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wmj19<\/a><\/p>\n

No. 3, September 2008
\nEditor in Chief
\nDr. P\u0113teris Apinis
\nLatvian Medical Association
\nSkolas iela 3, Riga, Latvia
\nPhone +371 67 220 661
\npeteris@nma.lv
\neditorin-chief@wma.net
\nCo-Editor
\nDr. Alan J. Rowe
\nHaughley Grange, Stowmarket
\nSu\ufb00olk IP143QT, UK
\nCo-Editor
\nProf. Dr. med. Elmar Doppelfeld
\nDeutscher \u00c4rzte-Verlag
\nDieselstr. 2, D-50859 K\u00f6ln, Germany
\nAssistant Editor Velta Poz\u0146aka
\nwmj-editor@wma.net
\nJournal design and
\ncover design by J\u0101nis Pavlovskis
\nCover painting : impressions on a wall
\nin northern Somalia, dated back to over
\n3000 years. A cover picture is selected as a
\nmoral support of WMA for Somalian people
\nand physicians
\nLayout and Artwork
\nThe Latvian Medical Publisher \u201cMedic\u012bnas
\napg\u0101ds\u201d, President Dr. Maija \u0160etlere,
\nHospit\u0101\u013cu iela 55, Riga, Latvia
\nPublisher
\nThe World Medical Association, Inc. BP 63
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\nPrinted by
\nDeutscher \u00c4rzte-Verlag
\nK\u00f6ln, Germany
\nISSN: 0049-8122
\nDr. J\u00f3n SN\u00c6DAL
\nWMA President
\nIcelandic Medicial Assn
\nHlidasmari 8
\n200 Kopavogur
\nIceland
\nDr. Kazuo IWASA
\nWMA Vice-Chairman of Council
\nJapan Medical Assn
\n2-28-16 Honkomagome
\nBunkyo-ku
\nTokyo 113-8621
\nJapan
\nDr. Otmar KLOIBER
\nWMA Secretary General
\n13 chemin du Levant
\nFrance 01212 Ferney-Voltaire
\nFrance
\nDr. Yoram BLACHAR
\nWMA President-Elect
\nIsrael Medical Assn
\n2 Twin Towers
\n35 Jabotinsky Street
\nP.O. Box 3566
\nRamat-Gan 52136
\nIsrael
\nDr. Eva NILSSON-
\nB\u00c5GENHOLM
\nWMA Chairperson of the Medical
\nEthics Committee
\nSwedish Medical Assn.
\nP.O. Box 5610
\n11486 Stockholm
\nSweden
\nDr. Guy DUMONT
\nWMA Chairperson of the Associate
\nMembers
\n14 rue des Tiennes
\n1380 Lasne
\nBelgium
\nDr. Nachiappan ARUMUGAM
\nWMA Immediate Past President
\nMalaysian Medical Assn.
\n4th Floor, MMA House
\n53000 Kuala Lumpur
\nMalaysia
\nDr. J\u00f6rg-Dietrich HOPPE
\nWMA Treasurer
\nBundes\u00e4rztekammer
\nHerbert-Lewin-Platz 1
\n10623 Berlin
\nGermany
\nDr. Mukesh HAIKERWAL
\nWMA Chairperson of the Finance
\nand Planning Committee
\n58 Victoria Street
\nWilliamstown, VIC 3016
\nAustralia
\nDr. Edward HILL
\nWMA Chairperson of Council
\nAmerican Medical Assn
\n515 North State Street
\nChicago, ILL 60610
\nUSA
\nDr. Jos\u00e9 Luiz GOMES DO
\nAMARAL
\nWMA Chairperson of the Socio-
\nMedical-A\ufb00airs Committee
\nAssocia\u00e7ao M\u00e9dica Brasileira
\nRua Sao Carlos do Pinhal 324
\nBela Vista, CEP 01333-903
\nSao Paulo, SP
\nBrazil
\nDr. Karsten VILMAR
\nWMA Treasurer Emeritus
\nSchubertstr. 58
\n28209 Bremen
\nGermany
\nWorld Medical Association O\ufb03cers, Chairpersons and O\ufb03cials
\nO\ufb03cial Journal Of The World Medical Association
\nOpinions expressed in this journal \u2013 especially those in authored contributions \u2013 do not necessarily re\ufb02ect WMA policy or positions
\nwww.wma.net
\n75
\nWe are occasionally faced with the question: What is the role of the
\nphysician? Is it to care for the individual patient, or does the physi-
\ncian\u2019s responsibility extend to include the health of the whole nation
\nor even the entire planet?
\nSome of my colleagues have expressed the view that a national
\nmedical association\u2019s task does not extend to the medical care for
\nthe whole nation. In their opinion, that responsibility belongs to
\nthe government or an agency of the government, or to society as a
\nwhole; the doctor\u2019s job is to care for his or her patients. Although
\nthis latter statement is true, our professional medical education puts
\nus in the position to be the best guarantors of public health. I hold
\nphysicians in very high regard as specialists who invest and synthe-
\nsize their energy, knowledge and experience in the total care of their
\npatient.
\nHowever, each physician\u2019s mission is broader than the care of in-
\ndividual patients, just as the mission of every national professional
\nsociety extends beyond the inhabitants of the country. The mission
\nof the physician, the national medical organization, and the World
\nMedical Association should also be the health of society as a whole.
\nBecause no one else has a grasp of the issues, only the doctors and
\ntheir professional associations can e\ufb00ectively deal with the health of
\nthe general population.
\nThe health of the population worldwide could be dramatically im-
\nproved by paying attention to a few basic concepts: adequate nutri-
\ntion, su\ufb03cient exercise, clean water and air, primary and secondary
\nprophylaxis against disease, access to medication, access to quali\ufb01ed
\nmedical personnel, improvement in physical and mental well-being
\nand eradication of harmful behaviors such as smoking, alcoholism
\nand the use of drugs.
\nToday, inspired by the Olympic Games in Beijing and the Declara-
\ntion of Helsinki Conference in S\u00e3o Paolo, I would like to discuss
\nthe importance of exercise in the improvement and maintenance of
\ngood health.
\nWe were enthralled by the incredible new Olympic stadiums in
\nChina, the spectacular opening and closing ceremonies and the
\nworld-class competition of athletes in Beijing.While winning a gold
\nmedal is a signi\ufb01cant achievement, participation in the competition
\nis even more important. We should encourage all to participate in
\nphysical activity even if they have no chance of winning a medal.
\nChina provides a good example by the large number of people of
\nall ages who practice Tai Chi every day as a means to physical and
\nspiritual well-being. Athletics can inspire as a spectator sport, but it
\nshould be a reality in the everyday life of all people.
\nThe Declaration of Helsinki Conference took place in S\u00e3o Paolo,
\nBrazil in August 2008. Each conference participant took something
\naway from this meeting. For me, the most striking insight was the
\none I gained during several very early mornings in a park. I was not
\nthe only person running. Many thousand people, primarily 40- to
\n60-year-olds, were also running, alone or in lively groups. I now
\nunderstand why Brazilian athletes are the trend-setters in soccer,
\nvolleyball and athletics worldwide: they simply love to exercise, and
\nthey continue to exercise all their lives.
\nMy proposal is simple. The World Medical Association and each
\nnational medical association should undertake to promote at least
\nsome daily exercise and physical training in every individual, young
\nand old.
\nSenior sports should also be included in a nation\u2019s public health
\nprogram. In the world literature there are reports of research stud-
\nies showing that regular, daily exercise at a su\ufb03ciently high level
\nof intensity (including activity in an anaerobic regimen) can bring
\nabout a noticeable improvement in health status, increase in muscle
\nmass,amelioration of coordination disturbances,and stabilization of
\nthe heart and circulatory system. Exercise programs in 80 to 90 year
\nold patients can save on resources that would otherwise be spent in
\nthe health or social services Furthermore, exercise is the best way
\nto combat the worldwide epidemic of obesity and the sharply in-
\ncreased incidence of type 2 diabetes.
\nAt the moment there is no clear strategy internationally to pro-
\nmote exercise in older people. Senior sports enjoy prestige in only a
\nfew countries. In Scandinavian countries, for example, the sport of
\norientation attracts many people at retirement age, who then start
\ntraining in earnest, attend training camps in mountainous regions,
\nand go to training camps in the winters in southern Europe. It is
\ntime for us to \ufb01nd recognition for senior sports championships equal
\nto those enjoyed by youths and 20- to 30-year-olds. Most resources
\nare invested in youth sports, on the assumption that these young
\npeople will then mature into adults who love to exercise. However,
\nelderly people should also be encouraged to participate in sporting
\nactivities, consistent with their abilities.
\nOur goal in promoting good health is su\ufb03cient exercise and optimal
\nnutrition for every person, regardless of age.
\nEditorial
\nP\u0113teris Apinis, M.D.
\nEditor-in-Chief of the World Medical Journal
\n76
\nThe 179th
\nCouncil met in Divonne-les-
\nBains, France 15-17th
\nMay 2008 under the
\nchairmanship of Dr. Edward Hill.
\nOpening the meeting the Chair called on
\nDr. Ishii, member of Council and Secretary
\nGeneral of the Confederation of Medi-
\ncal Associations in Asia and Oceania, who
\nspoke of the mortality, injury and devasta-
\ntion caused by the earthquake in China
\nand the cyclone in Myanmar. This raised
\nhuge challenges in the Region. The Chair,
\nechoing these remarks, also referred to the
\ne\ufb00ects of armed con\ufb02ict and violence on
\nhuman health. In particular he referred
\nto the tragedy a\ufb00ecting the family of Prof
\nBartov, member of council. He then read a
\nletter written on behalf of Council to Pro-
\nfessor Bartov and Council stood in silent
\ntribute to those who had lost their lives in
\nthe earthquakes and the victims of natural
\ndisasters, war and violence.
\nThe President, Dr. Sn\u00e6dal reported that he
\nhad he had visited a number of NMAs, re-
\nferring in particular to a successful meeting
\non Communicable diseases in Taiwan and
\nto the enormous problems facing NMAs
\nin Sub-Saharan Africa. He continued by
\nspeaking of meetings which he, with others,
\nhad attended in Ethiopia and Uganda on
\nHuman Health Resources and the concept
\nof Task Shifting ( also being considered by
\nthe WMA working group). Task shifting
\nwas very important as it removes tasks from
\nmedicine to others. The other health pro-
\nfessions had also recognised that this had
\nimplications for them. Others important
\nissues would be referred to in the Report of
\nthe Secretary General.
\nDr. Otmar Kloiber, Secretary General, re-
\nported that the sta\ufb00 increases would fa-
\ncilitate increased WMA representation and
\nadvocacy at political level. He was grateful
\nto the AMA for facilitating the appoint-
\nment of Clarisse Delorme, a Human Rights
\nlawyer, as the Advocacy Adviser. There had
\nbeen a lot of activity on Task Shifting (TS).
\nTask Shifting While this seemed shocking at
\n\ufb01rst,it was nevertheless necessary to address
\nthe problem of areas where the Physician\/
\nPopulation ration was down to 1 : 50000-
\nmeaning that the sick had no chance of
\nseeing a physician. In these extraordinary
\ncircumstances there was a compelling need
\nto act. On the other hand WHO and do-
\nnor organisations gave the impression of
\nconsidering Task Shifting as a general con-
\ncept widely applicable to dealing with all
\n179th
\nWMA Council Meets
\nPresidium of 179th
\nWMA Council
\nDelegates of the Council by the Divonne-les-Bains Palace
\n77
\nhealthcare human resource problems. They
\ndon\u2019t view this concept as only applicable to
\npoor countries with human health resource
\ndeprived areas, but rather it could be used
\nas a tool to solve the problems of Health
\ncare systems in developed and rich coun-
\ntries. They are looking at countries, nota-
\nbly in the west such as the USA and UK,
\nwho have already started Task Shifting, etc.
\nThese countries don\u2019t have to face the sort of
\nshortages experienced by African countries.
\nLast year and this we have had a chance to
\nin\ufb02uence a Task Shifting policy document,
\nand point out that this is primarily for ad-
\ndressing the problems of shortages of hu-
\nman resources. In Addis Ababa we learnt
\nthat the African Ministers of Health were
\nnot aware of the western proposal of Task
\nShifting. Dr.Kloiber referring to the Kam-
\npala meeting said that the Health Profes-
\nsions requested but, were given no opportu-
\nnity for, direct in\ufb02uence on policy as there
\nwas no open discussion of the prepared
\ndocument, but simply information on what
\nwas planned. The Declaration of Kampala*
\noutlined the importance of Task Shifting,
\nbut pressure by the WHPA resulted in the
\ninclusion of the President of WMA in a
\nclosed ministerial round and some modi-
\n\ufb01cation of the \ufb01nal document to recognise
\nthe needs for health professionals.
\nTuberculosis Sta\ufb00 member Dr. Julia Seyer
\nin charge of MDR-TB project, reported
\nto council that for some years WMA had
\nbeen working with the Stop TB Alliance
\nand commented that the provision of theo-
\nretical knowledge as to how to teach about
\nTuberculosis on-line should help this cam-
\npaign. Together with the ICN, WMA was
\nengaged in workshops on the training and
\non healthcare workers\u2019 safety guidelines
\nin managing tuberculosis. She referred on
\nagreement signed on the previous day and
\nthe plan for the second phase of the project
\nand its enlargement (including China, Rus-
\nsia and India). She would like to extend the
\non-line course to a CD-ROM and a Hand-
\nbook. Concerning the training of trainers\u2019
\ncourses on education in learning styles,
\nthere was cooperation with the World Eco-
\nnomic Forum who had a toolkit for working
\nin countries such as China (where Tuber-
\nculosis is stigmatised), addressing the prob-
\nlems of how to diagnose, treat and manage
\ntuberculosis. Referring to ethics in relation
\nto tuberculosis, she highlighted the right of
\nsociety to enforce Tuberculosis control.
\nTobacco \/Alcohol Dr. Kloiber then referred to
\nthe new approach to Tobacco developed in
\nCopenhagen where WMA were invited to
\nwork on Legal controls.NMAs had selected
\nthe issues of education and communication
\nin Tobacco Control and also on limiting
\nexposure to tobacco smoke.The WMA had
\nco-sponsored a seminar on Tobacco control
\nat the EFMA\/WHO annual meeting in Tel
\nAviv and WMA would host a side event at
\nthe World Health Assembly on \u201cFocuss-
\ning Opportunities for Tobacco Cessation\u201d.
\nResponding to a question from India on
\ncollaboration he stressed that there would
\nbe more opportunities for NMA involve-
\nment in the projects new phase. Turning to
\nAlcohol which was now before the World
\nHealth Assembly, the recommendation
\nbefore the Assembly included a direction
\nthat the Secretary General should cooper-
\nate with the Alcohol industry.In view of the
\nlobbying by the industry this was a matter
\nof concern.
\nLeadership The WMA course Leadership
\nwas held in the autumn together with IN-
\nSEAD, with 32 participants from all over
\nthe world. Dr. Kloiber thanked P\ufb01zer for
\nmaking this course possible.The course was
\nsuch a success that it would be repeated.
\nWHPA** The WMA had taken over the
\nsecretariat of the World Health Professions
\nAlliance (WHPA) from the International
\nCouncil of Nurses (ICN) for the next pe-
\nriod after which it would rotate though the
\nother professions. WHPA is a very strong
\n* see page 82
\n** see more page 95
\nMeeting \u201eFocussing Oportunities for Tobacco
\nCessation\u201d in Geneva
\nFrom the left: Burton Conrod, President FDI; Hiroko Minami, ICN President; John Snaedal,
\nPresident WMA; Marilyn Mo\ufb00at, President WCPT; Kamal Midha, President FIP
\n78
\nalliance of the health professions who found,
\nto their surprise, that they had a common
\nexperience in their di\ufb03culties in getting
\ntheir views to be taken seriously by WHO,
\nwho considered that their views would be
\nsectional and partial in the global health
\n\ufb01eld. The professions who joined together
\nin this alliance found that this changed the
\nsituation and the WHPA had been success-
\nful in presenting a broader collective voice
\nfrom the health professions. The need for
\nthis alliance had been enhanced by the pro-
\nfessions recognising the threats implicit in
\nTask Shifting.
\nDr. Kloiber then introduced Ms Clarisse
\nDelonne, a French Human Rights lawyer
\nadvising on Advocacy for and by the profes-
\nsion She reminded council that an approach
\nhad been made to Paul Hunt the previous
\nUN Special Rapporteur on Health in Hu-
\nman Rights.She set out the role of the Rap-
\nporteur on the Right to Health and the need
\nto in\ufb02uence the Commission to extend the
\nmandate of the Commissioner to include
\nintegrity of health professionals in the man-
\ndate. WMA has worked extensively with
\nthe ICN lobbying on extending this role.
\nA joint statement was being prepared which
\nwould be sent to the Human Rights Com-
\nmission requesting that Independence and
\nIntegrity of health professionals be included
\nin the Special Rapporteur\u2019s mandate.
\nIn discussion Dr. Nathanson (BMA) point-
\ned out that the Special Rapporteur on Tor-
\nture had an interest in the problems of phy-
\nsicians in reporting torture and this aspect
\nshould also be addressed to Mr Nowak with
\nwhom we could also work.
\nDr. Wilks (President of the CPME) said
\nthat the BMA had worked with Paul Hunt
\nand discussed with him the NMAs\u2019 role
\nin increasing indices of health. With ref-
\nerence to Alcohol, Europe had experience
\nto o\ufb00er. In the European Union they had
\nbeen able to harness industry in actions on
\nAlcohol control. The Chair, Dr. Hill, com-
\nmented that in the USA where the industry
\ndecided to advise the young on the hazards
\nof drinking, however, drinking in the young
\nhad increased in those areas where the in-
\ndustry was involved.
\nDr. Letlape considered that WMA needed a
\nposition on this topic. Dr. Nathanson agree-
\ning added that alcohol was not as socially ac-
\nceptable for control action as was Tobacco.
\nDr. Haikerwall returning to Task Shifting
\nsaid the trend was towards removing medi-
\ncal care from Health care.
\nHuman Rights in Zimbabwe. The Chair
\nof Council introduced Dr. Paul Chimedza,
\nPresident of the Zimbabwe Medical As-
\nsociation (ZiMA) who had been invited to
\nspeak about the report of health related hu-
\nman rights and violence in Zimbabwe.
\nThanking council for the opportunity,
\nDr. Chimedza said that political tensions
\nand violence began to rise after the recent
\nelections in Zimbabwe and that this was be-
\ning perpetrated by both political parties. He
\ndenied that any patients had been refused
\nmedical care on the basis of political a\ufb03li-
\nation and stated that ZiMA had stressed to
\nits members that they should report any in-
\nstances in which they were prevented from
\ntreating patients. The ZiMA had received
\nno such reports from its members.
\nReferring to Harare he said there was no
\nproblem with the elections but that these
\narose after the election, when the political
\ntemperature rose. There had been a lot of
\nallegations about the profession. He had
\nreceived e-mails alleging that the Minister
\nof Health and Dr. Chimedza himself had
\nbeen involved in political violence and that
\nthe ZiMA as an organisation was support-
\ning violence. The allegations came from
\nthe Zimbabwe Doctors for Human Rights
\n(ZIDHR). He had met with the Chair-
\nman of ZiDHR before travelling to the
\nWMA council meeting in Divonne. Dur-
\ning this meeting the Chairman of ZiDHR
\nsaid that they had no evidence to support
\nthe allegation but had heard rumours.
\nDr. Chimedza commented that it was sad
\n\u201cthat a professional organisation could
\nmake such serious allegations without evi-
\ndence to support them.\u201d He accepted that
\nthere was a strained relationship between
\nZADHR and ZiMA from the time that
\nZADHR had been denied associate mem-
\nbership of the ZiMA. This was however
\nbecause the ZiMA constitution required
\na\ufb03liates to be speci\ufb01c medical profes-
\nsional groupings, such as paediatricians
\netc. ZADHR as a human rights associa-
\ntion was therefore not eligible for a\ufb03lia-
\ntion. In fact there had been e\ufb00orts at three
\nsuccessive ZiMA Congresses to amend the
\nconstitution to admit ZADHR and they
\nhad all failed. Despite this ZiMA had been
\naccommodating to ZADHR whose Chair-
\nman was a member of the Executive of Zi-
\nMA\u2019s Mashonaland branch. Dr. Chimedza
\nstated that ZiMA was against violence of
\nany kind, perpetrated by anyone. ZiMA
\nhad resisted being pressurised. In an over-
\nview of ZiMA\u2019s action he referred to its
\nSocial Responsibility Programme in which
\nthere were many actions such as outreach
\nto rural health centres, including equip-
\nment provision also funding for furniture
\nin HIV clinics, provision of drugs and as-
\nsistance in refurbishing hospitals, such as
\noperating theatres, as well as engaging in
\nmany other actions to assist the Zimba-
\nbwean people.
\nDr. Nathanson commented that ZiMA was
\nvulnerable to the sort of allegation referred to
\nand this was because people were not aware
\nof its work.It was a good example of how the
\nWMJ could be used to publicise these activi-
\nties. Dr. Chimedza felt this would be helpful
\nand stated that he would request ZiMA Ex-
\nFrom the left Dr. J. E. Hill,
\nDr. Paul Chimedza
\n79
\necutive to allow a WMA delegation to con-
\nduct a fact \ufb01nding mission to investigate the
\nallegations which had been made.This would
\nalso allow WMA to see the work that ZiMA
\nis doing, the challenges it faces , and identify
\nways in which WMA could assist them. Dr.
\nPlested asked whether in an environment so
\npolitically violent physicians were at personal
\nrisk. Dr. Chimedza said this was a major
\nworry.There was no violence before but after
\nthe lection.\u201cNone of our member physicians
\nhad been targeted\u201d. Problems were related to
\nthe economy.
\nThe immediate Past President proposed
\na motion to support such a delegation, to
\nwhich the Secretary General observed that
\nthis was unnecessary as it was covered by
\nthe Resolutions adopted by Council and the
\nGeneral Assembly in 2007.
\nDr.Nielsonaskedwhetheritwouldbeappro-
\npriate for the WMA to call on all physicians
\nthroughout the world to behave according
\nto the highest standards of the medical pro-
\nfession, a suggestion subsequently adopted
\nby the Council. While indicating that the
\nAMA would support sending a delegation
\nto Zimbabwe AMA felt that in would not
\nbe appropriate to describe such a delegation
\nas \u201ca fact \ufb01nding mission\u201d.
\nThe Dr. Nakia informed Council that a
\nCanadian University had for many years
\nan infective diseases health group going to
\nZimbabwe, but had di\ufb03culty recently in
\ngetting supplies into the country, as well
\nas concerns about the safety of physicians
\nand she enquired whether ZiMA would be
\nable to look into the question of safety for
\nthese physicians. Dr. Chimedza responded
\nthat ZiMA did not have the capacity to
\nguarantee the safety of anyone who was not
\ndirectly involved in ZiMA programmes and
\nthat ZiMA had temporarily suspended its
\nown programmes until violence subsides.
\nThe Chair of Council reiterated WMA\u2019s wish
\nto assist ZiMA on issues a\ufb00ecting physicians
\nand patients and Council adopted a resolu-
\ntion calling on all physicians to observe the
\nhighest standards of medical ethics.
\nMedical Ethics Committee
\nThe Chair, Dr. Bagenholm welcomed new
\nmembers of the committee and the minutes
\nof the last meeting in Copenhagen were ap-
\nproved.
\nHelsinki Declaration
\nMoving to the Declaration of Helsinki revi-
\nsion, Dr. Bagenholm said that the working
\ngroup had corresponded, producing a num-
\nber of drafts and had had a productive meet-
\ning. She asked Dr. Williams, who had done
\nmost of the writing, to set out the situation
\nand outline the most controversial issues.
\nDr. Williams said that the group were con-
\nscious of their mandate which was to iden-
\ntify gaps and to promote the Declaration of
\nHelsinki (DoH).The group meeting in Hel-
\nsinki looked at the most controversial sec-
\ntions, considered suggestions for additions,
\nbut had sought not to expand but try to
\ncapitalise the ideas into one or two sentences
\nand this constituted the agenda.In the report
\nbefore the committee most of the changes
\nwere editorial.In considering the vocabulary
\nit was decided that the best term to be used
\nfor those submitting to research was \u201cre-
\nsearch subject\u201d. He then referred to speci\ufb01c
\nitems setting out the reasons for the group\u2019s
\ndecisions,mentioning the need to avoid long
\nsentences and points which needed clari\ufb01ca-
\ntion. The Chair, Dr. Bagenholm speaking of
\nthe process, said that there would be a fur-
\nther revision after the Ethics committee and
\na workshop in Brazil in September, with a
\nview to getting a \ufb01nal document to Coun-
\ncil and submission to the General Assembly
\nthis year.She reported that an invitation had
\nbeen received to a WHO meeting in Cairo
\nof the Eastern and North African Medi-
\nterranean countries to be coordinated by
\nthe WHO Cairo O\ufb03ce and UNESCO to
\ndiscuss \u201cChallenges to Ethics and Medical
\nResearch\u201dIt was hoped that there could be a
\nparallel meeting on DoH for WMA mem-
\nbers and stakeholders.
\nOpening the discussion Dr. Nathanson
\n(UK) referred to the use of the word \u201chu-
\nman\u201d. This was a key issue. It should not be
\ninterpreted in DoH as including \u201cembryos\u201d.
\nIn DoH we are talking about humans from
\nbirth to death. President Sn\u00e6dal thanking
\nDr. Williams for his work commented that
\nthe paragraphs appeared to be lengthened,
\nthey need dividing. Turning to\u201d Research in
\nChildren\u201d he commented that this subject
\nhad not been worked on. The alternatives
\nwere to include it in DoH, or in the Dec-
\nlarations of Lisbon or Ottawa. Dr. Lemye
\nrequested that Belgium be included in the
\nworking group. An amendment which Bel-
\ngium had submitted appeared not to have
\nbeen considered. Dr. Bagenholm responded
\nsaying that all representation were consid-
\nered in Helsinki and were incorporated as
\nfar as possible, if appropriate. Dr. Havaux
\n(Switzerland) considered the document
\ngenerally to be very satisfactory except the
\nproblems arising from the DoH in many
\nlanguages. He expressed great concerns
\nabout the French translation. It was not
\nonly a problem of translation but also of
\nguidance for the French speaking countries.
\nHe proposed that the documents should
\nbe circulated in French. Dr. Kloiber agreed
\nthat we need to change the translations and
\nasked if some of the four language groups
\ncould join the editorial group to agree \ufb01nal
\nversions. Dr. Mot added that France had
\nalso some similar concerns and had added
\nthe African French speaking group to their
\neditorial group.Dr.Collins -Nakai (Canada)
\nthought there were three areas of concern:
\naccess of post trial patients,\u2022
\nuse of placebos,\u2022
\nDr. John R.Williams, Ph.D.
\nDr. Eva Nilsson B\u00e4genholm
\n80
\nthe current language was too restrictive.\u2022
\nInformed consent there had been remark-
\nable developments in the CMA.
\nDr. Bagenholm, reverting to the topic of
\nResearch on Children, reported that there
\nwere comments on this from many NMAs.
\nDr. Bagenholm opened a discussion on the
\nproposal on Research in Children reported
\nthat there had been many comments from
\nNMAs.When the committee had discussed
\nDoH it could then decide on how to deal
\nwith children. It could either be dealt with
\nin the context of this revision or dealt with
\nseparately. After recalling that the revision
\nof DoH was not to include new material,
\nshe called for expressions of interest in in-
\ncluding it in DoH. The CMA wanted it
\nincluded in DoH, using the inclusive term
\n\u201cvulnerable populations\u201d. Dr. Palve (Fin-
\nland) felt that the DoH should have a broad
\napproach \u201cIf we take up any one group why
\nshould other groups not be taken up? It
\nwould be better if these were dealt with in
\nseparate statements\u201d. Dr. Nathanson UK
\nsaid a lot depended on the timescale. She
\nrecognised that children were particularly
\nvulnerable. \u201cWe could use a small addition
\nto DoH.It was possibly quicker to deal with
\nit in DoH\u201d.Dr.Nakai (Canada) felt that re-
\nsearch on children was very important- we
\ncould use minor amendments to DoH. But
\nperhaps the WMA should consider amend-
\nment of the Declaration of Ottawa or in-
\nclude this topic in a Charter on Children\u2019s
\nHealth, which could include the proposed
\nstatement as well as assessment and promo-
\ntion of children\u2019s health.
\nDr.Plested (USA) favoured inclusion in the
\nDoH. The Declaration would be weakened
\nif we did not include the issue in this semi-
\nnal document. Prof Spumont (Switzerland)
\nsaid it was a question of principle. This was
\nthe sixth revision of Helsinki. It dealt with
\nthe constitution of research ethics. The
\nworld and science were changing.If we wish
\nto preserve the value of the DoH it should
\nbe limited to principles. It would be bet-
\nter to link speci\ufb01c declarations\/statements
\nto the DoH. Having analysed the di\ufb00erent
\nways in which the DoH has been incor-
\nporated in legislation, this would be a way
\nto proceed. Dr. Ishi (Japan) thought it had
\nbeen agreed that the statement proposed on
\nResearch in Children should be dealt with
\nas a separate document and Dr. Letlape
\n(South Africa)) considered that while there
\nmight be some amendment, we still needed
\na speci\ufb01c document. Avv. Wapner (Israel)
\nfavoured one document \u2013 that of the DoH.
\nThe proposed statement would dilute the
\nDoH. The problem was with \u201cvulnerable
\npopulations\u201d \u2013 children, the elderly, prison-
\ners etc. President Sn\u00e6dal felt that the issue
\nof research in children must be addressed.
\nWe have a proposal, also one on \u201cMaking
\nmedicines child size\u201d by WHO. WMA had
\napproved this initiative on research in chil-
\ndren it would be very expensive to extend
\nthe DoH. Dr. Letlape felt the DoH should
\nbe generic; we can\u2019t stop initiatives from
\noutside. The Paediatric Society would pro-
\nduce a child friendly version of the DoH.
\nDr. Parsa Parsi (Germany) supported in-
\nserting small changes into DoH. Dr. Kumar
\n(India) called for the inclusion of embryos
\nin the DoH.
\nDr. Williams indicated that Dr. Appleyard
\nhad not proposed alterations in DoH. He
\nwanted a separate document.This document
\napplied the principles of DoH to children.
\nHe also reminded the committee that the
\nword \u201cassent\u201dnot \u201cconsent\u201dwas in the DoH.
\nIn Council later, Dr. Bagenholm reported
\nthat comments on this from NMAs had
\nbeen received, but the working group had
\nnot produced any new draft proposals for
\naction or wording. The options were that
\nthis should be included in DoH, or that the
\nDoH be considered to be adequate in this
\nmatter, that there should be a new state-
\nment, or that the proposal be combined
\nwith the Ottawa Declaration.
\nDr. Plested agreed that the proposal should
\ngo back to NMAs for their comments on the
\noptions.Dr.Nathanson said there were many
\ngood reasons to do this. Do NMAs want a
\nholistic document or a series of statements?
\nWe needed to ask the opinion of NMAs.
\nThe Chair of Council asked what do we do
\nif we go through a new statement and lose
\nownership of the document? Dr.Kloiber re-
\nsponded that we must try to ensure that we
\njustify our position. We could ask NMAs if
\nthere was anything in the proposed state-
\nment which should go in DoH.Dr.Williams
\nwas worried that this would hold up the re-
\nvision. He wondered whether the working
\ngroup could review the proposed statement
\nand put it in the next version of DoH i.e. he
\nsuggested that the work group look at this
\nbefore the next revision of DoH.
\nThe Council \ufb01nally adopted the following
\ndecision,
\nthat the proposed statement on Ethical\u2022
\nPrinciplesforMedicalResearchonchil-
\ndren be not accepted as a WMA docu-
\nment but that the subject of research on
\nchildren be addressed by WMA in the
\ncontext of the DoH.
\nthat the DoH workgroup take into con-\u2022
\nsideration appropriate issues from the
\nproposed statement in \ufb01nalising the
\nnext revision of DoH for broad consul-
\ntation.
\nEthics committee further discussion on Hel-
\nsinki
\nThe Chair of Ethics committee then com-
\nmented that the paragraph on disease was very
\nlong,andneededsomeattentionandalsoasked
\nDr. Williams what was included in the use of
\nthe word \u201chumans\u201d. Dr. Williams replied that
\nsome thought there were important di\ufb00erenc-
\nes.As long as the word was used as an adjective
\nit meant \u201cbeing\u201dor \u201ctissue\u201d.When using it as a
\nnoun it meant \u201cborn subjects\u201d. He noted that
\nsome had called for a glossary of DoH terms
\nbut the project had been abandoned. Dr. An-
\ndrade(Brazil)consideredtheDoH tobeacore
\ndocument. It should therefore remain a basic
\ndocument of principles. It deals with the vul-
\nnerable.The question was who were the most
\nvulnerable \u2013 for him these were children. He
\nthought DoH should set standards \u2013 a docu-
\nment which cannot be ignored. It should be
\nreadable and consist of primordial principles.
\nThe de\ufb01nition of \u201chumans\u201d is biological and
\nthat of \u201cbeing\u201d,philosophical.
\n81
\nThe committee then considered the sug-
\ngested revision document paragraph by
\nparagraph. In the course of the debate there
\nwas considerable discussion of the issue of
\ndealing with principles and the danger of
\nmaking exceptions was pointed out. When
\ndealing with the issue of consent and the
\nemphasis placed on the individual in the
\nDoH, it was pointed out that this raised
\nmore than matters of consent. It also raised
\nthe issue of the balance between issues of in-
\ndividual concern and issues which were the
\nconcern of population groups – the speaker
\nas a further example posed the question as
\nto whether individuals have the right in ex-
\nceptional circumstances to object to the use
\nof blood taken for one purpose being used
\nfor another. This question and a number of
\nothers were referred to the working group.
\nAfter detailed and lengthy discussion of
\nthe proposed amendments and other is-
\nsues the committee agreed to recommend
\nthat the new draft amended by the working
\ngroup would be presented to council before
\nit concluded its meeting and that this be
\nsent to NMAs and circulated widely for
\npublic comment. Following the conference
\nin Brazil, which would include other stake-
\nholders, a new draft would be prepared for
\ncouncil and if approved, sent to the General
\nAssembly in Seoul These recommendation
\nwere adopted by Council.
\nStem Cell Research
\nThe committee engaged in further consider-
\nation of this draft proposal.There was some
\ndiscussion concerning con\ufb02ict with national
\nlaw in some countries.It was agreed that the
\ndocument, as amended, would be sent out
\nto NMAs for their views. Council adopted
\nthis recommendation.
\nProfessionally led Regulation
\nThe committee considered a paper on this
\ntopic which, it was pointed out, arose out of
\nthe consideration of the Madrid Statement
\nand new thinking.Dr.Blackmer pointed out
\nthat the paper had been circulated and the
\ncomments had mostly been editorial. In the
\ne\ufb00ort to support professionally led regula-
\ntion there was, however, a need to recognise
\nthat there must be some public involvement.
\nDr. Haikerwall (Australia) stressed that this
\nwas an important issue. The question was
\nhow to translate the importance of profes-
\nsionally led regulation to the public. The
\nPast President Dr. Letlape, (SouthAfrica)
\nsaid that the concern for his country, which
\nmight not apply elsewhere, was that advo-
\ncacy by physicians for the patient is falling
\no\ufb00.There was a need to be honest that pro-
\nfessionalism and advocacy for the patient is
\ndiminishing. We havn\u2019t kept our duty to so-
\nciety.The profession needed to be seen to be
\nthe body appropriate to regulate itself and
\ntake this responsibility. The Swedish Medi-
\ncal Association opposed the statement. Self
\nregulation was important for some NMAs.
\nFor the SMA this is too much. However,
\ninvolvement of outside bodies may be good
\nor not so good, and in this connection refer-
\nence was made to the varying functioning
\nof patient associations.The Danish Medical
\nAssociation agreed with SAMA.It observed
\nthat Dr.Blackmer had had a di\ufb03cult task In
\nDenmark and Sweden \u201cwe don\u2019t place much
\nemphasis on self regulation\u201d and the DMA
\nwas happy with the authority in Denmark.
\nWe should try to get a common position.
\nSir Charles George (BMA) supported self-
\nregulation, a concept which is being chal-
\nlenged in the UK.
\nAfter further discussion it was agreed to
\nrecommend to Council that a work group
\nbe established. This recommendation was
\napproved by Council.
\nProfessional Autonomy
\nDuring discussion of a Declaration on Pro-
\nfessional Autonomy and Clinical Indepen-
\ndence, a number of speakers pointed out
\nrelated issues which need addressing and
\nagreed that these would not be appropriate
\nfor this document. Dr.Blackmer observed
\nthat the discussion paper would inevitably
\nlead to a series of papers. It was agreed that
\n\u201ccon\ufb02ict of interest\u201dwas not appropriate for
\nthis document but needed addressing and
\nthe committee recommended that the pro-
\nposed statement should go to the General
\nAssembly in 2008, a recommendation later
\nagreed by Council, together with a request
\nthat Dr. Blackmer develop a statement on
\n\u201ccon\ufb02ict of interest\u201d.
\nCommon guidelines for physicians and the
\npharmaceutical industry
\nFollowing further discussion in committee,
\nthe Council adopted a recommendation
\nthat this issue be not pursued but deter-
\nmined that the working group should de-
\nvelop a proposal indicating how the WMA
\nand the Pharmaceutical Industry should
\ninteract.
\n1998 policy reviews
\nContinuing its review of 1998 policies
\nCouncil accepted that Resolutions on
\nSIrUS and on Health related Violations
\nof Human Rights in Kosovo, should be re-
\nscinded and archived.
\nIt was recommended and agreed by Council
\nthat the Ottawa Declaration should un-
\ndergo a major revision.
\nConcerning further revision of the statement
\non Capital punishment, it was reported that
\nfurther work would be done by the French
\nand American Medical associations to deal
\nwith the need for legal wording to satisfy
\ntranslation and other problems.
\nDenunciation of Acts of Torture and Cruel
\nand Degrading Treatment
\nThe committee considered suggested edito-
\nrial changes to the statement on Denuncia-
\ntion of Acts of Torture and Cruel or De-
\ngrading Treatment, following the request
\nof the Copenhagen General Assembly that
\nduplication be removed. After more exami-
\nnation and an assurance that the suggested
\nchanges re\ufb02ected the request of the Assem-
\nbly, Council approved the changes.
\nDr. Alan J. Rowe
\n82
\nWe, the participants at the \ufb01rst Global\u2022
\nForum on Human Resources for Health
\nin Kampala, 2-7 March 2008, and repre-
\nsenting a diverse group of governments,
\nmultilateral, bilateral and academic in-
\nstitutions, civil society, the private sector,
\nand health workers\u2019 professional associa-
\ntions and unions;
\nRecognizing the devastating impact that\u2022
\nHIV\/AIDS has on health systems and
\nthe health workforce, which has com-
\npounded the e\ufb00ects of the already heavy
\nglobal burden of communicable and non-
\ncommunicable diseases, accidents and
\ninjuries and other health problems, and
\ndelayed progress in achieving the health-
\nrelated Millennium Development Goals;
\nRecognizing that in addition to the e\ufb00ec-\u2022
\ntive health system, there are other deter-
\nminants to health;
\nAcknowledging that the enjoyment of\u2022
\nthe highest attainable standard of health
\nis one of the fundamental human rights;
\nFurther recognizing the need for immedi-\u2022
\nate action to resolve the accelerating crisis
\nin the global health workforce, includ-
\ning the global shortage of over 4 million
\nhealth workers needed to deliver essential
\nhealth care;
\nAware that we are building on existing\u2022
\ncommitments made by global and na-
\ntional leaders to address this crisis, and
\ndesirous and committed to see immediate
\nand urgent actions taken;
\nNow call upon:
\n1. Government leaders to provide the
\nstewardship to resolve the health worker
\ncrisis, involving all relevant stakeholders
\nand providing political momentum to
\nthe process.
\n2. Leaders of bilateral and multilat-
\neral development partners to provide
\ncoordinated and coherent support to
\nformulate and implement comprehen-
\nsive country health workforce strategies
\nand plans.
\n3. Governments to determine the appro-
\npriate health workforce skill mix and to
\ninstitute coordinated policies, including
\nthrough public private partnerships, for
\nan immediate, massive scale-up of com-
\nmunity and mid-level health workers,
\nwhile also addressing the need for more
\nhighly trained and specialized sta\ufb00.
\n4. Governments to devise rigorous ac-
\ncreditation systems for health worker
\neducation and training, complemented
\nby stringent regulatory frameworks de-
\nveloped in close cooperation with health
\nworkers and their professional organiza-
\ntions.
\n5. Governments, civil society, private sec-
\ntor, and professional organizations to
\nstrengthen leadership and management
\ncapacity at all levels.
\n6. Governments to assure adequate incentives
\nand an enabling and safe working environ-
\nment for e\ufb00ective retention and equitable
\ndistribution of the health workforce.
\n7. While acknowledging that migration of
\nhealth workers is a reality and has both
\npositive and negative impact, countries
\nto put appropriate mechanisms in place
\nto shape the health workforce market in
\nfavour of retention. The World Health
\nOrganization will accelerate negotia-
\ntions for a code of practice on the inter-
\nnational recruitment of health person-
\nnel.
\n8. All countries will work collectively to ad-
\ndress current and anticipated global health
\nworkforce shortages.Richer countries will
\ngive high priority and adequate funding to
\ntrain and recruit su\ufb03cient health person-
\nnel from within their own country.
\n9. Governments to increase their own \ufb01-
\nnancing of the health workforce, with
\ninternational institutions relaxing the
\nmacro-economic constraints on their do-
\ning so.
\n10. Multilateral and bilateral development
\npartners to provide dependable,sustained
\nand adequate \ufb01nancial support and im-
\nmediately to ful\ufb01ll existing pledges con-
\ncerning health and development.
\n11. Countries to create health workforce
\ninformation systems, to improve re-
\nsearch and to develop capacity for data
\nmanagement in order to institutionalize
\nevidence-based decision-making and
\nenhance shared learning.
\n12. The Global Health Workforce Alliance
\nto monitor the implementation of this
\nKampala Declaration and Agenda for
\nGlobal Action and to re-convene this
\nForum in two years\u2019 time to report-and
\nevaluate progress.
\nHuman Resources for Health, Kampala
\nDeclaration and Agenda for Global Action
\nWHO Director General addresses the
\n61st
\nWorld Health Assembly
\nDr. Margaret Chan opening her address said
\n\u201cWe are meeting at a time of tragedy\u201d, ex-
\npressing her condolences to the millions who
\nhad lost loved ones,homes and livelihoods in
\nthe cyclone in Myanmar and the earthquake
\nin China.Commenting on the great generos-
\nity shown by the international community in
\nresponding to crises of this nature,she stressed
\nthe importance of early warning systems and
\npreparations to reduce risks in advance.
\nDr. Chan referred to three global crises
\nlooming on the horizon, all of which have
\nhealth e\ufb00ects. The \ufb01rst was Food Security,
\nin which WHO is part of the \u201chigh level\u201d
\ntask force. In order to guide priority actions,
\nWHO identi\ufb01ed 21 \u201chot spots\u201d around the
\nworld where there are high levels of acute
\nand chronic under-nourishment? The sec-
\nond was Climate Change, on which she
\nelaborated and indicated the draft resolu-
\ntion before the Assembly which de\ufb01ned
\nclear WHO responsibilities The third global
\ncrisis looming is that of Pandemic In\ufb02uenza,
\nwhere the threat had by no means receded.
\n\u201cAs with climate change all countries will
\nbe a\ufb00ected, though in a far more rapid and
\nsweeping way\u201d.While these events \u201ccould set
\nback progress in reducing poverty and hun-
\nger\u201d, the Millennium Health related Goals
\nHealth \u2013 a global overview
\n83
\nreaching the world would vastly increase the
\nworld\u2019s capacity to cope with these interna-
\ntional threats.
\nWith better data and statistical methods
\nWHO and UNAIDS had been able to
\nchart the evolution of HIV\/AIDS with
\ngreater precision. Prevalence had been level
\nsince 2001 and deaths from AIDS have sig-
\nni\ufb01cantly declined in the past two years.
\nReferring to Tuberculosis, Dr. Chan said
\nthat poor medical practice, which contrib-
\nutes to the development of drug resistance,
\nhas continued to be and is a major concern.
\nMDRTB has now reached the highest level
\never recorded. \u201cTo allow this form of TB to
\nbecome widespread would be a set back,a set-
\nback of epic proportions.\u201d. There had contin-
\nued to be solid progress in Malaria control.
\nTurning to immunisation she referred to the
\nsuccessful Global Immunisation Strategy and
\nalso spoke of the broad based impact of In-
\ntegrated Management of Childhood Illness
\nwhich was now adopted as the principal child
\nsurvival strategy in 100 countries. Research
\ncoordinated by WHO had also demonstrated
\nthat home based treatment of pneumonia in
\nchildren was as e\ufb00ective as hospital care.
\nImproving women\u2019s health had proved dis-
\nappointingly slow, notably in reducing ma-
\nternal mortality.
\nIn her comments on non-communicable dis-
\neases Dr. Chan referred to the \ufb01rst ever Glo-
\nbal Tobacco Epidemic report launched with
\nthe Bloomberg Foundation in February and
\nshe emphasized that tobacco taxes were the
\nmost powerful tobacco control measures.
\nIt was the aim to control Neglected Tropi-
\ncal Diseases by 2015, and she noted that
\nwe were on the brink of eradicating guin-
\nea-worm disease. While e\ufb00orts to control
\npolio in the four remaining countries con-
\ntinue, she was concerned about a new strain
\nemerging in Africa.
\nDr. Chan stressed the need to return to Pri-
\nmary Health Care in strengthening health
\ncare systems. Primary Health Care would
\nbe the subject of the World Health Report
\nand would be published on the 30th
\nanniver-
\nsary of Alma Ata in mid-October.
\nFinally, speaking about the 60th
\nyear of the
\nfoundation of WHO, whose task then was
\nto restore Health Services in a world devas-
\ntated by war, she said that the landscape of
\nPublic Health was now very di\ufb00erent. It is
\nnow a time of unprecedented global interest
\nand investment in health,as well as an unprec-
\nedented challenge. WHO had a clear role in
\nwhich,amongst the reforms being introduced,
\nthe Global Management System would con-
\ntribute to improving WHO e\ufb03ciency and
\ntransparency in carrying out its role.
\nVital Report of Global Health Group
\nFor more than a decade, the concept of
\n\u201cglobal health\u201d has been widely promoted
\naround the world. Generally speaking, the
\nterm refers to health problems that transcend
\nnational borders and that are best addressed
\nby cooperative and collective actions.
\nThe recent pandemics of HIV\/AIDS,SARS,
\nand avian \ufb02u, as well as the growing health
\ninequities within and between nations, have
\nincreased the visibility and popularity of
\nglobal health. Further, globalization has ac-
\ncelerated and deepened health interdepen-
\ndence among societies.In 2000,world leaders
\ncommitted to the Millennium Development
\nGoals, (MDGs) \u2013 ambitious development
\ngoals to be achieved by 2015 \u2013 which speci\ufb01-
\ncally focused on health and seemed to pro-
\nmote global health even further.
\nHowever, many argue that global health ac-
\ntion is still con\ufb01ned inside the ivory tower
\nof high-ranking health administrators, or
\nwithin the major international organiza-
\ntions. In other words, many recent global
\nhealth initiatives have actually followed a
\ntop-down process. Increasing numbers of
\nhealth actors, while trying to prove their
\ne\ufb00ectiveness in the local context, have
\nasked the following questions concerning
\nglobal health: How do citizens around the
\nworld perceive the value of global health?
\nCan global health be integrated into public
\nlives and values, like the stock markets or
\noil prices? How can global health be recog-
\nnized as essential for local health needs?
\nLocal e\ufb00orts must be taken into consider-
\nation in the overall broader scope of global
\nhealth. Donors have been advised to con-
\nsider how local communities bene\ufb01t from
\nglobal health activities and how local com-
\nmunities can possibly recognize the contri-
\nbutions of these e\ufb00orts. It seems urgent to
\nre-design the approach to address existing
\nglobal health challenges. Focusing on lo-
\ncal communities and players seem to be the
\nbetter alternative.
\nThese considerations lead to the rationale of
\nthe Initiative for a Vital Report on Global
\nHealth (VRGH 2008) launched on April
\n8th, 2008, in the European Parliament in
\nBrussels. The VRGH is unique in the sense
\nthat its goal is to provide an analysis on how
\npeople around the world and notably those
\nliving in the developing countries perceive
\nAn alternative to better global health
\nFocusing on local communities and players seem to be the better alternative
\nFrom the left WHO Director General
\nDr. Margaret Chan
\n84
\nThe international Classi\ufb01cation of Diseases
\n(ICD) provides a global standard to organ-
\nise and classify information about diseases
\nand related health problems. It was devel-
\noped by the WHO, based on the Interna-
\ntional List of Causes of Death from 1893
\nand was printed and published for the \ufb01rst
\ntime in 1948.
\nThe actual ICD system provides informa-
\ntion for the morbidity and mortality sta-
\ntistics worldwide and is the database for
\nreimbursement systems, hospital records,
\nthe general health situation of population
\ngroups and shows incidences and prevalence
\nof diseases. The classi\ufb01cation is designed to
\npromote international comparability in the
\ncollection, processing, classi\ufb01cation, and
\npresentation of these statistics.
\nThe 10th
\nedition of the ICD has been in use
\nsince 1994 and will now be updated and
\nadapted to additional necessities and an in-
\ncreased IT usage.
\nWHO reported that the revision process for
\nICD 10 is not only an update but will also
\ninclude new information, combines di\ufb00er-
\nent national and international classi\ufb01ca-
\ntions, o\ufb00ers di\ufb00erent formats for users and
\nis will be globally accessible for comments
\nthrough the internet. The following sum-
\nmarizes the WHO planning for ICD 11.
\nThe structure of ICD 11
\nICD 11 will have a three level approach to
\no\ufb00er the right information for various users.
\nThe \ufb01rst level is for the primary care setting,
\nwhere the focus is on most frequent con-
\nditions in primary care with broader cat-
\negories. The second level is for clinical care,
\nwhich includes more details.The last level is
\nfor research with standardized detailed cri-
\nteria and tentative disease labels that are not
\nyet in o\ufb03cial classi\ufb01cations.
\nThe information on disease in ICD 11
\nwill be extended and in comparison to the
\nICD 10 version where only the disease, the
\nepidemiology, physiology and pathology is
\nincluded, now interventions and treatment
\nguidelines will be incorporated as well.
\nThe new ICD 11 version will contain all
\ndi\ufb00erent international and national clas-
\nsi\ufb01cations (for example WONCA, ICD,
\nICFD, ICHI) and therefore be the mainly
\nused classi\ufb01cation.
\nTo capture all this information and make
\nthe use easier, the ICD 11 version will be
\nplaced in a Health Information System and
\nbene\ufb01t from new IT technology. Through
\nthe online storage of the data, linkages to
\nhealth information bases such as population
\nregistry, insurance systems, and health ser-
\nvices, can be developed and the direct use
\nof information for i.e. clinicians, adminis-
\ntration and health reporting departments
\nincluding the electronic health record will
\nbe possible.
\nThe process of the revision
\nThe tentative timeline is that in 2010 an
\nAlpha version of ICD 11 will be prepared.
\nThat means a draft version will be written.
\nBy 2011 the Beta version including \ufb01eld tri-
\nals will be ready and in 2013 the \ufb01nal ver-
\nsion for public viewing will be available. At
\nthe WHA in 2014 the ICD 11 will get ap-
\nproval and will be implemented by 2015.
\nFor the previous revision process for ICD
\n10 comments could be handed in only in
\nthe annual meetings, which gave an advan-
\ntage to the richer countries. In order to have
\nan equal balance in receiving comments an
\nICD revision platform (Hi-Ki) via the In-
\nternet is implemented to collect comments.
\nNow everyone is allowed to send comments
\nand the more comments someone hands in
\nthe more relevance their comments will get
\nin future.However the governing body con-
\nsisting of the Top Advisory Group, the Re-
\nvision Steering Group and the WHO-FIC
\ncommittee will \ufb01nally revise all comments.
\nThe governing body at WHO
\nA Revision Steering Group will serve as
\nthe planning and steering authority in the
\nupdate and revision process and focus on
\nreviewing the scope of health care diseases
\nand ensuring that they are consistent with
\nthe overall structure. They identify users of
\nthe classi\ufb01cation and address their needs
\nand de\ufb01ne basic taxonomic and ontological
\nprincipals.
\nglobal health. The initiative in collecting
\nand re\ufb02ecting these perceptions represents
\na pertinent aim to bring the value of global
\nhealth to and from the public, and to advise
\nthe world health decision-makers in forth-
\ncoming actions.
\nThe VRGH has been operated by an inter-
\nactive process,and an online survey has been
\nlaunched to lead the opinions of global con-
\ncerns. This multilingual questionnaire has
\nbeen o\ufb00ered through the internet (http:\/\/
\nvrgh2008.blogspot.com).
\nVRGH has been supported by dozens of
\nglobal health advisers and actors through-
\nout the world, and a report is expected to be
\navailable in December, 2008, to commemo-
\nrate the 60th anniversary of the Universal
\nDeclaration of Human Rights.
\nThe VRGH represents an essential and
\nan important \ufb01rst advanced and more so-
\nphisticated step toward harmonizing and
\nstrengthening the global health practices
\nthat will ultimately bene\ufb01t the health of all
\npeople globally.
\nCoordinator:
\nPr. Peter Chang, MD, MPH, ScD
\nCo-coordinator:
\nVincent Rollet , MIR
\nThe new revision process of the International
\nClassi\ufb01cation of Diseases
\n85
\nThe Topic Advisory Groups (TAG) will
\nserve as the planning and coordinating ad-
\nvisory body for speci\ufb01c issues, which are key
\ntopics in the update and revision process,
\nnamely Oncology, Mental Health, External
\nCauses of Injury, Communicable Diseases,
\nNon-communicable Diseases, Rare Diseas-
\nes and others to be established. Each TAG
\nwill determine the number and content ar-
\neas of the workgroups, identify the mem-
\nbers and chairs of the workgroups, present
\nan initial mandate to each workgroup and
\nestablish procedures for the activities of the
\nworkgroups. They will also give advice in
\ndeveloping protocols for and in implement-
\ning \ufb01eld trials.
\nFurther information can be found on the
\ninternet page: http:\/\/www.who.int\/classi\ufb01-
\ncations\/icd\/en
\nDr. Julia Seyer
\nThe Brazilian Medical Association (AMB)
\nwas honored to host the Work Group
\nfrom World Medical Association (WMA),
\nwhich discussed the Review of Declaration
\nof Helsinki, on August 20th
\nand 21st
\n. The
\nmeeting was held in S\u00e3o Paulo, one of the
\nlargest cities of Brazil.
\nOn August 19th
\nand on the morning of
\n20th
\n, before the WMA\u2019s Work Group meet-
\ning, AMB organized a debating forum and
\ninvited renowned Brazilian researchers to
\ndebate the placebo and post-trial access to
\ntreatment. The event raised di\ufb00erent points
\nof view.
\nComments given on the \ufb01rst day of the event
\nserved the basis for suggestions made to Eva
\nBagenholm, President of WMA\u2019s Ethics
\nCommittee, and Otmar Kloiber, General
\nSecretary, who kindly accepted AMB\u2019s invi-
\ntation to discuss with the forum participants.
\nIt was a very productive moment, because
\nBrazilian participants could express their
\nthoughts about the Declaration.
\nOn 20th
\nduring the afternoon, the Work
\nGroup,composed of Brazilian,South African,
\nGerman,Japanese and Swedish representants,
\ngot together to debate changes that eventu-
\nally will be presented in Seoul. There were
\nalso representants of Medical Associations
\nfrom Uruguay,Canada and Portugal,as well a
\nmember of International Federation of Phar-
\nmaceutical Manufacturers & Associations.
\nJohn Williams, Ethics director explained
\nto participants when previous Declaration
\nreviews, occurred each review\u2019s purpose and
\nthe need of adding notes of clari\ufb01cation.
\nNext, he described how the process of re-
\nview would be conducted: there will be no
\nchanges in the structure, just on the scope
\nand terminology; review of controversial is-
\nsues of paragraphs 29 and 30,besides enclo-
\nsuring notes of clari\ufb01cation. At that point
\ncame, up a question whether the document
\nshoud be only destined to physicians or to
\nall people that do research. After justi\ufb01ed
\narguments, it was decided that the Decla-
\nration should be destined initially to phy-
\nsicians, but other participants in medical
\nresearch involving human beings should be
\nencouraged to follow the same principles.
\nAnother aspect discussed was the use of
\n\u201cshould\u201d or \u201cmust\u201d. It was explained that
\ntranslations are complicated because not all
\nlanguages have this di\ufb00erentiation.To some
\npeople, must has a legal value and the Dec-
\nlaration of Helsinki is just a guide and not a
\ndocument with legal validity.
\nThe discussion gained more rhythm and
\nparticipation when was announced that
\nchanges would be discussed in the previous
\nparagraph 29 (version of 2004 of Declara-
\ntion) and current paragraph 32 (last version
\nof draft), which embodied one note of clari-
\n\ufb01cation. On that moment, all participants
\ngave their opinion and the placebo issue
\ntook all afternoon.
\nSome people defended that the, use of pla-
\ncebo should not happen when there is e\ufb00ec-
\ntive treatment,because in face of an innocu-
\nous substance, any new medicine would be
\nvalid. All participants agreed that the use of
\nplacebo must be extremely controlled and
\nlimited to circumstances in which there are
\nno other e\ufb00ective method.
\nThe importance of placebo in certain kinds
\nof therapeutics and this decision must be
\nsolely based on ethical principles was also
\npointed out.
\nThe \ufb01rst part of the morning of 21st
\nwas
\nopened with discussions about paragraph
\n30, which in the latest review will be the 14th
\nand will include the second note of clari\ufb01-
\ncation. Among the arguments brought up
\nabout the writing of this paragraph are: un-
\ntil when should treatment be guaranteed? Is
\nthe right endless? How to deal if the drug is
\nnot approved in the country? The remaining
\nquestion was how to include the guarantee of
\npost-trial access to treatment in the current
\nversion of the Declaration of Helsinki. In
\nthis case, they all agreed that arrangements
\nmust be detailed in the protocol.
\nAfter a small break, discussion was resumed
\nwith announcement of other proposal
\nchanges. One of them was the possibility of
\nincluding in the Declaration a note of clari-
\n\ufb01cation about children research. Changes
\ndone on the paragraph 5 met part of this
\nneed. Besides that, information might be
\nincluded in the Declaration of Ottawa,
\nwhich regulates rights of children to health
\ncare, that refers to ethical principles of Dec-
\nlaration of Helsinki.
\nAfter conclusion, representatives of the
\nWork Group, Eva Bagenholm, John Wil-
\nliams and Otmar Kloiber came together
\nduring a private lunch to consolidate the last
\nissues about the Declaration of Helsinki.
\nPaula Mobaid,
\nAMB, International Relations
\nDoH Revision meeting in S\u00e3o Paulo
\n86
\nDr. Julia Seyer
\nTo achieve the Millennium Development
\nGoals and established targets for 2015, the
\nStop TB Strategy was expanded in 2006 to
\naddress the pressing challenges posed by
\nHIV\/AIDS co-infection, TB drug resist-
\nance and limited access to adequate care.
\nOne of the strategy\u2019s chief components is to
\nengage health care providers from all public
\nand private sectors, as well as to strengthen
\nhealth systems, recognizing that in many
\nhigh-burdened countries, ill patients of-
\nten seek care outside the National TB
\nPrograms (NTP). The DOTS Expansion
\nWorking Group (DEWG), established un-
\nder the STOP TB Partnership, has moved
\nto promote the expansion of quality DOTS
\namong all relevant public and private health
\ncare providers in TB control through the
\nPublic-Private Mix (PPM) initiative.
\nThe PPM approach starts with a National
\nSituation Assessment where all relevant
\npublic and private health care providers are
\nidenti\ufb01ed and their roles analyzed in order
\nto de\ufb01ne where PPM should be imple-
\nmented and what the requirements are for
\nthis. The National TB programs will have
\nthe responsibility of funding, regulation and
\nmonitoring TB care and control. The actual
\nTB care and treatment is provided by local
\nNTP facilities or private and public hospi-
\ntals, clinics, specialists, GPs. They are called
\nnon-NTP providers.
\nThe 5th
\nPrivate-Public-Mix (PPM) sub-
\ngroup meeting in Cairo
\nThe \ufb01fth meeting was hosted by the WHO
\nregional o\ufb03ce of the Eastern Mediterrane-
\nan (EMRO) and concentrated on mecha-
\nnisms and tools to build capacities of insti-
\ntutions supporting and\/or undertaking TB
\ncare provision such as national professional
\norganizations, large hospitals, and corporate
\nsector health establishments.
\nThe conference started with an overview of
\nthe global and regional progress on PPM
\nfrom the implementation in 2002 until now.
\nTo date,over 40 PPM projects have been im-
\nplemented in 14 countries, of which 25 have
\nbeen evaluated with regards to progress and
\noutcomes. The detection rate of TB under
\nPPM increased from 10 % to 60 % and the
\ntreatment success rate is between 75 % and
\n90 %. However these \ufb01gures are misleading
\nin this context.Much data is still missing and
\nonly a small proportion of all TB patients are
\nreceiving the PPM DOTS services.
\nProject managers from NTP national level
\nreported that they are overwhelmed with
\ntheir workload. They have too many dif-
\nferent kinds of responsibilities and need a
\nstricter role de\ufb01nition. They should focus
\nmainly on organisation and less on tech-
\nnical assistance. Other stakeholders like
\nprofessional associations or care providers
\nshould be included and could o\ufb00er the lat-
\nter as well.
\nThe PPM subgroup meeting identi\ufb01ed
\nmechanisms and tools to engage institu-
\ntions, especially national professional orga-
\nnizations, large hospitals and the corporate
\nsector, and patients and communities in TB
\ncare and control.
\nThe group \u201cMobilizing professional as-
\nsociations and promoting ISTC (Interna-
\ntional Standard of TB Care)\u201d developed
\nkey recommendations for PPM subgroup
\nand NTPs on how to engage professional
\nassociations on a global and national level.
\nProfessional associations are seen as a very
\nimportant partner in developing and imple-
\nmenting the PPM strategy and communica-
\ntion and cooperation needs to be increased.
\nThey should take part in the national situ-
\nation assessment, development of regular
\noutcome reports, delivery of TB treatment
\nand their facilities should be certi\ufb01ed by
\nthe government. Ways to foster the com-
\nmunication with professional associations
\nare through TB training, CME, articles in
\nmedical journals, TB campaigns and more.
\nThe main focus is at the moment on the
\nmedical professional associations because
\nphysicians are the main persons o\ufb00ering TB
\ntreatment. It is the expectation that PPM
\nthrough professional associations can reach
\nout to public and private working physi-
\ncians. However in future other profession-
\nals like nurses or hospital managers will be
\nincluded as well.
\nDuring the UNION conference from 15-
\n18th
\nOctober the next PPM subgroup meet-
\ning will take place and the PPM strategy
\nwill be announced to the DOTS expansion
\nworking group. All participants and espe-
\ncially the WHO welcomed the WMA at-
\ntending the meeting in Cairo. Without the
\nparticipation of the physicians the PPM
\nstrategy won\u2019t be possible.
\nInformation material available:
\nGuidance on implementing PPM- en-\u2022
\ngaging all health care providers in TB
\ncontrol
\nToolkit for National situation assessment\u2022
\nGeneral guidelines and practical tools fro\u2022
\nimplementing hospital DOTS linkage
\nHandbook for using the ISTC\u2022
\nReport from the inter-regional planning\u2022
\nworkshop on PPM
\nCo-operation of WMA and the Stop TB
\npartnership \u2013 Private-Public-Mix in the \ufb01ght
\nagainst TB
\n87
\nGeneva, 14 May 2008 \u2013 Eli Lilly and Com-
\npany announced the scaling-up of an exist-
\ning partnership with the World Medical
\nAssociation (WMA) by providing a grant
\nof $998,773 to expand training courses for
\nphysicians on multi-drug resistant tuber-
\nculosis (MDR-TB). Tuberculosis (TB) is
\na preventable disease that kills close to two
\nmillion people every year and infects an es-
\ntimated nine million more. Of these, nearly
\n500,000 have multidrug-resistant TB.
\nThe purpose of this online training is to help
\nphysicians, both in the public and private
\nsector, to use the latest international guide-
\nlines and treatment protocols for MDR-TB
\ncare in their daily work.This will allow more
\nphysicians around the world to acquire the
\nbasic knowledge on standard TB manage-
\nment at a time when there is a resurgence
\nof the epidemic. A new toolkit will also be
\ndeveloped for physicians on how to manage
\nTB in the workplace. This will be produced
\nwith the World Economic Forum for use in
\nChina and South Africa.
\nThe announcement of the new four-year
\njoint partnership agreement was marked in
\nGeneva today by a signing ceremony be-
\ntween Jacques Tapiero, president of Lilly\u2019s
\nintercontinental operations and WMA
\npresident Dr. Jon Snaedal. Lilly\u2019s key part-
\nners including the World Health Organiza-
\ntion (WHO), the Stop TB Partnership, the
\nInternational Council of Nurses, the World
\nEconomic Forum and alongside Geneva-
\nbased diplomats and foreign dignitaries,
\nwere invited to the ceremony.
\nDr. Snaedal said: \u201cWe shall now be making
\nthe course more interactive with more case
\nstudies and a progressive learning pattern.
\nA TB refresher course was important to get
\nphysicians back on track regarding the basic
\nknowledge of standard TB.\u201d
\nJacques Tapiero added: \u201cWe applaud
\nWMA\u2019s commitment to developing inno-
\nvative approaches to stemming the MDR-
\nTB global burden. Given adequate health-
\ncare infrastructure and adherence to proper
\nmedication regimens, MDR-TB is not only
\ntreatable, but indeed curable. This online
\ntraining course was an important addition
\nto the already existing tools and activities of
\na larger partnership of 16 public and private
\norganizations worldwide dedicated to \ufb01ght-
\ning MDR-TB.\u201d
\nWith underwriting from Lilly, the WMA
\nover the past year has already developed
\nan online training course for physicians to
\nmore e\ufb00ectively diagnose, prevent and treat
\nmulti-drug resistant tuberculosis. Clini-
\ncal guidelines were developed and harmo-
\nnized with evidence-based material sourced
\nfrom the WHO, the International Council
\nof Nurses and the International Hospital
\nFederation. The course was tested among
\nphysicians in South Africa. The Norwegian
\nMedical Association has adapted the mate-
\nrial to a web-based format and will be pro-
\nviding CME credits to those following the
\ncourse. The German Medical Association
\nassisted in providing managerial support in
\nthe conception of the project.
\nThe online course will be expanded to de-
\nvelop a TB refresher course and a training
\ncourse on MDR-TB training. Training
\nchampions in MDR-TB treatment will be
\ncreated in South Africa, India and China.
\nThe course, already available in English, is
\nbeing translated into Spanish, French, Chi-
\nnese and Russian and will be published in
\nhandbook and CD form in addition to the
\nonline format. MDR-TB is a serious pub-
\nlic health threat in many parts of the world,
\nnotably in Sub-Saharan Africa,Central and
\nEastern Europe,mainland China,Southeast
\nAsia and in Central and South America.
\nThe recent identi\ufb01cation of extremely
\nvirulent TB and the increasing number of
\nMDR-TB cases show that the knowledge
\nand handling of TB treatment is still insuf-
\n\ufb01cient. With concrete evidence that incom-
\nplete TB treatment is responsible for the
\noccurrence of extremely drug resistant TB,
\nan ethics policy is being planned to look at
\nwhether and how patients can be encour-
\naged to complete their treatment regimen
\nand where the autonomy of a patient ends
\nin order to safeguard public health.
\nThe World Medical Association is the
\nindependent confederation of national
\nmedical associations from more than 80
\ncountries and represents more than eight
\nmillion physicians. Acting on behalf of
\npatients and physicians, the WMA endea-
\nvours to achieve the highest possible stan-
\ndards of medical care, ethics, education and
\nhealth-related human rights for all people.
\nwww.wma.net
\nThe Lilly MDR-TB Partnership was cre-
\nated to confront multidrug-resistant tuber-
\nculosis, a disease so daunting that no single
\norganization can \ufb01ght it alone. Since 2003,
\nthe public-private initiative, mobilizing 16
\npartners on \ufb01ve continents, has worked
\ntogether to share expertise in the quest to
\ncontain and conquer one of the world\u2019s
\noldest diseases. The Partnership\u2019s multi-
\npronged approach includes: community
\nsupport and patient advocacy; treatment,
\ntraining and surveillance; transferring tech-
\nnology; research; and awareness and pre-
\nvention. Additional information about The
\nLilly MDR-TB. Partnership is available at
\nwww.lillymdr-tb.com
\nContact:
\nNigel Duncan. WMA Public Relations
\nConsultant. nduncan@ndcommunications.co.uk
\nJJ Divino. Communications Manager,
\nInternational Aid Unit, Eli Lilly and
\nCompany. divinojj@lilly.com
\nLilly Commits $1MM to World Medical
\nAssociation to support Innovative
\nTuberculosis training course
\n88
\nBob Miglani
\nSenior Director, External Medical A\ufb00airs In-
\nternational, Department of the Chief Medical
\nO\ufb03cer, P\ufb01zer Inc.
\nIt doesn\u2019t take a doctor to diagnose that
\nthe healthcare systems of the world are in
\nvery bad shape. Factors such as the age-
\ning population and increasing prevalence of
\nlifestyle-related conditions like obesity are
\nplacing untenable pressure on traditional
\nmodels of healthcare provision. But while
\nmany healthcare \u201cexperts\u201d seek solutions
\nand propose reforms, those at the delivery
\nend of healthcare, namely physicians, are
\noften overlooked and excluded from health
\npolicy decision-making.
\nThe result is that physicians around the
\nworld are working within health systems
\nimposed upon them, usually without any
\nconsultation let alone involvement. De-
\nsigned with time and money rather than
\npatient care in mind, these systems restrict
\nand con\ufb01ne doctors making it increasingly
\ndi\ufb03cult for them to practice medicine as
\nthey wish. Growing frustration is lead-
\ning many healthcare professionals to take
\ndirect action as they seek to in\ufb02uence
\nhealthcare reform and policy direction for
\nthe future.
\nThroughout 2006 and 2007 German physi-
\ncians from across the country held various
\nprotests to demonstrate against new restric-
\ntive contracts being imposed on them by
\nthe government and which they felt would
\ngreatly reduce their e\ufb00ectiveness. In March
\nlast year UK junior doctors marched in pro-
\ntest against a new training system which
\nmade it impossible for them to apply for the
\nposts they wanted. In September of 2007
\nSpanish doctors undertook strikes to ask for
\nmore time with each patient (to a total of
\njust 10 minutes) and this summer,in the US
\nphysicians and nurses have also made their
\nvoices heard in major cities to advocate for
\nuniversal healthcare.
\nWhile the exact catalyst for these protests
\nmay vary, they all share a common theme: a
\ndesire to be allowed to exercise their voca-
\ntion as they wish. To be allowed to do what
\nthey do best: be doctors.
\nWhether they practice in Barcelona or Bei-
\njing, Montreal or Munich, physicians want
\nto spend their time treating patients to the
\nbest of their ability, not \ufb01lling out forms,
\nwrestling with \ufb01nancial targets or poring
\nover guidelines to determine which treat-
\nment approaches they are permitted to take
\nfor their patient.
\nAs part of its Medical Partnerships Initia-
\ntive, P\ufb01zer has been tracking the attitudes
\nand opinions of health professionals over
\nthe past few years. A series of surveys inves-
\ntigating how physicians feel about their role
\nin healthcare, developments in the quality
\nof care and the future of their profession,
\nhas been conducted in Asia, Europe and
\nthe Americas. The \ufb01ndings making salutary
\nreading not only for physicians but for all
\nthose involved in healthcare delivery, and
\nhighlight just how widely shared the con-
\ncerns and issues discussed above, are across
\nthe globe.
\nThe most recent of these surveys was car-
\nried out earlier this year among primary
\ncare physicians and specialists in 13 coun-
\ntries around the world. Research company
\nAPCO Insight interviewed 1,741 doctors
\nin Asia, Europe and North America and
\nfound some interesting trends and varia-
\ntions from region-to-region.
\nMedicine Moving in a Negative Direc-
\ntion
\nWhile across most of the globe, doctors re-
\nmain moderately satis\ufb01ed with their own
\npersonal experience of practicing medicine
\n(out of 10 Asia 7.25,Europe 6.32 and North
\nAmerica 6.94), when it comes to the bigger
\npicture and the practice of medicine overall,
\nEuropean and North American doctors are
\ngenerally negative. Over half of European
\ndoctors (51 percent) consider that the prac-
\ntice of medicine is going in a negative direc-
\ntion and in North America this \ufb01gure was
\n39 percent.
\nThe data from Asia was less homogenous
\nwith a clear split between Chinese and In-
\ndian doctors and those from Japan and Ko-
\nrea, with Australian physicians somewhat in
\nthe middle. Japanese and Korean doctors
\n(79 percent and 87 percent respectively)
\nagreed with European and North Ameri-
\ncan physicians that medicine is going in a
\nnegative direction. However, Chinese and
\nIndian doctors (78 percent and 77 percent
\nrespectively) felt medicine was going in a
\npositive direction. Australian physicians
\nwere less de\ufb01nitive with 50 percent positive
\nand 30 percent negative.
\nThe most frequently cited reasons for the
\nbelief that the practice of medicine is going
\nin a negative direction were \u201cgovernment
\nmismanagement of healthcare systems\u201d in
\nAsia (32 percent), \u201cnon-medical entities
\ninterfering in medical decisions\u201d in Europe
\n(36 percent) and \u201cbusiness aspects of medi-
\ncine\u201d in North America (42 percent).
\nWhat Physicians are REALLY Thinking
\n89
\nIs the Doctor-Patient Relationship on the
\nCritical List?
\nAs can be seen above, at the top of the list
\nwas the deterioration of the relationship
\nbetween doctor and patient. When asked
\nabout the factors which have changed the
\ndoctor-patient relationship, the majority of
\ndoctors believe this has been a\ufb00ected by pa-
\ntients:
\nexpecting to spend more time with their\u2022
\ndoctors (Asia 96 percent, Europe 72 per-
\ncent and North America 64 percent)
\nbeing increasingly concerned about being\u2022
\nable to pay for their care (Asia 93 percent,
\nEurope 62 percent and North America
\n81 percent) and,
\nspeci\ufb01c treatment expectations (Asia 84\u2022
\npercent, Europe 85 percent and North
\nAmerica 92 percent), presumably which
\nthe physician cannot always meet.
\nOther factors which physicians believe ad-
\nversely impact their relationships with their
\npatients include patients being concerned
\nthat they are not o\ufb00ered the best choices
\nfor quality care and increasing skepticism
\naround physicians\u2019 authority. In fact, the
\nsurvey found that between 47 percent (Asia
\nand North America) and 63 percent of phy-
\nsicians said that government-led clinical
\nassessments had limited the treatment they
\ncould choose on behalf of patients.
\nFrom this analysis of the doctor-patient re-
\nlationship, it is clear that patients are suf-
\nfering from the adverse e\ufb00ects of many of
\nthe unwelcome changes in healthcare that
\nhave negatively a\ufb00ected physicians. Pri-
\nmarily, this might best be summarized as a
\nloss of autonomy or outside interference in
\nmedical practice. As highlighted above,this
\nis borne out by the fact that \u201cgovernment
\nmismanagement of healthcare systems\u201d and
\n\u201cnon-medical entities interfering in medical
\ndecisions\u201d were among the most frequently
\ncited reasons for the perception that medi-
\ncine is moving in a negative direction. This
\nis further reinforced by other results of the
\nsurvey below.
\nTime is of the Essence
\nSo reducing the amount of interference in
\nclinical practice might be one way of im-
\nproving the ailing doctor-patient relation-
\nship. The survey results also highlighted
\npossible prescription for success: doctors
\nspending more time with their patients.
\nIn Europe and North America, half of
\nthe doctors surveyed (53 percent and 51
\npercent, respectively) say the average time
\nspent with patients has decreased since they
\nbegan practicing medicine. While in Asia
\nthe majority (41 percent) believe time spent
\nwith patients has remained the same.
\nThis \ufb01nding was reinforced by another
\nquestion posed in the survey: \u201cwhat would
\nyou change to improve the quality of patient
\nvisits\u201d. The most frequently quoted response
\nwas \u201cincrease time with patients\u201d with 51
\npercent of North American and 49 percent
\nof European respondents giving this answer.
\nIn Asia, 30 percent suggested this, second
\nonly to increased medical facilities.
\nTime also came to the fore when European
\nphysicians were asked to rank the signi\ufb01-
\ncance of various factors in relation to their
\njob satisfaction. \u201cHaving enough time with
\neach patient to provide care in the way I
\nwould choose\u201d was the most signi\ufb01cant is-
\nsue in Europe with the top score of 8.05 out
\nof ten.
\nBut when it comes to spending time with
\npatients,it is not just doctors\u2019desires that are
\nan issue here: the vast majority of doctors
\nworldwide (93 percent) agree that spending
\nmore time with each patient would con-
\ntribute to better health outcomes for those
\npatients, a view shared equally among Gen-
\neralists and Specialists.
\nTop 5 Unprompted Reasons Practice of Medicine Going a Negative Direction
\nReason Global
\nTotal
\nAsia
\nTotal
\nAsia
\nHigh
\nEurope
\nTotal
\nEurope High N
\nAmerica
\nTotal
\nNA
\nHigh
\nDoctor patient
\nrelationship dete-
\nriorating
\n28% 31% 50%
\nChina
\n25% 36% France 26% 27%
\nCanada
\nGeneral aspects of
\nprofession
\n25% 28% 55%
\nChina
\n24% 27% Germany 20% 26%
\nCanada
\nBusiness aspects of
\nmedicine
\n25% 19% 69%
\nKorea
\n28% 40% Germany 42% 45%
\nUS
\nGovernment
\nmismanagement of
\nhealthcare systems
\n22% 32% 70%
\nKorea
\n8% 16% Belgium 13& 15% US
\nNon-medical enti-
\nties interfering in
\nmedical decisions
\n21% 8% 23%
\nAustra-
\nlia
\n36% 46% Germany 39% 44% US
\nPercentage who \u201cstrongly agree\u201d or \u201csomewhat agree\u201d with statement
\nStatement Global
\nTotal
\nAsia
\nTotal
\nAsia
\nHigh
\nEurope
\nTotal
\nEurope
\nHigh
\nN America
\nTotal
\nNA
\nHigh
\nPhysicians have lost
\ncontrol of medical
\ncare decisions to
\nother people
\n46% 38% 81%
\nKorea
\n67% 87%
\nPortugal
\n82% 85% US
\nReducing govern-
\nment involvement
\nin healthcare
\nwould be better for
\neveryone
\n68% 66% 89%
\nKorea
\n72% 85%
\nGer-
\nmany
\n70% 73% US
\n90
\nWhile it could be argued that there is lit-
\ntle that can be done about the increasing
\nnumber of patients who seek their doctors\u2019
\ntime, there is surely a better way to allocate
\ndoctors existing and increasingly precious
\ntime. The survey found that 51 percent of
\nEuropean doctors who said that they were
\nspending less time with patients said that
\nthis was because of \u201cadministrative bureau-
\ncratic requirements\u201d.
\nThere is perhaps a correlation here with
\nanother question, when European phy-
\nsicians were asked \u201cwhich experience in
\nthe practice of medicine today is the most
\nunsatisfying to you?\u201d, the most frequently
\ncited response by some margin was \u201cad-
\nministrative tasks\u201d (30 percent). Perhaps
\nEuropean doctors would be happier if they
\ncould switch their focus back to treating
\ntheir patients rather than \ufb01lling in forms.
\nIt is therefore not surprising that, another
\nbusiness-related aspect of medicine was a
\ncause of dissatisfaction:
\nFew physicians take up the profession to
\nbecome more familiar with accounting pro-
\ncedures and indeed, money matters leave
\nmost physicians distinctly de\ufb02ated. When
\nasked to state the most unsatisfying experi-
\nences in their practice, globally, 17 percent
\ncited \u201crationing care\/cost containment\u201d,
\n14 percent \u201ccompensation\u201d and 13 percent
\n\u201cpayer issues\u201d.
\nSeeking Solutions and Support
\nOver the past \ufb01ve years as our research has
\ntracked the belief among physicians around
\nthe world that they are no longer masters
\nof their own destiny, we have seen a cor-
\nresponding rise in what is termed, physi-
\ncian-activism. A variety of movements and
\norganizations have emerged in countries
\naround the world, created by and for physi-
\ncians as they aim to take their place at the
\nhealth policy table. This wave of activism is
\nre\ufb02ected in the survey, with 90 percent of
\nphysicians worldwide agreeing that improv-
\ning healthcare will require public leader-
\nship from physicians. This view was shared
\nacross all three regions: strongest in North
\nAmerica (96 percent), then Europe (90 per-
\ncent) and Asia (89 percent).
\nPhysicians in all regions, generalists and
\nspecialists, strongly agree that they should
\nspeak out about the problems facing the
\npractice of medicine. Again, agreement was
\nstrongest in North America at a staggering
\n98 percent, but Europe at 90 percent and
\nAsia with 86 percent were not far behind.
\nAn obvious place for physicians to turn
\nwhen seeking to have their voices heard
\nwould seem to be the professional organi-
\nzations and medical societies which exist
\nto support the profession. Yet member-
\nship and enthusiasm levels in our survey
\nappeared low when questions were asked
\nabout these groups. Globally only 43 per-
\ncent said they were members of any profes-
\nsional organization or advocacy group that
\nadvances the interests of physicians. When
\nquestioned about how e\ufb00ective such bodies
\nare, 82 percent responded either \u201csomewhat
\ne\ufb00ective\u201d or \u201csomewhat ine\ufb00ective\u201d.
\nWhen asked about a group which would
\nspeci\ufb01cally advocate on behalf of physi-
\ncians, enthusiasm was more evident. Three
\nquarters of physicians around the world
\nprofessed that they would join an advocacy
\norganization which aimed to educate the
\npublic about the importance of the role of
\nphysicians to public health and to also in\ufb02u-
\nence government policies a\ufb00ecting the prac-
\ntice of medicine. This hunger for support
\ncontinued when given some suggested ways
\nin which they might advance their case:
\nPercentage who \u201c strongly support\u201d and \u201csomewhat support\u201d the following ideas that
\nhave been suggested to support physicians
\nStatement Global
\nTotal
\nAsia
\nTotal
\nAsia
\nHigh
\nEurope
\nTotal
\nEurope
\nHigh
\nN
\nAmerica
\nTotal
\nNA
\nHigh
\nParticipate in train-
\ning programs to help
\nphysicians become better
\nadvocates for reform of
\nhealthcare policies
\n89% 92% 98%
\nIndia
\n79% 99% UK 93% 94%
\nUS
\nCooperate with third-
\nparties to publicize the
\nimportant role of physi-
\ncians in society
\n84% 84% 86%
\nChina,
\nIndia and
\nAustralia
\n83% 87%
\nBelgium
\n90% 91%
\nUS
\nForm a coalition
\nbetween healthcare
\nprofessionals and private
\ncompanies to defend
\nphysicians\u2019 right to make
\nindependent medical
\ndecisions
\n79% 81% 94%
\nIndia
\n71% 73%
\nFrance
\nand
\nGer-
\nmany
\n86% 90%
\nUS
\nFor each of the following problems please tell me how signi\ufb01cant the problem is to your job
\nsatisfaction. Please use a 10 point scale, where a 1 means completely insigni\ufb01cant and a 10
\nmeans extremely signi\ufb01cant problem a\ufb00ecting job satisfaction
\nStatement Global
\nTotal
\nAsia
\nTotal
\nAsia
\nHigh
\nEurope
\nTotal
\nEurope
\nHigh
\nN America
\nTotal
\nNA
\nHigh
\nProtecting my
\nmedical practice
\nfrom threat of
\nlawsuits or civil
\nactions
\n8.3 8.58 8.93
\nChina
\n7.27 7.84 Por-
\ntugal
\n7.78 7.89 US
\n91
\nA Glimmer of Hope
\nIn summary, then, this latest round in P\ufb01z-
\ner\u2019s continuing investigations into the issues
\na\ufb00ecting the medical profession, has paint-
\ned a gloomy picture for some countries. On
\na macro level, physicians in Europe and
\nNorth America are generally negative about
\nthe direction of medicine, as are those in
\nJapan and Korea. This negativity is largely
\nattributed to interference in medical prac-
\ntice by non-medical entities such as govern-
\nments and insurance companies. Physicians
\nin China and India are very satis\ufb01ed with
\nthe direction of medicine and believe their
\nrespective medical societies are serving their
\nneeds e\ufb00ectively and that they are still in
\ncontrol of medical care.
\nTaking a closer look at Asia, Indian doctors
\ntend to be more positive about the practice
\nof medicine, perhaps partly because they
\nreport little interference in their medical
\ndecisions from third-parties. At the other
\nextreme, Korean doctors are negative about
\nthe direction of medicine generally: third-
\nparty payer issues dominate their dissatis-
\nfaction and prevent them from providing
\ncare according to their medical judgment.
\nJapanese doctors express similarly high lev-
\nels of dissatisfaction with the practice of
\nmedicine; however attribute less blame to
\nthird-party payers than the Koreans. Aus-
\ntralian and Chinese doctors are more mod-
\nerate, even variable in their attitudes.
\nAcross the EU, doctors su\ufb00er from similar
\nchallenges regarding too little time with pa-
\ntients (which leads to negative health out-
\ncomes) and too much time with administra-
\ntive burdens (which also leads to negative
\nhealth outcomes), causing a decline in the
\nquality of the doctor-patient relationship.
\nConsensus also emerges in Europe that
\nhealthcare system changes will require the
\npublic leadership of physicians and they are
\nsupportive of various potential programs to
\nhelp them advocate.
\nUS doctors are subject to high levels of
\nthird-party interference, su\ufb00er burdens of
\nmanaging private practice and, therefore,
\nspend more time than they want with ad-
\nministrative burdens. Canadian doctors
\nsu\ufb00er less from these particular ills though
\nboth countries su\ufb00er from similar chal-
\nlenges regarding time management. They
\nare similarly experiencing changes to the
\ndoctor-patient relationships and agree that
\nhealthcare system changes will require their
\npublic leadership.
\nTaking a worldwide view, perhaps one of
\nthe most disturbing \ufb01ndings for the pro-
\nfession is that the long-cherished doctor-
\npatient relationship is under severe threat
\nas patients become frustrated by the time
\nthey get to spend with their physician and
\nfailure to meet their expectations around
\ntreatment.
\nAnother point of agreement and indeed,
\nhope among doctors across the globe is
\nthat in order to change today\u2019s healthcare
\nsystems and move them away from their
\nfocus on cost rather than patient care, they
\nare going to have to take a lead themselves.
\nPhysicians need to speak up and make the
\nbroader public aware of the threat facing
\nmedicine. Only by taking a strong leader-
\nship position does the profession see any
\nhope of change.
\nSo, though it may not take a doctor to diag-
\nnose the problem with healthcare today, it is
\ncertainly going to need doctors to develop,
\nadminister and manage the necessary treat-
\nment. Today the profession is faced not so
\nmuch with a case of \u201cphysician heal thyself \u201d
\nas \u201cphysician, heal healthcare\u201d.
\nAbout the Survey Methodology
\nP\ufb01zer Inc. External Medical A\ufb00airs, Inter-
\nnational, commissioned APCO Insight, a
\nglobal opinion research \ufb01rm, to conduct a
\nscienti\ufb01c probability survey with physicians
\nin North America, Europe and Asia con-
\ncerning their attitudes toward the practice of
\nmedicine. Interviewswereconductedamong
\n1,741 general practice and specialist physi-
\ncians in the United States (n=248), Canada
\n(n=95), Germany (n=138), France (n=127),
\nthe UK (n=125),Belgium (n=126),Portugal
\n(n=127), the Netherlands (n=125), China
\n(n=125), India (n=130), Korea (n=125) Ja-
\npan (n=125) and Australia (n=125). Inter-
\nviews were conducted between December
\n15, 2007 and March 1, 2008 utilizing a va-
\nriety of data collection methodologies tai-
\nlored for each country, including mail (US
\nand Canada), telephone (Germany, France,
\nUK, Belgium, Portugal, Netherlands, Japan
\nand Australia) and in-person (China, India
\nand Korea). Sample frames were selected
\nin each country to provide maximum cov-
\nerage of practicing physicians and included
\nprofessional association member and non-
\nmember lists, licensing registries, public di-
\nrectories and health organization databases.
\nThe margin of sampling error for the global
\nsample is \u00b12.3%; sampling margin of error
\nat regional and country levels are higher
\ndepending on sample size. The sample
\nwas strati\ufb01ed among the 13 countries, and
\nwithin each country, strati\ufb01ed by medical
\nspecialty (general practice and specialists).
\nThe \ufb01nal dataset was post-weighted to be
\nrepresentative of the actual distribution of
\npracticing physicians across the countries
\nand specialties.
\nBob Miglani,
\nSenior Director, External Medical A\ufb00airs
\nInternational, Department of the Chief
\nMedical O\ufb03cer, P\ufb01zer Inc.
\n92
\nDr. Analice Gigliotti
\nPresident of Brazilian Asoociation on Studies
\nof Alcohol and Drugs (ABEAD)
\nSmoking is currently the leading prevent-
\nable cause of death in the world. If nothing
\nis done, by the end of the century this ad-
\ndiction will have killed one billion people,
\nanticipating the death of half the smokers,
\nwho lose from 8 to 22 years of life. Accord-
\ning to the World Health Organization, four
\nmillion people die every year due to diseases
\ncaused directly by tobacco derivatives. It is
\nestimated that 100 million individuals died
\nin the 20th
\ncentury due to nicotine depen-
\ndence and, if the present trend prevails, this
\nnumber will be 10 times higher, reaching
\none billion deaths in the 21st century. Many
\nof these deaths are potentially preventable if
\ntobacco users quit smoking.
\nDespite all the mortality and morbidity
\ncaused by tobacco, its global consumption
\nkeeps growing. The propagated decrease of
\nconsumption of this product takes place
\nonly in some industrialized countries.
\nAmong the less favoured ethnic minori-
\nties, tobacco consumption continues to be
\nan extremely common problem. China, for
\ninstance, is responsible for great part of the
\nincrease of per capita cigarette consumption
\nin the world. Following the decrease of to-
\nbacco consumption in developed countries,
\nthe tobacco industry increased their sales in
\ndeveloping countries. In the next decades,
\n70% of the deaths caused by tobacco will
\noccur in the Third World, where the prob-
\nlems associated to tobacco consumption
\nwill share the scenario with basic health
\nproblems such as malnutrition and lack of
\nsanitation.
\nMost people are unaware of the damage
\ncaused by smoking. About 30% of all cancer
\ncases and at least 85% of lung cancers are
\ncaused by tobacco. Oral cavity, faring, lar-
\nynx,stomach and esophagus cancers are also
\nclosely associated to tobacco consumption.
\nEven the organs not directed associated to
\nthe habit of cigarette smoking \u2013 such as
\nbladder, kidney and pancreas \u2013 are more
\na\ufb00ected by cancer among smokers than in
\nnon-smokers.
\nOther fatal diseases such as Chronic Ob-
\nstructive Pulmonary Disease (COPD), pe-
\nripheral arteriopaties, aortal aneurism and
\nmyocardial infarct are also associated to
\nsmoking. Even less lethal diseases such as
\nrespiratory infections, stomach and duode-
\nnal ulcers, osteoporosis and dental problems
\nare associated to tobacco. Smoking is the
\nleading cause of coronary disease among
\nwomen.
\nTobacco also a\ufb00ects the development of
\npregnancy in smoking pregnant women.
\nConsequently, the loss of the fetus is more
\nfrequent in all phases of pregnancy, with a
\nprobability 70% higher of miscarriage. The
\nrisk of prematurity increases 40% and the
\nchildren of smoking mothers are born with
\napproximately 200 grams less than children
\nof non-smokers. They are also particularly
\nmore likely to present sudden infant death
\nand other peri and neonatal diseases. Even
\nmore alarming data shows that non-smok-
\ning pregnant women, exposed to environ-
\nmental tobacco pollution can also give birth
\nto babies with low weight. The concentra-
\ntion of seric cotinine (a metabolite of nico-
\ntine) is higher in non-smoking pregnant
\nwomen who live with smokers.
\nEnvironmental exposition to the smoke of
\ncigarettes is also harmful, being the third
\nleading cause of preventable death in the
\nworld, second to active tobaccoism and ex-
\ncessive alcohol intake. The main symptoms
\nnon-smokers exposed to environmental to-
\nbacco pollution (EPS) complain are cough,
\nheadaches and sore eyes. They also have an
\nexacerbation of rhinitis, sinusitis and asth-
\nmatic bronchitis, besides showing a higher
\nprobability of developing lung cancer. The
\nU.S Environmental Protection Agency des-
\nignated classi\ufb01ed EPS as carcinogen Class
\nA, that is, showing enough evidence of
\ncause between exposition and cancer in hu-
\nman beings.The risk of lung cancer in non-
\nsmokers exposed to cigarette smoke is 30%
\nhigher than in non-smokers who are not
\nexposed to ETS. Cardiovascular diseases
\nare also higher in passive smokers. The risk
\nof coronary disease in non-smokers exposed
\nto ETS is 24% higher than in non-smokers
\nwho are not exposed to it.
\nChildren of smokers are more easily subject
\nto develop respiratory infections and pres-
\nent worse allergic features than children
\nwho live with non-smokers.
\nIn the last decades, due to the development
\nof public awareness of the damages of to-
\nbacco and to anti-smoking governmental
\ncampaigns, a progressive decreasing preva-
\nlence of smokers can be noticed, especially
\nin some developed countries, such as the
\nUnited States, where the number of smok-
\ners stabilized in 25% of the population in
\n1993, decreasing to only 20.5% in 2007, due
\nto public health policies in the country.
\nHowever, further reducing these rates is
\nbecoming a hard task. Although in the last
\nyears a decrease in the number of adult
\nsmoking women in the United States can
\nbe noticed, more young girls are starting to
\nSmoking: A disease that starts in the brain
\nand goes to the whole body
\n93
\nsmoke, a phenomenon that is also happen-
\ning in a great number of countries around
\nthe world,as in Brazil,for instance.Nicotine
\ndependence prevalence in the United States
\nfell from 42% in 1965 to 25% in 1982, nev-
\nertheless since then these numbers change
\nwith great di\ufb03culty. This occurs because
\nof the addictive properties of nicotine that
\nresult in only 2.5% of smokers abstaining
\nfrom the drug each year.
\nThe scienti\ufb01c community made widely
\nknown the addictive characteristics of nico-
\ntine publishing, in 1988, an important re-
\nport with the following conclusions:
\nCigarette and other tobacco forms cause\u2022
\ndependence.
\nThe cause of dependence in tobacco is\u2022
\nnicotine.
\nThe pharmacological and behavioural\u2022
\nprocesses that determine the tobacco ad-
\ndiction are similar to those which deter-
\nmine the addiction to other drugs such as
\nheroin and cocaine.
\nEach cigarette contains approximately 8 mg
\nof nicotine, from which 1 mg is rapidly
\nabsorbed by the lungs. In 10 seconds the
\nsmoker feels the \u201cgood\u201d e\ufb00ects of the drug,
\nsuch as better attention and concentration,
\nthe diminishing of appetite, the increase of
\nthe alert state, the reduction of anxiety and
\ndepressive mood improvement.
\nWith the suspension of smoking, the symp-
\ntoms of the abstention syndrome reach their
\npeak in two or three days. At the end of the
\n\ufb01rst week they decrease, normally disap-
\npearing in 2 to 4 weeks. Residual symptoms
\ncan persist for even 6 months in some cases,
\nmainly the symptom of augmented appe-
\ntite.
\nThe proof that nicotine is a drug that can
\nlead to addiction is the fact that cigarettes
\nfrom which nicotine is taken arti\ufb01cially is
\noften abandoned by smokers, who change
\nto the normal ones.In fact,smokers are used
\nto regulate the concentration of nicotine in
\ntheir body, with the objective of keeping it
\nin the limits that satisfy their needs. Even
\nwhen they change their habitual brand to
\nanother one with lower nicotine content,
\ntobacco users usually try to compensate it –
\nincreasing the number, depth and length of
\ndrags, for instance – trying to compensate
\nthe changes made and keep the concentra-
\ntion of nicotine constant.
\nThe direct action of nicotine on nicotinic-
\ncolinergic receptors is distributed all over
\nthe brain. Although its direct action is ex-
\nclusively in these receptors,the \ufb01nal result is
\nfrequently a complex pattern of the indirect
\ne\ufb00ects in other transmission systems, such
\nas dopaminergic, adrenergic, serotoningeric
\nand glutamatergic.
\nThe neurons of the ventral tegmental area,
\nwhere the nicotine bonds, are projected to
\nthe nucleus acumbens, where they release
\ndopamine in large amounts, substance that
\nis associated to the gratifying sensation ad-
\ndicts feel. The bigger and faster the libera-
\ntion of dopamine in this nucleus, the higher
\nthe pleasure users get.
\nNicotine has a double e\ufb00ect in the central
\nnervous system: initially it stimulates the
\nnicotinic receptor \u2013 agonist e\ufb00ect \u2013 and
\nthen it blocks it \u2013 antagonist e\ufb00ect.To adapt
\nto the disorganisational e\ufb00ects of the drug,
\nthe brain tries to surmount the blocking ef-
\nfects of nicotine, through an increase in the
\nnumber of nicotinic receptors. On the other
\nhand, part of the abstinence symptoms is
\nmediated by desensitization in the nora-
\ndrenergic neurons of the coeruleus locus.
\nMany smokers use tobacco according to a
\nclassic cyclic model of drug addiction, in
\nwhich they search for the bene\ufb01cial e\ufb00ects
\nof nicotine, but what keeps the individual
\nsmoking is the relief of the abstinence
\nsymptoms. However, it is not only the nico-
\ntine which determines the persistence in its
\nuse. As with any other drug, the desire of
\nconsumption can be triggered by environ-
\nmental stimuli independent from organic
\nneed. That is the reason why the individual
\ncan have a \u201ccraving\u201dfor smoking, even years
\nafter the abstinence syndrome is over, when
\nthey have any contact with \u201ctriggering situ-
\nations\u201d, such as drinking and seeing some-
\none smoking, for example.
\nThere is a projection for the \ufb01rst half of
\nthe XXI century of 500 million premature
\ndeaths, \u2153 being preventable should the
\nadult individuals stop smoking. This means
\nthat a public health approach aiming to
\nstop the use of cigarettes is a fundamental
\nelement in governmental policies in the
\ncontrol of smoking. Other actions recom-
\nmended by the World Health Organization
\ninclude preventing children from becoming
\ntobacco addicts, protecting non-smokers
\nfrom the involuntary exposition to cigarette
\nsmoke; eliminating all publicity, direct or
\nindirect, of tobacco products, and control-
\nling tobacco products, including warnings
\nin tobacco products and in any publicity
\neventually residual, among others.
\nAlthough the measures of primary preven-
\ntion are fundamental,it is a mistake to think
\nthat the treatment of addicts is a minor is-
\nsue. On the contrary, approaching smokers
\nis among the best cost\/bene\ufb01t relations in
\nmedical interventions.
\nThus, to deal with such lethal pandemic,
\none most use a combination of preventive
\nmeasures to prevent children from smoking
\nand treatment measures in order to moti-
\nvate and support smokers to quit. Cessation
\nsupport has also an e\ufb00ect on prevention,
\nsince it turns smoking a less frequent and
\nless socially accepted behaviour.
\nNicotine dependence is a chronically relaps-
\ning disorder of the brain. In fact, although
\nsmokers know smoking is harmful for their
\nhealth and most of them would like to quit,
\nonly a few really try,and even fewer succeed.
\nWithout treatment,only 3 % of the smokers
\nare able to achieve six months of abstinence.
\nWith pharmacological and psychotherapic
\ntreatment, abstinence rates raise up to 25-
\n30% up to 6 months of abstinence. To stop
\nsmoking is much more complicated than
\ndeciding to stop eating avocado. Smokers
\nneed to be motivated to quit, and treatment
\nshould be widely provided.
\n94
\nIn order to increase the availability of cessa-
\ntion support, educational measures must be
\ntaken, such as:
\nthe elaboration of guidelines,\u2022
\ninclusion of diagnosis and treatment of\u2022
\ntobacco dependence in health profession-
\nals curricula,
\nprovision of counselling services on ces-\u2022
\nsation of tobacco use in national pro-
\ngrammes,
\no\ufb00ering training programs to all kinds of\u2022
\nhealth professionals.
\nEvidence based treatments should be of-
\nfered and tailored to individual preferences
\nand needs. They can be divided in wide
\nreaching treatments (with low e\ufb03cacy and
\nlow cost) and face to face treatments (high
\ne\ufb03cacy and high cost).
\n1) Wide reaching treatments:
\nTelephone help-lines (the proactive\u2022
\nones and a bigger probability of e\ufb03-
\ncacy),
\nSMS messages,\u2022
\nWeb based treatments.\u2022
\n2) Face to face treatments:
\nBrief advice (up to 3 min),\u2022
\nBasic advice (up to 10 min),\u2022
\nIntensive support (once a week or\u2022
\nmore).
\nIn general, there is a dose-response rate, in
\nwhich the higher the dose (the frequency
\nand time during consultations) the higher
\nthe abstinence rates reached.
\nIn conclusion, those evidence based treat-
\nment and preventive measures must be used
\nto decrease the prevalence of smoking. If
\nthis alert is not heard and the policies here
\nsuggested are not implemented around the
\nworld, we will face the unnecessary death
\nof hundreds of million people in the near
\nfuture.
\nReferences
\n1. American Thoracic Society. Cigarette smok-
\ning and health. Am J Respir Crit Care Med
\n1996;153:861-5.
\n2. Jha P, Chaloupka FJ. Tobaco control in develop-
\ning countries. Oxford University Press on Behalf
\nof World Bank and World Health Organization;
\n2000.
\n3. Mackay J, Eriksen M. Tobacco Atlas. WHO;
\n2002.
\n4. Peto R, Lopez AD, Boreham J, Thun M, Heath
\nC. Mortality from smoking in developed countries
\n(1950-2000). Indirect estimates from national vital
\nstatistics. New York: Oxford University Press; 1994.
\n5. Proctor N. Tobacco and the global lung cancer
\nepidemic. Nat Rev Cancer 2001;1(1):82-6.
\n6. Raw M, Anderson P, Dubois G, Hasler J, et al.
\nWHO evidence based recommendations on the
\ntreatment of tobacco dependence. Tobacco Control
\n2002; 11: 44-46.
\n7. WHO Report on the Global Tobacco Epidem-
\nic, 2008 The MPOWER package. Geneva, World
\nHealth Organization, 2008.
\n8. United States. Morbidity and Mortality Weekly
\nReport (MMWR). Cigarette smoking-attributable
\nmortality and years of potential life lost. Centers for
\nDisease Control and Prevention. MMWR Morb
\nMortal Wkly Rep 1990;42:645-9.
\n9. United States. Morbidity And Mortality Weekly
\nReport (MMWR). Trends in Cigarette Smoking
\nAmong High School Students.United States,1991-
\n2001. Centers For Disease Control And Prevention.
\nMMWR Morb Mortal Wkly Rep 2002;51(19).
\n10. United States. Morbidity and Mortal-
\nity Weekly Report (MMWR). Cigarette smoking
\namong adults. MMWR Morb Mortal Wkly Rep
\n2002;51(29):642-5.
\n11. United States Department of Health and Hu-
\nman Services (USDHHS).The health consequences
\nof involuntary smoking. A report of the Surgeon
\nGeneral. Washington DC: US Government Print-
\ning O\ufb03ce; 1986.
\n12. United States Department of Health and Hu-
\nman Services (USDHHS).The health consequences
\nof smoking: nicotine addiction. A report of the Sur-
\ngeon General. Rockville: Public Health Service, Of-
\n\ufb01ce on Smoking and Health; 1988.
\n13. United States Department of Health and Hu-
\nman Services (USDHHS). The health bene\ufb01ts
\nof Smoking Cessation. A report of the Surgeon
\nGeneral. Atlanta (GA): Centers for Disease Con-
\ntrol and Prevention; 1990; DHHS Publication No:
\n(CDC)90-8416L.
\n14. United States Department of Health and Hu-
\nman Services (USDHHS). Best practices for com-
\nprehensive tobacco control programs. Centers for
\nDisease Control and Prevention, National Center
\nfor Disease Prevention and Health Promotion, Of-
\n\ufb01ce on Smoking and Health; 1999.
\n15. United States Department of Health and Hu-
\nman Services (USDHHS). Clinical practice guide-
\nline: treating tobacco use and dependence. Public
\nHealth Service; 2000.
\n16. United States Department of Health and Hu-
\nman Services (USDHHS). Reducing tobacco use: a
\nreport of the Surgeon General. Atlanta (GA): Cen-
\nters for Disease Control and Prevention, National
\nCenter for Chronic Disease Prevention and Health
\nPromotion, O\ufb03ce on Smoking and Health; 2000.
\n17. United States Department of Health and Hu-
\nman Services (USDHHS). PHS Clinical Practice
\nGuideline, Treating Tobacco Use and Dependence;
\n2007.
\nDr. Analice Gigliotti
\nPresident of Brazilian Asoociation on Studies
\nof Alcohol and Drugs (ABEAD)
\n95
\nAbout WHPA
\nThe global organisations representing the
\nworld\u2019s nurses, pharmacists and physicians
\njoined forces in 1999, creating a unique al-
\nliance to address global health issues – the
\nWorld Health Professions Alliance. In
\n2005, they were joined by the global rep-
\nresentative organisation of the dental pro-
\nfession. Dentists, nurses, pharmacists and
\nphysicians deliver health care to individu-
\nals, families and communities regardless of
\ntheir colour, creed, gender, religion or po-
\nlitical a\ufb03liation. The World Health Profes-
\nsions Alliance, speaking for more than 23
\nmillion health care professionals worldwide,
\nassembles essential knowledge and experi-
\nence from the key health care professions.
\nThe WHPA aims to facilitate collaboration
\nbetween key health professionals and major
\ninternational stakeholders such as govern-
\nments, policy makers and the World Health
\nOrganization. By working in collaboration,
\ninstead of along parallel tracks, the patient
\nand health care system bene\ufb01t.
\nMember Organisations
\nTheInternationalCouncilofNurses(ICN)
\nis a federation of national nurses\u2019associations
\nin 129 countries, representing the 13 mil-
\nlion nurses working worldwide. Founded in
\n1899, ICN works to ensure quality nursing
\ncare for all, sound health policies globally,
\nthe advancement of nursing knowledge, and
\nthe presence worldwide of a respected nurs-
\ning profession and a competent and satis\ufb01ed
\nnursing workforce. www.icn.ch
\nThe International Pharmaceutical Feder-
\nation (FIP) is the global federation of 114
\nnational organisations of pharmacists and
\npharmaceutical scientists. Pharmacists are
\nhealth professionals dedicated to improving
\nthe access to and value of appropriate medi-
\ncine use. www.\ufb01p.org
\nThe FDI World Dental Federation (FDI)
\nis the authoritative, worldwide voice of
\ndentistry with more than 130 member asso-
\nciations in more than 125 countries around
\nthe world, representing almost one million
\ndentists internationally. Its main roles are
\nto bring together the world of dentistry; to
\nrepresent the dental profession of the world
\nand to stimulate and facilitate the exchange
\nof information across all borders with the
\naim of optimal oral health for all people.
\nwww.fdiworldental.org
\nThe World Medical Association (WMA)
\nis the global federation of national medi-
\ncal associations, representing millions of
\nphysicians worldwide. Its membership is
\nmade up of national medical associations
\nfrom around the world, directly and indi-
\nrectly representing the views of more than
\nseven million physicians. The WMA was
\nfounded in 1946 and endeavours to achieve
\nthe highest possible standards of medical
\nscience, education, ethics and health care
\nfor all people. In order to achieve this ideal,
\nthe WMA is active in the \ufb01elds of policy
\ndevelopment and the setting of professional
\nstandards. www.wma.net
\nPriorities and Actions
\nWHPA is focused on the following key pri-
\norities for improved global health care.
\nHealth as a human right
\nAs health professionals, all WHPA mem-
\nbers support and promote the principle of
\nhealth as a basic human right.This includes
\nthe right to access safe and appropriate
\nhealth care for all people of the world.
\nPatient safety
\nHealth care interventions are intended to
\nbene\ufb01t the public, but due to the complex
\ncombination of processes, technologies and
\nhuman interactions there is an inevitable
\nrisk that adverse events will happen. The
\nWHPA is working actively to improve sys-
\ntems and therefore reduce such incidents.
\nAlliance partners are also acting together
\non other issues of patient safety, including
\nthe presence of counterfeit medicines, anti-
\nmicrobial resistance and the \ufb01ght against
\nHIV\/AIDS.
\nGlobal tobacco control
\nThe WHPA encourages governments to
\nratify and implement the WHO Frame-
\nwork Convention on Tobacco Control.This
\nincludes the developing of policies that ban
\ntobacco advertising and promotion; require
\nprominent and signi\ufb01cant tobacco warnings
\non all tobacco products; ban smoking in
\npublic places and commercial airline \ufb02ights;
\nprovide public education campaigns against
\ntobacco use; and encourage tobacco farm-
\ners to shift to crop substitution.WHPA also
\npromotes an active role for health profes-
\nsionals in tobacco control, both on the clin-
\nical care level and on the association level
\nwhere advocacy is key.
\nThe WHPA Leaders\u2019 Forum
\nBetter health worldwide can only be
\nachieved through collaboration, commu-
\nnication and dialogue to explore and ex-
\nchange new approaches and methodologies.
\nOne of WHPA\u2019s important contributions to
\nthis is to bring together leaders represent-
\ning the member organisations and other
\nstakeholders in international health in a bi-
\nennial WHPA Leaders\u2019Forum, strengthen-
\ning the bond and encouraging collaboration
\nbetween the four health professions in all
\ncountries and settings.
\nThe Future
\nWHPA is dedicated to continuing its role in
\naddressing global health issues.The Alliance\u2019s
\nstrategic orientation for the future will involve
\nboth proactive work on speci\ufb01c initiatives
\nand responsive action to issues as they unfold.
\nThese issues include: ethics, equity and access
\nto health care, patient safety, tobacco control,
\nstrengthening health professionals\u2019 involve-
\nment on policy and health human resources
\nplanning. With a forward looking vision and
\ncollaborative spirit, the Alliance partners have
\ncommitted to taking an unprecedented pro-
\nactive role to deliver improved health care to
\npopulations worldwide.
\nWorking together for safe health care,
\nthe World Health Professions Alliance (WHPA)
\n96
\n(IFPMA) The International Federation
\nof Pharmaceutical Manufacturers & As-
\nsociations (IFPMA) has appointed Alicia
\nGreenidge as its new Director General. She
\ntook o\ufb03ce on 2 June 2008 and succeeds
\nDr. Harvey Bale, who retired after almost
\neleven years in the position.
\nMr. Fred Hassan, President of the IFPMA
\nand Chairman and CEO of Schering-
\nPlough,said:\u201cMs.Greenidge has extensive
\nexperience working with the Geneva-
\nbased intergovernmental organizations, as
\nwell as substantive knowledge of many is-
\nsues of concern to the IFPMA.This experi-
\nence, combined with a practical approach
\nand keen mind, will equip her well for this
\nchallenging role. I am very pleased with her
\nappointment to lead IFPMA.\u201d
\nMs. Greenidge comes to the IFPMA with
\nmore than \ufb01fteen years experience in bi-
\nlateral and multilateral negotiations with
\ngovernments in the Americas, Africa, Asia,
\nPaci\ufb01c, Middle East, and Europe, working
\nlargely for the O\ufb03ce of the United States
\nTrade Representative (USTR), both in
\nWashington and in Geneva. In Geneva for
\nnearly ten years, Ms. Greenidge served for
\na period as Acting Deputy Chief of Mis-
\nsion and, for the last eight years, as Assis-
\ntant Deputy Chief of Mission and Senior
\nCounsel.
\nMs. Greenidge has gained a reputation as a
\nstrong and e\ufb00ective negotiator, but also as
\na bridge and coalition builder. She has kept
\nchannels of communication open and con-
\ntributed to many settlements and decisions
\nbefore the World Trade Organization, no-
\ntably the Public Health Declaration lead-
\ning up to and at Doha, Qatar in 2001 and
\nsubsequent agreements with regard to local
\npharmaceutical manufacturing capacity in
\ndeveloping countries, especially Africa. She
\nhas participated in deliberations concern-
\ning questions on the relationship of the
\nTrade Related Intellectual Property Rights
\nagreement (TRIPS), traditional knowledge
\nand the Convention on Biodiversity and led
\nin negotiated agreements on Least Devel-
\noped Country matters under TRIPS.
\nSince 1998, she also has interacted with,
\nand advised on issues before other inter-
\ngovernmental organizations, such as WHO
\n(including IGWG issues and the IGM on
\nvirus sharing and access to vaccines), UN-
\nAIDS, WIPO, UNCTAD and others. In
\naddition, she has engaged constructively
\nwith several non-governmental organiza-
\ntions in Geneva.
\nDuring her government service, she has
\ninteracted with industries and associations
\nrepresenting various sectors, including
\nPharmaceuticals and her activities spanned
\nacross other subjects as well, such as trade
\nremedies, dispute settlement, textiles, elec-
\ntronic commerce, investment measures,de-
\nvelopment assistance, aspects of the cotton
\nissue, bananas and services trade.
\nMs. Greenidge has a Ju-
\nris Doctorate from Boston
\nCollege, a Master\u2019s degree
\nin Public International Law
\n& International Develop-
\nment Economics from the
\nAmerican University, and
\na Bachelor\u2019s degree in In-
\nternational Relations and
\nSociology from C.W. Post
\nCollege\/LIU in the United
\nStates.
\nAbout the IFPMA
\nThe International Federation
\nof Pharmaceutical Manu-
\nfacturers & Associations is
\nthe global non-pro\ufb01t NGO
\nrepresenting the research-
\nbased pharmaceutical, bio-
\ntech and vaccine sectors. Its members com-
\nprise 25 leading international companies
\nand 43 national and regional industry as-
\nsociations covering developed and develop-
\ning countries. The industry\u2019s R&D pipeline
\ncontains hundreds of new medicines and
\nvaccines being developed to address global
\ndisease threats, including cancer, heart dis-
\nease, HIV\/AIDS and malaria. The IFPMA
\nClinical Trials Portal (www.ifpma.org\/
\nclinicaltrials), the IFPMA\u2019s Ethical Promo-
\ntion online resource.(www.ifpma.org\/Ethi-
\ncalPromotion) and its Health Partnerships
\ninformation www.ifpma.org\/HealthPart-
\nnetships – Developing World) help make
\nthe industry\u2019s activities more transparent.
\nThe IFPMA strengthens patient safety by
\nimproving risk assessment of medicines
\nand combating their counterfeiting. It
\nalso provides the secretariat for the Inter-
\nnational Conference on Harmonisation of
\nTechnical Requirements for Registration of
\nPharmaceuticals for Human Use (ICH).
\nIFPMA Appoints Alicia Greenidge as New
\nDirector General
\nAlica Greenidge, new Director General of IFPMA and
\nOtmar Kloiber, WMA Secretary General at the WMA o\ufb03ce in
\nFerney\u2013Voltaire
\n97
\nMyriah Lesko, BSc. Pharm., BSc.
\nProjects Coordinator FIP
\nFounded in 1912,the International Pharma-
\nceutical Federation (FIP) is the global feder-
\nation of national associations of pharmacists
\nand pharmaceutical scientists. FIP has been
\nin o\ufb03cial relations with the World Health
\nOrganization (WHO) since the WHO con-
\nception in 1949 and through its 120 Mem-
\nber Organisations in 90 countries represents
\nand serves almost two million practitioners
\nand scientists around the world.
\nThroughout its almost 100 year history, FIP
\nhas expanded both literally and \ufb01guratively.
\nThe emergence of pharmaceutical care as a
\ncornerstone of the profession and the grow-
\ning recognition of the pharmacist as an
\ninvaluable contributor to health outcomes
\nhave lead FIP to become a visible advocate
\nof the role of the pharmacist in the provi-
\nsion of healthcare,while still maintaining its
\ngrounding in pharmaceutical sciences.
\nOver the past several years, FIP has worked
\ntowards advancing pharmaceutical sciences,
\npharmacy practice and more recently phar-
\nmacy education to the ultimate bene\ufb01t of
\nthe patient.This has resulted from the work
\nFIP has done internally and through mutu-
\nally bene\ufb01cial partnerships with key global
\nplayers, such as WHO. This collaboration
\nhas served to promote the role of pharma-
\ncists in the WHO healthcare agenda and
\nhas further led to some of the most signi\ufb01-
\ncant partnerships between the key players
\non the global healthcare stage.
\nFIP is focused on improving the health and
\nwell being of communities through speci\ufb01c
\nand targeted projects. FIP works within the
\nWHO International Medical Products Anti
\nCounterfeiting Taskforce (IMPACT) to ad-
\nvocate for the input of health professionals
\nin assuring the integrity of the supply chain
\nof medicines, inherently including the iden-
\nti\ufb01cation and reporting of counterfeit medi-
\ncines. The implementation of the WHO-
\nFIP Good Pharmacy Practice Guidelines
\nthrough the Good Pharmacy Practice Pilot
\nProjects is a prime example of enabling phar-
\nmacists with the opportunity to use their
\nspecialised knowledge and skills, to interact
\nwith their patients and communities in order
\nto positively in\ufb02uence health outcomes.
\nThe past several years have seen FIP bring
\non an additional focus: pharmacy education.
\nFirmly believing that in\ufb02uential scientists and
\npractitioners are the result of comprehensive
\nand quality education, FIP has created the
\nPharmacy Education Taskforce. The Task-
\nforce is dedicated to coordinating and catalyz-
\ning action to develop pharmacy education, to
\nbe accomplished through the Pharmacy Edu-
\ncation Action Plan. In March of 2008 FIP,
\nWHO and UNESCO o\ufb03cially launched the
\n\ufb01rst phase of the Action Plan, which will be
\nimplemented between 2008-2010.
\nNeverforgettingitsroots,FIPcontinuestobe
\nfully engaged in the Pharmaceutical Sciences
\nand has successfully implemented a series of
\nPharmaceutical Sciences World Congresses,
\nwhich serve as global platforms for the ex-
\nchange of information related to the pharma-
\nceutical sciences.The parallel development of
\nnumerous FIP initiatives within pharmacy
\npractice, education and the pharmaceutical
\nsciences has demonstrated that the Federa-
\ntion is able to grow with concurrent streams
\nof interest without losing ground.
\nIn 1999, FIP, the World Medical Associa-
\ntion (WMA) and the International Council
\nof Nurses (ICN) founded the World Health
\nProfessions Alliance (WHPA)(the World
\nDental Federation (FDI) came on board
\nin 2005). This unique and \ufb01rst-of-its-kind
\nalliance brings together pharmacists, phy-
\nsicians, nurses, and dentists in initiatives
\nthat focus on e\ufb00ective interaction between
\nhealth professionals, while recognizing the
\nunique values and distinctive contributions
\nthat each brings to patient care.
\nThe potential of what may come of the com-
\nmunication and interaction brought about
\nby the partnerships built within the WHPA
\nis of pinnacle value to all professions and the
\ncommunities we serve. FIP is very pleased
\nto have clear and open opportunities for
\ncollaboration with our dedicated partners in
\nhealth. The Federation believes – and advo-
\ncates to our Members – that comprehensive
\npatient care can best be achieved through
\npartnership, team work and mutual respect
\nand understanding of what each profession
\ncan contribute.
\nIt is with this philosophy of growth that
\nFIP is headed into the future: the changing
\ntides of healthcare, its delivery and the role
\nof pharmacists and pharmaceutical scien-
\ntists demand that the Federation not only
\nkeep pace but also provide solid leadership
\nto its Members and quality information and
\nsolid input to its peers in healthcare,thereby
\nempowering all to positively in\ufb02uence glob-
\nal health.
\nRepresenting pharmacists and pharmaceutical
\nscientists \u2013 your partners in healthcare
\nThe International Pharmaceutical Federation
\nKamal Midha, President FIP
\n98
\nAquina Thulare, Secretary-General of the
\nSouth African Medical Association
\nThe South African Medical Association
\n(SAMA) is an independent professional asso-
\nciationformedicaldoctorswithoutanystatuto-
\nry or disciplinary powers. SAMA is a member
\nof the World Medical Association (WMA), a
\nglobal federation of national medical associa-
\ntions representing doctors worldwide.
\nThe South African Medical Association
\nwas established on 20 September 1997, fol-
\nlowing the uni\ufb01cation of the Medical Asso-
\nciation of South Africa (MASA), founded
\nin 1927,and the Progressive Doctors Group
\n(formerly NAMDA).The name change was
\ne\ufb00ected on the 21 May 1998.
\nOn 30 April 1999 total uni\ufb01cation of the
\nmajor groupings for medical practitioners
\nwas achieved when the National Medical
\nAlliance, representing the SA Medical and
\nDental Practitioners, Society of Dispensing
\nFamily Practitioners, Family Practitioners
\nAssociation, Dispensing Family Practi-
\ntioners Association and the Eastern Cape
\nMedical Guild, a\ufb03liated to SAMA.
\nMembership to the Association is volun-
\ntary. It is also a registered trade union for
\nits members employed in the public sector.
\nAt present some 70% of doctors in both the
\npublic and private sectors are members of
\nthe association, which is registered as an in-
\ndependent, non-pro\ufb01t section 21 company.
\nThe Association\u2019s activities focus on both
\nthe professional and business aspects of
\nmedical practice.
\nOur Mission
\nTo represent doctors with authority and\u2022
\ncredibility in all matters concerning their
\ninterests in the health care environment.
\nTo promote the integrity and image of\u2022
\nthe medical profession.
\nTo develop medical leadership and skills.\u2022
\nTo provide doctors with knowledge rele-\u2022
\nvant to the demands of medical practice.
\nTo promote medical education, research\u2022
\nand academic excellence.
\nTo encourage involvement in health pro-\u2022
\nmotion and education.
\nTo in\ufb02uence the health care environment\u2022
\nto meet the needs and expectations of the
\ncommunity by promoting improvements
\nto health reform, policy and legislation.
\nObjectives
\nSAMA represents doctors in all matters
\nconcerning their interests with authority
\nand credibility in the healthcare environ-
\nment.
\nThese objectives include:
\npromoting the integrity and image of the\u2022
\nmedical profession,
\nproviding doctors with knowledge rele-\u2022
\nvant to the demands of medical practice,
\npromoting medical education, research\u2022
\nand academic excellence,
\nin\ufb02uencing the health care environment\u2022
\nto meet the needs and expectations of the
\ncommunity by promoting improvements
\nto health reform, policy and legislation,
\nencouraging involvement in healthcare\u2022
\npromotion and education,
\npromoting trust, integrity, professional\u2022
\nconduct, e\ufb03ciency and goodwill within
\nthe profession,
\nto support, improve and protect the sta-\u2022
\ntus, rights, privileges and interests of all
\nmembers,
\nto lobby Government and any relevant\u2022
\nbody on behalf of the profession,
\nto facilitate in the maintenance of stan-\u2022
\ndards of practice by members to the pub-
\nlic via continuing medical education,
\nto judiciously use all subscriptions, en-\u2022
\ntrance fees, levies and donations for the
\npursuance of the aims and objectives of
\nthe Association, while also using funds
\nentrusted for the furtherance of medicine
\nby way of bursaries, research grants and
\nsubsidies,
\nto be the guardian of the codes structure\u2022
\nfor members; setting out the practice
\nguidelines in all \ufb01elds of practice,
\nto disseminate information to members\u2022
\nin order to keep them up to date with the
\nlatest developments in our industry by
\nmeans of relevant publications; and
\nto act in an advisory capacity regarding\u2022
\nmember concerns and enquiries where
\npossible.
\nSAMA has 20 branches countrywide that
\nserve members on a more personal level,and
\nrepresent their interests and needs in that
\nparticular geographical area. Branch council
\nTheSouthAfricanMedicalAssociation(SAMA)
\nUniting doctors for the health of the nation
\nProf. Ralph Kirsch, President of the South
\nAfrican Medical Association
\n99
\nThe Nigerian Medical Association founded
\nin 1960, began as a branch of the British
\nMedical Association in 1951. It is the larg-
\nest medical association in the West African
\nsub-region with over 35 000 members from
\n36 state branches and a branch from the
\nFederal Capital Territory. 70% of doctors
\npractice in urban areas where only 30% of
\nthe population resides. The population of
\nNigeria is about 130 million. Policy deci-
\nsions are made by the Association\u2019s Nation-
\nal Executive Council (NEC), which is the
\ngoverning body. The constitution of NMA
\nis supreme and its provisions have binding
\nforce on all authorities, organs, branches
\nand members of the Association and, where
\napplicable, on any other persons.
\nWhile our Vision is to build a formidable
\nprofessional body committed to fostering
\ne\ufb00ective and e\ufb03cient health care delivery,
\nhigh ethical standards and the interest of its
\nmembers, our mission is to build a sustain-
\nable professional association of medical and
\ndental practitioners that will advance the
\ndelivery of qualitative health care services
\nthrough continuing professional develop-
\nment, advocacy, and policy development,
\nknowledge management, public education
\nmembers are elected through a democratic
\nprocess every three years to represent mem-
\nbers at the annual National Council meeting
\nof SAMA. Branch o\ufb03ces arrange their own
\nactivities such as Continuing Professional
\nDevelopment (CPD) events and regular
\nbranch meetings, and o\ufb00ers a branch peer
\nreview function when needed. Branch sup-
\nport sta\ufb00 also deals with day-to-day queries
\nfrom members, with the assistance from
\nhead o\ufb03ce. New members are encouraged
\nto contact their local SAMA branch and
\nbecome involved in SAMA activities.
\nA\ufb03liated groups
\nMembers also enjoy representation through
\nthe various a\ufb03liated groups. SAMA has
\nmore than 56 a\ufb03liated specialist and special
\ninterest groups with proportional represen-
\ntation on National Council.
\nDecision making at SAMA
\nNational Council
\nAs a representative body for doctors,SAMA
\nencourages and facilitates member partici-
\npation in decision-making through a dem-
\nocratic and transparent governance process.
\nOrdinary members can participate at local
\nlevel in the activities of the 20 branches
\nand the 56 specialists and specialist inter-
\nest groups. Branches and groups have pro-
\nportionate representation on the SAMA
\nNational Council, which meets once a year
\nwhen all elected representatives meet to dis-
\ncuss and debate issues a\ufb00ecting doctors on
\na national basis.
\nBoard of Directors
\nNational Council appoints a Board of Di-
\nrectors, which meet quarterly to discuss
\nmatters regarding the business a\ufb00airs of the
\nAssociation including policy, budget, \ufb01nan-
\ncial, economic and management issues.
\nStanding Committees
\nNational Council also appoints the members
\nof ten standing committees,which each have
\na speci\ufb01c mandate. These include human
\nrights, law and ethics, private practice mat-
\nters,public sector doctor issues,health policy,
\nand education,science and technology.These
\ncommittees meet regularly and report back at
\nthe quarterly meetings of the SAMA Board
\nof Directors, and to their peers at the annual
\nNational Council meeting.
\nSecretariat
\nA secretariat is situated in Pretoria, Gau-
\nteng with a full-time support sta\ufb00 of 55.The
\nSecretary-General is the head of the Secre-
\ntariat from where she directs and adminis-
\nters the a\ufb00airs of the Association within the
\nframework of operating policies established
\nby National Council and the Board of Di-
\nrectors. She also exercises control over all
\nmatters concerning the administration and
\nmanagement of the head o\ufb03ce and sta\ufb00.
\nIn an environment that is constantly chang-
\ning, membership of The South African
\nMedical Association (SAMA) provides doc-
\ntors with the kind of support that they need
\nin order to be able to practise medicine suc-
\ncessfully. On behalf of its members, the As-
\nsociation strives for a healthcare dispensation
\nthat addresses the challenges of healthcare
\ndelivery in South Africa.
\nThe Association provides doctors with in-
\ndividual and collective representation aimed
\nat in\ufb02uencing medical and health legisla-
\ntion, regulation and policies.
\nDr. Kgosi (TKS) Letlape,
\nChairperson SAMA, former President WMA
\nOverview of the Nigerian Medical
\nAssociation (NMA)
\nDr. Ishaq Abdul (R) handing over to the Current
\nSecretary General,Dr.Kenneth Okoro (L)
\n100
\nin collaboration with other collaborating
\npartners in health.
\nAny medical or dental practitioner regis-
\ntered under the Medical and Dental Prac-
\ntitioners\u2019Act CAP 221 Laws of the Federa-
\ntion of Nigeria (1990) and as subsequently
\namended shall have a right of membership
\nof the Association on payment of the an-
\nnual practicing fee in the said Act as may be
\nreviewed from time to time, unless other-
\nwise prescribed in the constitution.The As-
\nsociation has both governance and manage-
\nment structures with the Annual Delegates\u2019
\nMeeting (ADM) as the highest decision
\nmaking body. The management is by the
\nNational O\ufb03cers\u2019 Committee (NOC) led
\nby the President and this occupies the third
\nlevel. The NOC has seven elected members
\nwho are democratically elected every two
\nyears and has responsibilities for manag-
\ning the a\ufb00airs of the Association. The cur-
\nrent National O\ufb03cers\u2019 (2008\/2010) are: Dr.
\nProsper Ikechukwu Igboeli, President; Dr.
\nBala Mohammed Audu, 1st
\nVice President;
\nDr. O.O. Alan Taiwo, 2nd
\nVice President;
\nDr. Kenneth Johnson Okoro, Secretary-
\nGeneral; Dr. Chris Enoch, Deputy Secre-
\ntary-General; Dr. Ibrahim Abubakar Kana,
\nTreasurer; Dr. S.N.C. Anyanwu, Editor, Ni-
\ngerian Medical Journal
\nThe administrative head of the secretariat is
\nthe Secretary-General and is assisted by a
\ncore of support sta\ufb00 for the smooth running
\nof the secretariat.
\nThe Association\u2019s Journal, Nigerian Medi-
\ncal Journal (NMJ) was founded in 1964
\nwith the following aims:
\n\u2022 to provide a medium
\nfor the dissemina-
\ntion and permanent
\nrecord of the result
\nof clinical experience
\nand scienti\ufb01c medical
\nresearch, particularly
\nin Nigeria.
\n\u2022 to serve as a forum
\nfor the dissemination
\nof general information
\nand report on conference of the Nigerian
\nMedical Association among members.
\nAlthough the Association is involved in
\nmany of the government\u2019s activities,it is con-
\nsulted formally by the government only on an
\n\u2018ad-hoc\u2019 basis. It is not consulted as \u2018of right\u2019
\non health issues and has to press for its par-
\nticipation.The Association nominates eleven
\nmembers of the Medical and Dental Coun-
\ncil of Nigeria (MDCN), which regulates the
\npractice of medicine & dentistry in Nigeria
\nand the curricula of its medical schools.
\nThe NMA is at present involved in in\ufb02uenc-
\ning health policy formulation in an ad hoc
\nmanner. This is done by making unsolicited
\nrecommendations to government on vari-
\nous health issues and also by making inputs,
\nwhenever invited, to some of the national
\ncommittee meetings on policy formulations.
\nThe Association holds training courses
\nfor doctors, and participates in radio pro-
\ngrammes and TV talk shows. It has several
\non-going projects including those on AIDS,
\non family planning and on Primary Health
\nCare (PHC). Project development is depen-
\ndent upon outside funding. Funding agen-
\ncies supporting the Association\u2019s activities
\ninclude UNFPA,UNICEF,WHO,USAID,
\nthe Ford Foundation, and the John D and
\nCatherine T MacArthur Foundation.
\nThe Association collaborates in speci\ufb01c
\nprojects on health issues with individual
\nNGOs and with the National Association
\nof Non-governmental Organizations on
\nHealth (NANGOH). The NMA plans to
\nmake more in-roads into the Federal Min-
\nistry of Health to ensure that it is involved
\nin all aspects of policy formulation, espe-
\ncially in the planning stages.
\nIt is also planned that the NMA continues
\nto cooperate with government in project
\ndevelopment so that the association may be
\nrepresented on the delegations to regional
\nand international health conferences.
\nThe Nigerian Medical Association (NMA)
\nis the host of the permanent secretariat of
\nthe Confederation of African Medical As-
\nsociation and Societies (CAMAS). The
\nAssociation is developing a proposal to in-
\nvolve all African Medical Associations and
\nSocieties in e\ufb00orts to improve reproductive
\nhealth and safe motherhood in Africa.
\nThe Nigerian Health System performance has
\nbeen poor, having been ranked 187th
\namongst
\n191 member states in 2000. Infant Mortality
\nrate was 97 per 1000 live births and has wors-
\nened to 110 per 1000 live births in 2005.This
\nis against the MDG \u2013 4 targeted improve-
\nment to 30 per 1000 live births by 2015. Ma-
\nternal Mortality rate was 704\/100,000 births
\nand has also worsened to 800\/100,000 births
\nin 2004 as against the MDG \u2013 5 targeted im-
\nprovement to 75\/100,000 births by 2015.Life
\nexpectancy at birth is 45 years for males and
\n46 years for females.
\nWhile budgetary provisions for health re-
\nmain grossly inadequate,other major factors
\ncontributing to the above poor health indi-
\nces include unfavourable working environ-
\nment, inadequate lack of essential medical
\nequipment, poor health seeking behaviour
\nof many Nigerians, lopsided distribution of
\nhealth facilities and very poor remuneration
\nof Medical Personnel. Lack of desired mo-
\ntivation has led to the massive brain drain of
\nMedical Professionals whose exodus from
\nNigeria became very noticeable in 1985.
\nIn deed, over 10,000 Nigerian Doctors are
\npractising outside the country.
\nIt is hoped that the above scenario will
\nchange for the better in the coming years.
\nDr. Kenneth Johnson Okoro,
\nSecretary-General
\nGroup picture of both the Immediate Past and Current Executives
\nafter the Handing Over Ceremony
\n101
\nDr. Florent Aka Kroo,
\nPresident of the NOPCI
\nLocated in the Guinea Gulf, the Republic
\nof C\u00f4te d\u2019Ivoire is a West African country,
\nindependent since August 1960 and with
\ncurrently about 18 million inhabitants.
\nThe National Order of Physicians of C\u00f4te
\nd\u2019Ivoire (NOPCI) was established in Sep-
\ntember 1960, one month after the birth of
\nthe Ivorian State by Parliament # 60-284
\nlaw of 10 September 1960.
\nThe NOPCI has two major missions, which
\nare as follows:
\nto empower all physicians who are will-\u2022
\ning to practice Medicine in the Country;
\nthey must go through a yearly registration
\nwith the National Board of Physicians;
\nto see that all physicians are respectful\u2022
\nof the principles of morality, probity, and
\ndevotion which are indispensable for the
\npractice of Medicine; the NOPCI ensures
\nas well the respect by all its members of
\nthe professional duties and the rules of
\nthe code of ethics; its defends the honour
\nand independence of the medical profes-
\nsion; it can also provide support and as-
\nsistance to its members.
\nThe NOPCI went through a long 40-year
\nperiod of lethargy. However, since 30 Oc-
\ntober 2004, it is becoming more dynamic
\nthanks to a new management team.
\nTherefore the participation index which
\nwas 15% (about 350 registered physicians
\nin good standing), is currently up to 85%
\n(about 3800 physicians out of 4500). The
\nnational ratio is 1 physician for 5000 inhab-
\nitants.
\nThe new team\u2019s e\ufb00ort is also extended out-
\nside the national area, to:
\nthe sub-regional area in relation to the\u2022
\nOrders Conference of the West African
\nEconomic and Monetary Union States
\n(WAEMUS),
\nthe French speaking area with the re-\u2022
\ncently established French-speaking Or-
\nders Conference (over 30 countries with
\nFrench as a full or partial language),
\nthe international and global arena with\u2022
\nthe NOPCI membership application to
\nthe World Medical Association (WMA).
\nThis application shall go through a vote at
\nthe General Assembly of the WMA to be
\nheld in Seoul (Korea) on 15-18 October
\n2008 and we hope it will succeed.
\nThe NOPCI is aware of its position of
\n\u201cGuardian of the Temple\u201d in Ivorian Medi-
\ncal practice. However it considers it impor-
\ntant to be informed of its members\u2019acts and
\nthoughts should they be willing to do so.
\nTherefore it is planning to establish the Ivo-
\nrian Medical Association prior to the WMA
\nGeneral Assembly of October 2008. Such
\nan initiative will bring Ivorian physicians to
\nmore representation at a global level.
\nThe C\u00f4te d\u2019Ivoire went through an eco-
\nlogical disaster in September 2006 as toxic
\nwaste was poured out in Abidjan, the eco-
\nnomic capital and its suburbs.
\nOver 100 000 inhabitants of the City were
\nconsidered victims of gas emissions, 12 of
\nthem died, 79 were admitted to care set-
\ntings, and more than 100 000 consultations
\nwere recorded.
\nIn January 2007, the NOPCI organised a
\nscienti\ufb01c workshop in order to check the
\nmedical aspects of this disaster,and its mean
\nand long term e\ufb00ects, as well in exposed
\nsubjects. It is now planning to establish a
\nnon-governmental Observatory, and needs
\ntechnical and \ufb01nancial support.
\nThe NOPCI along with the upcoming Ivo-
\nrian Medical Association is willing to be on
\nthe same wavelength as the WMA, regard-
\ning its objectives: improvement of patients\u2019
\ncare, respect of medical ethics, patients\u2019
\nrights, and sustained e\ufb00ort to ensure a post-
\nacademic training of quality.
\nThe National Order of Physicians of C\u00f4te
\nd\u2019Ivoire: presentation and perspectives
\nNational Order of Physicians of CI with CI President Gbagbo
\n102
\nBackground
\nThe Medical Association of Thailand is a
\nnon-governmental non-pro\ufb01t making so-
\ncial promotion organisation of the Medical
\nProfessions in Thailand. It was founded in
\n1921 in Bangkok. It is, at present, located
\nat the Royal Golden Jubilee Building #
\n2 Soi Soonvijai, New Petchburi Road,
\nHuaykwang district, Bangkok 10310, Thai-
\nland. CABLE Address \u201cMEDITHAI\u201d
\nTel. (66) 2 3144344, (66) 2 3188170 Fax.
\n(66) 2 3146305 Email address: math@lox-
\ninfo.co.th and http:\/\/www.mat.or.th.
\nThe present governing body of the Associa-
\ntion is composed of a President (Dr.Aurchart
\nKanjanapitak), President Elect (Pol. Major
\nGeneral Dr. Jongjate Aojanepong), Vice
\nPresident (Dr. Chatri Banchuin), Secretary
\nGeneral (Associated Professor Dr. Prasert
\nSarnvivad) with other 16 council members
\nand also Presidents of all specialty colleges
\nand faculties and invited past presidents and
\nrecognised members. The term of the com-
\nmittee will be 2 years from general election
\namongst members. The membership of the
\nAssociation at present is 23,000 out of a total
\n33,000 graduates or about 70 %
\nFunctions:
\nThe Medical Association of Thailand\u2022
\nworks towards;
\nPromoting and coordinating Medical\u2022
\nProfessions under ethical integrity;
\nPromoting relationship amongst mem-\u2022
\nbers;
\nPromoting education, research and medi-\u2022
\ncal services;
\nProviding welfare to members;\u2022
\nCoordinating and collaborating with other\u2022
\nmedical organisations both in governmen-
\ntal and in private sectors to improve better
\nstandard of medical provision and public
\nhealth to meet international standard;
\nAdvocating health promotion (exercise\u2022
\nand antismoking campaigns), prevention,
\nand medical services to public;
\nCollaborating with international health\u2022
\nand medical organizations to keep the
\nglobal standard.
\nThe Medical Association of Thailand has a
\nrole in bringing all health and medical pro-
\nviders from both governmental and private
\nsectors to work together through the elective
\nexecutive committee which is composed of
\nmembers from various sectors. The Medi-
\ncal Association of Thailand is also one of the
\nthree components forming a collaborative
\nbody from the Ministry of Public Health, the
\nMedical Council and the Medical Associa-
\ntion as a platform to oversee and overcome the
\narising problems in the Medical profession
\nand allied professions at monthly meetings.
\nThe Medical Association is also taking a role
\nin providing compromises in the con\ufb02icts
\namongst medical providers and consumers.
\nJournal of the Medical Association of Thai-
\nland is an accepted world class medical pub-
\nlication for medical education, research and
\nmedicalknow-how.Itispublishedbi-monthly
\nand distributed amongst members and medi-
\ncal institutes including medical faculties and
\nmedical libraries in the whole country.
\nThe Medical Association of Thailand is also
\ncurrently providing not only mobile teach-
\ning teams to the remote areas, but also sup-
\nports them with the professional insurance.
\nInternational Relationship
\nAt present the Medical Association of Thai-
\nland is taking more part in the international
\na\ufb00airs. One of its past Presidents (Prof. Dr.
\nSomsri Pausawasdi) has currently been elect-
\ned to the President of CMAAO (Confed-
\neration of the Medical Association in Asia
\nand Oceania with 17 member countries).
\nAlso its international relations chief o\ufb03cer
\n(Dr. Wonchat Subhachaturas) is the elected
\nChairman of the Council in CMAAO, as
\nwell the President of the Association is au-
\ntomatically a councillor in the CMAAO and
\nthe MASEAN ( The Medical Associations
\nin South East Asian Nations).
\nThe Medical Association of Thailand pro-
\nvides full support to the WMA (World
\nMedical Association) as an active member
\nand send its representatives to participate in
\nevery General Assembly Meeting and al-
\nways works closely with member countries
\nthrough e-mails and the website (http:\/\/
\nmat.or.th). Exchange visiting programmes
\nare also well ongoing within the region and
\noutside upon the invitations.
\nWonchat Subhachaturas M.D.,FRTCS
\nInternational Relations for the MAT
\nThe Medical Association of Thailand under
\nthe Royal Patronage of his Majesty the King
\nDr. Aurchart Kanjanapitak, President of The
\nMedical Association of Thailand
\nProf. Dr. Somsri Pausawasdi, Presi-
\ndent of CMAAO
\n103
\nThe Hong Kong Medical Association
\n(HKMA) was established in 1920. It is
\nthe professional body representing doctors
\nin Hong Kong, and is an independent non-
\ngovernment organization. It has a mem-
\nbership of 7,943, out of the 10,979 doctors
\nwithin a population of 7 million in the Spe-
\ncial Administrative Region of China. Hong
\nKong enjoys freedom due to the \u201cOne
\nCountry Two System\u201dpolicy and practice of
\nthe People\u2019s Republic of China.
\nThe motto of HKMA is \u201cSafe-guarding the
\nHealth of People\u201d.
\nWe have roughly half of our members work-
\ning in the public sector, and another half in
\nthe private. The issues that HKMA is con-
\ncerned with are usually important to both
\nthe private and public doctors.
\nThe professional autonomy of the medical
\nprofession is manifest by the peer-groups-
\nreview practice and self-regulatory power of
\nthe Medical Council of Hong Kong which
\nis the quasi-statutory body responsible for
\nthe setting of standards, implementation of
\nregulation and disciplining doctors.
\nWe are aiming at a better democratic rep-
\nresentation on the Medical Council as our
\nmedical regulatory body and independence
\nfrom the government.
\nThe Food and Health Bureau has been
\nconsidering health reform with Healthcare
\nFinancing Consultation. The HKMA has
\nconducted survey within the profession to
\ncollect the opinions of physicians towards
\nthe proposed health reform and healthcare
\n\ufb01nancing, especially the pros and cons of
\nmandatory medical insurance and medi-
\ncal saving. HKMA also met regularly with
\nmedical insurers to work on core elements
\nof good medical insurance scheme.
\nIn Hong Kong, we are concerned that the
\nfamily doctor concept should be better im-
\nplemented and more training opportunities
\nfor family physicians. There is a specialist
\nregister here but not a primary care regis-
\nter. We also strive to improve public-private
\ncollaboration. The HKMA proposed a pri-
\nmary care register but the medical council is
\napparently not yet ready.
\nThe HKMA has been \ufb01ghting for main-
\ntaining the right of dispensing by physi-
\ncians. Public opinion poll was done in
\n2007, conducted by the public opinion
\nprogram of the University of Hong Kong.
\nThe results showed that 3\/4 respondents
\nobjected to the separation of dispensing and
\nconsultation. However, the pharmacists are
\nstill campaigning to change the practice in
\nHong Kong to strip doctors of the rights
\nto dispense and to deprive patients of the
\nchoice of getting medicine from the doctors
\nthey consult.
\nWe had published the Good Dispensing
\nManual, encouraging members and their
\nsta\ufb00 to continually update themselves with
\ngood dispensing methods and risk manage-
\nment. Dispensing errors occurred not only
\nin the private sector, but also in the public,
\ni.e.the Hospital Authority; not only by doc-
\ntors but also by dispensers or pharmacists.
\nThe HKMA cooperates with the Medical
\nProtection Society (MPS) to assist doctors
\nin medico-legal litigation. These disputes
\noften cause immense stress and serious
\nconsequences to doctors. The secretariat
\nof HKMA will help members to contact
\nthe MPS. The soaring annual premiums
\nfor doctors become unbearable. HKMA is
\nnegotiating with MPS and the government
\nto think of ways to limit these burdens of
\ndoctors. We have established a mediation
\ncommittee to promote this \u201cwin-win\u201d me-
\ndiation approach to solve patient-physician
\ncon\ufb02icts.
\nIn the private sector,doctors su\ufb00er from un-
\nscrupulous rental increase in public housing
\nestates which cause tremendous di\ufb03culties
\nin running clinics. HKMA led our mem-
\nbers to protest against Link Real Estate In-
\nvestment Trust (Link REIT) and organized
\nrally and march by our members together
\nwith workers of other trades. Private Doc-
\ntors are also troubled by medical groups and
\nHMOs which have too much emphasis on
\ncustomers\u2019 service, marketing and commer-
\ncial elements of medical practice, but might
\nerode professional autonomy. HKMA
\nstrived to persuade the government and the
\nlegislature to regulate HMO, group practic-
\nes as well as insurance-run clinics to ensure
\nlevel playing \ufb01eld for solo practitioners.
\nIn the public sector doctors su\ufb00er from long
\ninhuman working hours, poor working en-
\nvironment, inadequate training and low re-
\nspect for professionalism from the govern-
\nment and the public. The morale has been
\nworsening and there has been sta\ufb00 exodus
\nfrom Hospital Authority, resulting in de-
\nterioration in quality service. This problem
\nwill eventually jeopardize the whole medi-
\ncal work force in the territory. The HKMA
\nis \ufb01ghting the battle together with our pub-
\nlic colleagues especially our junior members
\nwho were so demoralized. We had sent a
\nletter to WMA to see the working condi-
\ntions of junior colleagues in other NMAs.
\nOur members demonstrated together and
\nThe Hong Kong Medical Association
\n(HKMA)
\n104
\nmarched to the government house to \ufb01ght,
\nhoping to bring a brighter future for our
\nprofession and our next generation. Now,
\nthere has been some improvement in work-
\ning hours and training prospects after
\nlengthy battles, but more need to be done.
\nThe government (the Education Bureau,
\nFood and Health Bureau and University
\nMedical School) proposed to increase the
\nintake of medical students,aiming to double
\nthe number of graduates. HKMA opposed
\nand the Secretary for Education promised
\nto look into the matter from the perspective
\nof overall supply and demand of physicians
\nand also the training prospect of the medi-
\ncal graduates.
\nWe have regular exchange programmes and
\ncooperation with the Chinese Medical As-
\nsociation, while we are totally independent
\nof each other. The HKMA has 12 monthly
\nHKMA newsletters, 12 monthly CME
\nBulletins, and bi-monthly Hong Kong
\nMedical Journals. We are providers, orga-
\nnizing CME activities, as well as accredi-
\ntor of CME activities. We have an on-line
\nCME website as well as lots of cultural and
\nsports activities organized for our members.
\nThere are HKMA orchestra, HKMA choir
\nand singing group, HKMA no. one band,
\nand a HKMA charitable foundation. We
\nhave a theme song of the HKMA: \u201cWe are
\nconcerned\u201d. This year, the HKMA has or-
\nganized several concerts in theatres, as well
\nas mini-concerts in malls and streets to raise
\ndonations for needy people, patient groups
\nand the earthquake victims in Sichuan.
\nDr. Alvin Yee Shing CHAN,
\nVice President of the Hong Kong Medical
\nAssociation, Chairman of International
\nA\ufb00airs Committee, Chairman of
\nRehabilitation Committee, Central
\nCoordinator of the HKMA Community
\nNetwork, Chairman of HKMA Orchestra
\nCommittee and Choir Committee, Elected
\nmembers of the Medical Council of
\nHong Kong
\nDr.Safarli Nariman, AzMA president
\nThe Azerbaijan Medical Association
\n(AzMA) is the country\u2019s leading voluntary,
\nindependent, non-governmental, profes-
\nsional, membership medical organization
\nfor physicians, residents and medical stu-
\ndents who represent all medical specialties
\nin Azerbaijan.
\nIn 1999, Dr. Nariman Safarli and his col-
\nleagues founded the Azerbaijan Medical
\nAssociation (AzMA) and association was
\no\ufb03cially registered by Ministry of Justice
\nof Azerbaijan Republic in December 22,
\n1999.
\nSince its inception, the AzMA continues
\nserving for a singular purpose: to advance
\nhealthcare in Azerbaijan.
\nThe mission of the AzMA – is to unite all
\nmembers of the medical profession, to serve
\nas the premier advocate for its members and
\ntheir patients, to promote the science of
\nmedicine and to advance healthcare in Azer-
\nbaijan.
\nThe main aims of AzMA are:
\nto protect the integrity, independence,\u2022
\nprofessional interests and rights of the
\nmembers,
\nto promote high standards in medical\u2022
\neducation and ethics,
\nto promote laws and regulation that pro-\u2022
\ntect and enhance the physician-patient
\nrelationship,
\nto improve access and delivery of quality\u2022
\nmedical care,
\nto promote and advance ethical behavior\u2022
\nby the medical profession,
\nto support members in their scienti\ufb01c and\u2022
\npublic activities,
\nto promote and coordinate the activity of\u2022
\nmember- specialty societies and sections,
\nto represent members\u2019 professional inter-\u2022
\nests at national and international level,
\nto create relationship with other interna-\u2022
\ntional Medical Associations.
\nThe AzMA\u2019s vision for the future, and all
\nits goals and objectives are intended to sup-
\nport the principles and ideals of the AzMA\u2019s
\nmission.
\nIn 2000, the AzMA established its Per-
\nmanent Committees and the mission of
\nthe association is accomplished through its
\ncommittees as it realizes the decisions of the
\nAzMA General Assembly, studies health
\ncare delivery in Azerbaijan, and works out
\nand performs health policy and activities
\nthrough the Executive Board. The AzMA
\nThe Azerbaijan Medical Association (AzMA)
\n105
\nPermanent Committees are: Science and
\nEducation Committee, International Re-
\nlations Committee, Ethics Committee,
\nAdministration & Finance Committee,
\nMembership & Bylaws Committee, Pub-
\nlic Health Committee, Information &
\nPublications Committee, Private Medical
\nPractice Committee, Legislative Services
\nCommittee, Public Relations Committee,
\nPhysicians Health Committee. Member
\nphysicians volunteer countless hours to par-
\nticipate in one or more of the 11 Permanent
\nCommittees which meet on a regular basis
\nthroughout the year.
\nIn 2000, the AzMA has developed special
\nmembership sections to address the unique
\ninterests and concerns of association mem-
\nbers. These sections are following- Medical
\nStudent Section, Organized Medical Sta\ufb00
\nSection, Resident Physician Section, Young
\nPhysician Section, International Medical
\nGraduate Section.Now AzMA is in the pro-
\ncess of establishing its local AzMA branches
\nin 13 regions and also assists in creation of
\nmember-scienti\ufb01c societies on specialty
\nlevel.
\nInternational Relationship
\nToday AzMA continue to work closely with
\nother medical organizations both within the
\ncountry and at an international level. The
\nfollowing are the AzMA\u2019s national and in-
\nternational a\ufb03liations.
\nNational a\ufb03liations: In 2000, AzMA be-
\ncame a full member of the National NGO
\nForum of Azerbaijan Republic.
\nInternational a\ufb03liations: The year 2002
\nyielded memorable and historical events
\nfor Azerbaijan Medical Association such as
\nmembership to the World Medical Associa-
\ntion (WMA). AzMA became a part of the
\nWMA family. AzMA president participated
\nin several General Assemblies of WMA,and
\nthese were unique chance for our association
\nto develop its relations with other member
\nNational Medical Associations and also gain
\nnew experience in di\ufb00erent \ufb01elds of part-
\nnership within the WMA family. In 2002,
\nAzMA became an associate member of the
\nEuropean Union of Medical Specialists
\n(UEMS). In 2000, AzMA was admitted as
\nmember in the European Forum of Medical
\nAssociations(EFMA) with the right for con-
\nsultation. In 2000 Azerbaijan Medical Asso-
\nciation became a full member in the Forum
\nfor Ethics Committees in the Confederation
\nof Independent States (FECCIS).
\nAzMA Membership Services
\nAs a professional organization the AzMA
\nprovides services to its members.In the Leg-
\nislative Services Committee, lawyers provide
\ne\ufb00ective advocacy and legislative represen-
\ntation for member physicians. They give
\nconsultation on related legislative matters.
\nThe committee regularly organize legislative
\nseminars for physicians, students, hospital
\nand private medical centers sta\ufb00 members.
\nAlso since 2000,the \u201cAZMED\u201dResource &
\nTraining Center – organize for its members
\nregular courses on following issue: Basic
\nPrinciples of Bioethics, Medical Law and
\nHealth Legislation, English for Doctors,
\nBasic and Advanced Computer and Inter-
\nnet courses, Project proposals writing and
\nfundraising courses for Doctors, Leader-
\nship and Management for Doctors.
\nThe total number of members of the Azer-
\nbaijan Medical Association is 1250 (in-
\ncluding student membership). The admin-
\nistrative bodies of the Association are the
\nGeneral Assembly, the Councils, and the
\nExecutive board. AzMA sta\ufb00 consists of 8
\npersons, who are working on voluntary ba-
\nsis. Also working group which consists of
\n30 doctors and students actively involved to
\norganize the AzMA regular seminars,train-
\nings, conferences and work on edition and
\npublication of AzMA quarterly bulletin
\nfor members- \u201cAzMA VISION\u201d.
\nRelationship with Government
\nSince its establishment the AzMA work
\nclosely with MOH,especially on policy and
\nhealth system structure and organization.
\nIn 2001-2003 years, AzMA has been ac-
\ntively involved as Health NGO joining
\nPublic Health Workgroup of the coopera-
\ntive program of World Bank and Azerbai-
\njan Republic about \u201cEradication of Poverty
\nin Azerbaijan\u201d,In 2008,AzMA also actively
\ncooperate with MOH in National Health
\nReforms program,which \ufb01nancially support
\nby World Bank. During this year AzMA
\nconduct meetings several times with Health
\nReforms Center of MOH which have au-
\nthority to make decisions in the \ufb01eld of
\nHealth Care Policy.
\nFuture plans
\nCurrently AzMA is preparing to realize in
\nnear future its next project in Public health
\n\ufb01eld named as \u201cBe Healthy\u201d online health
\neducation for population of Azerbaijan.
\nProject goals:to make available online health
\ninformation and consultation to Azerbaijan
\ncitizens who use internet. In 2009, AzMA
\nplanning to publish a scienti\ufb01c journal\u201cAzer-
\nbaijan Medical Association Journal\u201d for Az-
\neri physicians.On 17-18 June 2009, AzMA
\nwill organize the International conference
\n\u201cCross-Cultural Aspects in Bioethics\u201d.
\nToday, AzMA members work hard to pro-
\nmote the science of medicine and to protect the
\nhealth of Azerbaijan citizens.
\nContact information:
\nE-mail: info@azmed.az
\nazerma@hotmail.com
\nWebsite: www.azmed.az
\nMeeting \u201cRole of Health Organizations in Na-
\ntional Health System\u201d with the representatives of
\nMinistry of Health, UN agencies and other In-
\nternational organizations functioning in Public
\nHealth \ufb01eld in Baku 2003
\n106
\nDr. Rosanna Capolingua, AMA President
\nAbout the AuMA
\nThe Australian Medical Association serves
\nto represent and protect the needs of pa-
\ntients in Australia. In doing so, it represents
\nthe goals of the Medical Profession. The
\nAustralian Medical Association (AMA),
\nthe country\u2019s peak health advocacy organi-
\nsation, was incorporated in 1961. Prior to
\nthis, it operated as a branch of the BMA.
\nWe currently represent more than 27,000
\ndoctors from each Australian state and ter-
\nritory and across every specialty craft group.
\nThese include salaried doctors in the public
\nsector and doctors in private practice, doc-
\ntors-in-training and medical students.
\nThe President, Vice President, Chair of
\nCouncil and Treasurer are elected annually
\nat the National Conference. The Executive
\ncommittee is made up of these o\ufb03ce bear-
\ners and two Federal councillors elected by
\nthe Federal Council. The policy setting for
\nthe organisation is performed the Federal
\nCouncil. This comprises 34 elected repre-
\nsentatives from the Australian States and
\nTerritories and each craft group (including
\nthe Australian Medical Students\u2019 Associa-
\ntion President and the Committee of Doc-
\ntors-in-Training) together with the four
\nO\ufb03ce-bearers.
\nAMA membership is discretionary. AMA
\nbranches are set up in each state and ter-
\nritory. These run independently and focus
\nprimarily on State issues, industrial repre-
\nsentation and services for members. They
\nenjoy a close, collaborative relationship with
\nthe federal Association – with all State and
\nterritory members being members of the
\nFederal AMA. The federal AMA drives
\nthe national agenda – primarily in lobbying
\nFederal Government, policy development
\nand dissemination,and maintains a national
\nmedia pro\ufb01le of the Federal President.
\nThe AMA is a strong voice in the medico-
\npolitical arena. Australians deserve a health
\nsystem that continues to improve and go
\nforwards. Government decisions on health
\ncare based on a political foundation and not
\nquality of care are not acceptable.The AMA
\nis loud and clear that it will not accept com-
\npromise to patient care. Our Association be-
\nlieves the solution is to build on the strengths
\nof our current system, using clinically-driven
\nreform to improve access to services.
\nCurrent Challenges in Healthcare for
\nthe Australian Medical Association
\nThe Australian health system ranks well in
\nthe world on many of the measures used
\nby the WHO and amongst OECD coun-
\ntries. We acknowledge that there are some
\nproblems within the system but, overall, it
\nprovides well for the vast majority of Aus-
\ntralians. There are many reasons for this
\nconsistently good performance but central
\nis the system of universal access to medical
\nservices, pharmaceuticals, free public hospi-
\ntal care and a subsidised private health in-
\nsurance scheme, which equalises premiums
\nacross the community with a \u2018community
\nrating\u2019. This is underpinned by good ac-
\ncess to highly-trained medical practitioners
\nproviding excellent patient-centred care to
\nindividuals whilst participating in continu-
\nous improvement cycles that enhance that
\nquality of medical care.
\nHowever, key challenges for health care
\ndelivery within Australia mirror the rest
\nof the world \u2013 primarily due to increasing
\ncosts of innovation and technology, an age-
\ning population, increased needs for patients
\nwith chronic and complex conditions and a
\nworkforce struggling to meet demand as the
\naverage working age increases, participation
\ntime at work reduces and morale and reten-
\ntion rates of health care professionals fall.
\nOne of the strengths of our health system
\nis that it is predominantly a primary health
\ncare delivered system with the general med-
\nical practitioner role being central as the
\nphysician, philosopher and friend or guide
\nof the patient through what is the health
\ncare maze. GPs perform roles in acute care,
\ninitiating investigations and diagnosing as
\nwell as making referrals to the other spe-
\ncialist medical and allied health providers in
\nthe system. This is an e\ufb00ective and e\ufb03cient
\nsystem but the current reform environment
\nThe Australian Medical Association \u2013
\na voice for patients and doctors
\nDr. Mukesh Haikerwal, Immediate Past Pres-
\nident AMA,Representative on WMA Council
\n107
\nsees proposals to shift some of the medi-
\ncal practitioner\u2019s responsibilities and roles
\nto other health providers including allied
\nhealth, paramedics, physicians\u2019 assistants,
\npharmacists and nurses.
\nAchieving a balance within a multi-disci-
\nplinary team is challenging. The medical
\npractitioners should provide the medical
\ncare coordination. They do work collabora-
\ntively with the various providers of health
\ncare, in a cooperative, holistic and continu-
\nous way avoiding duplication or, worse still,
\nfragmentation and neglect. Responsibility
\nand oversight as well as support for health
\nproviders by medical practitioners are cur-
\nrently markers of quality and the safety of
\nthe patient, which is paramount.
\nThere are notable exceptions to the overall
\ngood health outcomes in Australia, these
\nbeing Aboriginal and Torres Strait Islander
\nAustralians and people in regional, rural
\nand remote areas that are currently disad-
\nvantaged in terms of care provision and
\noutcomes. Aboriginal and Torres Strait Is-
\nlanders have a 17-year less life expectancy
\ncompared to non-Indigenous Australians.
\nThe AMA has entered a coalition of health
\nand welfare groups to \u2018Close the Gap\u2019.There
\nis a concerted and detailed plan of action
\nsetting out an agenda to improve health out-
\ncomes for Indigenous people and increase
\nthe number of people in the Indigenous
\nhealth workforce. A series of indicators and
\nbenchmarks for success have been detailed
\nand agreed by the coalition. AMA mem-
\nbers are also concerned about the proposed
\nNational Registration and Accreditation
\nscheme. At the moment, each state and ter-
\nritory has its own medical registration body.
\nThe Australian Medical Council provides
\nnational consistency for new entrants from
\nmedical schools and overseas. Professional
\naccreditation has always been a professional
\nresponsibility exercised by the learned Col-
\nleges. The AMA supports a system of Na-
\ntional Registration of doctors to enhance
\nworkforce mobility. The new scheme for
\nAustralia will however, be centralised, bu-
\nreaucratised and removed from where
\nmedicine is practised. At the same time the
\nnew scheme holds greater dangers with the
\npro\ufb01ciencies and standards for clinical cre-
\ndentialing and accreditation wrestled from
\nthe profession and placed into the political
\ncontrol of government.
\nThe loss of the independence of standard
\nsetting and accreditation of medical train-
\ning will serve to undermine standards and
\ncompromise quality of patient care.
\nAccess to free service in the nation\u2019s pub-
\nlic hospitals is a core component of our
\nsystem. Unfortunately, these have su\ufb00ered
\nfrom funding shortages and administra-
\ntive and bureaucratic failures. Many doctors
\nstop working in these hospitals, as they feel
\nunder-valued, unable to teach or to partici-
\npate in research. Further, they feel they are
\ncompromised in their ability to deliver care
\nto patients.
\nPublic hospitals run close to or above 100
\nper cent occupancy throughout the year and
\nthis often results in no availability for care in
\nthe hospital. Cancellation of elective wait-
\ning lists, long delays in elective and some-
\ntimes more urgent surgery, overcrowding in
\nemergency departments, ambulance bypass
\nand ambulance ramping are all symptoms of
\nbed shortages and excessive occupancy.
\nThe AMA wants two immediate measures
\nundertaken: establishing 85 per cent occu-
\npancy as a national safety benchmark; and
\nthe provision of 3,750 additional acute beds.
\nAustralia is lucky to be looking forward to
\nsigni\ufb01cantly more medical graduates. The
\nchallenge is to provide adequate high-quality
\nclinical training for these students and then
\nspecialist training places to allow them to
\npractice independently as GPs or other spe-
\ncialists.General practice and the private sector
\nand other settings will be needed to contribute
\nto providing this training environment.
\nAround 36 per cent of doctors practicing
\nin Australia at the moment have graduated
\nfrom an overseas medical school. Interna-
\ntional medical graduates are an essential
\npart of looking after patients in Australia.
\nRecently, there has been a focus on their
\nrole and the need for nationally-consistent
\nassessment processes. There is an identi\ufb01ed
\nneed to support new entrants from overseas
\nas they enter the Australian workforce.
\nThe Australian Medical Association has
\nbeen going strong and celebrates its 50th
\nanniversary in 2011. We will continue to
\n\ufb01ght for the best outcome for doctors, but
\nour fundamental concern will always be the
\nhealth and welfare that bene\ufb01t patients.
\nAMA Federal Council in Canberra in 2007. Front row, from the left, AMA Vice President
\nDr. Gary Speck, AMA Chairman of Council Dr. Dana Wainwright, Dr. Capolingua, and AMA
\nTreasurer Dr. Samuel Lees
\n108
\nThe New Zealand Medical Association
\n(NZMA) is the largest pan-professional
\nmedical representative group in New Zea-
\nland. The NZMA aims to provide leader-
\nship of the medical profession; and pro-
\nmote professional unity and values, and the
\nhealth of New Zealanders. The key roles of
\nthe NZMA are to provide advocacy on be-
\nhalf of doctors and their patients, to provide
\nsupport and services to members and their
\npractices, to publish and maintain the Code
\nof Ethics for the profession, and to publish
\nthe New Zealand Medical Journal.
\nCompletely independent, the NZMA is a
\nstrong advocate on medico-political issues,
\nwith a strategic programme of advocacy
\nwith politicians and o\ufb03cials at the highest
\nlevels, aimed at in\ufb02uencing the direction of
\ngovernment policy. NZMA representatives
\nare in regular contact with the Minister of
\nHealth, Director General of Health, Op-
\nposition party health spokespeople, and
\no\ufb03cials from the Ministry of Health, and
\nmany other agencies.
\nThe NZMA\u2019s main focus in recent years has
\nbeen the ongoing workforce issue, which is
\nthe greatest risk to New Zealand\u2019s ability
\nto provide ongoing quality health care. It is
\nnot just a crisis of the number of doctors or
\nsub-specialities, but a shortage of all health
\nworkers. The average age of doctors is in-
\ncreasing. While we acknowledge the global
\nmarketplace for health professionals \u2013 doc-
\ntors, nurses, and others \u2013 in New Zealand
\nwe have become aware that we need to be
\nsmarter in creating an environment that
\nkeeps those professionals in our country,
\nrather than has them leaving to work in
\ncountries which pay higher salaries.
\nNew Zealand is extremely reliant on over-
\nseas trained doctors. More than 42 per-
\ncent of doctors registered in New Zealand
\ntrained elsewhere in the world. For every
\n315-320 new doctors registered here each
\nyear (the medical schools\u2019 output of gradu-
\nates), between 1200-1600 doctors who
\ntrained overseas are also being registered
\n(although around half of them do not stay
\nmore than a year). It is imprudent for a \ufb01rst
\nworld country to not strive for self sustain-
\nability in medical practitioners.
\nNew Zealand is not training enough medi-
\ncal graduates. Compare us with Australia
\nwhich has doubled its medical student in-
\ntake. The NZMA has called on the Gov-
\nernment to double the number of medical
\ngraduates trained here.
\nAnother aspect of New Zealand\u2019s health
\nsystem which continues to be of great inter-
\nest to the international medical community
\nis our no-fault accident compensation leg-
\nislation.
\nThis dates back to 1966 when the Royal
\nCommission on Worker\u2019s Compensation
\n(known as the Woodhouse Commission)
\nproposed sweeping reforms. The Accident
\nCompensation Act was passed in 1972 and
\ncame into force in 1974, and remains to this
\nday, with some changes.
\nThe Woodhouse Commission proposed \ufb01ve
\ngeneral principles:
\ncommunity responsibility,\u2022
\ncomprehensive entitlement,\u2022
\ncomplete rehabilitation,\u2022
\nreal compensation,\u2022
\nadministrative e\ufb03ciency.\u2022
\nThe ACC system replaced a system of com-
\npensation which, similarly to many other
\ncountries, was expensive in legal costs, slow
\nin operation, and capricious in that similar
\ninjuries su\ufb00ered under similar circumstanc-
\nes might produce vastly di\ufb00erent \ufb01nancial
\noutcomes. The outcome was a scheme that
\nwas considered radical. The right to sue for
\ndamages for the tort of negligence causing
\ninjury was removed, and in return injury
\nwould be compensated regardless of fault,
\nincluding fault of the injured.
\nFour main factors have contributed to the
\nsystem\u2019s a\ufb00ordability.First, New Zealanders
\nbene\ufb01t from a strong social security system.
\nInjured patients, like everyone else, receive
\nfree hospital care and subsidized pharma-
\nceuticals. (Yet per capita health spending
\nwas only US$ 2448 in 2006, compared with
\nUS$ 6714 in the United States.) Thus, New
\nZealand\u2019s public health and welfare systems
\ncover many of the damages that would be
\nat issue in a U.S. medical malpractice claim,
\nleaving the ACCwith a much smaller com-
\npensation burden. Second, compensation
\nawards are generally lower and more con-
\nsistent than under a malpractice equivalent.
\nThird,the New Zealand experience suggests
\nthat even under such a system (which in-
\ncludes a legal duty of open disclosure), most
\nentitled patients never seek compensation,
\nand many may be unaware that they have
\neven su\ufb00ered an adverse event. And \ufb01nally,
\nthe New Zealand system does not incur
\nlarge legaland administrative costs.The sys-
\ntem has been very cost-e\ufb00ective, with ad-
\nministrative costs absorbing only 10 percent
\nof the ACC\u2019s expenditures compared with
\n50\u201360 percent among malpractice systems
\nin other countries.
\nSeparate and independent processes are
\navailable for responding to patients\u2019 non-
\nmonetary interests (such as the desire for
\nan apology, an explanation, or corrective ac-
\ntion to prevent harm to future patients). In
\nparticular, the Health and Disability Com-
\nmissioner resolves complaints by advocacy,
\ninvestigation,or mediation.
\nOne of the anomalies in the \ufb01rst 30 years
\nof the scheme was its handling of compli-
\ncations and undesirable outcomes of medi-
\ncal treatment. If the provider of care was
\nat fault, then this was an injury and was
\ncompensated. If it was a rare occurrence,
\nfor which the provider was not at fault (ex-
\npected in fewer than 1% of cases) then it
\nwas a medical mishap, and compensated. If
\nit did not meet either of these criteria, then
\nit was not compensated.This always seemed
\nThe New Zealand Medical Association
\nanomalous in a no-fault scheme. A review
\ncarried out in 2003 found that the require-
\nment to establish fault impacted on health
\nprofessionals by creating an overly blam-
\ning culture (rather than a culture of learn-
\ning from mistakes) \u2013 by focusing too much
\non the actions of individual health profes-
\nsionals, and by making health professionals
\nuneasy about participating in the medi-
\ncal misadventure claims process for fear of
\nthe repercussions, particularly from inter-
\nagency reporting. The consequences of this
\nincluded less focus on the patient\u2019s injury,
\nless focus on the prevention of similar inju-
\nries, confusion over the ACC\u2019s role, and op-
\nportunities to learn (and therefore improve)
\nsafety being limited.
\nThe NZMA had advocated for,and strongly
\nsupported, the amendment that came into
\nforce in April 2005 rede\ufb01ning all such oc-
\ncurrences as \u201ctreatment injury\u201d, and com-
\npensating regardless of perceived fault. That
\nprovides a much more equitable outcome for
\npatients, and helps to avoid the adversarial
\nsituation that could previously arise where
\na patient was required to assert negligence
\non the part of the doctor in order to receive
\ncompensation.
\nIn a population of four million people, in
\n2005\/2006 more than 1.2 million people
\nhad injuries treated by their local GP and
\npaid for by ACC,with ACC paying for over
\n2.3 million visits. ACC funded 2.6 million
\nphysiotherapist visits, 2.4 million visits to
\nother treatment providers and 250,000 re-
\nhabilitation services. Rehabilitation rates
\nare high: 66 % of people return to work af-
\nter three months, 84 % after six months and
\n93 % after a year. Injury prevention is a pri-
\nmary focus of ACC\u2019s work, with campaigns
\nfocused on safety at work, at home, on the
\nroad and playing sports.
\nAnother issue which has been high on the
\nNZMA\u2019s priorities is the membership of
\nthe statutory registration body, the Medi-
\ncal Council of New Zealand (MCNZ).The
\ngeneral public needs to have con\ufb01dence that
\nthe regulation of doctors is fair and open and
\ntransparent. In essence the public needs to
\nbe able to trust the medical profession, and
\nthe NZMA strongly supports this need.
\nThe Health Practitioners Competence
\nAssurance Act 2003 (which regulates all
\nhealth practitioners) took away the right
\nof the medical profession to have directly
\nelected members on the MCNZ. This can
\nbe viewed as part of a global trend to move
\naway from pure self-regulation to regula-
\ntion in partnership between the profession
\nand the public.
\nSelf regulation is a cornerstone of profes-
\nsionalism, and the NZMA has called for at
\nleast 50% of members to be elected from
\nthe profession.
\nNew Zealand has had a Primary Health
\nCare Strategy since 2001, and the NZMA
\nis fully supportive of many of its aims, such
\nas improving access to primary health care.
\nThe Government has substantially increased
\nfunding to primary care, particularly by in-
\ncreasing the level of patient subsidies with
\nconsequent improved access to general prac-
\ntice services. However, with this has come
\nattempts by the Government to impose
\ncontrols on the setting of general practice
\nfees. The NZMA has since 1938 supported
\nthe right of private sector medical practitio-
\nners, including GPs, to set and charge fees
\ncommensurate with the services they pro-
\nvide. This right has come under increasing
\nand unprecedented pressure in recent years.
\nGeneral practices are, in the main, private
\nbusinesses whose continued existence is de-
\npendent on them remaining viable.
\nThe NZMA is working with other general
\npractice organisations to assist the Govern-
\nment in achieving its health goals in pri-
\nmary care.
\nTowards the end of this year New Zealand
\nwill have a General Election. A Labour-led
\nGovernment, headed by Helen Clark, has
\nbeen in place for nine years, but political
\npolls are consistently putting the Opposi-
\ntion National Party substantially ahead.
\nThis means there may be a new government
\nin place by the end of the year. But whoever
\nis in power, the NZMA is willing to work
\nclosely with them to ensure that the health
\nsystem and the health of New Zealanders
\nremains a top priority.
\nReferences
\n1. Bismark M and Paterson R. No-Fault Com-
\npensation In New Zealand: Harmonizing Injury
\nCompensation, Provider Accountability, And Pa-
\ntient Safety. Health A\ufb00airs. 2006. 278-283.
\n2. Bismark M. Compensation and Complaints in
\nNew Zealand. BMJ. 2006 332:1095.
\n3. Accident Compensation Corporation. Review of
\nACC Medical Misadventure: Consultation Docu-
\nment.Wellington: ACC; 2003 (quoted in: Coates J
\nand Smith K.Reform of ACC Medical Misadven-
\nture. NZ Med J. 2004.Vol 117 No 1201)
\nDr. Peter Foley, Chairman
\nFrom the left Dr. Peter Foley, Chairman, Steve Chadwick, Associate Minister of Health,
\nDr. Mark Peterson, GP Council Chair
\n109
\n110
\nJe\ufb00 Blackmer, MD MHSc FRCPC
\nEthics and professionalism have long been
\npriority issues at the Canadian Medical As-
\nsociation. The Association was established
\nin 1867 and produced its \ufb01rst Code of
\nEthics in 1868, making it one of the oldest
\nsuch documents in existence.
\nThe CMA Code of Ethics is arguably the
\nmost important policy produced by the or-
\nganization. Since its original inception, it
\nhas undergone several modi\ufb01cations. The
\nlast revision, considered to be \u201cminor\u201d in
\nnature, was completed in 2004. In general,
\nmajor revisions of the document occur every
\n15-20 years, with 1-2 minor revisions in be-
\ntween.The Code is considered to be \u201chybrid\u201d
\nin nature as it is somewhere in length and
\ncontent between setting out basic principles
\nat the one end, and trying to cover all ethi-
\ncal topics and eventualities at the other. It
\nis intended to be of su\ufb03cient detail so as to
\nprovide clinicians with practical guidance in
\ndealing with complex ethical issues, but not
\nso detailed as to be behaviour-determining.
\nThe CMA Code of Ethics has been adopted
\nby all major medical bodies in Canada (with
\nthe exception of the province of Quebec,
\nwhich generally produces its own Codes and
\nregulations separate from the rest of the coun-
\ntry).For example,the provincial medical regu-
\nlatory bodies, the national educational col-
\nleges and the provincial medical associations
\nhave all adopted the CMA Code. It is to the
\nbene\ufb01t of physicians to have only one Code of
\nEthics,and not competing codes which would
\nserve as a point of confusion and potentially
\ncon\ufb02ict. This harmonization has occurred
\nthrough extensive and open dialogue and ne-
\ngotiations over the years to try and ensure that
\nthe Code meets, to the extent possible, the
\nneeds of all the stakeholders involved.
\nThe Canadian Medical Association O\ufb03ce
\nof Ethics,Professionalism and International
\nA\ufb00airs is responsible for working on poli-
\ncies, providing support and education to the
\nAssociation and its member divisions and
\na\ufb03liate specialty societies, and providing
\nsupport to the CMA Committee on Eth-
\nics. The O\ufb03ce has existed in one form or
\nanother at the CMA for many years.
\nIn 1989,the CMA increased its commitment
\nto ethics with the establishment of the Divi-
\nsion (later Department) of Ethics and Legal
\nA\ufb00airs. Work began on abortion, status of
\nthe foetus, transplantation of organs, repro-
\nductive technologies, and physicians and the
\npharmaceutical industry. In 1991 the CMA
\nrejoined the World Medical Association and
\nCMA ethics sta\ufb00 began to play a major role
\nin the ethics activities of the WMA. In 1996
\nthe CMA sta\ufb00 structure was reorganized and
\nEthics and Legal A\ufb00airs were separated.The
\nDirector of Ethics became a member of the
\nProfessional A\ufb00airs Directorate.In 2001,the
\nsta\ufb00 structure was reorganized again and the
\nDirector of Ethics became a member of the
\nResearch, Policy and Planning Directorate
\n(now titled the Research, Policy and Ethics
\nDirectorate).
\nThe O\ufb03ce is currently sta\ufb00ed by a full time
\nEthicist (with a background in basic philoso-
\nphy and ethical theory,as well as formal train-
\ning in clinical bioethics),an Executive Direc-
\ntor (who has an advanced degree in bioethics
\nand also continues to work part time as a
\nphysician) and administrative support. At
\nany point in time it is common to have stu-
\ndents or interns rotating through the O\ufb03ce,
\nas well as temporary sta\ufb00 who are employed
\nto work on speci\ufb01c projects or policies for a
\n\ufb01nite period of time.The O\ufb03ce has provided
\ntraining and experience for several students
\nover the past few years in research, policy
\ndevelopment and the practical application of
\nethical concepts and principles.
\nThe CMA Committee on Ethics meets in
\nOttawa twice a year for two-day sessions.
\nDuring this time, Committee members
\ndebate ethical issues and help direct policy
\ndevelopment in this area. With the support
\nof O\ufb03ce sta\ufb00, they assist in identifying cur-
\nrent ethical and professional issues that are
\nof importance to Association members, and
\ndecide how best to address these issues.
\nThe Committee on Ethics is the longest
\nstanding Committee at the CMA and is
\nconsidered unique in many respects.It is the
\nonly Committee that is elected by, and re-
\nports to, the General Council of the CMA,
\nwhich is considered to be the \u201cParliament\u201d
\nof Canadian organized medicine. Commit-
\ntee members are selected on a regional rath-
\ner than provincial basis, and the smaller size
\nof the Committee allows it to respond more
\nquickly to issues as they arise. In addition,
\nCommittee members are expected to have
\nsome background or expertise in the area of
\nethics as part of their membership on the
\nCommittee. Between General Council ses-
\nsions, which happen only once a year, the
\nCommittee reports through its Chair to the
\nCMA Board of Directors,and most policies
\nare discussed and approved at this level.
\nUntilthe1970stheCommitteeonEthicscon-
\ncerned itself mainly with professional issues.
\nDuring the 1970s it began addressing bioethi-
\ncal issues. During the 1980s the Committee
\npresented reports to General Council on is-
\nsues such as AIDS, as well as some amend-
\nments to the CMA Code of Ethics. Between
\n1991 and 1996 the Committee completed
\npolicies on advance directives, con\ufb01dential-
\nity, and physician-assisted dying; revised the
\nEthics and professionalism at the
\nCanadian Medical Association
\n111
\nDr. Isacio SIGUERO, President
\nThe \u201cConsejo General de Colegios O\ufb01ciales
\nde M\u00e9dicos\u201d(general medical council) is the
\nbody that brings together, co-ordinates and
\nrepresents the 52 local medical associations
\n(colegios o\ufb01ciales de m\u00e9dicos) at national
\nand international level, and for all purposes
\nit has the status of Public Law Corporation,
\nwith own legal personality and full capacity
\nto comply with its objectives.
\nSince 1898 it has been compulsory for doc-
\ntors to register as members in Spain and
\nthere is a local medical association for each
\nof the 52 Spanish provinces. The overall
\nrepresentation of this \u201cConsejo General\u201d
\ndates back to the year 1930. The Spanish
\nConstitution recognises the existence and
\nrepresentation of professional associations,
\nwith the requisite of having a democratic
\nfunctioning, like the undertaking of the
\n\u201cConsejo General\u201d, the \ufb01nal purpose of
\nthese institutions being to oversee a good
\nprofessional practice, namely the defence of
\nthe professional and patient.
\nThe \u201cConsejo General\u201d is made up of a
\nBoard and a General Assembly. The Board
\nis formed by the president, vice president,
\ngeneral secretary, vice secretary and trea-
\nsurer, all these being positions democrati-
\ncally elected every four years.The rights and
\ninterests of the corporation and profession
\nare defended through this Board vis \u00e0 vis all
\nclasses of jurisdictional, administrative and
\ninstitutional bodies.
\nThe General Assembly is integrated by the
\nBoard, by the Presidents of the 52 local
\nmedical associations, and by the national
\nCode of Ethics and the policy statement on
\nphysicians and the pharmaceutical industry;
\nand advised on CMA\u2019s brief on the revision of
\nthe Criminal Code and the \u201cJoint Statement
\non resuscitative interventions.\u201d
\nBetween 1996 and 2001 the Committee
\nrevised policies on organ and tissue dona-
\ntion and transplantation, physicians and the
\npharmaceutical industry, and, together with
\nthe Council on Health Care and Promotion,
\nviral serological status testing; and guided
\nCMA participation in the development of
\na \u201cJoint Statement on preventing and re-
\nsolving ethical con\ufb02icts involving health
\ncare providers and persons receiving care.\u201d
\nIt contributed to CMA policy development
\non assisted reproduction, health informa-
\ntion privacy, direct-to-consumer advertis-
\ning, the Charter for Physicians, the future
\nof medicine and scopes of practice.
\nRecent work by the Committee has in-
\ncluded an extensive revision of the policy
\non physician-industry interactions, the de-
\nvelopment of a new policy on ethical ob-
\nligations of physicians during a pandemic
\nand a new policy on blood borne pathogens
\nin the health care setting. Current work is
\nunderway on a major revision to the CMA
\nHealth Information Privacy Code, the issue
\nof conscientious objection by health care
\nproviders, a research ethics template for
\npracticing physicians and a project, together
\nwith the national organization of medical
\nregulators, to produce a series of clinical vi-
\ngnettes based on the CMA Code of Ethics.
\nTheissueofmedicalprofessionalismisextreme-
\nly topical in organized medicine.To re\ufb02ect the
\nimportance of professionalism, the Canadian
\nMedical Association has added the term to the
\ntitle of the O\ufb03ce (a recent development) and
\nhas also included work in medical professional-
\nism (and ethics) in one of the Key Result Areas
\nin its current strategic plan.This has helped to
\ndemonstrate in a tangible way the importance
\nof these issues within the overall structure and
\nstrategy of the organization.
\nThe CMA is the founder and Chair of the
\nCanadian Stakeholders Coalition on Medi-
\ncal Professionalism, a collection of several
\nmedical organizations from around the
\ncountry with an interest in medical profes-
\nsionalism, including educators, regulators,
\nprofessional liability insurers and others.
\nThe Coalition has been active in trying to
\nensure a consistent nation-wide approach
\nto de\ufb01ning, teaching, measuring, assessing,
\npromoting and role modelling the key as-
\npects of medical professionalism to physi-
\ncians and physicians-in-training through-
\nout the continuum of the medical life cycle.
\nCurrent e\ufb00orts are aimed at ensuring con-
\nsistency in how professional behaviours and
\ntraits are evaluated.
\nSta\ufb00 at the CMA O\ufb03ce of Ethics, Profes-
\nsionalism and International A\ufb00airs works
\nclosely with the World Medical Association
\nboth during and between WMA meetings.
\nCurrently,CMA sta\ufb00 is assisting the WMA
\nwith the drafting of new policies in medical
\nprofessionalism (including professionally-
\nled regulation, professional autonomy and
\ncon\ufb02ict of interest) and revision of current
\nWMA policies (including telemedicine and
\nhealth human resources). The relationship
\nbetween the CMA and WMA has always
\nbeen a close one, as evidenced by the fact
\nthat John Williams has served as the direc-
\ntor of ethics for both organizations, and the
\nauthor of this paper recently completed a
\nsecondment at the WMA o\ufb03ce where he
\nassisted with policy development and coor-
\ndination in ethics and professionalism.
\nThe \u201cConsejo General
\nde Colegios O\ufb01ciales de M\u00e9dicos\u201d
\n112
\nThe Slovak Medical Association (SkMA)
\nis an a\ufb03liation of professional medical and
\npharmaceutical societies and also regional so-
\ncieties of physicians, nurses and pharmacists.
\nSkMA is a non-pro\ufb01t, non-governmental
\nassociation representing more than 22 000
\nmembers. The tradition
\nof SkMA goes back to
\nthe 19th century. On 3
\nJanuary 1833 a group of
\nyoung medical students
\nestablished the Slavonic
\nMedical Association as
\na self-learning medical
\nsociety. Following the
\nfounding of Czechoslo-
\nvak republic there was
\nin place local medical
\nsocieties in Ko ice and
\nBratislava (1919-1920)
\nand various professional
\nassociations, which from
\n1949 comprised the or-
\nganisational units of
\nthe Czechoslovak Medical Association, and
\nfrom 1969 separate Czech and Slovak Medi-
\ncal Association. After the establishment of
\nindependent Czech and Slovak republics in
\n1993, the Slovak Medical Association con-
\ntinued to work on an autonomous basis.
\nMain activities:
\nEducation (Continuing Medical Educa-\u2022
\ntion, Non-institutional life-long Educa-
\ntion)
\nPublications of Medical Journals (co-op-\u2022
\neration with professional medical societ-
\nies, editors and publishers)
\nInternational Activities and Contacts,\u2022
\nMedical ethics
\nHealth care legislation, Quality of health-\u2022
\ncare development
\nMembership service, awards approval,\u2022
\npublic relations
\n1. Education
\nOne of the main missions of the Slovak Medi-
\ncal Association is the organisation of scienti\ufb01c
\nevents and scienti\ufb01c congresses, conferences,
\nsymposiums and other professional meet-
\nings with domestic and foreign participation,
\nto support the involvement of own experts
\nin similar events abroad and to publish and
\nsupport the issue of professional magazines
\nand publications. On basis of a mutual agree-
\nment among the statutory representatives of
\nthe Slovak Chamber of Physicians, the Slo-
\nThe Slovak Medical Association
\nProf. MUDr. Peter Kri\u0161t\u00fafek,
\nCSc. President
\nMUDr. Irina \u0160ebov\u00e1, CSc.
\nMPH, Scienti\ufb01c Secretary
\nrepresentatives from the di\ufb00erent profes-
\nsional sections through which doctors are
\nrepresented according to the modality and
\nform of professional practice they under-
\ntake: hospitals, urban and rural primary
\ncare, pensioners, in training, public admin-
\nistrations, with unstable employment, and
\nown private medical practice or as employ-
\nee. The task of these sections is to provide
\nguidance in matters of their speciality and
\nto undertake studies and proposals.Togeth-
\ner, the Board, local Presidents and sections\u2019
\nrepresentatives form the General Assembly,
\nwhich is the top governing authority of the
\n\u201cConsejo General\u201d.
\nThe \u201cConsejo General\u201d and the 52 local
\nmedical associations form what is known as
\n\u201cOrganizaci\u00f3n M\u00e9dica Colegial (OMC)\u201d.
\nThis body represents all registered doctors
\nin Spain, acting as safeguard for the core
\nvalues of the medical profession: deontol-
\nogy and code of ethics.
\nThe \u201cConsejo General\u201d is o\ufb03cially respon-
\nsible for representing the OMC before the
\nGeneral Administration of State and the
\npublic agencies related with or dependent
\non it, as well as for coordinating the profes-
\nsion at the di\ufb00erent organisational levels.
\nTo quote a few examples, the work of the
\n\u201cConsejo General\u201d is today centred on vari-
\nous questions of professional and social in-
\nterest that include the study of medical de-
\nmography to try and correct the de\ufb01cit in
\ndoctors and carry out a suitable planning of
\nhuman resources, even controlling the o\ufb03-
\ncial recognition of foreign medical quali\ufb01-
\ncations,fostering training and accreditation,
\nusing its own Council o\ufb03cially recognised
\nby the Government.
\nOther facets of its work include professional
\nand social promotion of doctors and their
\nadaptation to scienti\ufb01c and professional
\nchanges, as well as permanent and accred-
\nited professional development. It also has a
\nsocial Foundation to assist the needs of doc-
\ntors and their families, this being one of the
\nmost important works of the health sector.
\nThrough its \u201cConsejo General\u201d, the OMC
\nis present at almost all international medical
\norganisations, at which it provides its expe-
\nrience. These actions imply bene\ufb01ts for the
\nprofessional practice, for the patient \u2013 end
\nreceiver of such actions and true central hub
\nof the National Health System \u2013 and \ufb01nally
\nfor society as a whole.
\nDefending the values of the medical profes-
\nsion and rights of doctors and the patients,
\nthe \u201cConsejo General\u201d is now undertaking
\nactions in favour of prescriptions being an
\nact that is the exclusive competence of the
\ndoctor being the only professional who,con-
\nsidering his training and quali\ufb01cations, can
\nassure a safe and e\ufb03cient quality treatment
\nfor the patient; without waiving collabora-
\ntion with other health professionals, to as-
\nsure the quality of the health care process.
\n113
\nvak Medical Association, the Slovak Medical
\nUniversity, the Association of Private Physi-
\ncians and the Association of Medical Facul-
\nties in Slovakia, the Slovak Accreditation
\nCouncil for Continual Medical Education
\n(SACCME) was established in May 2004.
\nThe SACCME provides credits for CME ac-
\ntivities, as well as with the implementation of
\na quality control mechanism (standard partic-
\nipants satisfaction questionnaire). 250 credits
\nover a 5-year period were proposed, 150 from
\nthem are obtained from external educational
\nactivities (passive or active participation,auto-
\ndidactic tests in medical journals,publications,
\npresentations, teaching) and 100 credits are
\nreceived for professional performance and for
\nself-teaching.
\n2. Publications
\n17 medical journals (mainly in the Slovak
\nlanguage with English summaries):
\nMedical Monitor (6\/year),\u2022
\nRevue of Nursing and Laboratory Methods\u2022
\n(4\/year)
\nActa Chemotherapeutica (6\/year)\u2022
\nHead and Neck Diseases (4\/year)\u2022
\nClinical Immunology and Allergology\u2022
\n(4\/year)
\nSlovak Physician (12\/yars)\u2022
\nUrology (2\/year)\u2022
\nPractical Gynaecology (4\/year)\u2022
\nHaematology and Transfuziology (4\/year)\u2022
\nAtherosclerosis, Clinic,Treatment (3\/year)
\nLaboratory Diagnosis (4\/year),\u2022
\nSurgical News (4\/year)\u2022
\nSlovak Radiology (4\/year)\u2022
\nCardiology (4\/year)\u2022
\nPediatricon (4\/year)\u2022
\nRespiro (4\/year)\u2022
\nGeriatria (4\/year)\u2022
\nAccupunctura Bohemo-Slovaca (2\/year)\u2022
\nSlovak Sexulogy (2\/year)\u2022
\nMicrobiology and Epidemiology News\u2022
\n(4\/year)
\nFarmacoeconomics and Drug\u00b4s Policy\u2022
\n(4\/year).
\n3. International activities and contacts
\nThe Slovak Medical Association is a mem-
\nber of World Medical Association (WMA),
\nEuropean Forum of Medical Associations
\nand WHO (EFMA\/WHO), Union of
\nEuropean Medical Specialists (UEMS),
\nCouncil for International Organizations
\nof Medical Sciences (CIOMS). Interna-
\ntional cooperation is supplied also directly
\nby means of various SkMA professional
\nsocieties and their colleagues in European
\nUnion or abroad.
\nIn co-operation with WMA representatives
\nthe Slovak version of the Medical Ethics
\nManual was \ufb01nalised and will be distrib-
\nuted among our members. The SkMA sup-
\nport all ethical, social and environmental
\nactivities of the WMA. On 19 September
\n2006, the SkMA and Slovak Association of
\nPharmaceutical Companies (SAFS) signed
\nan agreement concerning ethical principles
\nco-operation between the medical profes-
\nsion and the pharmaceutical industry.
\nFrom 2007, the SkMA has representation
\non the EFMA\/WHO committee (Irina
\nSebova-liaison o\ufb03cer). On 1-3 April 2009,
\nwe will be organising the Annual Confer-
\nence of EFMA\/WHO in Bratislava. Pro-
\nposed topics: CME\/CPD, Palliative Care,
\nCreation of quality standards, Seniors Care.
\nThe good co-operation between the SkMa
\nand the UEMS was con\ufb01rmed on 19 March
\n2006 in Brussels by the signing of an agree-
\nment between the European and Slovak ac-
\ncreditation councils for CME (EACCME
\nand SACCME). The institutions declared
\nthat they are interested in co-operation in
\n\ufb01eld of CME accreditation through a formal
\nagreement aimed to foster the interchang-
\ning of experiences and the implementation
\nof a formal system mutual recognition of
\nCME credits.The SkMA was the organiser
\nof UEMS Meeting (Board and Council) on
\n11-13 October 2007 in Bratislava. One of
\nthe most important documents adopted at
\nthis Meeting was the Bratislava Declaration
\non E-Medicine.
\nOf growing importance are activities
\nwith regard to international contacts with
\nCIOMS, as well as membership of profes-
\nsional SkMA societies in partnership with
\nEuropean or non-European organisations.
\nThe SkMA co-operates very closely and in-
\ntensively with the Czech Medical Associa-
\ntion.
\n4. Health Care Legislation, Quality
\nof Healthcare Development
\nThe public Health System in Slovak repub-
\nlic is under the jurisdiction of the Ministry
\nof Health, which is responsible for manag-
\ning national health policy. The SkMA acts
\nas an opponent in discussions on health
\ncare legislation proposals from Minis-
\ntry of Health, proposes the nomination of
\nthe Main Experts, the Consultants for the
\nDrug Categorization Commissions and
\nthe Members of the Medical Performance
\nCatalogue Committees.
\nIn co-operation with other medical institu-
\ntions and professional associations submits
\nSkMA suggestions or projects for improve-
\nment of healthcare quality.
\n5. Membership service, awards
\napproval, public relations
\nThe SkMA has 87 professional societies ac-
\ncording to specialization or \ufb01eld of particular
\ninterests and a total of 48 regional societies
\nor alliances according to geographic loca-
\ntion independent from profession. Mem-
\nbership in the SkMA is voluntary. Main ex-
\necutive bodies of the SkMA in place of the
\nRepresentative Plenary Meetings are the
\nPresidium, Supervisory Board and Execu-
\ntive Secretariat. The Presidium of SkMA,
\nelected for 4 years period, encompasses 13
\nmembers including the President, Scienti\ufb01c
\nSecretary and two Vice-Presidents.The Su-
\npervisory Board has 3 members including
\nthe chief of Administration and is sta\ufb00ed
\nwith 19 full time employed persons headed
\nby the Director of Secretariat.
\nThe o\ufb03cial residence of SkMA is the House
\nof Medical O\ufb03cers (Domus Medica, Dom
\nzdravotn\u00edkov) with a Congress o\ufb03ce, De-
\npartment of membership service, Economic
\ndepartment and Auditorium.
\n114
\nKorean Medical Association
\nThe WMA General Assembly Seoul 2008
\nThe year of 2008 is very signi\ufb01cant in the
\nhistory of Korean Medical Association
\n(KMA), as it celebrates its 100-year anni-
\nversary. Modern medicine was introduced
\nin Korea in the year of 1884 by an American
\nmissionary physician. During a relatively
\nshort period,Korea has made rapid progress
\nin medical science and the practice.
\nIn 1908, KMA was established in Seoul and
\nsoon became the national organization repre-
\nsenting all medical doctors in Korea.In spite of
\nmany di\ufb03cult situations occurred in the Ko-
\nrean peninsula,KMA has made uni\ufb01ed e\ufb00orts
\nto promote health of the people.Through the
\nperiod of Japanese occupation, Korean War,
\nrapid economic development, and advance to
\nthe democratic society, KMA has always been
\nfor the people to secure health and happiness,
\nenhancing the standard of medical science and
\neducation, and participating actively to the
\ndecision-making process. With the devotion
\nand support of physicians in care for people,
\nthe government could achieve the universal
\nhealth insurance policy in 1989 only 12 years
\nafter the launch of the national health insur-
\nance program.
\nKMA\u2019s e\ufb00orts to enhance international
\ncooperation contributed to the drastic im-
\nprovement of the standard of health care
\nand now it reached the highest standard
\nakin to the advanced countries in OECD.
\nThe number of members has increased into
\n90,000 physicians today and the roles and
\nresponsibilities of KMA become more and
\nmore important in observance of medical
\nethics and provision of continuous medical
\neducation: training and certi\ufb01cation of spe-
\ncialists, introduction of malpractice insur-
\nance program.
\nIn this October, KMA is privileged to host
\nthe WMA General Assembly Seoul 2008.
\nThe Organizing Committee was launched
\nin September 2006 as the o\ufb03cial decision-
\nmaking body for KMA and is spearheaded
\nby Dr. Tai Joon MOON, the President
\nEmeritus and Dr. Soo Ho CHOO, the
\nPresident of KMA. Dr. Dong Chun SHIN
\nserves as secretary general of the commit-
\ntee. To make the Assembly successful and
\nmeaningful, KMA has been working very
\nhard. We have organized the scienti\ufb01c ses-
\nsion under the theme of \u201cHealth and Hu-
\nman Rights\u201d to cover health equity, health
\nfor under-privileged people, health prob-
\nlems from environmental perspectives and
\nmedical ethics and human rights, and so on.
\nAs keynote speeches, UN\u2019s activities and
\nstrategies for protecting human rights and
\nan overview on WMA\u2019s policies and history
\nof health and human rights will be present-
\ned and discussed.
\nTo commemorate the meaningful centen-
\nnial anniversary, KMA is planning a photo
\nexhibition on the sidelines of the Assembly
\nshowing historic highlights of development
\nof medical sciences from the late 19th
\ntill
\npresent days in front of the main meeting
\nhall of Shilla hotel during the Assembly.
\nTour programs will include beautiful sites of
\nSeoul city. We expect excellent weather in
\nOctober and you will enjoy the unique at-
\ntractiveness of Seoul where tradition meets
\nmodern vitality.
\nKMA would like to welcome you all to Seoul
\nand we are honored to share important dis-
\ncussions with you and exchange friendship
\namong leaders of organized medicine of the
\nworld during the Assembly.
\nBo-kyung Kang,
\nInternational Relations
\n32nd
\nKMA Scienti\ufb01c Congress Korea launch of universal health care
\ninsurance
\nThe hosting of the 12nd
\nCMAAO Meeting
\n115
\nThe roundtable \u201cHigh Quality Healthcare
\nin Europe,\u201d organized jointly by the Coun-
\ncil of European Dentists (CED) and the
\nStanding Committee of European Doctors
\n(CPME) on the 11th
\nof September,in Brus-
\nsels, provided one of the \ufb01rst opportunities
\nfor stakeholders to discuss the Commis-
\nsion\u2019s recent proposal for a Directive on Pa-
\ntients\u2019 Rights in Cross-Border Healthcare.
\nThe event under the patronage of Othmar
\nKaras, MEP, brought together Commission
\no\ufb03cials and MEPs to exchange views with
\nthe main organisations of European health
\nprofessionals and patients on the proposed
\nDirective, as well as on the wider institu-
\ntional and political framework for cross-
\nborder healthcare in Europe.
\nEU Commissioner for Health and Con-
\nsumers,Androulla Vassiliou,opened the de-
\nbate with a keynote presentation. She con-
\n\ufb01rmed the continued commitment of the
\nCommission to dialogue and cooperation
\nin the process leading to the adoption of the
\nproposed Directive on Patients\u2019 Rights in
\nCross-Border Healthcare with those most
\ndirectly a\ufb00ected by it: the health profession-
\nals and the patients.
\nDuring the debate, all representatives, those
\nof the health professionals as well as the
\npatients, welcomed the directive and reiter-
\nated the need to enshrine patients\u2019 rights of
\naccess to safe and high quality healthcare
\nthroughout the EU in a legal document.
\nCPME President Dr.Michael Wilks point-
\ned out, among other issues, the necessity of
\ngood information systems for both patients
\nand physicians that support cross-border
\ncare.
\nCED President Dr. Orlando Monteiro da
\nSilva noted that quality is de\ufb01nable but very
\ndi\ufb03cult to measure. \u201cWe must focus on
\nthe three main principles of strategy, high
\nquality and e\ufb03ciency, doing the right thing
\nright.\u201d
\nThe moderator,Dr.Matthias Wismar of the
\nEuropean Observatory on Health Systems
\nand Policies, concluded that there is a con-
\nsensus among the panellists on the need for
\nthis directive.
\nOthmar Karas, MEP (EPP), played a lead
\nrole in negotiating an agreement between
\nthe European Parliament and the Council
\nunder the Austrian EU Presidency in 2005,
\nleading to the exclusion of health services
\nfrom the Services Directive. Other speakers
\nincluded DG SANCO Head of Unit Ber-
\nnard Merkel, MEPs Bernadette Vergnaud
\n(PES) and Holger Krahmer (ALDE), and
\nDr. Anders Olauson, President of the Euro-
\npean Patients\u2019 Forum.
\nClaudia Ritter, Director \/ Brussels
\nO\ufb03ce,CED, Council of European Dentists.
\nwww.eudental.eu
\nLisette Tiddens-Engwirda, Secretary
\nGeneral,CPME, Standing Committee of
\nEuropean Doctors. www.cpme.eu
\nContents
\nEditorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
\n179th
\nWMA Council Meets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
\nHuman Resources for Health, Kampala . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
\nHealth \u2013 a global overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
\nAn alternative to better global health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
\nThe new revision process of the International Classi\ufb01cation of Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
\nDoH Revision meeting in S\u00e3o Paulo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
\nCo-operation of WMA and the Stop TB partnership \u2013 Private-Public-Mix in the \ufb01ght against TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
\nLilly Commits $1MM to World Medical Association to support Innovative Tuberculosis training course . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
\nWhat Physicians are REALLY Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
\nSmoking: A disease that starts in the brain and goes to the whole body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
\nWorking together for safe health care,the World Health Professions Alliance (WHPA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
\nIFPMA Appoints Alicia Greenidge as New Director General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
\nRepresenting pharmacists and pharmaceutical scientists \u2014 your partners in healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
\nThe South African Medical Association (SAMA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
\nOverview of the Nigerian Medical Association (NMA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
\nThe National Order of Physicians of C\u00f4te d\u2019Ivoire: presentation and perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
\nThe Medical Association of Thailand under the Royal Patronage of his Majesty the King . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
\nThe Hong Kong Medical Association (HKMA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
\nThe Azerbaijan Medical Association (AzMA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
\nThe Australian Medical Association \u2013 a voice for patients and doctors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
\nThe New Zealand Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108
\nEthics and professionalism at the Canadian Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
\nThe \u201cConsejo General de Colegios O\ufb01ciales de M\u00e9dicos\u201d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
\nThe Slovak Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112
\nKorean Medical Association.The WMA General Assembly Seoul 2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114
\nCross-border healthcare:
\nDebate between the EU institutions, health professionals
\nand patients on the draft directive launched<\/p>\n"},"caption":{"rendered":"

wmj19 No. 3, September 2008 Editor in Chief Dr. P\u0113teris Apinis Latvian Medical Association Skolas iela 3, Riga, Latvia Phone +371 67 220 661 peteris@nma.lv editorin-chief@wma.net Co-Editor Dr. Alan J. Rowe Haughley Grange, Stowmarket Su\ufb00olk IP143QT, UK Co-Editor Prof. Dr. med. Elmar Doppelfeld Deutscher \u00c4rzte-Verlag Dieselstr. 2, D-50859 K\u00f6ln, Germany Assistant Editor Velta Poz\u0146aka wmj-editor@wma.net […]<\/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\/wmj19.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/3572"}],"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=3572"}]}}