\ning all physicians and dentists and looking after their compliance;
\n\u2022\t representing and protecting the medical professions;
\n\u2022\t integrating the medical circles;
\nMaciej Hamankiewicz
\nNMA news
\n37
\nBACK TO CONTENTS
\n\u2022\t delivering opinion on matters concerning public health, state
\nhealth policy and organization of healthcare;
\n\u2022\t co-operating with scientific associations, universities and research
\ninstitutions in Poland and abroad;
\n\u2022\t offering mutual aid and other forms of financial assistance to phy-
\nsicians and dentists and their families;
\n\u2022\t administering the estate and managing the business activities of
\nthe chambers of physicians and dentists.
\nThe chambers of physicians and dentists:
\n\u2022\t award the right to practice the profession of a physician or dentist
\nand keep the register of physicians and dentists;
\n\u2022\t make decisions on matters relating to fitness to practice as a phy-
\nsician or dentist;
\n\u2022\t act as medical courts in matters involving professional liability of
\nphysicians and dentists;
\n\u2022\t deliver opinion on draft legislation concerning health protection
\nand exercise of the medical professions;
\n\u2022\t deliver opinions and make motions regarding under- and post-
\ngraduate training of physicians and dentists;
\n\u2022\t co-operate with public administration agencies, political organi-
\nzations, trade unions as well as other social organizations in mat-
\nters concerning protection of human health and conditions of
\nexercising the medical professions;
\n\u2022\t defend individual and collective interests of members of the self-
\ngovernment of physicians and dentists;
\n\u2022\t negotiate conditions of work and remuneration;
\n\u2022\t Co-operate in the field of continuous medical education.
\nul. Sobieskiego 110, 00-764 Warsaw, Poland
\nPhone: (+48) 22 559 13 00
\nE-mail: sekretariat@hipokrates.org, zagranica@hipokrates.org
\nWebsite: www.nil.org.pl
\nPortuguese Medical Association
\nOffice Bearers:
\nPresidente: Prof. Jos\u00e9 Manuel Silva
\nTreasurer: Prof. Alberto Caldas Afonso
\nSecretariat: Dra. Rita Martinho
\nThe organisation of medical practice in Por-
\ntugal started with the creation of the Portu-
\nguese Medical Association in 1898.
\nOn 24 November 1938, by Decree-law no
\n29171 the Medical Association was created
\ncovering mainly those physicians that prac-
\ntice independently.
\nFacts like the need to separate disciplinary action from administra-
\ntive or directive action and the need to imply juridical expression to
\na set of important principles of deontological nature as well as social
\nevolution led to the revocation of the statute approved by the afore
\nmentioned decree and its replacement by a statute approved by the
\nDecree-law no 40651, of 21st
\nof June 1956.
\nThis Statute, integrated in the political rule in force, even if fully re-
\nspecting the defence of deontology and technique by the medical asso-
\nciative body to which it also granted disciplinary action had neverthe-
\nless been approved by doctors but resulted solely from governmental
\ndecision, in the use of powers that the Constitution 1933 allowed.
\nThe evolution of Portuguese society and the changes that occurred
\nin the course of time towards a bigger intervention of state services
\nin rendering medical care to the population as a means of guarantee
\nthe right to health, in an organised way, and of which the creation
\nof Socio-Medical Services of the Welfare fund are an example, gave
\na progressive importance to dependant medical practice and proved
\nthat the existing regulation is incapable and outdated.
\nThe events that took place after 25th
\nof April 1974 (Carnation Revo-
\nlution) and the social changes occurred pointed out the need to ad-
\njust the Statute of the Portuguese Medical Association to the new
\nsocial philosophy and conditionality.
\nAs a result of the work developed, a new statute project was drafted and
\nthe whole process ended in consulting doctors and democratic voting
\nleading to its approval by an overwhelming percentage of votes in favour.
\nThis statute, besides covering all the doctors in practice of their pro-
\nfession, reveals a remarkably decentralised feature and full respect
\nfor democratic liberties.
\nThe renovated Medical Association being urged to practice its activity
\nfully independently from the government, political groups or other
\norganisations, the statute recognises and supports that the defence of
\ngenuine interest of doctors may reflect in the first place a humanised
\npractice that respects the right to health of all citizens and devotes the
\nprinciple of creation of a National Health Service in which the doctor
\nwill necessarily play a predominant and fundamental role.
\nIt is the government\u2019s domain, in the use of its legislative powers to
\napprove the Statute of the Portuguese Medical Association, given
\nthe important public goal that it pursues, the need to imply a com-
\npulsory feature to the enrolment in the Association, the attribution
\nof deontological function and disciplinary power. In any case the
\nrevocation of the previous statute approved by Decree-Law would
\nalways have to be done through the legislative form.
\nMembership:All the doctors to practice the profession must be
\nregistered (mandatory) in the Portuguese Medical Association and
\nhave a individual license.The practice of medicine depends on the
\nenrolment in the Portuguese Medical Association.
\nThe Portuguese Medical Association accepts enrolment solely of
\nPortuguese or foreign graduates in medicine by a Portuguese or for-
\neign university, as long as in this last case there is an official equiva-
\nlence of the course duly recognised by the Medical Association.Jos\u00e9 Manuel Silva
\nNMA news
\n38
\nThe mission of the PMA is the preservation of high standards on
\nthe formation and exercise of medical professions and protection of
\npatients and public from the malpractice of health services.
\nCompetence of the Portuguese Medical Association
\n1.\t Recognition of responsibility of physicians emerging from in-
\nfractions of Medical Ethics is a disciplinary responsibility that is
\nexclusive to the Medical Association.
\n2.\t When violations of medical ethics are found relating to physi-
\ncians working in state bodies, cooperatives or private compa-
\nnies, these organizations shall limit themselves to notifying the
\nMedical Association of the supposed infractions.
\n3.\t If the nature of ethical and technical infractions also includes
\nsupposition of a disciplinary infraction included in the legal
\nremit of these entities, respective responsibilities shall be sepa-
\nrately exercised.
\nPrinciples and goals
\n1.\t The Medical Association recognises that the protection of doc-
\ntors\u2019legitimate interests imply the practice of a humanised med-
\nicine that respects every citizen\u2019s right to health.
\n2.\t The Medical Association practices its activity with full autonomy
\nfrom the state, political, religious groups or other organisations.
\n3.\t The democratic system rules the structure and the internal life
\nof the Medical Association and its control is a duty and a right
\nof all its associates namely in what concerns the election and
\ndestitution of all its leaders and the free discussion of all the is-
\nsues of associative life.
\n4.\t The freedom of opinion and the free democratic game foreseen in
\nthe previous number and guaranteed in the present Statute do not
\njustify the constitution of any autonomous organisms within the
\nMedical Association that may distort or influence the normal rules
\nof democracy and may lead to disagreement among its members.
\n5.\t The Medical Association may adhere to any unions or federa-
\ntions of medical associations and shall collaborate with other
\nhealth technicians through the competent professional organ-
\nisations in the interest of health protection and promotion.
\n6.\t The Medical Association\u2019s main goals are:
\n— To protect medical ethics, deontology and professional qualifi-
\ncations in order to assure and make respect the user\u2019s rights to
\na qualified medicine;
\n— To encourage and protect the interests of medical profession at
\nall levels, particularly in what concerns socio-professional pro-
\nmotion, social security and work relations; (1)
\n— To promote the development of medical culture and contribute
\nto the establishment and constant improvement of a National
\nHealth Service collaborating in the national health politics in
\nevery aspect namely in the medical education and careers;
\n— To give opinion on all matters related to teaching, the practice
\nof medicine and with the organisation of services that deal with
\nhealth whenever it may be convenient to do so, close to the
\ncompetent official entities or when the latter may request;
\n— To watch for the correct observance of legal formalities of the
\npresent Statute and respective regulations namely in what con-
\ncerns the title and the medical profession promoting judicial
\naction against those who use or practice it, illegally;
\n— To issue professional licence and promote doctor\u2019s professional
\nqualification by the concession of titles of differentiation and
\nfor the active participation in post-graduate education.
\nPortuguese Medical Association
\nAv. Almirante Gago Coutinho, n 151, 1749-084 Lisboa, Portugal
\nE-mail: intl@omcne.pt
\nWebsite: www.ordemdosmedicos.pt
\nRoyal Dutch Medical Association
\n(KNMG)
\nOffice Bearers (2012\u20132016):
\nPresident: Prof. Dr. R.J. (Rutger Jan) van
\nder Gaag
\nThe Royal Dutch Medical Association
\n(KNMG) is the professional organization
\nfor physicians of The Netherlands. It was es-
\ntablished in 1849.Since January 1st 1999 the
\nKNMG has become a federation of medical
\npractitioners\u2019professional associations.
\nOur main objectives are to improve the quality of medical care and
\nhealthcare in general, and to improve public health.This is achieved
\nby proactively responding to developments in health care and so-
\nciety, by developing guidelines and policies, by lobbying, and by
\nproviding services to our members. Another important task of the
\nKNMG is the regulation of vocational training and registration of
\nspecialists.
\nThe federation consists of the Association of Public Health Phy-
\nsicians (KAMG), the National Association of salaried Doctors
\n(LAD), the National Association of General Practitioners (LHV),
\nthe Dutch Association for occupational Health (NVAB), the Asso-
\nciation for elderly care physicians (Verenso), the Dutch Association
\nof Insurance Medicine (NVVG), the Dutch Federation of Medical
\nSpecialists (Federatie van medisch specialisten) and the Association
\nof Medical Students (De Geneeskundestudent).
\nWe work in close collaboration with other stakeholders, e.g. gov-
\nernment, politics, health care insurance companies, patient organi-
\nzations, and other organizations in healthcare. The goal is to pro-
\nmote the medical and associated sciences, and achieve high quality
\nR.\u00a0J. van der Gaag
\nNMA news
\n39
\nBACK TO CONTENTS
\nhealthcare. Our policies cover the full range from public health is-
\nsues, medical ethics, science, health law to medical education.
\nAnother important task of the KNMG is the legal system concern-
\ning the postgraduate training and registration of specialists.Legisla-
\ntive boards issue rules on specialist training, recognition of trainers,
\nhospitals etc., specialist registration and the recertification of spe-
\ncialists. The registration committees carry out legislation regarding
\nthe tasks mentioned above in the interest of the public.
\nKNMG activities
\n1. A campaign on medical professionalism. In 2009 a national
\ncampaign will be launched, aimed at all physicians.The main goal is
\nto support doctors in their professional conduct: good quality, earn-
\ning trust of their patients and accountability.
\n2.Promoting.Promoting quality of healthcare,safety and transparency
\nof medical practice and professional integrity, through the establish-
\nment of guidelines and advice and influencing government and politics.
\nActivities are:
\n\u2022\t Development of a quality framework: the quality and patient
\nsafety requirements any doctor in The Netherlands should meet;
\n\u2022\t Contribute to educational modernisation of the training of medi-
\ncal specialists and the curriculum in accordance with the Can-
\nMEDs model;
\n\u2022\t Contribute to the modernisation of the Individual Health Care
\nProfessionals Act (Wet BIG). This Act concerns the quality of
\ncare guaranteed by legally protected professional titles and pro-
\nvides a register of health care professionals (the BIG-register).
\nThe BIG-register registers pharmacists, physicians, physiothera-
\npists, health care psychologists, psychotherapists, dentists, mid-
\nwives and nurses. Only those listed in this register may carry the
\nlegally protected titles belonging to these professions;
\n\u2022\t Monitoring Health Insurance Act: under the new Health Insur-
\nance Act, all residents of the Netherlands are obliged to have a
\nhealth insurance.The system is a private health insurance with so-
\ncial conditions.The system is operated by private health insurance
\ncompanies; the insurers are obliged to accept every resident in
\ntheir area of activity. A system of risk equalization enables the ac-
\nceptance obligation and prevents direct or indirect risk selection.
\n\u2022\t Contribute to strengthening patients\u2019 rights. Especially in the
\nfields of quality, safety and legal complaints.
\n\u2022\t Activities related to \u201cend of life\u201dcare: implementing the palliative
\nsedation guideline and research on decisions of physicians con-
\ncerning the final stage of life. See: KNMG position paper: the
\nrole of the physician in the voluntary termination of life
\n3. Studies. The KNMG studies trends and influences policies and
\nlegislation in relevant areas where professional values en responsi-
\nbilities are of major significance. e.g.:
\n\u2022\t Monitoring, and if possible, influencing developments on health
\ninsurances and the Exceptional Medical Expenses Act (AWBZ)
\nwhich is a national insurance act for long-term care. This is in-
\ntended to provide the insured with chronic and continuous care.
\nThis involves considerable financial consequences, such as care for
\ndisabled people with congenital, physical or mental disorders;
\n\u2022\t Commenting on reports from government advisory boards
\n4. International activities. The KNMG is an active member of
\nthe Comit\u00e9 Permanent des M\u00e9decins Europ\u00e9ens (CPME) and
\nthe World Medical Association (WMA). The CPME is involved
\nin influencing policy at European level and is of great importance,
\nbecause the practice of European doctors is increasingly influenced
\nby the European dimension.
\nMercatorlaan 1200, 3528 BL Utrecht
\nE-mail: info@fed.knmg.nl
\nWebsite: www.knmg.nl
\nRomanian College of Physicians
\nOffice Bearers:
\nPresident: Dr. Gheorghe Borcean
\nVice President: Dr. Constantin Carstea
\nVice President: Prof. dr. Mircea Cinteza
\nVice President: Dr. Calin Bumbulut
\nSecretary General: Dr. Viorel Radulescu
\nMembers: who can become a member, how
\nmany members are registered and what ser-
\nvices are available for the members:
\nAny doctor who wants to practice medicine
\nin Romania, according to the law, may become member of the Ro-
\nmanian College of Physicians.
\nThe Romanian College of Physicians has 9,000 members.They can:
\n\u2022\t vote and can be elected,
\n\u2022\t be informed about any action performed by the College,
\n\u2022\t use all infrastructure belonging to the College,
\n\u2022\t take part in any of the actions carried out by the College,
\n\u2022\t litigate any sanction applied by the College,
\n\u2022\t request material help from the College, for special situations, for
\nthem and their family.
\nActivities:
\n\u2022\t with the members
\n\u2022\t with public
\n\u2022\t with the government
\n\u2022\t with the media
\n\u2022\t other strategic partnerships
\nGheorghe Borcean
\nNMA news
\n40
\nThe Romanian College of Physicians is an active member of the
\nfollowing international organisations: WMA, UEMS, CPME,
\nAEMH, UEMO, CEOM.
\nBlvd. TIMISOARA, No.15, SECTOR 6, BUCHAREST,
\nROMANIA, 061303
\nPhone: +4 0214138800, +4 0214138803
\nFax: +4 0214137750
\nE-mail: office@cmr.ro
\nWebsite: www.cmr.ro
\nSingapore Medical Association
\nOffice Bearers:
\nPresident: Dr. Wong Tien Hua
\n1st
\nVice President: A\/Prof Chin Jing Jih
\n2nd
\nVice President: Dr.Toh Choon Lai
\nHonorary Secretary: Dr. Daniel Lee Hsien
\nChieh
\nHonorary Assistant Secretary: Dr. Lim
\nKheng Choon
\nHonorary Treasurer: Dr.Tammy Chan
\nTeng Mui
\nHonorary Assistant Treasurer: Dr. Benny
\nLoo Kai Guo
\nMembers: Dr. Anantham Devanand, Dr. Chong Yeh Woei,
\nDr.\u00a0Lee Pheng Soon, Dr. Lee Yik Voon, Dr. Ng Chee Kwan,
\nDr. Noorul Fatha As\u2019art, A\/Prof Nigel Tan Choon Kiat, A\/Prof
\nTan Sze Wee, Dr.Tan Tze Lee, Dr.Tan Yia Swam, Dr.Toh Han
\nChong, Dr. Wong Chiang Yin, Dr. Bertha Woon
\nAs the national medical association,SMA is committed to engaging
\nin dialogue with various stakeholders on issues related to patient
\ncare and medical practice, by highlighting concerns received via
\nfeedback from members, and proposing alternative policies, where
\napplicable.At SMA,we adopt a wide spectrum of approaches,rang-
\ning from quiet diplomacy to public position statements, to help ad-
\nvocate the rights of patients and doctors.
\nIn 2015, SMA took official positions on important issues related
\nto both doctors and patients, sparking active discourse and creat-
\ning awareness of issues pertinent to our current medical landscape.
\nThese areas of concern include cost of medical indemnity and medi-
\ncal litigation reforms, ethical code and guidelines changes and as-
\nsimilation of foreign-trained doctors into our healthcare landscape.
\nAided by SMA publications\u2019growing influence on the local health-
\ncare landscape, we aim to continue bringing greater awareness to
\nissues that impact both doctors and patients for the betterment of
\nlocal healthcare.
\nOur members are at the heart of what we do.We remain focused on
\nengaging the profession and delivering services that our members
\nvalue. These include providing resources and opportunities to aid
\nour members in their development as a medical professional and a
\nleader in their respective fields.
\nThe SMA Centre for Medical Ethics and Professionalism (CMEP)
\nwas officially launched in June 2000 to promote the art and science
\nof medical ethics and medical care for the betterment of patient care
\nand public health. SMA CMEP aims to provide leadership in the
\nareas of academic training,discussion,resource development and re-
\nsearch, so as to support a high standard of medical professionalism.
\nIn 2013, the SMA set up a separate Charity for its charitable work
\nof mainly supporting needy medical students with bursaries and
\npromoting volunteerism amongst the profession. The Charity is
\nsupported through donations from the SMA, its members, and its
\nwell-wishers.
\nA commitment to lifelong learning is part of the professionalism
\nthat comes with being a medical doctor. SMJ has remained an open-
\naccess journal, as we recognise that broad access to research results
\nis an essential component of lifelong learning. We provide access to
\ninformation-rich literature in the form of scientific research papers,
\nself-learning CME articles, as well as insightful discussions on prac-
\ntice guidelines, medicolegal issues and others.Through waiver of our
\narticle submission fee, we also encourage SMA members to share
\ntheir knowledge and research results with the medical community.
\nKey Statistics
\n\u2022\t 20 councils members
\n\u2022\t 7361 members
\n\u2022\t 74 courses conducted for more than 2900 participants with
\nS$64,000 course subsidies disbursed
\n\u2022\t 30 membership events for >2400 participants
\nInternational collaboration
\n\u2022\t WMA: SMA is a Constituent member of the WMA.
\n\u2022\t CMAAO
\n— Dr. Chong Yeh Woei Vice-chair of council
\n— Dr. Bertha Woon Councilor
\n\u2022\t MASEAN: SMA serves as the secretariat for MASEAN.
\n— Dr. Wong Tien Hua Chairperson (since 2014)
\n— Dr. Lee Yik Voon Secretary General (since 2009)
\n— Dr. Daniel Lee Assistant Secretary General (since 2014)
\n— Dr.Tammy Chan Chairperson,Finance Committee (since 2011)
\nSingapore Medical Association
\n2 College Road, Level 2
\nAlumni Medical Centre,
\nSingapore 169850
\nE-mail: sma@sma.org.sg
\nWesite: www.sma.org.sg
\nWong Tien Hua
\nNMA news
\nBACK TO CONTENTS
\nSpanish General Medical
\nCouncil (OMC)
\nOffice Bearers:
\nPresident: Dr. Juan Jos\u00e9 Rodriguez-Sendin
\nSecretary General: Dr. Juan-Manuel
\nGarrote
\nThe Organizaci\u00f3n M\u00e9dica Colegial of
\nSpain (OMC) or General Medical Council
\nis the institution formed by the 52 medical
\ncolleges of Spain and is in charge of the ar-
\nrangement, regulation, control and defence
\nof the medical profession according to the
\nSpanish rules and regulations. Although the medical colleges have
\nbeen regulated by Law since 1898, the General Council of Medi-
\ncal Colleges of Spain was formed in 1921. This is the body which
\ngroups and coordinates the provincial and autonomous Medical
\nColleges, as public law corporations, that are an authority within
\nthe profession.
\nThe General Medical Council activities are focused on very di-
\nverse areas, always related to the medical profession. Besides the
\nhabitual activities of record and professional control as well as
\nqualifications, the General Medical Council promotes continu-
\nous medical training activities for which it has a specific Founda-
\ntion. It also has a Central Medical Ethics Commission which not
\nonly studies the cases that it receives from the Medical Colleges,
\nbut it also carries out studies and documents about the position
\nof the medical profession in fundamental ethical questions that
\nconcern it.Thus in the last months, it has updated its positions on
\nmedical care at the end of life and on the regulation of conscience
\nclause for health care professionals who don\u2019t want to perform
\nabortions.
\nThe General Medical Council has a digital journal \u201cM\u00e9dicos y
\nPacientes\u201d http:\/\/www.medicosypacientes.com and OMC magazine
\nhttp:\/\/www.cgcom.es\/revista\/archivo and other newsletter from In-
\nternational Department, and from Fundaci\u00f3n para la Protecci\u00f3n
\nSocial (Foundation for Social Protection) and Fundaci\u00f3n de los
\nColegios M\u00e9dicos para la Cooperaci\u00f3n Internacional (Foundation
\nfor International Cooperation) which maintains updated informa-
\ntion about questions of medical health care and social interest, but
\nalso of information and interest for the patients. Also the General
\nMedical Council has approved the creation of a Social Council to
\nfoster and to promote meetings and collaboration with patients who
\nare the raison d\u203a\u00eatre of medicine.
\nIn the last years the General Medical Council has tightened its
\nbonds of collaboration and action with the most representative
\nmedical entities of Spain: the medical trade unions, the Conference
\nof Deans of Medical Universities, the State Council of Medical
\nStudents,the Federation of Spanish Medical Scientific Associations
\nand the National Commission of Specialities in Health Sciences,
\nintegrating with them all what is known as the Forum of the Medi-
\ncal Profession.
\nIn addition, the General Medical Council is developing a wide ac-
\ntivity in defence of medical association and contributing its point
\nof view to the legal regulations. Our association understands that
\nthe association formula is the one that best guarantees the social
\nprotection of the patient\u2019s interests, the fulfilment of Ethics, the
\ncontrol and regulation of the profession, which has been com-
\nmended the protection of an important asset: health. We belong
\nto the Ethics Committee Also it undertakes intense actions to
\nassure that the authority to prescribe drugs is reserved to health
\ncare professionals because the competence to prescribe is insepara-
\nbly linked with the diagnosis for reasons of efficiency, quality and
\nsafety in health care.
\nEfforts are also being made in social and health matters of gen-
\neral interest, promoting numerous training and informative ac-
\ntions aimed at health care professionals and the population at large,
\namong which can be highlighted information about Influenza A
\n(H1N1), the Effects of the Climate Change on Health, the Pre-
\nscription and the Rational Use of Drugs.
\nCertifying the competence of the doctor and the licensing based
\non the achievement of professional, accredited psychophysical and
\nupdating of professional competence criteria is another challenge
\nthat has raised the Spanish medical Council from 2010,strengthen-
\ning corporate commitment patient and society and transparency for
\nphysicians and society.
\nThe Spanish medical Council has a very extensive international
\ncollaboration. It plays an active role in the World Medical As-
\nsociation, European medical organizations like the CEOM (Eu-
\nropean Council of Medical Orders) and organizations of medi-
\ncal specialists (UEMS), general practitioners (UEMO), hospital
\nhealth care professionals (AEHM), doctors in training (EJD). Re-
\ncently the OMC became full member at the Confederaci\u00f3n M\u00e9di-
\nca de Latinoam\u00e9rica y el Caribe (CONFEMEL).The cooperation
\nwith the countries of Latin America organized through the FIEM
\n(Latin-American Forum of Medical Entities) is of special inter-
\nest, without forgetting the social and solidarity action for which
\nthe OMC has formed a Solidarity Foundation with the purpose
\nof promoting and channelling help and cooperation for medical \u2013
\nhealth care in countries with precarious health care and vulnerable
\nand needy populations.
\nPlaza de las Cortes, 11. 28014 – Madrid
\nTel.: +34 91 360 03 50
\nFax: +34 91 431 96 20
\nE-mail: internacional@cgcom.es
\nWebsite: www.cgcom.es
\nJuan Jos\u00e9 Rodriguez-
\nSendin
\nNMA news
\nIV
\nDr. Eitaka Tsuboi passed away at the age of 86 due to respiratory
\nfailure on February 9, 2016.
\nHe was born in 1929 in Koriyama City,Fukushima Prefecture,Ja-
\npan.He majored in radiology at the Japan Medical University and
\ngraduated in 1952.He continued to study radiology at the Nation-
\nal Cancer Center from 1962. In 1977, he became the chairman of
\nthe board of directors of Tsuboi Hospital and contributed to the
\nenhancement of community health. His area of specialization was
\nrespiratory cancer. He served as the President of the Japan Medi-
\ncal Association (JMA) from 1996 to 2004. During his term, he
\nworked with the belief that JMA\u2019s activities should be expanded
\nglobally and the JMA should be open minded in considering the
\nideal way of the professional development of physicians and in
\ndeveloping visions for national healthcare. He was also involved
\nin World Medical Association\u2019s (WMA) activities; he was inau-
\ngurated as the WMA President at the WMA Edinburgh Gen-
\neral Assembly in 2000. He invited the WMA executives and held
\ntwo international conferences in Tokyo in 2001 on the themes of
\n\u201cHighly advanced medical care and medical ethics\u201d and \u201cPatient
\nsafety.\u201d The WMA declarations prepared from these events are
\nstill a part of the WMA policy documents. He was also active
\nin other international activities during this period. He also sup-
\nported the Takemi Program in International Health at the Har-
\nvard School of Public Health. In 2000, King Birendra of Nepal
\nhonored Dr. Tsuboi
\nthe highest award
\nfor foreigners for
\nover a 10-year-long
\ncontribution to
\nschool health and
\ncommunity medi-
\ncine projects in Ne-
\npal. Early in his
\ncareer, he became
\ninvolved in the es-
\ntablishment of the
\nNational Cancer
\nCenter in Bangkok,
\nThailand. Based on
\nhis experience, he
\nregarded the bond-
\ning of physicians across the borders as the key element in Asia.
\nHe constantly underlined the importance of an affiliated regional
\norganization of the WMA, namely the Confederation of Medical
\nAssociations in Asia and Oceania (CMAAO). During his eight
\nyears of tenure as the JMA president, his drive was supported by
\nhis ability to take actions and by belief in the foundation.
\nWe would like to express our sincere gratitude to all WMA col-
\nleagues who helped Dr. Tsuboi during his tenure at the WMA.
\nJapan Medical Association (JMA)
\nObituary
\nDr. Eitaka Tsuboi, 1929\u20132016<\/p>\n"},"caption":{"rendered":"

wmj201601 COUNTRY vol. 62 MedicalWorld Journal Official Journal of The World Medical Association, Inc. ISSN 2256-0580 Nr. 1, March 2016 Contents Health Databases and Biobanks \u2014 Ethical Dilemmas . . . . . . . . . . . . . . . . . . . . . . . . . . . […]<\/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\/wmj201601.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/3687"}],"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=3687"}]}}