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wmj6<\/a><\/p>\n

WorldMMeeddiiccaall JJoouurrnnaall
\nVol. No.2,June200551
\nOFFICIAL JOURNAL OF THE WORLD MEDICAL ASSOCIATION, INC.
\nG 20438
\nContents
\nEEddiittoorriiaall
\nHuman health resources and moral responsibilities 29
\nSaving the lives of Siamese Twins 30
\nMMeeddiiccaall EEtthhiiccss aanndd HHuummaann RRiigghhttss
\nThe World Medical Association \u2013
\nDeclaration of Geneva 31
\nCouncil of Europe 32
\nWWMMAA
\n170th WMA Council meets in Divonne 33
\nCouncil Resolutions adopted at the 170th
\nWMA Council Session, May 2005 38
\nWMA Dues Reform Proposal 40
\nWWMMAA SSeeccrreettaarryy GGeenneerraall
\n\u201eDanger on the safe side\u201c 42
\nMMeeddiiccaall SScciieennccee,, PPrrooffeessssiioonnaall PPrraaccttiiccee
\naanndd EEdduuccaattiioonn
\nPatient Safety highlighted at World
\nHealth Professions\u2019 Reception 43
\nThe Swedish Patient Insurance System \u2013
\nA No-Fault System 44
\nNew Online Tool Kit On HIV\/AIDS
\nPrevention For Sex Workers 46
\nTwin Study Reveals Role in Female Infidelity 47
\nThe national UK Multiple Sclerosis tissue Bank
\nco-ordinates the collection of donated tissue
\nand distributes samples to scientists conducting
\nresearch into the causes and treatment of MS 47
\nWWHHOO
\nDr. Lee addressing the World Health Assembly:
\nEnds with concern with preparation before Avian
\ninfluenza strikes 48
\nRemarks of Mr Bill Gates at the World Health
\nAssembly 50
\nStrengthening health information systems to better
\naddress health needs worldwide 52
\nThe World Health Report 2005 \u2013 \u201eMake every mother
\nand child count\u201c 53
\nAn Innovative Approach to Health Systems Research 54
\nVaccinating African Children against
\nPneumococcal Disease Saves Lives 55
\nRReeggiioonnaall aanndd NNMMAA NNeewwss
\nFigures and facts from Africa 56
\nBMA \u201eCall for action\u201c 56
\nWebsite: https:\/\/www.wma.net
\nWMA Directory of National Member Medical Associations Officers and Council
\nAssociation and address\/Officers
\nWMA OFFICERS
\nOF NATIONAL MEMBER MEDICALASSOCIATIONS AND OFFICERS
\ni see page ii
\nPresident-Elect President Immediate Past-President
\nDr K. Letlape Dr Y. D. Coble Dr J. Appleyard
\nSouth African Med. Assn. 102 Magnolia Street Thimble Hall
\nP.O. Box 74789 Neptune Beach, FL 32266 108 Blean Common
\nLynnwood Ridge 0040 USA Blean, Nr Canterbury
\nPretoria 0153 Kent, CT2 9JJ
\nSouth Africa Great Britain
\nTreasurer Chairman of Council Vice-Chairman of Council
\nProf. Dr. Dr. h.c. J. D. Hoppe Dr Y. Blachar Dr N. Hashimoto
\nBundes\u00e4rztekammer Israel Medical Association Japan Medical Association
\nHerbert-Lewin-Platz 1 2 Twin Towers 2-28-16 Honkomagome
\n10623 Berlin 35 Jabotisky Street Bunkyo-ku
\nGermany P.O. Box 3566 Tokyo 113-8621
\nRamat-Gan 52136 Japan
\nIsrael
\nSecretary General
\nDr O. Kloiber
\nWorld Medical Association
\nBP 63
\nFrance
\nANDORRA S
\nCol\u2019legi Oficial de Metges
\nEdifici Plaza esc. B
\nVerge del Pilar 5,
\n4art. Despatx 11, Andorra La Vella
\nTel: (376) 823 525\/Fax: (376) 860 793
\nE-mail: coma@andorra.ad
\nWebsite: www.col-legidemetges.ad
\nARGENTINA S
\nConfederaci\u00f3n M\u00e9dica Argentina
\nAv. Belgrano 1235
\nBuenos Aires 1093
\nTel\/Fax: (54-114) 383-8414\/5511
\nE-mail: comra@sinectis.com.ar
\nWebsite: www.comra.health.org.ar
\nAUSTRALIA E
\nAustralian Medical Association
\nP.O. Box 6090
\nKingston, ACT 2604
\nTel: (61-2) 6270-5460\/Fax: -5499
\nWebsite: www.ama.com.au
\nE-mail: ama@ama.com.au
\nAUSTRIA E
\n\u00d6sterreichische \u00c4rztekammer
\n(Austrian Medical Chamber)
\nWeihburggasse 10-12 – P.O. Box 213
\n1010 Wien
\nTel: (43-1) 51406-931
\nFax: (43-1) 51406-933
\nE-mail: international@aek.or.at
\nREPUBLIC OF ARMENIA E
\nArmenian Medical Association
\nP.O. Box 143, Yerevan 375 010
\nTel: (3741) 53 58-63
\nFax: (3741) 53 48 79
\nE-mail:info@armeda.am
\nWebsite: www.armeda.am
\nAZERBAIJAN E
\nAzerbaijan Medical Association
\n5 Sona Velikham Str.
\nAZE 370001, Baku
\nTel: (994 50) 328 1888
\nFax: (994 12) 315 136
\nE-mail: Mahirs@lycos.com \/
\nazerma@hotmail.com
\nBAHAMAS E
\nMedical Association of the Bahamas
\nJavon Medical Center
\nP.O. Box N999
\nNassau
\nTel: (1-242) 328 6802
\nFax: (1-242) 323 2980
\nE-mail: mabnassau@yahoo.com
\nBANGLADESH E
\nBangladesh Medical Association
\nB.M.A House
\n15\/2 Topkhana Road,
\nDhaka 1000
\nTel: (880) 2-9568714\/9562527
\nFax: (880) 2-9566060\/9568714
\nE-mail: bma@aitlbd.net
\nBELGIUM F
\nAssociation Belge des Syndicats
\nM\u00e9dicaux
\nChauss\u00e9e de Boondael 6, bte 4
\n1050 Bruxelles
\nTel: (32-2) 644-12 88\/Fax: -1527
\nE-mail: absym.bras@euronet.be
\nWebsite: www.absym-bras.be
\nBOLIVIA S
\nColegio M\u00e9dico de Bolivia
\nCasilla 1088
\nCochabamba
\nTel\/Fax: (591-04) 523658
\nE-mail: colmedbo_oru@hotmail.com
\nWebsite: www.colmedbo.org
\nBRAZIL E
\nAssocia\u00e7ao M\u00e9dica Brasileira
\nR. Sao Carlos do Pinhal 324 \u2013 Bela Vista
\nSao Paulo SP \u2013 CEP 01333-903
\nTel: (55-11) 317868 00
\nFax: (55-11) 317868 31
\nE-mail: presidente@amb.org.br
\nWebsite: www.amb.org.br
\nBULGARIA E
\nBulgarian Medical Association
\n15, Acad. Ivan Geshov Blvd.
\n1431 Sofia
\nTel: (359-2) 954 -11 26\/Fax:-1186
\nE-mail: usbls@inagency.com
\nWebsite: www.blsbg.com
\nCANADA E
\nCanadian Medical Association
\nP.O. Box 8650
\n1867 Alta Vista Drive
\nOttawa, Ontario K1G 3Y6
\nTel: (1-613) 731 9331\/Fax: -1779
\nE-mail: monique.laframboise@cma.ca
\nWebsite: www.cma.ca
\nCHILE S
\nColegio M\u00e9dico de Chile
\nEsmeralda 678 – Casilla 639
\nSantiago
\nTel: (56-2) 4277800
\nFax: (56-2) 6330940 \/ 6336732
\nE-mail: sectecni@colegiomedico.c
\nWebsite: www.colegiomedico.cl
\nTitlepage: Rigshospital, Oslo: Architecturally a globally unique combination of health care and art. Also combining both academic
\nmedicine and healthcare in one building, on either side of a \u201cmain street\u201d running right through the building.
\nCHINA E
\nChinese Medical Association
\n42 Dongsi Xidajie
\nBeijing 100710
\nTel: (86-10) 6524 9989
\nFax: (86-10) 6512 3754
\nE-mail: suyumu@cma.org.cn
\nWebsite: www.chinamed.com.cn
\nCOLOMBIA S
\nFederaci\u00f3n M\u00e9dica Colombiana
\nCalle 72 – N\u00b0 6-44, Piso 11
\nSantaf\u00e9 de Bogot\u00e1, D.E.
\nTel: (57-1) 211 0208
\nTel\/Fax: (57-1) 212 6082
\nE-mail: federacionmedicacol@
\nhotmail.com
\nDEMOCRATIC REP. OF CONGO F
\nOrdre des M\u00e9decins du Zaire
\nB.P. 4922
\nKinshasa \u2013 Gombe
\nTel: (242-12) 24589\/
\nFax (Pr\u00e9sidente): (242) 8846574
\nCOSTA RICA S
\nUni\u00f3n M\u00e9dica Nacional
\nApartado 5920-1000
\nSan Jos\u00e9
\nTel: (506) 290-5490
\nFax: (506) 231 7373
\nE-mail: unmedica@sol.racsa.co.cr
\nCROATIA E
\nCroatian Medical Association
\nSubiceva 9
\n10000 Zagreb
\nTel: (385-1) 46 93 300
\nFax: (385-1) 46 55 066
\nE-mail: orlic@mamef.mef.hr
\nCZECH REPUBLIC E
\nCzech Medical Association .
\nJ.E. Purkyne
\nSokolsk\u00e1 31 – P.O. Box 88
\n120 26 Prague 2
\nTel: (420-2) 242 66 201\/202\/203\/204
\nFax: (420-2) 242 66 212 \/ 96 18 18 69
\nE-mail: czma@cls.cz
\nWebsite: www.cls.cz
\nCUBA S
\nColegio M\u00e9dico Cubano Libre
\nP.O. Box 141016
\n717 Ponce de Leon Boulevard
\nCoral Gables, FL 33114-1016
\nUnited States
\nTel: (1-305) 446 9902\/445 1429
\nFax: (1-305) 4459310
\nDENMARK E
\nDanish Medical Association
\n9 Trondhjemsgade
\n2100 Copenhagen 0
\nTel: (45) 35 44 -82 29\/Fax:-8505
\nE-mail: er@dadl.dk
\nWebsite: www.laegeforeningen.dk
\nDOMINICAN REPUBLIC S
\nAsociaci\u00f3n M\u00e9dica Dominicana
\nCalle Paseo de los Medicos
\nEsquina Modesto Diaz Zona
\nUniversitaria
\nSanto Domingo
\nTel: (1809) 533-4602\/533-4686\/
\n533-8700
\nFax: (1809) 535 7337
\nE-mail: asoc.medica@codetel.net.do
\nECUADOR S
\nFederaci\u00f3n M\u00e9dica Ecuatoriana
\nV.M. Rend\u00f3n 923 \u2013 2 do.Piso Of. 201
\nP.O. Box 09-01-9848
\nGuayaquil
\nTel\/Fax: (593) 4 562569
\nE-mail: fdmedec@andinanet.net
\nEGYPT E
\nEgyptian Medical Association
\n\u201eDar El Hekmah\u201c
\n42, Kasr El-Eini Street
\nCairo
\nTel: (20-2) 3543406
\nEL SALVADOR, C.A S
\nColegio M\u00e9dico de El Salvador
\nFinal Pasaje N\u00b0 10
\nColonia Miramonte
\nSan Salvador
\nTel: (503) 260-1111, 260-1112
\nFax: -0324
\nE-mail: comcolmed@telesal.net
\nmarnuca@hotmail.com
\nESTONIA E
\nEstonian Medical Association (EsMA)
\nPepleri 32
\n51010 Tartu
\nTel\/Fax (372) 7420429
\nE-mail: eal@arstideliit.ee
\nWebsite: www.arstideliit.ee
\nETHIOPIA E
\nEthiopian Medical Association
\nP.O. Box 2179
\nAddis Ababa
\nTel: (251-1) 158174
\nFax: (251-1) 533742
\nE-mail: ema.emj@telecom.net.et \/
\nema@eth.healthnet.org
\nFIJI ISLANDS E
\nFiji Medical Association
\n2nd Fl. Narsey\u2019s Bldg, Renwick Road
\nG.P.O. Box 1116
\nSuva
\nTel: (679) 315388
\nFax: (679) 387671
\nE-mail: fijimedassoc@connect.com.fj
\nFINLAND E
\nFinnish Medical Association
\nP.O. Box 49
\n00501 Helsinki
\nTel: (358-9) 3930 826\/Fax-794
\nTelex: 125336 sll sf
\nE-mail: fma@fimnet.fi
\nWebsite: www.medassoc.fi
\nFRANCE F
\nAssociation M\u00e9dicale Fran\u00e7aise
\n180, Blvd. Haussmann
\n75389 Paris Cedex 08
\nTel: (33) 1 53 89 32 41
\nFax: (33) 1 53 89 33 44
\nE-mail: cnom-international@
\ncn.medecin.fr
\nGEORGIA E
\nGeorgian Medical Association
\n7 Asatiani Street
\n380077 Tbilisi
\nTel: (995 32) 398686 \/ Fax: -398083
\nE-mail: Gma@posta.ge
\nGERMANY E
\nBundes\u00e4rztekammer
\n(German Medical Association)
\nHerbert-Lewin-Platz 1
\n10623 Berlin
\nTel: (49-30) 400-456 363\/Fax: -384
\nE-mail: renate.vonhoff-winter@baek.de
\nWebsite: www.bundesaerztekammer.de
\nGHANA E
\nGhana Medical Association
\nP.O. Box 1596
\nAccra
\nTel: (233-21) 670-510\/Fax: -511
\nE-mail: gma@ghana.com
\nHAITI, W.I. F
\nAssociation M\u00e9dicale Haitienne
\n1\u00e8re
\nAv. du Travail #33 \u2013 Bois Verna
\nPort-au-Prince
\nTel: (509) 245-2060
\nFax: (509) 245-6323
\nE-mail: amh@amhhaiti.net
\nWebsite: www.amhhaiti.net
\nHONG KONG E
\nHong Kong Medical Association, China
\nDuke of Windsor Building, 5th Floor
\n15 Hennessy Road
\nTel: (852) 2527-8285
\nFax: (852) 2865-0943
\nE-mail: hkma@hkma.org
\nWebsite: www.hkma.org
\nHUNGARY E
\nAssociation of Hungarian Medical
\nSocieties (MOTESZ)
\nN\u00e1dor u. 36
\n1443 Budapest, PO.Box 145
\nTel: (36-1) 312 3807 \u2013 311 6687
\nFax: (36-1) 383-7918
\nE-mail: motesz@motesz.hu
\nWebsite: www.motesz.hu
\nICELAND E
\nIcelandic Medical Association
\nHlidasmari 8
\n200 K\u00f3pavogur
\nTel: (354) 8640478
\nFax: (354) 5644106
\nE-mail: icemed@icemed.is
\nINDIA E
\nIndian Medical Association
\nIndraprastha Marg
\nNew Delhi 110 002
\nTel: (91-11) 337009\/3378819\/3378680
\nFax: (91-11) 3379178\/3379470
\nE-mail: inmedici@vsnl.com \/
\ninmedici@ndb.vsnl.com
\nINDONESIA E
\nIndonesian Medical Association
\nJalan Dr Sam Ratulangie N\u00b0 29
\nJakarta 10350
\nTel: (62-21) 3150679
\nFax: (62-21) 390 0473\/3154 091
\nE-mail: pbidi@idola.net.id
\nIRELAND E
\nIrish Medical Organisation
\n10 Fitzwilliam Place
\nDublin 2
\nTel: (353-1) 676-7273
\nFax: (353-1) 6612758\/6682168
\nWebsite: www.imo.ie
\nISRAEL E
\nIsrael Medical Association
\n2 Twin Towers, 35 Jabotinsky St.
\nP.O. Box 3566, Ramat-Gan 52136
\nTel: (972-3) 6100444 \/ 424
\nFax: (972-3) 5751616 \/ 5753303
\nE-mail: estish@ima.org.il
\nWebsite: www.ima.org.il
\nJAPAN E
\nJapan Medical Association
\n2-28-16 Honkomagome, Bunkyo-ku
\nTokyo 113-8621
\nTel: (81-3) 3946 2121\/3942 6489
\nFax: (81-3) 3946 6295
\nE-mail: jmaintl@po.med.or.jp
\nKAZAKHSTAN F
\nAssociation of Medical Doctors
\nof Kazakhstan
\n117\/1 Kazybek bi St.,
\nAlmaty
\nTel: (3272) 62 -43 01 \/ -92 92
\nFax: -3606
\nE-mail: sadykova-aizhan@yahoo.com
\nREP. OF KOREA E
\nKorean Medical Association
\n302-75 Ichon 1-dong, Yongsan-gu
\nSeoul 140-721
\nTel: (82-2) 794 2474
\nFax: (82-2) 793 9190
\nE-mail: intl@kma.org
\nWebsite: www.kma.org
\nKUWAIT E
\nKuwait Medical Association
\nP.O. Box 1202
\nSafat 13013
\nTel: (965) 5333278, 5317971
\nFax: (965) 5333276
\nE-mail: aks.shatti@kma.org.kw
\nLATVIA E
\nLatvian Physicians Association
\nSkolas Str. 3
\nRiga
\n1010 Latvia
\nTel: (371-7) 22 06 61; 22 06 57
\nFax: (371-7) 22 06 57
\nE-mail: lab@parks.lv
\nLIECHTENSTEIN E
\nLiechtensteinischer \u00c4rztekammer
\nPostfach 52
\n9490 Vaduz
\nTel: (423) 231-1690
\nFax: (423) 231-1691
\nE-mail: office@aerztekammer.li
\nWebsite: www.aerzte-net.li
\nLITHUANIA E
\nLithuanian Medical Association
\nLiubarto Str. 2
\n2004 Vilnius
\nTel\/Fax: (370-5) 2731400
\nE-mail: lgs@takas.lt
\nLUXEMBOURG F
\nAssociation des M\u00e9decins et
\nM\u00e9decins Dentistes du Grand-
\nDuch\u00e9 de Luxembourg
\n29, rue de Vianden
\n2680 Luxembourg
\nTel: (352) 44 40 331
\nFax: (352) 45 83 49
\nE-mail: secretariat@ammd.lu
\nWebsite: www.ammd.lu
\nAssociation and address\/Officers
\nii
\nAssociation and address\/Officers
\niii
\nMACEDONIA E
\nMacedonian Medical Association
\nDame Gruev St. 3
\nP.O. Box 174
\n91000 Skopje
\nTel\/Fax: (389-91) 232577
\nMALAYSIA E
\nMalaysian Medical Association
\n4th Floor, MMA House
\n124 Jalan Pahang
\n53000 Kuala Lumpur
\nTel: (60-3) 40418972\/40411375
\nFax: (60-3) 40418187\/40434444
\nE-mail: mma@tm.net.my
\nWebsite: http:\/\/www.mma.org.my
\nMALTA E
\nMedical Association of Malta
\nThe Professional Centre
\nSliema Road, Gzira GZR 06
\nTel: (356) 21312888
\nFax: (356) 21331713
\nE-mail: mfpb@maltanet.net
\nWebsite: www.mam.org.mt
\nMEXICO S
\nColegio Medico de Mexico
\nFenacome
\nHidalgo 1828 Pte. Cons. 410
\nColonia Obispado C.P. 64060
\nMonterrey, Nuevo L\u00e9on
\nTel\/Fax: (52-8) 348-41-55
\nE-mail: fenacomemexico@usa.net
\nWebsite: www.fenacome.org
\nNEPAL E
\nNepal Medical Association
\nSiddhi Sadan, Post Box 189
\nExhibition Road
\nKatmandu
\nTel: (977 1) 225860, 231825
\nFax: (977 1) 225300
\nE-mail: nma@healthnet.org.np
\nNETHERLANDS E
\nRoyal Dutch Medical Association
\nP.O. Box 20051
\n3502 LB Utrecht
\nTel: (31-30) 28 23-267\/Fax-318
\nE-mail: j.bouwman@fed.knmg.nl
\nWebsite: www.knmg.nl
\nNEW ZEALAND E
\nNew Zealand Medical Association
\nP.O. Box 156
\nWellington 1
\nTel: (64-4) 472-4741
\nFax: (64-4) 471 0838
\nE-mail: nzma@nzma.org.nz
\nWebsite: www.nzma.org.nz
\nNIGERIA E
\nNigerian Medical Association
\n74, Adeniyi Jones Avenue Ikeja
\nP.O. Box 1108, Marina
\nLagos
\nTel: (234-1) 480 1569,
\nFax: (234-1) 493 6854
\nE-mail: info@nigeriannma.org
\nWebsite: www.nigeriannma.org
\nNORWAY E
\nNorwegian Medical Association
\nP.O.Box 1152 sentrum
\n0107 Oslo
\nTel: (47) 23 10 -90 00\/Fax: -9010
\nE-mail: ellen.pettersen@
\nlegeforeningen.no
\nWebsite: www.legeforeningen.no
\nPANAMA S
\nAsociaci\u00f3n M\u00e9dica Nacional
\nde la Rep\u00fablica de Panam\u00e1
\nApartado Postal 2020
\nPanam\u00e1 1
\nTel: (507) 263 7622 \/263-7758
\nFax: (507) 223 1462
\nFax modem: (507) 223-5555
\nE-mail: amenalpa@sinfo.net
\nPERU S
\nColegio M\u00e9dico del Per\u00fa
\nMalec\u00f3n Armend\u00e1riz N\u00b0 791
\nMiraflores
\nLima
\nTel: (51-1) 241 75 72
\nFax: (51-1) 242 3917
\nE-mail: decano@colmedi.org.pe
\nWebsite: www.colmed.org.pe
\nPHILIPPINES E
\nPhilippine Medical Association
\nPMA Bldg, North Avenue
\nQuezon City
\nTel: (63-2) 929-63 66\/Fax: -6951
\nE-mail: pmasec1@edsamail.com.ph
\nPOLAND E
\nPolish Medical Association
\nAl. Ujazdowskie 24
\n00-478 Warszawa
\nTel\/Fax: (48-22) 628 86 99
\nPORTUGAL E
\nOrdem dos M\u00e9dicos
\nAv. Almirante Gago Coutinho, 151
\n1749-084 Lisbon
\nTel: (351-21) 842 71 00\/842 71 11
\nFax: (351-21) 842 71 99
\nE-mail: ordemmedicos@mail.telepac.pt
\n\/ intl.omcne@omsul.com
\nWebsite: www.ordemdosmedicos.pt
\nROMANIA F
\nRomanian Medical Association
\nStr. Ionel Perlea, nr 10
\nSect. 1, Bucarest, cod 70754
\nTel: (40-1) 6141071
\nFax: (40-1) 3121357
\nE-mail: AMR@itcnet.ro
\nWebsite: www.cdi.pub.ro\/CDI\/
\nParteneri\/AMR_main.htm
\nRUSSIA E
\nRussian Medical Society
\nUdaltsova Street 85
\n121099 Moscow
\nTel: (7-095)932-83-02
\nE-mail: rusmed@rusmed.rmt.ru
\ninfo@russmed.com
\nSLOVAK REPUBLIC E
\nSlovak Medical Association
\nLegionarska 4
\n81322 Bratislava
\nTel: (421-2) 554 24 015
\nFax: (421-2) 554 223 63
\nE-mail: secretarysma@ba.telecom.sk
\nSLOVENIA E
\nSlovenian Medical Association
\nKomenskega 4
\n61001 Ljubljana
\nTel: (386-61) 323 469
\nFax: (386-61) 301 955
\nSOUTH AFRICA E
\nThe South African Medical Association
\nP.O. Box 74789, Lynnwood Rydge
\n0040 Pretoria
\nTel: (27-12) 481 2036\/7
\nFax: (27-12) 481 2058
\nE-mail: liliang@samedical.org
\nWebsite: www.samedical.org
\nSPAIN S
\nConsejo General de Colegios M\u00e9dicos
\nPlaza de las Cortes 11
\nMadrid 28014
\nTel: (34-91) 431 7780
\nFax: (34-91) 431 9620
\nE-mail: internacional1@cgcom.es
\nSWEDEN E
\nSwedish Medical Association
\n(Villagatan 5)
\nP.O. Box 5610
\nSE – 114 86 Stockholm
\nTel: (46-8) 790 33 00
\nFax: (46-8) 20 57 18
\nE-mail: info@slf.se
\nWebsite: www.lakarforbundet.se
\nSWITZERLAND F
\nF\u00e9d\u00e9ration des M\u00e9decins Suisses
\nElfenstrasse 18 \u2013 POB 293
\n3000 Berne 16
\nTel: (41-31) 359 \u20131111\/Fax: -1112
\nE-mail: fmh@hin.ch
\nWebsite: www.fmh.ch
\nTAIWAN E
\nTaiwan Medical Association
\n9F No 29 Sec1
\nAn-Ho Road
\nTaipei
\nDeputy Secretary General
\nTel: (886-2) 2752-7286
\nFax: (886-2) 2771-8392
\nE-mail: intl@med-assn.org.tw
\nTHAILAND E
\nMedical Association of Thailand
\n2 Soi Soonvijai
\nNew Petchburi Road
\nBangkok 10320
\nTel: (66-2) 314 4333\/318-8170
\nFax: (66-2) 314 6305
\nE-mail: math@loxinfo.co.th
\nWebsite: http:\/\/www.medassocthai.org\/
\nindex.htm.
\nTUNISIA F
\nConseil National de l\u2019Ordre
\ndes M\u00e9decins de Tunisie
\n16, rue de Touraine
\n1082 Tunis Cit\u00e9 Jardins
\nTel: (216-71) 792 736\/799 041
\nFax: (216-71) 788 729
\nE-mail: ordremed.na@planet.tn
\nTURKEY E
\nTurkish Medical Association
\nGMK Bulvary,.
\nPehit Danip Tunalygil Sok. N\u00b0 2 Kat 4
\nMaltepe
\nAnkara
\nTel: (90-312) 231 \u20133179\/Fax: -1952
\nE-mail: Ttb@ttb.org.tr
\nUGANDA E
\nUganda Medical Association
\nPlot 8, 41-43 circular rd.
\nP.O. Box 29874
\nKampala
\nTel: (256) 41 32 1795
\nFax: (256) 41 34 5597
\nE-mail: myers28@hotmail.com
\nUNITED KINGDOM E
\nBritish Medical Association
\nBMA House, Tavistock Square
\nLondon WC1H 9JP
\nTel: (44-207) 387-4499
\nFax: (44- 207) 383-6710
\nE-mail: vivn@bma.org.uk
\nWebsite: www.bma.org.uk
\nUNITED STATES OF AMERICA E
\nAmerican Medical Association
\n515 North State Street
\nChicago, Illinois 60610
\nTel: (1-312) 464 5040
\nFax: (1-312) 464 5973
\nWebsite: http:\/\/www.ama-assn.org
\nURUGUAY S
\nSindicato M\u00e9dico del Uruguay
\nBulevar Artigas 1515
\nCP 11200 Montevideo
\nTel: (598-2) 401 47 01
\nFax: (598-2) 409 16 03
\nE-mail: secretaria@smu.org.uy
\nVATICAN STATE F
\nAssociazione Medica del Vaticano
\nStato della Citta del Vaticano 00120
\nTel: (39-06) 6983552
\nFax: (39-06) 69885364
\nE-mail: servizi.sanitari@scv.va
\nVENEZUELA S
\nFederacion M\u00e9dica Venezolana
\nAvenida Orinoco
\nTorre Federacion M\u00e9dica Venezolana
\nUrbanizacion Las Mercedes
\nCaracas
\nTel: (58-2) 9934547
\nFax: (58-2) 9932890
\nWebsite: www.saludfmv.org
\nE-mail: info@saludgmv.org
\nVIETNAM E
\nVietnam General Association
\nof Medicine and Pharmacy (VGAMP)
\n68A Ba Trieu-Street
\nHoau Kiem district
\nHanoi
\nTel: (84) 4 943 9323
\nFax: (84) 4 943 9323
\nZIMBABWE E
\nZimbabwe Medical Association
\nP.O. Box 3671
\nHarare
\nTel: (263-4) 791\/553
\nFax: (263-4) 791561
\nE-mail: zima@healthnet.zw
\nEditorial
\nHuman health resources and
\nmoral responsibilities
\nSince the beginning of the 21st
\ncentury there has been increasing concern, both nationally and
\ninternationally, about the distribution and shortages of human health resources-doctors, den-
\ntists, nurses, pharmacists and all other varieties of paramedical professions. In the \u201870s. and
\neven in the \u201880s. physicians were gloomily predicting an excess number of physicians, and
\nthere were even calls for the reduction of the number of medical students in some countries.
\nSuddenly all changed, and from a projected excess which had been predicted there was con-
\ncern about a shortage of doctors and nurses, first at national level and more recently at global
\nlevel. Over the past five years there have been a number of demographic studies of the distri-
\nbution and future needs of the various categories of health workers \u2013 not least physicians.
\nBy the year 2003 international bodies were beginning to be concerned not only about the
\nshortage, but also with the effects of efforts to recruit doctors and nurses from countries
\nwith limited economic resources and which already had serious under supply of health-
\ncare professionals. In 2001, the Commonwealth Ministers of Health considered a paper
\nprepared by its secretariat and at a pre-World Health Assembly meeting in 2003, the Mini-
\nsters adopted a Commonwealth Code of Practice for the International Recruitment of He-
\nalth Workers. The World Medical Association considered the issue and adopted a Statement
\non this topic in 2003. At this time the World Health Assembly, noting the Commonwealth
\nCode, requested the Director-General to explore possible ways forward to improve the situ-
\nation concerning international recruitment (including the possibility of a Code of Practice
\non international recruitment of health personnel, in particular from developing countries)
\nThe key issues have been concerns that migration of health workers, notably doctors and
\nnurses from undeveloped and developing countries were not only consuming substantial
\nnumbers of professionals from these countries, but were diminishing the national workforce
\nin these countries to even more dangerous levels, from their already overstretched and un-
\nderstaffed position. In the columns of this journal we have already drawn attention to this
\nsituation (see Orvil Adams, WMJ50(3)pp 60-64,2004).
\nIn the early part of this year the concerns were such that the British Medical Association is-
\nsued a \u201cCall for Action\u201c and held an international conference at which Medical Associa-
\ntions notably from America, several African States, Canada and other interested bodies
\nsuch as the Commonwealth Secretariat, The World Health Organisation, MEDACT and the
\nRoyal College of Nurses were represented. The resulting statement, together with the Four
\nKey Points which were identified (see p. 56), were drawn to the attention of the Common-
\nwealth Conference and other international bodies meeting this summer. Concern this year
\nhas been reflected in the adoption in May of a Council Resolution (reinforcing its earlier
\nStatement in 2003) by the World Medical Association, by the consideration of this issue
\nat the WHO World Health Assembly and WHO\u2019s designation of \u201cHuman Resources for He-
\nalth\u201d as the topic for next year\u2019s Annual WHO Health report and of the year 2006 as the be-
\nginning of a decade of action on this topic.
\nThat there is a moral issue underlying all this activity is understandable in the light of the
\nconcern about the pattern of affluent countries recruiting health professionals from less de-
\nveloped and economically weak countries, not only depriving them of healthcare resources,
\nbut also having indirect economic consequences. The cost of training healthcare professio-
\nnals, especially physicians, is a considerable burden in any society, let alone those whose
\neconomies are already weak. When as much as 50% or more of the graduates from such
\ncountries migrate (often not returning), this spells disaster for care in developing countries
\nwho are economically weak but have already borne the cost of their professional training.
\nEditorial
\n29
\nOFFICIAL JOURNAL OF
\nTHE WORLD MEDICAL
\nASSOCIATION
\nHon. Editor in Chief
\nDr. Alan J. Rowe
\nHaughley Grange, Stowmarket
\nSuffolk IP14 3QT
\nUK
\nExecutive Editor
\nDr. Ivan M. Gillibrand
\n19 Wimblehurst Court
\nAshleigh Road
\nHorsham
\nWest Sussex RH12 2AQ
\nUK
\nCo-Editor
\nProf. Dr. med. Elmar Doppelfeld
\nDeutscher \u00c4rzte-Verlag
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\nTHE WORLD MEDICAL
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\nThis expenditure is a complete loss to the
\npoorer economies which are not in any way
\ncompensated for this loss either financially
\nor in terms of the professional resources of
\nwhich they have been deprived.
\nMigration for higher training is of course
\nessential, especially when it is not available
\nin the home country, and the basic human
\nright to migrate, whether for better working
\nconditions or other reasons, is that of every-
\none, including physicians. However, while
\nregard must be paid by health professionals
\nthemselves to the community in which they
\nhave been trained to carry out their profes-
\nsional responsibilities, it is also the duty of
\nmore affluent communities to have regard
\nto the more impoverished and deprived
\ncommunities in other countries.
\nIs it morally defensible to recruit health
\npersonnel from deprived communities?
\nIs it morally acceptable to offer posts where
\nwork and training are accessible to mi-
\ngrants who lack facilities for such training
\nin their own country and then actively seek
\nto retain them, rather than encourage their
\nreturn to their own country which despera-
\ntely needs their skills?
\nIs any recruitment of this nature justifiable
\nfor affluent countries who have simply not
\ntrained enough health professionals to meet
\ntheir need, preferring rather to depend on
\nmigrant professionals to make up the short
\nfall? At a time when affluent developed
\ncountries are beginning to recognise the po-
\nverty in some parts of the world as unaccep-
\ntable and requiring positive action (such as
\nhas led to the Millenium Goals), is there not
\na duty to address these problems in a practi-
\ncal way?
\nIn the next month the G8 Group will meet.
\nIt has many problems to address, including
\nthat of Poverty \u2013 and the link between Po-
\nverty and Health is clearly undeniable. It is
\ntherefore not surprising that the attention of
\nthis powerful group is being drawn to the
\nfundamental importance of the need for
\ninternational agreement to a positive inter-
\nnational discipline in the field of health pro-
\nfessionals\u2019 recruitment, and to individual
\ngovernments\u2019duties to provide facilities for
\ntraining enough healthcare professionals
\nfor their own needs, as well as working
\nEditorial
\n30
\nSaving The Lives Of Siamese Twins
\nSiamese twins are exceedingly rare,
\napproximately one in a million live births.
\nIn the 16th and 17th centuries they were
\ndisplayed as circus freaks, which has
\nevolved at the present day into intense
\nmedia interest.
\nProfessor Lewis Spitz, Head of Paediatric
\nSurgery at Great Ormond Street Children’s
\nHospital since 1979, has carried out 24 con-
\njoined Siamese twin separations in his 25-
\nyear surgical career prior to retirement. In
\norder to ensure that both twins survive,
\nwhere one may be a parasite on the other,
\nthe surgery involved can be complex and
\ndifficult, with conglomerate masses repre-
\nsenting fused organs. \u201eNothing is quite
\nwhere you expect it to be\u201c he says.
\nEvery support is given to ensure survival,
\nwith two surgical teams, one for each twin,
\nof about 15 nurses, surgical registrars and
\ntheatre assistants under the two leading
\npaediatric surgeons, Mr Ed Kylie and
\nProfessor Spitz.
\nThe chances that one twin will die on sepa-
\nration are nevertheless around 1 in 5.
\nMajor organs like the heart can be fused
\ntogether making separation impossible.
\nAt the start of the operation, the skin is
\nincised down to the level of the bone \u2013
\nbarn-door surgery as Professor Spitz puts it,
\nrather than keyhole surgery. Skin flaps
\nremain essential to provide cover later on
\nagainst hospital-acquired infection such as
\nMRSA. It is essential to make sure that
\neach affected organ has its own survival
\nline in place, which can be very tricky when
\nthe stage is reached for the body to be
\nturned over before separation.
\nBlood loss from dissecting out the liver,
\nwhich has a particularly rich blood supply,
\ncan be fatal. Also, the twins may share a
\ncommon bile duct, which can lead on to
\nobstructive jaundice. The dilemma for the
\nsurgeon whether nature be allowed to take
\nits course or should the surgeon terminate
\nearly? The surgical ethical view is that
\nconditions which will retain these profes-
\nsionals in their own countries. Where ne-
\ncessary this debate must take account of the
\nneed for some countries to assist others to
\nmeet the latter where their resources are in-
\nadequate to fulfil their requirements.
\nThe USA calculate that by the year 2020, it
\nwill require an additional 200000 physici-
\nans and at present it apparently forsees no
\nalternative but to continue recruiting as be-
\nfore. The distribution of physicians in the
\nUSA in 1996 per 10000 population was
\n26.5 (www consulted June 05) and in Gha-
\nna it is currently 0.75 per 10000 i.e.1500
\nphysicians for a population of 20 million
\npopulation i.e. (personal communication).
\nAs an illustration of disparity in migrant
\nphysician usage, an OECD study in 2002
\n(Bourassa-Forcier M & Giuffrida A \u201cInter-
\nnational Migration of Physicians and Nur-
\nses\u2026\u201d – OECD Human Resources for He-
\nalth Care Project 2002), showed that the
\npercentage of workforce varied from the
\nUK and New Zealand 34.5% (in 2000),
\ncompared with that Canada 25% (in 1998)
\nand in Austria which was 1.9% (in 1998).
\nClearly physicians and other health profes-
\nsionals need to be aware of principles be-
\nhind Codes and Guidelines on Migration
\nand Recruitment in addition to their indivi-
\ndual responsibilities as members of their
\nprofessions, Of vital importance however,
\nthe situation also calls for a radical re-thin-
\nking of political attitudes in developed
\ncountries concerning both their responsibi-
\nlities to developing and deprived communi-
\nties, the duty of countries to provide ade-
\nquate resources to train and retain enough
\nphysicians and other health professionals to
\nmeet their own country\u2019s needs, and also to
\nassist, where necessary, the desperate needs
\nof others elsewhere in the world.
\nAlan Rowe
\nSiamese twins being stuck together for life
\nin this age of modern medicine is intolera-
\nble. With such a good outlook, there is
\nevery reason for these patients to lead a
\nnormal, independent life-with a normal
\nlifespan.
\nAetiology & future
\ntreatments
\nIf the Siamese twins present as an emer-
\ngency, the survival rate is comparatively low
\nat 13%, but where the surgery can be planned
\nin advance, with MRI scans and the con-
\nstruction of models of affected organs, then
\nsurvival is much higher at around 80%. The
\nsurgery is the product of very difficult deci-
\nsions, where he mass of tissues have to be
\nseparated out and re-wired before being put
\nback together again in order as intact re-con-
\nnections. This can take 18 hours or even
\nlonger for, a complex operation.
\nCausation
\nAt present there are two theories of causa-
\ntion. The first suggests that at 13 days gesta-
\ntion or thereabouts, the dividing mass of
\nembryonic cells in a single pregnancy fails to
\nseparate properly. The second hypothesis
\nplaces the emphasis on parts of the develop-
\ning embryo which fuse together. Given the
\nchoice, the optimal time to operate for suc-
\ncessful separation is about 7 months, when
\nthe patients are still very tiny babies,
\nalthough every case is different and must be
\nevaluated on an individual basis.
\nThe future
\nAt the present rate of progress in terms of
\nmedical advances in liver transplant
\nresearch, conjoined livers will soon be oper-
\nable provided that there is no excessive
\nblood loss from the rich blood supply. With
\nenhanced powers of cellular regeneration, re-
\nwired and re-connected twinned livers are
\nexpected to respond very well to treatment in
\naddition to the present successes of trans-
\nformed bowels and urinary systems.
\nIvan M. Gillibrand
\nMedical Ethics and Human Rights
\n31
\nAmongst the Declarations to which minor editorial changes were approved
\nat the 170th
\nCouncil meeting was the Declaration of Geneva. This was one
\nof the earliest and fundamental declarations of the World Medical
\nAssociation and in view of its importance and worldwide use, the revised
\ntext is reproduced below.
\nThe World Medical Association
\nDeclaration of Geneva
\nAdopted by the 2nd
\nGeneral Assembly of the World Medical Association,
\nGeneva, Switzerland, September 1948 and amended by the 22nd
\nWorld
\nMedical Assembly, Sydney, Australia, August 1968, the 35th
\nWorld
\nMedical Assembly, Venice, Italy, October 1983, the 46th
\nWMA General
\nAssembly, Stockholm, Sweden, September 1994 and editorially revised
\nat the 170th
\nCouncil Session, Divonne-les-Bains, France, May 2005.
\nAT THE TIME OF BEING ADMITTED AS A
\nMEMBER OF THE MEDICAL PROFESSION:
\nI SOLEMNLY PLEDGE to consecrate my life to the service of humanity;
\nI WILL GIVE to my teachers the respect and gratitude that is their due;
\nI WILL PRACTISE my profession with conscience and dignity;
\nTHE HEALTH OF MY PATIENT will be my first consideration;
\nI WILL RESPECT the secrets that are confided in me, even after the patient
\nhas died;
\nI WILL MAINTAIN by all the means in my power, the honour and the noble
\ntraditions of the medical profession;
\nMY COLLEAGUES will be my sisters and brothers;
\nI WILL NOT PERMIT considerations of age, disease or disability, creed,
\nethnic origin, gender, nationality, political affiliation, race, sexual orienta-
\ntion, social standing or any other factor to intervene between my duty and
\nmy patient;
\nI WILL MAINTAIN the utmost respect for human life;
\nI WILL NOT USE my medical knowledge contrary to the laws of humanity,
\neven under threat;
\nI MAKE THESE PROMISES solemnly, freely and upon my honour.
\nThe Committee of Ministers of the Council
\nof Europe (CoE) opened on January 25th,
\n2005 the Protocol concerning Biomedical
\nResearch for signature.
\nThis Protocol, already signed by 14 mem-
\nber states, is the first international legally
\nbinding instrument to regulate research on
\nman. This framework defines the legal lim-
\nitations of research on man which need to
\nbe incorporated in law, unlike the
\nDeclaration of Helsinki or recommenda-
\ntions of CIOMS (see \u201cBiomedical Research
\nin Europe\u201d WMJ, Vol. 50, 64-66, 2004) etc.
\nSpecial attention should be paid to some
\nvery important protective provisions which
\nare dealt with in a different manner, often
\nwithout regulation. These points are
\na) research on persons not able to consent
\nand
\nb) use of placebo.
\nFor information, these original articles are
\nprinted below. Readers who are especially
\ninterested in accessing the whole protocol
\nwill find this on the CoE website:
\nhttp:\/\/www.coe.int\/T\/E\/Legal_Affairs\/
\nLegal_co-operation\/Bioethics\/
\nCHAPTER V
\nProtection of persons not able
\nto consent to research
\nArticle 15 \u2013 Protection of persons not
\nable to consent to research
\n1. Research on a person without the capac-
\nity to consent to research may be under-
\ntaken only if all the following specific
\nconditions are met:
\ni. the results of the research have the
\npotential to produce real and direct
\nbenefit to his or her health;
\nii. research of comparable effectiveness
\ncannot be carried out on individuals
\ncapable of giving consent;
\niii. the person undergoing research has
\nbeen informed of his or her rights
\nand the safeguards prescribed by law
\nfor his or her protection, unless this
\nperson is not in a state to receive the
\ninformation;
\niv. the necessary authorisation has been
\ngiven specifically and in writing by
\nthe legal representative or an author-
\nity, person or body provided for by
\nlaw, and after having received the
\ninformation required by Article 16,
\ntaking into account the person\u2019s pre-
\nviously expressed wishes or objec-
\ntions. An adult not able to consent
\nshall as far as possible take part in
\nthe authorisation procedure. The
\nopinion of a minor shall be taken
\ninto consideration as an increasingly
\ndetermining factor in proportion to
\nage and degree of maturity;
\nv. the person concerned does not
\nobject.
\n2. Exceptionally and under the protective
\nconditions prescribed by law, where the
\nresearch has not the potential to produce
\nresults of direct benefit to the health of
\nthe person concerned, such research
\nmay be authorised subject to the condi-
\ntions laid down in paragraph 1, sub-
\nparagraphs ii, iii, iv, and v above, and to
\nthe following additional conditions:
\ni. the research has the aim of contribut-
\ning, through significant improve-
\nment in the scientific understanding
\nof the individual\u2019s condition, disease
\nor disorder, to the ultimate attain-
\nment of results capable of conferring
\nbenefit to the person concerned or to
\nother persons in the same age cate-
\ngory or afflicted with the same dis-
\nease or disorder or having the same
\ncondition;
\nii. the research entails only minimal
\nrisk and minimal burden for the indi-
\nvidual concerned; and any consider-
\nation of additional potential benefits
\nof the research shall not be used to
\njustify an increased level of risk or
\nburden.
\n3. Objection to participation, refusal to
\ngive authorisation or the withdrawal of
\nauthorisation to participate in research
\nshall not lead to any form of discrimina-
\ntion against the person concerned, in
\nparticular regarding the right to medical
\ncare.
\nArticle 16 \u2013 Information prior to autho-
\nrisation
\n1. Those being asked to authorise partici-
\npation of a person in a research project
\nshall be given adequate information in a
\ncomprehensible form. This informa-
\ntion shall be documented.
\n2. The information shall cover the pur-
\npose, the overall plan and the possible
\nrisks and benefits of the research pro-
\nject, and include the opinion of the
\nethics committee. They shall further be
\ninformed of the rights and safeguards
\nprescribed by law for the protection of
\nthose not able to consent to research and
\nspecifically of the right to refuse or to
\nwithdraw authorisation at any time,
\nwithout the person concerned being
\nsubject to any form of discrimination, in
\nparticular regarding the right to medical
\ncare. They shall be specifically
\ninformed according to the nature and
\npurpose of the research of the items of
\ninformation listed in Article 13.
\n3. The information shall also be provided
\nto the individual concerned, unless this
\nperson is not in a state to receive the
\ninformation.
\nArticle 17 \u2013 Research with minimal risk
\nand minimal burden
\n1. For the purposes of this Protocol it is
\ndeemed that the research bears a mini-
\nmal risk if, having regard to the nature
\nand scale of the intervention, it is to be
\nexpected that it will result, at the most,
\nin a very slight and temporary negative
\nimpact on the health of the person con-
\ncerned.
\nMedical Ethics and Human Rights
\n32
\nMedical Ethics and Human Rights
\nCouncil of Europe
\nAdditional Protocol To The Convention On Human Rights
\nAnd Biomedicine Concerning Biomedical Research
\nWMA
\n33
\nDr. Otmar Kloiber opened the meeting, wel-
\ncoming especially the seven new members of
\nCouncil, and introduced Dr. Johnson (USA)
\nPast President of the WMA who gave an
\nintroductory talk for new members on the
\nstructure and functions of Council and its
\ncommittees. He stressed the importance of
\ninput into debates, the importance of always
\nremembering the diversity of cultures and
\nlanguages and explained the procedures used
\nby council and committees. This was warm-
\nly appreciated by Council.
\nThe Secretary General called for nominations
\nfor the Chair. Dr. Y. Blachar (Israel) was
\nelected, with Dr. N. Hashimoto (Japan) as
\nVice-Chair, both by acclamation. Dr. Blachar
\nafter expressing his thanks both to council
\nand all the officers who had supported him
\nduring the past two years continued with the
\nelections Dr. J. D. Hoppe (Germany) was
\nelected Treasurer.
\nDr. K. Vilmar (Germany) was granted the
\nhonorary title of Treasurer Emeritus.
\nThe following were elected as members of
\nthe Ethics Committee:
\nDr. P. Anttila (Finland), Dr E. N. Bagenholm
\n(Sweden), Dr. H. Haddad (Canada), Dr. N.
\nHashimoto (Japan), Dr. J. D. Hoppe
\n(Germany), Dr. H. Miyazaki
\n(Japan), Dr. J. C. Nelson (America), Dr. D. J.
\nPalmisano (America), Dr. B. Selebano
\n(South Africa), Dr. Viera de Paiva (Brazil),
\nDr. Y. T. Wu (Taiwan).
\nThe following were elected members of the
\nSocio-Medical Affairs Committee:
\nDr. J. Haddad (Canada), Dr. L. J. Callo\u2019h
\n(France), Dr. N. Hashimoto (Japan), Dr. J. E.
\nHill (USA), Dr. J. Johnson (USA), Dr. DJ.
\nPalmisano (USA), Dr. B. Selebano (south
\nAfrica), Dr. K. Vilmar (Germany), Dr. E.
\nViera de Paiva (Brazil), Dr. Y. T. Wu
\n(Taiwan).
\nAdvisers to the committees were also
\nappointed
\nThe following were elected members of the
\nFinance and Planning Committee
\nDr. J. Nelson (USA), Dr. Antilla (Finland),
\nDr. E. N. Bagenholm (Sweden), Dr. J.
\nCalloc\u2019h, Dr. J. E. Hill (USA), Dr. J. D.
\nHoppe (Germany), Mr. J. J. Johnson (U. K.),
\nDr. H. Myazaki (Japan), Dr. K. Vilmar
\n(Germany).
\nFollowing the adoption of the Minutes of the
\n169th Council meetings in Tokyo, the
\nPresident then reported on his activities dur-
\ning the past months following the Tokyo
\nGeneral Assembly.
\nPresident\u2019s interim report
\nDr. Coble reported that he had the privilege
\nof visiting the Hungarian, Portuguese, Israel,
\nIndian, Taiwan, China the UK and many
\nother NMAs during the past year All his con-
\ntacts with physicians had confirmed his pre-
\nvious impressions that NMAs were con-
\ncerned with the care of patients, quality of
\ncare, patients\u2019 access to healthcare and activ-
\nity as advocates for patients for whom free-
\ndom to chose their physicians was fundamen-
\ntal. There was also concern about physicians\u2019
\nautonomy. He also referred to his contacts
\nwith and the work of WONCA, the Society
\nof Internal Medicine and other global groups
\nin all aspects of medicine. Dr Coble also
\nreferred to important contacts with the other
\nhealth professions, in particular through the
\nWorld Health Professions Alliance,
\nemphasing especially the value of relation-
\nships with the Nursing Profession.
\nIn referring to the major role of WMA in
\nMedical Ethics since its foundation in 1948,
\nhe stressed the wider role of WMA as set out
\nits mission, and stressed that WMAs activi-
\nties were more and more having to be extend-
\ned into other fields such as improving health
\ncare provision and the quality of healthcare.
\nRelevant to this was the World Ocean Forum,
\nwhich the WMA had founded to discuss the
\nvital health topic of potable water. This had
\nbeen a particular success involving a large
\nnumber of interested bodies including the
\nUN, WHO, and the World Bank. Mentioning
\nespecially the non-governmental bodies, he
\nreferred to International Rotary who had
\nplayed a notable role in the provision of
\npotable water. This Forum illustrated the
\nstrength and real value of public\/private ini-
\ntiatives.
\nHe paid a special tribute to the Japanese
\nMedical Association for their hospitality in
\nhosting the highly successful General
\nAssembly in Tokyo.
\n2. It is deemed that it bears a minimal bur-
\nden if it is to be expected that the dis-
\ncomfort will be, at the most, temporary
\nand very slight for the person con-
\ncerned. In assessing the burden for an
\nindividual, a person enjoying the special
\nconfidence of the person concerned
\nshall assess the burden where appropri-
\nate.
\nArticle 23 \u2013 Non-interference with neces-
\nsary clinical interventions
\n1. Research shall not delay nor deprive
\nparticipants of medically necessary pre-
\nventive, diagnostic or therapeutic pro-
\ncedures.
\n2. In research associated with prevention,
\ndiagnosis or treatment, participants
\nassigned to control groups shall be
\nassured of proven methods of preven-
\ntion, diagnosis or treatment.
\n3. The use of placebo is permissible where
\nthere are no methods of proven effec-
\ntiveness, or where withdrawal or with-
\nholding of such methods does not pre-
\nsent an unacceptable risk or burden.
\nProf. Elmar Doppelfeld, MD
\nChair of the Steering Committee on \u201cBio-
\nethics\u201d of the Council of Europe
\nWMA
\n170th WMA Council meets in Divonne
\nDr. Coble also paid particular tribute to Dr.
\nMyllymaki and Dr. Appleyard, his predeces-
\nsors for all their work and support.
\nTurning to the change of Secretary General,
\nhe outlined the process of change. The
\nSearch Committee who considered the
\nnumerous applications for the post eventual-
\nly resulting in the appointment of Dr. Otmar
\nKloiber, and said that the process of the tran-
\nsition and hand-over had been smooth and
\nsuccessful In the course of this, earlier in the
\nyear both Dr. Human and Dr. Kloiber had
\nmet with him on a number of occasions,
\nnotably on two of them to consider the
\nresponses of NMAs on governance and their
\nco-ordination into a single document. During
\nthese periods there had also been the oppor-
\ntunity to attend the Executive meeting of
\nWHO which received Dr. Nabarro\u2019s initial
\nreport on the tsunami, and to meet Dr.
\nNabarro on a further occasion which
\npromised fruitful Opportunities for further
\ncollaboration.
\nTurning to the \u201cCaring Physicians\u201d project he
\ngave some details of the project and its
\nprogress. This was a project responding to the
\nNMAs indication that there was a need for
\ngreater transparency to be given to the \u201ccar-
\ning role\u201d of physicians which was not as
\nwidely known as it should be. Hence the pro-
\nject asked individual NMAs to identify
\nexamples of physicians whose work demon-
\nstrated these qualities, with the intention of
\npublicising this in book form which he felt
\nwould go some way to emphasise these val-
\nues. He had approached the Pfizer
\nHumanities Division, which felt this to be
\nthis worthy of support and a committee rep-
\nresentative of the six regions was appointed
\nto advise on the project. NMAs from 55
\ncountries made a very good response on a
\nvery tight time scale, to an approach to iden-
\ntify physicians from their own countries who
\nillustrated these qualities. Following a meet-
\ning of the judges in London, appropriate can-
\ndidates were identified and this publication
\nwould be released at the GeneralAssembly in
\nSantiago.
\nReferring to the regions, he reported that he
\nhad had contact with the Council of the
\nIndian Medical Association and there was an
\nincrease in their participation in WMA. The
\nChinese Medical Association was more
\nactive and he would be attending a Bio-ethic
\nConference there later this year at which the
\nethics of transplantation would be on the
\nagenda. He gave further details of regional
\nmeetings including one which had taken
\nplace, involving 8 of the Sub- Saharan coun-
\ntries. He had met with and assisted the Iraq
\nMedical Association concerning the re-estab-
\nlishment of their Medical Association which
\nhad been illegal under the previous regime,
\nand attended a number of Regional meetings.
\nFor the future, much would depend on the
\nStrategic plan but he stressed that his contacts
\nwere very positive for further Regional meet-
\nings in various parts of the world, mentioning
\nSouth America and South East Asia in partic-
\nular, and expressed his concern at the few
\nmembers in the Middle East.
\nFinally he thanked those who had been par-
\nticularly helpful with the problems of the
\nRegional meetings and expressed his thanks
\nto the Chair and to the new Secretary
\nGeneral.
\nDr. Blachar acknowledged Dr Coble\u2019s exten-
\nsive work and called for the Secretary
\nGeneral\u2019s report.
\nSecretary-General\u2019s report
\nDr. Kloiber commented on the transition
\nfrom Dr. Delon Human who had held the
\noffice for nearly eight years, finishing his
\nwork with three major projects to be intro-
\nduced or finalised.
\nThe first was the launching of the initiative
\nby the President in Tokyo of the \u201cCaring
\nPhysicians of the World\u201d referred to in the
\nPresident\u2019s report.
\nThe second was the Ethics Manual which had
\nbeen prepared by the Director of Ethics, Dr.
\nJ. Williams, assisted by a committed team of
\nadvisers. This was released at a successful
\nlaunch in January 2005 and has received con-
\nsiderable attention. French, Spanish and
\nGerman translations are nearly complete, and
\nother translations under consideration.
\nThe Third was the World Ocean Forum held
\nin New York 15\u201316 November 2004. This
\nwas a common endeavour of the World
\nOcean Observatory, the Pfizer Medical
\nHumanities Initiative and the World Medical
\nAssociation. It was well attended by scien-
\ntists and activists from water ecology inter-
\nests, and high officials of the UN
\nDevelopment programme, the UN, national
\n(USA, Canada, Australia) authorities as well
\nas the Executive Director of the WHO
\nEnvironmental Division, Dr. Kerstin Leimer.
\nThis successful event tragically just preceded
\nthe tsunami disaster, following which the
\nwater and ocean related issues discussed dur-
\ning the meeting were illustrated in a most
\ndramatic fashion (The full report is available
\nat www.worldoceanforum.org.
\nDr. Kloiber commented \u201cthese three projects
\nare just a few examples of the outstanding
\nservice provided by Dr. Delon Human as the
\nSecretary General over nearly eight years.
\nWe owe him our gratitude and appreciation
\nfor his work.\u201d
\nDr. Kloiber used the time between his
\nappointment in Tokyo and his assumption of
\nduties as the Secretary General on 1st
\nFebruary 2005 for the hand-over, including
\nhis introduction to regional organisations, to
\nthe WHO Executive Board meeting and his
\nparticipation in the World Ocean Forum.
\nReporting on these meetings he expressed
\nhopes for further co-operation with all such
\nbodies in the future.
\nThe Governance Working Group continued
\nas the highest priority, in several meetings
\nand telephone conferences proposals were
\nanalysed and collated into one report referred
\nback to Council. The implementation of the
\ndecisions of Council and the General
\nAssembly would be a major task for the sec-
\nretariat.
\nReporting on the First Global meeting of the
\nInternational Alliance of Patients\u2019
\nAssociations (IAPO) in February 2005, he
\nreported that representatives of the World
\nHealth Professions Alliance (WHPA) had
\naddressed the question of collaboration
\nbetween the two bodies, this had been warm-
\nly welcomed by IAPO. Such discussions will
\nbe of importance not only at global but also
\nat national level (www.iapo.org).
\nThe Secretary General reported on the work
\nof the European Forum of Medical Associa-
\ntions and WHO at its meeting in March (see
\npp WMJ 51(5)28), on the initiative of the
\nStanding Committee of European Doctors
\nWMA
\n34
\n(CPME) on Patient Safety and on their iden-
\ntification of key problems in common with
\nWHO Regional Scientific Session. In this
\nconnection, systems to identify or report haz-
\nards in patients safety net need to be set up; a
\nsafety culture has to be built up that departs
\nfrom the blame and shame approach and pro-
\nvides a blame-free procedure to handle mis-
\ntakes, accidents and \u201cclose calls\u201d. The use of
\ntelematics (e-health) should be promoted. It
\nwill allow health care to be made safer, as
\ndemonstrated in the field of drug prescrip-
\ntion. Senior officials including the Mr
\nMarkos Kyprianou, European Commissioner
\nfor Health, the current Chair of the Council
\nHealth Ministers, and the Director of Public
\nhealth of the European Commission, all com-
\nmitted themselves to EU support for research
\nand development in the field of patient
\nsafety.
\nHe reported his attendance at several
\nAssemblies of National Medical
\nAssociations. Dr. Kloiber detailed the objec-
\ntives for the future incorporated in the
\nStrategic Plan 2003-2007 namely, to increase
\nvisibility of the WMA at all levels, to
\nincrease both membership and associate
\nmembership by 20%, to focus on agreed
\nobjectives and not pursuing all possible
\nopportunities, and create a stable financial
\nposition. He detailed the main activities
\nneeded in
\n– the improvement of medical care and
\nhealth in general;
\n– medical ethics
\n– human rights
\n– advocacy
\n– networking and management
\n– non-dues revenue,
\nand the problems associated with achieving
\nthese.
\nFinally he reported that action had already
\nbeen taken on consolidation of the bank
\naccounts of the Association and the invest-
\nment of liquid assets, on a cost analysis of
\ndaily business processes and subsequent cost
\nreduction, and outsourcing the position of
\none translator.
\nDr. Masson inquired whether the Chinese
\nMedical Association adhered to the ethical
\nstandards of WMA, in particular in relation to
\nTransplantation of organs, and the involun-
\ntary donation of organs?
\nDr. Kloiber responded by indicating that he
\nrepeatedly had contacts with CMA. There
\nshould not be preconditions, but transplanti-
\nng of Organs will be in the agenda. The
\nPresident commented that talking continues
\nwith the Chinese, and there was cosponsoring
\nfor a meeting in the period June- August.
\nFollowing the decision to refer several
\nmotions respectively to the Ethics and
\nMedico-Social Committees, Council
\nadjourned until Sunday 15th May.
\nMedical Ethics Committee
\nThe committee met on 13th May under the
\nChairmanship of Dr. Bagenholm, who paid
\ntribute to the stalwart work of her predeces-
\nsor Dr. Snaedel.
\nFollowing the adoption of the minutes of the
\nlast meeting in Tokyo, Dr. John Williams, in
\npresenting his report on the work of the
\nEthics unit, thanked Dr. Snaedel for all the
\nwork he had done during his Chairmanship
\nof the committee. He continued by stressing
\nthat the key objective of the unit had been to
\nmake the WMA Ethics activities better
\nknown. The Ethics Manual had been distrib-
\nuted widely to 125 Medical journals. There
\nhad been many positive reviews of the man-
\nual, which had been well received. In addi-
\ntion to the French and Spanish version being
\nprepared, there had been offers for Japanese,
\nChinese, Armenian, German, Macedonian
\nand many others Funds were not, however,
\navailable to publish in all these languages,
\nbut he hoped that NMAs who translate will
\nbe able to distribute the version by e-mail,
\nweb, CD ROM etc. Turning to future activi-
\nties, these would include continuing the poli-
\ncy review, promotion of the manual -possibly
\nweb based, and it was hoped that an ethics
\neducation course would be available in
\nMarch. Dr. Haddad enquired whether assis-
\ntance was needed either in terms of finance or
\nother NMAassistance, to which Dr. Williams
\nreplied that money was needed especially to
\nproduce hard copies and Dr. Kloiber made
\nclear that funds were not available for distri-
\nbution of copies.
\nPolicy Review
\nThe committee then considered the recom-
\nmendations on policies for minor review fol-
\nlowing consultation with NMAs, and decided
\non the following categorisations
\nDeclaration of Tokyo Approved with minor
\namendment
\nDeclaration of Oslo – Major review
\nIn discussion, Estonia felt that the document
\nwas too narrow and Bolivia also felt a major
\nreview was required.
\nThe Statement on Human Rights and
\nIndividual Freedom of Medical Practitioners:
\nfollowing amendment of the title to \u201cNon-
\ndiscrimination in professional membership,
\nand activities of physicians\u201d the statement
\nwas adopted as revised.
\nDeclaration of Madrid on Professional
\nAutonomy and Self- Regulation, was adopt-
\ned, with minor amendments.
\nThe Madrid declaration on Euthanasia was
\napproved, unamended.
\nThe Resolution on Academic Sanction or
\nboycotts was approved with minor amend-
\nments
\nThe Marbella statement on Physician-assist-
\ned Suicide, was approved, unamended.
\nWith minor editorial changes, the revised
\nstatement on Body Searches of prisoners was
\napproved.
\nThe proposed revised Declaration of
\nGeneva, with minor changes, was approved
\n(see p 31).
\nStatements for major revision:
\nDr. Snaedel reported that work on the
\nInternational Code of Medical Ethics on
\nwhich the Working group established in
\nTokyo would continue, and it was noted that
\nsections on patient autonomy and freedom of
\nchoice, the duties of physicians to keep up to
\ndate, to teach, dual responsibility (e.g. when a
\nphysician acts for a third party), and the
\nduties of physicians to themselves, would be
\nproposed as additions to the redraft.
\nWMA
\n35
\nAdv. Malke Borrow introduced the proposed
\nstatement on Genetics and Medicine on
\nwhich NMA comments had been received.
\nThe draft produced considerable discussion,
\nin particular in relation to the use of the word
\n\u201cregulated\u201d in relation to developments in the
\nfield of Gene therapy and genetic research. It
\nwas finally decided hat this word was not
\nappropriate and the relevant sentence intro-
\nducing guidelines should read \u201cHowever,
\nwith the continuing development of this field
\n(Gene therapy and genetic research) it should
\nproceed, according to the following guide-
\nlines\u2026\u201d.Anumber of other texts and amend-
\nments were introduced and the text adopted
\nas amended Organ donation and transplant.
\nThe working group would continue its work.
\nThe proposed statement on HIV\/AIDS was
\nreferred to NMAs; as was a document on
\nTelematics, and the Venice Declaration on
\nTerminal illness.
\nAlthough the Statement on Human Organ
\nand Tissue Donation and Transplant was a
\nrelatively new one, the Danish Medical
\nAssociation had proposed an addition in
\nJanuary 2005. Having received comments on
\nthis from NMAs, it was agreed that this
\nshould undergo general review.
\nOf the pre- 1995 documents, it was agreed
\nthat the Declaration of Sydney (determina-
\ntion of Death), the Statements on Freedom to
\nattend medical meetings (Singapore), the
\nStatements on Foetal Tissue (Hong Kong), on
\nPatient Advocacy (Budapest), on Medical
\nEthics in the event of Disaster (Stockholm),
\nand on Animal use in Medical Research
\n(Hong Kong) should all have major revi-
\nsion.
\nThe following should be rescinded and
\narchived:
\nStatement on Physician Independence and
\nProfessional freedom (Rancho Mirage)
\nwhich was- largely covered by Madrid, the
\nStatement on Genetic Counselling and
\nEngineering, the Declaration on the Human
\nGenome Project and the Resolution on
\nCloning.
\nConcerning post 1995 documents, the
\nStatements on Ethical Aspects of Embryonic
\nReduction (Bali), and that on Child Abuse
\nand Neglect (Singapore) required major
\nrevision.
\nThe Statement on Patients\u2019 rights (Lisbon)
\nrequired minor amendment and those on
\nMental Illness (Bali), Human Rights (Rancho
\nMirage) should be archived.
\nHuman Rights
\nDr. Williams referring to his Report on
\nHuman Rights stated that the education pro-
\ngramme on Doctors and Prisons had been a
\ngreat success. The CD-ROM was now avail-
\nable in Spanish. Members of Council had
\nparticipated in the pilot projects on the
\nIstanbul Protocol. Dr. Appleyard commented
\non the importance of ICRC participation and
\nthe support of the European Union. He spoke
\nabout his visit to Uganda where there had
\nbeen a conference with participants from 5
\ncountries and training (which included
\nlawyers) on support and identification of vic-
\ntims.
\nConcerning Zimbabwe, both Drs Appleyard
\nand Letlape stressed the problems and
\nappealed for help for colleagues in
\nZimbabwe. An attempt to organise a regional
\nmeeting including Zimbabwe eventually took
\nplace after some delay. Speaking of the crisis
\nthere, one in eight children die and one in five
\nchildren are orphans. Concerning emigration
\nof healthcare workers it was pointed out that
\nthe number of physicians had dropped from
\n1400 to 800 for a population of 11 million.
\nHarare Hospital, the largest in the country,
\nwas literally breaking up and there was insti-
\ntutionalised violence and torture. CME in
\nZimbabwe was now obligatory, and we must
\ntry to connect with colleagues through this.
\nDr. Letlape commented on the silence from
\nthe Zimbabwe Medical Association on
\nHuman Rights. There had been a meeting of
\nthe two organisations and there was no call
\nfor help from ZMA. Thus it was not possible
\nto intervene without a request from the ZMA.
\nTheir autonomy must be respected but he
\nsaid, \u201cwe therefore must respond to any call.
\nWe want to establish a regional meeting and
\nhe hoped to report further in Chile\u201d.
\nThe committee had further discussion on the
\nhuman rights issues in Zimbabwe.
\nTwo members referred to the absence in cer-
\ntain WMA statements of reference to physi-
\ncians\u2019participation in torture, actively or pas-
\nsively. Dr. Nathansen referring to this pointed
\nout that this had been highlighted in the New
\nEngland Journal of Medicine and comment-
\ned that the \u201cDual issues\u201d concerning loyalty
\nwas important in this context…
\nProfessor Blahos who had twice been in
\nEthiopia spoke of the situation in the Fistula
\nHospital in Addis Ababa and said that the sit-
\nuation was terrible outside Addis Ababa. Dr.
\nHaddad felt it important to establish a work-
\ning group to inquire into whether there was a
\nneed for additional wording in the
\nDeclarations of Geneva or Tokyo, and this
\nwas agreed.
\nThe Danish Medical Association raised the
\nissue of removal of organs for sale from pris-
\noners in China on which it had received a
\nreport. It would produce a motion for the
\nGeneral Assembly. Following a lively debate
\nthe Secretary General was asked to look into
\nthis matter.
\nThe Israeli Medical Association proposed a
\nCouncil resolution on the situation in Darfur,
\nwhere there were 300,00 deaths and over a
\nmillion displaced persons. Dr. Blachar said
\nthat \u201cThe WMA as an international medical
\norganisation committed to the protection of
\nhealth and human rights for all, has frequent-
\nly expressed its support for human rights in
\nstatements, and today we are urging national
\nmedical associations around the world to
\npress their governments to intervene now to
\nstop the mass killings and to protect the
\nhealth and safety of refugees in the region\u201d.
\nThis was approved and subsequently adopted
\nby Council.
\nAll the recommendations of the committee
\nlisted above sere subsequently agreed by
\nCouncil in adopting the report of the Ethics
\ncommittee.
\nSocio-Medical Affairs
\nCommittee
\nThe committee met on 13 May and Dr.
\nHaddad was elected Chair of the Committee.
\nFollowing the approval of the minutes of the
\nTokyo meeting in October 2004, the
\nCommittee considered NMA views on pro-
\nWMA
\n36
\nposed policy changes designated in Tokyo as
\nrequiring minor revision.
\nThe committee recommended approval of
\nthe revision to the Boxing Statement and the
\nStatement on female Genital Mutilation and
\nthe Declaration on the Abuse of the Elderly
\n(Hong Kong).
\nHowever, it recommended that the Statement
\non Adolescent Suicide undergo major revi-
\nsion.
\nConcerning those policies requiring major
\nrevision, the committee next considered
\nreports on the progress, which had been
\nmade.
\nDr. Calloc\u2019h reported that in relation to the
\nStatement on the Role of Physicians in
\nEnvironmental and Demographic issues, the
\nFrench Medical Association felt that a major
\nissue needed to be addressed, namely the
\nneed for WMA to adopt policy on achieving
\na balance between informing the public and
\navoiding public alarm on environmental and
\npreventive issues, citing Pollution and
\nAsthma as an example. At the Chairman\u2019s
\nsuggestion the FMA would prepare an appro-
\npriate document.
\nDr. Letlape reported that the South African
\nMedical Association had decided to delay
\nrevision of the Statement on Access to Health
\nCare until after the General Assembly discus-
\nsion of this issue later in the year.
\nFollowing considerable discussion and some
\namendment, the proposed Statement on
\nDrugs Substitution was recommended for
\napproval and forwarding to the General
\nAssembly for adoption, and that the
\nStatement on Generic Drug Substitution and
\nthe resolution on Therapeutic Substitution be
\nrescinded and archived.
\nA proposed WMA Statement on Medical
\nEducation as amended was recommended to
\nbe forwarded for NMA comment.
\nTurning to a proposed statement on Medical
\nLiability Reform, Dr. Palmisano stressed the
\nseriousness of the situation in the USAwhere,
\nin the previous week, awards of 20 and 30
\nmillion US$ had sent a chill through the pro-
\nfession. The Swedish delegation stated that
\nthe document as written was unacceptable to
\nthem as they had a \u201c no-fault system\u201d, and
\nthere was a contribution from Spain which
\npointed out that both criminal and civil courts
\nmay consider liability cases where appropri-
\nate. \u201cThere was however a need to fight
\nagainst the criminalisation of liability.\u201d
\nFollowing a discussion on these issues a suit-
\nable form of words was agreed and the pro-
\nposed WMA Statement on Medical
\nLiability Reform as amended was recom-
\nmended for approval and transmission to
\nthe General assembly for Adoption.
\nTurning to six policies which had not been
\nclassified; the following decisions were
\nmade:
\nRecommendations concerning Medical care
\nin Rural Areas – be rescinded and archived
\nThe Statement on Use and Misuse of
\nPsychotrophic Drugs to undergo major revi-
\nsion
\nThe Statement on Persistent Vegetative State
\nbe rescinded and archived
\nThe Statement on traffic Injury undergo
\nmajor revision
\nThe Statement on Noise Pollution, to under-
\ngo major revision.
\nThe Statement onAlcohol and Road Safety to
\nundergo major revision (also to include
\nconsideration of drugs and road safety).
\nConcerning 1995 Socio-medical policies, the
\ncommittee recommended the following
\nThe Statement on the Prescription of
\nSubstitute drugs in the Outpatient Treatment
\nof Addicts to Opiate Drugs to undergo
\nmajor revision
\nThe Statement on Health Promotion to
\nundergo major revision
\nThe Resolution on Testing of Nuclear
\nWeapons to be rescinded and archived.
\nVarious NMAs accepted responsibility for
\nrevision of some of these policies and the sec-
\nretariat for two others.
\nThe Irish delegation reported on the progress
\nof the workgroup on a Statement on Obesity.
\nDr. Calloc\u2019h reported that the CPME were
\nalso working on this topic and he called for
\nsomething from WMA on Lipids, carbohy-
\ndrates etc.
\nThe Secretariat reported on the development
\nof an On-line Course on the Treatment of
\nDrug- Resistant TB, and the South African
\nMedical Association gave a report on their
\nprogress in co-operation with WHO on this
\nissue.
\nThe Committee proposed that a statement on
\nreducing the Global Impact of Alcohol on
\nHealth and Society be forwarded for NMA\u2019s
\nfor comment.
\nIn the discussion of a proposed Council
\nResolution on the Healthcare Skills Drain,
\nThe UK reported on the conclusions of a suc-
\ncessful Conference recently held at the BMA
\nwhich included amongst those attending, var-
\nious Commonwealth countries as well as oth-
\ners including Africa, WHO, the
\nCommonwealth Secretariat, Nurses and other
\ninterested bodies.
\nThe Canadian Medical Association com-
\nmended WHO for taking a leadership role in
\nfacing the global challenges of Human Health
\nResources. It concluded by stressing the
\nmajor ethical implications for health care, the
\nproblem of the northern countries \u201csiphoning
\noff\u201d resources, and stressed that in the discus-
\nsions the financial cost of medical studies
\nshould not be overlooked. There was an
\nimpassioned plea from South Africa that doc-
\ntor substitution was not the only answer, but
\nit was vital to produce doctors to meet needs
\n(see page 56).
\nThe Committee was informed that an invita-
\ntion had been received from WHO to con-
\ntribute to the WHO Annual report for next
\nyear, which would be on Human Resources
\nfor Health.
\nThe Proposed Council Resolution on
\nHealthcare Skills Drain was recommended
\nfor approval by Council and NMAs offered
\nto participate in the work group called for in
\nthe resolution. Council subsequently adopted
\nthe Resolution (see box).
\nThe Committee also recommended that the
\nproposed Council Resolution on observer
\nStatus for Taiwan to the WHO and its inclu-
\nsion as a participating party to the
\nInternational Health regulations be
\napproved.
\nA Proposed Council Resolution on
\nImplementation of the WHO Framework
\nconvention on Tobacco Control was recom-
\nWMA
\n37
\nWMA
\n38
\nWMA Council Resolution on
\ngenocide in Darfur
\nAdopted at the 170th WMA Council Ses-
\nsion, Divonne-les-Bains, France, 15 May
\n2005
\nWHEREAS, a reported 300,000 Darfuri-
\nans have been killed and one million refu-
\ngees displaced since early 2003, on the ba-
\nsis of racial or ethnic origins; and
\nWHEREAS, there have been official re-
\nports of savage killing, torture, rape and
\nmutilation of men, women and children by
\nthe Government of Sudan and its allied mi-
\nlitia; and
\nWHEREAS, many of these reports, inclu-
\nding that of the UN Commission of Inquiry
\non Darfur, have only recently been publici-
\nzed; and
\nWHEREAS, genocide, as defined by the
\n1948 UN Convention on the Prevention
\nand Punishment of the Crime of Genocide,
\nis the killing or destroying of populations
\non the basis of their racial or ethnic identi-
\nty; and
\nWHEREAS, the WMA, as an international
\nmedical organization committed to the pro-
\ntection of health and human rights for all,
\nhas expressed its support for human rights
\nin statements and resolutions, among them
\nthe Resolution on Human Rights, adopted
\nby the WMA in Rancho Mirage during the
\n42nd General Assembly and amended by
\nthe 45th, 46th and 47th GeneralAssemblies,
\nTHEREFORE, BE IT RESOLVED, that
\nthe WMAcondemns the genocide in Darfur
\nand calls upon its member NMAs to urge
\ntheir governments and the international
\ncommunity to take immediate action to
\nstop the mass killings, expulsions, rape and
\ndestruction in Darfur and to protect the he-
\nalth and safety of refugees in the region.
\nWMA Council Resolution on
\nthe healthcare Skills Drain
\nAdopted at the 170th WMA Council Ses-
\nsion, Divonne-les-Bains, France, 15 May
\n2005
\nRecognising that the lack of healthcare
\nworkers in developing countries, particu-
\nlarly those in sub-Saharan Africa, is one of
\nthe most serious global problems of today
\nand that the impact of healthcare worker
\nmigration from developing to developed
\ncountries is a significant component in the
\ncrisis,
\nTherefore, be it resolved:
\n1. That the WMA reaffirms its 2003 State-
\nment on Ethical Guidelines for the Inter-
\nnational Recruitment of Physicians, par-
\nticularly para. 14: \u201cEvery country
\nshould do its utmost to educate an ade-
\nquate number of physicians, taking into
\naccount its needs and resources. A coun-
\ntry should not rely on immigration from
\nother countries to meet its need for phy-
\nsicians\u201d; and para. 15: \u201cEvery country
\nshould do its utmost to retain its physici-
\nans in the profession as well as in the
\ncountry by providing them with the sup-
\nport they need to meet their personal and
\nprofessional goals, taking into account
\nthe country\u2019s needs and resources.\u201d
\n2. That developed countries must assist de-
\nveloping countries to expand their capa-
\ncity to train and retain physicians and
\nnurses, to enable developing countries
\nto become self-sufficient.
\n3. That action to combat the skills drain in
\nthis area must balance the right to health
\nof populations (Universal Declaration of
\nHuman Rights (1948), Article 25.1;
\nInternational Covenant on Economic,
\nSocial, and Cultural Rights (1976), Arti-
\ncle 12.1.) and other individual human
\nrights.
\n4. That the WMA reconvene the expert
\nworking group on physician resources
\nto coordinate development of WMA in-
\nput to WHO preparations for the decade
\non human resources for health.
\n5. That the WMA commend WHO for ta-
\nking a leadership role in the global chal-
\nlenges of human resources for health;
\ncommend to WHO the afore-mentioned
\nprinciples (1, 2 and 3); and call upon
\nWHO to convene a global roundtable to
\ndiscuss HHR issues.
\nWMA Council Resolution on
\nobserver Status for Taiwan to
\nthe World Health Organiza-
\ntion (WHO) and inclusion as
\nparticipating party to the
\nInternational Health Regula-
\ntions (IHR)
\nAdopted at the 170th WMA Council Ses-
\nsion, Divonne-les-Bains, France, 15 May
\n2005
\nPreamble
\n1. The ethical obligation of health profes-
\nsionals is to serve all human beings irre-
\nspective of their political or religious af-
\nfiliation or any other factor. The goal of
\nall nations must be the protection of he-
\nalth of all human beings without any
\ndiscrimination. Protection of human he-
\nalth can only be achieved if all people
\nand health care systems collaborate.
\nWHO must be able to invite all people
\nand health care systems to participate in
\nthe fight against disease and premature
\ndeath. Protection of human health must
\nbe separated from politics.
\nCouncil Resolutions adopted at the 170th WMA Council Session,
\nMay 2005
\nWMA
\n39
\nmended forApproval, and was subsequent-
\nly adopted by Council.
\nDr. Appleyard drew attention to a report on
\nthe Prevention of Chronic Disease in
\nChildren, which would be launched in
\nLondon in October. He urged that NMAs
\npromoted this and stressed the importance of
\nhow best to ensure successful interventions
\nin schools the report should be distributed to
\nall NMAs when it was available.
\nDr. Letlape suggested that the workgroup on
\nHuman Healthcare Resources should be
\nreconstituted. i.e. members from AMA,
\nBMA and CMA, together with representa-
\ntion from the East.
\nFinance and Planning
\nCommittee
\nDr. Nelson was elected to the Chair of the
\nCommittee by acclamation. He thanked the
\ncommittee for its confidence and stated what
\na pleasure it had been to work with the
\nSecretary General and Dr. Vilmar. The work
\nhad been considerable, involved lots of tele-
\nphone consultation and had been done well
\nand accurately.
\nThe minutes of the meeting in Tokyo 2004
\nwere approved
\nDr. Kloiber spoke about the question of Dues
\n(see p. 40) and the problem of the non-
\npayers, some for as long as 2 years. The
\nStatutes required erasure of the member
\nassociation after this period. A solution was
\nneeded for Santiago.
\nAfter a considerable debate the committee
\nrecommended that WMA waive all dues in
\narrears prior to 2005.
\nThe Committee also considered a report on
\nWMA Dues Structure Reform Proposal (see
\np. 40) and recommended that it be sent
\nto NMAs for comment, the Secretary
\nGeneral to report to the next Committee
\nmeeting.
\nAfter presentation and detailed discussion it
\nwas recommended that the Preliminary
\nFinancial Statement for 2004 be approved
\nThe Committee then engaged in a lengthy
\nand detailed debate on the report of the
\n2. A burning example of discrimination in
\nthe recent years has been Taiwan. There
\nare 23 million people living in Taiwan,
\nof which a significant number required
\nmedical assistance or help from interna-
\ntional relief organizations in the after-
\nmath of the 1999 earthquake. In addi-
\ntion, Taiwan was significantly affected
\nand suffered several deaths due to the
\nSARS epidemic during 2002 and 2003
\nand is under threat by the current out-
\nbreak of Avian Flu in South East Asia.
\n3. There are 23 million people who are
\nwilling and take pride in contributing to
\ninternational relief efforts when other
\npeople are in need, as demonstrated
\nagain by generous donations and signi-
\nficant humanitarian aid support in the
\naftermath of the tsunami disaster during
\n2004.
\n4. 23 million people should not be exclu-
\nded from the work of the World Health
\nOrganization, but without taking a stand
\nas to the legal status of Taiwan.
\nResolution
\n5. The World Medical Association
\n(WMA), as a non-governmental organi-
\nzation in official relations with WHO,
\ncalls on WHO to grant Taiwan observer
\nstatus to WHO;
\n6. The WMA calls on WHO and all its
\nMember States to ensure that Taiwan is
\nincluded as a participating party to the
\nWHO International Health Regulations;
\n7. The World Medical Association further
\nurges its members to call on their natio-
\nnal governments to advocate for obser-
\nver status for Taiwan at WHO, as well
\nas inclusion as a participating party to
\nthe WHO International Health Regula-
\ntions.
\nWMA Council Resolution
\non implementation of the
\nWHO Framework
\nConvention on tobacco
\ncontrol
\nAdopted at the 170th WMA Council Ses-
\nsion, Divonne-les-Bains, France, 15 May
\n2005
\nThe World Medical Association
\nWelcomes the recognition of the essential
\nrole of health professionals in tobacco con-
\ntrol as the focus of World No Tobacco Day,
\n31 May 2005;
\nRecognises the importance of the WHO
\nFramework Convention on Tobacco Con-
\ntrol (FCTC) in furthering the campaign to
\nprotect people from exposure and addic-
\ntion to tobacco;
\nEncourages national medical associations
\nto work assiduously and energetically to
\nget their governments to ratify and imple-
\nment the FCTC;
\nUrges governments to introduce regulation
\nand other measures as set out in the FCTC.
\nGovernments should also introduce a ban
\non smoking in enclosed public places and
\nwork places as an urgent public health
\nintervention;
\nRecognises the vital role of health profes-
\nsionals in public health education and in
\nsupport for smoking cessation;
\nCommits, with the other members of the
\nWorld Health Professions Alliance, to mo-
\nbilise health professionals in the fight to
\nimplement the FCTC and to reduce the hu-
\nman cost of tobacco.
\nGovernance Committee. Dr. Coble, in intro-
\nducing the report commented that the work-
\ning group had representation from all regions
\nand there had been very good input into the
\nreport. They had divided the issues into three
\ngroups, namely (a) those for which the was
\ngeneral agreement on, (b) those on which
\nthere appears to be no answer and (c) those
\nwhich were rejected by consensus There was
\nalso the need to look at the Bye- laws and
\nother standing documents which needed to be
\nconsolidated. Finally he referred to Council
\nreports which had not been put into policy.
\nIn the opening discussions the need for the
\ngovernance review was expressed forcibly by
\nseveral members, in particular stressing the
\nneed for a clear structure setting out where
\nauthority lies and likewise where responsibil-
\nity lies. The Secretary General pointed out
\nthat there was a clear understanding that gov-
\nernance was being worked on urgently. Other
\nspeakers urged that the work go forward and
\nthe committee then engaged in a detailed
\ndebate on the report before them, as a result
\nof which the following Recommendations
\nwere made and later adopted by Council:
\nThat an Executive Committee with an adviso-
\nry role, be established, comprising the Chair
\nand Vice-Chair of Council and the Chairs of
\nthe three Standing committees, the Secretary
\nGeneral being a non- voting member. This
\ncommittee would also undertake the Chief
\nExecutive Officer review process.
\nThe Chair of Council to establish an \u201cad
\nhoc\u201d committee to review, consolidate and
\nupdate WMA bye-laws, rules of procedures
\nand operating policies.
\nOne committee should make a trial of the use
\nof a \u201cconsent calendar\u201d.
\nA proposal for the possible consolidation of
\nthe positions of Treasurer and Chair of
\nFinance and Planning Committee be circu-
\nlated to NMAs for comment.
\nA proposal for the timing of leadership tran-
\nsition be circulated to NMAs
\nThat approval be given for a proposal to
\nrestrict the term of office of all Chairs of
\nCouncil and Standing Committees and
\nTreasurer to three two year terms (6 years
\n\u201cin toto\u201d) for each position.
\nCouncil later endorsed all the recommenda-
\ntions of the Finance and Planning
\nCommittee.
\nCouncil, in addition to endorsing the reports
\nlisted above from the committee agreed that
\na proposed statement on reducing the Global
\nimpact of Alcohol on Health and Society be
\nreferred to NMAs for comment. Council,
\nalso discussed possible dates and venues for
\nfuture meetings of the General Assembly and
\nCouncil, and other many other internal
\nissues. It received reports on the forthcoming
\nGeneral Assembly in Santiago and a presen-
\ntation on the 2006 Assembly in South Africa
\nat Sun City.
\nAt the end of the Council meeting tributes
\nwere paid to Drs Aarima and Palmisano who
\nwere attending their last Council meeting and
\nto Dr. Moon and Dr. Vilmar for their contri-
\nbutions during their many years as Officers
\nof the WMA.
\nWMA
\n40
\nIntroduction
\nThe current dues structure is based on a
\nmembership fee per physician represented
\nby the member organisation. Thus, organi-
\nsations representing more physicians pay
\nhigher dues than those representing lower
\nnumbers of physicians. In turn, voting
\nrights are coupled to the number of physi-
\ncians represented. Currently, 10,000 physi-
\ncians equal one vote in the General
\nAssembly, while 50,000 give entitlement to
\none seat in the Council for a term of two
\nyears. Smaller countries can also have a
\nseat on council if their votes from other
\ncountries support them on the occasion of
\nthe Regional Elections of the WMA
\nCouncil. This mechanism in principle pro-
\nvides proportional representation of the
\nphysicians of the world in the WMA
\nthrough their national medical associations.
\nAccording to the statutes, the most repre-
\nsentative physicians’ association of a coun-
\ntry is eligible for membership in the WMA.
\nDepending on the national situation, the
\ndegree of representation of the different
\nnational medical associations varies consid-
\nerably: while membership of the national
\nmedical association is obligatory in some
\ncountries (100% membership), private as-
\nsociations with voluntary membership can
\nrepresent only a share of the physicians in
\ntheir countries
\nMoreover, membership status in the con-
\nstituent organisations varies as well, with
\nsome associations having only one mem-
\nbership level, while others have several
\nmembership levels, with different contribu-
\ntions. Overall, physicians’ contributions to
\ntheir national associations vary even more:
\nnot only is there a vast difference in the
\ncontributions between poorer and richer
\ncountries, but the service package con-
\nstituent organisations deliver to their mem-
\nbers is also not comparable. Some are not
\nonly associations, but also unions, some
\nprovide retirement funds, some have
\nextended membership perks that others do
\nnot provide. For these reasons, strict cou-
\npling of the WMA dues to the number of
\nenlisted members of constituent organisa-
\ntions would not only be unfair, it would also
\nmake it impossible for poorer medical asso-
\nciations to participate in the WMA. The
\nnational membership organisations are
\ntherefore free to determine the number of
\nphysicians they wish to notify to the WMA
\nas their represented membership.
\nWMA Dues Reform Proposal
\nThis paper sets out a proposal for reforms of the WMA Dues and has been circulated
\nto all NMAs. It was prepared by the Treasurer Emeritus, Dr. K. Vilmar and endorsed by
\nDr. J.-D. Hoppe, the Treasurer.
\nCriticism of the current
\nsituation
\nDue to the fixed contribution rate per noti-
\nfied member physician of the constituent
\norganisation, smaller and poorer nations
\nhave less voting power in the General
\nAssembly and fewer seats to occupy in the
\nCouncil. While the first reflects the general
\nidea of a representational democracy, the
\nlatter is indeed challenging the democratic
\nunderstanding of the institution.
\nA more transparent system with a higher
\ndegree of fairness should allow the finan-
\ncially less potent medical associations the
\nsame chance of representing their physi-
\ncians as the richer ones.
\nFurthermore, the potential unfairness of the
\ndues structure in relation to poorer associa-
\ntions and the fact that Council membership
\nis determined only every two years, has led
\nto disappointments and concern, as some
\nconstituent organisations pay a higher share
\nin the year the Council seats are deter-
\nmined, reducing it significantly in the fol-
\nlowing year, thereby remaining in the
\nCouncil without contributing the proper
\ndues.
\nPrevious attempts at change
\nDuring the last fifteen years, major changes
\nin the dues structure were attempted twice.
\nThey aimed both to increase the dues
\nincome and to improve the fairness of the
\ndues structure and representation. (The
\nfree-rider effect mentioned above was not
\naddressed.) A first task force in the late 80s
\ndelivered a moderate change, when the
\nnumber of votes in the General Assembly
\nwas changed from one vote per 5,000 noti-
\nfied members to one vote per 10,000 noti-
\nfied members. Although especially the
\nquestion of unfairness was addressed at that
\ntime, it was neither changed then nor by a
\nlater working group in the late 90s.
\nSeveral models for a new dues structure
\nwere analysed in these attempts:
\n\u2022 A one-country-one-vote principle would
\nfail, as stronger medical associations
\nwere not prepared to pay a higher share
\nthan others with the same voting rights.
\nOn the other hand, an equal (flat-rate)
\ncontribution of all constituent organisa-
\ntions would have clearly overcharged
\nthe smaller organisations. Therefore, and
\nfor lack of proportional and adequate
\nrepresentation, the one-country-one-vote
\nprinciple was not followed up. (It exist-
\ned before in the 70s and was abandoned,
\nbecause large associations decided to
\nmove out or reduce their commitment.)
\n\u2022 A contribution based on the membership
\nand economic strength of the country
\nappeared neither possible nor truly fair
\nfor several reasons: the economic data
\nare not reliable. During the last decade,
\nsome countries changed their reported
\ngross domestic product (GDP) following
\npolitical changes or new calculations.
\nMoreover, poorer countries in particular
\nhave huge differences in individual
\nincome. While people in general may
\nhave a very low income, thus yielding a
\nsmall GDP, physicians may live as rela-
\ntively wealthy people, meaning that
\nassessment of the WMA dues solely in
\nrelation to the GDP would be unfair
\ncompared to other nations with more
\nbalanced national wealth.
\n\u2022 A stratified model of flat-rate dues based
\non a rough economic stratification
\nmodel was not followed, because it
\nwould not have allowed proportional
\nrepresentation and would have over-
\ncharged smaller associations.
\nConditions for change
\nAlthough increasing the dues income of the
\nWMA will be important in the future to
\nmaintain the independence and functional
\ncapacity of the WMA, a first step must be
\ntaken to make the dues structure fairer and
\nstable. Many national member associations
\nmay find that a dues structure of the WMA
\nthat fails to give adequate consideration to
\ntheir financial situation or capabilities
\ndeters them from applying for membership
\nor paying a higher contribution. Therefore,
\na solution to this problem may be a door-
\nopener for new constituent organisations
\nand for fairer representation of financially
\nless powerful organisations.
\nOn the other hand, a change in the dues
\nstructure must not lead to a drop in overall
\ndues. What is more, it should not reduce the
\nwillingness of each single constituent
\norganisation of the WMA to contribute its
\nown dues.
\nFurthermore, a new dues structure or the
\ndistribution of voting rights should not
\nencourage the free rider phenomenon in the
\nCouncil mentioned above.
\nSolution
\nA. Access and fairness
\nIn order to maintain the dues income of the
\nWMA and the principle of democratic repre-
\nsentation, and in order to acknowledge the
\ndifferent levels of ability to contribute to the
\nWMA, both the coupling of dues to the
\nnumber of notified physicians and the free-
\ndom of the associations to determine the
\nnumber of physicians being notified may
\nhave to remain. However, they should be
\nsupplemented by recognition of the financial
\npower of the respective country, making
\naccess to the WMA and representation in the
\nWMA fairer for associations with less
\nmoney.
\nHowever, as explained earlier, data on the
\neconomic strength of the nations is of only
\nrelative value due to comparability prob-
\nlems and relevance for the profession in the
\nrespective country. Individual calculation
\nof the economic power of each country
\nwould be possible, but impractical in the
\nframework of an organisation with more
\nthan 80 members.
\nTherefore, and in order to enable associa-
\ntions from countries with less financial
\npower to obtain a higher share of represen-
\ntation, the contribution rate per member
\nshould be stratified from \u20ac 2.00 (current
\namount) in four levels (Category A, \u20ac 0.40;
\nCategory B, \u20ac 0.90; Category C, \u20ac 1.50; and
\nCategory D, \u20ac 2.00), depending on the
\ngross national income of the respective
\ncountry. Thus, the four Categories (A to D)
\nwould reflect the wealth or economic power
\nof a country, assuming that the financial sit-
\nuation of the physicians is roughly propor-
\ntional to that.
\n41
\nWMA
\n42
\nThe pictures are dreadful \u2013 pictures of
\npatients who have died because of medical
\nerrors! Sir Liam Donaldson, chief Medical
\nOfficer of England and Chairman of the
\nWHO World Patient SafetyAlliance starts his
\nstandard presentation with such images and
\nalso allegorical images of several crashed
\nJumbo Jets as equivalents for the calculated
\nnumber of people who reportedly die every
\nday because of medical errors.
\nI have doubts as to whether or not these
\nimages are helpful, as they divide the World
\ninto the \u201cGood-ones\u201d showing or painting the
\nimages, and the \u201cBad-ones\u201d making the mis-
\ntakes. Secondly, the images suggest that those
\ntalking about the mistakes know how to avoid
\nthem. But do they?
\n\u201cIf aviation produced as many dead as health
\ncare does \u2013 nobody would fly anymore, the
\noperations would be shut down immediate-
\nly!\u201d So, why don\u2019t we shut down health care
\ninstitutions and resume business only when
\nwe are sure that no more mistakes happen?
\nIndeed, who would travel with a plane when
\nthe pilot doesn\u2019t know how much fuel he has
\non board, fly a passenger plane without
\nknowing where the journey is heading for, or
\ntake a plane whose engines are badly main-
\ntained or even burning?
\nWho entrusts himself or herself to pilot a long
\ndistance flight without maps, without naviga-
\ntion system, or would fly with a pilot who had
\nbeen on duty for more than 24 hrs? Which
\nairline would take on board a significant
\nnumber of passengers who cannot pay?
\nWhich pilot would start knowing that he
\nnever can make it, or take a woman in labour
\non board? And who would join a travelling
\nparty, where politicians and leaders sing the
\nsong: \u201cPut the passenger in the driver\u2019s seat\u201d?
\nBut this is exactly the situation which physi-
\ncians encounter every day in the real world:
\nStarting to work without having appropriate
\nresources \u2013 saving peoples\u2019 lives and health
\nand being blamed and often even charged for
\nspending \u201ctoo much\u201d. -caring for severely
\nsuffering patients and having not having a
\nconfirmed diagnosis available. Caring for
\npatients with chronic diseases where physi-
\ncians are far away from understanding the
\ndisease \u2013 not to mention healing it! Taking
\ncare of and comforting those with terminal
\nillness. Treating high risk patients and taking
\ninsurmountable responsibility on their own
\nshoulders. Doctors do this even after having
\nworked 36 hours already, because of the
\nneed, for example, to deal with the patient
\nwith a ruptured aneurysm which can\u2019t wait
\nuntil tomorrow. All this, taking also into
\naccount individual differences, wishes, pref-
\nerences, emotions and personalities. Ever
\ntried this with a fully loaded Jumbo Jet?
\nMost of the main contributors to the WMA
\n(in financial terms) would be classed in
\nCategory D and therefore would not see
\nany change in their contributions and vot-
\ning rights. The constituent organisations
\nfrom economically less powerful countries
\nwould not receive a reduction in their dues
\namount, but they would get more voting
\nrights.
\nOnly if a country that has already notified
\nthe real number of physicians were to be
\nclassified in Categories A to C, would the
\nincome of the WMA possibly be reduced in
\nthe future. This is currently not the case.
\nB. Fairness and sustainability
\nAs the financial situation of each medical
\nassociation may vary over time, the princi-
\npal option of determining the number of
\nphysicians notified to the WMA should not
\nbe given up. However, those associations
\nseeking representation in the Council
\nshould commit themselves for the full peri-
\nod of Council activities (2 years). Thus, an
\nartificial increase in the number of mem-
\nbers notified in the year of Council consti-
\ntution, and a reduction in the following
\nyear, should be avoided, as this procedure is
\nunfair to the other payers and puts the
\nfinances of the WMA in jeopardy. There are
\nseveral options for change:
\n1. Maintenance rule
\nIn addition to constitution\/election every
\ntwo years, there should be an eligibility
\nrule saying that the representation
\ndemonstrated at the time of election – a
\nminimum of 50,000 reported members –
\nmust be maintained during the period of
\noffice. Otherwise, the office will be ter-
\nminated or, alternatively, voting rights
\nwill be suspended. This would apply
\nequally to Council members from con-
\nstituent organisations notifying more
\nthan 50,000 members, and to those
\nelected with the votes from several con-
\nstituent organisations.
\nThe maintenance rule would also apply
\nto Council seats awarded for a fraction
\nof 50,000 notified physicians.
\n2. Look-back option
\nCouncil seats would be awarded for
\nnotified or cumulative representations of
\n50,000 physicians during the last two
\nyears before the election. (Alternatively:
\nin the year of election and the year
\nbefore the election.) This model would
\ngive stability. However, it may discour-
\nage members notifying 50,000 members
\nor more for the first time, as they would
\nhave to wait for one or two years.
\nThe look-back option would also apply
\nto Council seats awarded for a fraction
\nof 50,000 notified physicians. Thus, the
\naverage number of notified physicians
\nfor the last two years (alternatively: the
\nyear of election and the year before the
\nelection) would be counted for the elec-
\ntion process.
\n* Details concerning country classification
\nare available from the WMA Secretariat.
\n(wma@wma.net)
\nWMA Secretary General
\nWMA Secretary General
\nFrom the desk of the Secretary General
\n\u201cDanger on the safe side!\u201d
\n43
\nBut this comparison can even be topped by
\nthose who have the answer as to why aviation
\nis so much safer \u2013 those who really know
\nabout medicine and aviation: \u201cDoctors don\u2019t
\nget hurt when they make mistakes \u2013 pilots
\ndo.\u201c
\nIsn\u2019t that simple?
\nBut what about those who acquired infections
\nwhile treating patients ever though they were
\nbeing careful; or those ending up in the ditch
\nwhen returning to the hospital in a cold win-
\nter night on icy streets, or when seeing their
\npatients when called for an emergency? What
\nabout those who are killed in combat zones of
\nconflicts they had nothing to do with. What
\nabout those who are burnt out and depressive
\nafter virtually working to death? What about
\nthose suffering from the emotional stress they
\nencounter every day? There are far more doc-
\ntors getting hurt from their work than pilots.
\nBut these are statistics nobody is interested in.
\nPerhaps flying a plane and
\ntreating a patient isn\u2019t all that
\nsimilar
\nFirst, of all we usually fly for fun or business.
\nIn times of trouble both of these can wait.
\nHowever no-one sees a doctor for fun. And
\nlet\u2019s not forget: The (health) problem exists in
\nthe first place. Health Care systems are crisis
\nmanagement systems.
\nSecondly, when flying a plane there is for
\neach (critical) situation one (!) ideal way to
\nhandle it. As a pilot you should know it by
\nheart and everybody can look it up in the
\nflight manual. Unfortunately, patients don\u2019t
\nbring their manuals with them and \u201cstandard
\npatients\u201d only exist in theoretical examina-
\ntions. In the end flying an aeroplane is oper-
\nating a machine. Treating a patient is caring
\nfor a human being!
\nThirdly, a flight is a planned procedure. Each
\nflight can and should be planned for its nor-
\nmal performance from the beginning to the
\nend. Deviation from that rule is the exception.
\nIn health care this only sometimes happens.
\nWhile it would be wrong to disregard statis-
\ntics, but physicians\u2019 first care is for the
\npatient. Those who work a lot, make mis-
\ntakes. We would be negligent if we ignored
\nthis.
\nWhat can we do apart from
\nregreting the situation?
\nFlying is not the same as treating patients. But
\naviation has inherent dangers as has medicine
\nand aviation has dealt with many of these
\ndangers very efficiently. Most of these solu-
\ntions cannot be applied to medicine but some
\nkey elements can. These include reporting
\nmistakes, accidents and near misses and
\nanalysing them, making materials and struc-
\ntures safer, and processes clearer and simpler.
\nAlso setting or changing rules in order to
\navoid mistakes and making systems more
\nerror-tolerant.
\nWe are far away from this in medicine. In a
\n\u201eblame and shame\u201c culture nobody wants to
\nadmit his or her mistakes. Instead of learning
\nfrom mistakes we punish for mistakes.
\nInstead of making procedures clearer and
\nsimpler, we are confusing many processes
\nmore and more. When we set rules, they still
\nare of a disciplinary nature and not made for
\nsafety from the beginning. Instead of making
\nlife saving systems more error-tolerant, we
\nmake them more economic, which in most
\ncases doesn\u2019t serve the purpose of safety.
\nA non-punitive system for reporting is need-
\ned. The process of reporting must be protect-
\ned by law so that attorneys don\u2019t see it as a
\nfishing ground. What has been reported must
\nbe analysed. While this is expensive, it is cer-
\ntainly also a good investment in health.
\nA reporting system ensuring a certain degree
\nof protection for the reporting person will
\nhave to provide some kind of amnesty. The
\nreporting system in aviation depends on this.
\nIf someone fears being punished for reporting
\na mistake, nobody will report mistakes.
\nHowever a non-punitive system can be no
\nwaiver of responsibility. Negligence and
\nunresponsiveness must be subject to sanction;
\nthere can be no \u201ccarte blanche\u201d for reckless-
\nness and stupidity. This approach can be
\nachieved and examples are already working.
\nAnother problem may be more difficult:
\nPatients claim the right to be informed about
\nsafety. They want not only to know about the
\nsafety of the procedure they may undergo, but
\nthey also want to know about the quality and
\nsafety standards and results of an individual
\ninstitution. They want to know whom to trust.
\nIf reporting is to become a shame and blame-
\nfree process, this may be difficult to reconcile
\nwith the patients\u2019 request for information.
\nMaybe the current misconception is a misun-
\nderstanding of \u201ctransparency\u201d. Nora O\u2019Neil
\nin her 2002 Reith Lecture \u201cA Question of
\nTrust\u201d gave some clues to this. \u201cIn fact, our
\nclearest images of trust do not link it with
\nopenness or transparency at all. Family life is
\noften based on high and reciprocal trust, but
\nclose relatives do not always burden one
\nanother with full disclosure of their financial
\nor professional dealings, let alone with com-
\nprehensive information about their love lives
\nor health problems; and they certainly do not
\ndisclose family information promiscuously to
\nall the world. Similarly, in trusting doctor-
\npatient relationships (that\u2019s the sort we sup-
\nposedly no longer enjoy), medically relevant
\ninformation was disclosed under conditions
\nof confidence. Mutual respect precludes
\nrather than requires across-the-board open-
\nness between doctor and patient, and disclo-
\nsure of confidential information beyond the
\nrelationship is wholly unacceptable. Perhaps
\nit is not then surprising that public distrust has
\ngrown in the very years in which openness
\nand transparency have been so avidly pur-
\nsued. Transparency certainly destroys secre-
\ncy: but it may not limit the deception and
\ndeliberate misinformation that undermine
\nrelations of trust. If we want to restore trust
\nwe need to reduce deception and lies rather
\nthan secrecy. Some sorts of secrecy indeed
\nsupport deception, others do not.
\nTransparency and openness may not be the
\nunconditional goods that they are fashionably
\nsupposed to be. By the same token, secrecy
\nand lack of transparency may not be the ene-
\nmies of trust.
\nWMA Secretary General
\n44
\nDr. Bernhard Grewin (Past President) and
\nMr Gunnar Lonnquist (International
\nSecretary), Swedish Medical Association.
\nContinuing our series on medical liability,
\nthis paper, presented at the Oslo EFMA\/
\nWHO meeting in March 2005, describes the
\nsystem which has been in existence in Sweden
\nsince 1975, and is now obligatory for all
\nhealth care providers
\nVoluntary Insurance
\nA patient insurance – no-fault compensation
\nscheme – has been in existence in Sweden
\nsince 1975. It was developed jointly by some
\nof the large insurance companies and the pub-
\nlic health care providers. The insurance was
\nbased on a voluntary commitment on the part
\nof the health care providers to financially
\ncompensate patients for injuries caused to
\nthem in connection with diagnostic and ther-
\napeutic interventions. The majority of private
\nhealth care providers also joined the insur-
\nance scheme.
\nInsurance Regulated by Law
\nFrom 1 January 1997 the patient insurance
\nscheme has been regulated by law. According
\nto the law all health care providers in Sweden
\nare obliged to have a patient insurance. The
\nCounty Councils (regional political bodies
\nentrusted with the responsibility for planning,
\nfinancing and delivering health care services
\nto their populations) are by far the biggest
\nhealthcare providers in Sweden. They pay 45
\nSwedish kronor (SEK) or approximately 4.90
\n\u20ac per county inhabitant per year to the insur-
\nance scheme. No other factors, such as spe-
\nciality and kind of treatment have an impact
\non this fixed amount.
\nThe administration of the insurance and the
\npayment of compensation is handled by a
\ncompany jointly owned by the Swedish pub-
\nlic health care providers i.e. the County
\nCouncils.
\nFor private medical care, which is rendered
\nwithout any formal cooperation agreements
\nbetween the private provider and the
\nCounties, the private provider has to take a
\npatient insurance of his own. This is usually
\ndone as part of a group insurance.
\nPayment of compensation due to injuries
\nwithin this genuinely private health care field
\nis administered by the respective insurance
\ncompanies from whom the doctor or the
\nmedical unit has purchased the insurance pol-
\nicy.
\nThe right to financial compensation (dam-
\nages) for injuries incurred is independent of
\nthe regulations laid down by tort law. This
\nmeans e.g. that the patient, in order to get
\ncompensation, need not prove that the injury
\nhas been caused by fault or negligence on the
\npart of any health care personnel.
\nFor injuries caused by pharmaceutical prod-
\nucts (side-effects) a voluntary scheme is still
\noperating, regulating the financial compensa-
\ntion.
\nRequirements for
\nCompensation
\n1. Patient-injury compensation can be grant-
\ned for injuries \u2013 both physical and men-
\ntal \u2013 that have occurred in connection
\nwith providing health care services in
\nSweden \u2013 including injuries occurring
\nduring transport e.g. ambulance trans-
\nport.
\n2. Personal injuries: physical as well as
\nmental injuries can be compensated.
\n3. Causal connection: The injury must
\nhave arisen as a result of the health care
\nprocedure performed.
\n4. Types of injuries compensated:
\na) Treatment injuries; provided that the
\ninjury could have been avoided either
\nby using another medical method or
\nby using the method applied in anoth-
\ner manner.
\nb) Material-related injuries: this refers to
\nsituations where the medical devices,
\nMedical Science, Professional Practice and Education
\nThe Swedish Patient Insurance System \u2013
\nA No-Fault System
\n\u201dThe World Health ProfessionsAlliance host-
\ned a reception in Geneva for Ministers attend-
\ning the 58th
\nWorld Health Assembly on 16th
\nMay 2005. The three presidents of the profes-
\nsions (Nurses, Pharmacists, Physicians) in
\nwelcoming the guests spoke briefly about
\ntheir concerns and activities.
\nThe guests were addressed by the keynote
\nspeaker, Sir Liam Donaldson, who spoke
\nabout the important subject of Patient Safety.
\nHe referred to the research by Professor Pittet
\nanalysing and reporting on Risk Prevention.
\nAs Chairman of the World Alliance for
\nPatient Safety, Sir Liam stressed the impor-
\ntance of the five essential challenges which
\nneed to be met. The first of these to be tack-
\nled in the first two year programme was
\nInfection. Under the network title \u201eCLEAN
\nCARE IS SAFE CARE\u201c, the initiative would
\nbe launched this year. He emphasised that
\nbasic actions such as adequate hand washing,
\ncleanliness in hospitals, buildings and homes,
\nclean instruments were all essential, and that
\nboth health professionals and individual citi-
\nzens need to take this seriously.
\nThis message about cleanliness was endorsed
\nby Professor Didier Pittet, Director of
\nInfection Control, University of Geneva
\nHospitals, who gave more details of the prob-
\nlems, Among the most telling facts presented
\nwas that one in ten patients entering hospital
\ndeveloped an infection! What was essential
\nwas safe sterilisation, education and training,
\nsafe blood, safe injections and safe surgery,
\ntogether with improved resources to achieve
\nthese. WHO would be producing guidelines
\nfor better provision of this aspect of Patient
\nSafety.
\nMedical Science, Professional Practice and Education
\nPatient Safety highlighted at World Health
\nProfessions\u2019 Reception
\napparatus etc. have been defective in
\nsome way or that they have been
\nused\/handled in the wrong manner.
\nc) Diagnostic injuries; if a wrong diagno-
\nsis has resulted in injuries to the
\npatient.
\nd) Infection injuries: a clear condition is
\nthat the infection must have been
\nacquired as a result of the medical care
\nsituation. If the patient already had this
\ninfection it cannot be compensated. Of
\nimportance is also whether the risk of
\nan infection could be foreseeable or
\nnot. The patient\u2019s basic illness and
\ngeneral medical condition are taken
\ninto account here.
\ne) Accident injuries: due to accidents in
\nconnection with diagnostics, care,
\ntreatment, transport or other accident
\nspecifically related to the medical care
\nprovided.
\nf) Medication injuries: these refer to
\ninjuries resulting from wrongful han-
\ndling of the medications \u2013 wrong
\ndosage or other mistakes. As men-
\ntioned above side-effects of drugs are
\nnot part of this insurance. They are
\ncompensated by means of a specific
\ndrug insurance.
\ng) Compensation is not possible for
\ninjuries resulting from medical proce-
\ndures which had to be taken in emer-
\ngency situations without the possibili-
\nty of adhering to normal routines.
\n5. Principles for Compensation Amounts
\nThe compensation follows the principles
\nlaid down in tort law pertaining to person-
\nal injuries.
\nEconomic loss (e.g. loss of income) as
\nwell as non-economic loss (pain and suf-
\nfering) can be compensated.
\nA limited self-risk payment is involved in
\nall cases compensated.
\n6. Patient Claims Panel
\nThis body can give its opinion on various
\ninsurance cases. Patients, insurers, health
\ncare providers or courts of law can ask for
\nits opinion.
\nThe Panel consists of seven members.
\nThe Chairperson should be or at least
\nhave been a judge. The other six persons
\nshould represent the patients (3), be med-
\nically qualified (1), be specifically knowl-
\nedgeable on health care issues (1) and
\nhave good experience of settlement of
\nclaims concerning personal injuries with-
\nin the insurance field.
\n7. Limitation Period for Claims
\nClaims for compensation must have been
\nfiled at the latest 3 years after the patient
\nwas informed of the possibility of claim-
\ning compensation, and definitely within
\n10 years after the injury occurred. Claims
\nfor compensation are most often made by
\nthe injured patient him\/herself, but can
\nalso be made by a relative, should the
\ninjury render the patient incapable of fil-
\ning the claim.
\n8. Number of Cases
\nThe number of claims have during the last
\nyears been around 9,000\/year. Ten years
\nago the corresponding figure was around
\n5,000.
\nApproximately 45% of the claims will
\nresult in compensation.
\n9. Compensation Levels
\nThe amount of the compensation is based
\non the rules laid down in the Swedish tort
\nlaw.
\nThe most common compensation will be
\nup to 20,000 SEK (2,162 \u20ac) per injury.
\nThe average figure though is around
\n110,000 SEK (11,892 \u20ac). This is due to
\nthe fact that there are also cases which
\nwill result in much higher compensation.
\nThere is an absolute ceiling on how high
\nthe compensation might be in any indi-
\nvidual [one singular] case. That limit is at
\npresent 7,500,000 SEK (810,811 \u20ac). Such
\nan amount might be considered e.g. if a
\nbrain damage occurs in connection during
\na child\u2019s birth resulting in life-long inva-
\nlidity and life-long loss of income.
\n10. Total Cost
\nThe total cost for the insurance compen-
\nsation might be expressed in two ways:
\nIn 2003 the total sum of compensation
\nwas 290,000,000 SEK (31,351,350 \u20ac)
\nand for 2004 this figure is estimated
\nto be around 310,000,000 SEK (33,
\n513,515 \u20ac).
\nThe compensations paid out in a certain
\nyear do not usually (not) pertain to the
\ninjuries incurred that year, since it takes
\ntime to process the claim.
\nIn conclusion one might state that the
\nexistence of a no-fault patient insurance
\nhas considerably enhanced the possibili-
\nties for patients who have been injured in
\nconnection with health care treatment to
\nget a reasonable financial compensation,
\nand to get this compensation without hav-
\ning to resort to court of law procedures
\nwith the difficulty of proving that some-
\none has been at fault and also risking los-
\ning such a tort law case resulting in some-
\ntimes heavy fees for legal counselling.
\nLiability Insurances for
\nDoctors
\nDoctors also have individual Liability
\nInsurances. These insurances cover e.g. possi-
\nble costs for a tort law process but a small part
\nof the premium is also a premium to the
\nPatient Insurance Scheme. A tort law process
\nagainst an individual doctor would be very
\nrare in Sweden. The general Patient Insurance
\nis one reason for that. Another reason is that
\nclaims in a tort law process would be primar-
\nily directed against the doctor\u2019s employer \u2013 if
\nemployed \u2013 according to the principle of vic-
\narious liability \u2013 or against his company if
\nhe\/she performs his work in that organisation-
\nal form.
\nTherefore the premiums for doctors\u2019 liability
\ninsurances are very limited in an internation-
\nal comparison. Today (April 2004) the annu-
\nal premiums charged by the most used insur-
\nance company for these matters are as fol-
\nlows:
\nNot yet licensed doctors 500 SEK (54 \u20ac)
\nEmployed licensed doctors 550 SEK (59 \u20ac)
\nLicensed doctors employed and with
\nother practice part-time 2392 SEK (259 \u20ac)
\nLicensed doctors full time private
\nPractice 3572 SEK (386 \u20ac)
\nNote: 1 \u20ac = 9.25 SEK
\n45
\nMedical Science, Professional Practice and Education
\nGTZ, WHO and sex workers networks
\nshare information and lessons learned.
\nBerlin\/Geneva \u2013 The German technical
\ncooperation (GTZ) and the World Health
\nOrganization, in collaboration with sex
\nwork networks around the world, are
\nlaunching the first ever online tool kit
\naimed at helping sex workers to protect
\nthemselves and their clients from infection
\nwith HIV and other sexually transmitted
\ninfections. The tool kit is intended for use
\nby people working with female, male and
\ntransgender sex workers including pro-
\ngramme managers, field workers and peer
\neducators. This is the first time this exper-
\ntise has been formally documented and
\nmade widely accessible.
\n\u201cThanks to this innovative project, people
\nworking on HIV\/AIDS prevention for sex
\nworkers can now learn what does and does
\nnot work from Poland to Papua New
\nGuinea. Targeted HIV\/AIDS prevention
\nand care programmes are urgently needed
\nfor sex workers, injecting drug users and
\nother vulnerable groups and we welcome
\nGTZ\u2019s leadership and support in this often
\nunder funded area,\u201d said Dr Jim Yong Kim,
\nWHO\u2019s Director of HIV\/AIDS.
\nIncluded in the online sex work tool kit are
\npractical \u201chow to do it\u201d documents like
\n\u201cHustling for Health\u201d and \u201cMaking Sex
\nWork Safe\u201d, written by experienced sex
\nworker groups to support programme man-
\nagers in setting up and maintaining pro-
\njects. \u201cOf Veshyas, vamps, whores and
\nwomen\u201d for example, is based on experi-
\nences from an Indian NGO and gives prac-
\ntical advice on how to build up a network of
\npeer educators in brothels and deal with the
\nbrothel owners, how to set up condom dis-
\ntribution networks and how to structure
\npayment incentives for peer educators.
\nDespite proof that prevention programmes
\nare useful in sex work settings, currently
\nonly 16% of sex workers have access to
\nthese services. Around the world, poor ser-
\nvices generally mean higher HIV preva-
\nlence.
\n\u201cSex workers know better than anyone
\nabout the problems they face, the kind of
\nlanguage and programs that are effective.
\nOnly by involving them can both male and
\nfemale sex workers and clients be motivat-
\ned to make use of condoms and health clin-
\nics,\u201d said Friederike Strack from Hydra \u2014
\none of the sex worker organizations collab-
\norating on the tool kit.
\nThe tool kit also includes valuable data and
\nanalysis which can be shared across regions
\nand used to design better HIV\/AIDS pre-
\nvention programmes for sex workers, for
\nexample \u201cPolice and Sex Workers in Papua
\nNew Guinea\u201d. A report on \u201cMeeting the
\nsexual health needs of men who have sex
\nwith men in Senegal\u201d gives valuable insight
\ninto dealing with the cultural sensitivity
\nsurrounding male homosexuals in West
\nAfrica, how their lives are characterized by
\nviolence and rejection and that many find it
\neasier to get help and treatment from clinics
\nthan traditional healers.
\nWHO and GTZ worked closely with sex
\nwork networks and organizations to pro-
\nduce an online collection of more than 130
\neasily-accessible documents, manuals,
\nreports, and research studies. The aim of the
\ntool kit is to make vital information about
\nsex work interventions more accessible to a
\nwider audience and to share lessons learnt
\nto contribute to global efforts which will
\ndevelop and increase effective HIV preven-
\ntion and care interventions among sex
\nworkers.
\n\u201cTargeted programmes make a difference
\n\u2014 in Germany we have shown over the last
\n15 years that these kinds of interventions
\ncan really work. It\u2019s important to share
\nknowledge across borders and within com-
\nmunities to help save lives within one of the
\noldest professions in the world. We are
\npleased to support this initiative,\u201d said
\nThomas Kirsch-Woik, Senior Consultant
\nHIV\/AIDS, GTZ.
\nIn many countries, sex workers are fre-
\nquently exposed to HIV and other sexually
\ntransmitted infections (STIs). Where sex
\nworkers have poor access to HIV preven-
\ntion, HIV prevalence can be as high as 60-
\n90%. Evidence shows that targeted preven-
\ntion interventions in sex work settings can
\nturn the epidemic around.
\nIn Thailand and Cambodia for example,
\ncondom use rose to over 80% and HIV and
\nSTIs declined dramatically thanks to large
\nscale programmes targeting sex workers and
\nclients. In Nairobi, Kenya, strengthened
\ninterventions with sex workers \u2013 including
\npeer support, condom promotion and STI
\nservices \u2013 led to falls in HIV incidence,
\nfrom 25-50 % to 4 % in Nairobi sex work-
\ners.
\n\u201cTo really have an impact on the epidemic,
\nit is important for services and policies to
\nbe made more user-friendly and to be
\nadapted to the reality of the sex work as
\nwell as to regional differences. Injecting
\ndrug use and sex work are closely linked in
\nEastern Europe and it is essential to inte-
\ngrate the services\u201d, said Monica Ciupagea
\nfrom the Open Society Institute Hungary
\nwhich also collaborated on the tool kit
\ndevelopment.
\nThe HIV\/AIDS Sex work tool kit brings
\ntogether over a decade\u2019s worth of research
\nand practical experience on what does and
\nnot work to change behaviour and protect
\nsex work and clients from HIV\/AIDS. Now
\nonline, it will also be available as CD-ROM
\nand hard copy in early 2005.The kit is a liv-
\ning document and will continue to be updat-
\ned as new resources are released.
\nThe Sex Work tool kit is one of a series of
\nonline tool kits produced by WHO and
\nGTZ and can be found at
\nwww.who.int\/hiv\/toolkit\/sw. The
\nAntiretrovrial (ARV) Tool kit: A public
\nhealth approach for scaling up ARV treat-
\nment (www.who.int\/hiv\/toolkit\/arv) and the
\nTool kit for scaling up HIV Testing
\nand Counselling services
\n(www.who.int\/hiv\/ toolkit\/ tc) are also
\navailable online.
\n46
\nMedical Science, Professional Practice and Education
\nAIDS
\nNew Online Tool Kit On HIV\/AIDS Prevention
\nFor Sex Workers
\n47
\nA confidential survey of more than 1,600
\npairs of female twins has revealed that
\ngenetic factors have a substantial impact on
\nhow likely women are to cheat on their
\npartner and how many sexual partners they
\nwill have.
\nThis is the first ever study to look at the
\ngenes underlying these influences in
\nhumans.
\nThe results of the new research \u2013 led by
\nProfessor Tim Spector, Director of the Twin
\nResearch Unit at St Thomas\u2019 Hospital,
\nLondon \u2013 were revealed by Professor
\nSpector during a press briefing at the
\nScience Media Centre.
\nFemale twins from the Twin Research Unit
\ndatabase answered a range of questions in a
\nconfidential questionnaire relating to their
\nsexual attitudes and behaviour. They report-
\ned previous episodes of infidelity, total life-
\ntime number of sexual partners and also
\ntheir attitudes towards infidelity.
\nThe average age of respondents was 50,
\ntheir average number of sexual partners was
\nbetween four and five, just over 20% admit-
\nted to infidelity, 25% were divorced and
\n98% were heterosexual.
\nProfessor Spector says: \u201cNot surprisingly,
\nthe average number of sexual partners was
\nsignificantly higher among respondents
\nwho had been unfaithful compared with
\nthose who had remained faithful \u2013 a mean
\nof eight compared with four.\u201d
\nHeadline findings of the research study
\ninclude:
\n\u2022 Genes are an important influence in
\nexplaining variation between women in
\nboth infidelity and number of sexual
\npartners \u2013 with a heritability of 41% and
\n38% respectively.
\n\u2022 Further analysis of these results failed to
\nsupport the hypothesis that a gene impli-
\ncated in previous research into patterns
\nof sexual behaviour among rodents
\n(AVPR1A or vasopressin gene) could
\nexplain the observed variation in human
\nsexual behaviour.
\n\u2022 However, the study did find some evi-
\ndence that genes in three other chromo-
\nsomal areas (chromosomes 3, 7, 20)
\ncould be implicated.
\n\u2022 In contrast, attitudes to infidelity are not
\ninfluenced to any significant degree by
\ngenetic factors \u2013 environmental factors
\nincluding society, education or religion
\nprevail.
\n\u2022 Believing infidelity was wrong in prin-
\nciple prevailed even in a significant pro-
\nportion of those women who admitted
\nhaving been unfaithful, highlighting the
\ndistinction between attitudes and actual
\nbehaviour.
\nProfessor Spector says: \u201cBy demonstrating
\nthe heritability of female infidelity and
\nnumber of sexual partners in humans, this
\nstudy justifies additional genetic and mole-
\ncular research on human sexual behaviour.\u201d
\n\u201cThe fact that psychosocial traits such as
\nnumber of sexual partners and infidelity
\nappear to behave as other common complex
\ngenetic traits in humans, in that they have a
\nheritable component, lends support to evo-
\nlutionary psychologists\u2019 theories on the ori-
\ngins of human behaviour.\u201d
\nProfessor Spector believes that the logical
\nconclusion of his team\u2019s new research may
\nbe that infidelity and other sexual behav-
\niours persist because they have been evolu-
\ntionarily advantageous for women.
\nMedical Science, Professional Practice and Education
\nTwin Studies
\nTwin study reveals genetic role in female
\ninfidelity
\nMS
\nA UK national Multiple Sclerosis tissue Bank, funded by the
\nMS Society, co-ordinates the collection of donated tissue and
\ndistributes samples to scientists conducting research into the
\ncauses and treatment of MS.
\nWhile other techniques can be used to study
\nMS \u2013 such as experimental animal models,
\nMRI and cell culture, they are not an ade-
\nquate substitute for studying samples of tis-
\nsue that have actually been damaged by
\nMS. The bank not only takes donations of
\ntissue from people with MS, but also from
\npeople without MS, which are vital for
\ncomparison purposes.
\n\u201cThe UK MS Tissue Bank exists only
\nbecause of the foresight and generosity of
\npeople who have pledged their tissue to
\nresearch,\u201d says Professor Richard
\nReynolds, its Scientific Director. \u201cIt is an
\nact of pure altruism that will be of no bene-
\nfit to the individual, but helps future gener-
\nations.\u201c
\nLocated at Charing Cross Hospital in
\nLondon, the tissue Bank has put in place
\nprocedures allowing collection of tissue as
\nquickly as possible after death to minimise
\ndeterioration \u2013 within 24 hours wherever
\npossible.
\n\u201cFor a donation to work efficiently a lot of
\npeople need to work together, such as the
\nrelatives, GPs, funeral directors, hospital
\npathologists and tissue bank staff who
\nretrieve the samples,\u201d says Dr Abhi Vora,
\nManager of the Tissue Bank. \u201cWe all pull
\nout all the stops, seeing it as something pos-
\nitive and lasting to come out of a sad
\nevent.\u201d
\n48
\nSince it was set up in 1998, 1700 people
\nhave so far registered as tissue donors. To
\ndate, 84 people with MS and 14 people
\nwithout MS donated tissues, which are
\nbeing used in a total of 27 different
\nresearch projects around the world.
\n\u201cDonations from a single brain and spinal
\ncord can be dissected to yield 200 different
\nsamples that can be supplied to many dif-
\nferent research projects,\u201d says Dr Vora.
\nProjects benefiting from the tissue bank
\ninclude those aiding better diagnosis.
\nScanning slices of brain containing MS
\nlesions, which are then examined under a
\nmicroscope will allow any changes on the
\nMRI to be directly compared with what is
\ngoing on in the brain. Ultimately such pro-
\njects may help scientists to understand
\nmore from MRI scans about the type of MS
\na person has and make it possible to target
\ntreatments more effectively.
\nBrain tissue is being used to see whether
\nviruses and bacteria can be detected.
\nResearch teams from the Royal Free
\nHospital and the Imperial College School
\nof Medicine in London, have developed
\nsensitive techniques to see if the virus
\nhuman herpes virus 6 (HHV6) and the bac-
\nterium Chlamydia pneumoniae are present
\nin MS lesions donated to the tissue bank.
\nIdentifying agents that may trigger the
\ndamage in MS could mean that treatments
\nmay be developed to neutralise them.
\nResearchers from Belfast believe that an
\nearly step in the formation of a lesion is a
\nsubtle change in microglial cells that are
\nnormally resident in the brain. The group
\nare currently characterising these cells in
\nbrain tissue from MS patients containing
\nlesions at different stages of development.
\nThe study hopes to find out whether
\nchanges in the microglia herald the forma-
\ntion of an MS lesion.
\nChemical messengers, Cytokines, released
\nby cells within a developing lesion are cen-
\ntral to the cascade of events that leads to
\ndemyelination. Understanding the role of
\nthese molecules is the goal of a number of
\nprojects supported by the Tissue Bank.
\nSuch research could form the basis of
\ndeveloping ways of knocking out the criti-
\ncal messengers and stopping damage.
\nWHO
\n\u2022 providing samples of brain tissue to
\nMSresearchers worldwide
\n\u2022 identifying targets of myelin damage
\n\u2022 identifying unique protein n myelin
\n\u2022 how to switch off damaging activity in
\nMS
\n\u2022 finding ways to encourage repair of
\nmyelin
\n\u2022 identifying genes that make people sus-
\nceptible to MS
\n\u2022 the role of viruses in MS
\n\u2022 identifying cells that could be used for
\nthe repair of myelin
\n\u2022 investigating how nerve fibres can be
\nprotected against MS
\n\u2022 finding ways to monitor disease activity
\nin MS
\n\u2022 protecting the brain from leakage
\nthrough the blood-brain barrier in MS
\n\u2022 identifying novel drugs that can help
\nnerves work better in MS
\n\u2022 supporting the world\u2019s first MRI scan-
\nner dedicated solely to MS research
\n\u2022 the role of social support for carers of
\npeople with MS
\n\u2022 identification of the role of a herpes
\nvirus in MS
\n\u2022 understanding how myelin is made
\n\u2022 using new imaging methods to look at
\nnerve fibre damage in MS
\n\u2022 how to improve nerve function in MS
\n\u2022 how growth factors promote repair in
\nMS
\n\u2022 identifying cells for transplantation to
\nrepair myelin
\n\u2022 potential role of hepatitis B virus in MS
\n\u2022 clinical trial treatment of incontinence
\n\u2022 setting up a research centre in rehabili-
\ntation of people with MS
\n\u2022 setting up new centres for MS research
\nin Glasgow and Aberdeen
\n\u2022 education programme for people to help
\nmanage their MS
\n\u2022 looking at bone mass in people with MS
\n\u2022 identifying how to encourage repair of
\nmyelin
\n\u2022 helping people to cope with wheelchairs
\n\u2022 supporting the trial of cannabis in treat-
\ning spasticity in MS
\n\u2022 clinical trial of whether cannabis can
\nhelp control on continence
\n\u2022 investigate health provision needs in
\nNorthern Ireland
\n\u2022 helping people cope with entering long
\nterm residential care
\nMS Society sponsored research projects
\nSome of the many research projects supported financially by
\nthe MS Society
\nWHO
\nDr. Lee addressing the World Health
\nAssembly: ends with concern with preparation
\nbefore Avian influenza strikes
\nIn his address to the World Health
\nAssembly (WHA) in Geneva 21st May
\n2005, the Director General of WHO drew
\nanalogies between the discussions 60 years
\nago on how to assure the wellbeing of
\nhumanity after the Second World War and
\nthe situation before the World Health
\nAssembly. Sixty years ago it was necessary
\nto consider how to apply the knowledge
\nacquired at the price of the devastating fight
\nof the previous years. Amongst other con-
\nclusions this resulted in the UN system. In
\nour turn the WHA was meeting to learn the
\nlessons of the past and put them into prac-
\ntice. The condition of the world continued
\nto change and our institutions continue to
\nadapt themselves. The agenda of the 58th
\nWHA reflected the changes and bore wit-
\nness to the continuing importance of the
\nfight against sickness and the improvement
\nof health essential for a viable world.
\nWhile the Millenium Goals placed Health
\nat their centre,, the translation of them into
\nreality was very far from completion and
\nprogress towards them was not reassuring.
\n\u201eUnless we succeed in bringing about the
\nmajor changes we are working for in the
\nnear future, the targets for reducing child
\nmortality will not be achieved by 2015\u201c. In
\nsome areas death rates have actually risen
\nas a result of extreme poverty and epi-
\ndemics. While the necessary technical and
\npractical know-how exists, we have not
\nfound ways of applying it on a large enough
\nscale.\u201c While funding for health develop-
\nment had risen steeply, it remained a small
\nfraction of that needed.
\nAiming at reinforcing the positive trend of
\nimproving results in countries, the budget
\nshows increases in the areas of epidemic
\nalert and response, maternal and child
\nhealth, non-communicable diseases, tobac-
\nco control, and response to emergencies.
\nDr. Lee stressed the importance of creative
\ndialogue and negotiation as exemplified by
\nthe Convention on Tobacco Control. With
\n64 parties engaged in the Convention-now
\nin force -the goal was the greatest possible
\nnumber of Member states becoming
\nContracting Parties to maximise the effect
\nof the Convention and to save lives.
\nReferring to the International Health regu-
\nlations, if the WHA reached agreement on
\nthem this would be a landmark event for
\npublic health. He said that their significance
\nwould only be realised when they are in
\nplace, observed and implemented.
\nThe Strategic Health Operations Centre, set
\nup last year, had provided a valuable asset
\nto global coordination.It provided instant
\ncommunication between Member States
\nand technical partners, with 60 offices,
\nincluding the Emergency Network.
\nFollowing the Tsunami in Asia, our Health
\nAction in Crises unit used it to maximum
\nadvantage to coordinate responses.
\nCurrently it was enabling health workers to
\ncontain the Angolan Marburg haemorrhag-
\nic fever outbreak. At the Thailand Tsunami
\nConference he had made clear that the
\nwarnings on possible cholera, malnutrition
\nand epidemics in Thailand had avoided the
\nescalation of the disaster by taking rapid
\naction to ensure water safety, adequate
\nnutrition, and reliability of disease surveil-
\nlance. This was an unprecedented effort of
\ncollaboration including the government,
\nnon-governmental and private sector
\nefforts.
\nThe Global Outbreak Alert and Response
\nNetwork, now comprising 130 institutions,
\nhas responded to more than 50 major dis-
\nease outbreaks.Major demands included
\nAvian influenza, Ebola, Marburg, meningi-
\ntis, myocarditis and plague, and the
\nNetwork was also involved in establishing
\nthe early warning system following the
\nTsunami disaster.
\nThe success of the global effort to maintain
\nand increase security depends on reliable
\ninformation being available and clear to
\nthose who need it. The Health Metrics
\nNetwork, a new partnership with support
\nfrom the Bill and Melinda Gates
\nFoundation, hosted by WHO, will provide
\nextremely valuable support for this effort.
\nProgress on the core information function
\nin all activities is also highlighted by a new
\npublication \u201eWorld Health Statistics\u201c,
\nwhich provides national, regional and glob-
\nal information on 50 health indicators.
\nThe Director General urged the need for
\nresearch and the urgent need for new diag-
\nnostics, vaccines and treatments stressed at
\nthe Ministerial Summit on Health Research,
\nheld in Mexico. After consensus building
\nmeetings \u201cwe are ready to move forward
\nwith the International Clinical Trial
\nRegistry\u201c which will strengthen the
\nresearch process and its ability to win pub-
\nlic trust.\u201c
\nThe Commission on Social Determinants of
\nHealth launched in March, with leading
\npractitioners from all six regions contribut-
\ning, has the task of devising initiatives to
\nmake health systems work effectively and
\nfairly in the context of defining and con-
\nfronting major underlying causes of ill-
\nhealth in the 21st century.
\nHe stated that this year the focus of the
\nWorld Health Report and World Health Day
\non the health of Mothers, newborn and chil-
\ndren also reflected the importance of part-
\nnership. In this case the key partnership was
\nwith UNICEF and he welcomed Mrs
\nVeneman its new Executive Director (who
\naddressed the Assembly).
\nReferring to creative solidarity in health as
\none of the millenium goals, he said that
\ncombining expertise and resources was cur-
\nrently the greatest need, as well the basis
\nfor hope. The WHO goal of universal
\naccess to effective health is attainable,
\nworking with partners in fighting major
\ninfectious diseases, polio eradication, pre-
\nventing and treating chronic diseases. He
\nillustrated this with the campaign for treat-
\nment of 3 million people living with
\nHIV\/AIDS by the end of this year. This was
\na first step towards universal access to treat-
\nment.
\nWhile treatment of TB success rate had
\nreached 82% , detection still lagged at 45%.
\nThe \u201creach and cure more patients\u201c meant
\nadopting WHO policies for HIV-linked TB
\n,drug-resistant disease and bolstering ser-
\nvice quality\u201c
\nHe expressed concern that in two countries
\npolio had recurred. The urgent need is to
\nachieve Polio eradication.
\nThe strategy to achieve adequate malaria
\ncontrol continues ,with the new
\nartemesinin-based combination therapies
\nand long lasting insecticide repellent nets
\nwhich are effective.
\nHe referred to the growing threat to health
\nsystems from shortage of adequately
\ntrained staff. In 2006 the World Health
\nReport will be on Human Resources for
\nHealth , which will be the theme of World
\nHealth Day. The Report will launch the
\ndecade of Human Resources for Health.
\nDr. Lee ended by highlighting the serious
\nthreat to the world today – Avian influenza .
\n\u201eThe timing cannot be predicted, but rapid
\ninternational spread is certain once the pan-
\ndemic virus appears.\u201c The Spanish pan-
\ndemic in 1918 gave some idea of its poten-
\ntial magnitude. He continued \u201cBy good for-
\ntune we have had time, and still have the
\ntime , to prepare for the next global pan-
\n49
\nWHO
\n50
\nMr. Gates said that in his view \u2013 and there
\nwas no diplomatic way to put this: \u201cThe
\nworld is failing billions of people. Rich
\ngovernments are not fighting some of the
\nworld\u2019s most deadly diseases because rich
\ncountries don\u2019t have them. The private sec-
\ntor is not developing vaccines and medi-
\ncines for these diseases, because develop-
\ning countries can\u2019t buy them. And many
\ndeveloping countries are not doing nearly
\nenough to improve the health of their own
\npeople\u201d.
\nTo be frank. \u201cIf these epidemics were rag-
\ning in the developed world, people with
\nresources would see the suffering and insist
\nthat we stop it. But sometimes it seems that
\nthe rich world can\u2019t even see the developing
\nworld. We rarely make eye contact with the
\npeople who are suffering \u2013 so we act some-
\ntimes as if the people don\u2019t exist and the
\nsuffering isn\u2019t happening.
\nAll these factors together have created a
\ntragic inequity between the health of the
\npeople in the developed world and the
\nhealth of those in the rest of the world.\u201d
\nHe would speak about how the world,
\nworking together, could dramatically
\nreduce this inequity.
\nI first learned about these tragic health
\ninequities some years ago when I was read-
\ning an article about diseases in the develop-
\ning world. It showed that more than half a
\nmillion children die every year from
\n\u201crotavirus\u201d. I thought, \u2018Rotavirus\u2019? \u2013 I\u2019ve
\nnever even heard of it. How could I never
\nhave heard of something that kills half a
\nmillion children every year!?\u201d
\nWhen reading an article about diseases in
\nthe developing world he learnt that millions
\nof children were dying from diseases that
\nhad essentially been eliminated in the
\nUnited States. \u201cMelinda and I assumed that
\nif there were vaccines and treatments that
\ncould save lives, governments would be
\ndoing everything they could to get them to
\nthe people who needed them. But they
\nweren\u2019t. We couldn\u2019t escape the brutal con-
\nclusion that \u2013 in our world today \u2013 some
\nlives are seen as worth saving and others
\nare not. We said to ourselves: This can\u2019t be
\ntrue. But if it is true, it deserves to be the
\npriority of our giving.\u201d
\nToday, in malaria; AIDS; tuberculosis;
\nnutrition; maternal, newborn, and child ill-
\nness; and so many other health problems,
\nthe world was not doing enough to deliver
\nthe solutions we do have, and we\u2019re not
\nspending enough to find the solutions we
\ndon\u2019t have. As a result, millions of people
\ndie every year. This didn\u2019t tell a flattering
\nstory. But the story wasn\u2019t over. In fact, the
\nstory is starting to change.
\nHe believed we were on the verge of taking
\nhistoric steps to reduce disease in the devel-
\noping world. What will make it possible to
\ndo something in the 21st century that we\u2019ve
\nnever done before?
\nScience and technology
\nNever before have we had anything close to
\nthe tools we have today to both spread
\nawareness of the problems and discover
\nand deliver solutions.
\nGlobal communications technology today
\ncan show us the suffering of human beings
\na world away. As the world becomes small-
\ner, this technology will make it harder to
\nignore our neighbors, and harder to ignore
\nthe call of conscience to act.
\nWe are seeing the power of conscience in
\nefforts such as the United States\u2019
\nEmergency Plan for AIDS, the United
\nKingdom\u2019s Commission on Africa, and the
\nGlobal Fund for AIDS, TB and Malaria.
\nBut the desire to help means nothing with-
\nout the capacity to help \u2013 and our capacity
\nto help is increasing through the miracles of
\nscience. Again and again, over and over,
\nscientists make the impossible possible.
\nRecent advances in basic research, particu-
\nlarly the sequencing of the genome, give us
\na foundation for much better progress
\nagainst all disease. If we match these accel-
\nerating capacities of science with the
\nemerging moral awareness of global health
\ninequities \u2013 we have an historic chance to
\nbuild a world where all people, no matter
\nwhere they\u2019re born, can have the preventive
\ncare, vaccines, and treatments they need to
\nlive a healthy life.
\nTo build this world, I see four priorities:
\nFirst, governments in both developed and
\ndeveloping countries must dramatically
\nincrease their efforts to fight disease.
\nThe wealthy world\u2019s governments must not
\nbe content to merely increase their commit-
\nment every year. They need to match their
\ncommitment to the scale of the crisis. Yet
\nthis will not happen unless we see a dramat-
\nic increase in the efforts of developing
\ncountries to fight the diseases that affect
\ntheir people.
\nCountries in sub-Saharan Africa spend a
\nsmaller percentage of their gross domestic
\nproduct on health than other regions of the
\nworld. A stronger commitment from devel-
\noping countries will inspire a stronger com-
\nmitment from the rest of the world.
\nPriority number 2. The world needs to
\ndirect more scientific research to health
\nissues that can save the greatest number of
\nlives \u2013 which means diseases that dispro-
\nportionately affect the developing world. In
\nthe early 1900s, Nobel Prizes were awarded
\ndemic, because the conditions for it have
\nappeared before the outbreak itself. We
\nmust do everything is our power to max-
\nimise that preparedness. When this event
\noccurs, our response has got to be immedi-
\nate, comprehensive and effective.\u201c
\nWHO
\nRemarks of Mr Bill Gates, co-founder of the
\nBill and Melinda Gates Foundation, at the
\nWorld Health Assembly
\nfor discoveries about the causes of both
\ntuberculosis and malaria. Yet, more than a
\nhundred years later, we don\u2019t have effective
\nvaccines for either one. It\u2019s not because the
\nproblem is unsolvable; it\u2019s because we
\nhaven\u2019t put our scientific intelligence to the
\ntask. The world can change this \u2013 for malar-
\nia, tuberculosis, and many other diseases.
\nIn order to get the world\u2019s top scientific
\nminds to take on the world\u2019s deadliest dis-
\neases, in 2003 our foundation launched
\n\u201cThe Grand Challenges in Global Health.\u201d
\nWe asked top researchers to tell us which
\nbreakthroughs could help solve the most
\ncritical health problems in the developing
\nworld. Scientists from more than 80 coun-
\ntries sent in thousands of pages of ideas,
\nwhich led to 14 specific Grand Challenges
\nin Global Health. Once we published these
\nchallenges, more than 10,000 scientists
\nsubmitted proposals for research. They
\nincluded ideas such as vaccines that don\u2019t
\nneed refrigeration, handheld microdevices
\nthat health workers can use with minimal
\ntraining to detect life-threatening fevers,
\nand drugs that can attack diseases that hide
\nfrom the immune system. The quality of the
\nideas and the volume of the response
\nshowed us that when scientists are given a
\nchance to study questions that could save
\nmillions of lives \u2013 they flock to it. We were
\nso taken with the response that today we are
\nannouncing an increase of our commitment
\nto these Grand Challenges from 200 million
\ndollars to 450 million dollars.
\nI am optimistic. I\u2019m convinced that we will
\nsee more groundbreaking scientific
\nadvances for health in the developing world
\nin the next ten years than we have seen in
\nthe last fifty.
\nWe\u2019re already seeing exciting advances.
\nWe\u2019re seeing today a new, safe, cheap drug
\nfor visceral leishmaniasis, a disease that
\nkills more than a quarter of a million people
\nper year.
\nWe\u2019ve seen a demonstration this past year
\nthat we can have a single vaccine for pneu-
\nmonia that could reduce all deaths in Africa
\nby 15 percent. seeing older malaria drugs
\nmake way for new, more effective drugs \u2013
\nincluding new drug combinations that are
\nextremely effective with only 3 days of
\ntreatment.
\nMalaria vaccine in trials last year showing
\npromise of preventing severe malaria.
\nAnd also progress this year towards the first
\nnew drug for sleeping sickness in 50 years
\n\u2013 a new oral drug that was 100 percent
\neffective and showed no toxicity in phase
\ntwo trials.
\nOf course, one of our most daunting chal-
\nlenges is to create an effective vaccine to
\nprevent HIV\/AIDS. Some of the world\u2019s
\ntop scientific minds are working on this
\nchallenge, but many of the researchers are
\nisolated, under pressure for immediate
\nresults, and unaware of their colleagues\u2019
\ndiscoveries.
\nRefering to the challenge of creating an
\neffective vaccine to prevent HIV\/AIDS he
\ncommented that, over the past two years the
\nglobal scientific community has come
\ntogether under the HIV Vaccine Enterprise to
\ncoordinate AIDS research under one strategy
\n\u2013 to help eliminate duplication, identify the
\ngaps, and maximize the synergy from so
\nmany brilliant minds. There is new energy
\naround this global HIV Vaccine Enterprise,
\nand our foundation has recently announced
\n400 million dollars in funds to implement
\ncritical parts of this plan. It is time that the
\nenergy and commitment to find an HIV vac-
\ncine matches the magnitude of the pandem-
\nic.
\nNot everyone shared this enthusiasm. We
\nhave been criticized for emphasizing the
\nhealth discoveries that will come in the near
\nfuture. Research into big health break-
\nthroughs. Some point to the better health in
\nthe developed world and say that we can
\nonly improve health when we eliminate
\npoverty. And eliminating poverty is an
\nimportant goal. But the world didn\u2019t have to
\neliminate poverty in order to eliminate
\nsmallpox \u2013 and we don\u2019t have to eliminate
\npoverty before we reduce malaria. We do
\nneed to produce and deliver a vaccine \u2013 and
\nthe vaccine will save lives, improve health
\nand reduce poverty. Improving health
\nimproves education; it expands productivi-
\nty; it results in people having smaller fami-
\nlies, so that resources go further. When
\nhealth improves, life improves by every
\nmeasure. That\u2019s why we will continue to
\ninvest a significant percentage of our
\nresources in searching for low-cost, life-
\nsaving breakthroughs, especially through
\nvaccine research \u2013 and we encourage
\nwealthy governments to do the same.
\nThe foundation would continue to invest
\nlife saving breakthroughs and he urged gov-
\nernment to do the same.
\nPriority number 3. The world has to devote
\nmore thinking and funding to delivering
\ninterventions \u2013 not just discovering them.
\n\u201cImagine that one day there is worldwide
\nrejoicing over the discovery of an effective
\nAIDS vaccine. But imagine this too: we
\ndiscover the vaccine, but don\u2019t distribute it.
\nAnd millions continue to die.
\nWhat a horrifying thought. Most people
\nwould say we\u2019d never let that happen. But,
\nin a sense, we already are! That\u2019s what the
\nworld has been doing for decades in the
\ncase of diseases like measles, diphtheria,
\ntetanus, and hepatitis B. In the past 5 years,
\nmore than 30 million children every year
\nwent unvaccinated with the basic vaccines
\nthat are widely used in the industrialized
\nworld. As a result, more than a million chil-
\ndren die from vaccine-preventable diseases
\neach year.
\nGetting the intervention to the people who
\nneed it should never be an afterthought; it
\nshould be built into the design of the new
\ndiscovery.\u201d
\nWe need an emphasis on \u201cbreakthroughs
\nyou can use\u201d or what we like to call
\n\u201cdeliverable technology\u201d \u2013 which means
\ngetting it to the people who need it. At the
\nvery outset, researchers should be seeking
\ninterventions that are not only effective, but
\nalso inexpensive to produce, easy to distrib-
\nute, and simple to administer.
\nIf we can go from 20 pills a day to three
\npills a day, why can\u2019t we go from three pills
\na day to a once-a-month treatment?
\nToday, we have tuberculosis drugs that you
\nhave to take for 9 months. Why can\u2019t we
\nfind one that works in 3 days?
\nHis background was in information tech-
\nnology very different from global health.
\n\u201cBut it does give us a useful lesson: early in
\n51
\nWHO
\nthe computer age, computers were very
\nlarge and costly, which limited the number
\nof people who could use them. The contin-
\nuous process of discovering new designs
\nhelped make the technology smaller and
\ncheaper so that someone like me could
\ndeclare the goal of a computer in every
\nhome and on every desk. Millions more
\npeople can get the benefits of new discover-
\nies if you make delivery a priority, and if
\ndelivery shapes the design.\u201d
\n\u201cPriority number 4. To find new discoveries
\nand deliver them, we need to make political
\nand market forces work better for the
\nworld\u2019s poorest people.\u201d
\nPolitical systems in rich countries work
\nwell to fuel research and fund health care
\ndelivery, but only for their own citizens.
\nThe market works well in driving the pri-
\nvate sector to conduct research and deliver
\ninterventions, but only for people who can
\npay.
\nUnfortunately, these political and market
\nconditions that drive high quality health
\ncare in the developed world are almost
\nentirely absent in the rest of the world. We
\nhave to make these forces work better for
\nthe world\u2019s poorest people.
\nThere is a model in the Global Alliance for
\nVaccines and Immunization \u2013 an effort we
\nlaunched in 2000 to address the tragedy of
\nmillions of children dying every year from
\nvaccine-preventable diseases. When the
\nproject began, vaccines were sitting on the
\nshelf as kids were dying from those very
\ndiseases. Other necessary vaccines were not
\nbeing manufactured at all. The market
\nwan\u2019t working to bring people what they
\nneeded because there wasn\u2019t enough money
\nto create a demand and guarantee a supply.
\nSince 2000, eleven governments have pro-
\nvided hundreds of millions of dollars for
\nvaccine purchase and distribution. This has
\ngiven companies a market incentive to
\nmanufacture these vaccines. As a result, in
\nfive short years, four million additional
\nchildren have been immunized with basic
\nvaccines, 42 million with hepatitis B, five
\nmillion with haemophilus influenzae type
\nB, and over three million with yellow fever
\n\u2013 saving more than 700,000 lives.
\n\u201cWe hope even more funding will be made
\navailable through the proposed
\nInternational Financing Facility for
\nImmunizations proposed by the United
\nKingdom; with support pledged by France,
\nGermany, Sweden, and Italy, this initiative
\nwould provide developing countries with
\nthe reliable funding they need, year after
\nyear, to buy vaccines, which gives the pri-
\nvate sector the market incentive to make
\nthem and deliver them.\u201d He believes that if
\nwe act on these four priorities, we can build
\na world where all people, no matter where
\nthey\u2019re born, can have the preventive care,
\nvaccines, and treatments they need to live a
\nhealthy life.
\nGovernments in developed countries
\nshould match their financial commitments
\nto the scale of the crisis \u2013 and make sure
\ntheir efforts get results.
\nGovernments in developing countries
\nshould make health a priority by dramati-
\ncally increasing the percentage of their bud-
\ngets they commit to health \u2013 particularly in
\ntheir efforts to build health systems that can
\nadopt and deliver low-cost interventions.
\nCitizens around the world should petition
\ntheir governments to put up money to make
\nmarket forces work better for the world\u2019s
\npoorest people.
\n\u201cIt\u2019s one thing to define the goals and
\ndesign the tasks, it\u2019s quite another to get
\nthem done. An important duty falls to the
\nhealth ministers in this room.\u201c
\nHe appealed to Health Ministers present.
\nThey occupied a crucial position between
\nthe people who make funding decisions and
\nthe people suffering from disease. They can
\nmake an immense difference by urging the
\nworld to make eye contact with the people
\nwho are suffering and can also show the
\nworld that there are solutions that work.
\nOne key to this is the new Health Metrics
\nNetwork, which will be announced tomor-
\nrow and which the foundation are proud to
\nsupport. This network will work to
\nstrengthen health information systems in
\ncountries so that health efforts are based on
\nevidence, not speculation.
\n\u201cThere is no bigger test for humanity than
\nthe crisis of global health. Solving it will
\nrequire the full commitment of our hearts
\nand minds. We need both. Without compas-
\nsion, we won\u2019t do anything. Without sci-
\nence, we can\u2019t do anything. So far, we have
\nnot applied all we have of either. I was opti-
\nmistic that in the next decade, people\u2019s
\nthinking will evolve on the question of
\nhealth inequity and people would finally
\naccept that the death of a child in the devel-
\noping world is just as tragic as the death of
\na child in the developed world.\u201c
\n52
\nWHO
\nA new global partnership that will work to
\nimprove public health decision-making
\nthrough better health information was
\nlaunched on 18 May 2005 at the World
\nHealth Assembly (WHA). The Health
\nMetrics Network (HMN), a partnership
\ncomprised of countries, multilateral and
\nbilateral development agencies, founda-
\ntions, global health initiatives and technical
\nexperts will increase the availability and
\nuse of timely, reliable health information by
\ncatalyzing the funding and development of
\ncore health information systems in develop-
\ning countries.
\nToday, despite the efforts of many country,
\nregional and global partners, there are sig-
\nnificant gaps in the health information that
\nis available to policy-makers and health
\npractitioners. \u201cIn some areas of the world,
\neven basic facts such as a person\u2019s birth,
\ntheir death and cause of death are not
\nrecorded,\u201c said Dr. LEE Jong-wook,
\nDirector-General of the World Health
\nOrganization (WHO). The Health Metrics
\nNetwork will work to close this gap by
\nStrengthening Health Information Systems to
\nbetter address health needs worldwide
\nhelping countries improve their ability to
\ngather this vital health information.
\nAccurate data is critical to identifying prob-
\nlems and implementing effective solutions
\nfor people\u2019s health.\u201c
\nHMN brings together health and statistical
\nconstituencies to build capacity and exper-
\ntise for strengthening health information
\nsystems so that local, regional and global
\ndecision-makers have quality data on which
\nto base decisions to improve health.
\n\u201cHealth information is not simply an end in
\nitself but provides the basis for better deci-
\nsion-making,\u201d said Dr. Richard Klausner,
\nExecutive Director, Global Health, the Bill
\n& Melinda Gates Foundation. \u201cGood data,
\nquality reporting and tracking, thoughtful
\nanalysis and consistent health information
\nsystems will enable decision-makers to
\nmake informed and therefore better deci-
\nsions on disease control and human devel-
\nopment.\u201d
\nHMN responds to a need for evidence-
\nbased policy-making that can enable coun-
\ntries to make more efficient use of health
\nbudgets. In addition, other global initiatives
\nincluding the Millennium Development
\nGoals, the Global Fund to Fight AIDS,
\nTuberculosis and Malaria, Global Alliance
\nfor Vaccines & Immunization (GAVI) and
\nthe President\u2019s Emergency Plan for AIDS
\nRelief (PEPFAR) have increased the
\ndemand for sound health information.
\nHMN partners have agreed to align their
\nindividual efforts around a common health
\ninformation framework thereby reducing
\noverlapping and duplicative demands that
\nhave burdened fragile information systems
\nin developing countries in the past.
\n\u201cWe have agreed to better coordinate and
\nalign our investments in the development of
\nhealth information systems in accordance
\nwith the broader development agenda
\nincluding the Millennium Development
\nGoals,\u201d according to a statement endorsed
\nby the HMN partners.
\nThe initial HMN partners include: African
\nPopulation and Health Research Center;
\nBill & Melinda Gates Foundation, Centers
\nfor Disease Control and Prevention of the
\nU.S. Department of Health and Human
\nServices, Danish International
\nDevelopment Agency, Department for
\nInternational Development (U.K.), Euro-
\npean Commission, Ghana Health Services,
\nGlobal Fund to fight AIDS, Tuberculosis
\nand Malaria, GAVI, Ministry of Health,
\nMexico, Ministry of Public Health, Thai-
\nland, Organisation for Economic Co-
\nOperation and Development, Statistics
\nSouth Africa, Swedish International
\nDevelopment Agency, Uganda Bureau of
\nStatistics, UNICEF, United Nations
\nStatistics Division, U.S. Agency for Inter-
\nnational Development, World Bank and
\nWorld Health Organization.
\nHMN will meet its objectives through a
\nrange of activities. Low- and middle-
\nincome countries will be eligible to apply
\nfor grants of up to US$ 500 000 for health
\ninformation system strengthening and can
\ncall upon HMN partners for technical assis-
\ntance.
\nBy 2011, HMN expects that at least 80
\ncountries will be able to report on agreed,
\nstandardized global health goals and indica-
\ntors in a timely and sound manner.
\nHMN has received an initial grant of US$
\n50 million over seven years from the Bill &
\nMelinda Gates Foundation and additional
\ncontributions from other donors including
\nthe Department for International
\nDevelopment (U.K.), U.S. Agency for
\nInternational Development and Danish
\nInternational Development Agency.
\nFor more information contact:
\nChristine McNab
\nTelephone: +41 22 791 4688
\nEmail: mcnabc@who.int
\n53
\nWHO
\nThis year`s World Health Report focuses on
\nMaternal and Child Health under the title
\n\u201eMake every mother and child count.\u201c This
\nhighlights the fact that there is only a decade
\nleft to achieve the Millennium Development
\nGoals which, in particular, highlights access
\nto care and improvement in health, particu-
\nlarly in the context of reduction of poverty.
\nThe extensive analysis which precedes the
\nAppendix of global basic statistical informa-
\ntion, this year focuses especially on mater-
\nnal and child health, reflecting the needs and
\nproblems in implementing the progress that
\nis still required to ensure full implementa-
\ntion of the technical knowledge which, if put
\nin place, would reduce mortality and mor-
\nbidity in mothers and children alike. The
\noverview preceding the seven chapter com-
\nmentary refers at an early stage to the 3.3
\nmillion or more stillbirths, the 4 million plus
\ndeaths within 28 days of birth, the 6.6 mil-
\nlion children dying before their fifth birth-
\nday, and the 529 thousand maternal deaths
\nin pregnancy and during or following child-
\nbirth.
\nWhile referring to the increase in countries
\nwho have improved maternal and child
\nhealth recently, depressingly, it states that
\nthose countries who had the highest burden
\nof mortality and ill-health made the least
\nprogress in the 90\u2019s. For some, progress has
\neven slowed down.
\nIn analysing why progress is patchy and list-
\ning the many factors contributing to this,
\nincluding inability to invest adequately in
\nhealth systems, stress is laid on the dispari-
\nties between countries and also between rich
\nand poor within countries.
\nThe seven chapters analyse not only the his-
\ntory of maternal and childcare, the progress
\nas well as failings, but also outlines ways
\nforward for progress, and the financial and
\nother resources required to achieve this.
\nThey make compelling reading and hopeful-
\nly will meet with an adequate response from
\nboth the wealthy industrialised nations as
\nwell as those still at various stages of devel-
\nopment, and other international agencies.
\nThe World Health Report 2005 \u2013
\n\u201eMake every mother and child count\u201c
\nScience Can Do More \u2013 Research To
\nBridge The \u201cKnow-Do\u201d Gap
\nGeneva \u2013 Health Systems Research has the
\npotential to produce dramatic improvements in
\nhealth worldwide and to meet some of the
\nmajor development challenges in the new mil-
\nlenium. Effective research could prevent half of
\nthe world\u2019s deaths with simple and cost-effec-
\ntive interventions, the World Health
\nOrganization says in a new world report on
\nglobal health research.
\nThe WHO World Report on Knowledge for
\nBetter Health: Strengthening Health Systems
\nhighlights aspects of health research that, if
\nmanaged more effectively, could produce even
\nmore benefits for public health in future. It sets
\nout the strategies that are needed to reduce glob-
\nal disparities in health by strengthening health
\nsystems.
\nInequities in health are among the major devel-
\nopment challenges in the new millenium and
\nmalfunctioning health systems are at the heart
\nof the problem. Moreover, the culture and prac-
\ntice of health research should reach beyond aca-
\ndemic institutions and laboratories to involve
\nhealth service providers, policy-makers, the
\npublic and civil society.
\nThe report also argues that science must help to
\nimprove public health systems and should not
\nbe confined to producing drugs, diagnostics,
\nvaccines and medical devices. Biomedical dis-
\ncoveries cannot improve people\u2019s health with-
\nout research to find out how to apply them with-
\nin different health systems and diverse political
\nand social contexts, thus ensuring that they
\nreach those who need them the most.
\n\u201cThere is a sense that science can do more,
\nespecially for public health,\u201d said Dr LEE Jong-
\nwook, WHO Director-General. \u201cThere is a gap
\nbetween today\u2019s scientific advances and their
\napplication \u2013 between what we know and what
\nis actually being done. Health systems are
\nunder severe pressure and there is an urgent
\nneed to generate knowledge for strengthening
\nand improving them.\u201d
\nA team of 12 internationally prominent health
\nresearchers in both developed and developing
\ncountries, coordinated by Dr Tikki Pang, WHO
\nDirector for Research Policy & Cooperation,
\ndeveloped the 143-page World Report on
\nKnowledge for Better Health over 18 month.
\nBased-on a wide-ranging consultative process
\nand on previous reviews of global health
\nresearch, the report advocates that health equity
\ncan only be achieved through better manage-
\nment of health research and increased invest-
\nment in health systems research.
\nHealth systems research suffers from a poor
\nimage and has been under-funded compared to
\nbiomedical research despite widespread recog-
\nnition of its importance. The field attracts less
\nthan one tenth of 1% of total health expenditure
\nin low-income countries.
\nThe lack of attention given to this field is also
\nreflected in the fact that only 0.7% of scientific
\narticles published globally in the year 2000
\nwere in the area of health systems research.
\n\u201cIt is extremely important to get this report out
\nnow. The report demonstrates the enormity and
\ncomplexity of the problem and outlines a way
\nto go forward,\u201d said Eva Harris, President of the
\nSustainable Science Institute based at the
\nUniversity of California, Berkeley, USA. \u201cIt
\nanticipates how the global community can get a
\nhandle on the problem in a constructive manner
\ninstead of lamenting a lack of action.\u201d
\nIn Africa, for example, it is estimated that only
\nbetween 2-15% of children slept under bed-nets
\nin 2001 \u2013 a simple, effective and proven method
\nto prevent malaria. \u201cWe need to put a stronger
\nemphasis on translating knowledge into actions
\n\u2013 health systems research will help us to bridge
\nthis \u201cknow-do\u201d gap\u201d. Also, that research is an
\ninvestment, not a cost\u201d, said Dr Pang.
\nThe report also illustrates how health systems
\nresearch can strengthen human resources for
\nhealth, health financing, as well as information
\nand delivery of health services, with some pro-
\njects already yielding impressive results.
\nAmong the research projects mentioned in the
\nreport is the Tanzania Essential Health
\nInterventions Project (TEHIP) which was set up
\nto find new ways to plan, set priorities and allo-
\ncate resources as part of a major reform of the
\ncountry\u2019s health-care system. The aim was to
\nevaluate the impact of health interventions in
\nterms of burdens of disease and per capita cost.
\nResearchers found that in two Tanzanian dis-
\ntricts, malaria alone accounted for 30% of all
\nhealthy years of life lost due to deaths in 1996-
\n97. In response, government planners increased
\nthe budget for malaria prevention and treatment
\nprogrammes from 10% to 26% by 2000-2001.
\nOverall, the research has resulted in a better
\nmatch between disease burden and health bud-
\nget allocation, and the child mortality rate has
\nbeen reduced by more than 40% since the late
\n1990s.
\n\u201cHealth systems should nurture a stronger cul-
\nture of learning and problem-solving to tackle
\nthe major health challenges of our times,\u201d said
\nTim Evans, Assistant Director-General, WHO.
\n\u201cThis could be achieved by understanding how
\nelements within a health system interact with
\neach other and by finding innovative ways to
\nsolve complex problems.\u201d
\nWhat is a health system?
\nA health system includes all actors, organiza-
\ntions, institutions and resources whose primary
\npurpose is to improve health. In most countries
\na health system has public, private, traditional
\nand informal sectors. Although the defining
\ngoal of a health system is to improve health,
\nother goals are to be responsive to the popula-
\ntion it serves. This responsiveness is determined
\nby the environment in which people are treated,
\nand should ensure that the financial burden of
\npaying for health is fairly distributed. Four key
\nfunctions determine the way inputs are trans-
\nformed into outcomes that people value:
\nresource generation, financing, service provi-
\nsion and stewardship. The effectiveness, effi-
\nciency and equity of national health systems are
\ncritical determinants of population health status.
\nMinisterial summit on health
\nresearch
\nMinisters of Health from more than 30 nations
\nas well as representatives of research institu-
\ntions, academia, non-governmental organiza-
\ntions, pharmaceutical companies and various
\nkey stakeholders in health\/medical research
\ngathered in Mexico City, Mexico, from 16-20
\n54
\nWHO
\nSustainable Health Systems
\nAn Innovative
\nApproach To Health
\nSystems Research
\n55
\nGeneva \u2013 The World Health Organization has
\nwelcomed the results of a pneumococcal con-
\njugate vaccine trial conducted in the Gambia
\nwhich are published in the Lancet comment-
\ned as follows:
\nDr LEE Jong-wook, Director-General,
\nWHO, declared:
\n\u201cThe results of this vaccine trial hold great
\npromise for improving health and saving
\nlives in resource-poor populations. The inter-
\nnational community\u2019s task now is to continue
\nto work together productively to make the
\npneumococcal conjugate vaccine widely
\navailable to children in Africa, as lives are
\nlost every minute to pneumococcal disease.
\nImmunizing children with pneumococcal
\nconjugate vaccine in developing countries
\nwill be a critical intervention towards achiev-
\ning a two-thirds reduction in the under-five
\nmortality rate, a Millennium Development
\nGoal.\u201d
\nDr Felicity Cutts, principal investigator of the
\ntrial who is currently based at WHO, said:
\n\u201cThe trial results are highly positive and
\npromising, and provide us with a clearer pic-
\nture of the pneumococcal disease burden in
\nAfrica. The trial confirms that pneumococcal
\npneumonia, meningitis, and sepsis are major
\ncauses of death and serious illness among
\nAfrican infants and young children. Most
\nimportantly, it demonstrates that pneumococ-
\ncal vaccination can prevent many of these
\nserious infections even in a rural African set-
\nting. This is great news for children and par-
\nents in rural areas everywhere.\u201d
\nA similar vaccine has had a dramatic impact
\non reducing pneumococcal disease in the
\nUnited States. The Gambia vaccine trial has
\nnow clearly demonstrated that a significant
\nproportion of illness, disability and death in
\nAfrican children can be averted through vac-
\ncination against this disease, a leading killer,
\nespecially of young children in developing
\ncountries.
\nDr Thomas Cherian, Team Coordinator in the
\nWHO Initiative for Vaccine Research stated:
\n\u201cExperience has shown that in areas where
\nhealth systems are unable to provide hard to
\nreach, rural populations with round-the-clock
\naccess to high-quality curative care, immu-
\nnization can be delivered through outreach
\nservices to great benefit. The pneumococcal
\nvaccine will therefore be particularly impor-
\ntant to save lives in the most disadvantaged
\npopulations.\u201d
\nThe trial was supported by a broad coalition
\nof international partners including the WHO
\nInitiative for Vaccine Research, the National
\nInstitute of Allergy and Infectious
\nDiseases\/National Institutes of Health; the
\nBritish Medical Research Council\/United
\nKingdom working with The Gambia
\nGovernment; the London School of Hygiene
\nand Tropical Medicine; the U.S. Agency for
\nInternational Development; the Centers for
\nDisease Control and Prevention of the United
\nStates Health and Human Services
\nDepartment; Wyeth-Lederle Vaccines; the
\nProgram for Appropriate Technology in
\nHealth (PATH) Children’s Vaccine Program,
\nas well as WHO.
\nIn the Gambia and other African countries,
\nrates of invasive pneumococcal disease
\n(severe forms of the disease, where bacteria
\nare isolated from blood, spinal fluid or anoth-
\ner site in the body where bacteria are not usu-
\nally found), are up to ten times higher than in
\nindustrialized countries and the disease is a
\nmajor cause of hospital admissions and
\ndeaths. WHO estimates that between 700,000
\nand 1 million children under five die from
\npneumococcal diseases each year.
\nA randomized, controlled, double-blind trial
\nof a pneumococcal conjugate (made from
\nlinking purified polysaccharides or complex
\nsugars from the coat of a disease-causing
\nbacterium to a protein carrier) vaccine took
\nplace in eastern Gambia starting in August
\n2000. 17,437 children aged 6-51 weeks were
\nenrolled in the study. Those 8719 children in
\nthe control group received a diphtheria-
\ntetanus-pertussis-Haemophilus influenzae
\nserotype b vaccine. 8718 children received
\npneumococcal conjugate vaccine, mixed
\nwith the tetravalent vaccine received by the
\ncontrol group.
\nResults of the trial indicated that in the group
\nof children who received pneumococcal con-
\njugate vaccine, there were:
\n\u2022 37% fewer cases of pneumonia (as con-
\nfirmed by chest X-ray);
\n\u2022 15% fewer hospital admissions
\n\u2022 16% reduction in overall mortality; and
\n\u2022 half the rate of laboratory-confirmed
\npneumococcal pneumonia, meningitis
\nand septicaemia.
\nMoreover, the vaccine was 77% effective in
\npreventing infections caused by nine
\nserotypes (strains) of pneumococcal bacteria
\nwhose sugar capsules make up the vaccine.
\nTo summarise, in this rural African setting,
\npneumococcal conjugate vaccine was shown
\nin this trial to be highly effective against
\npneumonia and invasive pneumococcal dis-
\nease. It can substantially reduce admissions
\nand improve child survival.
\nFull details of the trial are available in a
\nLancet 26 March 2005 Dr Felicity T. Cutts et
\nal. \u201cEfficacy of nine-valent pneumococcal
\nconjugate vaccine against pneumonia and
\ninvasive pneumococcal disease in the
\nGambia: randomised, double-blind, placebo-
\ncontrolled trial.\u201c
\nNovember 2004, to address the vital role of
\nresearch in strengthening health systems and
\nhow it can better serve the health needs of the
\nglobal population. Hosted by the Government
\nof Mexico and the World Health Organization,
\nthe Ministerial Summit on Health Research
\nfocussed on the \u201cknow-do gap\u201d \u2013 how to trans-
\nlate knowledge into action to improve health.
\nThe Summit also discussed research needed to
\nachieve the health-related Millenium
\nDevelopment Goals (MDGs) by 2015.
\nBy gathering a large number of players in
\nhealth research, the Summit represents a
\nunique opportunity to develop a platform of
\nspecific initiatives to strengthen health sys-
\ntems and to improve imformation access. The
\nkey recommendations of the Summit have
\nbeen incorporated into the \u201cMexico Agenda
\non Health Research.\u201d
\nWHO
\nVaccinating african children against
\npneumococcal disease saves lives
\n56
\nIn the course of a presentation on Migration
\nof Health Workers at the BMA Conference
\nreported above, Professor Agyeman Badu
\nAkosa, Director General of Health Services
\nGhana and President of the Commonwealth
\nMedical Association ,described the organisa-
\ntion of healthcare in Ghana and identified
\nthree problems of Human Resources, These
\nwere
\na) Poor retention of staff
\nb) Inadequate production of staff
\nc) Maldistribution.
\nAfter elaborating on these, setting out the rea-
\nson why there is a brain drain from this coun-
\ntry and possible factors which might reverse
\nthis, he addressed more generally the situa-
\ntion concerning the migration of physicians
\nin the Sub-Saharan countries, quoting figures
\nfrom Hagopian et al 2004, and his analysis of
\nmigration to the USA.
\nOf the 771491 physicians (2002), 23%
\ntrained in low- income or lower middle-
\nincome countries, 5335 physicians were from
\nSub-Saharan Africa. This represented more
\nthan 6% of the physicians currently practic-
\ning in Sub-Saharan Africa now.
\nOf 87 medical schools in the Region, it
\nappears that ten medical schools in four
\ncountries (South Africa, Ghana, Nigeria and
\nEthiopia) produce 79.4% of the \u00e9migr\u00e9
\nphysicians to the USA (targeting these 10
\nmedical schools could therefore be of greater
\nvalue than addressing the problem in 47
\ncountries).
\nThe cost of training physicians who subse-
\nquently migrate was estimated to be 9 million
\n$US a year for Ghana and 20 million $US for
\nNigeria. (Hagopian & Ofosu et al, unpub-
\nlished 2003)
\n(Medical students contribute 5% only of the
\ncosts of their medical education)
\nIt is of interest to note that the U.N.
\nCommission for Trade and Development
\nestimates that each professional leaving
\nAfrica costs the continent 184000 $US or 4
\nbillion $US a year. The loss of tax revenue
\nfrom absent physicians also represents a sig-
\nnificant economic loss.
\nCompared with affluent countries the
\ndistribution of physicians in he population is
\nAfrica is dramatically demonstrated by the
\nfollowing:
\nCountry Physicians per
\n100,000 population
\nUSA 279
\nCanada 229
\nAustralia 240
\nUK 164
\nUganda 4
\nZambia 7
\nGhana 6
\nSouth Africa 57
\nRegional and NMA News
\nRegional and NMA News
\nFigures and facts
\nfrom Africa
\n(extracted from a paper
\ngiven at the BMA \u201cCall for
\nAction\u201c Conference)
\nThe healthcare skills drain \u2013 a call to action
\nOn 14 April 2005, the British Medical
\nAssociation organised an international con-
\nference on the global health workforce in
\nassociation with the Commonwealth, and
\nwith participants from the American Medical
\nAssociation, the American Nurses Associa-
\ntion, the Canadian Medical Association, the
\nFederation, Health Canada, the Medical
\nCouncil of Canada, the Royal College of
\nNursing and the South African Medical
\nAssociation. The conference agreed the fol-
\nlowing principles and recommendations.
\nThe lack of healthcare workers in developing
\ncountries, particularly those in sub-Saharan
\nAfrica, is an emergency that demands urgent
\naction. The impact of healthcare worker
\nmigration from developing to developed
\ncountries is a significant component in this
\ncrisis.
\nAll citizens have a right to enjoy the highest
\nattainable standard of health, and this, along
\nwith the prevention and treatment of ill
\nhealth, is central to sustaining poor people`s
\nability to escape poverty. Measures to realise
\nthese aims are essential to the Millennium
\nDevelopment Goal of poverty reduction.
\nTherefore, recognising that:
\n\u2022all countries need an adequate healthcare
\nworkforce strategy and the means to manage
\nthis, and that the workforce represents the
\nmost important investment in healthcare
\nsystems;
\n\u2022many countries have actual and projected
\nshortages of health workers. Examples
\ninclude a projected deficit by 2020 in the
\nUSA of 200000 doctors and 800000 nurses,
\nand one million health workers in Sub-
\nSaharan Africa to meet the Millennium
\nDevelopment Goals (MDGs) by 2015.
\n\u2022In countries which already have severe
\nshortages of healthcare workers (fewer than
\none health worker per 1000 population) fur-
\nther loss of such workers through premature
\ndeath or migration is very likely to result in
\nloss of health services and loss of life in the
\ncountries` populations;
\n\u2022Billion dollar funds amassed to address
\noverwhelming global health problems (such
\nas HIV\/AIDS) are constrained primarily by
\nthe lack of healthcare professionals;
\nthe conference agreed on the following four
\nkey points:
\n1) All countries must strive to attain self-
\nsufficiency in their healthcare work-
\nforce without generating adverse con-
\nsequences for other countries;
\n2) Developed countries must assist devel-
\noping countries to expand their capaci-
\nty to train an retain physicians and
\nnurses, to enable them to become self-
\nsufficient;
\n3) All countries must ensure that their
\nhealthcare workers are educated, fund-
\ned and supported to meet the health-
\ncare needs of their populations;
\n4) Action to combat the skills drain in this
\narea must balance the right to health1
\nof populations and other individual
\nhuman rights.
\n1 Universal Declaration of Human Rights (1948),
\nArticle 25.1; International Covenant on Economic,
\nSocial an Cultural Rights (1976), Article 12.1.<\/p>\n"},"caption":{"rendered":"

wmj6 WorldMMeeddiiccaall JJoouurrnnaall Vol. No.2,June200551 OFFICIAL JOURNAL OF THE WORLD MEDICAL ASSOCIATION, INC. G 20438 Contents EEddiittoorriiaall Human health resources and moral responsibilities 29 Saving the lives of Siamese Twins 30 MMeeddiiccaall EEtthhiiccss aanndd HHuummaann RRiigghhttss The World Medical Association \u2013 Declaration of Geneva 31 Council of Europe 32 WWMMAA 170th WMA Council meets in […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":727,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/wmj6.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/3533"}],"collection":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=3533"}]}}