WMJ 01 2016

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vol. 62
Official Journal of The World Medical Association, Inc.
ISSN 2256-0580
Nr. 1, March 2016
Health Databases and Biobanks — Ethical Dilemmas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Ageing and Ageism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
‘Show Doctors’ and Korean Medical Association’s Efforts for Self-Regulation . . . . . . . . . . . . 5
Medical School Numbers and Career Choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Medical Education in the Postmodern Era . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Social Determinants of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Solving the Climate Crisis will Make us Healthier and More Prosperous . . . . . . . . . . . . . . . . 13
Punching to Fortune or to the Grave? Scrutiny on Boxing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Carte Blanche on Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
European Countries Moving Towards Digital Prescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
“This Year Our Office Will Go Green”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
On the International Public Coordination Health Committee . . . . . . . . . . . . . . . . . . . . . . . . . 25
Australian Medical Association (AMA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Austrian Medical Chamber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Association Belge des Syndicats Médicaux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Brazilian Medical Association (AMB) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
French Medical Council. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Bundesärztekammer/German Medical Association (GMA) . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Indian Medical Association (IMA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Kuwait Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
New Zealand Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Nigerian Medical Association (NMA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Norwegian Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Panhellenic Medical Association (PhMA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Polish Supreme Chamber of Physicians and Dentists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Portuguese Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Royal Dutch Medical Association (KNMG). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Romanian College of Physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Singapore Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Spanish General Medical Council (OMC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
Editor in Chief
Dr. Pēteris Apinis, Latvian Medical Association, Skolas iela 3, Riga, Latvia
Phone +371 67 220 661
peteris@arstubiedriba.lv, editorin-chief@wma.net
Prof. Dr. med. Elmar Doppelfeld, Deutscher Ärzte-Verlag, Dieselstr. 2, D-50859 Köln, Germany
Assistant Editor
Maira Sudraba, Velta Pozņaka; lma@arstubiedriba.lv
Journal design and
cover design by
Pēteris Gricenko
Layout and Artwork
The Latvian Medical Publisher, “Medicīnas apgāds”, President Dr. Maija Šetlere, Skolas street 3, Riga, Latvia
The Latvian Medical Association, “Latvijas Ārstu biedrība”,
Skolas street 3, Riga, Latvia.
ISSN: 2256-0580
Sir Michael MARMOT
WMA President
British Medical Association
BMA House,Tavistock Square
London WC1H 9JP
United Kingdom
Dr. Donchun SHIN
WMA Chairperson of the Finance
and Planning Committee
Korean Medical Association
46-gil Ichon-ro
Yongsan-gu, Seoul 140-721
Prof. Dr. Frank Ulrich
WMA Vice-Chairperson of Council
Herbert-Lewin-Platz 1 (Wegelystrasse)
10623 Berlin
Dr. Xavier DEAU
WMA Immediate Past-President
Conseil National de l’Ordre des
Médecins (CNOM)
180, Blvd. Haussmann
75389 Paris Cedex 08
Dr. Joseph HEYMAN
WMA Chairperson
of the Associate Members
163 Middle Street
West Newbury, Massachusetts 01985
United States
Dr. Masami ISHII
WMA Treasurer
Japan Medical Assn
2-28-16 Honkomagome
Tokyo 113-8621
Dr. Heikki PÄLVE
WMA Chairperson of the Medical
Ethics Committee
Finnish Medical Association
P.O. Box 49
00501 Helsinki
Dr. Miguel Roberto JORGE
WMA Chairperson of the Socio-
Medical Affairs Committee
Brazilian Medical Association
Rua-Sao Carlos do Pinhal 324,
CEP-01333-903 Sao Paulo-SP
Dr. Ardis D. HOVEN
WMA Chairperson of Council
American Medical Association
AMA Plaza, 330 N. Wabash,
Suite 39300
60611-5885 Chicago, Illinois
United States
Secretary General
World Medical Association
13 chemin du Levant
01212 Ferney-Voltaire
World Medical Association Officers, Chairpersons and Officials
Official Journal of The World Medical Association
Opinions expressed in this journal – especially those in authored contributions – do not necessarily reflect WMA policy or positions
The electronic environment of medical service and research has in-
creased immensely the possibilities of connecting information but
at the same time it poses various new ethical aspects to physicians.
The electronic medical record is one of these welcomed novelties
as it helps physicians and other health care workers in their daily
practice. It is a practical solution that makes it possible to have all
information on a given individual easily accessible.The main ethical
issues are security of data and who is having access but apart from
that there are few difficult dilemmas. On the other hand, informa-
tion for secondary use creates multiple ethical issues.The WMA has
for a long time been aware of these possible problems, but a specific
initiative in Iceland in the last years of the 20th century spurred a
lively dialogue, not only inside the country but internationally as
well. It was an eye opener on how data can be used on a higher level
as all information from medical records was supposed to be linked
to a genealogical database of a whole population as well as to a third
database on genetic information. The main “selling point” was to
create new knowledge, but the intention was also to sell informa-
tion to various buyers such as insurance companies. The issue was
brought to the WMA who subsequently made a policy statement
on the secondary use of medical data, adopted in 2002. This policy
was up for revision in 2012 and a prolonged process started, most
likely coming to an end this year.
The revision policy has in many aspects been unique for the WMA
only to be compared to the policy making for the Document of
Helsinki (DoH). This is not a coincidence as the policy on Health
Data and Biobanks is to some extent an extension of the DoH with
the addition that is not only directed to research on humans but for
other secondary use as well. One of the main dilemmas has been
the rights of individuals on the one hand and the interest of the
holders of data on the other hand. To guard the rights of patients
and healthy individuals in their dealings with the health system has
been one of the cornerstones of the work of the WMA, evident
by many of its policies such as the DoH and the Declaration of
Lisbon on the rights of patients. In the case of the use of health
data and human biological material, consent is one of main ethi-
cal issues. Individuals should have the right to decide on the use of
data of themselves. On the other hand, when planning for the use
of data from millions of individuals, it is not practical to ask each
and everyone to consent. This has been solved in many ways. One
is simply to use data without consent of any kind but that is unac-
ceptable. Another solution is the so-called open consent when an
individual accepts that his/her data can be used for any purpose at
a later time. This is also unacceptable, at least to the WMA. Other
terms have been coined such as broad consent or even mega consent,
meaning that the individual is to some extent informed of later use.
In the current draft of the revised policy this is solved in a rather
complex way but that is unavoidable. Just to mention some of the
requirements for consent, individuals should be well informed of
the purpose of keeping the data or material, the rules of access to
data, the governance arrangements, commercial use, if applicable,
and benefit sharing. Many other ethical aspects are addressed as
well in the draft that now has been sent formally to the Secretariat
of the WMA for processing.
This has been the work of many. Foremost, the representatives of
nine National Member Associations of the WMA forming a work
group that has had this topic in its hands for the last four years. In
two mini-conferences in Copenhagen and Seoul, external experts
have been invited to explain various aspects of the use of data and
material and they have participated in a dialogue with the work-
group members.The participation in an open consultation was over-
whelming as around 90 different partners commented and brought
forward various ideas.
As a chair of the workgroup I would like to extend special thanks to
all of the work group members, to the Danish and Korean Medical
Associations for hosting the meetings with external experts and to
the German Medical Association for hosting a smaller work group
meeting. Thanks are also due to our special experts at many of our
meetings, professors Urban Wiesing from Tübingen in Germany
and Dominique Sprumont from Neuchatel in Switzerland.
Last but not least, the help of the Secretariat has been absolutely
instrumental in making the whole process possible.
Jon Snaedal
Representative of the Icelandic Medical Association and
Chair of the Work Group on Health Data and Biobanks
Health Databases and Biobanks — Ethical Dilemmas
Life expectancy and longevity
Life expectancy is a statistical measure of
how long a person may live, based on the
year of his/her birth. The term is, however,
more frequently used for whole popula-
tions and is one of the terms used to es-
timate the overall health of a population.
The term equals average number of years
a person born today is expected to live, if
mortality rate for each age remains the
same in the future. Life expectancy of hu-
man populations has been increasing for
at least a century and there is no plateau
in sight. Inequality in life expectancy is,
however, immense and seems not to be
diminishing, neither between countries
nor inside countries. This is in some cases
the result of population unrest and armed
conflicts that have been shaping the life of
entire populations such as in Syria, Yemen
and Sudan just to mention the few most
recent and apparent cases. The inequality
between countries becomes apparent when
looking at the UN population prospects
showing life expectancy of lower than 45
years in some sub-Saharan Africa but more
than 85 years in Japanese women. This fol-
lows very closely the economic state of re-
spective countries (Figure 1).
When looking at the numbers and how
they have been changing, it is amazing to
see that the average lifespan in high-income
countries has increased by almost three
months every year since 1840. For the first
many decades, this increase was due to de-
creasing mortality among the new-born and
young children but during the last decades,
the life expectancy of the >65 years of age
has increased the most.
The causes of increased longevity are mani-
fold but public health initiatives have had
more impact than direct medical interven-
tion but there is an overlap between these
two types of measures such in the case of
general vaccination. Of medical interven-
tion, vaccination of children is the single
most effective intervention leading to lower
infant mortality and by that, increased lon-
gevity. Taking this fact into account, it is
really sad to witness some misguided ideas
of possible side effects of vaccination that
have lead to lower proportion of individu-
als being vaccinated and in turn increased
susceptibility of children and vulnerable
populations to communicable diseases. This
has been much debated and is tackled in
many ways. One is to inform and educate,
exemplified by the American Academy of
Pediatrics [1], another to dictate by laws.
The WMA addressed this in a policy docu-
ment of 2012 “WMA Statement on Priori-
tization of Immunization”[2]. Another very
successful medical intervention, accounting
for a very low maternal and infant mortal-
ity in high-income countries, is prophylac-
tic health care in pregnancy and for infants
in the first year of life. It is a sad reminder
of inequality of the world that even simple
interventions, with very well documented
results, are not provided for in many low-
income countries. We know better and we
can do better.
Yet another medical intervention leading
to increased longevity of individuals and
increased life expectancy is antibiotic treat-
ment for communicable diseases. This has
benefited adults as well as children and has
lead to very low mortality of infections that
before were deleterious.
More complicated interventions such
as treatment of cardiovascular diseases
or cancer have had some effect, not least
to increase longevity of middle aged and
older individuals. As a consequence of all
this, more and more are living to older age
and as fertility rate has been decreasing,
the proportion of older people has been
increasing drastically during the last few
decades leading to ageing populations,
a development with no definite end in
sight [3].
As mentioned before, inequality is evident
and seems not to be generally decreasing.
This leads to differences in life expectancy
related to different social classes and educa-
tion.This has been addressed in the Marmot
review [4] and in the WMA policy docu-
ment “WMA Declaration of Oslo on Social
Determinants of Health in 2012”[5]. Some
examples from the first Marmot review: In
England, premature death caused by health
inequalities amounts totally to between 1.3
and 2.5 million extra years of life. Another
example: if those without a university de-
gree would live as long as those with degree,
more than 200.000 premature deaths would
be prevented each year.
Life extension
Some attention has been put on the pos-
sible biological increase in life expectancy.
Ageing and Ageism
Based on a plenary presentation at the 3rd
International Congress of Person Centered
Medicine in London, October 2015
Jon Snaedal
Figure 1.  Life expectancy and economic state
Even though life expectancy has been
increasing generally and the number of
centenarians has been rising, there is yet
no direct evidence of increased absolute
maximum life span of humans that seems
to be around 120 years. The attention has
been focused on the genetics of ageing and
many have been dreaming of some kind of
manipulation of longevity genes in order to
increase life expectancy. The term “Life ex-
tension science” has been created, address-
ing possible intervention with the aim to
extend both maximal and average life span.
The ideas are many: to use molecular repair,
stem cell therapy or by use of simple anti-
ageing products. Specific organizations
have been established to further research
in this field [6]. This has been widely criti-
cized in the medical and lay press [7] and
very few established scientists have been
active in this field. It came therefore as a
surprise when the FDA in the US decided
to allow for a trial for age prolonging by
an old medication for diabetes, metformin.
This trial is both based on evidence from
animal research [8] and compelling evi-
dence from epidemiological studies on hu-
mans with type 2 diabetes [9]. This study
used observational data from the UK Clini-
cal Practice Research Datalink (CPRD)
with information from almost 80 thousand
subjects treated with metformin, 12  000
treated with sulphonylurea drugs, and
90 000 matched subjects without diabetes
with a total, censored follow-up period of
more than 500 000 years. Patients with
type 2 diabetes treated with metformin
monotherapy had longer survival than did
matched, non-diabetic controls. However,
those treated with sulphonylurea drugs had
markedly reduced survival compared with
the other groups. The planned metformin
trial, which is called Targeting Aging with
Metformin, or TAME, is scheduled to start
in 2016 and participants are currently be-
ing recruited. It is of course interesting to
see if individuals can live a healthier life by
simple intervention but to prolong life be-
yond maximal life span creates many ethi-
cal dilemmas.
Social aspects of ageing
With ageing comes less ability to work and
to earn for living. This has, of course, been
known for centuries but it was not legally
addressed until the Prussian authorities ad-
opted “The Old Age Pension Program” in
1889 designed to provide a pension annuity
for workers who reached age 70. This is the
first legislation containing social action to
secure income for the oldest in society. At
that time, the average life span was less than
60 years and thus the proportion of those
older than 70 was low. In most middle in-
come and high-income societies, schemes
of old age pension have now been in place
for decades but the age limit for pension has
been lowered to 60-65 years in most coun-
tries in spite of increased longevity of popu-
lations. The scenario is, however, changing
rapidly and the financial burden has now
increased to the level that this is not longer
sustainable. One country after another is
now taken actions to try to lessen the finan-
cial burden and the most influential act is to
increase the pension age. For example in the
UK, the state pension age for men has been
65 years and for women 60 years.According
to the Pension Acts of 2011 and 2014 [10],
there will be a stepwise increase, steeper for
women, up to 67 years in the coming years.
But when do we get old? For practi-
cal purposes, ageing is often divided into
“younger old” (65–80 years) and “older
old” (>80 years) but this distinction is not
universal and biological age is not equal to
chronologic age. Generally, individual nor-
mal variation increases with age and to that
is added the effect of intrinsic and extrinsic
factors. Therefore, the difference in “age ap-
pearance” increases with age. In line with
increased longevity, more aged individuals
than ever enjoy healthy life without diseas-
es and disabilities and to some extent, the
goal of “compression of morbidity” is being
met as described in a landmark article in
1980 [11]. By that is meant that the time
spent with ill health, functional disability
and frailty before death is being shortened.
In every discussion on the effect of age-
ing of societies, old people are considered
a financial burden and when looking at the
increasing proportion of older individuals
towards people in working age it is evident
that there is an ever increasing burden in
society. The International Labour Orga-
nization has discussed this frequently and
has provided some advice [12]. However,
older individuals need not to be a financial
burden in society. Actually, in Iceland, it
has been calculated that in a decade or two
from now,those older than 65 years will be a
financial asset instead of burden for the so-
ciety. The reasons are mainly twofold. One
is the high level of employment in the ages
65-75 years. Another reason is that pension
funds outside the state pension system have
been created and form now a good deal of
the income of older individuals. Currently,
the pension funds are little less than 150%
of GDP of the country, the second highest
level in the world.On top of this comes that
older individuals are becoming healthier.
The increased proportion of the aged in
society has many consequences other than
financial. The constant focus on the burden
of the aged creates a negative view of the in-
dividuals and groups and is to some extent
the cause of what we call Ageism.
The term “ageism” was coined in 1969 by
Robert N. Butler [13]. The term is used for
prejudice or discrimination and involves
holding negative stereotypes of individu-
als and groups based on age. Ageism has
mainly been used for individuals in old
age but can also be used for other ages,
for example, teenagers that feel they are
not respected because of their immaturity.
Ageism towards the elderly involves often
how younger people expect older people to
behave but the concept is broader and ex-
ists in all aspects of society. Ageism can be
categorized such as:
Succession: younger people assume that
older people have “had their turn” and
should make way for younger generations.
Consumption: there are limited resources
in society and younger people feel they
should be spent on them (education, etc.)
rather than on the older generation.
Identity: older people should “act their age”
rather than “steal”from younger people such
as in clothing and manner.
Ageism leads to discrimination and in a
study by University of Kent [14], age was
the single most prevalent basis for dis-
crimination, more than those based on
gender, religion or sexual orientation even
though the latter ones have created more
headlines (Fig 2). Ageism can also been
categorized in terms of intention or if it is
directed at persons or is institutionalized.
Ageism can also be evident or hidden.
Intentional ageism is when attitudes and
language is used with purpose, taking ad-
vantage of older people vulnerability. This
includes missions, rules and practices that
discriminate against individuals or groups
based on their age. An upper age limit for
polls is one such example indicating that
the views of older individuals are not in-
teresting or important. Another example is
how individuals are chosen for interviews
in official media. Unintentional ageism is
possibly more prevalent.These are descrip-
tions and practices that include bias due
to age by those unaware of the bias. The
use of language is throwing a light on this.
In a survey carried out in students partici-
pating in senior mentoring program, 12%
of tweeds they used contained remarks
that were considered discriminating [15].
Sometimes this is done by the best of in-
tentions, to avoid putting responsibility
on individuals based on their age without
recognizing that the same individuals wel-
come this responsibility.
% Reporting experience of predjudice or
unfair treatment in the past year
Source: Ago Concom/University of Kent
Figure 2. Discrimination based on age,
gender etc.
Ageism is evident in working life such as
in legislation, in advertising, in attitudes in
the workplace and when cut downs are per-
formed. Ageism is prevalent in the health
care and often unintentionally. Upper age
limits based on chronological ageing has
been prevalent but increasingly, consider-
ations based on biological ageing are used.
Older individuals referred to emergency
units are sometimes termed “social refer-
rals” when an obvious medical reason is not
found. The reason in these cases is most of-
ten multi-morbidity in an individual that
has experienced a deterioration, small to
outsiders but immense in his or her own
experience. Another term used for older in-
dividuals in hospital wards is “bed blockers”,
a hugely degrading term.
But how is ageism felt by older individuals?
From data derived from the fifth wave of
the English Longitudinal Study of Ageing
(ELSA) it seems evident that a third of the
respondents experienced age discrimination
and this increased with the age of the re-
spondents. Discrimination was associated
with older age, higher education, lower lev-
els of household wealth and being retired
Show DoctorsKOREA
Initiated by the Brazilian Medical Asso-
ciation, the WMA is currently developing
a policy document on ageing that is now
being considered by the National Member
Associations.In this comprehensive draft to
a statement, an advice is given to appropri-
ately train all health care professionals, es-
pecially physicians, to deal with the health
problems of older people, which imply not
only training geriatricians but also main-
streaming aspects of ageing into the medi-
cal curriculum.This draft to a policy will be
discussed and debated at the next Council
meeting in Buenos Aires.
1. Diekema DS, American Academy of Pediatrics
Committee on Bioethics. Responding to paren-
tal refusals of immunization of children. Pediat-
rics.2005; 115(5):1428–1431
2. World Medical Association. WMA State-
ment on the Prioritisation of Immunisation.
WMA[Internet] [cited 2015 Nov 22]. Available
from: https://www.wma.net/en/30publications/
3. United Nations, Department of Economic and
Social Affairs, Population Division (2013).World
Population Ageing 2013. ST/ESA/SER.A/348.
4. Fair Society,Healthy Lives.The Marmot Review
2010.[Internet] [cited 2015 Nov 22]. Available
from: http://www.instituteofhealthequity.org/
5. World Medical Association. WMA Dec-
laration of Oslo on Social Determinants
of Health. WMA[Internet] [cited 2015
Nov 20]. Available from: https://www.wma.net/
6. About Life Extension. Life Extension Foun­
dation[Internet] [cited 2015 Nov 22]. Available
from: http://www.lifeextensionfoundation.org/
7. Lucke JC, Wayne Hall W.Who wants to live
forever? EMBO Rep. 2005 Feb; 6(2): 98–102.
Available from: http://www.ncbi.nlm.nih.gov/
8. Martin-Montalvo A, Mercken EM, Mitchell SJ,
et al. Metformin improves healthspan and lifes-
pan in mice. Nat Commun. 2013;4:2192.
9. Bannister CA, Holden SE, Jenkins-Jones S, et
al. Can people with type 2 diabetes live longer
than those without? A comparison of mortality
in people initiated with metformin or sulphony-
lurea monotherapy and matched, non-diabetic
controls. Diabetes Obes Metab. 2014; 16 (11):
10. Pensions ACT 2014. The National Archives
[Internet] [cited 2015 Nov 22].Available from:
11. Fries JF. Ageing, natural death and compression
of morbidity. N Engl J Med. 1980;303(3):245-
12. Ageing societies: The benefits, and the costs of
living longer. World of Work 2009;67:9-12.
13. Butler, RN. Age-ism: Another form of bigotry.
The Gerontologist 1969;9(4):243–246.
14. How ageist is Britain? Age concern Report
2000. The Age UK network [Internet] [cited
2015 Nov 23]. Available from: http://www.
15. Gendron TL, Welleford EA, Inker J and White
JT. The Language of Ageism: Why We Need to
Use Words Carefully. Gerontologist. 2015 Jul 16.
16. Rippon I, Kneale D, de Oliveira C, et al. Per-
ceived age discrimination in older adults. Age
Ageing. 2014 May; 43(3):379-86.
Prof. Jon Snaedal,
Former President of the WMA
E-mail: jsnaedal@landspitali.is
TV Appearances by Physicians
and ‘Show Doctors’
KMA strongly recommends that physi-
cians contribute to public health by de-
livering correct health information to the
public as professionals through broadcast-
ing media. However, recently many medical
information programs have grown beyond
a platform for simply providing medical
information and have increasingly become
entertainment programs, leading to issues
of being too sensational and including dis-
torted and exaggerated content.
Of course, most of the physicians who ap-
pear on these shows are respected experts
in their relevant fields and conduct them-
selves properly on TV in line with their
professional honor and integrity by provid-
ing the public with evidence-based health
information in an easy-to-understand
manner. However, some physicians have
either abused TV appearances as a means
of commercial marketing or have provided
unclear information to viewers which di-
rectly harms not only the public but also
other physicians who conduct themselves
properly on TV. As a result, KMA came to
establish guidelines regarding TV appear-
ances by physicians.
What are ‘Show Doctors’?
According to KMA’s definition, a show
doctor is a physician who appears on broad-
casting media as a physician and either
promotes procedures not medically recog-
nized or frequently carries out indirect, ex-
aggerated or false advertisement including­
‘Show Doctors’ and Korean Medical
Association’s Efforts for Self-Regulation
Hyun-Young Deborah Shin
Show Doctors KOREA
endorsement of specific health foods or
Birth of Show Doctors and
Show Doctor Cases
Nos. 1 and 2
Late last year, a famous Korean singer in his
late 40s suddenly passed away after receiv-
ing surgery. The singer had already received
gastric banding surgery and underwent
another round of surgery from the same
surgeon after complaining of abdominal
pain, but died during post-operative pe-
riod. As a part of legal proceedings aimed
at determining whether medical negligence
was involved, it was discovered that the sur-
geon in question had appeared on a health
and medical information program regu-
larly, which led to some media to speculate
whether the surgeon may have been negli-
gent of patient care because of his frequent
media appearances.
Also, late last year, a physician appeared on
a health information program related with
hair loss and said that Houttuynia cordata
Thunb, a herb, was effective in treating hair
loss, and also sold products containing the
same herb through on-line shopping sites.
This led to a sudden increase in prices of
the herb, and a patient who had received
hair transplant surgery strongly protested
to his doctor after watching this program.
The doctor described above has been des-
ignated as the first show doctor by KMA
and is currently pending a decision by the
KMA’s Central Ethics Committee.The sec-
ond show doctor case involves another doc-
tor who appeared on a TV health program
and said that after taking lactic acid bacteria
per oral infertility patients became preg-
nant, people who used to wear glasses no
longer had to and patients on medication
for chronic diseases such as diabetes and
rheumatoid arthritis stopped medication.
At the same time, the physician appeared
on home-shopping channels and sold lactic
acid bacteria products, which triggered seri-
ous social controversy.
Reasons for Show Doctors
1. Excessive competition over ratings
due to increase in medical information
2. TV channels need cast members and
physicians want to appear on TV.
3. Black market regarding payment for
appearances by TV companies.
Types of Show Doctors
1. Physicians who appear on TV to pro-
mote products or to market his/her
2. Physicians who want to become celeb-
rities or TV personalities.
3. Physicians who participate in health
food businesses.
4. Physicians who place ungrounded
trust on efficacy of foods or health
5. Physicians who place strong belief in
alternative medicine rather than mod-
ern medicine.
KMA’s Adoption of Guideline
on Show Doctors
KMA referenced various sources including
the regulations of the Korea Communica-
tions Standards Commission, related provi-
sions of the Broadcasting Act, regulations
on broadcasting program review, regula-
tions on review of programs that introduce
or sell products, regulations of the KMA’s
Central Ethics Committee, Article 56 of
the Medical Services Act on prohibition
of medical advertisement and Article 23
of the Enforcement Decree of the Medical
Services Act on standards for prohibition of
medical advertisement in order to create the
basic framework for the guideline, which
was then finalized by having the Show
Doctor Taskforce revise and supplement
the framework according to ethics regula-
tions.The Medical Services Director, Public
Relation Director, Legal Affairs Director
of KMA and the Director of the Medical
Policy Research Institute participated in
the Show Doctor Taskforce to share ex-
pert knowledge on experiences of reviewing
medical advertisement and ethics regula-
tions of other countries. KMA’s Guideline
on Broadcasting Appearances by Physicians
version 1.0 was distributed on March 26,
2015 after receiving feedback from medical
journalists and the Korean Society of Medi-
cal Ethics.
Used as Guideline for
Physician TV Appearances
KMA distributed the guideline to its
physician members and broadcasting re-
lated personnel and asked for their active
participation. The Korean Association of
Producers, the Korean Communications
Standards Commission, the Ministry of
Health and Welfare and various health and
medical organizations responded positively
and MOUs were signed to promote the
production of proper health information
programs in the future. Also the broadcast-
ing review standard was recently amended
and supplemented according to the KMA
guideline, and even the press extensively
covered the guideline which has increased
public support for KMA for its efforts to
Ethics Guideline and
Controversy over Adoption
as Legal Obligation
The Ministry of Health and Welfare newly
added regulations on administrative penal-
ties against show doctors to the Enforce-
ment Decree of the Medical Services Act
for “actions that harm the dignity of medi-
cal professionals” (up to 1 year of license
Regarding this, KMA’s position is that any
guideline on broadcasting appearances by
Medical Education
physicians should be approached as a rec-
ommendation and ethical norm, and KMA
is against the adoption of any compulsory
legal measure against physicians. However,
the issue of show doctors is not limited to
just physicians and involves all health-relat-
ed professionals such as traditional medi-
cine doctors, dentists, pharmacists, nurses
and nutritionists. In particular, Korea has a
two-tracked medical system that recognizes
traditional medicine doctors who practice
empirical alternative medicine as a separate
professional group, apart from physicians
who practice modern medicine. As a result,
there is greater concern of medical profes-
sionals appearing on TV and transmitting
wrong medical information to the public
without any or proper evidence. Accord-
ingly, the medical authority has insisted
that penalties against show doctors should
maintain equity among different medical
professions, and adopted the amended en-
forcement decree which is expected to be
applied to all medical and health profes-
Future KMA Plans
against Show Doctors
KMA created the Show Doctor Review
Committee on May 20, 2015 to restart its
activities regarding sanctions against show
doctors. The Review Committee expressed
its commitment to consider the issue of
show doctors from a more fair and profes-
sional perspective by appointing KMA of-
ficers who had been members of the Show
Doctor Taskforce as well as journalists and
ethics experts as members. Also, the Re-
view Committee is planning to strengthen
its exchange with the Korean Communi-
cations Standards Commission and broad-
casting producers to prevent TV programs
from violating the guideline and to prepare
follow-up measures regarding any future
violations. The Committee also plans to
expand the guideline to cover appearances
by physicians in all forms of mass media.
KMA is greatly encouraged by the fact
that the Guideline on Broadcasting Ap-
pearances by Physicians proposed by KMA
was adopted as a WMA resolution at the
WMA General Assembly held in Russia
in October 2015 and promises to continue
its efforts to provide correct health infor-
mation to the public.
Hyun-Young Deborah Shin, MD
Executive Board Member of Public
Relations and Spokesperson,
Korean Medical Association
Clinical Assistant Professor,
Myongji Hospital,
Department of Family Medicine,
Seonam University
Former JDN Communication/
Publication director
E-mail: shy801117@gmail.com
It is generally agreed that there has been
progress in recent years in many of the as-
pects of medical education, but a particular
problem is that we do not have good in-
formation on the numbers of new medical
schools, and their quality. How do we de-
cide how many medical schools are needed?
How do we decide which standards these
schools as well as long-established schools
should use, and how do we assess their per-
formance in meeting those standards? We
also need a better understanding of the pro-
cesses that decide entry of newly qualified
doctors into specialist training. How are
their choices influenced and managed, and
how do they meet the needs of the health
care system?
The development of new medical schools is
an uncertain process [1,2]. Very broadly, in
first-world countries, the approximate fig-
ure of new medical students required was
that, for each million of the population,
there should be 100 new medical students
each year [3]. This figure is probably now
Medical School Numbers and Career
Choices: Current Problems in Medical
David Gordon Line Engelbrecht Jensen
Medical Education
1940 1950 1960 1970 1980 1990 2000 2010 2020
Number of
Figure 1.
­significantly higher for a number of rea-
sons  – the increased feminisation of the
medical workforce [4] and the increasing
complexity [1] of medical practice being
important factors. However, in many coun-
tries, a new medical school may be agreed
for reasons that are political [5] or commer-
cial rather than rational, for example “for
profit” medical schools[6].
An interesting example of a planned process
for the development of new medical schools
comes from the early history of the USSR.
Leaving aside the long-established medi-
cal schools of Russia and Ukraine (and also
the special case of the three Baltic states),
in each republic of the former USSR, the
first ever medical school was always set
up within 10 years of the republic joining
the USSR. This is a remarkable example of
planning of the health medical workforce
to meet the needs of the population in na-
tions that had been neglected by the Czar-
ist Russian empire, and contrasts with the
many failures of planned Soviet economies
in other walks of life [7].
Since 2013, the World Federation for
Medical Education (WFME) [8] and the
Foundation for the Advancement of In-
ternational Medical Education and Re-
search (FAIMER)[9] have jointly managed
the World Directory of Medical Schools,
WDMS[10], the only authoritative list of
all the medical schools in the world.In 2015,
WDMS lists over 2700 medical schools,
but there is a supplementary list of about
600 additional schools that are believed to
exist. This supplementary list was created
using information obtained from a num-
ber of sources. However, verification that
these additional schools actually exist, and
meet the criteria for inclusion in WDMS,
is difficult to obtain, because reliable official
sources are slow, and sometimes unwilling,
to provide information.
The number of medical schools in the world
is growing rapidly and much of this growth
is without good reason – national govern-
ments failing to take, or ignoring, expert
advice, or subject to corrupt practices; or
commercial organisations establishing un-
necessary schools solely for profit. However,
many new medical schools are undoubtedly
founded for worthy reasons: the health care
system that will benefit from the new school
needs more doctors.
Yet, even if there is a good reason for a new
school or schools, exact decisions are not
always made on the best evidence. Predict-
ing the future is logically not easy, but many
countries do work actively with workforce
planning [1,11]. These predictions are obvi-
ously not the exact truth but may be the best
evidence available. However, these efforts to
predict future demand as well as understand
fluctuations of supply of doctors have been
seen to be ignored when decisions on chang-
es in medical student numbers and open-
ing of new schools are taken. This tends to
happen when current political “gut feelings”,
often related to election years, take priority
over best evidence with politicians acting
primarily in response to current political, de-
mographic and economic pressures [5].
These decisions naturally carry implications
far into the future. Another flaw is the fail-
ure to consider the careers and career choic-
es of doctors after obtaining their primary
medical qualification. A potentially large
increase in number of medical students
needs to be matched by additional numbers
of postgraduate training positions and un-
wanted, rushed, educational reforms can be
the result when the lack of postgraduate ca-
pacity is realised too late, as seen in the UK
[12]. This led to disruption of many careers
and loss of doctors overseas from the UK.
Another risk is to educate doctors with little
prospect apart from unemployment, a per-
sonal problem for the unemployed doctor, a
potential financial problem for society and
a stimulus for further rushed reforms [11].
Regarding the quality of new as well as
already existing medical schools, the stan-
dards for medical education have been a
concern of WFME for many years [13].Al-
though WFME standards for basic medi-
cal education have been extensively adopted
world-wide, with appropriate adjustment
to meet the local context of medical educa-
tion, the process of systematically assessing
whether or not a medical school is actually
meeting the standards has been patchy.This
process  – the accreditation of educational
programmes, the certification of the suit-
ability of medical education programmes,
and of the competence of medical schools
Medical Education
in the delivery of medical education – is of
the highest importance.
After WFME had completed its programme
of developing standards for medical educa-
tion, including standards for basic medical
education, for postgraduate medical educa-
tion, and for continuing professional de-
velopment of medical doctors, it turned to
consideration of the use of these standards
in accreditation. The outcome was a joint
World Health Organization–WFME state-
ment on the promotion of accreditation, and
a WHO–WFME policy paper on the pro-
cesses of accreditation [14]. That policy pa-
per remains the definitive statement of how
the accreditation of medical education pro-
grammes should be carried out.
Accreditation has a cost in money and staff
time, but it is a cost that must be accepted.
To run the teaching programmes of a medi-
cal school without assessing how well they
are performing their function is as illogical as
flying an aeroplane without making sure the
aircraft is mechanically sound, regularly ser-
viced, and supplied with fuel. The evidence
for the efficacy of accreditation is limited
[15] but is often seen most clearly when ac-
creditation is introduced for the first time to
a long-established education system [16].
The implicit value of accreditation was
acknowledged by the Educational Com-
mission for Foreign Medical Graduates
(ECFMG) of the USA when it announced
the policy that, with effect from 2023, over-
seas medical graduates wishing to work in
the USA will only be accepted for assess-
ment if they have graduated from a school
that meets North American or WFME
standards for accreditation [17]. This re-
quires that we must be certain that ac-
crediting agencies are meeting accepted
international standards, to verify that the
assessment of medical schools within the
remit of each accrediting agency are work-
ing to the right standard. The outcome is
the WFME Recognition of Accreditation
Programme, in which official accrediting
agencies are evaluated in their performance
in a transparent and rigorous process to en-
sure that accreditation of medical schools is
always at an internationally accepted and
high standard, meeting the agreed WHO–
WFME policy [14].
The new ECFMG policy has undoubtedly
been a powerful stimulus to the accredita-
tion of medical education, world-wide.
However, international recognition of ac-
creditation of medical schools is much more
important than simply a permit to apply
to work in another country. It is important
that it verifies the standard of education for
all medical graduates, to the future benefit
of society and the patients of these doctors
of the future.
We therefore call for a coherent system: stu-
dent numbers and (where necessary) new
medical schools determined by rational and
evidence-based data; postgraduate service
and training posts aligned to the needs of
the health care system and to the number of
emerging graduates; medical schools deliv-
ering programmes of education to contex-
tually relevant standards; the performance
of medical schools being evaluated and
enhanced by accreditation; and accredit-
ing agencies being evaluated to ensure that
they are also at the required standard. If all
elements of this system work together, and
with the best motives, then the problems of
medical education will be many fewer.
1. Planning the Medical Workforce – Third Report
of the Medical Manpower Standing Advisory
Committee: Department of Health, London,
UK, December 1997.
2. Norris, Tom E. Coombs, John B. House, Peter,
Moore, Sylvia; Wenrich, Marjorie D.; Ramsey,
Paul G. Regional Solutions to the Physician
Workforce Shortage: The WWAMI Experience.
Academic Medicine: October 2006; 81: 857-862.
3. Data presented to the Association of Medical
Schools in Europe in 2001 by V Grabauskas.
4. Elston M A, Lee D W The Impact of Increas-
ing Numbers of Women Doctors in the Medical
Workforce – A Report for the Medical Work-
force Standing Advisory Committee: Royal
Holloway, University of London, March 1996.
5. Nielsen K, Gregersen H, Gøtzsche C-O.Læ-
geuddannelse på Aalborg Sygehus [Internet]
[cited 2015 Nov 30]. Available from: http://
6. Karle H. How do we Define a Medical School?:
Reflections on the occasion of the centennial of
the Flexner Report. Sultan Qaboos Univ Med J.
2010 Aug; 10(2):160-8. Epub 2010 Jul 19.
7. World Medical Association.WMA General
Assembly, Moscow 2015[Internet] [cited 2015
Nov 30].Available from: https://www.wma.net/
8. World Federation for Medical Education [In-
ternet] [cited 2015 Nov 30].Available from:
9. Foundation for Advancement of International
Medical Education and Research [Internet]
[cited 2015 Nov 30]. Available from: http://
10. World Directory of Medical Schools  [Internet]
[cited 2015 Nov 30].Available from: http://
11. Lægeprognose – Udbuddet af læger 2000-2025,
Sundhedsstyrelsen Copenhagen 2003.
12. Modernising Medical Careers, The next steps,
The future shape of Foundation, Specialist and
General Practice Training Programmes, Depart-
ment of Health, London, April 2004.
13. World Federation for Medical Education.
Standarts [Internet] [cited 2015 Nov 30]. Avail-
able from: http://wfme.org/standards
14. World Federation for Medical Education.
WHO/WFME Policy [Internet] [cited 2015
Nov 30].Available from: http://wfme.org/ac-
15. van Zanten M, Boulet JR. The association be-
tween medical education accreditation and
examination performance of internationally
educated physicians seeking certification in the
United States. Quality in Higher Education 2013;
19:3, 283-299.
16. General Medical Council. UK primary legisla-
tion [Internet] [cited 2015 Nov 30]. Available
from: http://www.gmc-uk.org/about/legisla-
17. Educational Commission for Foreign Medi-
cal Graduates [Internet] [cited 2015 Nov 30].
Available from:www.ecfmg.org/accreditation/
David Gordon, President,
World Federation for Medical Education
E-mail: president@wfme.org
Line Engelbrecht Jensen,
Surgical resident, Region Zealand, Denmark
E-mail: lineengelbrecht@gmail.com
Medical Education
One generation passeth away, and another
generation cometh; and the earth abideth for
ever. (Ecclesiastes 1:4)
How do you know something is fine art in
the postmodern era? Because the museum
curator said it is.
In the postmodern era, characterized by a
democratization of opinion and influence,
anyone can be an art critic, anyone can be
a politic pundit and anyone can be a medi-
cal expert. In today’s “flat world,” truth
is supposed to be relative. Information is
now crowd-sourced and diversified. Medi-
cal opinions that were once taken at face
value from one’s own doctor are now parsed
through the internet, dissected in online fo-
rums with other laypersons. The question is
not whether this evolution is good or bad;
the question is how traditional systems and
structures – such as medical education – will
evolve to remain relevant and at their best.
We are now more than half a century into
the postmodern era, which introduced mul-
ticulturalism and relativism into a world of
certainty and hierarchy. In 1966 the artist
Carl Andre debuted with Equivalent VIII,
known colloquially as the Bricks. Andre’s
piece comprised 120 bricks that were “placed
in meticulous rectilinear relationship within
the gallery space”[1] making a new use of the
environment as part of an art display.Stacked
firebricks became art when a museum bought
and displayed them.Not long after,a non-or-
chestral performance with a sound mixer and
no plot became an opera when its director
called it an opera. In 1967 Jacques Derrida’s
Of Grammatology was published, creating the
concept of deconstructive criticism and effec-
tively reinventing literary theory.
Postmodernism differs from modernity in
its questioning of reason, rejection of great
narratives and emphasis on subcultures.
Rather than searching for one ultimate
truth that could explain all of history, post-
modernism focuses on contingency, con-
text and diversity. The postmodern world is
characterized by the coexistence of various
narratives in one global village.
Amid these changes in philosophy, cultures
and values contracted and expanded, and
medicine, once an absolute, began its trans-
formation. Modernism had venerated doc-
tors as educated authority figures, experts
on medicine whose knowledge could be
taken for granted; postmodernism emerged
and questioned reason, rejected overarching
narratives and respected alternative back-
grounds and approaches.
Fifty years later, medical schools and resi-
dency programs are made up of the second
postmodern generation, millennials [2].
This generation approaches medical school
with a wholly new set of expectations, needs
and learning styles. When millennials enter
medical school, they are older than medical
students have traditionally been, and their
backgrounds more varied. They have needs
that will not be met within a traditional
program. Millennial students have expecta-
tions of a less formal relationship with their
professors; they crave mentors and inter-
action, rather than lectures and authority.
They prefer team learning as much as team
working. They place much less emphasis on
professional formalities and much more on
their individual impacts and purposes within
medicine.They are accustomed to digital for-
mats and interactive learning,and resistant to
the traditional podium-audience model [3].
The medical world is very different from the
one in which the more traditional teaching
format was developed, and the distinction
between modern and postmodern theory
has been amplified by the digital age. Medi-
cal students and residents, like everyone in
the developed world, live a reality of en-
tirely new forms of communication. They
have been habituated to visual learning and
prompt gratification, accustomed to having
answers always at their fingertips. There is
an information explosion: no longer do we
live in a world in which information is cen-
tralized. “Truth” and “expertise” are more
democratic than ever before, and with the
perseverance of postmodern theory, there is
an ongoing focus on the diversity of ideas
and a rejection of absolute truth.
Millennial learning practices are the new-
est iteration of the postmodern movement.
When burnout and job dissatisfaction
among physicians are at record highs, the
probable conclusion is that the old system
does not suit contemporary needs.The only
option now is to make adjustments and sync
up postmodern needs and desires with a
postmodern learning environment.
Millennials begin their training with the
same excitement and same good intentions
as medical students always have, but they suf-
fer burnout increasingly early in their careers:
45% of physicians have symptoms of burnout,
and 46% of interns experience symptoms of
depression in their first year [4]. According
to Richard Schwartzstein,“We have [medical
Medical Education in the Postmodern Era
Leonid A. Eidelman
NMA and Regional News
The Medical Association of Malta (MAM)
organised a satellite meeting for the Com-
monwealth People’s Forum during the Com-
monwealth Heads of Government Meeting
(CHOGM) held in Malta in November 2015.
Mr. Gordon Caruana Dingli, President of
MAM, introduced the topic of social deter-
minants of health and argued that these are
not only significant in less developed coun-
tries since social gradients exist even in af-
fluent societies. His main message was that
measures to reduce inequities require com-
mitment at all levels: political, social, and
individual healthcare professionals.
The conference was
opened by the Hon.
Parliamentary Sec-
retary Mr. Chris
Fearne who de-
scribed social deter-
minants of health as
being the area where
politics and health
interact. He be-
lieves that politicians
should work together in a whole-of-gov-
ernment approach and take policy decisions
that would improve
these social factors,
to ultimately lead to
an improvement in
public health.
Dr.Solaiman Juman,
President of the
Medical Associa-
Social Determinants of Health
Report from Satellite Meeting Commonwealth People’s Forum
Sascha Reiff Gordon Caruana
Chris Fearne
Solaiman Juman
students] memorize long lists of facts, delay
their involvement with patients, and expose
them to frustrated and overwhelmed faculty
members who are under increasing pressure
to generate greater clinical revenue. And stu-
dents’empathy diminishes [5].”
It is imperative, therefore, that the medical
establishment makes adjustments to insure
that medical students are taught in the envi-
ronments in which they will learn most ef-
fectively and be content in their chosen pro-
fession. Physician dissatisfaction is strongly
associated with medical errors, prescribing
habits, patient compliance, patient dis-
satisfaction and medical malpractice suits.
Learning styles are just one component of
keeping students and residents on track. To
preempt burnout, the medical community
must encourage “happiness”among medical
students and young doctors. Young doctors
should be given the skills, time and space to
create healthy lifestyles. Medical programs
should use their platforms to emphasize
a work-life balance, and remind students
that they will be better doctors – and more
fulfilled individuals – if they regularly re-
member to take care of themselves as well
as their patients.
Today, medical students are well-educated,
technology-oriented and empathetic. They
have expectations that should be considered
and valued,and the postmodern era calls for
recognition of the evolution of learning.The
medical establishment can, by adjusting to
the new styles of the millennial generation,
create better working conditions and better
patient care, delay burnout, enhance resil-
ience and ultimately lead to professional
1. Alle, R. Catalogue of the Tate Gallery’s Collection
of Modern Art other than Works by British Artists,
Tate Gallery and Sotheby Parke-Bernet, Lon-
don 1980, pp11-12
2. Strauss Wd Howe N. Millennials Rising:The Next
Great Generation.New York:Vintage Books,2000
3. Ullma, K. Medical Education needs of the Mil-
lennial Generation. ENTtoday. January 13, 2015
4. Oaklande, M. Doctors on life support. Time.
September 7-14, 2015, p.47
5. Schwartzstei, RM. Getting the right medical
students – nature versus nurture. N Engl J Med.
Dr. Leonid A. Eidelman, MD
NMA and Regional News
tion described social determinants of health
as being the root causes of the causes of ill
health and argued for investment in areas
other than healthcare, to indirectly improve
public health. His main message was that
countries should aim to improve empower-
ment and health literacy of their population,
mainly through education.
Dr. Natasha Az-
zopardi Muscat,
President Elect of
the European Pub-
lic Health Associa-
tion presented sta-
tistics which clearly
show that Malta
is not immune to
social gradients.
Differences in edu-
cational level, gender, ethnicity, household
income and even living in certain regions
are associated with differences in rates of
mortality, health, level of physical activity,
BMI, and presence of certain diseases. She
also argued the case that general socioeco-
nomic, cultural and environmental condi-
tions influence outcomes in health as much
as, if not more than, individual lifestyle fac-
tors. The former is causing social gradients
to increase, especially post-financial cri-
sis, and is due to the non-implementation
of preventive interventions. Countering
this trend requires the will and the means
to make change happen. Further research,
implementing effective policies and sharing
of best practice across the EU and Com-
monwealth are key to reducing health in-
Mr. Duncan Sel-
bie, CEO of Public
Health England
followed up on Dr.
Azzopardi Muscat’s
by listing the most
important contri-
butions to reducing
inequity in health:
employment and housing.These would pro-
vide a positive feedback by decreasing risks
to health, and increasing income, access to
healthcare, education and ultimately better
Sir Michael Mar-
mot, who chaired
the WHO Com-
mission on Social
Determinants of
Health and is now
President of the
World Medical As-
sociation, present-
ed evidence that
showed how inter-
ventions in early childhood can help chil-
dren in the lowest quintile of development
to catch up with their peers who are in the
highest quintile of development if placed
within a better socioeconomic environment.
Similarly, countries which have high levels
of social mobility have less income inequali-
ties. Inequities in the current generation are
damaging the chances of future generations,
further perpetuating the problems. He ar-
gued for giving children the best start in life
possible,creating fair employment and good
work, ensuring a healthy standard of living
and growing old healthily. Inequalities are
inevitable but it is up to us to change the
magnitude of inequalities. Do something,
do more, do better!
Ms. Mary Ann Sant
Fournier, Presi-
dent of the Malta
Chamber of Phar-
macists introduced
Mr. Raymond An-
derson, President of
the Commonwealth
Pharmaceutical As-
sociation who reit-
erated the message
that we should follow the social model of
care which is based on the understanding
that in order for health gains to occur,social,
economic and environmental determinants
must be addressed. He believes resources
should be channelled towards building so-
cial capital – interventions which increase
community awareness, connections and re-
lations. He presented a programme (Build-
ing the Community- Pharmacy Partner-
ship) which takes advantage of the close
contact that community pharmacists have
with their communities, to create a partner-
ship between them, encourage community
activity and empower people. This could
lead to a reduction in health inequalities.
Finally, the Rt Hon. the Lord Kakkar con-
cluded that the
true underlying fac-
tors for improving
health are not the
technology and
procedures that are
available in special-
ist institutions, but
the general socio-
economic, cultural
and environmental
conditions within our society. We need to
turn our attention to these determinants of
health and work towards equity in our soci-
eties.This requires action at all levels.
Dr. Sascha Reiff, Specialist Trainee
in Public Health Medicine;
Dept. of Health, Malta; Council member
of the Medical Association of Malta;
President of the European Junior Doctors;
Permanent Working Group (EJD).
E-mail: sascha.reiff@gov.mt
Dr. Gordon Caruana Dingli, Consultant
Surgeon and Head of Breast Clinic;
Deputy Chairman Department of
Surgery; Mater Dei Hospital;
President of the Medical Association of Malta.
E-mail: gordon.caruana-dingli@gov.mt
Sir Michael Marmot
Raymond Anderson
Lord Kakkar
Duncan Selbie
Natasha Azzopardi
Climate Change
Scientists and medical professionals have
warned for decades that climate change
will create unprecedented challenges to
public health, especially among impover-
ished communities. According to recent
research published in the scientific journal,
Lancet, climate change “threatens to un-
dermine the last half century of gains in
development and global health.”We are al-
ready observing some of those consequenc-
es. Parts of Asia and Latin America that
were previously immune are experienc-
ing unprecedented levels of insect-borne
disease such as malaria and dengue fever,
while drought and famine have wreaked
havoc on a massive scale across the Middle
East and Africa, in some cases prompting
or exacerbating violent conflict.There is no
question, addressing climate change is an
issue of human rights and civil rights – of
life and death.
Fortunately, it is not too late to slow or pre-
vent altogether many of the worst impacts of
a warming planet.Based on what the science
is telling us,it is no overstatement to say that
tackling climate change could be the great-
est global health opportunity of this century.
The Paris agreement establishes ambitious
goals that, if met, would go a long way to
avert a global health catastrophe. But it is up
to each and every nation, and to the subna-
tional governments at every level, to see to
it that we meet those goals. Ultimately, this
fight will be won or lost nation by nation,
state by state, city by city.
Now the truly difficult work begins. We
need to ensure that our transition to a clean
energy economy protects our most vulner-
able and disproportionately impacted com-
munities, both globally and locally, includ-
ing the poor, sick, and elderly, who bear the
disproportionate impacts of air pollution,
extreme weather, and other impacts associ-
ated with climate change.
In the United States, pollution from free-
ways, power plants, refineries, ports and
other sources disproportionately harm the
poor and people of color. A recent study by
the national NAACP found that 40% of the
6 million Americans living in close proxim-
ity to coal-fired power plants are people of
As President Obama has noted, “Today, an
African-American child is more than twice
as likely to be hospitalized from asthma; a
Latino child is 40 percent more likely to die
from asthma.” So, the President continued,
“if you care about low-income, minority
communities, start protecting the air that
they breathe.” (Remarks by the President,
August 3, 2015).
My home state of California is no stranger
to the costs of air pollution and extreme
weather patterns. According to the Ameri-
can Lung Association, California is home
to the five most polluted cities in the na-
tion for ozone and particulate matter, which
come primarily from vehicle tailpipe emis-
sions. 8 in 10 Californians currently live
in areas with unhealthy air. Twice as many
Californians die early deaths from the
health impacts of vehicular pollution than
from motor vehicle accidents every year. To
make matters worse, we have endured near-
ly five consecutive years of record drought,
along with devastating wildfires, both of
which have harmed our economy and the
health of our communities.
Making clean energy and low-carbon trans-
portation options available to all, regardless
of socioeconomic background, is critical not
only because it is the right thing to do, but
because it accelerates our transition to a
more sustainable economy.
When electric vehicles, solar panels, and
other clean energy technologies are avail-
able only to the wealthy and privileged, we
are not achieving the reductions in emis-
sions and improvements in air quality that
we need to achieve to make a difference for
the climate or for the health of our com-
The voice of health professionals is vitally
important in this debate. From the per-
spective of legislators trying to advance
equitable solutions to this monumental
challenge, we need you to be engaged in
the policy trenches. We need you to edu-
cate your communities, colleagues, and
policymakers at every level of government
about why climate change is the health eq-
uity issue of this century: what’s at stake,
and the health co-benefits of strong cli-
mate action.
I urge you: use your voice to support climate
policy solutions that bring health and equity
co-benefits to the communities that need
them most.
Senator Kevin de León (D-Los Angeles),
President pro Tempore of the
California State Senate
Solving the Climate Crisis will Make us
Healthier and More Prosperous
Kevin de León
Studies prove that boxing is a dangerous
sport associated with devastating injuries
and chronic neurological damage to its
participants. Despite this, boxing still has
a huge following worldwide and concerned
health bodies have expressed serious con-
cern about the dangers associated with the
Deep in the Eastern Cape (EC) province
of South Africa, in a local township called
Mdantsane  – the second largest township
in South Africa – thousands of youngsters
are raised up in a boxing climate of almost
religious proportions. In that township,
ramshackle and overcrowded gymnasiums
and boxing clubs flourish, to which scores
of youths daily flock for training sessions
under the tutelage of home-grown trainers.
Doubtless, many of the youngsters are lured
by the prospect of fame and fortune, some
by genuine love of the ‘sport’. A handful of
schools in the area offer boxing as an extra-
curricular activity.
Located in the same province as the home
of the illustrious, once amateur boxer and
former president of South Africa, Nelson
Mandela, Mdantsane has earned itself the
name “the Boxing Mecca of South Af-
rica”. It is where boxing world champions
like Nkosana ‘Happyboy’ Mgxaji, Welcome
Ncita and Vuyani Bungu hail from.It is also
where the shock of a native hero’s death hits
the most,such as when the boxer Mzwanele
Kompolo died in 2015 following a fatal
blow to the head during a match.
About 1500 kilometres from Mdantsane,
in the north-lying South African prov-
ince of Limpopo, a rural Venda village has
also earned its title of “the Mecca of bare-
knuckle fighting”. The indigenous tradition
of Musangwe  – characterised by extreme,
unsupervised, open field fist fighting  – is
a common Venda cultural event believed
to have been handed down to the genera-
tions by ancestors since as early as the 18th
century. At a traditional Musangwe boxing
tournament, only male villagers qualify as
spectators and participants. High profile
traditional leaders, tribesman and organis-
ers fiercely defend the practice, which they
claim helps young men build their courage
and prepare them for life’s challenges.
To the participants, the treacherous punch-
es, dangerous knockouts, loss of teeth, and
other unseen bodily harms are a fair price
for the personal and tribal glory that ac-
companies the conquest. Unlike Mdantsane
though, Musangwe fighters are not in the
game for money, and there has never been
a world champion from that area.
Such is the character of boxing in certain
places in South Africa.There could be simi-
lar – or worse – versions of this sort of in-
formal brutal activity in other countries in
Africa or across the globe. Unsupervised or
underground boxing competitions put at
risk the lives and health of many athletes,
especially naive youngsters who are enticed
by money. On the whole, South Africa has
a relatively well established formal boxing
regime which has significant spectatorship,
over 500 licensed boxers, and 9 interna-
tional title holders in 2012 [1]. Further, the
existence of the South African Boxing Act
2001 as well as formal boxing authorities,
such as Boxing South Africa and the South
African National Amateur Boxing Organ-
isation, facilitate the control and regulation
of the sport, although lacking emphasis on
health and safety of boxers.
Figure 1. Mdantsane township, South
Arguments against boxing
Boxing is a collision sport. While partici-
pating in any sporting activity entails the
risk of catastrophic or fatal injury, boxing is
unique in its intent on inflicting deliberate
physical harm on the opponent; this is the
hallmark of boxing criticism. As knocking
the opponent down is a principal motiva-
Punching to Fortune or to the Grave? Scrutiny on Boxing
Bernard Mutsago Mzukisi GrootboomSelaelo Mametja
tion in boxing,the head region is specifically
targeted, producing an alarming incidence
of chronic brain injury [2]. Calling for the
abolishment of boxing, the then Secretary
General of the World Medical Association
in 2000, Dr. Delon Human, described box-
ing in strong terms: “It [boxing] cannot fairly
be described as a sport; it is simply a barbaric
practice” (emphasis mine) [3].
Examination of the available literature
shows that repeated trauma to the head re-
sults in minor to serious head injuries and
associated neurological complications lead-
ing to long term neurodegenerative diseases
such as Parkinson’s and Alzheimer’s diseas-
es. For example, study findings published in
the British Journal of Sports Medicine [4]
show that the most commonly injured body
region was the head/neck/face (89.8%), fol-
lowed by the upper extremities (7.4%). Spe-
cifically, injuries to the eye region (45.8%)
and concussion (15.9%) were the most
common. Another study found that 51%
of injuries were to the facial area, 17% to
the hands, 14% to the eyes, and 5% to the
nose [5].
Sustained blows to the head lead to acute
and sub-acute neurological consequences
that include cerebral concussions (“knock
outs”), headaches, tinnitus, forgetfulness,
impaired hearing, dizziness, nausea, im-
paired gait, cognitive deficits and acute
neuronal and astroglial cell lesions associ-
ated with Alzheimer’s disease. The most
threatening of long term consequences of
head blows/injuries is chronic traumatic en-
cephalopathy (CTE) also known as chronic
traumatic brain injury (CTBI), dementia
pugilistica and ‘punch drunk’[6]. Other
consequences include tremors, dysarthria,
Parkinson’s disease, ataxia spasticity, de-
mentia, memory disorders, depression, ad-
diction and irritability [2, 5, 7].
Not only do boxing injuries affect the head
but many other areas of the body, such as
the upper and lower extremities as well as
the thorax and back [8].
Boxing risks for children and adolescents
have particularly attracted great attention.
Many young boys and girls around the
world take part in the dangerous sport of
boxing despite the attendant risks. For ex-
ample,an excess of 18 000 youngsters below
19 years of age were registered with USA
Boxing in 2008 [9]. Although amateur box-
ing is considered safer than professional
boxing, injuries still occur [10]. Medical or-
ganisations such as the American Academy
of Paediatrics, the Australian Medical As-
sociation and the Canadian Paediatric So-
ciety oppose boxing as a sport for children
and adolescents [9].
Not only do injuries occur during competi-
tion but also during training. A prospective
cohort study published in 2006 found 57%
of injuries occurring during competition,
versus 43% occurring in training. Intensity
of the physical combat was found to be a
stronger risk factor than exposure time.The
study also found that although training
took 99% of the time, only 43% of injuries
occurred during training and 92% of the in-
juries sustained by the cohort during com-
petition were to the head [10].
Other arguments in condemnation of box-
ing border on the moral, ethical and legal
grounds.These include observed association
with aggression and criminality [5] as well
as the discreditable demonstration of inter-
personal violence through the media. The
later sparks calls for censorship by authori-
ties such as the Australian Medical Associa-
tion which recommends that media cover-
age of boxing should be subject to control
codes similar to those which apply to televi-
sion screening of violence [11]. It is argued
that the courage and discipline purported to
be provided by boxing can be obtained from
other safer sports.
Boxing fatalities
While surveillance data is generally poor,
boxing fatalities are reported in various
sources, including the media. The cause of
sudden death in the ring is either cardiac or
neurological [12],with subdural haematoma
being the leading cause of death in sports-
related traumatic brain injury [2]. Annually,
about 10 boxers die due to a knockout in
most cases [13]. There were 339 mortalities
between 1950 and 2007 (mean age, 24 ± 3.8
years); 64% were associated with knockouts
and 15% with technical knockouts [14].
There has been a string of boxer fatalities
in South Africa, including the deaths of
Phindile Mwalase and Mswanele Kom-
polo who both died directly as a result of
a blow to the head in 2014 and 2015 re-
spectively. Unfortunately most local boxers
are not well funded and end up seeking
healthcare in public health facilities. Glob-
ally, some deaths have not been mere sta-
tistics but incendiary events that changed
the history of boxing. In 1994 the British
Medical Association made calls for the ban
of boxing following the death of a 23 years
old professional boxer, hours after a box-
ing fight. A blood clot was removed from
his brain. In March 2015, the Australian
Medical Association also called for a ban
following the death of a 23 years old pro-
fessional boxer
The fortune factor
Boxing was never initially intended for
physical fitness, but for the amusement of
ancient nobles and crowds, against the will
of participants who were often slaves. To-
day, boxers have autonomy and they partake
in boxing for a variety of reasons. A certain
national boxing authority identifies fitness
merely as an ‘additional benefit’ of boxing
[1]. It is highly unlikely that many modern
fighters climb into the ring just to entertain
There is something else phenomenal lurk-
ing behind the craze of boxing. Although
few of them reach the level of better-paying
professional boxing, “for young men, in this
place [Eastern Cape Province, South Africa],
boxing is the only way out of poverty” (em-
phasis mine) [15]. This telling expression
reveals the power of the lucrativeness of this
‘sweet science’ to many aspiring boxers in
deprived circumstances in various parts of
the world. Not surprisingly, needy parents
of such ambitious youngsters seem to accept
and encourage the pursuit of a boxing career
as a straight route out of poverty.
Under the fortune proposition, it becomes
easy to explain boxers’ tendency to hide
their unfitness or previous injuries. Noh et
al. found that “of the athletes who returned
to training following injury, only 19.33%
of them had completed their full treat-
ment. Most returned to training early due
to greed” [16]. Some sources also note that
the pressure to participate while injured or
not having fully recovered may come from
coaches and managers [17].
One wonders how many youngsters go
into the boxing sport without fully under-
standing the risks. Ironically, many box-
ers, most probably in the African milieu,
die bankrupt. In the article Whores, Slaves
and Stallions: Languages of Exploitation and
Accommodation among Boxers [18], Wac-
quant eloquently elucidates the ‘corporeal
exploitation’ and manipulation of boxers
by “flesh peddlers”, i.e. the promoters and
matchmakers who further their financial
interest at the expense of boxers’ safety and
dignity. Against the constant plea by box-
ers and boxing structures for more boxing
sponsorship, the British Medical Associa-
tion, one of the most ardent opponents of
boxing, criticises increased funding for
boxing [19].
Boxing legality in various
countries and the banning-
unbanning ‘seesaw’
While boxing participation and spectator-
ship continues to be huge and permitted
in many countries, in other countries it is
either outright untolerated — as in Ice-
land, Iran and North Korea — or has been
on a legal pendulum. For example, Albania
banned boxing in 1960 only to unban it
in 1991. In Sweden, boxing was forbidden
from 1970 until 2007, when the country
amended boxing conditions. Recently, two
more countries, Cuba and Norway, joined
the unbanning bandwagon in 2013 and
2014 respectively. The ongoing wave of un-
banning in countries appears to be based
on considerations not quite allied to boxers’
Clearly, boxing has failed to garner attrac-
tiveness among medical bodies, a number
of whom possesses official positions con-
demning boxing or some forms of it on
the basis of scientific evidence. The World
Medical Association (WMA), a represen-
tative body for 112 national medical asso-
ciations and about 10 million physicians,
issued a statement recommending the ul-
timate banning of boxing [20]. Among the
medical associations supporting banning
of boxing are the Australian, American,
British, Canadian, Irish, Danish, Finnish,
Portuguese, German and Belgian medical
associations [21, 4]. Other medical bodies,
such as the South African Medical Asso-
ciation, currently do not have official posi-
tions on boxing.
Role of the ringside physician
To the medical fraternity, the boxer’s health
and safety is the first concern. Many medi-
cal professionals serve as sports physicians
rendering medical services in various capac-
ities at sporting events. In the 2012 London
Olympic Games, 5000 medical volunteers
were involved. Such roles require physi-
cians to possess appropriate skills, educate
boxers or parents about the risks of box-
ing, be cognisant of possible litigation [22],
and exercise personal choice on whether or
not to provide care in boxing events [17].
The ringside physician, as part of an inte-
gral multidisciplinary boxing team, plays
a part at each stage of the boxer’s career,
such as issuing of boxing licences; pre- and
post- contest examinations; involvement in
training; attending to boxers during com-
petition; and performing annual medical
evaluations [23].
The relationship between the boxing referee
and the ringside physician is a contentious
subject that is discussed elsewhere [12]. By
virtue of their training, ringside physicians
are uniquely positioned to assess boxers’
health risks and to avert catastrophic inju-
ries and deaths in the ring. Calls have been
made (for example, by the World Medical
Association and the Australian Medical
Association, among others) for ringside
Table 1. Medical Organisations’ Position Statements on Boxing Ban
Organization Position Organization Position
American Medical Association
Recommends that until boxing is banned, head
blows should be prohibited
American Academy of Paediatrics
Opposes boxing as a sport for any child, adolescent,
or young adult
Australian Medical Association
Opposes all forms of boxing; recommends the pro-
hibition of all forms of boxing for people younger
than 18 years
British Medical Association
Opposes amateur and professional boxing; calls for
complete ban on boxing; recommends banning box-
ing for those younger than 16 years
Canadian Medical Association
Recommends that all boxing be banned in Canada
World Medical Association (2005) Recommends that boxing be banned
physicians to be given the power to termi-
nate a bout [20, 11].
Boxing safety standards
Interventions to enhance boxing safety dif-
fer from country to country. Although a
series of vital amendments to boxing rules,
standards and equipment that were gradu-
ally implemented since the 20th
century have
minimised the risks in boxing, neurological
and non-neurological injuries have contin-
ued with this sport [24]. This demonstrates
that the intervention measures may not be
adequate. As with any other sports, boxing
injury risk cannot be totally eliminated, but
lessened. Risk to the head remains. Even in
amateur boxing, where a knockout is less
common, there is still a risk of concussion
from blows to the head [22]. Although in
most countries, including South Africa,
boxing is regulated, the health and safety
of boxers is not adequately emphasized. In
a number of countries, the governments or
boxers carry the costs of health care and in-
surance companies do not usually provide
cover for health care or disability amongst
boxers.The boxers are at risk of catastrophic
health expenditure. Boxers often rely on
governments for social security grants in
case of disability. The current WMA state-
ment, inter alia, is propounding an injury
preventive approach that includes: strict
medical evaluation of boxers,education,im-
provement and use of safety equipment,and
the active role of ringside physicians.
Whilst banning boxing will be an ideal pre-
vention strategy, in the absence of banning,
international boxing bodies, governments
and local boxing bodies must develop ev-
idence-based injury prevention measures
amongst boxers. The medical surveillance
should be implemented starting at the be-
ginning of boxer’s careers and to the grave.
This will provide information on long term
sequelae of boxing and risk reduction strat-
egies.The boxers must have access to quality
health care services and be protected against
financial catastrophe. Doctors looking after
boxers must promote evidence-based pre-
vention, treatment and rehabilitation of
1. Boxing South Africa. 2012/2013  – 2016/17
Strategic Plan. 2012
2. Ling H, Hardy J, Zetterberg H. Neurologi-
cal consequences of traumatic brain injuries in
sports. Mol Cell Neurosci. 2015; 66:114–122.
3. World Medical Association. WMA Calls
For Ban On Boxing. 2000. Available from:
4. Zazryn T R, Finch C F, McCrory P. A 16 year
study of injuries to professional boxers in the
state of Victoria, Australia. Br J Sports Med.
5. Förstl H, Haass C, Hemmer B, Meyer B, Halle
M. Boxing—Acute Complications and Late Se-
quelae, from Concussion to Dementia. Dtsch Ar-
ztebl Int. 2010; 107(47): 835–9. DOI:10.3238/
6. Ann C. McKee AC, Cantu RC, Nowinski JE,
Hedley-Whyte T, Gavett BE, Budson AE, et al.
Chronic Traumatic Encephalopathy in Athletes:
Progressive Tauopathy following Repetitive
Head Injury. J Neuropathol Exp Neurol. 2009;
68(7): [cited 2015 Nov 19 ]; 709–735. Available
from: doi:10.1097/NEN.0b013e3181a9d503.
7. Stiller JW, Yu SS, Brenner LA, Langenberg P,
Scrofani P, Pannella P, et al. Sparring and neu-
rological function in professional boxers. Front.
Public Health. 2014; 2:69 [cited 2015 Nov 19].
Available from: doi: 10.3389/fpubh.2014.00069
8. Siewe J, Rudat J, Zarghooni K, Sobottke R, Ey-
sel P, Herren C, et al. Injuries in Competitive
Boxing. A Prospective Study. Int J Sports Med.
2014. [Internet] [cited 2015 Nov 19 ], Available
from: doi: 10.1055/s-0034-1387764.
9. American Academy of Pediatrics. Policy State-
ment—Boxing Participation by Children and
Adolescents. Pediatrics. 2011;128:617–623
10. Zazryn T, Cameron P, McCrory P. A prospec-
tive cohort study of injury in amateur and pro-
fessional boxing. Br J Sports Med. 2006; 40:670–
11. Australian Medical Association (AMA) Posi-
tion Statement on Boxing. 1997. Reaffirmed
12. Sethi N K. Boxer safety, and the relationship
between the referee and the ringside physician.
S Afr J Sports Med. 2015; 27(1):3; [cited 2015
Oct  6]. Available from: DOI:10.7196/SA-
13. Svinth, Joseph R. Death under the Spotlight:
The Manuel Velazquez Boxing Fatality Col-
lection. Journal of Combative Sport .2007 [cited
2015 Oct 22 ] Available from: http://ejmas.com/
14. Baird LC, Newman CB, Volk H, Svinth JR,
Conklin J, Levy ML. Mortality resulting from
head injury in professional boxing. Neurosurgery.
2010; 67(5):1444-50.
15. Media Club South Africa. From Mdantsane to
the world: The Eastern Cape’s champion box-
ers. [cited 2015 Nov 15 ] Available from: http://
16. Noh JW , Park BS, Kim MY, Lee LK,Yang SM,
Lee WD, et al. Analysis of combat sports play-
ers’ injuries according to playing style for sports
physiotherapy research. J Phys Ther Sci. 2015; 27:
17. British Medical Association Science and Edu-
cation department and the Board of Science.
An information resource for doctors providing
medical care at sporting events. 2014.
18. Wacquant L. Whores, Slaves and Stallions:
Languages of Exploitation and Accommoda-
tion among Boxers. Body & Society. 2001.Vol 7
(2 – 3): [Cited 2015 Nov 23];181 – 94. Available
from: http://loicwacquant.net/assets/Papers/
19. Hawkes N. BMA criticises increased funding
for boxing. BMJ. 2012; 345.
20. World Medical Association. Statement on Box-
ing. Adopted 1983, editorially revised 2005
21. British Medical Association Scientific Depart-
ment. The Boxing Debate. 1993
22. Lecrerc S, Herrera CD. Sport medicine and the
ethics of boxing. West J Med. 2000 Jun; 172(6):
23. SA Journal of Sports Medicine; Issue 10, Special
Feature: Boxing.1982
24. Loosemore M, Lightfoot J, Beardsley C. Box-
ing injuries by anatomical location: a systematic
review. Journal of the Romanian Sports Medicine
Society. 2015; vol. XI( 2): 2583-2590
Bernard Mutsago, Health Policy Researcher,
South African Medical Association.
Selaelo Mametja,Head: Knowledge
Management and Research Department,
South African Medical Association
Mzukisi Grootboom,Chairman, South
African Medical Association
E- mail: BernardM@samedical.org
Tobacco Smoking BELGIUM
Media regularly mention the measures to
reduce the number of smokers and tobacco
consumption in general. Such measures are
sporadically but begrudgingly taken. Nev-
ertheless, tobacco consumption is a real
pledge for health and deserves to mobilize
all efforts.
Adult smokers have to leave public places
to satisfy their bad habit but people still
have to go through the smoky cloud.
Smokers jeopardize not only their own
health but first and foremost other people’s
Still the main victims are children, particu-
larly in the private sphere. They have not
chosen it, but they are prejudiced twice.
First of all because of the passive smok-
ing whose harmfulness is well known. It
seems it is even worse than active smoking
in open spaces. Secondly, they are under
the influence of adults’ example (parents in
particular) who give them a positive im-
age of smoking. We all know that most
children whose parents smoke also become
It is of paramount importance to protect
children. Small infants run more risk of
suffering from respiratory infections when
submitted to a smoky environment. In such
cases, infections are more severe.
Teenagers under the influence of their
parents and adults in general are tempted
to smoke and start at a very young age.
Therefore, they are one of the favorite target
groups for tobacco companies. Since these
are killing their customers, they have to
replace them on a more regular basis. To-
bacco is impregnated and treated to make
cigarettes more enjoyable but above all to
speed up the addiction process. They de-
velop commercial and advertising strategies
in order to interest as many people as pos-
sible – the younger, the better.
Keeping our children away from this pledge
should be a priority. Smoking kills more
than terrorism.
With this in mind, children should live in a
tobacco-free environment from a very early
age: without smoke and without any relat-
ed waste product. They also should evolve
without any advertising message which
could give a positive image of smoking.
It is up to the legislator to take measures
concerning those advertising messages.
As far as the non-smoking environment is
concerned, many initiatives have already
been taken but the legislators,wherever they
come from, are afraid of interfering in the
private sphere. This is wrong. One person›s
freedom ends where another›s begins and it
is the same about private life, in particular
when it concerns children.
The first step should consist of introducing
in children’s rights the right to live in a non-
smoking environment. This way, this right
will naturally extend to the private sphere.
Every house, common area or kid’s bed-
room (at least the one where he/she sleeps)
must be smokeless.The same applies to cars
in which children are transported.
Is this an invasion of privacy? Is this objec-
tive impossible to achieve?
I do believe it is possible. Most countries
legislated to make corporal punishments
illegal. This prohibition applies to both the
family framework and the family home.
Even if we know that the aim has not been
totally achieved, it has had an unprecedent-
ed influence on society.
In Belgium, plenty of social workers are
visiting families to check on feeding and
care babies or infants receive. Their work
is mostly educational but can also include
more coercive guidance.Social workers have
means of action in case mistreatments, for
example, are observed. Smoking in a child’s
environment is a kind of mistreatment. We
must consider it as an abuse. We must do
Maybe legislators will take measures. If
so, they will act reluctantly, as usual. They
should feel the moral pressure of the whole
society on their shoulders.
May everyone feel responsible for this issue!
Dr. Roland Lemye
Belgium Association
of Medical Unions
E-mail: info@absym-bvas.be
Carte Blanche on Smoking
Roland Lemye
Digital prescription or ePrescription is un-
derstood as the process of electronic trans-
fer of a prescription by a healthcare provid-
er in a primary care or community health
centre setting to a pharmacy for retrieval
of the drug by the patient [1, p.  36]. In
2010 only a few European countries used
e-prescription system in full  – electronic
prescribing was possible in 15 countries,
electronic transfer to the pharmacy – in 9
countries, and dispensation data were re-
corded in 7 countries [1, p. 7].
In Estonia, e-prescription was launched on
1 January, 2010 as a complete nation-wide
system. According to the data of the Es-
tonian Health Insurance Fund (EHIF) in
2014, 98.5% of all prescriptions in Estonia
were issued in the format of e-prescription.
The authors’ aim was to study the current
e-prescription related experiences of fam-
ily physicians in other European countries
in 2014.
The survey was done and reflects the data of
2014.To gather the relevant data a question-
naire consisting of 14 multiple-choice ques-
tions with a space for free text commentary
was sent to representatives of pan-European
quality and safety promoting organization
(EQuiP) member countries and to experts
in non-EQuiP countries Latvia and Lithu-
ania. In 2014 representatives of 23 European
countries belonged to EQuiP. Altogether we
received answers from representatives of 25
countries and the current analysis is based
on these answers except for Greece where
major inconsistency was found between the
answers from the expert and international
reports, according to which the answers
were corrected [2]. Representatives of Croa-
tia, United Kingdom, Belgium, Denmark,
Germany, Norway, Slovenia, Spain, Turkey,
Austria, Czech Republic, Estonia, Finland,
France, Greece, Hungary, Ireland, Italy, Lat-
via, Lithuania, the Netherlands, Portugal,
Poland, Sweden, and Switzerland completed
the questionnaire. All respondents were ex-
perts whose jobs were related to the field
of family medicine – practicing GPs, those
involved in training of GPs, scientists or
healthcare managers of family medicine.
Out of the 25 participating countries, a na-
tion-wide e-prescription system existed in
nine countries: Estonia, Finland, Sweden,
the Netherlands, Denmark, Turkey, United
Kingdom, Croatia, and Greece. Region-
ally functioning e-prescription system was
in Spain and Italy, and it was organized be-
tween some partners – insurance providers,
healthcare providers, and pharmacies  – in
three countries: Belgium (ongoing pilot proj-
ect), the Czech Republic and Norway. Digi-
European Countries Moving Towards
Digital Prescription
Le Vallikivi
Figure 1. Existence of digital prescription system in the responding countries (01.07.2014)
E-health ESTONIA
tal prescription did not exist in eleven coun-
tries: Austria, France, Germany, Hungary,
Ireland, Latvia, Lithuania, Poland, Portugal,
Slovenia, and Switzerland. In the countries
where digital prescribing was available (Fig-
ure 1), around 90–100% of the prescriptions
were issued using the digital system.
There was no digital prescription system or
it existed only between selected partners in
14 countries altogether. In most of these
countries there were ongoing discussions
about digital prescription or such a system
was about to be launched in the near future.
According to the opinion of the representa-
tives of Ireland and Switzerland there had
been no discussions about implementing a
nation-wide digital prescription system in
these countries, however, according to the
Swiss e-health strategy report [3] such dis-
cussions have been held.
In European countries, the systems for han-
dling prescriptions had diverse structures
for collecting various data at various levels.
A nation-wide prescription database ex-
isted in eleven of the responding countries;
in two countries, the database existed at the
regional level and in four countries, there
was a database between certain partners.
A  healthcare provider based database ex-
isted in two countries. No database existed
in Lithuania (Table 2).
Seventeen countries used the database to
manage various medication-related data
(Figure 2). The database usually contained
information about the active substance, trade
name of the medicament, prescribed dosage,
patient and doctor writing out the prescrip-
tion.In several countries,the database also in-
cluded information about the purchase made
according to the prescription (Figure 2).
In all countries, the doctor could obtain in-
formation about the treatment the patient
was receiving as reported orally by the pa-
tient or in written form from the doctor.
Medication data were available to the doctor
in the form of electronic interaction in eight
countries; in three countries, this informa-
tion was available in the regional database
and in four countries only within the re-
spective healthcare institution. Experts from
several countries (Norway, Belgium, United
Kingdom) indicated that family doctors and
other specialists differed in their possibili-
ties to access the prescription data, e.g. the
systems allowed to follow the prescriptions
issued by GPs but not by other specialists.
In many countries, various data sets to as-
sist in prescribing were available (Figure 3).
Supported by linking different e-solutions
the system provided pre-filled information
of the prescribing doctor, healthcare pro-
vider and patient, thereby diminishing both
manual input and error, influencing sig-
nificantly both quality and safety. No e-pre-
scribing system gave a possibility to assess
the use of over-the-counter medication yet.
The exact definition of clinical decision sup-
port system was not given before asking the
Table 1. Discussions on nation-wide digital prescription system as future perspective.
Yes, digital prescription system will be
implemented in the near future
Yes, but different parties have
different opinions
No discussion
Czech Republic
Table 2. Existence of central prescription database in responding European countries.
central database
Database between
certain partners
Health care
provide database
No database
Czech Republic
United Kingdom
Trade name and substance name
Patient’s personal information
Prescribing physician’s data
Medical service provider’s data
Insurance and reimbursement
Data about dispensing the drug
Drug’s interactions and side effects
0 1412108642 16
Figure 2. Information in central database, number of countries
experts about its existence and functionality.
The answers indicated that no decision sup-
port existed in 11 countries out of 25, in the
rest of the countries there was some level
of clinical decision support. There was no
country with 100% decision-making support
system coverage for all the doctors. The ex-
tent of the decision support application was
different between countries. For example, in
Finland around 40% of GPs and 50% of hos-
pital based doctors used the EbMed decision
support system, while in Belgium there were
certain support modules in only one or two
parts of the medical software out of 17.
The nature and content of decision support
depended on the software used by the par-
ticular GP. In some countries, for example
Germany, optional software supplements
for decision support were available at an ex-
tra cost. The most extensive functionalities
of the decision support system have been
developed in Finland.
The most often encountered ways of deci-
sion support dealt with pharmacological
data of the medication, drug interactions,
adverse reactions, warning about patient’s
allergies, concurrent diagnosis, gender and
age-based warnings and helped with correct
dosage in accordance with the treatment
guidelines (Figure 4).
Renewals and prescribing
out of office
In eight countries the only way to renew a
prescription was by visiting the doctor. In the
remaining 17 countries, there were various
alternatives: a phone contact with the doc-
tor, visit to the nurse, phone contact with the
nurse, and electronic prescription request or
prescription renewal by the pharmacologist.
In some countries it was possible to request
medication electronically either by sending an
e-mail to the practice or using its homepage.
In 11 countries out of 25 only paper pre-
scription could be issued outside of the doc-
tor’s office. In Denmark, Sweden, the Neth-
erlands, and with some software versions
in Turkey there was a smartphone/tablet
solution for browser based remote desktop.
In Denmark,the Netherlands,Finland,UK,
and Ireland it was possible to order a pre-
scription from the pharmacy by phone. In
Portugal, Greece, Finland, UK and Den-
mark it was possible to prescribe over the
internet. In Switzerland, France and Den-
mark it was possible to send a prescription
to the pharmacy by fax.
Feedback about prescribing
Doctors received systematic feedback on
prescriptions in 16 countries. Surpris-
ingly there was no feedback system in well
digitalized Finland and Norway. Doctors
did not receive systematic feedback on the
medications they had prescribed also in It-
aly, Ireland, Latvia, Switzerland, Germany,
Poland and Slovenia. The most common
kind of feedback dealt with the prescrip-
tion’s compliance with clinical guidelines
(15 countries), and also with cost control by
encouraging prescription of generic medi-
cations (10 countries). Usually the institu-
tions giving feedback were insurance com-
panies or healthcare regulating institutions.
Benefits and harms of
digital prescribing
According to the respondents’ responses,
the benefits of the digital prescription sys-
tem from the doctors’ points of view were
the following: complete overview of the
patient’s medication, indirect information
about the treatment compliance with the
dispensation data. Issuing the prescription
was easier, faster, and safer for the patient
Data of reimbursement
Data about the medical service provider
Prescriptions prescribed by other doctors
Data about patient’s medical insurance
Drug interactions database
Drug information database (SPC)
Possibility to copy previous prescriptions
Patient’s personal data
None, doctor fills out all the fields manually
0 2015105
Figure 3. E-health solutions to help the prescribing doctor, number of countries
Warnings about patient’s allergies
Drug interactions
Access to pharmacological information
Help determining the dosage
Intercurrent diagnosis
Side effects of the drug
Compliance with clinical guidelines
Age-based warnings (e.g. children)
Renal malfunction and drug dosage
Gender-based warnings
0 10642 8 12
Figure 4. Functions of clinical support systems, number of countries
E-health ESTONIA
(decision support assisted, for example, in
dosing, selecting the most suitable medi-
cation, and selecting applicable discount).
The experts presumed that from patient’s
point of view receiving the prescribed medi-
cation got faster, easier and safer, the pre-
scription could be requested over the inter-
net or by phone; the patient could not lose
the prescription.
As concerns pharmacists, the main benefit
was that prescriptions were 100% readable,
and handling was fast and safe – there were
fewer errors due to misreading or typing.
Pharmacists needed less time to enter the
prescription; in addition, a pharmacist was
better informed when advising the patient
if there was access to the information about
all the medications prescribed.
The experts saw simplicity and safety of
the system as its most important benefit
for society: a patient, healthcare provider
and pharmacist could save time. There was
a good overview of both: the prescribing
practice and dispensation giving a possi-
bility to analyze the treatment quality and
treatment costs, there was timely and accu-
rate overview available for different partners
in the system.
According to the respondents’ responses, the
transit to digital prescription has not been
flawless and has caused problems unknown
during the paper-prescription era. Episodic
disturbances in the internet, prescription cen-
tre’s or GP’s software were causing occasional
disruptions in the functioning of the system.
From the doctors’ point of view, there was
occasionally insufficient systematic control
over repeat prescriptions and the patient
might get the medication for a long time
without meeting the doctor even if it was
needed.There is apprehension that the doc-
tor-patient relationship was transforming
to be even more computer-centred.
From the patient’s point of view the concern
was most often related to a patient loosing
contact with the doctor.It was sometimes dif-
ficult for a patient to understand the prescrip-
tions, and there was a need to turn to a phar-
macy or the GP office to check the details.
The experts presumed that for pharmacists
the digital prescription system required
more IT knowledge and IT equipment in
the pharmacy.
As concerns society the experts saw as po-
tential problematic areas the security of sen-
sitive personal data as well as weakening of
the relationship between the doctor and the
The purpose of this study was to get an
overview how widely the digital prescribing
is used in European countries, how the sys-
tems work and whether they are connected
to nation-wide or regional databases, and
whether there are supporting mechanisms
for safe prescribing.
From the quality and safety aspect, digital
prescription provides an excellent opportu-
nity to prevent treatment errors and support
the compliance of clinical practices with the
current treatment guidelines through the
decision support system. The central da-
tabase provides an opportunity to analyze
prescribing on the whole and at the level
of single practitioner’s practice. Adequate
feedback mechanisms enable to introduce
changes into the prescribing practice.
The dream of pan-European digital pre-
scriptions may remain a dream for a long
period of time. There are large differences
in the digital prescription systems in Eu-
ropean countries. Still, the benefits of the
system outweigh the difficulties. The ex-
perience of developing and implementing
the digital prescribing system in different
countries provides all partners with valuable
information on developing novel combined
IT-services for healthcare and a possibility
to avoid mistakes made in other countries.
Katrin Martinson
Green Health
“This year our office will go green.” Have
you said or thought this? Has this been a
goal for your office, clinic or outpatient fa-
cility that you have not accomplished? The
World Medical Association now offers to
its members a new free service, My Green
Doctor, which can make this possible.
My Green Doctor is located on the web at
www.mygreendoctor.org. This practice man-
agement tool has demonstrated that it can
save offices money as they learn environ-
mental sustainability. One large group in the
United States began saving money in the first
month of using this system and continues to
save more than $2000 US per doctor annually.
My Green Doctor is a complete, simple-to-
follow program that is used by those who
work in the office. They learn how to create
and manage an office Green Team, and how
to make changes in the office that make the
office healthier and more efficient. The of-
fice also learns ways to teach these ideas to
the patients. This is another way in which
your practice improves community health
outcomes. My Green Doctor will make
your colleagues and you truly proud.
Why Go “Green”?
First of all, what do we mean by “green”and
why should this be a goal for your office?
“Green” means to become an office that has
reached established benchmarks in man-
aging its environmental impact. With My
Green Doctor, each office decides which
topics are important to and relevant to its
situation. An office might consider how
energy, water, paper products, chemicals or
other resources are used. It might consider
how office staff members and patients travel
to and from the office since our transpor-
tation decisions have an environmental
impact. It might mean changing the foods
we choose to have in the office. My Green
Doctor offers more than 140 Action Steps
and Education Steps to pick from.
Becoming a green doctor office is not dif-
ficult; your Green Teams simply meet over
lunch to make changes according to the
plans provided by My Green Doctor. In
this manner, the office can look forwards to
making gradual improvements that over six
to twelve months provide significant satis-
The benefits are real and nearly immedi-
ate. Your office is likely to save electricity
and water, which is real money. For ex-
ample, a five-office practice in Pensacola,
Florida is saving more than $14,000 US
each year on its electric bill. In addition,
the people who join your office “Green
Team” will enjoy it because each person
is contributing to making their workplace
safer, cleaner and healthier.This builds of-
fice morale and a team approach to prob-
Your patients will see the improvements:
recycling bins in your waiting room, bro-
chures or posters for them to read, a “Green
Doctor Recognition” certificate from the
“This Year Our Office Will Go Green”:
Announcing a New Free Service for
WMA Member Countries
Todd L Sack
1. Stroetmann K, Artmann J, Stroetmann V, Prot-
ti D, Dumortier J, Giest S, et al. European coun-
tries on their journey towards national eHealth
infrastructures – evidence on progress and rec-
ommendations for cooperative actions. Final
European progress report [Internet ]. ehstrate-
gies_final_report.pdf. 2011 [cited 15 January
2016]. Available from: http://www.ehealthnews.
2. Papanikolaou C. Implementation of ePrescrip-
tion in Greece [Internet ]. [Cited 12 January
2016]. Available from: http://ehealth2014.org/
3. Schmid A, Wyss S, Giest S. E-Health Strate-
gies Country Brief: Switzerland [Internet ]. 1st
ed. Bonn, Brussels: European Commission, DG
Information Society and Media, ICT for Health
Unit; 2010 [cited 14 January 2016]. Avail-
able from: https://www.academia.edu/869241/
The authors are thankful to all EQuiP As-
sembly members and Dr.  Dana Mishina,
Dr.  Evelin Hanikat, Dr.  Siiri Johanson,
Professor Vytautas Kasulievicius, Professor
Christos Lionis for their contribution.
Katrin Martinson, Family doctor,
Linnamõisa Family Medicine Center,
EQuiP Estonian representative
Le Vallikivi, Family doctor,
Medicum Family Medicine Center Ltd,
EQuiP Estonian representative
E-mail: perearst.martinson@gmail.com
World Medical Association on your wall,
and likely other measures that will tell them
that yours’ is a modern, progressive office
with a broad interest in their health. My
Green Doctor is designed for doctor offices,
is peer-written, peer-reviewed, non-parti-
san, based on solid science, and is written
to be understood by anyone working in a
medical office.
Text box idea: “Www.mygreendoctor.org is
a free, non-profit site that is based on solid
science and is managed by physicians. It is
easy to use and confidential, plus no ads, pop-
ups, banners, or passwords.”
Getting Started
Start by talking with your practice’s manag-
ing physicians, owners or Board of Direc-
tors. They should agree to adopt environ-
mental sustainability as a core value for your
company and to choose My Green Doctor
to guide the process.My Green Doctor pro-
vides a sample company environmental sus-
tainability policy and a ten-minute Power
Point talk to introduce these ideas. If you
are a large practice, your company will want
to appoint an Environmental Sustainability
Committee that will meet monthly to coor-
dinate your progress.
Each office will learn how to initiate and
manage an office Green Team. The Team
consists of members of the office staff who
are willing to meet monthly over lunch.
The best teams draw volunteers from many
sectors of the office—nurses, front office
staff, cleaning personnel, managers, phy-
sicians, etc. At these meetings, the Team
members will consider Action Steps to
adopt for the office. At subsequent meet-
ings, the Team will review the progress
made as well as the setbacks, and will con-
sider other Action Steps to pursue. Along
the way, the Team decides how to share
this information with other staff members,
with their families and the patients. These
are the Education Steps.
A key early step is to find someone to be
the Green Team Leader. This might be a
physician, an office manager, or anyone who
wants to help out. The leader will sched-
ule the Team meetings, send reminders to
members, and manage the meetings to be
sure that each Action Step has a Champion
who takes responsibility for reporting back
at the next Team meeting. The position of
Team leader can rotate every few months.
The Team will report its progress quarterly
to your Environmental Sustainability Com-
mittee or to the Board of Directors.
Six Tips for Green Team Success:
1. Declare environmental sustainability
to be a core value.
2. Adopt an environmental sustainabil-
ity policy for your practice.*
3. Require Green Teams to meet month-
ly in every office.
4. Make small, steady steps with one
new Action Step each month.
5. Teach: use email, brochures, green
tips, posters, & meetings.*
6. Reward your Team with thanks,praise,
and more.
  *  available at www.mygreendoctor.org/resources
A Green Team’s First Meeting
Your Green Team will not need experts,
outside consultants, or prior knowledge
of environmental management. Ask office
members to join you for your first meeting
over lunch and to register at www.mygreen-
doctor.org (no passwords are needed). They
can bring their laptops or you might pho-
tocopy the one-page “Quick Start, Now!”
guide and the “Quick Start, Now!” Action
Steps from one of the Workbooks.
At the first meeting, the Green Team will
choose one or two Action Steps from any
of the seven Workbooks. It is easiest to pick
from “Energy Efficiency”, “Solid Waste &
Recycling”, or “Drug Disposal & Chemi-
cals”. Each of these workbooks has an
“Introduction” section, a “Background In-
formation” section, and an “Action Steps”
A good place to start is the “Energy Ef-
ficiency” Workbook. You might adopt the
policy to turn machines off at night or
to adjust the thermostats to save money.
For each Action Step, discuss how it will
be implemented, how you will share your
plans with the entire office, pick a cham-
pion from the Team to oversee the Step,
and set a date for completion. Someone
should record your decisions on the Green
Team Notes form provided by My Green
Doctor, and be sure to set the date for the
next meeting.
Your Next Meetings
Plan for your Green Team to meet month-
ly. At each meeting, review the progress
and setbacks experienced with the Action
Steps that you have adopted. Look at other
Workbooks, starting with those that have
the easy “Quick Start, Now!” steps. Read
together the “Introduction” and “Back-
ground Information” sections because
these sections provide the knowledge base
that will engage and empower each mem-
ber of your Team.
After a few months, consider some of the
more ambitious but interesting options for
your office. For example, you might build a
comprehensive energy plan to save big mon-
ey, or reconfigure people’s work schedules­to
minimize their transportation environmen-
tal impacts, or eliminate Styrofoam, bottled
water or hazardous cleaning chemicals.
You could agree to use the “Healthy Foods”
guidelines for food gifts that are brought to
your office by salespeople. You could spon-
sor a community garden or start one your-
selves. You could install a solar hot water
heater or simply turn off your hot water
heater forever as a few offices have done.
You can purchase renewable energy credits
(REC’s) to offset the carbon dioxide pollu-
tion from your office’s energy use.
Green Health
Education Steps: Your
Biggest Impact
Whatever your office does, you will want to
talk about it,perhaps even to brag a bit.Www.
mygreendoctor.org offers dozens of Educa-
tion Steps. These can be a powerful part of
each Green Team meeting. An Education
Step could be a short text message or memo
to co-workers, a brief report at each staff
meeting, or an item in each office newsletter.
For patients, they can be a poster in the wait-
ing room or a sticker on light switches such
as “Please Turn Me Off”. The website offers
many free, downloadable brochures that you
can print and place in your waiting rooms
for your patients to take home (click the Re-
sources tab). Your Green Team will only be
truly effective if you educate those around you.
Green Team members take ideas home to
their families and neighbors. These include
ideas about energy efficiency, wise water
and chemicals uses, healthy food choices,
and healthy transportation decisions. Peo-
ple look to health providers and doctors as
role models; when we recycle, keep organic
gardens, bicycle to work or drive energy-ef-
ficient cars, our patients and neighbors pay
attention. The exchange of information is a
two-way street with Green Team members
often bringing green ideas to the office that
they learn from their children.
Text box idea: “A Green Team’s greatest im-
pact comes from teaching others.”
Green Doctor Office Recognition
Monthly meetings can earn your office the
Green Doctor Office Recognition certificate
within six months. The office must meet the
standards established and maintained by
My Green Doctor physicians. These include
completing five Green Team Meetings, im-
plementing five Action Steps, and complet-
ing five Education Steps.The “Nuts & Bolts”
tab of www.mygreendoctor.org describes
how to record your Green Team Notes and
how to submit your documentation.
Going Green, For Good
Businesses large and small have been “go-
ing green” for decades. Their motivations
are as diverse as their business plans and
profit margins. Like doctor offices, most
start because they want to save money
and most accomplish that. But many busi-
nesses report that the non-monetary ad-
vantages are the most rewarding and are
gained when businesses not only “go green”
but also stay green “for good”.These offices
have used the greening process to foster a
culture of teamwork, resources conserva-
tion and mutual respect. The World Medi-
cal Association is proud to offer My Green
Doctor to its members without a fee and
urges you to register your office today.
Todd L Sack,
MD, Florida physician in private
practice for more than twenty years;
editor My Green Doctor for the WMA.
E-mail: tsack8@gmail.com
On the International Public
Coordination Health Committee
The International Public Coordination
Health Committee was established on
May 15, 2015, in Almaty, Kazakhstan, at
the initiative of the National Medical As-
sociation of the Republic of Kazakhstan
and the non-commercial partnership the
National Medical Chamber of the Russian
Federation. The purpose of the Commit-
tee is to create a dialogue platform for the
medical community from different coun-
tries and various medical organizations
and associations whose activities are aimed at improving the quality
indicators of health and preservation of human life.
The Headquarters of the International Coordination Public Health
Committee is at the office of the National Medical Association in
Almaty, 117/1 Kazybek bi str.
On October 13, 2015, in Moscow the first meeting of the Inter-
national Public Coordination Health Committee was held which
took place at the Research Institute of Emergency Children’s Sur-
gery and Traumatology. The meeting was attended by representa-
tives of Belarus, Bulgaria, Greece, Kazakhstan, Latvia, the Prid-
nestrovian Moldavian Republic, Russia and Finland.
The meeting adopted Regulations on the International Public Co-
ordination Health Committee and regulations on the following
structural units: Eurasian Council on Bioethics, Eurasian Council
on Mediation in Healthcare, International Committee on Infor-
matization of Health and International Committee on Indepen-
dent Expertise of Treatment Quality. The Heads of the units were
nominated and approved.
The Committee welcomes further cooperation through Memoran-
dum of International Cooperation and Mutual Understanding in
Health Sector which now is open for signing to all organizations.
Address: Kazakhstan, 050 000 Almaty,
117/1 Kazybek bi str
E-mail: doctor_sadykova@mail.ru
Fax/tel: +7 727 2 331890
Aizhan Sadykova
Australian Medical Association
Office Bearers:
President: Professor Brian Owler, a Neuro-
surgeon based in Sydney, Australia
Vice President: Dr. Stephen Parnis, an
Emergency Physician based in Melbourne,
The AMA is the peak representative and
advocacy body for all registered medical
practitioners and medical students in Aus-
Medical students can join the AMA for free and are supported with
advocacy, lobbying and mentoring.
AMA membership provides political representation, political and
professional lobbying, media commentary, public health advocacy,
workplace representation and advice, career advice and support, in-
dustrial relations expertise and craft group representation.
Members shape and debate current issues facing the medical work-
force and patients. Policies are developed at the association’s annual
National Conference.
The AMA publishes two magazines that are distributed to all mem-
bers and which contribute to national information and debate on
medical research and health policy.
The prestigious Medical Journal of Australia, which celebrated its
centenary in 2014, publishes peer reviewed medical research papers
and provides a forum for debate on pressing clinical issues.
In addition, the AMA publishes a fortnightly national news
magazine, Australian Medicine, which keeps members informed
about national and international developments affecting health
policy, as well as updates on the Association’s policy and advocacy
The AMA has a strong presence in national health policy debates.
It is one of the nation’s most active lobby groups, and maintains a
strong network of contacts among Government Ministers, Federal
politicians and political parties.
It frequently presents submissions to, and appears before, parlia-
mentary inquiries into health issues, and is also represented on
many government committees, advisory bodies and instrumentali-
ties, ensuring that the voice of the profession is heard well before
decisions are made.
The AMA keeps politicians informed about the views of the profes-
sion in order to help achieve better health outcomes for all Austra-
The AMA frequently runs campaigns to influence government de-
cisions and policies.
All policies and advocacy by the AMA is conducted in the interests
of patients and the medical profession.
AMA House, 42 Macquarie Street, Barton, ACT, Australia, 2600
Secretary General Anne Trimmer
Ph: 61 2 6270 5460; Fx: 61 2 6270 5499
E-mail: atrimmer@ama.com.au
Website: www.ama.com.au
Austrian Medical Chamber
(ÖÄK – Österreichische Ärztekammer)
Office Bearers:
President: Dr. Artur Wechselberger
Vice Presidents: Dr. Karl Forstner,
Dr. Harald Mayer
International Affairs: Dr. Johannes
Steinhart, Dr. Reiner Brettenthaler
Directors: Dr. Lukas Stärker, Dr. Johannes
Membership: According to the Austrian
Medical Act, the Austrian Medical Cham-
ber represents the professional, social and economic interests of all
doctors engaged in medical activities in Austria.Furthermore,it acts
as umbrella association under public law for its nine members, the
medical chambers in the Austrian provinces. Membership is obliga-
tory for every doctor wishing to pursue medical activities in Austria.
Activities and Services:Legal responsibilities of the Austrian Medical
Chamber include, besides others, admission to and administration of
the medical register, as well as recognizing foreign medical qualifica-
tions. Furthermore, the Austrian Medical Chamber is the competent
authority for issuing medical diplomas and for conducting specialist
and GP qualifying exams.The elaboration of concepts,expert opinions
and proposals regarding the Austrian health care system, including the
right to comment on draft bills or enacting guidelines on medical fees,
on the medical code of conduct etc., as well as concluding contracts
with social insurance institutions and collective agreements, and exe-
cuting disciplinary legislation and arbitration also belong to the respon-
sibilities of the Austrian Medical Chamber. Moreover, the Chamber
is involved in the elaboration of specialist and GP training programs,
and it also has its own institution offering CME/CPD for Austrian
medical doctors. The Chamber provides counselling for its members
in issues relating to professional law and in international matters. In-
formation for members is provided on the website and in the journal
of the Austrian Medical Chamber (Österreichische Ärztezeitung).
Brian Owler
Artur Wechselberger
NMA news
International collaboration: Besides its WMA membership, the
Austrian Medical Chamber is also a member of AEMH, CEOM,
ZEVA. The Austrian Medical Chamber actively participates in the
work of these organisations and regularly attends meetings.
Vision:The Austrian Medical Chamber aims at achieving a positive
framework for medical practice in Austria.This includes in particu-
lar the improvement of the specific working conditions for doctors.
Thereby, the work of the Austrian Medical Chamber constitutes a
major contribution to the wellbeing of the patients and the Austrian
healthcare system in general.
Weihburggasse 10-12
1010 Wien
E-mail: post@aerztekammer.at
Website: www.aerztekammer.at
Association Belge des Syndicats
Office Bearers:
President: Dr. J. de Toeuf
Vice-President: Drs. M. Moens –
L. De Clercq – R. Lemye – M. Vermeylen
Secretary General: Drs. M. Masson –
Y. Louis
Treasurer: Dr. L. Herry
Head of International Affairs:
Dr. B. Maillet
Activities: The ABSyM/BVAS (Belgian Association of Medical
Unions) was created in 1963 as a reaction to the decision of the
government to oblige the medical profession to be regulated by the
Belgian State. Belgian physicians thought that this system could
not match their medical ethics which is based on a doctor-patient
relationship of trust implying free choice of a doctor by a patient,
doctor’s therapeutic freedom as well as secrecy.The rules and legisla-
tion established by the State affected those principles.
Quite rapidly, physicians from all over the country get organized
and created doctor’s associations on the ground. Those associations
federated and developed necessary means to deal with conflicting
situations. This association that is presently called ABSyM/BVAS
was the successor of the former Belgian Medical Federation (Fé-
dération médicale belge – FMB) which was unable to organize a
resistance movement.The conflict raised the year after,in 1964,with
a medical strike that lasted nearly one month and had been very
well planned.The medical corps, organized as an emergency doctor
service, then proposed nothing more than depersonalized care, ac-
cording to the modalities and procedures the government wanted to
establish. As the conflict got worse and since the government had
decided to requisition physicians, the ABSyM/BVAS launched a
“luggage” operation. Most of the physicians went abroad to escape
the potential requisitions.This operation brought the government to
give in on this issue. The conflict led to some agreements that fore-
saw an annual collaboration system between the ministry of public
health and social affairs, mutual companies and physicians which
allowed the coexistence of a medical private practice and a social
financing.This annual or biennial agreements’system is still ongoing
although it has been dealing with many problems and had to tackle
the evolution of the medical profession in which it is often diffi-
cult to fully preserve the Hippocratic principles. Let’s think about
the control over expenditure, the necessity of teamwork but also the
exchange of data which is the inevitable consequence to reach the
necessary balance.
The ABSyM/BVAS did not only focus on union defense. It has
been firmly committed in the defense of patients’ interests and dia-
logue with them, who have also formed associations. The ABSyM/
BVAS has been committed in the quality of care thanks to an incen-
tive system rather than restraints and sanctions. Furthermore, the
ABSyM/BVAS gives priority to security and patients’ rights and
also organizes direct dialogue with other health care professionals
(pharmacists, dentists, nurses, physiotherapists…). It also takes care
of the working conditions of physicians and their health. Its sphere
of activity is as extended as the one of associations but in the mean-
time, it also preserves means of action when the negotiation shows
no signs of good results.The Belgian “defederalization”which is cur-
rently ongoing gives the ABSyM/BVAS new concerns, especially
since it remains one of the few unitary organizations in the country.
Nevertheless, the strongly professionalized ABSyM/BVAS is look-
ing to the future with confidence.
The ABSyM/BVAS is active in many organs of the INAMI/RIZIV
(Belgian Federal Institute for Health Insurance), such as the Gen-
eral Council,the Insurance Committee,the Assessment Committee
of Medical Practices with regard to Medicines, the Drug Reim-
bursement Commission, etc. and is also represented into work-
groups of the Public Health Ministry.
Chaussée de la Hulpe 150
B – 1170 Brussels
Phone: +32 2/644 12 88
E-mail: info@absym-bvas.be
Website: www.absym-bvas.be
J. de Toeuf
NMA news
Brazilian Medical Association
Office Bearers (2014–2017):
President: Florentino de Araujo Cardoso
1st Vice-President: Eleuses Vieira de Paiva
2nd Vice-President: Lincon Lopes Ferreira
Secretary General: Antônio Jorge Salomão
1st Secretary: Aldemir Humberto Soares
1st Tresurer: José Luiz Bonamigo Filho
2nd Treasurer: Miguel Roberto Jorge
Director of International Affairs: Nivio
Lemos Moreira Junior
Membership:Any medical doctor from any
State in the country can join the Brazilian Medical Association as
a regular member if he/she is a regular member of his/hers State
Medical Association which are Affiliated to the AMB. Medical
Students can join as associate member and has its representation
through the Young Doctor Committee.
Services provided:The main services provided by the AMB to their
members are: Board Certification along with the respective Spe-
cialty Society, the Brazilian Hierarchical Classification of Medical
Procedures which defines the minimum cost of medical procedures
should be, news and scientific publications, representation of their
interests in national and international forums.
• for Members: a Continuing Medical Education Program,the Evi-
dence Based Medical Guidelines Project,cultural activities,Medi-
cal Meetings, Members Benefits Club and Leadership Program.
• for the Public: Salve Saúde (Cheers Health) – Campaign to pro-
mote healthy habits and the prevention of Non Communicable
Chronic Diseases. Caixa Preta da Saude ( Health Black Box) –
Campaing to encourage the population to denounce precarius
conditions of health services. Patient Safety Commission . Elec-
tronic Prescription.
With the Government: a Law Proposal to increase yearly fund-
ing for health to a minimum of 10% of the GDP, lobby at the
Ministry of Education for quality control when approving new
and inspecting existent medical schools and Medical Residents
Training Program , lobby at the Ministry of Health for adoption
of a medical career in the public services, and improve the quality
of Public Health Care.
With the Media: press releases related to health issues of public
interest, promotion of debates related to health policies, educa-
tion on health related issues, Social Media and Digital Comu-
With Strategic Partners: special programs with pharmaceutical and
health insurance companies, and financial institutions aiming to
promote health information to the public as well as to provide free
access to scientific publications to Brazilian physicians. Exchange of
information and activities with others National Medical Associa-
tions and International Health Organizations.
Rua Sao Carlos do Pinhal 324,
CEP 01333-903, São Paulo-SP, Brazil
Phone: +55 11 31786800
Email: internacional@amb.org.br
Website: www.amb.org.br
French Medical Council
Office Bearers:
President: Dr. Patrick Bouet
Secretary General: Dr. Walter Vorhauer
President of the International Relations
Delegations: Dr. Xavier Deau, Immediate
Past-President of the WMA.
The French Medical Council in a nutshell
The French Medical Council brings togeth-
er all doctors in France whatever their spe-
cialty and their mode of practice, defends
the honor, protects the independence and represents the medical
profession. By taking on a moral, administrative, consultative, me-
diation and jurisdictional role, the French Medical Council is the
guarantor of the doctor/patient relationship. The commitment of
the French Medical Council in its everyday activities is being at the
service of doctors in the best interest of patients.
• The French Medical Council is a private body charged with a
public service obligation whose existence is established in the
French Code of Public Health.
• In France, doctors must be registered to be allowed to provide
items of medical service.According to the French Law,the French
Medical Council is the one managing the whole process of regis-
tration of doctors (including the establishment and maintenance
of the official register of doctors), monitoring their conditions of
practice as well as taking care of the recognition of their profes-
sional qualifications.
• The French Medical Council consists of one Departmental Coun-
cil per French Department (95 in total), one Regional Council
per French Region (22 in total). The French National Council
is made up of 54 members (from each Region), elected by the
Florentino de
Araujo Cardoso
Patrick Bouet
NMA news
Departmental Councils, a member appointed by the Academy of
Medicine, and a Councilor of State appointed by the Minister of
• Members of the National Council meet in four different sections:
Ethics and good medical practice, Professional practice, Medical
training and competence and Public health and medical demog-
• The Council writes and updates the French Code of Medical
Ethics, which is an integral part of the French National Code of
Public Health.
• The French Medical Council also acts as a disciplinary body for
• The Council has set up 2 Delegations: one for internal affairs (to
support and oversee the Departmental and Regional Councils)
and one for European and International Affairs (DAEI) (to work
with other European and international bodies).
European and International Commitments
• Since 2012, the French Medical Council is an official member of
the World Medical Association
• The French Medical Council runs the General Secretariat of:
— The European Council of Medical Orders (CEOM) which
brings together Medical Councils and regulatory bodies from
16 European countries. It aims at promoting the practice at
European level of high quality medicine respectful of patients’
— The Conference of Medical Councils from French-speaking
countries (CFOM) which is a collegial forum for discussion
among medical regulatory bodies from French-speaking coun-
Brussels representative office
The French Medical Council opened in 2008 a representative office
to the European Institutions in Brussels in order to closely monitor
European legislation on health.
Conseil national de l’Ordre des médecins
180 boulevard Haussmann
75389 Paris Cedex 08
E-mail: conseil-national@cn.medecin.fr;
Website: www.conseil-national.medecin.fr
German Medical Association
Office Bearers and Representatives:
President: Prof. Dr. Frank Ulrich
Vice-President: Dr. Martina Wenker,
Vice-President: Dr. Max Kaplan,
Honorary President: Prof. Dr. Karsten
Secretary General: Tobias Nowoczyn,
Head of Department for International
Affairs: Dr. Ramin Parsa-Parsi, MD MPH,
Policy Advisor: Domen Podnar,
Department for International Affairs
The German Medical Association (Bunde­särz­tekammer) is the joint
association of the State Chambers of Physicians (Landesärztekam-
mer) in Germany. It represents the interests of all 481,174 physi-
cians in Germany (as of 31/12/2014) in matters relating to profes-
sional policy and plays an active role in opinion-forming processes
with regard to health and social policy and in legislative procedures.
In addition to in-house committees focused on specific topics rel-
evant to the medical profession, separate bodies such as the Scien-
tific Advisory Board and the Drug Commission are housed within
the GMA, but have their own statutes and rules of procedure.Their
members are elected by the Executive Board of the German Medi-
cal Association or the German Medical Assembly – the annual par-
liament of the German medical profession.
The GMA is also home to the Office for Transplantation Medi-
cine (Geschäftsstelle Transplantationsmedizin), which advises on and
monitors compliance with transplantation regulations.
The activities of the German Medical Association include:
• Developing and maintaining the
— (Model) Professional Code ((Muster-)Berufsordnung), used by
the State Chambers of Physicians as a basis for their own le-
gally binding Professional Codes, which outline the ethical and
professional obligations of physicians among themselves and
vis-à-vis patients.
— (Model) Specialty Training Regulations ((Muster-)Weiterbil-
dungsordnung), used by the State Chambers of Physicians as a
basis for their own legally binding Specialty Training Regula-
tions, which define the content, duration and objectives of spe-
cialty training and specialist designations.
Frank Ulrich
NMA news
— (Model) Regulations on Continuing Medical Education
((Muster-)Fortbildungsordnung), used by the State Chambers of
Physicians as a basis for their own legally binding Regulations
on Continuing Medical Education.
• Ensuring quality medical care by coordinating exchange among
the 17 State Chambers of Physicians.
• Cultivating a sense of unity among all physicians practising in
Germany by advising and informing them of all important pro-
cesses and activities relevant to their profession.
• Achieving the most uniform possible regulation of professional
duties and principles for medical practise in all fields.
• Safeguarding the professional interests of physicians in matters
beyond state jurisdiction through exchanges with the Federal
Government, the Bundestag and the Bundesrat (the two houses of
parliament) and political parties.
• Communicating the position of the medical profession on mat-
ters relating to health policy and medicine.
• Promoting continuing medical education.
• Promoting quality assurance.
• Establishing and maintaining good relations with the global
medical community.
Membership in one of the 17 State Chambers of Physicians is
compulsory for all physicians practising medicine in Germany. In-
dividual physicians are therefore indirectly members of the German
Medical Association.
International commitment
The GMA represents the interests of the German medical profes-
sion on the international stage through its membership in numer-
ous international organisations and bilateral relations with medical
organisations abroad.
In its work with the World Medical Association (WMA), the
Standing Committee of European Physicians (CPME), the Eu-
ropean Forum of Medical Associations (EFMA), the European
Conference of Medical Chambers (CEOM), the European Net-
work of Medical Competent Authorities (ENMCA) and the an-
nual ZEVA Symposium of the Central and Eastern European
Chambers of Physicians, the GMA contributes to the dialogue on
important social and ethical issues that impact the global medical
Herbert-Lewin Platz 1
D-10623 Berlin
Telephone: + 49 30 400 456 361
Telefax: + 49 30 400 456 384
E-mail: international@baek.de
Website: www.bundesaerztekammer.de
Indian Medical Association
Office Bearers:
President: Dr. S S Agarwal
National Hon Secretary General:
Dr. K K Aggarwal
Indian Medical Association (IMA) is the
only representative, national voluntary or-
ganization of Doctors of Modern Scientific
System of Medicine in India, which looks
after the interest of doctors and the well-
being of the community at large with the
following objectives:
1. To promote and advance medical and allied sciences in all their
different branches and to promote the improvement of public
health and medical education in India.
2. To maintain the honour and dignity and to uphold the interest
of the medical profession and to promote co-operation amongst
the members thereof;
3. To work for the abolition of compartmentalism in medical edu-
cation, medical services and registration in the country and thus
to achieve equality among all members of the profession.
The founding fathers way back in 1928, felt the need of a national
organization of the Medical Profession. Before that, some members
of the profession – a selected few – were members of the British
Medical Association, which had opened branches in India to cater
to the local needs. These stalwarts, ultimately succeeded in forma-
tion of Indian Medical Association and reached an agreement with
the British Medical Association that they will have no branch in
India and got mutually affiliated which relationship continues till
Indian Medical Association, in the year 1946, helped in the orga-
nization of the World Medical Association and thus became one of
its founder members. As an organization, it has been and continues
to play an important role in its deliberations.
Dr. R.V.Sathe, the then President, IMA held the chair of the Presi-
dent of WMA when the WMA met in New Delhi in 1962. It’s
a matter of pride that another illustrious Past President of IMA
Dr. A.K.N. Sinha also held the office of the WMA and now an-
other eminent Past President Dr. Ketan Desai will take over this
post in 2016.
The IMA has been playing an important role in the deliberations
of the World Medical Association at New Delhi since its inception.
IMA, withdrew from World Medical Association in 1985, since the
organization refused to expel South Africa despite its dismal record
S S Agarwal
NMA news
of racial discrimination. IMA later in February, 1993 decided again
to become its member. 45th General Assembly of the World Medi-
cal Association at its meeting held on October 2-5, 1993 approved
IMA’s membership of the WMA.
Today, IMA is a pan-India voluntary organization of practitio-
ners of modern system of medicine. It has a membership of over
2,56,000 doctors spread over 30 state branches & 1700 local
branches in almost all the districts of India. IMA is reaching to
approximately 33 crores (330 million) of people every month and
ensuring affordable & quality treatment.
The vast human resources and infrastructure at the command of
IMA is a national health asset.IMA members have been involved in
various programmes which are aimed mainly for the benefit of the
community organized by various national and international agen-
IMA has complemented many Government Programmes like
Revised National Tuberculosis Control Programme (RNTCP),
Anaemia-Free India, Leprosy Eradication Programme, Child
Survival & Reduction of Infant Mortalities and has provided all
assistance and expertise, whenever required, to ensure making
healthcare accessible, affordable, qualitative and available timely
for all.
IMA branches run Blood Banks, Bio-medical waste dispos-
al units, Palliative care units for cancer and Reproductive &
Child Health (RCH) centres besides imparting training to its
members in meeting various health challenges. IMA also ar-
ticulates its views on policy matters and legislations pertaining
to health.
National Headquarters
The National Headquarter of the IMA is situated at New Delhi. It
publishes a monthly Journal “Journal of Indian Medical Associa-
tion” as an academic feast to all its members.
The leadership of all IMA consists of Office-bearers Headquar-
ters, of State & Local Branches, Working Committee and Central
Council Members.
IMA has three Academic Wings
• IMA College of General Practitioners
• IMA Academy of Medical Specialties
• IMA AKN Sinha Institute of Continuing Medical & Health
Education and Research
IMA has the following wings & Schemes running for the benefit
of its members:
• IMA National Social Security Scheme
• IMA National Professional Protection Scheme
• IMA Hospitals Board of India
• IMA National Health Scheme
• IMA National Pension Scheme
IMA leadership communicates to each and every member through
virtual Team IMA Group & through eIMA News & SMSes on a
daily basis. We also communicate to the public through IMA PR
and communication department on a daily basis.
IMA also organizes Press Conferences in every State on regular
basis and conducts similar Press Conference simultaneously in 100
Branches at the time.
IMA has trained 100% operational PCR staff of Delhi Police on
CPR-10 in a record time. The same is now being replicated at a
national level.
IMA projects include awareness regarding Child Sexual Abuse,
Standards of TB Care, Violence against medical establishments,
sealing of charges during national calamity & availability of emer-
gent medical care to everybody in time.
IMA’s Swacch Bharat Swastha Bharat Initiative (Clean India
Healthy India Initiative) spreads awareness about safe water, food
hygiene and control of vector borne diseases.
Under Aao Gaon Chalen (Let’s Go to Villages), IMA has adopted
more than 100 villages and provides them free treatment on a regu-
lar basis. Over 10,000 free surgeries have already been done through
this Project.
IMA is represented on various Government and Semi-Gov-
ernment bodies of the Central and State Governments and on
other national institutions and thus contributes its view at these
forums and renders active cooperation within its policy frame
work. As a voluntary body, the Association has been drawing the
attention of the Government and others concerned, to the spe-
cific areas in the field of health care in which the voluntary agen-
cies could play a leading role particularly in the implementation
of national health programs for achieving the goal of “Health for
All”. It has been organizing International and National Confer-
ences, Seminars and Conventions on subjects of topical interest
from time to time.
The official representatives of the Association have also been par-
ticipating in International Conferences abroad and in the General
Assembly and Council Meetings of the World Medical Association,
the Commonwealth Medical Association & WONCA etc.
As a part of our commitment to public health, Indian Medical
Association has undertaken a large number of projects related
to the health of the general masses and the social practices of
the Indian community. To name a few others, IMA has success-
fully undertaken projects related to Polio, Tuberculosis, Anaemia
Free India, HIV/AIDS, Hepatitis, Prostrate Diseases, Avian and
Swine Flu and many other. We have collaborated with many In-
ternational agencies and organizations like UNICEF, UNFPA,
PLAN International and Clinton Foundation etc. and Govt. de-
partments in our other projects related to Child Trafficking, Sex
Selection, Baby Friendly Hospitals Initiative where breastfeeding
is promoted, Infant mortality, Adolescent Health and Pharmaco
Vigilance etc.
NMA news
It is desirable for various National Medical Associations to ex-
change study programmes, e-connect through video conferences
and conduct medical educational programmes and faculty exchange
with Indian Medical Association.
IMA can also provide consultancy services from Indian doctors to
patients from other countries.
IMA helps in providing regular medical updates and updating med-
ical journals of various NMAs. We can even issue joint advisories
from time to time during any infection outbreaks.
IMA House, Indraprastha Marg
New Delhi (India)
Mobile: +91-9811090206
E-mail: np@ima-india.org
E-mail: hsgima@gmail.com
Website: www.ima-india.org/ima
Kuwait Medical
Office Bearers (2014–2016):
President: Dr. Mohammad AlMutairi
Vice President: Dr. AbdulMehsen
General Secretary: Dr. Mohammad Faisal
Treasurer: Dr. Mohammad Abdullah
Executive Board Member: Dr. Laila Saud
Executive Board Member: Dr. Aseel O A AlSabbrei
Executive Board Member: Dr. Nawaf F S Dehrab
Membership: All physicians in Kuwait from different specialties
including newly graduates are members of Kuwait Medical Asso-
ciation (KMA).
Services provided:
1. Issuance of Kuwaiti Medical Journal since 1967
2. Establishment of Health Studies Centers such as Late Mo-
hamed Abdul Mohsen Al-Kharafi Center for Medical Infor-
3. Training sessions for medical practice related-skills (e.g. writing
medical articles)
4. Establishment and strengthening the collective solidarity fund
for the members of the medical professions associations
5. Regulation of seasonal Association Group tours inside Kuwait
and abroad regularly
6. Association provides its professional consults for the National
Assembly, the Amiri Diwan and the Council of Ministers upon
their request
7. Playing a role in fortifying the health development in the com-
munity advocacy and awareness campaigns in relation to diabe-
tes, heart disease, AIDS and others
1. Improving health and healthcare services in Kuwait
2. Encouraging cooperation , support and exchange of experiences
between the Arab physicians
3. Cooperating with similar foreign professional bodies , interna-
tional and regional organizations to serve the objectives of the
International collaboration
Kuwait Medical Association is currently collaborating with several
international organizations including:
1. Doctors Without Borders (MSF)
2. Healthcare Without Harm
3. World Medical Association
4. Arab Medical Union
Kuwait Medical Association
P.O.Box 1202 Safat 13013
State of Kuwait
E-mail: kma@kma.org.kw
Website: www.kma.org.kw
New Zealand
Medical Association
Office Bearers (2013–2015):
President: Branko Sijnja
Chair: Stephen Child
Deputy Chair: Kate Baddock
General Practitioners Council Chair: Kate
Specialists Council Chair: Harvey White
Doctors-in-Training Council Chair: Marise Stuart
Membership: The New Zealand Medical Association (NZMA)
is the country’s foremost pan-professional medical organisation in
New Zealand representing the collective interests of all doctors.The
Mohammad AlMutairi
Branko Sijnja
NMA news
NZMA’s members come from all disciplines within the medical
profession, and include specialists, general practitioners, doctors-
intraining and medical students.
Services provided: The NZMA is a strong advocate on medicopo-
litical issues, with a strategic programme of advocacy with politi-
cians and offi cials at the highest levels.
The key roles of the NZMA are:
• to provide advocacy on behalf of doctors and their patients
• to provide support and services to members and their practices
• to publish and maintain the Code of Ethics for the profession
• to publish the New Zealand Medical Journal.
The NZMA works closely with many other medical and health
organisations, and provides forums that consider pan-professional
issues and policies. The NZMA has a close relationship with, and
provides support to, the New Zealand Medical Students Associa-
tion (NZMSA).
The NZMA provides administrative, advocacy and communica-
tions activities for the New Zealand Branch of the Royal Austra-
lian and New Zealand College of Ophthalmologists (RANZCO).
It also provides support services to the Medical Benevolent So-
Activities (some examples)
• With Members:
— Revision of the profession’s Code of Ethics, which lays down
principles of ethical behaviour, applicable to all doctors. It also
includes recommendations for ethical practice.
— Representing member practices in employment negotiations
with the nurses’ union.
— Providing advisory services for both employer and employee
doctors on professional and business matters
• With the Public: Reducing alcohol-related harm: a policy briefing –
this publication recommended a suite of measure to be considered
as part of an approach to tackling the harm caused by alcohol
abuse.This was a major piece of work for the NZMA,with several
months’ research into the latest evidence of the harms associated
with alcohol and on the successful ways in which these can be
• With local and central Government: Advocacy on: Physician as-
sisted dying; National Health Strategy; Pharmacy Action Plan;
local alcohol policies; New Zealand’s climate change target; free
trade agreements; health literacy; support for plain packaging for
tobacco products; eliminating illicit trade in tobacco products; a
new national drug policy; non-medical prescribing; health equity
and social determinants ; health structure and funding, with par-
ticular reference to primary care.
• With the Media: Responsiveness to media and release of media
releases related to health issues of public interest (obesity etc);
promotion of debates related to health policies (Trans Pacific
Partnership Agreement; tobacco packaging; refugee support; al-
cohol policies etc).
• With Strategic Partners: Submissions to the Medical Council
of New Zealand on good prescribing, better data, registration of
foreign-trained doctors. Advocacy to the national funding agency
for pharmaceuticals (PHARMAC) on proposals for procure-
ment of medical devices for hospitals; prescribing by different
occupational groups; and various individual drug funding pro-
posals; advocacy to the Pharmaceutical Society on the draft Na-
tional Pharmacist Services Framework; workforce planning and
sustainability (with Health Workforce New Zealand and other
PO Box 156, Wellington 6140,
New Zealand
E-mail: nzma@nzma.org.nz
Website: www.nzma.org.nz
Nigerian Medical Association
Office Bearers (2014–2016):
President: Dr. Kayode Obembe
Vice President: Dr.Titus Ibekwe
Vice President: Dr. Barthy
Secretary General: Dr. Adewunmi Alayaki
Deputy Secretary General: Dr. Chuks
ossai- Abaninwa
National Treasurer: Dr. Abdulrahman
Editor NMJ: Dr. Francis Uba
Membership: All medical and dental practioners in Nigeria are
members of the Nigerian Medical Association on induction as a
medical practioner and fulfilling the necessary provisions as stipu-
lated by the Medical and Dental Council of Nigeria. Membership
cuts across members in Nigeria and those in the Diaspora.
Aims and Objecitves:
1. To ensure that Medical and Dental Practioners in the country
uphold the physicians oath
2. To promote the advancement of health and allied sciences
Kayode Obembe
NMA news
3. To assist thr government and people of the federal Republic of
Nigeria is the provision of smooth,efficient and effective health-
care delivery system in the country.
4. Tp promote the welfare and interaction of all medical and den-
tal practioners in the country
5. To cooperate with organizations anywhere in the world wich
have similar aims and objectives
To consider and Express views on all proposed legislations and na-
tional issues especially those affecting healthcare delivery system
and medical and dental education in Nigeria.
Vision: A formidable professional body committed to fostering ef-
fective and efficient health care delivery, high ethical standarts and
the interest of its members.
Core Values:
• High ethical standarts of practice
• welfare of members
• compassionate service
• integrity
Mission:To build a sustainable proffesional Association of Medical
and Dental proffessionals that will advance the delivery pf qualita-
tive health care services through continuing Professional develop-
ment, advocacy and policy development. knowledge management
and publicē education, in collaboration with ither relevant stake-
International collaboration: The NMA is in collaboration with
several International oganisations, among these includes:
World Medical Association,African Medical Association,Collabo-
ration is ongoing with svereal national medical associations, United
Nations organisations, USAID, DFID etc.
8 Benghazi Street, Off Addis Ababa Crescent, Wuse Zone 4,
Abuja, FCT, Nigeria
P.O. Box: 8829, Wuse Abuja
tel: +2348035870494, +2348066102538
E-mail: nationalnma@yahoo.com
E-mail: k_obembe@yahoo.co.uk
Website: www.nationalnma.org
Norwegian Medical
Office Bearers:
President: Dr. Marit Hermansen
Vice-president: Dr. Jon Helle
Secretary General: Dr.Geir Riise
The Medical Ethics Committee:
chairperson: Dr.Svein Aarseth
Organisation and membership: The Nor-
wegian Medical Association (NMA), was
founded in 1886 as the professional asso-
ciation and trade union for Norwegian physicians. Membership is
voluntary, and approximately 96 % of the Norwegian physicians are
members. The main aims of the NMA are to protect and develop
the professional, social and financial interests of its members, to
promote their interests in matters concerning medical education,
professional development and scientific activities, and to advance
the quality of the Norwegian health care system.
Main bodies of the Norwegian Medical Association: The Annual
Representative Meeting (ARM) is the chief decision-making body
and elects the Central Board of 9 members, including the president
and vice-president. The election period for the board is two years.
ARM also elects the Medical Ethics Committee
The NMA consists of 19 local branches (one in each county), 7 oc-
cupational branches, 45 speciality branches, one for retired doctors
and one student organisation.
The seven occupational branches organise members that share occu-
pational interests: junior doctors, consultants, general practitioners,
researchers, occupational health doctors, private practicing special-
ists and public health doctors.The occupational branches have their
main interests in salaries and working conditions, while the spe-
cialty branches are engaged in scientific and professional activities
like education, quality improvement etc.
The secretariat: The secretariat has six departments: Dep. of Pro-
fessional Affairs, Dep. of Communication and Politics, Dep. of Fi-
nance and Administration, Dep. of Law and Working Life, Insti-
tute for Studies of Medical Profession and The Norwegian Medical
Journal.The number of full-time staff members is 140.
The role of The Norwegian Medical Association
The Norwegian Medical Association is the only medical association
for doctors in Norway.The NMA has two main responsibilities:
1. Negotiating salaries and working conditions for the members
2. Taking care of the members professional and scientific interests
Marit Hermansen
NMA news
In addition the NMA is responsible for much of the post-graduate
specialist education.
Areas of priority
The Norwegian Medical Association will for the next two years
(2015–17) particularly work for:
• Confident physicians – safe patients
• Improve governance, organization and leadership of the specialist
health care sector
• Improve the leadership of the medical profession in the primary
health care sector
• Secure quality and capacity in the specialist education
Some data about Norway
Norway has a population of 5 160 000 and is situated in the
northern part of Europe and has borders to Sweden, Finland and
Healthcare and services are financed by taxation and are designed
to be equally accessible to all residents, independent of social status.
With its 220 000 employees, the health sector is one of the largest
sectors in Norwegian society.
The healthcare system is under the jurisdiction of the Ministry of
Health and Care services, which is responsible for planning and
monitoring national health policy. Responsibility for provision of
services is decentralized to the municipal and regional level. The
municipalities are in charge of providing primary healthcare ser-
vices, while the four Health regions provide the specialized medical
services, mainly hospital care.
General practice is organised through a list patient system. The
list-patient system is a national system organised and run through
agreements between the NMA and the health authorities where the
general practitioners are mainly self-employed.
There are some specialist practices working under agreements with
the Health regions.
Norway only has a few numbers of authorized private hospitals and
health services in addition to the public facilities.
The number of doctors, including students and retired doctors, are
about 32 262. In relation to inhabitants we have among the highest
number of doctors in Europe, in 2014 the ratio was one doctor per
218 inhabitants.
The Journal of The Norwegian Medical Association is issued ev-
ery second week (22–24 per year).
Post-graduate medical education: There are 45 recognised medi-
cal specialities in Norway of which eight are sub-specialities under
internal medicine and five are sub-specialities under general surgery.
The majority of the specialities relate to health services in institu-
tions (hospitals).Specialities i primary health care are general medi-
cine, community medicine and occupational medicine.
Health politics: The NMA is involved in many of the activities run
by the health authorities through meetings, working groups and
political work. The NMA also appoints members to participate in
different task groups, and meetings with the political parties in the
International collaboration: The Norwegian Medical Association
meets twice a year with the other Nordic medical associations to
discuss areas of common interest. We cooperate with the Chinese
Psychiatric Association on human rights and ethics in psychiatry
and Human Rights Foundation of Turkey on torture and rehabili-
tation of torture survivors. We also have a project in Malawi, to
support the Society of Medical Doctors of Malawi establishing a
well-functioning secretariat.
The Norwegian Medical Association
P.O.Box 1152 Sentrum
NO-0107 Oslo
Phone +47 23 10 90 00
Telefax +47 23 10 90 10
E-mail: legeforeningen@legeforeningen.no
Website: www.legeforeningen.no
Panhellenic Medical Association
Office Bearers:
President: Dr. Michail Vlastarakos,
Vice-President: Dr. Constantinos
Vice-President: Dr. Constantinos
Secretary General: Dr. Dimitris Varnavas
Treasurer: Dr. Vladimiros Panagiotidis
Members of the Board: Drs Anastasios
Vasiadis, Athanasios Exadactylos, Pavlos
Kapsambelis, Anna Mastorakou, Christos Papazoglou, Grigorios
Rokadakis, Ioannis Chronopoulos, Michalis Psaltakos, Panagiotis
The Panhellenic Medical Association, the national Medical Asso-
ciation of Greece, is an independent public legal entity, established
by the Legislative Decree of 1923 (OJ 309 A/1923), having its reg-
istered offices in Athens. It is the central coordinative body and the
supervisory organisation of all Greek physicians and country’s local
Medical Associations.
Marit Hermansen
NMA news
Within the Panhellenic Medical Association, the Supreme Disci-
plinary Board is constituted, with 6 regular members and 4 surro-
gate members, elected by the General Assembly, as well.The Disci-
plinary Board is empowered to hear doctors’appeals of the decisions
of the local medical associations’ disciplinary board.
President of the Supreme Disciplinary Board of PhMA: Dr.Matina
Vice-President: Dr. Stavros Fotopoulos
Members:Members of the PhMA are the 60 local medical associa-
tions of the country. Doctors’ registration within the local medical
association of the region where they practice medicine is mandatory.
The Panhellenic Medical Association’s bodies are the General As-
sembly, which is consisted of elected delegates from the local medi-
cal associations and the Board, consisted of 15 members elected by
the General Assembly.
Aims and objectives: The Panhellenic Medical Association is an
institutional consultant of the State on health issues, and it covers
competences of medical trade unions. It participates in the nego-
tiations on issues such as, the remuneration of physicians’ salaries,
working conditions of doctors, medical fees for self-employed phy-
sicians, pension issues, etc., and is represented at competent govern-
mental expert committees.At the same time,it is in regular dialogue
with other national bodies in the health field, making every effort to
resolve problems that arise.
Since April 2016, the PhMA has been legislated to grant medical
specialty titles and medical practice licenses, which are issued by the
local Regions, so far.
The PhMA, having signed a Cooperation Agreement with the
UEMS-EACCME, accredits scientific educational events related
to lifelong learning of physicians and continuing professional de-
Recently, the Institute of Scientific Research of the PhMA is es-
tablished, dealing with issues of Healthcare, pharmaceutical policy,
medical tourism, international affairs, etc.
International membership: The PhMa represents Greek phy-
sicians, as a member, to: Standing Committee of European
Doctors (C.P.M.E.), European Union of Medical Specialists
(U.E.M.S.), European Association of Senior Hospital Physi-
cians (A.E.M.H), Conseil Européen des Ordres de Médecins
(CEOM) and since October 2015, the PhMA is the 112 mem-
ber of the WMA.
Panhellenic Medical Association
Ploutarchou 3, GR-106 75 Athens, Greece
Tel. +30 210 72 58 660-662 (ext.3)/F. +30 210 72 58 663
E-mail: pisinter1@pis.gr
Website: www.pis.gr
Polish Supreme Chamber
of Physicians and Dentists
(Naczelna Izba Lekarska)
Office Bearers (2014–2018):
President: Maciej Hamankiewicz
Vice-Presidents: Romuald Krajewski,
Zyta Kaźmierczak-Zagórska, Agnieszka
Ruchała-Tyszler (dental practitioner)
Secretary: Marek Jodłowski
Deputy Secretary: Anna Lella (dental
Treasurer: Wojciech Marquardt
The Polish (Supreme) Chamber of Phy-
sicians and Dentists (Naczelna Izba Lekarska) and the regional
chambers of physicians and dentists (okręgowe izby lekarskie) are
the organizational bodies of the professional self-government of
physicians and dental practitioners in Poland who are associated in
the chambers with equal status.The professional self-government of
physicians and dental practitioners in Poland was founded in 1922,
dissolved in 1952 and reestablished in 1989. There are 23 regional
chambers and a separate chamber of military physicians and dentists
that has legal status of the regional chamber although it is active in
the entire country. Every physician and every dental practitioner
who holds the right to practice the profession in Poland is a member
of one of the regional chambers by virtue of the law. Currently the
joint self-government associates 178 000 physicians and dentists in
Poland, including approximately 125 000 practicing physicians.The
highest authority of the Supreme Chamber of Physicians and Den-
tists is the General Medical Assembly whereas the regional medical
assemblies are the highest authorities of the regional chambers. In
the period between assemblies – the Supreme Medical Council and
regional medical councils respectively.The Supreme Medical Coun-
cil represents the medical and dental professions at the state level,
and regional councils at regional levels.
Scope of activity
The field of activities of the self-government of physicians and den-
tists, as laid down in the Law of 2 December 2009 on Chambers of
Physicians and Dentists, include:
• supervising the proper and conscientious exercise of the medical
• determining the principles of professional ethics and deontology bind-
ing all physicians and dentists and looking after their compliance;
• representing and protecting the medical professions;
• integrating the medical circles;
Maciej Hamankiewicz
NMA news
• delivering opinion on matters concerning public health, state
health policy and organization of healthcare;
• co-operating with scientific associations, universities and research
institutions in Poland and abroad;
• offering mutual aid and other forms of financial assistance to phy-
sicians and dentists and their families;
• administering the estate and managing the business activities of
the chambers of physicians and dentists.
The chambers of physicians and dentists:
• award the right to practice the profession of a physician or dentist
and keep the register of physicians and dentists;
• make decisions on matters relating to fitness to practice as a phy-
sician or dentist;
• act as medical courts in matters involving professional liability of
physicians and dentists;
• deliver opinion on draft legislation concerning health protection
and exercise of the medical professions;
• deliver opinions and make motions regarding under- and post-
graduate training of physicians and dentists;
• co-operate with public administration agencies, political organi-
zations, trade unions as well as other social organizations in mat-
ters concerning protection of human health and conditions of
exercising the medical professions;
• defend individual and collective interests of members of the self-
government of physicians and dentists;
• negotiate conditions of work and remuneration;
• Co-operate in the field of continuous medical education.
ul. Sobieskiego 110, 00-764 Warsaw, Poland
Phone: (+48) 22 559 13 00
E-mail: sekretariat@hipokrates.org, zagranica@hipokrates.org
Website: www.nil.org.pl
Portuguese Medical Association
Office Bearers:
Presidente: Prof. José Manuel Silva
Treasurer: Prof. Alberto Caldas Afonso
Secretariat: Dra. Rita Martinho
The organisation of medical practice in Por-
tugal started with the creation of the Portu-
guese Medical Association in 1898.
On 24 November 1938, by Decree-law no
29171 the Medical Association was created
covering mainly those physicians that prac-
tice independently.
Facts like the need to separate disciplinary action from administra-
tive or directive action and the need to imply juridical expression to
a set of important principles of deontological nature as well as social
evolution led to the revocation of the statute approved by the afore
mentioned decree and its replacement by a statute approved by the
Decree-law no 40651, of 21st
of June 1956.
This Statute, integrated in the political rule in force, even if fully re-
specting the defence of deontology and technique by the medical asso-
ciative body to which it also granted disciplinary action had neverthe-
less been approved by doctors but resulted solely from governmental
decision, in the use of powers that the Constitution 1933 allowed.
The evolution of Portuguese society and the changes that occurred
in the course of time towards a bigger intervention of state services
in rendering medical care to the population as a means of guarantee
the right to health, in an organised way, and of which the creation
of Socio-Medical Services of the Welfare fund are an example, gave
a progressive importance to dependant medical practice and proved
that the existing regulation is incapable and outdated.
The events that took place after 25th
of April 1974 (Carnation Revo-
lution) and the social changes occurred pointed out the need to ad-
just the Statute of the Portuguese Medical Association to the new
social philosophy and conditionality.
As a result of the work developed, a new statute project was drafted and
the whole process ended in consulting doctors and democratic voting
leading to its approval by an overwhelming percentage of votes in favour.
This statute, besides covering all the doctors in practice of their pro-
fession, reveals a remarkably decentralised feature and full respect
for democratic liberties.
The renovated Medical Association being urged to practice its activity
fully independently from the government, political groups or other
organisations, the statute recognises and supports that the defence of
genuine interest of doctors may reflect in the first place a humanised
practice that respects the right to health of all citizens and devotes the
principle of creation of a National Health Service in which the doctor
will necessarily play a predominant and fundamental role.
It is the government’s domain, in the use of its legislative powers to
approve the Statute of the Portuguese Medical Association, given
the important public goal that it pursues, the need to imply a com-
pulsory feature to the enrolment in the Association, the attribution
of deontological function and disciplinary power. In any case the
revocation of the previous statute approved by Decree-Law would
always have to be done through the legislative form.
Membership:All the doctors to practice the profession must be
registered (mandatory) in the Portuguese Medical Association and
have a individual license.The practice of medicine depends on the
enrolment in the Portuguese Medical Association.
The Portuguese Medical Association accepts enrolment solely of
Portuguese or foreign graduates in medicine by a Portuguese or for-
eign university, as long as in this last case there is an official equiva-
lence of the course duly recognised by the Medical Association.José Manuel Silva
NMA news
The mission of the PMA is the preservation of high standards on
the formation and exercise of medical professions and protection of
patients and public from the malpractice of health services.
Competence of the Portuguese Medical Association
1. Recognition of responsibility of physicians emerging from in-
fractions of Medical Ethics is a disciplinary responsibility that is
exclusive to the Medical Association.
2. When violations of medical ethics are found relating to physi-
cians working in state bodies, cooperatives or private compa-
nies, these organizations shall limit themselves to notifying the
Medical Association of the supposed infractions.
3. If the nature of ethical and technical infractions also includes
supposition of a disciplinary infraction included in the legal
remit of these entities, respective responsibilities shall be sepa-
rately exercised.
Principles and goals
1. The Medical Association recognises that the protection of doc-
tors’legitimate interests imply the practice of a humanised med-
icine that respects every citizen’s right to health.
2. The Medical Association practices its activity with full autonomy
from the state, political, religious groups or other organisations.
3. The democratic system rules the structure and the internal life
of the Medical Association and its control is a duty and a right
of all its associates namely in what concerns the election and
destitution of all its leaders and the free discussion of all the is-
sues of associative life.
4. The freedom of opinion and the free democratic game foreseen in
the previous number and guaranteed in the present Statute do not
justify the constitution of any autonomous organisms within the
Medical Association that may distort or influence the normal rules
of democracy and may lead to disagreement among its members.
5. The Medical Association may adhere to any unions or federa-
tions of medical associations and shall collaborate with other
health technicians through the competent professional organ-
isations in the interest of health protection and promotion.
6. The Medical Association’s main goals are:
— To protect medical ethics, deontology and professional qualifi-
cations in order to assure and make respect the user’s rights to
a qualified medicine;
— To encourage and protect the interests of medical profession at
all levels, particularly in what concerns socio-professional pro-
motion, social security and work relations; (1)
— To promote the development of medical culture and contribute
to the establishment and constant improvement of a National
Health Service collaborating in the national health politics in
every aspect namely in the medical education and careers;
— To give opinion on all matters related to teaching, the practice
of medicine and with the organisation of services that deal with
health whenever it may be convenient to do so, close to the
competent official entities or when the latter may request;
— To watch for the correct observance of legal formalities of the
present Statute and respective regulations namely in what con-
cerns the title and the medical profession promoting judicial
action against those who use or practice it, illegally;
— To issue professional licence and promote doctor’s professional
qualification by the concession of titles of differentiation and
for the active participation in post-graduate education.
Portuguese Medical Association
Av. Almirante Gago Coutinho, n 151, 1749-084 Lisboa, Portugal
E-mail: intl@omcne.pt
Website: www.ordemdosmedicos.pt
Royal Dutch Medical Association
Office Bearers (2012–2016):
President: Prof. Dr. R.J. (Rutger Jan) van
der Gaag
The Royal Dutch Medical Association
(KNMG) is the professional organization
for physicians of The Netherlands. It was es-
tablished in 1849.Since January 1st 1999 the
KNMG has become a federation of medical
practitioners’professional associations.
Our main objectives are to improve the quality of medical care and
healthcare in general, and to improve public health.This is achieved
by proactively responding to developments in health care and so-
ciety, by developing guidelines and policies, by lobbying, and by
providing services to our members. Another important task of the
KNMG is the regulation of vocational training and registration of
The federation consists of the Association of Public Health Phy-
sicians (KAMG), the National Association of salaried Doctors
(LAD), the National Association of General Practitioners (LHV),
the Dutch Association for occupational Health (NVAB), the Asso-
ciation for elderly care physicians (Verenso), the Dutch Association
of Insurance Medicine (NVVG), the Dutch Federation of Medical
Specialists (Federatie van medisch specialisten) and the Association
of Medical Students (De Geneeskundestudent).
We work in close collaboration with other stakeholders, e.g. gov-
ernment, politics, health care insurance companies, patient organi-
zations, and other organizations in healthcare. The goal is to pro-
mote the medical and associated sciences, and achieve high quality
R. J. van der Gaag
NMA news
healthcare. Our policies cover the full range from public health is-
sues, medical ethics, science, health law to medical education.
Another important task of the KNMG is the legal system concern-
ing the postgraduate training and registration of specialists.Legisla-
tive boards issue rules on specialist training, recognition of trainers,
hospitals etc., specialist registration and the recertification of spe-
cialists. The registration committees carry out legislation regarding
the tasks mentioned above in the interest of the public.
KNMG activities
1. A campaign on medical professionalism. In 2009 a national
campaign will be launched, aimed at all physicians.The main goal is
to support doctors in their professional conduct: good quality, earn-
ing trust of their patients and accountability.
2.Promoting.Promoting quality of healthcare,safety and transparency
of medical practice and professional integrity, through the establish-
ment of guidelines and advice and influencing government and politics.
Activities are:
• Development of a quality framework: the quality and patient
safety requirements any doctor in The Netherlands should meet;
• Contribute to educational modernisation of the training of medi-
cal specialists and the curriculum in accordance with the Can-
MEDs model;
• Contribute to the modernisation of the Individual Health Care
Professionals Act (Wet BIG). This Act concerns the quality of
care guaranteed by legally protected professional titles and pro-
vides a register of health care professionals (the BIG-register).
The BIG-register registers pharmacists, physicians, physiothera-
pists, health care psychologists, psychotherapists, dentists, mid-
wives and nurses. Only those listed in this register may carry the
legally protected titles belonging to these professions;
• Monitoring Health Insurance Act: under the new Health Insur-
ance Act, all residents of the Netherlands are obliged to have a
health insurance.The system is a private health insurance with so-
cial conditions.The system is operated by private health insurance
companies; the insurers are obliged to accept every resident in
their area of activity. A system of risk equalization enables the ac-
ceptance obligation and prevents direct or indirect risk selection.
• Contribute to strengthening patients’ rights. Especially in the
fields of quality, safety and legal complaints.
• Activities related to “end of life”care: implementing the palliative
sedation guideline and research on decisions of physicians con-
cerning the final stage of life. See: KNMG position paper: the
role of the physician in the voluntary termination of life
3. Studies. The KNMG studies trends and influences policies and
legislation in relevant areas where professional values en responsi-
bilities are of major significance. e.g.:
• Monitoring, and if possible, influencing developments on health
insurances and the Exceptional Medical Expenses Act (AWBZ)
which is a national insurance act for long-term care. This is in-
tended to provide the insured with chronic and continuous care.
This involves considerable financial consequences, such as care for
disabled people with congenital, physical or mental disorders;
• Commenting on reports from government advisory boards
4. International activities. The KNMG is an active member of
the Comité Permanent des Médecins Européens (CPME) and
the World Medical Association (WMA). The CPME is involved
in influencing policy at European level and is of great importance,
because the practice of European doctors is increasingly influenced
by the European dimension.
Mercatorlaan 1200, 3528 BL Utrecht
E-mail: info@fed.knmg.nl
Website: www.knmg.nl
Romanian College of Physicians
Office Bearers:
President: Dr. Gheorghe Borcean
Vice President: Dr. Constantin Carstea
Vice President: Prof. dr. Mircea Cinteza
Vice President: Dr. Calin Bumbulut
Secretary General: Dr. Viorel Radulescu
Members: who can become a member, how
many members are registered and what ser-
vices are available for the members:
Any doctor who wants to practice medicine
in Romania, according to the law, may become member of the Ro-
manian College of Physicians.
The Romanian College of Physicians has 9,000 members.They can:
• vote and can be elected,
• be informed about any action performed by the College,
• use all infrastructure belonging to the College,
• take part in any of the actions carried out by the College,
• litigate any sanction applied by the College,
• request material help from the College, for special situations, for
them and their family.
• with the members
• with public
• with the government
• with the media
• other strategic partnerships
Gheorghe Borcean
NMA news
The Romanian College of Physicians is an active member of the
following international organisations: WMA, UEMS, CPME,
ROMANIA, 061303
Phone: +4 0214138800, +4 0214138803
Fax: +4 0214137750
E-mail: office@cmr.ro
Website: www.cmr.ro
Singapore Medical Association
Office Bearers:
President: Dr. Wong Tien Hua
Vice President: A/Prof Chin Jing Jih
Vice President: Dr.Toh Choon Lai
Honorary Secretary: Dr. Daniel Lee Hsien
Honorary Assistant Secretary: Dr. Lim
Kheng Choon
Honorary Treasurer: Dr.Tammy Chan
Teng Mui
Honorary Assistant Treasurer: Dr. Benny
Loo Kai Guo
Members: Dr. Anantham Devanand, Dr. Chong Yeh Woei,
Dr. Lee Pheng Soon, Dr. Lee Yik Voon, Dr. Ng Chee Kwan,
Dr. Noorul Fatha As’art, A/Prof Nigel Tan Choon Kiat, A/Prof
Tan Sze Wee, Dr.Tan Tze Lee, Dr.Tan Yia Swam, Dr.Toh Han
Chong, Dr. Wong Chiang Yin, Dr. Bertha Woon
As the national medical association,SMA is committed to engaging
in dialogue with various stakeholders on issues related to patient
care and medical practice, by highlighting concerns received via
feedback from members, and proposing alternative policies, where
applicable.At SMA,we adopt a wide spectrum of approaches,rang-
ing from quiet diplomacy to public position statements, to help ad-
vocate the rights of patients and doctors.
In 2015, SMA took official positions on important issues related
to both doctors and patients, sparking active discourse and creat-
ing awareness of issues pertinent to our current medical landscape.
These areas of concern include cost of medical indemnity and medi-
cal litigation reforms, ethical code and guidelines changes and as-
similation of foreign-trained doctors into our healthcare landscape.
Aided by SMA publications’growing influence on the local health-
care landscape, we aim to continue bringing greater awareness to
issues that impact both doctors and patients for the betterment of
local healthcare.
Our members are at the heart of what we do.We remain focused on
engaging the profession and delivering services that our members
value. These include providing resources and opportunities to aid
our members in their development as a medical professional and a
leader in their respective fields.
The SMA Centre for Medical Ethics and Professionalism (CMEP)
was officially launched in June 2000 to promote the art and science
of medical ethics and medical care for the betterment of patient care
and public health. SMA CMEP aims to provide leadership in the
areas of academic training,discussion,resource development and re-
search, so as to support a high standard of medical professionalism.
In 2013, the SMA set up a separate Charity for its charitable work
of mainly supporting needy medical students with bursaries and
promoting volunteerism amongst the profession. The Charity is
supported through donations from the SMA, its members, and its
A commitment to lifelong learning is part of the professionalism
that comes with being a medical doctor. SMJ has remained an open-
access journal, as we recognise that broad access to research results
is an essential component of lifelong learning. We provide access to
information-rich literature in the form of scientific research papers,
self-learning CME articles, as well as insightful discussions on prac-
tice guidelines, medicolegal issues and others.Through waiver of our
article submission fee, we also encourage SMA members to share
their knowledge and research results with the medical community.
Key Statistics
• 20 councils members
• 7361 members
• 74 courses conducted for more than 2900 participants with
S$64,000 course subsidies disbursed
• 30 membership events for >2400 participants
International collaboration
• WMA: SMA is a Constituent member of the WMA.
— Dr. Chong Yeh Woei Vice-chair of council
— Dr. Bertha Woon Councilor
• MASEAN: SMA serves as the secretariat for MASEAN.
— Dr. Wong Tien Hua Chairperson (since 2014)
— Dr. Lee Yik Voon Secretary General (since 2009)
— Dr. Daniel Lee Assistant Secretary General (since 2014)
— Dr.Tammy Chan Chairperson,Finance Committee (since 2011)
Singapore Medical Association
2 College Road, Level 2
Alumni Medical Centre,
Singapore 169850
E-mail: sma@sma.org.sg
Wesite: www.sma.org.sg
Wong Tien Hua
NMA news
Spanish General Medical
Council (OMC)
Office Bearers:
President: Dr. Juan José Rodriguez-Sendin
Secretary General: Dr. Juan-Manuel
The Organización Médica Colegial of
Spain (OMC) or General Medical Council
is the institution formed by the 52 medical
colleges of Spain and is in charge of the ar-
rangement, regulation, control and defence
of the medical profession according to the
Spanish rules and regulations. Although the medical colleges have
been regulated by Law since 1898, the General Council of Medi-
cal Colleges of Spain was formed in 1921. This is the body which
groups and coordinates the provincial and autonomous Medical
Colleges, as public law corporations, that are an authority within
the profession.
The General Medical Council activities are focused on very di-
verse areas, always related to the medical profession. Besides the
habitual activities of record and professional control as well as
qualifications, the General Medical Council promotes continu-
ous medical training activities for which it has a specific Founda-
tion. It also has a Central Medical Ethics Commission which not
only studies the cases that it receives from the Medical Colleges,
but it also carries out studies and documents about the position
of the medical profession in fundamental ethical questions that
concern it.Thus in the last months, it has updated its positions on
medical care at the end of life and on the regulation of conscience
clause for health care professionals who don’t want to perform
The General Medical Council has a digital journal “Médicos y
Pacientes” http://www.medicosypacientes.com and OMC magazine
http://www.cgcom.es/revista/archivo and other newsletter from In-
ternational Department, and from Fundación para la Protección
Social (Foundation for Social Protection) and Fundación de los
Colegios Médicos para la Cooperación Internacional (Foundation
for International Cooperation) which maintains updated informa-
tion about questions of medical health care and social interest, but
also of information and interest for the patients. Also the General
Medical Council has approved the creation of a Social Council to
foster and to promote meetings and collaboration with patients who
are the raison dݐtre of medicine.
In the last years the General Medical Council has tightened its
bonds of collaboration and action with the most representative
medical entities of Spain: the medical trade unions, the Conference
of Deans of Medical Universities, the State Council of Medical
Students,the Federation of Spanish Medical Scientific Associations
and the National Commission of Specialities in Health Sciences,
integrating with them all what is known as the Forum of the Medi-
cal Profession.
In addition, the General Medical Council is developing a wide ac-
tivity in defence of medical association and contributing its point
of view to the legal regulations. Our association understands that
the association formula is the one that best guarantees the social
protection of the patient’s interests, the fulfilment of Ethics, the
control and regulation of the profession, which has been com-
mended the protection of an important asset: health. We belong
to the Ethics Committee Also it undertakes intense actions to
assure that the authority to prescribe drugs is reserved to health
care professionals because the competence to prescribe is insepara-
bly linked with the diagnosis for reasons of efficiency, quality and
safety in health care.
Efforts are also being made in social and health matters of gen-
eral interest, promoting numerous training and informative ac-
tions aimed at health care professionals and the population at large,
among which can be highlighted information about Influenza A
(H1N1), the Effects of the Climate Change on Health, the Pre-
scription and the Rational Use of Drugs.
Certifying the competence of the doctor and the licensing based
on the achievement of professional, accredited psychophysical and
updating of professional competence criteria is another challenge
that has raised the Spanish medical Council from 2010,strengthen-
ing corporate commitment patient and society and transparency for
physicians and society.
The Spanish medical Council has a very extensive international
collaboration. It plays an active role in the World Medical As-
sociation, European medical organizations like the CEOM (Eu-
ropean Council of Medical Orders) and organizations of medi-
cal specialists (UEMS), general practitioners (UEMO), hospital
health care professionals (AEHM), doctors in training (EJD). Re-
cently the OMC became full member at the Confederación Médi-
ca de Latinoamérica y el Caribe (CONFEMEL).The cooperation
with the countries of Latin America organized through the FIEM
(Latin-American Forum of Medical Entities) is of special inter-
est, without forgetting the social and solidarity action for which
the OMC has formed a Solidarity Foundation with the purpose
of promoting and channelling help and cooperation for medical –
health care in countries with precarious health care and vulnerable
and needy populations.
Plaza de las Cortes, 11. 28014 – Madrid
Tel.: +34 91 360 03 50
Fax: +34 91 431 96 20
E-mail: internacional@cgcom.es
Website: www.cgcom.es
Juan José Rodriguez-
NMA news
Dr. Eitaka Tsuboi passed away at the age of 86 due to respiratory
failure on February 9, 2016.
He was born in 1929 in Koriyama City,Fukushima Prefecture,Ja-
pan.He majored in radiology at the Japan Medical University and
graduated in 1952.He continued to study radiology at the Nation-
al Cancer Center from 1962. In 1977, he became the chairman of
the board of directors of Tsuboi Hospital and contributed to the
enhancement of community health. His area of specialization was
respiratory cancer. He served as the President of the Japan Medi-
cal Association (JMA) from 1996 to 2004. During his term, he
worked with the belief that JMA’s activities should be expanded
globally and the JMA should be open minded in considering the
ideal way of the professional development of physicians and in
developing visions for national healthcare. He was also involved
in World Medical Association’s (WMA) activities; he was inau-
gurated as the WMA President at the WMA Edinburgh Gen-
eral Assembly in 2000. He invited the WMA executives and held
two international conferences in Tokyo in 2001 on the themes of
“Highly advanced medical care and medical ethics” and “Patient
safety.” The WMA declarations prepared from these events are
still a part of the WMA policy documents. He was also active
in other international activities during this period. He also sup-
ported the Takemi Program in International Health at the Har-
vard School of Public Health. In 2000, King Birendra of Nepal
honored Dr. Tsuboi
the highest award
for foreigners for
over a 10-year-long
contribution to
school health and
community medi-
cine projects in Ne-
pal. Early in his
career, he became
involved in the es-
tablishment of the
National Cancer
Center in Bangkok,
Thailand. Based on
his experience, he
regarded the bond-
ing of physicians across the borders as the key element in Asia.
He constantly underlined the importance of an affiliated regional
organization of the WMA, namely the Confederation of Medical
Associations in Asia and Oceania (CMAAO). During his eight
years of tenure as the JMA president, his drive was supported by
his ability to take actions and by belief in the foundation.
We would like to express our sincere gratitude to all WMA col-
leagues who helped Dr. Tsuboi during his tenure at the WMA.
Japan Medical Association (JMA)
Dr. Eitaka Tsuboi, 1929–2016