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wmj12<\/a><\/p>\n

WorldMedical Journal
\nVol. No.4,December200652
\nOFFICIAL JOURNAL OF THE WORLD MEDICAL ASSOCIATION, INC.
\nG 20438
\nContents
\nWorld Medical Association International
\nCode of Medical Ethics 87
\nEditorial
\nRegulation and Self-Regulation 88
\nNew appointments and honours 89
\nLibyan Court Decision on
\nBulgarian Doctor and Nurses 89
\nMedical Ethics and Human Rights
\nWMA Declaration on Hunger Strikers 90
\nWHO announces new standards for
\nregistration of all human medical research 92
\nWMA Statement On Professional Responsibility
\nFor Standards Of Medical Care 93
\nWorld Medical Association
\nWMA 57th General Assembly 93 Adjourned Meeting 97
\n175th WMA Council Meeting 99
\nWMA Statement on avian and
\npandemic influenza 100
\nWMA Resolution on tuberculosis 103
\nWMA Resolution on medical assistance
\nin air travel 104
\nWMA Resolution on child safety in air travel 105
\nFrom the Secretary General
\nSelf-governmental Structures are
\nendangered in many countries 106
\nMedical Science, Professional Practice
\nand Education
\nWMA Statement on the Physician\u2019s role
\nin obesity 107
\nObesity \u2013 A Growing Problem 107
\nObesity \u2013 a condition of excess body fat;
\nnot excess weight 108
\nThe Hajj and Influenza risk 109
\nWHO
\nDr. Margaret Chan to be WHO\u2019s
\nnext Director-General 110
\nGlobal polio eradication now hinges
\non four countries 111
\nWHO Global Task Force outlines measures
\nto combat XDR-TB worldwide 111
\nRegional and NMA News 113
\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. J. Snaedal Dr. N. Arumagam Dr. Kgosi Letlape
\nIcelandic Medical Assn. Malaysian Medical Association The South African Medical Association
\nHlidasmari 8 4th Floor MMA House P.O Box 74789
\n200 Kopavogur 124 Jalan Pahang Lynnwood Ridge 0040
\nIceland 53000 Kuala Lumpur Pretoria 0153
\nMalaysia South Africa
\nTreasurer Chairman of Council Vice-Chairman of Council
\nProf. Dr. Dr. h.c. J. D. Hoppe Dr. Y. Blachar Dr. K. Iwasa
\nBundes\u00e4rztekammer Israel Medical Association Japan Medical Association
\nHerbert-Lewin-Platz 1 2 Twin Towers 2-28-16 Honkomagome
\n10623 Berlin 35 Jabotinsky 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
\n01212 Ferney-Voltaire Cedex
\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: (54-11) 4381-1548\/4384-5036
\nE-mail:
\ncomra@confederacionmedica.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\/Fax: -933
\nE-mail: international@aek.or.at
\nREPUBLIC OF ARMENIA E
\nArmenian Medical Association
\nP.O. Box 143, Yerevan 375 010
\nTel: (3741) 53 58-68
\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 1857\/Fax: 323 2980
\nE-mail: mabnassau@yahoo.com
\nBANGLADESH E
\nBangladesh Medical Association
\nBMA Bhaban 5\/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
\nCalle Ayacucho 630
\nTarija
\nFax: (591) 4663569
\nE-mail: colmed_tjo@hotmail.com
\nWebsite: colegiomedicodebolivia.org.bo
\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\/Fax: -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 8610\/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: rdelcastillo@colegiomedico.cl
\nWebsite: www.colegiomedico.cl
\nTitle page: London School of Tropical Medicine and Hygiene, London U.K. Photo courtesy of LSTMH. Top view: front of the present bu-
\nilding. Bottom view: Headstone and window. This prestigious and internationally recognised centre of excellence in all aspects of inter-
\nnational health, health policy and public health, was founded in 1899 by Sir Robert Manson, as the London School of Tropical Medicine
\nThis became the London School of Hygiene and Tropical Medicine (LSHTM) in 1924, formally opened by the Prince of Wales in 1929.
\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
\nCarrera 7 N\u00b0 82-66, Oficinas 218\/219
\nSantaf\u00e9 de Bogot\u00e1, D.E.
\nTel\/Fax: (57-1) 256 8050\/256 8010
\nE-mail: federacionmedicacol@
\nsky.net.co
\nDEMOCRATIC REP. OF CONGO F
\nOrdre des M\u00e9decins du Zaire
\nB.P. 4922
\nKinshasa \u2013 Gombe
\nTel: (243-12) 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: hlz@email.htnet.hr
\nWebsite: www.hlk.hr\/default.asp
\nCZECH REPUBLIC E
\nCzech Medical Association
\nJ.E. Purkyne
\nSokolsk\u00e1 31 – P.O. Box 88
\n120 26 Prague 2
\nTel: (420-2) 242 66 201-4
\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
\n(EsMA)Pepleri 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\/Fax: (679) 387671
\nE-mail: fijimedassoc@connect.com.fj
\nFINLAND E
\nFinnish Medical Association
\nP.O. Box 49
\n00501 Helsinki
\nTel: (358-9) 3930 91\/Fax-794
\nE-mail: fma@fimnet.fi
\nWebsite: www.medassoc.fi
\nFRANCE F
\nAssociation M\u00e9dicale Fran\u00e7aise
\n180, Blvd. Haussmann
\n75389 Paris Cedex 08
\nTel\/Fax: (33) 1 45 25 22 68
\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) 400-456 369\/Fax: -387
\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, Chi-
\nnaDuke 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 \u2013 PO.Box 145
\n1443 Budapest
\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) 23370009\/23378819\/
\n23378680
\nFax: (91-11) 23379178\/23379470
\nE-mail: inmedici@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) 676-7273Fax: (353-1)
\n6612758\/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: doritb@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
\nWebsite: www.lgs.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
\nMACEDONIA E
\nMacedonian Medical Association
\nDame Gruev St. 3
\nP.O. Box 174
\n91000 Skopje
\nTel\/Fax: (389-91) 232577
\nE-mail: mld@unet.com.mk
\nMALAYSIA E
\nMalaysian Medical Association
\n4th Floor, MMA House
\n124 Jalan Pahang
\n53000 Kuala Lumpur
\nTel: (60-3) 40413740\/40411375
\nAssociation and address\/Officers
\nii
\nAssociation and address\/Officers
\niii
\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. D-107
\nColonia Deportivo Obispado
\nMonterrey, Nuevo L\u00e9on
\nTel\/Fax: (52-8) 348-41-55
\nE-mail: rcantum@doctor.com
\nWebsite: www.cmm-fenacome.org
\nNAMIBIA E
\nMedical Association of Namibia
\n403 Maerua Park \u2013 POB 3369
\nWindhoek
\nTel: (264) 61 22 44 55\/Fax: -48 26
\nE-mail: man.office@iway.na
\nNEPAL E
\nNepal Medical Association
\nSiddhi Sadan, Post Box 189
\nExhibition Road
\nKatmandu
\nTel: (977 1) 4225860, 231825
\nFax: (977 1) 4225300
\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) 492 4179
\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@cwpanama.net
\nPERU S
\nColegio M\u00e9dico del Per\u00fa
\nMalec\u00f3n Armend\u00e1riz N\u00b0 791
\nMiraflores, Lima
\nTel: (51-1) 241 75 72
\nFax: (51-1) 242 3917
\nE-mail: decano@cmp.org.pe
\nWebsite: www.cmp.org.pe
\nPHILIPPINES E
\nPhilippine Medical Association
\nPMA Bldg, North Avenue
\nQuezon City
\nTel: (63-2) 929-63 66\/Fax: -6951
\nE-mail: medical@pma.com.ph
\nWebsite: www.pma.com.ph
\nPOLAND E
\nPolish Medical Association
\nAl. Ujazdowskie 24, 00-478 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: intl@omcne.pt
\nWebsite: www.ordemdosmedicos.pt
\nROMANIA F
\nRomanian Medical Association
\nStr. Ionel Perlea, nr 10
\nSect. 1, Bucarest
\nTel: (40-1) 460 08 30
\nFax: (40-1) 312 13 57
\nE-mail: AMR@itcnet.ro
\nWebsite: ong.ro\/ong\/amr
\nRUSSIA E
\nRussian Medical Society
\nUdaltsova Street 85
\n119607 Moscow
\nTel: (7-095)932-83-02
\nE-mail: info@rusmed.ru
\nWebsite: www.russmed.ru
\nSAMOA E
\nSamoa Medical Association
\nTupua Tamasese Meaole Hospital
\nPrivate Bag \u2013 National Health Services
\nApia
\nTel: (685) 778 5858
\nE-mail: vialil_lameko@yahoo.com
\nSINGAPORE E
\nSingapore Medical Association
\nAlumni Medical Centre, Level 2
\n2 College Road, 169850 Singapore
\nTel: (65) 6223 1264
\nFax: (65) 6224 7827
\nE-Mail: sma@sma.org.sg
\nwww.sma.org.sg
\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, 61001 Ljubljana
\nTel: (386-61) 323 469
\nFax: (386-61) 301 955
\nSOMALIA E
\nSomali Medical Association
\n14 Wardigley Road \u2013 POB 199
\nMogadishu
\nTel: (252-1) 595 599
\nFax: (252-1) 225 858
\nE-mail: drdalmar@yahoo.co.uk
\nSOUTH AFRICA E
\nThe South African Medical Associa-
\ntionP.O. Box 74789, Lynnwood Rydge
\n0040 Pretoria
\nTel: (27-12) 481 2036\/2063
\nFax: (27-12) 481 2100\/2058
\nE-mail: sginterim@samedical.org
\nWebsite: www.samedical.org
\nSPAIN S
\nConsejo General de Colegios M\u00e9dicos
\nPlaza de las Cortes 11, Madrid 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, SE – 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 C.P. 170
\n3000 Berne 15
\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
\nTel: (886-2) 2752-7286
\nFax: (886-2) 2771-8392
\nE-mail: intl@med-assn.org.tw
\nWebsite: www.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: www.medassocthai.org
\nTUNISIA F
\nConseil National de l\u2019Ordre
\ndes M\u00e9decins de Tunisie
\n16, rue de Touraine
\n1002 Tunis
\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
\nSehit Danis Tunaligil Sok. N\u00b0 2 Kat 4
\nMaltepe 06570
\nAnkara
\nTel: (90-312) 231 \u20133179\/Fax: -1952
\nE-mail: Ttb@ttb.org.tr
\nWebsite: www.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 Citt\u00e0 del Vaticano
\n00120 Citt\u00e0 del Vaticano
\nTel: (39-06) 69879300
\nFax: (39-06) 69883328
\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 Medical Association
\n(VGAMP)68A Ba Trieu-Street
\nHoau Kiem District
\nHanoi
\nTel\/Fax: (84) 4 943 9323
\nZIMBABWE E
\nZimbabwe Medical Association
\nP.O. Box 3671
\nHarare
\nTel: (263-4) 791553
\nFax: (263-4) 791561
\nE-mail: zima@zol.co.zw
\n87
\nOFFICIAL JOURNAL OF
\nTHE WORLD MEDICAL
\nASSOCIATION
\nHon. Editor in Chief
\nDr. Alan J. Rowe
\nHaughley Grange, Stowmarket
\nSuffolk IP14 3QT
\nUK
\nCo-Editors
\nProf. Dr. med. Elmar Doppelfeld
\nDeutscher \u00c4rzte-Verlag
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\nAt present rate-card No. 3 a is valid.
\nThe magazine is published quarterly.
\nSubscriptions will be accepted by
\nDeutscher \u00c4rzte-Verlag or the World
\nMedical Association.
\nSubscription fee \u20ac 22,80 per annum (incl. 7 %
\nMwSt.). For members of the World Medical
\nAssociation and for Associate members the
\nsubscription fee is settled by the membership
\nor associate payment. Details of Associate
\nMembership may be found at the World
\nMedical Association website www.wma.net
\nPrinted by
\nDeutscher \u00c4rzte-Verlag
\nK\u00f6ln \u2013 Germany
\nISSN: 0049-8122
\nAdopted by the 3rd General Assembly of the World Medical Association, London, England, October
\n1949 and amended by the 22nd World Medical Assembly Sydney, Australia, August 1968 and the 35th
\nWorld Medical Assembly Venice, Italy, October 1983 and the WMA General Assembly, Pilanesberg,
\nSouth Africa, October 2006.
\nDuties of Physician in General
\nalways exercise his\/her independent professional judgment and maintain the
\nhighest standards of professional conduct.
\nrespect a competent patient\u2019s right to accept or refuse treatment.
\nnot allow his\/her judgment to be influenced by personal profit or unfair discrim-
\nination.
\nbe dedicated to providing competent medical service in full professional and
\nmoral independence, with compassion and respect for human dignity.
\ndeal honestly with patients and colleagues, and report to the appropriate authori-
\nties those physicians who practice unethically or incompetently or who engage in
\nfraud or deception.
\nnot receive any financial benefits or other incentives solely for referring patients
\nor prescribing specific products.
\nrespect the rights and preferences of patients, colleagues, and other health profes-
\nsionals.
\nrecognize his\/her important role in educating the public but should use due cau-
\ntion in divulging discoveries or new techniques or treatment through non-profes-
\nsional channels.
\ncertify only that which he\/she has personally verified.
\nstrive to use health care resources in the best way to benefit patients and their
\ncommunity.
\nseek appropriate care and attention if he\/she suffers from mental or physical illness.
\nrespect the local and national codes of ethics.
\nDuties of Physician to Patients
\nalways bear in mind the obligation to respect human life.
\nact in the patient\u2019s best interest when providing medical care.
\nowe his\/her patients complete loyalty and all the scientific resources available to
\nhim\/her. Whenever an examination or treatment is beyond the physician\u2019s capacity,
\nhe\/she should consult with or refer to another physician who has the necessary ability.
\nrespect a patient\u2019s right to confidentiality. It is ethical to disclose confidential
\ninformation when the patient consents to it or when there is a real and imminent
\nthreat of harm to the patient or to others and this threat can be only removed by
\na breach of confidentiality.
\ngive emergency care as a humanitarian duty unless he\/she is assured that others
\nare willing and able to give such care.
\nin situations when he\/she is acting for a third party, ensure that the patient has full
\nknowledge of that situation.
\nnot enter into a sexual relationship with his\/her current patient or into any other
\nabusive or exploitative relationship.
\nDuties of Physician to Colleagues
\nbehave towards colleagues as he\/she would have them behave towards him\/her.
\nNOT undermine the patient-physician relationship of colleagues in order to
\nattract patients.
\nwhen medically necessary, communicate with colleagues who are involved in the
\ncare of the same patient. This communication should respect patient confidentiality
\nand be confined to necessary information
\nWorld Medical Association International
\nCode of Medical Ethics
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nA PHYSICIAN SHALL
\nEditorial
\n88
\nproviding professional services to them
\nthrough whatever healthcare system is pro-
\nvided. What is disturbing the profession is
\nthe potential risk that the non-medical
\nmembers appointed by government to \u201crep-
\nresent the consumer interest\u201d may be influ-
\nenced by the views of the governments who
\nappoint them or by their appointed advisers,
\nthus diluting the professional voice of the
\nmain body of physicians, whose ethical and
\nprofessional duty is to ensure that impartial
\ninformed clinical and not political consider-
\nations are the basis of advice and action by
\nphysicians in the best interests of their
\npatients. This would be of particular con-
\ncern if the balance between professional
\nand lay members were at or near parity and
\na deciding vote rested with a President,
\nwhose independence might be compro-
\nmised through his appointment by one of
\nthe parties or by government , rather than
\none appointed through the expressed wish-
\nes of the majority of both elements of the
\nRegulating Body, professional and lay, e.g.
\na senior member of the judiciary..
\nWhilst these concerns may appear to be
\nunwarranted, they are very real and are not
\nreflections of opposition to any reform of
\nlong established traditions. Indeed, physi-
\ncians are increasingly aware of the need to
\nensure that professional competence should
\nensure that the best possible quality of med-
\nical care provided by physicians is main-
\ntained throughout active professional life,
\nreaffirmed from time to time by continuing
\nprofessional development, re-accreditation
\nand licensing, as appropriate .Such trends
\nare actively being pursued in a number of
\ncountries. What is essential is that necessary
\nappropriate change is achieved through
\nopen transparent productive dialogue
\nbetween the medical profession and the
\nother interested parties, be they consumers
\nor healthcare providing agencies, both gov-
\nernmental or non-governmental. In this way
\nthe primary role of physicians, in preven-
\ntive, diagnostic, therapeutic, advisory roles
\nor as advocates of the healthcare interests of
\nindividual patients and communities, can be
\nmaintained by appropriate regulatory bod-
\nies established for this purpose.
\nAs already indicated, it is just and proper
\nfor the views of the community (who use
\nand finance health care services), through
\nEditorial
\nRegulation and Self-Regulation
\nof the medical profession
\nAt the General Assembly of the WMA, held in Pilansberg, South Africa, NMAs gave
\nexpression to their concerns on a number of topics of which they felt WMA should be
\naware. Two NMAs opened the discussions by expressing their disquiet at the increasing
\nintrusion of governmental and healthcare authorities in the self regulation of the medical
\nprofession.
\nThis trend has most recently been led notably by the English speaking countries, as, for
\nexample, by the United Kingdom in the development of its body regulating the medical
\nprofession. In the UK, this is the General Medical Council, in which, for many years the
\nChief Medical Officers England, Northern Ireland and Scotland and Wales, as government
\nofficials, were ex-officio members of the Council (*). Over the past few decades however,
\ninitially a small number of Lay members were appointed to the Council. Then, in the more
\nrecent reforms, the number of these has been increased and it has been suggested that there
\nshould not be a majority of the medical profession in the regulating body. Appointed Lay
\nmembers, as well as the physicians elected by the profession, all play their part in the activ-
\nities of the Council, including disciplinary hearings. The fundamental argument for all of
\nthis is the concern that the views of the consumers of healthcare professional services
\nshould be represented in the regulation of the professional providers of medical services.
\nSelf-regulation was commented on in the World Health Organisation Report 2006 on
\nHuman Health Resources in which, while recognising that self-regulation could and had
\nworked well in a number of Member States and also setting out reasons why it had not
\nworked well in others, the author(s) did not recommend that self-regulation of the profes-
\nsion be further developed. Commenting on changing trends in the role of governments, led
\nby pressures for universal access and financial protection in relation to healthcare services,
\nthey write \u201cRather than relying on one single regulatory monopoly, national health work-
\nforce strategies should insist on cooperative governing e.g. between professional organisa-
\ntions-self-regulatory professional organisations\u201d indicating professional organisations deal-
\ning with entry to the professions, ethics, sanctions and training; institutional regulators
\n(social health insurance\/state managed employment contracts etc.) and civil organisations
\n(relating to protecting the interests of citizens), and the behaviour of healthcare institutions,
\nall as players influencing the behaviour of healthcare institutions and workers. (1)
\nIt should be noted that, whilst in a number of countries regulation is not delegated by
\nMinisters to self-regulating bodies such as the elected Medical Orders or Councils, in such
\ncountries the internal disciplinary determinations of the Medical Orders, Councils etc com-
\nprising elected professional peers (commonly with legal advisers), frequently tend to play
\nsome role in disciplinary and regulatory procedures. Indeed in some cases, decisions, other
\nthan withdrawing the licence to practice (although in a number of countries including sus-
\npension or withdrawal of the licence) rest with these bodies. In others, where the jurisdic-
\ntion lies with special courts, the profession is present in a statutory role as advisers to the
\njudge considering the matter. (2)
\nThere is little doubt that, in future, the age of absolute autonomy of the physician who is
\nlicensed to provide medical services to the public (which through social security\/healthcare
\nsystems consume a considerable part of GNP) will be modified, to permit lay representa-
\ntion in the regulating and licensing bodies.. In the age of consumerism there is a demand
\nthat the voice of consumers should play a role in the regulation of the standards of those
\nEditorial
\n89
\nappropriate government or other lay mem-
\nbers of the public, to play some part in
\napproving the standards of care and behav-
\niour of those providing medical services.
\nBut once these have been approved, the
\njudgement of whether or not these standards
\nhave been breached or abused should prop-
\nerly be left to the judgement of professional
\npeers and judged strictly by the agreed stan-
\ndards of conduct, having regard to all the
\nrelevant circumstances.
\nIn a paper on \u201cThe teaching of medicine as
\na service of healing\u201d, (3) the authors write
\n\u201cThe profession\u2019s desire for autonomy is
\npredicated on its promise to police itself in
\nthe public interest. These legal measures
\n(laws governing registration and licensing
\nin UK,USA and other English speaking
\ncountries) granted medicine a broad
\nmonopoly over healthcare \u2013 along with the
\nunderstanding that in return, medicine
\nwould concern itself with the health prob-
\nlems of the society it served and would
\nplace the welfare of society above its own.\u201d.
\nThey continue \u201cThe primary obligation as a
\nphysician is to act as a \u201chealer\u201d, but society
\nhas chosen professional status as the way to
\norganise the activities required from medi-
\ncine and entrusted to the profession\u201d.
\nIn the changing modern world, where
\nadvances in knowledge and the ability to
\nintervene in both life-threatening and
\nchronic diseases has hugely increased,
\n(with consequent changes in management
\nand treatment now requiring substantial
\nteamwork with other professionals rather
\nthan individual action), some change in the
\nregulation of the profession is inevitable.
\nNevertheless, the concerns expressed above
\nwhich are\u201d in the best interests of patients\u201d
\nneed to be met, not substantially jettisoned
\nin an enthusiastic rapid \u201cpolitically correct\u201d
\nresponse to the changing circumstances of
\nthe 21st century.
\nIn order to face up to these challenges the
\nmedical profession needs to inform the gen-
\neral public not only of nature of the prob-
\nlems, but also of the threat to the freedom of
\nphysicians to provide them with indepen-
\ndent impartial best advice, uninfluenced by
\nthe constraints imposed by political consid-
\nerations or the perceived need for instant
\nreactions to particular circumstances. At the
\nsame time the responsibilities outlined
\nabove, on which clinical autonomy and the
\nright to give the best advice in the interest
\nof the patient is granted, must be seen to be
\nproperly governed by the regulating body, if
\nthe \u201cself-disciplining\u201d of the profession is
\nto be retained.
\nAlan Rowe
\n* The National Chief Medical Officers
\n(CMOs) were represented by the Chief
\nMedical Officer of England plus the CMO of
\neither Scotland, Northern Ireland or Wales in
\nalternation.
\n(1) Working together for Health. World Health
\nReport 2006, 121-124 Geneva
\n(2) Rowe A, Garcia-Barbero M, Regulation and
\nLicensing of Physicians in the European
\nRegion, WHO (2005) p. 21-22. WHO
\nCopenhagen. WHOLIS number
\nEUR\/05\/5051794
\n(3) Creuss R and S \u201cTeaching medicine as a pro-
\nfession in the service of Healing\u201c Acad. Med.
\n1997,72,941-52.
\n(See also page 106)
\nWHO new Director General
\nDr. Margaret Chan has been appointed as the new Director
\nGeneral of the World Health Organisation. Dr. Chan was
\nearlier Director of Health for Hong Kong and she joined
\nWHO in 2003. Prior to her appointment as Director
\nGeneral she was Assistant Director General for
\nCommunicable Diseases and Representative of the Director
\nGeneral for Pandemic Influenza. (for further details see page
\n110)
\nDespite the huge international outcry and
\nthe accumulated scientific evidence follow-
\ning the original outrageous decision con-
\ncerning the accused during their first trial,
\nin a second trial, in what has been described
\nas \u201ca highly politicised retrial and a
\ngrotesque miscarriage of justice\u201d the death
\nsentence has been imposed by a Libyan
\nJudge.
\nThe overwhelming scientific evidence, not
\nonly of Montagnier \u2013 the discoverer of the
\nHIV \u2013 who stated that the virus was active
\nin the hospital before those accused started
\nto work there, and the most recent report of
\nthe Oxford Team on the Genetic history of
\nthe genetic subtype of the HIV virus from
\nthe infected children, has been disregarded
\nby the court.
\nLibyan Court Decision on Bulgarian
\nDoctor and Nurses
\nDr. Andr\u00e9 Wynen honoured
\nThe World Medical Association\u2019s Secretary-General Emeritus, Dr.
\nAndr\u00e9 Wynen has been honoured by his appointment as Grand
\nOfficier de l\u2019Ordre de Leopold, in recognition of his work and role
\nas Founder and Former President of the Chambres Syndicales des
\nM\u00e9decins Belges, Secretary General of the World Medical
\nAssociation and President of the Groupe Memoire.
\nMedical Ethics and Human Rights
\n90
\nIn a joint statement about the decision by
\nthe Libyan court, the International Council
\nof Nurses and the World Medical
\nAssociation said:
\n\u201cWe are appalled by the decision of the
\nLibyan court to sentence the five Bulgarian
\nnurses and the Palestinian doctor to death.
\nToday\u2019s decision turns a blind eye to the sci-
\nence and evidence that points clearly to the
\nfact that these children were infected well
\nbefore the medical workers arrived at the
\nhospital.
\nHow many children will go on dying in
\nLibyan hospitals while the Government
\nignores the root of the problem?
\nIf there is any hope of justice for these nurs-
\nes and this doctor, we appeal to the Supreme
\nCourt to again quash these death sen-
\ntences.\u201d
\nAs indicated above an appeal is to be
\nlodged once again and the Libyan Justice of
\nMinister, has been reported as saying
\n\u201cThere could be a complete revision of the
\ncase\u201d. From the comments emanating from
\nthe rest of the world notably in the West, the
\noutcome of such review is likely to be more
\ndiplomatic or political rather than ensuring
\njustice to the accused and a verdict, based
\non all the evidence.
\nThe whole medical profession and the rest
\nof the civilised world must surely be horri-
\nfied at this barbaric decision which clearly
\nflies in the face of the evidence and trans-
\nparent impartial administration of justice.
\n(see also Secretary General\u2019s comment
\np. 106)
\nWMA Policy Revision
\nWhilst it has not previously been our custom to reproduce all WMA Statements and
\nDeclaration in the Journal, readers will have noted that we have recently published revi-
\nsions to such document as the Geneva Declaration which have achieved general interna-
\ntional acceptance as setting out fundamental principles relating to human rights and med-
\nical ethics. The WMA approved the result of the fundamental review of WMA Policy doc-
\nument which has been taking place over the past two years at its General Assembly in
\nSouth Africa (see page 93). As a result we have decided to publish some of the other
\nimportant documents in their revised form in addition to listing all the documents revised
\nor archived, in addition to the new policy adopted at this General Asembly. (all policy
\ndocuments are, of course, accessible at www.wma.net) \u2013 Editor
\nAdopted by the 43rd World Medical
\nAssembly Malta, November 1991 and edi-
\ntorially revised at the 44th World Medical
\nAssembly Marbella, Spain, September
\n1992 and revised by the WMA General
\nAssembly, Pilanesberg, South Africa,
\nOctober 2006
\nPreamble
\n1. Hunger strikes occur in various contexts
\nbut they mainly give rise to dilemmas in
\nsettings where people are detained (pris-
\nons, jails and immigration detention cen-
\ntres). They are often a form of protest by
\npeople who lack other ways of making
\ntheir demands known. In refusing nutri-
\ntion for a significant period, they usually
\nhope to obtain certain goals by inflicting
\nnegative publicity on the authorities.
\nShort-term or feigned food refusals
\nrarely raise ethical problems. Genuine
\nand prolonged fasting risks death or per-
\nmanent damage for hunger strikers and
\ncan create a conflict of values for physi-
\ncians. Hunger strikers usually do not
\nwish to die but some may be prepared to
\ndo so to achieve their aims. Physicians
\nneed to ascertain the individual\u2019s true
\nintention, especially in collective strikes
\nor situations where peer pressure may be
\na factor. An ethical dilemma arises when
\nhunger strikers who have apparently
\nissued clear instructions not to be resus-
\ncitated reach a stage of cognitive impair-
\nment. The principle of beneficence urges
\nphysicians to resuscitate them but respect
\nfor individual autonomy restrains physi-
\ncians from intervening when a valid and
\ninformed refusal has been made. An
\nadded difficulty arises in custodial set-
\ntings because it is not always clear
\nwhether the hunger striker\u2019s advance
\ninstructions were made voluntarily and
\nwith appropriate information about the
\nconsequences. These guidelines and the
\nbackground paper address such difficult
\nsituations.
\nPrinciples
\n2. Duty to act ethically. All physicians are
\nbound by medical ethics in their profes-
\nsional contact with vulnerable people,
\neven when not providing therapy.
\nWhatever their role, physicians must try
\nto prevent coercion or maltreatment of
\ndetainees and must protest if it occurs.
\n3. Respect for autonomy. Physicians
\nshould respect individuals\u2019 autonomy.
\nThis can involve difficult assessments
\nas hunger strikers\u2019 true wishes may not
\nbe as clear as they appear. Any deci-
\nsions lack moral force if made involun-
\nMedical Ethics and Human Rights
\nWorld Medical Association Declaration on Hunger Strikers
\nMedical Ethics and Human Rights
\n91
\ntarily by use of threats, peer pressure or
\ncoercion. Hunger strikers should not be
\nforcibly given treatment they refuse.
\nForced feeding contrary to an informed
\nand voluntary refusal is unjustifiable.
\nArtificial feeding with the hunger strik-
\ner\u2019s explicit or implied consent is ethi-
\ncally acceptable.
\n4. \u2018Benefit\u2019 and \u2018harm\u2019. Physicians must
\nexercise their skills and knowledge to
\nbenefit those they treat. This is the con-
\ncept of \u2018beneficence\u2019, which is comple-
\nmented by that of \u2018non-maleficence\u2019 or
\nprimum non nocere. These two con-
\ncepts need to be in balance. \u2018Benefit\u2019
\nincludes respecting individuals\u2019 wishes
\nas well as promoting their welfare.
\nAvoiding \u2018harm\u2019 means not only min-
\nimising damage to health but also not
\nforcing treatment upon competent peo-
\nple nor coercing them to stop fasting.
\nBeneficence does not necessarily
\ninvolve prolonging life at all costs, irre-
\nspective of other values.
\n5. Balancing dual loyalties. Physicians
\nattending hunger strikers can experi-
\nence a conflict between their loyalty to
\nthe employing authority (such as prison
\nmanagement) and their loyalty to
\npatients. Physicians with dual loyalties
\nare bound by the same ethical principles
\nas other physicians, that is to say that
\ntheir primary obligation is to the indi-
\nvidual patient.
\n6. Clinical independence. Physicians must
\nremain objective in their assessments
\nand not allow third parties to influence
\ntheir medical judgement. They must not
\nallow themselves to be pressured to
\nbreach ethical principles, such as inter-
\nvening medically for non-clinical rea-
\nsons.
\n7. Confidentiality. The duty of confiden-
\ntiality is important in building trust but
\nit is not absolute. It can be overridden if
\nnon-disclosure seriously harms others.
\nAs with other patients, hunger strikers\u2019
\nconfidentiality should be respected
\nunless they agree to disclosure or unless
\ninformation sharing is necessary to pre-
\nvent serious harm. If individuals agree,
\ntheir relatives and legal advisers should
\nbe kept informed of the situation.
\n8. Gaining trust. Fostering trust between
\nphysicians and hunger strikers is often
\nthe key to achieving a resolution that
\nboth respects the rights of the hunger
\nstrikers and minimises harm to them.
\nGaining trust can create opportunities to
\nresolve difficult situations. Trust is
\ndependent upon physicians providing
\naccurate advice and being frank with
\nhunger strikers about the limitations of
\nwhat they can and cannot do, including
\nwhere they cannot guarantee confiden-
\ntiality.
\nGuidelines For The
\nManagement Of Hunger
\nStrikers
\n9. Physicians must assess individuals\u2019
\nmental capacity. This involves verifying
\nthat an individual intending to fast does
\nnot have a mental impairment that
\nwould seriously undermine the person\u2019s
\nability to make health care decisions.
\nIndividuals with seriously impaired
\nmental capacity cannot be considered to
\nbe hunger strikers. They need to be
\ngiven treatment for their mental health
\nproblems rather than allowed to fast in a
\nmanner that risks their health.
\n10. As early as possible, physicians should
\nacquire a detailed and accurate medical
\nhistory of the person who is intending to
\nfast. The medical implications of any
\nexisting conditions should be explained
\nto the individual. Physicians should ver-
\nify that hunger strikers understand the
\npotential health consequences of fasting
\nand forewarn them in plain language of
\nthe disadvantages. Physicians should
\nalso explain how damage to health can
\nbe minimised or delayed by, for exam-
\nple, increasing fluid intake. Since the
\nperson\u2019s decisions regarding a hunger
\nstrike can be momentous, ensuring full
\npatient understanding of the medical
\nconsequences of fasting is critical.
\nConsistent with best practices for
\ninformed consent in health care, the
\nphysician should ensure that the patient
\nunderstands the information conveyed
\nby asking the patient to repeat back
\nwhat they understand.
\n11. A thorough examination of the hunger
\nstriker should be made at the start of the
\nfast. Management of future symptoms,
\nincluding those unconnected to the fast,
\nshould be discussed with hunger strik-
\ners. Also, the person\u2019s values and wish-
\nes regarding medical treatment in the
\nevent of a prolonged fast should be
\nnoted.
\n12. Sometimes hunger strikers accept an
\nintravenous saline solution transfusion
\nor other forms of medical treatment. A
\nrefusal to accept certain interventions
\nmust not prejudice any other aspect of
\nthe medical care, such as treatment of
\ninfections or of pain.
\n13. Physicians should talk to hunger strik-
\ners in privacy and out of earshot of all
\nother people, including other detainees.
\nClear communication is essential and,
\nwhere necessary, interpreters uncon-
\nnected to the detaining authorities
\nshould be available and they too must
\nrespect confidentiality.
\n14. Physicians need to satisfy themselves
\nthat food or treatment refusal is the indi-
\nvidual\u2019s voluntary choice. Hunger strik-
\ners should be protected from coercion.
\nPhysicians can often help to achieve
\nthis and should be aware that coercion
\nmay come from the peer group, the
\nauthorities or others, such as family
\nmembers. Physicians or other health
\ncare personnel may not apply undue
\npressure of any sort on the hunger strik-
\ner to suspend the strike. Treatment or
\ncare of the hunger striker must not be
\nconditional upon suspension of the
\nhunger strike.
\n15. If a physician is unable for reasons of
\nconscience to abide by a hunger strik-
\ner\u2019s refusal of treatment or artificial
\nfeeding, the physician should make this
\nclear at the outset and refer the hunger
\nstriker to another physician who is will-
\ning to abide by the hunger striker\u2019s
\nrefusal.
\n16. Continuing communication between
\nphysician and hunger strikers is critical.
\nPhysicians should ascertain on a daily
\nbasis whether individuals wish to con-
\ntinue a hunger strike and what they want
\nMedical Ethics and Human Rights
\n92
\nto be done when they are no longer able
\nto communicate meaningfully. These
\nfindings must be appropriately recorded.
\n17. When a physician takes over the case, the
\nhunger striker may have already lost
\nmental capacity so that there is no oppor-
\ntunity to discuss the individual\u2019s wishes
\nregarding medical intervention to pre-
\nserve life. Consideration needs to be
\ngiven to any advance instructions made
\nby the hunger striker. Advance refusals
\nof treatment demand respect if they
\nreflect the voluntary wish of the individ-
\nual when competent. In custodial set-
\ntings, the possibility of advance instruc-
\ntions having been made under pressure
\nneeds to be considered. Where physi-
\ncians have serious doubts about the indi-
\nvidual\u2019s intention, any instructions must
\nbe treated with great caution. If well
\ninformed and voluntarily made, howev-
\ner, advance instructions can only gener-
\nally be overridden if they become invalid
\nbecause the situation in which the deci-
\nsion was made has changed radically
\nsince the individual lost competence.
\n18. If no discussion with the individual is
\npossible and no advance instructions
\nexist, physicians have to act in what they
\njudge to be the person\u2019s best interests.
\nThis means considering the hunger strik-
\ners\u2019 previously expressed wishes, their
\npersonal and cultural values as well as
\ntheir physical health. In the absence of
\nany evidence of hunger strikers\u2019 former
\nwishes, physicians should decide
\nwhether or not to provide feeding, with-
\nout interference from third parties.
\n19. Physicians may consider it justifiable to
\ngo against advance instructions refusing
\ntreatment because, for example, the
\nrefusal is thought to have been made
\nunder duress. If, after resuscitation and
\nhaving regained their mental faculties,
\nhunger strikers continue to reiterate
\ntheir intention to fast, that decision
\nshould be respected. It is ethical to
\nallow a determined hunger striker to die
\nin dignity rather than submit that person
\nto repeated interventions against his or
\nher will.
\n20. Artificial feeding can be ethically
\nappropriate if competent hunger strikers
\nagree to it. It can also be acceptable if
\nincompetent individuals have left no
\nunpressured advance instructions refus-
\ning it.
\n21. Forcible feeding is never ethically
\nacceptable. Even if intended to benefit,
\nfeeding accompanied by threats, coer-
\ncion, force or use of physical restraints
\nis a form of inhuman and degrading
\ntreatment. Equally unacceptable is the
\nforced feeding of some detainees in
\norder to intimidate or coerce other
\nhunger strikers to stop fasting. \u25a0
\nThe World Health Organization was urged
\nresearch institutions and companies to reg-
\nister all medical studies that test treatments
\non human beings, including the earliest
\nstudies, whether they involve patients or
\nhealthy volunteers. As part of the
\nInternational Clinical Trials Registry
\nPlatform, a major initiative aimed at stan-
\ndardizing the way information on medical
\nstudies is made available to the public
\nthrough a process called registration, WHO
\nis also recommending that 20 key details be
\ndisclosed at the time studies are begun.
\nThe initiative seeks to respond to growing
\npublic demands for transparency regarding
\nall studies applying interventions to human
\nparticipants, known as clinical trials. Before
\nmaking the recommendations, the Registry
\nPlatform initiative consulted with all con-
\ncerned stakeholders, including representa-
\ntives from the pharmaceutical, biotechnolo-
\ngy and device industries, patient and con-
\nsumer groups, governments, medical jour-
\nnal editors, ethics committees, and acade-
\nmia over a period of nearly two years.
\n\u201cRegistration of all clinical trials and full
\ndisclosure of key information at the time of
\nregistration are fundamental to ensuring
\ntransparency in medical research and fulfill-
\ning ethical responsibilities to patients and
\nstudy participants,\u201c said Dr Timothy Evans,
\nAssistant Director-General of the World
\nHealth Organization.
\nAlthough registration is voluntary, there is a
\ngroundswell of policies aimed at spurring
\nregistration of all clinical trials. In July
\n2005, for example, the International
\nCommittee of Medical Journal Editors, a
\ngroup representing 11 prestigious medical
\njournals, instituted a policy whereby a sci-
\nentific paper on clinical trial results cannot
\nbe published unless the trial had been
\nrecorded in a publicly-accessible registry at
\nits outset.
\nSome groups have raised concerns that
\nthese new requirements could jeopardize
\nacademic or commercial competitive
\nadvantage if they apply to preliminary trials
\nof new interventions. Similar concerns have
\nbeen voiced about the requirement to dis-
\nclose certain items–such as the scientific
\ntitle of the study, the name of the treatment
\nbeing tested and the outcomes expected
\nfrom the study–at the time of registration.
\n\u201cOur aim is to make clinical research trans-
\nparent and enhance public trust in science,
\nbut we are engaged in a fair and open
\nprocess with all stakeholders. We look for-
\nward to continued dialogue about trial reg-
\nistration and results reporting as we move
\nforward with the Registry Platform,\u201c said
\nDr Ida Sim, Associate Director for Medical
\nInformatics at the University of California,
\nSan Francisco and coordinator of the
\nRegistry Platform initiative.
\nWHO announces new standards for
\nregistration of all human medical research
\nWMA
\n93
\nThe planned Registry Platform will not be a
\nregister itself, but rather will provide a set
\nof standards for all registers. It has not only
\nstandardized what must be reported to reg-
\nister a trial but is creating a global trial iden-
\ntification system that will confer a unique
\nreference number on every qualified trial.
\nCurrently, there are several hundred regis-
\nters of clinical trials around the world but
\nlittle coordination among them. The
\nRegistry Platform seeks to bring participat-
\ning registers together in a global network to
\nprovide a single point of access to the infor-
\nmation stored in them.
\nThe WHO Registry Platform will launch a
\nweb-based search portal where scientists,
\npatients, doctors and anyone else who is
\ninterested can search among participating
\nregisters for clinical trials taking place or
\ncompleted throughout the world. \u25a0
\nAdopted by the 48th WMA General
\nAssembly, Somerset West, Republic of
\nSouth Africa, October 1996, and editorially
\nrevised at the 174th Council Session,
\nPilanesberg, South Africa, October 2006.
\nRecognising that:
\n1. The physician has an obligation to pro-
\nvide his or her patients with competent
\nmedical service and to report to the
\nappropriate authorities those physicians
\nwho practice unethically and incompe-
\ntently or who engage in fraud or decep-
\ntion (International Code of Medical
\nEthics); and
\n2. The physician should be free to make
\nclinical and ethical judgements without
\ninappropriate outside interference; and
\n3. Ethics committees, credentials commit-
\ntees and other forms of peer review have
\nbeen long established, recognised and
\naccepted by organised medicine to scru-
\ntinise physicians\u2019 professional conduct
\nand, where appropriate, impose reason-
\nable restrictions on the absolute profes-
\nsional freedom of physicians; and
\nReaffirming that:
\n4. Professional autonomy and the duty to
\nengage in vigilant self-regulation are
\nessential requirements for high quality
\ncare and therefore are patient benefits
\nthat must be preserved;
\n5. And, as a corollary, the medical profes-
\nsion has a continuing responsibility to
\nsupport, participate in, and accept appro-
\nWMA Statement On Professional Responsibility
\nFor Standards Of Medical Care
\npriate peer review activity that is con-
\nducted in good faith;
\nPosition
\n6. A physician\u2019s professional service
\nshould be considered distinct from com-
\nmercial goods and services, not least
\nbecause a physician is bound by specific
\nethical duties, which include the dedica-
\ntion to provide competent medical prac-
\ntice (International Code of Medical
\nEthics).
\n7. Whatever judicial or regulatory process
\na country has established, any judgement
\non a physician\u2019s professional conduct or
\nperformance must incorporate evalua-
\ntion by the physician\u2019s professional
\npeers who, by their training and experi-
\nence, understand the complexity of the
\nmedical issues involved.
\n8. Any procedure for considering com-
\nplaints from patients which fails to be
\nbased upon good faith evaluation of the
\nphysician\u2019s actions or omissions by the
\nphysician\u2019s peers is unacceptable. Such a
\nprocedure would undermine the overall
\nquality of medical care provided to all
\npatients. \u25a0
\nGeneral Assembly Ceremonial Session
\nThe General Assembly Ceremonial Session
\nwas opened by the Chair of Council,
\nDr. Yoram Blachar, following which the
\nofficial delegates from member states were
\nintroduced to the President by the Secretary
\nGeneral.
\nThe President of the South African Medical
\nAssociation, Dr. J.P. Niekerk, in welcoming
\nparticipants, made reference to a statement
\nmade by Archbishop Tutu that, while the
\nChurch must not be an organ of the State it
\nmust be the conscience of the State, like-
\nwise, National Medical Associations must
\nserve as the medical conscience of the State.
\nHon. Edna Molewa, Premier of the North
\nWest Province was then introduced by the
\nPresident, Dr. Letlape. Welcoming dele-
\ngates to South Africa, she made reference to
\nWorld Medical Association
\nWorld Medical Association 57th General
\nAssembly, Pilansberg, South Africa,
\n13\u201314 October 2006
\nWMA
\n94
\nthe final report of the outgoing Secretary
\nGeneral of the United Nations, Kofi Anan,
\nin which he emphasized the need for global
\npartnerships and improved coordination
\nand cooperation between nations She said
\nthat the WMA was exactly the kind of
\norganisation needed to achieve this goal.
\nThe world has an ambitious agenda in the
\nMillenium Development Goals. The health
\nprofession must lead the way, helping gov-
\nernments to understand that investing in
\nhealth is critical. NMAs must be partners
\nwith governments in this regard, so that
\nbudgets, policies and programmes ade-
\nquately prioritise the health of citizens.
\nAlongside this priority must be a concerted
\neffort to address the complex and multidi-
\nmensional problems of poverty. The rela-
\ntionship between poverty and disease
\nmeans that meeting this challenge is a mat-
\nter of life and death. The Premier encour-
\naged the General Assembly to examine
\nspecifically the problems created by med-
\nical migration, noting that Africa was suf-
\nfering the effects of aggressive recruitment
\nof physicians from wealthy countries. She
\nconcluded by stating that there is no invest-
\nment more important than the investment in
\nhealth and that the world\u2019s physicians must
\nwork with decision makers to ensure its
\nhigh placement in national agendas.
\nPresentation of Past-President\u2019s Medal
\nThe Chair of Council,Dr. Blachar, paying
\ntribute to the outgoing President of the
\nWMA, Dr. Kgosi Letlape said:
\n\u201cIt is with great admiration that I look back
\nupon Dr. Letlape\u2019s career and various
\nachievements. Graduating MB., ChB at the
\nUniversity of Natal and then pursuing his
\nspecialist training in Ophthalmology in
\nEdinburgh, Scotland, Dr. Letlape became
\nthe first black South African ophthalmolo-
\ngist in 1988, at a troubling time for the
\nnation of South Africa which was at the
\nheight of its Apartheid era.
\nSince being elected chairperson of the
\nSouth African Medical Association in 2001,
\na position he still holds today, he has dili-
\ngently worked towards providing public
\nhealthcare for the 38 million South Africans
\nwho cannot afford private funding.
\nIn his attempts to address the HIV\/AIDS
\nepidemic and erase the stigma attached to
\nthe disease, he spearheaded the establish-
\nment of the Tschepang Trust in 2002,
\ntogether with the Nelson Mandela
\nFoundation. The trust facilitates the treat-
\nment of HIV-positive patients at specific
\ncentres all over South Africa. Dr. Letlape
\nhas also been outspoken on the issue of the
\nso-called \u201cBrain Drain\u201d phenomenon,
\nadvocating the improvement of working
\nconditions in order to retain doctors, partic-
\nularly those working in public health sys-
\ntems.
\nAs part of the WMA, he served on the
\nworking group for one of the WMA\u2019s most
\nrenowned documents, the Declaration of
\nHelsinki. Along with former WMA
\nSecretary General Dr. Delon Human, he has
\nmade tremendous headway in the founding
\nof the African Regional WMA offices,
\nwhich will be holding their first annual
\nmeeting next January. Dr. Letlape has
\nrelentlessly worked to bring together the
\nvarious African Medical Associations, for
\nthe purpose of getting Africa\u2019s endemic
\nhealth problems placed on the international
\nhealth agenda. The grave disparities in
\nhealthcare can now be addressed at interna-
\ntional level. As President of the WMA he
\nhas been vocal in his support for including
\nTaiwan in the WHO, in order to forge a
\nglobal health system that can bypass poli-
\ntics and help countries around the world
\nprepare for and cope with pandemics. He
\nhas been equally outspoken on the topic of
\nmedical professionalism whereby he main-
\ntains that physicians should always work in
\nthe best interests of their patients, as well as
\ntraining doctors to be good leaders in their
\ncommunities.\u201d
\nDr. Blachar formally thanking Dr. Letlape
\non behalf of the World Medical Association,
\nthen presented Dr. Letlape with a Past
\nPresident\u2019s Medal and invited him to deliv-
\ner his Valedictory Address.
\nValedictory Adress Of
\nDr. K. Letlape
\nIn his Valedictory Address, Dr. Letlape first
\nexpressed his gratitude to the organisation
\nand its members for the privilege of serving
\nthem. Continuing, he asserted that the
\nWMA must be the global champion of basic
\nhealth care for all, free at the point of deliv-
\nery and called for an increased emphasis on
\npubic health globally. Physicians must
\nengage in social and community affairs,
\ndirectly influencing policy to the greatest
\nextent possible. This includes involvement
\nin areas such as working to prevent armed
\nconflict, which is within the portfolio of the
\nhealth profession because of the devastating
\neffect of war on human health and on
\nnational health systems. The profession
\nmust not accept limited health care
\nresources as an unfortunate fact of human
\nlife. Dr. Letlape stated that \u201cWe must bake
\na bigger cake and ensure that it is shared
\nequitably\u201d. This will require resourceful-
\nness and leadership across medical disci-
\nplines. There must be commitment by
\neveryone to be part of the solution to the
\nglobal medical human resources problem.
\nModern medicine must represent progress
\nacross all boundaries, engaging stakehold-
\ners at all levels, from national governments
\nto patients.
\nInstallation of President
\nDr. N. Araguman of the Malaysian Medical
\nAssociation, who had been elected by the
\n2005 General Assembly, then took the
\nPresidential Oath and was installed as the
\n58th President of the World Medical associ-
\nation.
\nPresidential Address Of The
\nNew President,
\nDr. N. Arumugam
\n\u201cIt is a great honour and privilege to be
\nelected as the President of the World
\nMedical Association. I would like to thank
\nyou for electing me and giving me the
\nopportunity to serve as the president of the
\nassociation.
\nThe WMA in its mission statement clearly
\nstates the objective to provide a forum for
\nits member associations to communicate
\nfreely, to co-operate actively, to achieve
\nconsensus on high standards of medical
\nethics and professional competence, and to
\npromote the professional freedom of physi-
\nWMA
\n95
\ncians worldwide. The WMA is committed
\nto serve humanity by endeavouring to
\nachieve the highest international standards
\nin Medical Education, Medical Science,
\nMedical Art, Medical Ethics, and Health
\nCare for all people in the world.
\nThe Association has been led by a series of
\ndistinguished presidents who have promot-
\ned the ideals of the WMA. Dr. Kgosi
\nLetlappe has continued in this tradition and
\non his visits to numerous national medical
\nassociation meetings, he has in his fervent
\nspeeches appealed to the membership for
\nstrong commitment to the profession and
\nemphasised the importance of being united
\nand proactive. Dr.Yank Coble the immedi-
\nate past president over the last couple of
\nyears, has through the \u201cCaring Physicians
\nof the World\u201d initiative organised regional
\nmeetings in different parts of the world to
\nbring the different associations of the vari-
\nous regions together to communicate and
\nlearn from one another. I would like to
\nthank The South African Medical
\nAssociation, especially the organising com-
\nmittee, for having successfully organised
\nthis year\u2019s meetings and social events. I
\nwould also like to thank Dr. Otmar Kloiber
\nthe Secretary General and the WMA secre-
\ntariat for their committed service and
\nsmooth running of the General Assembly.
\nThe World Medical Association which was
\nestablished after the Second World War by
\ntwenty seven national medical associations,
\nnow has a membership of over eighty
\nnational medical associations. Recognising
\nthe need to draw more of the many non-
\nmember nations, the council, after much
\ndeliberation, has revamped and streamlined
\nthe subscriptions payable by member
\norganisations depending on economic status
\nof the country. It is earnestly hoped that this
\nwill help to draw more national associations
\nto join the WMA in the coming years, and
\nboost the strength of the WMA and help to
\nenhance the cause of medicine.
\nIn any large organisation generally, the big-
\nger and more vocal members will tend to
\ndominate discussion and influence. The
\nestablishment of the recent regional meet-
\nings should provide opportunities and impe-
\ntus for the smaller member national associ-
\nations to play a more active role in the
\naffairs of the WMA. As universal participa-
\ntion is a necessity for any healthy organisa-
\ntion in the coming year, I will work with
\ncouncil to find ways to stimulate contribu-
\ntion of some of the dormant and smaller
\nmembers of the association.
\nMany National Medical Associations are
\nunable to allot sufficient time to the con-
\ncerns and activities of the WMA as they
\nhave their own demanding schedules and
\nactivities. Many individual physicians of
\nNational Medical Associations (NMAs) are
\nnot aware of the workings and the signifi-
\ncance of the WMA. Physicians nowadays
\nbelong to many different medical societies,
\nespecially specialist\/subspecialty societies
\nrelated directly to their work and they do
\nnot see the immediate relevance of the
\nWMA. It is important for the development
\nand the importance of the WMA that
\nnational associations highlight the activities
\nof the WMA in their newsletters, their web-
\nsites and in their activities whenever possi-
\nble. It is also necessary to have prominent
\nvisible links to the WMA website in the
\nhomepages of member organisations. I
\ntherefore strongly urge all of you to incor-
\nporate the activities of the WMA in as many
\nways as possible in the activities of your
\nnational associations, thus making the
\nWMA more visible to the physicians of the
\nworld.
\nEthics derived from a basic view of human-
\nity, has been part of medical practice from
\nthe beginning. Ethical medical practice
\nrefers to the appropriate treatment of a
\npatient, maintaining a high standard of
\nmedical ability and skills with a caring and
\nmoral obligation. Doctors are taught to be
\ndedicated to the service of humanity and
\nsubscribe to the caring spirit when entering
\nthe profession of medicine. Medical prac-
\ntice has attracted much criticism about
\nunsympathetic personal uncaring attitudes
\nand inappropriate treatments. That this
\nprobably applies to a small minority of doc-
\ntors compared with the huge number of
\ndoctor-patient contacts each day, gets over-
\nlooked and the profession as a whole is dis-
\ncredited.
\nThe WMA has emphasized the core values
\nof the profession of caring, ethics, science,
\ncompassion and universal accessibility.
\nOver the years the association has achieved
\nreasonable success in promoting these val-
\nues not only to the profession but also to the
\npublic and relevant authorities. During the
\nlast two years under the Caring Physicians
\nof the World initiatives doctors from vari-
\nous countries were nominated, selected, and
\nrecognised. A book published in conjunc-
\ntion with the initiative highlighted their
\ncontribution to society. This was a worthy
\nproject as it highlighted the caring aspect of
\nthe profession. To continue this initiative
\nand to motivate more doctors to follow
\nthese exemplary footsteps and to recognize
\nthose who have dedicated their life to the
\ncare of the needy it is time we institute a
\nWorld Physicians\/Doctors Day. On this day
\nthe WMA should honour a doctor from each
\nof the five regions of the world for their
\ncare, compassion and contribution to soci-
\nety. The day will help to emphasize, pro-
\nmote, develop and help to maintain the tra-
\ndition of caring.
\nSince the end of the Second World War,
\nmore than half a century ago there have
\nbeen remarkable discoveries and inventions
\nin medicine, which have led to unparalleled
\nimprovement in the health of the world pop-
\nulation. We are able to control and treat
\ndeadly infectious diseases, which were
\ncausing fatalities and unthinkable suffering
\naround the world, with newly discovered
\nmedications. Through innovative proce-
\ndures and operations we are also able to
\ncorrect congenital abnormalities and
\nacquired disabilities. The medications and
\ntreatment modalities have helped relieve
\nsuffering, improve the quality of life of the
\nindividual, the family and the nation.
\nChanges in the living standards of many
\ncountries in the world further contributed to
\nhealthier populations. Eradication of polio
\nand the discovery of medicines to treat
\ndeadly infections gave hope and optimism
\nto the people of the world that they were
\ngoing to enjoy uninterrupted improving
\ngood health.
\nThese achievements and improvements
\nseem to have been short lived and the world
\nis again faced with new epidemics and chal-
\nlenges. The health of the population of the
\nworld seems more vulnerable and more
\nhazardous than ever before in recent histo-
\nry. The last decade has not only seen emer-
\nWMA
\n96
\ngence of deadly infections like AIDS
\n(Acquired Immunodeficiency Syndrome)
\nand SARS (Severe Acute Respiratory
\nSyndrome) but also of a chronic serious epi-
\ndemic commonly termed as \u201clife style dis-
\neases\u201c. The number of patients afflicted
\nwith Obesity, Hypertension, Diabetes
\nMellitus, Dyslipidaemia and related dis-
\neases has been increasing at an alarming
\nrate the world over. This surge in life style
\ndiseases has not been confined to the
\nwealthier and more developed countries but
\nhas been spreading at an alarming rate in
\nthe developing and poorer countries. The
\ncurrent epidemic affecting people in the
\nprime of life, causes untold misery to indi-
\nviduals, families and countries. The
\nimmense drain on the financial resources of
\nfamilies and nations has jeopardised the
\ndevelopment of sustainable heath care sys-
\ntems in many countries.
\nAs life style diseases are chronic in nature
\nand progression insidious, patient\u2019s atten-
\ntion to the problem is delayed and aware-
\nness is only drawn to the disease at a late
\nstage, making it complex and expensive to
\ntreat. In many countries life style diseases
\naffect about 30% of the population, while in
\nsome it affects almost 60% of the popula-
\ntion and is rising incessantly. Researchers
\nand pharmaceutical companies are trying to
\ndevelop new therapeutic medicinal com-
\npounds to control and treat these conditions.
\nThough new medicines are necessary to
\ntreat those already afflicted, the only sus-
\ntainable solution in overcoming this epi-
\ndemic will be by concerted lifestyle
\nchanges and instituting preventive mea-
\nsures. The WMA should through its various
\nmember organisations lobby relevant
\nauthorities and governments to emphasize
\nthe necessity for change, as governments
\nare not doing enough. They have either not
\nrecognised the enormity of the problem or
\nhave been reluctant to face reality.
\nWhile many organisations have highlighted
\nthe problem there have only been limited
\nresults. It is now time for the WMA with the
\nNational Medical Associations to launch a
\nrigorous effort to stress the importance, to
\nboth the people and governments of the
\nworld, of the need for global action.
\nAdvocacy for diet modification, encourag-
\ning physical activity, anti-smoking mea-
\nsures and regular medical examination
\naimed at early preventive actions may look
\ndaunting but without the immediate institu-
\ntion of these measures the world will with-
\nin the next decade or two face such an
\nenormous problem that it will not be able to
\nhandle it.
\nThe new millennium was awaited with
\neagerness and globalisation was the buzz
\nword of the new century. Newer technolo-
\ngies especially electronic communication,
\nthe internet, the media and air travel have
\nall contributed to shrinking the world at a
\nstaggering pace. Nations were being more
\nconnected and interdependent then ever
\nbefore. International business was thriving
\nand there was high expectation for improve-
\nment of international understanding, coop-
\neration and unity in the world. Increasing
\npace of international travel, liberalisation of
\nnational borders and increasing changing
\nmigration patterns were moving the world
\ntowards to a more homogenous society.
\nSuddenly the world was shattered by events
\nnever seen before, turmoil set in and now
\nterror reigns. Ideological differences, reli-
\ngious extremism, racial confrontations, eco-
\nnomic disagreements have resulted in
\nextreme provocation and excessive retalia-
\ntions. These actions have divided the world
\nand ushered in an era of anguish and unpre-
\ndictability which has affected all of us in
\nmany ways.
\nSouth Africa, which has probably experi-
\nenced one of the most traumatic periods in
\nmodern history under the apartheid regime,
\nwas liberated after a long and protracted
\nstruggle. The liberation of South Africa and
\nthe transition to a prosperous and successful
\ndemocracy gives hope that old differences
\ncan be put aside and a new beginning bene-
\nfiting all can be established. The Centenary
\ncelebration of the start of the civil rights
\nstruggle, started by one of the pioneers in
\nthe liberation struggles in South Africa
\nMohandas Karamchand Gandhi, was held a
\nfew weeks ago here in South Africa.
\nMahatma Gandhi, as he has now come to be
\nknown, was the pioneer of Satyagraha \u2013
\nresistance through mass civil disobedience,
\nstrongly founded upon ahimsa \u2013 non-vio-
\nlence, becoming one of the strongest
\nphilosophies of freedom struggles world-
\nwide. It has been noted that Gandhi
\nremained committed to non-violence and
\ntruth, even in the most extreme situations.
\nNumerous medical groups through the
\nyears have served in areas of disasters and
\nconflicts to help the needy and suffering,
\nirrespective of their allegiance to any polit-
\nical or religious grouping. The events of the
\nlast few years should make the profession
\nreflect on its role as curing the sick and use
\nits unique position to explore the greater
\npossibility of helping to re-establish unity
\nand harmony in the world and thus healing
\nwounds of the people, both physical and
\nmental.
\nEmergencies and crisis are a part of medical
\npractice and intermittent outbreaks of epi-
\ndemics have occurred through out history.
\nWhat was new in the recent emergencies
\nwas the scale and ferocity. The world in
\ngeneral and the Asia pacific region in par-
\nticular, has experienced unprecedented
\ncalamities over the last five years. Natural
\ndisasters \u2013 Tsunami and Katrina, the epi-
\ndemics of Severe Acute Respiratory
\nSyndrome (SARS), Avian Flu, and man
\nmade environmental disasters of flood and
\nhaze \u2013 are continually threatening the health
\nof the world. Doctors and healthcare work-
\ners have always been in the frontline treat-
\ning and combating diseases with all the
\ninherent dangers. These disasters in general
\nand SARS in particular have startled and
\nalarmed the doctors and healthcare workers,
\nas many of them were struck by the illness.
\nAffected and battered countries around the
\nworld urgently announced measures to
\nreduce the health consequences after each
\nepisode. As of today, forests are being
\ndestroyed and burned blatantly contrary to
\ninternational agreements; the haze is chok-
\ning regions of the world, avian flu is smoul-
\ndering, and raging floods are causing havoc
\nin many areas. All these have not only
\ncaused major damage and hardship but have
\nexposed huge populations to a myriad of
\ndiseases. Environmental degradation in the
\nname of progress must be halted and health
\nmust be given the rightful priority it
\ndeserves.
\nThese are challenging times to practice
\nmedicine as the widening gap between what
\nWMA
\n97
\nmedicine can do today and what the indi-
\nvidual or the society can afford has shaken
\nup the fundamentals of medical practice.
\nThe changes in the last few decades espe-
\ncially in the mode of health care delivery,
\ncommercialisation of medicine and the
\ngrowing disparity of medicine in popula-
\ntions, due to the staggering cost of new
\ndevelopments, all put the doctor in an unen-
\nviable position between the patient and the
\nsystems. Increasing public demand for
\nmedical services with counter demands by
\npayers to control costs, has put tremendous
\npressure on doctors and healthcare profes-
\nsionals.
\nThe patient\u2019s quest for perfect results, often
\nnot fathoming the unpredictability of med-
\nical procedures, has put further tension on
\nthe doctors while escalating medical indem-
\nnity costs. The increasing control of the pro-
\nfession by administrators, regulatory
\nauthorities, governments and third party
\npayers, has caused much annoyance and
\nuneasiness. Private hospitals are generally
\nmanaged by commercial interests and the
\ndifference between commercial values and
\nprofessional values often leads to conflicts.
\nIt is important for doctors to be objective,
\nbalanced and keep the interest of the
\npatients foremost at all times.
\nIn spite of the uphill tasks and emerging
\nchallenges, the profession must stand and
\nwork together to achieve the best working
\nconditions for the profession while deliver-
\ning efficient and caring treatments to
\npatients.\u201d
\nThe Chair of Council, then formally
\nadjourned the session.
\nGeneral Assembly,
\nAdjourned Plenary Session
\nThe Session was formally opened by the
\nChair of Council, Dr. Y. Blachar. Apologies
\nwere received from Drs. Wynen and
\nOdenbach.
\nThe Credentials committee reported that 42
\nNMAs were registered, recognised and in
\ngood standing with full voting rights, the
\ncollective number of votes being 93.
\nAfter the adoption of Standing Orders, the
\nMinutes of the General Assembly in
\nSantiago, Chile 2005 were adopted.
\nThere were three nominations for the post
\nof President 2007-2008 and Dr. J. Snaedel
\n(Icelandic Medical Association) was elect-
\ned to this office.
\nDr. Y.D. Coble, Past President, presented an
\nupdate of the Caring Physicians of the
\nWorld initiative. He reported that WMA
\nregional meetings had been held in Africa,
\nLatin America, Europe, North America and
\nthe Asian and Pacific regions, under the
\nauspices of the project. He introduced Dr.
\nMalegapuru Makgoba, a South African
\nphysician chosen for inclusion in the CPW
\nbook and presented him with a copy of the
\nbook.
\nThe Assembly then received the Report of
\nCouncil. Under the reports of matters from
\nthe Socio-Medical Affairs and of the
\nMedical Ethics Committees the recommen-
\ndations arising from the huge review of
\nWMA statements, recommendations and
\npolicies occupied much of the time. The
\ndecisions on the recommendations for revi-
\nsion adopted are listed below. Some recom-
\nmendations involved rescinding and archiv-
\ning of previous statements. Details of the
\nrecommended changes adopted are avail-
\nable on the WMA website (www.wma.net)
\nor from the WMA office.
\nNew proposals adopted are shown in bold
\nbelow and the texts appear elsewhere in this
\nissue of the journal or the next issue. (See
\nalso page 100\u2013106)
\nSocio-Medical
\nStatement on Obesity \u2013 new (see page 107)
\nStatement on Medical Education \u2013revision
\nStatement on Adolescent Suicide \u2013revision
\nStatement on Traffic Injury \u2013 revision
\nResolution on Tuberculosis \u2013 new
\nResolution on Medical Assistance in Air
\nTravel \u2013 new
\nStatement on the Role of Physicians in
\nEnvironmental Issues \u2013 revision
\nStatement on Physicians and Public Health
\n\u2013 revision
\nStatement on Injury Control \u2013 revision
\nStatement on Access to Health Care \u2013 revi-
\nsion
\nStatement on Responsibilities of Physicians
\nin Preventing and Treating Opiate and
\nPsychotrophic Drug Abuse \u2013 revision
\nStatement on Alcohol and Road Safety \u2013
\nrevision)
\nResolution on Child Safety in Airline Travel
\n\u2013 new
\nStatement on Avian and Pandemic
\nInfluenza \u2013 new
\nMedical Ethics
\nStatement on HIV\/AIDS and the Medical
\nProfession \u2013 revision
\nResolution on Combating HIV\/AIDS \u2013 new
\nDeclaration of Venice on Terminal Illness \u2013
\nrevision
\nStatement on Human Organ Donation and
\nTransplantation \u2013 revision
\nStatement on Ethical Issues Concerning
\nPatients with Mental Illness Statement of
\nSydney \u2013 revision
\nDeclaration of Sydney on determination of
\nDeath and the recovery of Organs \u2013 revision
\nDeclaration of Oslo on Therapeutic
\nAbortion \u2013 revision
\nStatement on Assisted reproductive
\nTechnologies \u2013 new
\nStatement on Animal Use in Biomedical
\nresearch \u2013 revision
\nStatement on Medical Ethics in the event of
\nDisasters \u2013 revision
\nStatement on Child Abuse and Neglect \u2013
\nrevision
\nStatement on Patient Advocacy and
\nConfidentiality \u2013 revision
\nInternational Code of Ethics \u2013 revision (see
\npage 87)
\nDeclaration of Malta on Hunger Strikers \u2013
\nrevision (see page 90)
\nThe Secretary General noted that there had
\nbeen no discernable consensus among
\nNMAs concerning rescinding the WMA
\nResolution concerning Dr. Radovan
\nKaracic. The German Medical Association
\ninformed the Assembly that the original rea-
\nsons for adopting the resolution had not
\nchanged, Dr. Karacic had not surrendered
\nnor been captured and there had been no
\njustice for the crimes he is alleged to have
\ncommitted. The recommendation to rescind
\nand archive the Resolution Concerning Dr.
\nRadovan Karacic was not accepted by the
\nAssembly
\nWMA
\n98
\nThe following resolutions were rescinded\/
\narchived:
\nEducation: the Declaration of Rancho
\nMirage on Medical Education: Statement
\non Drug Treatment of Tuberculosis: the
\nTwelve principles of Healthcare in any
\nNational healthcare system: Use and misuse
\nof Psychotrophic drugs and on the prescrip-
\ntion of substitute drugs in the outpatient
\ntreatment of Addicts to opiate drugs.
\nAfter the Chair of Ethics had explained that
\na new document on telemedicine was being
\nprepared, the documents on Statements etc.
\nrescinded and\/or archived including the
\nFifth World Conference in Medical Use of
\ncomputer in Medicine: Statement on
\nAccountability, Responsibilities and Ethical
\nGuidelines in the Practice of Telemedicine
\nand the Statement on Home Medical
\nMonitoring, Telemedicine and Medical
\nEthics, were rescinded and archived.
\nFinance and Planning
\nIn matters relating to Finance and Planning
\nthe Assembly adopted recommendations
\nrelating to future General Assemblies
\n– that the theme for the Scientific Session of
\nthe 2007 Assembly to be held in Copen-
\nhagen should be \u201cInformation Technology
\nin Health Care\u201d
\n– that the 2009 General Assembly be held in
\nIndia.
\nThe applications for membership from the
\nMedical Association of Namibia, the
\nSamoa Medical Association and that of
\nthe Somali Medical Association were
\napproved.
\nFollowing a detailed overview of the 2005
\nFinancial Statement and the 2007 Budget,
\nboth the 2005 Statement and the 2007
\nProposed Budget were approved.
\nThe proposed amendment of the Bylaws to
\nallow a new differentiated dues structure
\naccepted in principle in 2005 in Santiago,
\nwere formally adopted and the Secretary
\nGeneral reported that the new system would
\nbe reviewed annually by Council and every
\nfive years by the General Assembly.
\nDespite some discussion as to whether the
\nproposal to impose a six year limit on the
\nnumber of consecutive years an individual
\ncan serve as Chair or Vice-Chair of Council
\nor as Treasurer should be reduced to four
\nyears, the six year proposal was adopted.
\nThe following Resolution introduced by the
\nJapan Medical Association on North
\nKorean Nuclear Testing was adopted by the
\nAssembly
\nFollowing this, the rest of the Council
\nReport was adopted.
\n(for Resolutions adopted by the Council see
\npage 99)
\nAssociate Members
\nThe Associates\u2019 members report presented
\nby Dr. Dumont, reported that in the absence
\nof Dr. Franzblau whose apologies were
\nreceived, the motions he had submitted were
\ndeferred. No new proposals from Associate
\nmembers had been received. The Associates
\nnoted that their proposal for a statement on
\n\u201cChild Safety in Airline Travel\u201d had been
\nforwarded to the Assembly for adoption.
\nDrs. Fuchs and Mot were elected as the two
\nrepresentatives. The report of the Associate
\nMembers\u2019 meeting was received.
\nOpen Session
\nDuring this session when delegates were
\ninvited to present matters of importance to
\nthe medical profession which needed to be
\nbrought to the attention of the WMA,
\nNMAs made the following points:
\nThe Hong Kong Medical Association
\nexpressed concern about the trend for gov-
\nernments to encroach on self-regulation by
\nthe medical profession. This they consid-
\nered presents a serious threat to profession-
\nal autonomy. These concerns were shared
\nby the Australian Medical Association who
\noffered to cooperate with WMA activity to
\ndefend medical professionalism.
\nThe Bolivian Medical Association reported
\nconcerns about the by-passing of standard
\naccrediting processes as a consequence of
\nan agreement between the Bolivian and
\nCuban governments. This was supported by
\nthe Spanish and Uraguayan Medical
\nAssociations. The American Medical
\nAssociation announced its intention to sub-
\nmit an emergency resolution on this topic to
\nthe Council meeting immediately following
\nthe General Assembly (see page 99).
\nThe New Zealand Medical Association, in
\nrelation to the harvesting of organs and
\ntransplantation in China, expressed concern
\nthat the core issue, namely that informed
\nconsent cannot be obtained from con-
\ndemned prisoners, was being lost in the
\nWMA\u2019s diplomatic approach to the prob-
\nlem. It felt that the Chinese Medical
\nAssociation should publicise the position
\ntaken that condemned prisoners are in no
\nposition to give informed consent, and pro-
\nvide evidence of its efforts to educate its
\nmembers of this fact. The Chair of Council
\ninformed the Assembly that a WMA delega-
\ntion will meet with members of the Chinese
\nMedical Association to discuss many sub-
\njects, with the hope that the outcome of the
\nmeeting would be a documented mutual
\nagreement or memorandum, which would
\nbe presented to Council at its next session.
\nThe Phillipine Medical Association
\ninformed the General Assembly that the
\npresent health care budget in their country
\nwas less than 1% of GDP. This underinvest-
\nWorld Medical Association
\nResolution On North
\nKorean Nuclear Testing
\nAdopted by the WMA General
\nAssembly, Pilanesberg, South Africa,
\nOctober 2006
\n\u201cRECALLING the WMA Declaration
\non Nuclear Weapons adopted at the
\nWMA General Assembly in Ottawa,
\nCanada, in October 1998; the WMA:
\nDenounces North Korean nuclear testing
\nconducted at a time of heightened global
\nvigilance on nuclear testing and arsenals;
\n1) Calls for the immediate abandonment
\nof the testing of nuclear weapons; and
\n2) Requests all member National
\nMedical Associations to urge their
\ngovernments to understand the
\nadverse health and environmental
\nconsequences of the testing and use
\nof nuclear weapons.\u201d
\nWMA
\n99
\nment was compromising patient care. It has
\nresulted in massive unemployment of health
\nprofessionals, causing some physicians to
\nleave the country to work as nurses else-
\nwhere.
\nThe Canadian Medical Association
\nexpressed support for the establishment of
\nan annual \u201cWorld Doctors\u2019 Day\u201d an idea
\nraised in the WMA President\u2019s speech.
\nThe Secretary General referred to the fact
\nthat the American Medical Association
\n(AMA) had provided important assistance
\nto the WMA for many years through offer-
\ning the services of various staff members to
\nserve as the WMA Legal Advisor. While
\nthey would continue to provide corporate
\nlegal services to the WMA, especially on
\nissues arising from WMA\u2019s corporate status
\nas a US corporation, they would no longer
\nprovide a legal adviser during WMA meet-
\nings. The Secretary General in thanking the
\nAMA for its invaluable contribution
\nreferred in particular to the work of the
\nmost recent WMA Legal Adviser, Sharon
\nOstrowski, who was no longer with the
\nAMA. The General Assembly agreed a note
\nof appreciation to Ms Ostrowski which the
\nSecretary General will convey to her. He
\nalso thanked Ms Leah Wapner of the Israel
\nMedical Association for serving as the
\nLegal adviser during this Assembly.
\nHe also announced that that Dr. Alan Rowe
\nwho had served as Editor of the World
\nMedical Journal had retired and that a
\nsearch for his replacement was almost com-
\npleted.
\nIt was noted that Dr. Rowe could not attend
\nthe meeting for health reasons. The General
\nAssembly thanked Dr. Rowe for his
\nengagement and dedication to the WMA
\nand his excellent work in developing the
\nWMJ. The General Assembly agreed a note
\nof warm appreciation to Dr. Rowe which
\nthe Secretary General agreed to convey to
\nhim.
\nInforming the General Assembly that Dr.
\nJohn Williams, WMA Ethics Adviser would
\nend his tenure as a staff member at Ferney-
\nVoltaire in December, although he would
\ncontinue to advise the WMA on ethical
\nissues. Paying tribute to Dr. William\u2019s, he
\nsaid that Dr. William\u2019s excellent work had
\nhelped WMA to clarify its approach to pol-
\nicy development, strengthening WMA poli-
\ncy. The Secretary General expressed his
\nhope that continuing to work together
\nwould assist in eventually growing the
\nEthics Unit into a WMA Ethics Institute.
\nThe Assembly joined in a Standing ovation
\nto Dr. Williams for his tireless efforts and
\noutstanding contributions.
\nClosing the 2006 WMA General Assembly
\nthe Chair of Council thanked the South
\nAfrican Medical Association for its gener-
\nous hospitality. He also recognised the work
\nof the Secretary General, the staff and the
\ninterpreters.
\nDuring the meeting of the 175th Council in
\nPilansberg,October 2006, the following two
\nCouncil resolutions were adopted:
\nCouncil Resolution In Sup-
\nport Of The Bolivian Medical
\nAssociation
\n\u201cThere are credible reports that arrange-
\nments between the Cuban government and
\nthe Bolivian government to supply Cuban
\nphysicians to Bolivia are bypassing systems
\nestablished to protect patients that have
\nbeen set up to verify physicians\u2019 credentials
\nand competence.
\nThe World Medical Association is signifi-
\ncantly concerned that patients are put at risk
\nby unregulated medical practices, including
\nthe provision of drugs and medical supplies
\nthat are improperly labelled and of uncer-
\ntain origin.
\nThere already exists a duly constituted and
\nlegally authorized Bolivian Medical
\nAssociation, which is charged with the reg-
\nistration of physicians and which is required
\nto be consulted by the Bolivian Ministry of
\nHealth.
\nTherefore, the WMA:
\n1) Condemns any collusion of two coun-
\ntries in policies and practices that disrupt
\nthe accepted standards of medical cre-
\ndentialing and medical care;
\n175th WMA Council Meeting Pilansberg,
\nSouth Africa 2006
\n2) Calls upon the Bolivian government to
\nwork with the Bolivian Medical
\nAssociation on all matters related to
\nphysician certification and the practice
\nof medicine and to respect the role and
\nrights of the Bolivian Medical
\nAssociation;
\n3) Urges, as a matter of utmost concern,
\nthat the Bolivian government respect the
\nWMA International Code of Medical
\nEthics that guides the medical practice of
\nphysicians all over the world.\u201c
\nCouncil Resolution On Legis-
\nlation Banning Smoking In
\nPublic Places
\n\u201cRecognizing the abundant evidence link-
\ning adverse health outcomes and exposure
\nto second-hand smoke; and
\nNothing that despite this new evidence,
\nmany countries still allow smoking in pub-
\nlic places
\nThe World Medical Association:
\nCongratulates the French government and
\nFrench physicians on the introduction of
\nlegislation that would ban smoking in pub-
\nlic areas; and
\nUrges other National Medical Associations
\nto advocate for similar legislative changes
\nin their own countries if such legislation
\ndoes not exist.\u201c
\nWMA
\n100
\nis common. It is anticipated that H5N1
\nwill continue to spread along the migra-
\ntory pathways of wild birds. Most
\nhuman infections have occurred in rural
\nareas where freely-roaming small poul-
\ntry flocks are kept.
\n4. HPAI is controlled by rapidly destroy-
\ning all infected and\/or exposed birds, by
\nproper disposal of the carcasses, and by
\nquarantining and rigorous disinfection
\nof farms. In order to contain an out-
\nbreak, aggressive measures are needed
\nimmediately after the outbreak is detect-
\ned.
\n5. Human pandemic influenza occurs three
\nto four times a century and can take
\nplace in any season, not just winter.
\nPandemic influenza results from the
\nemergence of a new human influenza
\nstrain to which no human immunity
\nexists. This new human pandemic strain
\ncan arise from either avian influenza
\nstrains or from influenza viruses infect-
\ning swine and potentially other mam-
\nmalian species. It is usually associated
\nwith a higher severity of illness and,
\nconsequently, a higher risk of death. All
\nage groups may be at risk, and experts
\npredict an infection rate of 25-50% of
\nthe population, depending on the sever-
\nity of the strain. Since the virus strain
\ncannot be accurately predicted, a vac-
\ncine against pandemic flu may not be
\navailable until several months after the
\npandemic begins. A major factor in pro-
\ntecting populations will be the time
\nfrom emergence of a new strain to the
\ndevelopment and manufacture of vac-
\ncine. It is hypothesized that use of anti-
\nvirals may control the progression of a
\npandemic following its emergence, so
\nadequate supplies of anti-virals are
\nimportant. At all phases of a pandemic
\noutbreak, but especially during the peri-
\nod when vaccine is unavailable, infec-
\ntion control is critical.
\n6. Health officials are concerned that avian
\ninfluenza, if given the right opportuni-
\nties, could mutate to form a new strain
\nof human influenza virus against which
\nhumans have no immunity or existing
\nvaccine \u2013 a pandemic strain. It is appar-
\nent that H5N1 has the capacity to direct-
\nly jump the species barrier and cause
\nserious disease in humans but thus far,
\nH5N1 has demonstrated very limited, if
\nany, human transmission potential. A
\nnew pandemic virus could develop if a
\nhuman became simultaneously infected
\nwith H5N1 and a human influenza
\nvirus, resulting in gene swapping. Also,
\nthe H5N1 virus could mutate on its
\nown. With this new virus strain, direct
\nhuman-to-human transmission could
\nresult, and if the virus remains highly
\npathogenic, a pandemic with high mor-
\ntality rates could occur. This is believed
\nto have happened in the worst pandem-
\nic of the 20th century, the \u201cSpanish Flu\u201d
\nof 1918, that killed 50 million people
\nworldwide.
\n7. Even though the H5N1 virus is not easi-
\nly transmitted to humans, any H5N1
\nhuman infection provides an opportuni-
\nty for co-existence with a human
\ninfluenza virus. Consequently, the World
\nHealth Organization (WHO) and other
\nhealth organizations recommend that
\nany person coming in contact with
\ninfected poultry receive the current
\nannual flu vaccine. Since it is not yet
\nknown whether residual immunity to the
\nN1 component of the annual vaccine
\nprovides any immunity to H5N1, there is
\nno way to accurately predict the severity
\nof the next pandemic. It is important to
\nrecognize that while there is current con-
\ncern surrounding H5N1, a pandemic
\ninfluenza strain may not arise from
\nH5N1 but may come from another HPAI
\nstrain. Regardless of this, the odds are
\ngreat that another pandemic will occur.
\nPrinciples of Pandemic
\nInfluenza Planning
\nThe Role of Governments
\n8. The WHO has responsibility for co-
\nordinating the international response to
\nAdopted by the WMA General Assembly,
\nPilanesberg, South Africa, October 2006
\n1. This statement provides guidance to
\nNational Medical Associations and
\nphysicians on how they should be
\ninvolved in their respective country\u2019s
\npandemic planning process. It also
\nencourages governments to involve
\ntheir National Medical Associations
\nwhen planning for pandemic influenza.
\nFinally, it provides broadly stated rec-
\nommendations about activities that
\nphysicians should consider in preparing
\nthemselves for pandemic influenza.
\nAvian Influenza versus
\nPandemic Influenza
\n2. Avian influenza (bird flu) is a conta-
\ngious common viral infection of birds
\nand, less commonly, pigs. Two forms
\nhave been identified: less pathogenic
\navian influenza (LPAI) and highly path-
\nogenic avian influenza (HPAI), which is
\nextremely contagious and has nearly a
\n100% mortality rate in birds. Avian
\ninfluenza viruses differ from human
\ninfluenza viruses. While avian influenza
\nviruses do not normally infect humans,
\nsince 1997 several cases of human
\ninfection have been documented.
\n3. The current H5N1 HPAI virus is a sub-
\ntype of influenza type A viruses and was
\nfirst isolated from South African terns in
\n1961. The current outbreak started in
\nlate 2003 and early 2004 in eight coun-
\ntries in Asia. While originally reported
\nas controlled, since June 2004 new out-
\nbreaks of H5N1 have reappeared.
\nMigratory and smuggled birds are like-
\nly to be responsible for the spread of
\nH5N1. The infected birds shed large
\nquantities of virus in their feaces, and
\nexposure to infected droppings or to
\nenvironments contaminated by the virus
\nWMA New Statements
\nWMA Statement on avian and
\npandemic influenza
\nWMA
\n101
\nan influenza pandemic. It has defined
\nphases in the evolution of a pandemic
\nthat allow an escalating approach to pre-
\nparedness planning and response lead-
\ning up to a declaration of onset of a pan-
\ndemic.
\n9. The development of a national pandem-
\nic plan, will, by necessity, be led by the
\nnational government, but physicians
\nshould be involved at all stages. While
\neach nation will have unique situations
\nto address, the following pandemic pre-
\nparedness principles apply:
\na) Define key preparedness issues,
\nneeds, and goals.
\ni. The prioritization of one or two
\ngoals for the nation\u2019s pandemic
\nplanning is essential. Depending
\non these goals, the prioritization
\nand use of vaccines and antivirals
\nwill vary. For example, a goal of
\nreducing morbidity and mortality
\ndue to influenza will have very dif-
\nferent planning criteria from a goal
\nof preserving societal infrastruc-
\nture.
\nii.Defining the nation\u2019s needs in the
\nevent of a pandemic will require
\nmaking some basic assumptions
\nabout the severity of the pandemic
\nin the at nation. Based upon that
\nassumption, it will then be possible
\nto make some predictions about
\nthe issues and needs facing the
\ncountry. It will be useful to consult
\nwith other nations that have pre-
\npared pandemic plans to see what
\nchallenges they faced in identify-
\ning their needs and issues.
\nb) In countries where there is a substan-
\ntial presence of healthcare profes-
\nsionals in the private sector, involve
\nthose in the private sector who will
\nbe managing the pandemic on the
\nground, particularly physicians, in
\nthe decision-making process.
\ni. The administration of millions of
\ndoses of antivirals and vaccine to
\nthe management of surge capacity
\nand hospital beds will all require
\nspecific participation of those most
\nknowledgeable and involved in the
\nprocess.
\nc) Prepare risk communication and cri-
\nsis communication strategies and
\nmessages in anticipation of public
\nand media fear and anxiety.
\nd) Provide guidance and timely infor-
\nmation to regional health depart-
\nments, health care organizations, and
\nphysicians. Utilize physicians as
\nspokespeople to explain the medical
\nand ethical issues to the public.
\nEnsure that communications mecha-
\nnisms and infrastructure continue to
\nfunction efficiently.
\ni. As planning proceeds, timely and
\nclear information not only of the
\nplan, but also of the rationale
\nbehind decisions, needs to be made
\navailable to public health authori-
\nties and the medical establishment
\nas well as to the public. Physician
\nleaders in a community are well-
\nrespected and frequently can serve
\nas excellent spokespersons to edu-
\ncate the public about the issues
\nsurrounding pandemic planning.
\nPublic feedback into important
\ndecisions that may have moral and
\nethical implications will help
\nsecure public acceptance of the
\nplan. For example, holding a pub-
\nlic engagement process to assess
\nthe public\u2019s opinion about
\nrationing of vaccine during a pan-
\ndemic can be useful.
\nii.It is important that government
\nrepresentatives and physicians
\nspeak with one voice in order to
\navoid confusion and panic during a
\npandemic event.
\ne) Identify the legal issues and authori-
\nties for pandemic responses, e.g. lia-
\nbility, quarantine, closing borders.
\ni. Authorities will need to make
\ndecisions that range in complexity
\nfrom local decisions to close pub-
\nlic areas, to national decisions
\nregarding border closings and\/or
\nquarantine\/isolation of exposed\/
\ninfected citizens. The legal and
\nethical issues surrounding these
\ndecisions need to be in place prior
\nto a pandemic.
\nf) Determine the order of importance
\nfor use of scarce resources such as
\nvaccines and antivirals, based on
\npandemic response goals. Priority
\ngroups chosen for vaccine should be
\nthose that help maintain essential
\ncommunity services and those at
\nhighest risk.
\ng) Do not put physicians in the position
\nof being responsible for decisions
\nregarding the rationing of vaccine,
\nantivirals and other scarce resources
\nduring a pandemic. Those decisions
\nmust be made by the government.
\nh) Outline coordination and implemen-
\ntation of a response by stages of the
\npandemic.
\ni. Depending on the size of a coun-
\ntry, this response may be at a
\nnational level or at a regional level.
\nLarge countries may see the pan-
\ndemic occur in waves in which
\ncase affected regions will need to
\nhave their own response ready to
\nbe implemented.
\ni) Consider the surge capacity of hospi-
\ntals, laboratories, and the public
\nhealth infrastructure and improve
\nthem if necessary. Prepare for
\nabsences of key staff and the need to
\nmaintain health services for condi-
\ntions other than influenza.
\nj) Prepare for the psychosocial impact
\non health care workers in managing
\nthe waves of a pandemic.
\nk) Consider whether the safety of those
\nin facilities managing the pandemic
\nmust be ensured, such as police pro-
\ntection of the supply chain for vac-
\ncines and antivirals. Address what
\nmight be needed to control a pan-
\ndemic in the absence of a vaccine.
\nl) Assess whether there is sufficient
\nfunding available to adequately pre-
\npare for pandemic influenza.
\ni. Political will to fund public health
\npreparedness is essential. Resources
\nspent on pandemic planning should
\nbe framed in the context of general
\npreparedness; pandemic prepared-
\nness and public health preparedness
\nshare many of the same issues.
\nm)Identify key issues that remain to be
\nresolved, which may include manage-
\nment of patients in the community,
\ntriage in hospitals, ventilation man-
\nagement, safe handling of bodies, and
\ndeath investigations and reports.
\nWMA
\n102
\nThe Role of the National Medical
\nAssociation (NMA)
\n10. In any disaster situation or infectious
\ndisease outbreak, physicians and their
\nprofessional organisations will be chal-
\nlenged to continue to provide needed
\ncare to the vulnerable and sick, as well
\nas to aid in the emergency response
\ncalled for in the specific situation. The
\nfollowing issues should be considered
\nin this regard:
\na) NMAs should have their own organi-
\nzation-specific business contingency
\nplan in place to ensure continued
\nsupport of their members.
\ni. Many existing plans anticipate dis-
\nruptions such as fires, earthquakes,
\nand floods that are geographically
\nrestricted and have fairly well
\ndefined timeframes. However,
\npandemic influenza planning
\nrequires assumptions that the
\ninfluenza will be widely dispersed
\ngeographically and will potentially
\nlast many months.
\nb) NMAs should clearly identify their
\nresponsibilities during a pandemic.
\ni. The NMA should actively seek
\nparticipation in the nation\u2019s pan-
\ndemic planning process. If this is
\nachieved, the NMA\u2019s responsibili-
\nties will also be clearly defined
\nboth to its physicians as well as to
\nthe government.
\nc) For effective global pandemic
\ninfluenza planning, NMAs should
\ncollaborate and network with NMAs
\nfrom other countries.
\ni. Many NMAs have already been
\ninvolved in their countries\u2019 pan-
\ndemic planning process.
\nChallenges and key roles for the
\nNMA that have been identified
\nshould be shared.
\nd) NMAs should have an essential role
\nin communicating vital information:
\ni. to the public. As the authoritative
\nmedical voice, an NMA engen-
\nders public trust and should use
\nthat trust to communicate accurate
\nand timely information regarding
\npandemic planning and the cur-
\nrent state of the pandemic to the
\npublic;
\nii. between authorities and physi-
\ncians, and between physicians in
\naffected areas and their colleagues
\nelsewhere;
\niii.Between health care profession-
\nals. NMAs should work with
\nother health care provider organi-
\nzations (e.g., nurses, hospital
\ngroups) to identify common
\nissues and congruent policies and
\nmessages regarding pandemic
\npreparedness and response.
\ne) NMAs should offer training semi-
\nnars and clinical support tools, such
\nas online and e-published self-help
\ntraining materials, for physicians and
\nregional medical associations.
\ni. Such training\/tools should consid-
\ner how, in a worst-case pandemic
\nscenario, physicians will manage
\nrespiratory crises without intensive
\nor critical care facilities. Training
\nshould also be given in triage
\nstrategies and how infected
\npatients should be counselled.
\nf) NMAs should consider what new
\nprograms and services they might
\noffer during a pandemic, such as
\ncoordination or provision of mental
\nhealth crisis support programs for
\naffected members and their families,
\nfacilitation of health emergency
\nresponse teams, emergency locum
\nrelief, and facilitation of equipment
\nsupply lines.
\ng) NMAs should be involved in and
\nsupport the development and imple-
\nmentation of government plans while
\nstill considering their own profes-
\nsional code of ethics. They should
\nmonitor and assess the implementa-
\ntion of said plans to ensure that as
\npandemic outbreaks cycle through
\ntheir natural history, health interests
\nremain paramount.
\nh) NMAs should advocate for adequate
\ngovernment funding to prepare for
\npandemic influenza.
\ni) NMAs should anticipate the different
\npractice environments that may
\nevolve during pandemic conditions
\nand be prepared to discuss liability
\nand related issues with health author-
\nities and advise members on such
\nissues.
\nj) NMAs should be prepared to advo-
\ncate on behalf of members who, dur-
\ning a pandemic, will have rapidly
\nemerging professional needs that
\nmust be met, and on behalf of
\npatients and the public who will be
\naffected by the unfolding events.
\nThe Role of the Physician
\n11. Physicians will be the first point
\nof contact and source for advice for
\nmany as a pandemic evolves. The
\nfollowing are broad issues that
\nphysicians should consider in the
\nevent of a pandemic:
\na) Be sufficiently educated about pan-
\ndemic influenza and transmission
\nrisks.
\ni. Communication about the actual
\nrisks of pandemic influenza is
\nimportant to impart a sense of
\nurgency without creating undue
\npublic alarm. Consider active
\nphysician participation in the
\nmedia response to a pandemic.
\nb) Be vigilant for the possibility of
\nsevere or emerging respiratory dis-
\neases, especially in patients who
\nhave recently travelled international-
\nly.
\ni. As with any emerging infection,
\nthe astute physician is one of the
\nimportant surveillance tools for
\ndetecting and managing an out-
\nbreak.
\nc) Plan for how to manage high-risk
\npatients in the office\/clinic setting
\nand communicate the plan to clinic
\nstaff.
\ni. Isolation and infection control
\nplans must be available and staff
\nshould be well-versed in them. Be
\naware of what regional public
\nhealth authorities are requesting be
\ndone with potential patients and
\ntheir exposed contacts.
\nd) Plan how to concurrently manage
\npatients with chronic illnesses who
\nrequire routine medical manage-
\nment.
\ne) Plan accordingly for possible inter-
\nruptions of essential services like
\nsanitation, water, power, and disrup-
\ntions to the food supply. Plan for the
\npossibility of staff shortages because
\nWMA
\n103
\nof personal illness and\/or the care of
\nnext-of-kin who are ill.
\ni. It is vital to have contingency
\nplans in place to deal with possible
\nsocietal disruption. Recognize that
\nthe usual sources of these essential
\nservices may not be functioning so
\nthat identifying alternative sources
\nfor these essentials may be neces-
\nsary.
\nf) Prepare educational materials for
\npatients and staff, including recom-
\nmendations for proper infection con-
\ntrol.
\ni. An educated patient\/public that
\nrecognizes the necessity for strin-
\ngent measures such as quarantine
\nand isolation will make a physi-
\ncian\u2019s job easier should s\/he have
\nto utilize such procedures when a
\npandemic occurs.
\ng) Remain involved in local pandemic
\nplanning efforts and understand how
\nthe plan will affect the physician.
\nParticipate in local simulation exer-
\ncises.
\ni. Since physicians will be on the
\nfrontlines of monitoring, reporting,
\nand eventually managing pandem-
\nic influenza patients, they must be
\nclosely involved in the planning
\nprocess. They must continuously
\nprovide feedback as to what is
\nlogistically possible regarding
\nphysicians\u2019 efforts on the ground
\nwhen a pandemic arrives.
\nh) Physicians have an ethical responsi-
\nbility to provide services to the
\ninjured or ill. They should have
\nresources in place in the event they
\nand\/or their own families become
\ninfected.
\ni. A physician will have a strong
\npublic health duty in the time of a
\npandemic and his\/her services
\nwill be critical at a time when
\nsurge capacity will be stressed.
\nPhysicians should make arrange-
\nments for the care of their families
\nand dependents in the event of a
\npandemic.
\nii. Physicians should take all mea-
\nsures necessary to protect their
\nown health and the health of their
\nstaff.
\niii.Physicians can also consult the
\nWMA Statement on Medical
\nEthics in the Event of Disasters
\nfor additional guidance.
\ni) Develop a clinic plan to decrease
\npotential for contact including isola-
\ntion areas for infected patients, use of
\nclose-fitting surgical masks, desig-
\nnating separate blocks of time for
\nnon-influenza-related patient care,
\nand postponing non-essential med-
\nical visits.
\nj) Review staff infection control proce-
\ndures and train staff in the use of per-
\nsonal protective equipment. Provide
\nsignage in the office instructing
\npatients on respiratory hygiene prac-
\ntices; provide tissues, receptacles for
\ntheir disposal, and hand hygiene
\nmaterials in waiting areas and exam-
\nination rooms.
\nk) Get vaccinated against annual
\ninfluenza each year and urge all staff
\nto be vaccinated.
\ni. Annual influenza readiness goes a
\nlong way for pandemic prepared-
\nness. Additionally, it is possible
\nthat components in the annual vac-
\ncine (e.g., N1) may provide some
\nimmunity against H5N1.
\nl) Work to ensure that the office\/clinic
\nhas access to adequate supplies of
\nantibiotic and antiviral medications
\nas well as commonly prescribed
\ndrugs such as insulin or warfarin, in
\ncase the pharmaceutical supply line
\nis disrupted.
\nRecommendations
\n12. That the WMA increase its collabora-
\ntion with the WHO on pandemic plan-
\nning and commit itself to becoming an
\nimportant participant in the decision-
\nmaking process.
\n13. That the WMA communicate to the
\nWHO its capabilities and the capabili-
\nties of its NMA members to provide a
\ncredible voice that can efficiently reach
\nmany practising physicians.
\n14. That the WMA acknowledge that
\nalthough pandemic planning is a coun-
\ntry-specific task, it can provide general
\nprinciples for guidance. Additionally,
\nthe WMA can provide basic advice that
\ncan be given by its member NMAs to
\npractising physicians.
\n15. That the WMA establish an operational
\ncapacity to develop and maintain emer-
\ngency communication channels
\nbetween the WMA and NMAs during a
\npandemic.
\n16. That the WMA provide timely evi-
\ndence-based control measures to coun-
\ntries with no or limited or no up-dated
\ninformation about pandemics.
\n17. That NMAs be actively involved in the
\nnational pandemic planning process.
\n18. That physicians participate in local pan-
\ndemic planning efforts and be involved
\nin communicating vital information to
\nthe public.
\nAdopted by the WMA General Assembly,
\nPilanesberg, South Africa, October 2006
\nPreamble
\n1. According to the World Health
\nOrganization, tuberculosis is a problem
\naffecting over 9 million people every
\nyear and ranks among the leading infec-
\ntious diseases with an annual incidence
\nrate of 1%. The Eastern European
\nregion is particularly affected.
\n2. In developing countries, the incidence
\nof tuberculosis has risen dramatically
\ndue mainly to its prevalence in areas
\nwith a high rate of HIV\/AIDS. The
\nWMA Resolution on tuberculosis
\n4. Even well-trained flight personnel are
\nlimited in their knowledge and experi-
\nence and cannot offer the same assis-
\ntance as a physician or other certified
\nhealth professional. Currently, continu-
\ning medical education courses are avail-
\nable to physicians to train them specifi-
\ncally for in-flight emergencies.
\n5. Physicians are often concerned about
\nproviding assistance due to uncertainty
\nregarding legal liability, especially on
\ninternational flights or flights within the
\nUnited States. While numerous airlines
\nprovide some kind of liability insurance
\nfor medical professionals and lay per-
\nsons who will provide voluntary assis-
\ntance during flight, this is not always the
\ncase and even where it does exist, the
\nterms of the insurance cannot always be
\nadequately explained and understood in
\na sudden medical crisis. The financial
\nand professional consequences of litiga-
\ntion against physicians who offer assis-
\ntance can be very costly.
\n6. Some important steps have been taken
\nto protect the life and health of airline
\npassengers, yet the situation is far from
\nideal and needs improvement. Many of
\nthe major problems could be mitigated
\nby simple actions taken by both airlines
\nand national legislatures, ideally in
\ncooperation with one another and with
\nthe International Air Transport
\nAssociation (IATA) to arrive at coordi-
\nnated and consensus-based international
\npolicies and programs.
\n7. National Medical Associations have an
\nimportant leadership role to play in pro-
\nWMA
\n104
\nincreased movement of populations has
\nalso exacerbated the problem.
\n3. The multi-resistant forms of tuberculo-
\nsis, a by-product of original bacilli
\nresistant to the action of the main tuber-
\nculosis medicines, also present great
\ndifficulties in controlling the disease.
\n4. Radiological detection and sputum
\nexamination targeted at high-risk sub-
\njects continues to be an essential ele-
\nment of tuberculosis prevention.
\n5. Among migrants, the homeless, prison-
\ners and other high risk groups, such a
\nstrategy is particularly efficient in pre-
\nventing epidemics.
\n6. The reactivation of screening and fol-
\nlow-up programmes and the application
\non a large scale of rapid and strictly
\nsupervised daily treatment should help
\naddress the epidemic.
\n7. The vaccination policy for BCG (bacille
\nCalmette-Gu\u00e9rin) should be targeted at
\nchildren from their first vaccination.
\nResolutions
\n8. The World Medical Association, in con-
\nsultation with the WHO and national
\nand international health authorities and
\norganisations, will continue to work for
\nthe improvement of tuberculosis treat-
\nment and surveillance and will also pro-
\nmote surveys of individual cases, the
\nreactivation of screening and surveil-
\nlance programs, and the large-scale
\napplication of daily care delivery and
\ntreatment supervision.
\n9. The WMA supports calls for adequate
\nfinancial, material and human resources
\nfor tuberculosis and HIV\/AIDS preven-
\ntion, including adequately trained health
\ncare providers and adequate public
\nhealth infrastructure, and will partici-
\npate with health professionals in provid-
\ning information on tuberculosis and its
\ntreatment.
\n10. The WMA encourages continuing pro-
\nfessional development for healthcare
\nprofessionals in the field of tuberculo-
\nsis. Specialized courses on multi-drug-
\nresistant TB are particularly important.
\n11. The WMA calls on its National Member
\nAssociations to support the WHO in its
\nDOTS strategy and in other work to
\npromote the more effective manage-
\nment of tuberculosis. \u25a0
\nAdopted by the WMA General Assembly,
\nPilanesberg, South Africa, October 2006
\n1. Air travel is the preferred mode of long
\ndistance transportation for people across
\nthe world. The growing convenience and
\naffordability of air travel has led to an
\nincrease in the number of air passengers,
\nincluding older passengers and other
\nindividuals at increased risk for health
\nemergencies. In addition, long-duration
\nflights are common, increasing the risk
\nof in-flight medical emergencies.
\n2. The environment in normal passenger
\nplanes is not conducive to the provision
\nof quality medical care, especially in the
\ncase of medical emergencies. Noise and
\nmovement of the plane, a very confined
\nspace, the presence of other passengers
\nwho may be experiencing stress or fear
\nas a result of the situation, the insuffi-
\nciency or complete lack of diagnostic
\nand therapeutic materials and other fac-
\ntors create extremely difficult condi-
\ntions for diagnosis and treatment. Even
\nthe most experienced medical profes-
\nsional is likely to be challenged by these
\ncircumstances.
\n3. Most airlines require flight personnel to
\nbe trained in basic first aid. In addition,
\nmany provide some degree of training
\nbeyond this minimum level and may
\nalso carry certain emergency medicines
\nand equipment on board. Some carriers
\neven have the capacity to provide
\nremote ECG reading and medical coun-
\nselling services.
\nWMA Resolution on medical assistance
\nin air travel
\nWMA
\n105
\nmoting measures to improve the avail-
\nability and efficacy of in-flight medical
\ncare.
\n8. Therefore the World Medical
\nAssociation calls on its members to
\nencourage national airlines providing
\nmedium and long range passenger
\nflights to take the following actions:
\na) Equip their airplanes with a suffi-
\ncient and standardised set of medical
\nemergency materials and drugs that:
\n\u2022 are packaged in a standardised and
\neasy to identify manner;
\n\u2022 are accompanied by information
\nand instructions in English as well
\nthe main languages of the coun-
\ntries of departure and arrival; and
\n\u2022 include Automated External
\nDefibrillators, which are consid-
\nered essential equipment in non-
\nprofessional settings.
\nb) Provide stand-by medical assistance
\nthat can be contacted by radio or tele-
\nphone to help either the flight atten-
\ndants or to support a volunteering
\nhealth professional, if one is on
\nboard and available to assist.
\nc) Develop medical emergency plans to
\nguide personnel in responding to the
\nmedical needs of passengers.
\nd) Provide sufficient medical and
\norganisational instruction to flight
\npersonnel, beyond basic first aid
\ntraining, to enable them to better
\nattend to passenger needs and to
\nassist medical professionals who vol-
\nunteer their services during emergen-
\ncies.
\ne) Provide insurance for medical pro-
\nfessionals and assisting lay personnel
\nto protect them from damages and
\nliabilities (material and non-materi-
\nal) resulting from in-flight diagnosis
\nand treatment.
\n9. The World Medical Association calls on
\nits members to encourage their national
\naviation authorities to provide yearly
\nsummarised reports of in-flight medical
\nincidents based on mandatory standard-
\nised incident reports for every medical
\nincident requiring the administration of
\nfirst aid or other medical assistance
\nand\/or causing a change of the flight.
\n10. The World Medical Association calls on
\nits members to encourage their legisla-
\ntors to enact legislation to provide
\nimmunity from legal action to physi-
\ncians who provide emergency assis-
\ntance in in-flight medical incidents.
\n11. In the absence of legal immunity, the
\nairline must accept all legal and finan-
\ncial consequences of providing assis-
\ntance by a physician.
\n12. The World Medical Association calls on
\nits members to:
\na) educate physicians about the prob-
\nlems of in-flight medical emergen-
\ncies;
\nb) inform physicians of training oppor-
\ntunities or provide or promote the
\ndevelopment of training programs
\nwhere they do not exist; and encour-
\nage physicians to discuss potential
\nproblems with patients at high risk
\nfor requiring in-flight medical atten-
\ntion prior to their flight.
\n13. The World Medical Association calls on
\nIATA to further develop precise stan-
\ndards in the following areas and, where
\nappropriate, work with governments to
\nimplement these standards as legal
\nrequirements:
\na) medical equipment and drugs on
\nboard medium and long range
\nflights;
\nb) packaging and information materials
\nstandards, including multilingual
\ndescriptions and instructions in
\nappropriate languages;
\nc) medical emergency organisation pro-
\ncedures and training programs for
\nmedical personal. \u25a0
\nAdopted by the WMA General Assembly,
\nPilanesberg, South Africa, October 2006
\n1. Whereas air travel is a common mode of
\ntransportation and is used by people of
\nall ages every day;
\n2. Whereas high standards of safety for
\nadult passengers in air travel have been
\nachieved;
\n3. Whereas strict safety procedures are
\nbeing followed in air travel that greatly
\nincrease the chance of survival during
\nemergency situations for properly
\nsecured adults;
\n4. Whereas infants and children are not
\nalways guaranteed adequate and appro-
\npriate safety measures during emer-
\ngency situations in aircraft;
\n5. Whereas restraint and safety systems for
\ninfants and children have been success-
\nfully tested to reduce the risk of suffer-
\ning injuries during emergency situations
\nin aircraft;
\n6. Whereas child restraint systems have
\nbeen approved for usage in standard
\npassenger aircrafts and successfully
\nintroduced by several airlines;
\nTherefore, the World Medical Association
\n7. Expresses grave concern regarding the
\nfact that adequate safety systems for
\ninfants and children have not been gen-
\nerally implemented;
\n8. Calls on all airline companies to take
\nimmediate steps to introduce safe, thor-
\noughly tested and standardized child
\nrestraint systems;
\n9. Calls on all airline companies to train
\ntheir staff in the appropriate handling
\nand usage of child restraint systems;
\n10. Calls for the establishment of a univer-
\nsal standard or specification for the test-
\ning and manufacturing of child restraint
\nsystems; and
\n11. Calls on national legislators and air
\ntransportation safety authorities to:
\nWMA Resolution on child safety
\nin air travel
\nFrom the Secretary General
\n106
\na) require for infants and children, as a
\nmatter of law, safe individual child
\nrestraint systems that are approved
\nfor use in standard passenger air-
\ncraft;
\nb) ensure that airlines provide child
\nrestraint systems or welcome passen-
\ngers using their own systems, if the
\nequipment is qualified and approved
\nfor the specific aircraft;
\nc) ban the usage of inappropriate \u201cLoop
\nBelts\u201d frequently used to secure
\ninfants and children in passenger air-
\ncraft;
\nd) provide appropriate information
\nabout infant and child safety on
\nboard of aircraft to all airline passen-
\ngers. \u25a0
\nhealth professions enjoying some degree of
\nfreedom for self-regulation the same danger
\nof dismantlement exists.
\nThe argument for doing so is always the
\nsame: Self-governing regulatory bodies are
\nnot capable of doing the things necessary to
\nregulate the profession and to protect the
\npublic.
\nAnd indeed, we often are desperate about
\nour (in-)capabilities of self-regulation. We
\nknow where we failed and we sometimes
\nfeel helpless ourselves. We tend to narrow
\nregulation, to install systems of recertifica-
\ntion, validation and assessment, we review
\nand sometimes punish. But even so, all this
\nseems not to be enough.
\nAs medicine gets more effective and effi-
\ncient every day, the degree of complications
\nand the concomitant dangers grow as well.
\nWhile everybody accepts new treatments
\nand new approaches to prevention as the
\nnatural course of events, the concomitant
\ndangers need someone be blame for them.
\nCertainly complexity is no waiver of
\nresponsibility and difficulties are no excuse
\nfor a lack of professionalism. On the other
\nhand blaming every risk and wrong devel-
\nopment on individual health professionals is
\nneither fair nor appropriate. To attribute
\nindividual or system failures to the self-
\ngovernment is only fair if it has violated its
\nown responsibility. Self-government should
\nnot be charged with deficits in health care
\nfinancing caused by legal regulations or a
\nshortage of resources. Parliaments and gov-
\nernments are responsible for that. Self-gov-
\nernments should not be charged for their
\nincapacity of dealing with criminal misbe-
\nhavior of professionals. This is a job for the
\nlaw-enforcement agencies
\nThe inclusion of patients in medical self-
\ngovernment is one option for cooperation.
\nHowever government manipulations water-
\ndown self-government by installing repre-
\nsentatives who have neither the competence
\nnor a mandate from those to be regulated, is
\nneither democratic nor helpful. But indeed,
\nthe achievement of more democracy or
\ncompetence may not be intended in the first
\nplace, the real aim may be just another way
\nto silence a very active and critical part of
\nsociety.
\nprofession, are watered down to lay bodies,
\nor governments determine the members of
\ninstitutions.
\nIn this way the respect for democratic
\nprocesses and the sharing of powers gets
\nlost on a large scale. In history this is not a
\nnew political development, but the prece-
\ndents are truly scaring. In the thirties the
\nGerman Reichsregierung stopped any
\ndemocratic decision making process within
\nthe physicians\u2019 self-government and substi-
\ntuted the formerly professionally elected
\nbody by a government nominated \u201cReichs-
\n\u00c4rztef\u00fchrer\u201d. The communist governments
\nin Europe dissolved, prohibited self-gov-
\nernment and\/or seized their properties after
\nWorld War II. A democratic mandated, but
\nyet extra-parliamentarian power \u2013 not to say
\n\u201copposition\u201d \u2013 was unwanted then and it
\nseems to be becoming increasingly unpopu-
\nlar with governments around the world
\nnow.
\nThese changes do not affect us alone: other
\npartners in the health care systems are
\naffected as well. All groups enjoying the
\nright of self-regulation are being faced with
\nthe same problem. For some liberal profes-
\nsions, this may not be a first line item as
\nthey may find their self-regulation to be a
\nmore technical process. However for those
\nRegardless whether your understanding of a
\njust state is based on Magna Carta or on
\nMontesquieu, sharing power is an essential
\nelement. The horizontal separation of
\npower results in the classical split into a leg-
\nislative, executive and juridical branch. But
\nthere is \u2013 less visibly and often less regulat-
\ned \u2013 also a vertical separation of power.
\nWe have associations and parties, groups
\nand families, which all have their formal or
\ninformal power of regulation. In modern
\nlanguage this is called \u201csubsidiarity\u201d and it
\ngives way to allocation of power by social
\nor decisive factors. Issues are being dealt
\nwith on the level of competence, in the fam-
\nily in the group, in the profession.
\nThis vertical power sharing is now being
\nsilently reduced in many countries of the
\nworld. With an amazing synchronicity, gov-
\nernments in the different parts of the world
\ndismantle the self-governments of our pro-
\nfession. In Germany, Great Britain, New
\nZealand, in Romania or Hong Kong, all
\nover the world and regardless of the politi-
\ncal system, changes or attempts have been
\nmade or are underway to disrupt the demo-
\ncratic representation of our interest through
\nour self-governments. Medical Councils
\nwhich formerly were freely elected by the
\nFrom the Secretary General
\nSelf-governmental Structures are
\nendangered in many countries
\nMedical Science and Professional Practice
\n107
\nWe tend to take democracy and freedom for
\ngranted, but they are not! Actually, hard as
\nthey were to obtain, we have no right to
\ngive them up. Democracy and freedom are
\nnot ours: they belong first to the generations
\nto come. If we give them up, their chances
\nto get them back are extremely unlikely.
\nTherefore it is our strict obligation and
\nmoral imperative to fight for our democrat-
\nic rights and freedom.
\nOtmar Kloiber
\nAdopted by the WMA General Assembly,
\nPilanesberg, South Africa, October 2006
\nPreamble
\n1. Obesity is one of the single most impor-
\ntant health issues facing the world in the
\ntwenty-first century, affecting all coun-
\ntries and socio-economic groups and
\nrepresenting a serious drain on health
\ncare resources.
\n2. Obesity has complex origins linked to
\neconomic and social changes in society
\nincluding the obesogenic environment
\nwithin which much of the population
\nlives.
\n3. Therefore the WMA urges physicians to
\nuse their roles as leaders to advocate for
\nrecognition by national health authori-
\nties that reduction in obesity should be a
\npriority, with culturally appropriate
\npolicies involving physicians and other
\nkey stakeholders.
\nThe WMA recommends that
\nphysicians:
\n4. Lead the development of societal
\nchanges that emphasize environments
\nwhich support healthy food choices and
\nregular exercise or physical activity for
\nall people;
\n5. Individually and through medical asso-
\nciations, express concern that excessive
\ntelevision viewing and video game
\nplaying are impediments to physical
\nactivity among children and adolescents
\nin many countries;
\n6. Encourage individuals to make healthy
\nchoices;
\n7. Recognise the role of personal decision
\nmaking and the adverse influences
\nexerted by current environments;
\n8. Recognise that collection and evalua-
\ntion of data can contribute to evidence
\nbased management, and should be part
\nof routine medical screening and evalu-
\nation throughout life;
\n9. Encourage the development of life skills
\nthat contribute to a healthy lifestyle in
\nall persons and to better public knowl-
\nedge of healthy diets, exercise and the
\ndangers of smoking and excess alcohol
\nconsumption;
\n10. Contribute to the development of better
\nassessment tools and databases to
\nenable better targeted and evaluated
\ninterventions;
\n11. Ensure that obesity, its causes and man-
\nagement remain part of continuing pro-
\nfessional development programmes for
\nhealth care workers, including physi-
\ncians;
\n12. Use pharmacotherapy and bariatric
\nsurgery consistent with evidence-based
\nguidelines and an assessment of the
\nrisks and benefits associated with such
\ntherapies.
\nMedical Science and Professional Practice
\nWMA Statement on the Physician\u2019s role
\nin Obesity
\nDo others share my cynicism about the
\nvalue of worthy statements emanating form
\ngatherings of the \u201cgood and great\u201d held in
\nsome salubrious resort?
\nEven the most hardened sceptic would con-
\nceeded that there are occasions when a
\nmajor health threat demands personal and
\ncollective action. The pandemic of obesity
\nevokes a guilt reaction \u2013 it seems to have
\ntaken the medical world by surprise. We
\nshould be chastened to realise that in our
\npreoccupation with rescuing patients from
\nindividual lethal diseases like cardiovascu-
\nlar disease, cancer and diabetes, we have
\nneglected the root causes of such afflictions,
\nof which obesity reigns supreme. Ironically,
\nits domain extends to the developing world
\nwhere under-nutrition, at the opposite end
\nof the spectrum of malnutrition, remains
\nprevalent.
\nOf course, there are genetic causes of obesi-
\nty including the mercifully uncommon
\nAlstrom and Prader-Willi syndromes, as
\nwell as the more common endocrine causes
\nsuch as hypothyroidism, whose victims are
\nobviously exempt from the approbrium
\nattached to the typical obese individuals
\nwhose plight is no less self-inflicted than
\nthose in thrall to tobacco or alcohol.
\nWhat then, can or should physicians and
\nother health professionals do about obesity?
\nThe World Medical Association\u2019s Statement
\nis terse and clear. How then is Europe \u2013
\nwhere over 50% of adults and nearly 25%
\nof children are already overweight and obe-
\nsity in adults accounts for up to 6% of direct
\nhealth costs and 12% of indirect costs of
\ndisease(2) \u2013 responding to the challenge ?
\nIndividual countries, with support from
\nNational Medical Associations (NMAs) are
\ntaking specific and commendable initiatives
\nsuch as promoting healthy catering in
\nschools and encouraging physical activity
\nby prescribing exercise. Physicians are act-
\nObesity \u2013
\nA Growing Problem
\nThis WMA statement has already provoked
\nthe following comment from Sir Alexander
\nMacara. (ed.)
\nMedical Science and Professional Practice
\n108
\ning on points 6 to 12 of the WMA mani-
\nfesto, but we also need to take political
\naction on points 4 and 5. Reassuringly,
\nopinion polls show that physicians are still
\nthe most trusted professionals in society and
\nour collective activity in collating and pre-
\nsenting evidence underpins our advocacy of
\ncommunal action and governmental respon-
\nsibility.
\nThe medical profession in Europe is inti-
\nmately involved in initiatives by both the
\nEuropean Union (EU) Commission through
\nDG Sanco and the European Region of the
\nWorld Health Organisation (WHO). In
\nDecember 2006, the EU adopted a \u201cGreen
\nPaper\u201d signalling its intention to promote
\nhealthy diets and physical activity, follow-
\ning advice from a network of experts from
\nMember states which had been set up two
\nyears previously. Contemporaneously in
\nMarch 2005, it set up a \u201cPlatform\u201d on Diet,
\nPhysical Activity and Health, involving
\nEuropean medical and consumer associa-
\ntions including the Standing Committee of
\nDoctors in the EU (the CPME) and the
\nEuropean Heart Network, the Food
\nIndustry, Non-governmental organisations
\n(NGO\u2019s) such as the International Obesity
\nTask Force( IOTF) and individual experts \u201c
\nunited by a common determination to play
\ntheir part in the fight against obesity\u201d (3)
\nTo quote the spokesman for the World
\nFederation of Advertisers, \u201dthe Platform has
\nchanged the terms in which the stakeholders
\n\u2013 the NGO\u2019s and Industry among others –
\nare talking\u201d(4). Intergovernmental organi-
\nsations are also involved, including the
\nWHO and the European Food Safety
\nAuthority as observers. The Platform\u2019s
\nchairman, Robert Madelin, who is the
\nEuropean Commission\u2019s Director General
\nfor Health and Consumer Protection, is on
\nrecord as saying \u201cWe are giving industry
\nthe chance to show that it is committed to
\nthe fight. We propose to start by avoiding
\nregulation\u201d. (5) A robust framework has
\nbeen constructed for monitoring and evalu-
\nating efforts and outcomes. Commissioner
\nMarkos Kyprianou has identified projects
\non reformulation, portion sizes and con-
\nsumer communication, especially to chil-
\ndren, as key issues (6) and has declared his
\nintention to legislate if voluntary measures
\nfail. Given the reluctance of industry to
\nagree upon a clear system of labelling of the
\nlevels of salt in cereals or to refrain from
\nadvertising junk food to children, the
\nauthor, representing the COME in the
\nPlatform fears that Kyprianou will be oblig-
\ned to act.
\nThe EU also jointly organised with the
\nWHO\u2019s European Regional Office, a
\nMinisterial Conference, held in Istanbul in
\nNovember 2006, in which Health Ministers
\nwere joined by colleagues from other sec-
\ntors including Education, Transport,
\nAgriculture and Environment and Sport. As
\nin the EU Platform, relevant NGOs partici-
\npated and public-private partners were
\nincluded (7). The outcome was a \u201cEuropean
\nCharter on counteracting Obesity\u201d,
\nendorsed enthusiastically by all 53 Member
\nStates. Preventive actions, including the
\npromotion of breast feeding, a reduction in
\nthe levels of salt, sugar and fat in processed
\nfoods, and the design of environments
\nwhich will facilitate physical activity, were
\nagreed. Follow-up will involve a detailed
\n\u201caction plan\u201d and triennial reviews of
\nprogress.
\nIs it realistic to expect meaningful evidence
\nof success? A leading article in the British
\nMedical Journal has identified sources of
\nguidance which might deliver such evi-
\ndence, but comments \u201cthe first people to
\nseduce are Europe\u2019s finance ministers\u201d (8).
\nThere speaks the voice of reality!
\nAlexander Macara
\nCorrespondence to:
\n10 Cheyne Road
\nBishops Stoke
\nBristol
\nB59 2DH
\nUK
\nReferences
\n1. World Medical Association Statement on the
\nPhysician\u2019s Role in Obesity, adopted by the
\nWMA General assembly, Pilansberg, South
\nAfrica, October 2006.
\n2. World Health Organisation Regional Office for
\nEurope \u201cObesity swallos rising share of GDP in
\nEurope up to 1% and counting\u201d Press relase
\nEURO\/10?06.London\/Copenhagen:WHO
\nRowe,2 Nov. 2006.
\nwww.euro.who.int\/mediacentre\/PR\/2002\/
\n20061101_5
\n3. Health and Consumer Voice \u2013 Special Edition
\n\u201cUniting Key Players to fight Obesity in the
\nEU\u201d, Health and Consumer Protection DG,
\nISSN 1725-7400, May 2006.
\n4. Loerke, Stephan, Ibid.p.2
\n5. Madelin, Robert, Ibid. p.1.
\n6. Kyprianou, Marko, Ibid. p.1.
\n7. WorldHealth Organisation Ministerial Confe-
\nrence on Counteracting Obesity. European
\nCharter on Counteracting Obesity. EUR\/06\/
\n5062700\/8, Istanbul.
\nwww.euro.int\/Document\/NUT\/Obesity_
\nChsrter_E_pdf
\n8. Groves,T. \u201cPandemic Obesity in Europe\u201d,
\nBMJ,330,1081-2,25 Nov. 2006
\nMost of your patients will be able to tell you
\ntheir weight, albeit a little reluctantly!
\nHowever, very few of these people will be
\nmaking any clear distinction in their minds
\nbetween \u2018weight\u2019 and \u2018fat\u2019. This confusion
\nhas contributed to the plethora of diet plans
\nwhich focus on different measures of suc-
\ncess. Through this misconception,
\nunhealthy patterns of eating have devel-
\noped, resulting in often long-term unhappi-
\nness as a consequence of unstable and
\nseemingly uncontrollable weight fluctua-
\ntions, not to mention health risks.
\nObesity is a condition of excess body fat
\nand successful weight reduction must
\ninvolve a sustained decrease in fat and not
\njust weight. Dr Susan Jebb, Head of
\nObesity
\nObesity \u2013 a condition of excess body fat;
\nnot excess weight
\nMedical Science and Professional Practice
\n109
\nNutrition and Health at MRC Human
\nNutrition Research in Cambridge, has con-
\nducted research into body composition and
\nobesity for many years. \u201cThe difficulty is
\nthat it requires a reduction of 9,000 calories
\nto remove ikg of fat, whereas you can lose
\nlkg of water without any calorie deficit at
\nall. Changes in body fat occur much more
\nslowly than changes in weight\u201d.
\nUnfortunately the popular and easy mea-
\nsurement of body mass index (BMI) only
\ngives a measure of relative weight-
\nfor-height and does not make any specific
\nmeasurement of body fat. The most accu-
\nrate methods to measure fat (such as under-
\nwater weighing or scanning techniques) are
\ndifficult and expensive to use.
\nSimple, rapid and relatively cheap methods
\nof examining body composition (e.g. using
\ncalipers to measure the thickness of subcu-
\ntaneous fat, or the newer method of bioelec-
\ntrical impedance analysis (BIA)) can give a
\nbetter estimate of fatness than BMI alone.
\nHowever, until recently these procedures
\nhave needed the input of a health profes-
\nsional, restricting the measure of body fat
\noutside the clinical setting.
\nIn recent years there has been a break-
\nthrough in impedance technology, led by
\nthe electronic manufacturers Tanita. All
\nBIA operates on the principle that body fat
\nacts as an insulator, whereas lean tissue,
\nwith its salt and water content, is an effec-
\ntive conductor. Hence, the body impedance
\ngives a measure of relative fatness.
\nTraditional impedance measuring devices
\ninvolve attaching four electrodes to the
\npatient on the hand and foot on one side of
\nthe body and measuring the voltage drop
\nacross the body when a small battery driven
\nelectric current is applied. In contrast, the
\nTanita Body Fat monitor, resembles a set of
\nbathroom scales. It calculates an individ-
\nual\u2019s percentage of body fat by passing a
\nsafe, low level electrical current through the
\nbare feet and gives an immediate digital dis-
\nplay of the body fat percentage. This simple
\nprocedure allows patients to regularly mon-
\nitor their own body composition at home.
\nThe Tanita Body Fat Monitor can also be
\nused by health professionals to identify
\npatients with excess body fat and more
\nimportantly to monitor the impact of treat-
\nment programmes to reduce health risks.
\nExcess fat is associated with an increased
\nrisk of many conditions, notably CHD and
\ndiabetes. Sustained reductions in body fat
\nlead to reductions in disease-related risk
\nfactors.
\nBy placing the emphasis on the measure-
\nment of body fat, health professionals can
\nhelp to encourage the public away from
\n\u2018crash diets\u2019 which promise rapid weight
\nlosses and towards permanent changes in
\ntheir eating and exercise habits which will
\nhelp them to achieve and maintain a healthy
\nbody composition. \u25a0
\nIn an editorial entitled \u201cHajj and the risk of
\ninfluenza\u201d (Gatrad et al., BMJ 303, 1182-3)
\nattention is drawn to the major risk of a
\nrampant spread of the influenza virus and a
\nglobal pandemic \u201ca potentially devastating
\nprospect that has been inadequately pre-
\npared for\u201d.
\nRecalling that the Hajj attracts more than 2
\nmillion pilgrims from almost every country
\non earth \u2013 \u201cthe largest annual gathering in
\nthe world\u201d (1) (2) \u2013 to this deeply spiritual
\njourney which follows months or years of
\npreparation. Nevertheless, it is stated \u201cthat
\nfrom a public health point of view such a
\ngathering makes possible rampant spread of
\nthe influenza virus and a global epidemic\u201d.
\nThe authors, while noting that the Saudi
\nauthorities currently recommend vaccina-
\ntion against influenza for pilgrims with high
\nrisk chronic illnesses, quote data from a UK
\npilgrim survey indicating that many
\nremained unimmunised (3). They comment
\nthat probably this picture is far worse
\namongst pilgrims coming from the econom-
\nically developing world. Further, recalling
\nthat following a previous epidemic
\nmeningococcal immunisation is already
\nmandatory for all pilgrims, they suggest
\nthat mandatory influenza immunisation for
\nall pilgrims should be considered. Calling
\non WHO, which is still developing its strat-
\negy to prevent an influenza pandemic, to
\nwork with the Saudi authorities, they state
\nthat a \u201ccoherent international response will
\nbe needed to ensure that resources and
\nlogistics are in place so that strategies can
\nbe implemented\u201d.
\n(1) GatradAR. SheikhA. Hajj:journet of a life-
\ntime BMJ 2005.330,13-7.
\n(2) Ahmed Q, Arabi Y, Memish Z.,2 Health risks
\nat the Hajj\u201d Lancet 2006,267,1008-15
\n(3) Shafi S, Rashid H, Ali K, El-Bashir
\nH,Haworht E, Memish ZA, Booy R, \u201cInfluenza
\nuptake among British Moslems attending Hajj,
\n2005 BMJ 2005 and 2006
\nThe Hajj and Influenza risk \u2013 The threat can
\nno longer be ignored
\nWHO
\n110
\n9 NOVEMBER 2006 | GENEVA \u2013 Dr.
\nMargaret Chan of China will be the next
\nDirector-General of the World Health
\nOrganization (WHO).
\nIn her acceptance speech, Dr. Chan said:
\n\u201cwhat matters most to me is people. And
\ntwo specific groups of people in particular.
\nI want us to be judged by the impact we
\nhave on the health of the people of Africa,
\nand the health of women. \u2026 Improvements
\nin the health of the people of Africa and the
\nhealth of women are key indicators of the
\nperformance of WHO.\u201c
\n\u201cAll regions, all countries, all people are
\nequally important. This is a health organiza-
\ntion for the whole world. Our work must
\ntouch on the lives of everyone, every-
\nwhere\u201c. \u201cBut we must focus our attention
\non the people in greatest need.\u201c
\nDr. Chan was nominated as Director-
\nGeneral on Wednesday by the WHO
\nExecutive Board and her appointment was
\nconfirmed by the World Health Assembly.
\nThe Director-General is WHO\u2019s chief tech-
\nnical and administrative officer. She was
\npreviously WHO Assistant Director-
\nGeneral for Communicable Diseases and
\nRepresentative of the Director-General for
\nPandemic Influenza.
\nDr. Chan obtained her Medical Degree from
\nthe University of Western Ontario in
\nCanada and also has a degree in public
\nhealth from the National University of
\nSingapore. She joined the Hong Kong
\nDepartment of Health in 1978, and was
\nappointed as Director of Health in 1994. As
\nDirector, she launched new services focus-
\ning on prevention of disease and promotion
\nof health. She also introduced new initia-
\ntives to improve communicable disease sur-
\nveillance and response, enhance training for
\npublic health professionals, and to establish
\nbetter local and international collaboration.
\nShe has effectively managed outbreaks of
\navian influenza and the world\u2019s first out-
\nbreak of severe acute respiratory syndr.ome
\n(SARS).
\nDr. Chan paid tribute to her predecessor.
\n\u201cWe are all here because of the untimely
\ndeath of Dr. LEE Jong-wook. We are also
\nall here because of many millions of
\nuntimely deaths. I know Dr. Lee would
\nhave wanted me to make this point. He will
\nalways be remembered for his 3by5 initia-
\ntive. That was all about preventing untime-
\nly deaths on the grandest scale possible.\u201c
\nDr. Chan told the Assembly that as
\nDirector-General she would focus on six
\nkey issues for WHO: health development,
\nsecurity, capacity, information and knowl-
\nedge, partnership, and performance.
\nShe emphasized the importance of global
\nhealth security in her vision of the
\nOrganization\u2019s role: \u201cHealth security brings
\nbenefits at both the global and community
\nlevels. New diseases are global threats to
\nhealth that also bring shocks to economies
\nand societies. Defence against these threats
\nenhances our collective security.\u201c
\nUnderlining the importance of strong sys-
\ntems to deliver health care to the people
\nwho need it, she said: \u201cAll the donated
\ndrugs in the world won\u2019t do any good with-
\nout an infrastructure for their delivery. You
\ncannot deliver health care if the staff you
\ntrained at home are working abroad.\u201c
\nShe especially praised the people who
\ndeliver health care. \u201cThe true heroes these
\ndays are the health workers with their heal-
\ning, caring ethic. They are determined to
\nsave lives and relieve suffering, and they
\nwork with impressive dedication, often
\nunder difficult conditions. The world needs
\nmany, many more of them.\u201c
\nDr. Chan underlined the diverse approaches
\nneeded to strengthen health and health care
\nin different parts of the world. \u201cMany coun-
\ntries in Africa face the challenge of rebuild-
\ning social support systems. Others in central
\nAsia and Eastern Europe are undergoing
\ntransition from planned to market
\neconomies. They want WHO support. They
\nwant to make sure that equitable and acces-
\nsible systems built on primary health care
\nare not sacrificed in the process.\u201c
\nShe said she would strengthen WHO\u2019s com-
\nmitment to gather, analyse and build recom-
\nmendations based on evidence: \u201cI plan to
\nset up a global health observatory to collect,
\ncollate and disseminate data on priority
\nhealth problems. I will integrate WHO\u2019s
\nresearch activities to more strategically
\naddr.ess a common health research agenda.\u201c
\nThere is a growing number of initiatives
\nand players in the field of global health. Dr.
\nChan said she would work strategically
\nwith partners to deliver the best possible
\nresults for global health. \u201c Today, collabora-
\ntion to achieve public health goals is no
\nlonger simply an asset. It is a critical neces-
\nsity. WHO needs to develop an approach to
\ncollaboration that emphasizes management
\nof diversity and complexity.\u201c
\nTurning her attention to the internal man-
\nagement of WHO, Dr. Chan said: \u201cI will
\nalso accelerate human resource reform to
\nbuild a work ethic within WHO that is
\nbased on competence, and pride in achiev-
\ning results for health.\u201c
\nShe also addr.essed the challenges ahead of
\nthe Organization: \u201cAs we know, not all of
\nthe problems faced by WHO in its efforts to
\nimprove world health are subject to scientif-
\nic scrutiny, or yield their secrets under a
\nmicroscope. You know the ones I mean:
\nlack of resources and too little political
\ncommitment. These are often the true
\n\u2018killers\u2019.\u201c
\nEnding her address, Dr. Chan repeated her
\npledge to work hard to improve the health
\nof people around the world. \u201cThe work we
\ndo together saves lives and relieves suffer-
\ning. I will work with you tirelessly to make
\nthis world a healthier place.\u201c
\nDr. Anders Nordstr\u00f6m, appointed by the
\nExecutive Board as Acting Director-
\nGeneral of WHO in May, will continue in
\nthis role until a new Director-General takes
\noffice.
\nWHO
\nDr. Margaret Chan to be WHO\u2019s
\nnext Director-General
\nWHO
\nCountries, WHO and partners to mobi-
\nlize response teams to confront extensive-
\nly drug-resistant tuberculosis
\nGENEVA, 17 OCTOBER 2006 – Health
\nexperts have confirmed that the emergence
\nof extensively drug-resistant tuberculosis
\n(XDR-TB) poses a serious threat to public
\nhealth, particularly when associated with
\nHIV. At its first meeting, the World Health
\nOrganization (WHO) Global Task Force on
\nXDR-TB also outlined a series of measures
\nthat countries must put in place to effective-
\nly combat XDR-TB. In addition, the Task
\nForce will help mobilize teams that can
\nrespond to requests for technical assistance
\nfrom countries, and be deployed at short
\nnotice to XDR-TB risk areas.
\nThese were among a series of outcomes
\nissued by the Global Task Force meeting
\nheld on 9 and 10 October in Geneva. The
\nmeeting was urgently convened to review
\nthe latest available evidence on the impact
\nof highly resistant tuberculosis, including
\nwhen associated with HIV.
\nAddressing the Task Force, Acting
\nDirector-General of WHO, Dr Anders
\nNordstr\u00f6m, said the Organization was
\n\u201cabsolutely committed\u201c to supporting coun-
\ntry efforts to fight TB in all forms.
\nStop TB
\nWHO Global Task Force outlines measures
\nto combat XDR-TB worldwide
\n111
\npolitical will. The first three are in place.
\nThe last will make the difference,\u201c said Dr
\nRobert Scott, Chair of Rotary
\nInternational\u2019s PolioPlus Committee,
\nspeaking on behalf of the spearheading
\npartners of the Global Polio Eradication
\nInitiative. Rotary is the top private-sector
\ncontributor and volunteer arm of the
\nInitiative, having contributed US$600 mil-
\nlion and countless volunteer hours in the
\nfield since 1985.
\nThe ACPE advised the four polio-endemic
\ncountries to set realistic target dates for
\nstopping transmission, noting that improve-
\nments in reaching all children in these areas
\nhave been only incremental, and that these
\nGENEVA, 12 OCTOBER 2006 \u2014 The
\nworld\u2019s success in eradicating polio now
\ndepends on four countries \u2013 Afghanistan,
\nIndia, Nigeria, and Pakistan \u2013 according to
\nthe Advisory Committee on Polio
\nEradication (ACPE), the independent over-
\nsight body of the eradication effort.
\nWith a targeted vaccine and faster ways of
\ntracking the virus, most countries that
\nrecently suffered outbreaks are again polio-
\nfree. In parts of the four endemic countries,
\nhowever, there is a persistent failure to vac-
\ncinate all children, and polio-free countries
\nare considering new measures to help pro-
\ntect themselves from future outbreaks.
\n\u201cWith a more effective monovalent vaccine
\nand accelerated lab processes for identify-
\ning poliovirus, these countries have the best
\ntools we\u2019ve ever had,\u201c noted Dr Stephen
\nCochi, Chair of the ACPE and Senior
\nAdviser to the Director of the Global
\nImmunization Division at the US Centers
\nfor Disease Control and Prevention..
\n\u201cEradicating polio is no longer a technical
\nissue alone. Success is now more a question
\nof the political will to ensure effective
\nadministration at all levels so that all chil-
\ndren get vaccine.\u201c As an illustration, the
\noffice of Afghan President Hamid Karzai
\nhas already taken direct oversight of polio
\nvaccinations, following the sharp increase
\nin cases in the Southern Region of
\nAfghanistan,.
\nGiven that all children paralysed by polio in
\nthe world this year were infected by virus
\noriginating in one of the four endemic coun-
\ntries, polio-free countries are now taking
\nnew measures to protect themselves. The
\nMinistry of Health of Saudi Arabia, for
\nexample, will be enforcing stringent polio
\nimmunization requirements for the upcom-
\ning pilgrimage to Mecca.
\n\u201cPolio eradication hinges on vaccine sup-
\nply, community acceptance, funding and
\nGlobal polio eradication now hinges on four
\ncountries
\nPolio-free countries seek to protect themselves
\ncountries will take more than 12 months to
\nend polio.
\nCirculation of wild poliovirus: Since
\n1988, global polio eradication efforts
\nreduced the number of polio cases from
\n350,000 annually to 1403 in 2006 (as at 10
\nOctober 2006), of which 1300 are in the
\nfour endemic countries (where poliovirus
\ntransmission has never been stopped):
\nNigeria, India, Afghanistan and Pakistan.
\nThis is the lowest number of endemic coun-
\ntries in history.
\nFunding: In addition to strengthened polit-
\nical ownership in the remaining endemic
\ncountries, key to success is the ongoing
\ncommitment of the international donor
\ncommunity. For 2006, a further US$50 mil-
\nlion is urgently needed, to ensure planned
\nimmunization activities through to the rest
\nof the year can proceed. Additional funding
\nof US$390 million is needed for 2007-
\n2008, of which US$100 million is needed
\nfor activities in the first half of 2007.
\nWHO
\n\u201cIt is critical that urgent steps are taken to
\naddress XDR-TB, especially in areas of
\nhigh HIV prevalence,\u201c said Dr Nordstr\u00f6m.
\n\u201cAt the same time we should not lose sight
\nof the need to make long-standing improve-
\nments to strengthen TB control, and build
\nthe necessary capacity in health services to
\nrespond to drug-resistant tuberculosis.\u201c
\nAlong with a call for countries to strengthen
\nTB control \u2013 the key to preventing TB drug
\nresistance \u2013 consensus was reached on an
\nXDR-TB case definition (see below). In
\nhigh HIV prevalence settings, there was also
\nagreement that control of XDR-TB will not
\nbe possible without close coordination of TB
\nand HIV programmes and interventions.
\nThe Task Force also made specific recom-
\nmendations on drug-resistant TB surveil-
\nlance methods and laboratory capacity mea-
\nsures; implementing infection control mea-
\nsures to protect patients, health care work-
\ners and visitors (particularly those who are
\nHIV infected); access to second-line anti-
\nTB and antiretroviral drugs for countries;
\ncommunication and information-sharing
\nstrategies related to XDR-TB prevention,
\ncontrol, and treatment including co-man-
\nagement with antiretroviral therapy; and
\nresearch and development of new TB drugs,
\nvaccines and diagnostic tests.
\nWHO and Task Force members will now
\ncoordinate with national and international
\npartners involved in TB as well as HIV pre-
\nPreventing XDR-TB through strength-
\nening TB and HIV control
\nTo prevent the appearance and spread of
\ndrug-resistant TB, the Task Force under-
\nlined as a priority the need for the immedi-
\nate strengthening of TB control in coun-
\ntries, as detailed in the new Stop TB
\nStrategy and Global Plan to Stop TB 2006-
\n2015. This should be done in coordination
\nwith scaling up universal access to HIV
\ntreatment and care. WHO and Task Force
\nmembers will help mobilize teams of
\nexperts that can be deployed in the field, at
\nthe request of countries, to assist in
\nstrengthening TB control, and where rele-
\nvant HIV control.
\nThere were also specific recommendations
\non:
\nManagement of XDR-TB suspects in
\nhigh and low HIV prevalence settings:
\nAccelerate access to rapid tests for
\nrifampicin resistance, to improve case
\ndetection of all patients suspected of mul-
\ntidrug-resistant TB (MDR-TB) so that
\nthey can be given treatment that is as
\neffective as possible. Rapid diagnosis is
\npotentially life saving to those who are
\nHIV positive.
\nProgramme management of XDR-TB
\nand treatment design in HIV negative
\nand positive people:
\n\u2022 Adhere to WHO Guidelines for the
\nProgrammatic Management of Drug
\nResistant TB;
\n\u2022 Improve MDR-TB management condi-
\ntions;
\n\u2022 Enable access to all MDR-TB second-
\nline drugs, under proper conditions;
\n\u2022 Ensure all patients with HIV are ade-
\nquately treated for TB and started on
\nappropriate antiretroviral therapy.
\nLaboratory XDR-TB definition:
\nXDR-TB is defined as resistance to at least
\nrifampicin and isoniazid from among the
\nfirst line anti-TB drugs (which is the defi-
\nnition of MDR-TB) in addition to resis-
\ntance to any fluoroquinolone, and to at
\nleast one of three injectable second-line
\nanti-TB drugs used in TB treatment
\n(capreomycin, kanamicin, and amikacin).
\nInfection control and protection of
\nhealth care workers with emphasis on
\nhigh HIV prevalence settings:
\nAccelerate wide implementation of rec-
\nommended infection control measures in
\nhealth care settings and other risk areas in
\norder to reduce the ongoing transmission
\nof drug-resistant TB, especially among
\nthose who are HIV positive.
\nImmediate XDR-TB surveillance activi-
\nties and needs:
\nStrengthen laboratory capacity to diag-
\nnose, manage and survey drug resistance;
\nCommence rapid surveys of drug-resistant
\nTB so that the extent and size of the XDR-
\nTB epidemic, and its association with HIV,
\ncan be determined.
\nAdvocacy, communication and social
\nmobilization:
\n\u2022 Initiate information-sharing strategies
\nthat promote effective prevention, treat-
\nment, control of XDR-TB at global and
\nnational levels and also in high HIV
\nprevalence settings;
\n\u2022 Strengthen communication with affect-
\ned communities and individuals;
\n\u2022 Develop a fully-budgeted plan with the
\nresources and funding required to
\naddress XDR-TB, including through
\nnecessary improvements in overall TB
\ncontrol and HIV care in the immediate
\nand medium term;
\n\u2022 Initiate resource mobilization.
\nPlanning is also underway for a focused
\nmeeting in the near future on research and
\ndevelopment issues relating to TB, includ-
\ning promoting the development of the new
\ndiagnostics, drugs and vaccines that are
\nurgently needed. A meeting on antiretrovi-
\nral therapy and XDR-TB is also planned.
\nWHO Global Task Force on XDR-TB, October 2006
\nOutcomes and Recommendations
\nRegional and NMA News
\n113
\nWMA Asian-Pacific Regional
\nConference: Day 1
\nThe first day of the Asian-Pacific Regional
\nConference, held at Chinzan-so in Tokyo,
\nbegan with an Open Session attended by Dr.
\nYank Coble, Chair of the Caring Physicians
\nof the World Initiative; Dr. Yoshihito
\nKarasawa, President of the JMA; Dr. Kgosi
\nLetlape, President of the WMA; and Dr.
\nYoram Blachar, WMA Chair of Council.
\nThis session included addresses by Dr.
\nShigeru Omi, Regional Director of the
\nWHO Regional Office for the Western
\nPacific, who spoke on \u201cCurrent Situation of
\nPandemic Influenza\u201d, and by Dr. Jorge
\nPuente, Vice President of Medical and
\nRegulatory Affairs for Japan and Asia at
\nPfizer, who spoke on \u201cThe State of the
\nProfession in the World Today\u201d. Dr. Ross
\nBoswell, Vice-Chair of Council of
\nCMAAO and Dr. Otmar Kloiber, WMA
\nSecretary General, both then reported on
\nthe state of the medical profession in their
\nrespective countries.
\nDr. Omi, who has a tremendous track record
\nin the eradication of polio and containment
\nof SARS, explained in his presentation the
\ncurrent situation concerning highly-patho-
\ngenic avian influenza, the threat of a pan-
\ndemic, and measures to prevent the occur-
\nrence of such a pandemic. He explained that
\nmigratory birds were not the only carriers of
\nthe infection, as was commonly believed,
\nbut that factors such as the export of domes-
\ntic poultry were also extremely critical.
\nGiving the example of Vietnam and
\nThailand, which were successful in contain-
\ning the spread of highly-pathogenic influen-
\nza, Dr. Omi emphasized the importance of
\nmeasures such as the identification of early
\nsymptoms of infectious disease and the
\nswift reporting of accurate information to
\nthe WHO; precise evaluation of the situa-
\ntion and decision-making; and a systematic
\nresponse that includes monetary compensa-
\ntion for the disposal of domestic poultry. He
\nparticularly emphasized the problem of los-
\ning opportunities to contain infectious dis-
\nease due to failure to promptly release and
\nshare information.
\nFollowing they keynote speeches, a wel-
\ncome reception also attended by Mr. Jiro
\nPreceding the conference, in the early after-
\nnoon of September 10, a public lecture held
\nby the JMA and supported by the WMA
\nwas held on the same themes as the confer-
\nence. Two lectures were presented: \u201cCrisis
\nManagement for Infectious Diseases\u201d, by
\nDr. Takeshi Kasai, WHO Regional Adviser
\nin Communicable Disease Surveillance and
\nResponse for the Western Pacific; and
\n\u201cDisaster Preparedness and Response\u201d, by
\nDr. Yasuhiro Yamamoto, Professor,
\nDepartment of Emergency and Critical Care
\nMedicine, Nippon Medical School. Held at
\nthe JMA Auditorium as a satellite event
\nattended by nearly 700 people. President of
\nthe WMA, Dr. Kgosi Letlape and Chair of
\nCouncil Dr. Yoram Blachar addressed the
\nlecture.
\nvention, care and treatment to take the rec-
\nommendations forward. They will also
\ndevelop a plan that identifies the resources
\nrequired to implement these outcomes and
\nthe overall emergency response.
\nDrug-resistant TB has emerged as an
\nincreasing threat to TB control but a WHO
\n\/ US Centers for Disease Control and
\nPrevention study, published earlier this
\nyear, documented for the first time cases of
\ntuberculosis that were extensively resistant
\nto current drug treatments. XDR-TB was
\nidentified in all regions of the world, though
\nit is still thought to be relatively uncom-
\nmon.
\nLast month, concerns about the emergence
\nof XDR-TB were heightened by reports and
\nstudies from KwaZulu-Natal province in
\nSouth Africa of high mortality rates in HIV-
\npositive people with XDR-TB. This led to
\nwarnings that XDR-TB could seriously
\nthreaten the considerable progress being
\nmade in countries on TB control and the
\nscaling up of universal access to HIV treat-
\nment and prevention.
\nAmong the first countries to request assis-
\ntance to strengthen its national emergency
\nXDR-TB response, and the extra challenges
\nposed by HIV, is South Africa. The South
\nAfrican Department of Health is to host an
\nXDR-TB meeting on 17 and 18 October,
\nwith participation from WHO and represen-
\ntatives from other affected southern African
\ncountries.
\nSpecial Public Lecture
\nThe 1st
\nWMA Asian-Pacific Regional
\nConference, held jointly by the World
\nMedical Association (WMA) and the Japan
\nMedical Association (JMA), opened auspi-
\nciously on the warm and sunny afternoon of
\nSeptember 10, 2006 in Tokyo. The confer-
\nence brought together participants from 18
\ncountries to discuss the themes of natural
\ndisasters such as earthquakes and tsunami,
\nwhich occur virtually yearly in the Asian
\nregion; infectious diseases, which pose an
\nincreasing risk of a pandemic beginning in
\nAsia and spreading throughout the world;
\nand the state of the medical profession and
\nmedical associations.
\nRegional and NMA News
\nAsian Pacific Regional Conference
\nHow to cope with Natural Disasters and Infectious Diseases \u2013
\nCaring Physicians of the World: 1st
\nWMA Asian-Pacific Regional
\nConference
\nDr. Masami Ishii
\nSecretary General, CMAAO Executive Board Member, Japan Medical Association
\nRegional and NMA News
\n114
\nKawasaki, Minister of Health, Labour, and
\nWelfare, as well as several parliament mem-
\nbers was held, allowing participants to
\ndeepen their friendships.
\nAsian-Pacific Regional
\nConference: Day 2
\nSeptember 11 dawned with thunder show-
\ners but cleared to a sunny day. The program
\nfor Day 2 of the conference covered three
\nthemes.
\nSession 1: Disaster Preparedness and
\nResponse \u2013 Earthquake and Tsunami;
\nSession 2: Disaster Preparedness and
\nResponse \u2013 Infectious Disease; and
\nSession 3: The State of the Profession.
\nSession 1 began with an explanation by Dr.
\nYoshinobu Tsuji, Associate Professor at the
\nEarthquake Research Institute at the
\nUniversity of Tokyo, that the Asian-Pacific
\nregion, collectively known as the Pacific
\nRim, is prone to earthquake and tsunami
\ndisasters due to plate tectonics. Reviewing
\nthe history of past earthquakes and tsunami
\nup until the present, he also briefly
\ndescribed the tsunami warning systems and
\nevacuation measures that have been used to
\ndate.
\nThis presentation was followed by keynote
\nspeeches by Dr. Yasuhiro Yamamoto and
\nDr. Takeshi Kasai, who had both also spo-
\nken at the public lecture held the previous
\nday. Dr. Yamamoto presented results of
\nanalysis of the case of the Great Hanshin-
\nAwaji Earthquake in Japan in1995 that
\nshowed that in the 72 hours following the
\nearthquake, over 80% of rescues were per-
\nformed or assisted by family members or
\nneighbors of trapped people or by trapped
\npeople themselves; less than 20% of rescues
\nwere performed by professional rescue
\nworkers in the line of duty.
\nDr. Yamamoto also reported that with the
\npassage of time, the need for medical care
\nfor chronic disease as well as psychological
\ncare increases. This highlights the need for
\npre-hospital care and synchronization with
\nrescue measures in other countries that pro-
\nmote training workshops on AED and other
\nresuscitation methods. Japan and the other
\ndeveloped countries are all expected to have
\nincreasingly aging populations. With the
\nimportance of elderly people themselves
\ntaking measures to prevent falls and keep
\nwith them at all times a medical history and
\nlist of their medications, as well as
\nbystanders to an incident having learned
\nhow to respond to an emergency, not only
\ncross-border responses to major disasters
\nbut also the further promotion of safety edu-
\ncation and training in the future is vital.
\nDr. Kasai spoke about measures against a
\nnew, highly infectious influenza strain, say-
\ning that there were three levels of response:
\nmeasures against avian influenza; early
\ncontainment of a new human influenza
\nvirus; and measures against a pandemic.
\nUnlike in natural disasters, support from
\nneighboring countries or regions cannot be
\nanticipated in the case of a pandemic, and
\nso preparedness is the cornerstone of risk
\ncontrol. It is vital that each region is as pre-
\npared as possible for a pandemic and that
\ninformation sharing is prompt.
\nDr. Dongchun Shin of the Korean Medical
\nAssociation reported on the prompt rescue
\nactivities of that medical association in coop-
\neration with Indonesian Medical Association
\nin the aftermath of the Sumatra Earthquake,
\nand it was proposed that networks such as
\nthe WMA and CMAAO could play a useful
\nrole in international disaster relief activities.
\nIn Session 3, on the state of the medical pro-
\nfession and medical associations, there was
\na free discussion about the future direction
\nof medical association activities based on
\nreports of the current situation for each
\nnational medical association and reports
\npresented in this session.
\nIn conclusion, Dr. Kazuo Iwasa, Vice-
\nPresident of JMA and Vice-Chair of
\nCouncil of WMA, spoke about the signifi-
\ncance of this conference and of medical
\nactivities that overcome national bound-
\naries and differences of race and religion
\nunder the enduring values laid down in the
\nWMA Declaration of Geneva and the Oath
\nof Hippocrates, the fundamental principles
\nof all medical practitioners.
\nConclusion
\nIn enabling the sharing and discussion of
\ninformation about medical response to the
\nextremely relevant themes of natural disas-
\nters, which are a very real risk in this
\nregion, and outbreaks of infectious disease,
\ninternational regional meetings such as this
\nare deeply significant. Health care essen-
\ntially should not be limited to healthcare
\nservices provided by health insurance based
\non assessments and agreements, but should
\ncomprehensively involve all aspects of the
\nhealth and lives of members of the public as
\nwell as seek and find directions for prob-
\nlems that cross national boundaries.
\nLooking at the unexpectedly great response
\nto the public lecture held in conjunction
\nwith this conference, it is clear that mem-
\nbers of the public feel tremendous uncer-
\ntainty about responses to major natural dis-
\nasters and have even greater needs.
\nMoreover, changing our perspective, the
\ntwo themes of this conference \u2013 natural dis-
\nasters and infectious diseases \u2013 both occur
\nacross national and social boundaries and
\nrequire a collective response by human and
\norganizational networks when they occur.
\nFor this reason also, it is highly significant
\nthat the results of this regional conference
\nwill be announced widely through the
\nAsian-Pacific areas. We should note that
\nthis kind of conference is strongly needed
\nby the NMAs which lack of national
\nresources to cope with the natural disasters
\nand infectious diseases. Information sharing
\nwill be more increasingly required among
\nthe regional NMAs.
\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
\nCarrera 7 N\u00b0 82-66, Oficinas 218\/219
\nSantaf\u00e9 de Bogot\u00e1, D.E.
\nTel\/Fax: (57-1) 256 8050\/256 8010
\nE-mail: federacionmedicacol@
\nsky.net.co
\nDEMOCRATIC REP. OF CONGO F
\nOrdre des M\u00e9decins du Zaire
\nB.P. 4922
\nKinshasa \u2013 Gombe
\nTel: (243-12) 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: hlz@email.htnet.hr
\nWebsite: www.hlk.hr\/default.asp
\nCZECH REPUBLIC E
\nCzech Medical Association
\nJ.E. Purkyne
\nSokolsk\u00e1 31 – P.O. Box 88
\n120 26 Prague 2
\nTel: (420-2) 242 66 201-4
\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
\n(EsMA)Pepleri 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\/Fax: (679) 387671
\nE-mail: fijimedassoc@connect.com.fj
\nFINLAND E
\nFinnish Medical Association
\nP.O. Box 49
\n00501 Helsinki
\nTel: (358-9) 3930 91\/Fax-794
\nE-mail: fma@fimnet.fi
\nWebsite: www.medassoc.fi
\nFRANCE F
\nAssociation M\u00e9dicale Fran\u00e7aise
\n180, Blvd. Haussmann
\n75389 Paris Cedex 08
\nTel\/Fax: (33) 1 45 25 22 68
\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) 400-456 369\/Fax: -387
\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, Chi-
\nnaDuke 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 \u2013 PO.Box 145
\n1443 Budapest
\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) 23370009\/23378819\/
\n23378680
\nFax: (91-11) 23379178\/23379470
\nE-mail: inmedici@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) 676-7273Fax: (353-1)
\n6612758\/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: doritb@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
\nWebsite: www.lgs.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
\nMACEDONIA E
\nMacedonian Medical Association
\nDame Gruev St. 3
\nP.O. Box 174
\n91000 Skopje
\nTel\/Fax: (389-91) 232577
\nE-mail: mld@unet.com.mk
\nMALAYSIA E
\nMalaysian Medical Association
\n4th Floor, MMA House
\n124 Jalan Pahang
\n53000 Kuala Lumpur
\nTel: (60-3) 40413740\/40411375
\nAssociation and address\/Officers
\nii
\nAssociation and address\/Officers
\niii
\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. D-107
\nColonia Deportivo Obispado
\nMonterrey, Nuevo L\u00e9on
\nTel\/Fax: (52-8) 348-41-55
\nE-mail: rcantum@doctor.com
\nWebsite: www.cmm-fenacome.org
\nNAMIBIA E
\nMedical Association of Namibia
\n403 Maerua Park \u2013 POB 3369
\nWindhoek
\nTel: (264) 61 22 44 55\/Fax: -48 26
\nE-mail: man.office@iway.na
\nNEPAL E
\nNepal Medical Association
\nSiddhi Sadan, Post Box 189
\nExhibition Road
\nKatmandu
\nTel: (977 1) 4225860, 231825
\nFax: (977 1) 4225300
\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) 492 4179
\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@cwpanama.net
\nPERU S
\nColegio M\u00e9dico del Per\u00fa
\nMalec\u00f3n Armend\u00e1riz N\u00b0 791
\nMiraflores, Lima
\nTel: (51-1) 241 75 72
\nFax: (51-1) 242 3917
\nE-mail: decano@cmp.org.pe
\nWebsite: www.cmp.org.pe
\nPHILIPPINES E
\nPhilippine Medical Association
\nPMA Bldg, North Avenue
\nQuezon City
\nTel: (63-2) 929-63 66\/Fax: -6951
\nE-mail: medical@pma.com.ph
\nWebsite: www.pma.com.ph
\nPOLAND E
\nPolish Medical Association
\nAl. Ujazdowskie 24, 00-478 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: intl@omcne.pt
\nWebsite: www.ordemdosmedicos.pt
\nROMANIA F
\nRomanian Medical Association
\nStr. Ionel Perlea, nr 10
\nSect. 1, Bucarest
\nTel: (40-1) 460 08 30
\nFax: (40-1) 312 13 57
\nE-mail: AMR@itcnet.ro
\nWebsite: ong.ro\/ong\/amr
\nRUSSIA E
\nRussian Medical Society
\nUdaltsova Street 85
\n119607 Moscow
\nTel: (7-095)932-83-02
\nE-mail: info@rusmed.ru
\nWebsite: www.russmed.ru
\nSAMOA E
\nSamoa Medical Association
\nTupua Tamasese Meaole Hospital
\nPrivate Bag \u2013 National Health Services
\nApia
\nTel: (685) 778 5858
\nE-mail: vialil_lameko@yahoo.com
\nSINGAPORE E
\nSingapore Medical Association
\nAlumni Medical Centre, Level 2
\n2 College Road, 169850 Singapore
\nTel: (65) 6223 1264
\nFax: (65) 6224 7827
\nE-Mail: sma@sma.org.sg
\nwww.sma.org.sg
\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, 61001 Ljubljana
\nTel: (386-61) 323 469
\nFax: (386-61) 301 955
\nSOMALIA E
\nSomali Medical Association
\n14 Wardigley Road \u2013 POB 199
\nMogadishu
\nTel: (252-1) 595 599
\nFax: (252-1) 225 858
\nE-mail: drdalmar@yahoo.co.uk
\nSOUTH AFRICA E
\nThe South African Medical Associa-
\ntionP.O. Box 74789, Lynnwood Rydge
\n0040 Pretoria
\nTel: (27-12) 481 2036\/2063
\nFax: (27-12) 481 2100\/2058
\nE-mail: sginterim@samedical.org
\nWebsite: www.samedical.org
\nSPAIN S
\nConsejo General de Colegios M\u00e9dicos
\nPlaza de las Cortes 11, Madrid 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, SE – 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 C.P. 170
\n3000 Berne 15
\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
\nTel: (886-2) 2752-7286
\nFax: (886-2) 2771-8392
\nE-mail: intl@med-assn.org.tw
\nWebsite: www.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: www.medassocthai.org
\nTUNISIA F
\nConseil National de l\u2019Ordre
\ndes M\u00e9decins de Tunisie
\n16, rue de Touraine
\n1002 Tunis
\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
\nSehit Danis Tunaligil Sok. N\u00b0 2 Kat 4
\nMaltepe 06570
\nAnkara
\nTel: (90-312) 231 \u20133179\/Fax: -1952
\nE-mail: Ttb@ttb.org.tr
\nWebsite: www.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 Citt\u00e0 del Vaticano
\n00120 Citt\u00e0 del Vaticano
\nTel: (39-06) 69879300
\nFax: (39-06) 69883328
\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 Medical Association
\n(VGAMP)68A Ba Trieu-Street
\nHoau Kiem District
\nHanoi
\nTel\/Fax: (84) 4 943 9323
\nZIMBABWE E
\nZimbabwe Medical Association
\nP.O. Box 3671
\nHarare
\nTel: (263-4) 791553
\nFax: (263-4) 791561
\nE-mail: zima@zol.co.zw<\/p>\n"},"caption":{"rendered":"

wmj12 WorldMedical Journal Vol. No.4,December200652 OFFICIAL JOURNAL OF THE WORLD MEDICAL ASSOCIATION, INC. G 20438 Contents World Medical Association International Code of Medical Ethics 87 Editorial Regulation and Self-Regulation 88 New appointments and honours 89 Libyan Court Decision on Bulgarian Doctor and Nurses 89 Medical Ethics and Human Rights WMA Declaration on Hunger Strikers 90 […]<\/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\/wmj12.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/3551"}],"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=3551"}]}}