WMJ 02 2012

COUNTRY
• 191st
WMA Council Meetingt
• In Memoriam Alan Rowe
vol. 58
MedicalWorld
JournalJournal
Official Journal of the World Medical Association, INC
G20438
Nr. 2, May 2012
Cover picture from Turkey
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Latvian Medical Association
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Co-Editor
Dr. Alan J. Rowe †
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World Medical Association Officers, Chairpersons and Officials
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41
My first meeting with Alan Rowe was at the German Annual As-
sembly in Dresden, 1992. He explained me his plans for the Eu-
ropean Forum of Medical Associations and WHO (EFMA), for
which he was Secretary from 1984 to 2001. With the fall of com-
munism in East Europe, the Forum should take on a new role and
he was very clear about the importance of reaching out to the medi-
cal communities of the new democracies.
My first meeting with Alan Rowe was, in a way, a disappointment,
I thought. He would not argue with me. Whatever I criticized, he
reflected my criticism and did not oppose any point. My arguments
weren’t that good,I knew.So was he an opportunist? The impression
of him as a passive man stayed with me all day. But in the follow-
ing days, I observed a man who was driven by a cause, a mission: a
unified Europe. One that was more than the Europe of the rich, or
the European Economic Community as it was called then. He was
looking for all of Europe and actually beyond. Very soon it became
clear that my first impression was wrong and that Alan Rowe was
a true philanthropist constantly searching for harmony and under-
standing. A very rare species in this world.
The humble General Practitioner from the east of England was his
outer appearance, but in his portfolio was a number of important
positions he held and filled during his long career. He was rooted
in a very thorough and traditional education. After his basic medi-
cal education in London, he studied pathology and then became a
General Practitioner in 1954. He served in this capacity in Ixworth
Suffolk, during what others would consider a full work life until
1988. It would be unfair, however, to describe his medical inter-
est strictly by his role as a family physician. He engaged as well in
specialised fields of medicine such as rheumatology and oncology,
as well as in general fields, such as medical education and, most
important, public health.The latter found him cooperating with the
World Health Organization, to whose European Branch in Copen-
hagen he always stayed closely connected.
His work brought him respect and recognition in many countries
of Europe and there are probably not many other physicians who
have been recognized and awarded in so many countrie – and in
some even several times! Aside from his home country, which made
him an Officer of the British Empire, he received honours in Italy,
France, Portugal, Germany, Poland, Kazakhstan, Georgia, Romania,
and Macedonia. (This list is probably not exhaustive.)
Alan Rowe engaged in organized medicine and volunteered for
many duties in the British Medical Association, the European
Union of General Practitioners, the Standing Committee of Eu-
ropean Doctors, the European Forum of Medical Associations and
WHO,and neither last nor least,the World Medical Association.In
2003 he joined and volunteered to edit the World Medical Journal
and he reviewed it from a mere existence to being a real membership
journal.He only promised to do it for a year or two and when finally
Peteris Apinis took over as Editor in 2007, he remained committed
and continued to volunteer as a co-editor.
On a few occasions he treated us with his special gift as a musician.
Whenever there was an opportunity he gave us – sometimes spon-
taneously – an organ concert.
His health limited him during his last years of life more and more,but
he still participated in our European meetings and collaborated en-
thustiastically over the phone and by e-mail until the very last weeks.
On April 30th
Alan peacefully passed away and many of us have
lost a good friend, a kind and gentle colleague, an artist and a great
European spirit. And while my first encounter with him appeared
to be disappointing for a moment, the rest was a wonderful friend-
ship.
Dr. Otmar Kloiber
Secretary General, WMA
Editorial
In Memoriam Alan J. Rowe
42
WMA news
In the last six months,a full working agenda
has been accomplished by the Presidency of
the World Medical Association (WMA).
After taking the Office in Montevideo
(Uruguay), in October last year, the Brazil-
ian Dr. José Luiz Gomes do Amaral, hold
a debate on Social Determinants of Health
as his first commitment at the International
Conference in Rio de Janeiro in the same
month.
At that time,having the opportunity to rep-
resent physicians from a hundred Nations,
he expressed the importance of finding a
solution for social inequalities, observed in
both the rich and the developing countries.
These inequalities are the main responsible
for the health level populations are facing.
They refer to the conditions people are born
and grow up, to the differences in educa-
tion, opportunities and working conditions
and to the conditions people age. Physi-
cians play an important role in this field,
since, besides assisting people in need, the
profession comprehends the intervention in
the factors that give rise to poor health. For
instance, tobacco and excessive alcohol con-
sumption are causes of several diseases. And
the question arises what makes us smoke
and drink excessively? The “causes of causes”
of diseases, i.e., their social determinants,
require analysis and intervention. Increased
taxation on tobacco, sale of alcoholic bever-
ages to the underaged made cumbersome,
tobacco and alcohol advertisements banned
are examples to deeply impact the access
and consumption of these products.
In Chihuahua, Mexico, last November, the
President of the WMA offered solidarity
to the Mexican colleagues at the Assembly
of Mexican Medical College, where the is-
sue was a response to the violence against
health professionals fighting drug traf-
ficking, mainly in the city of Juarez. Vari-
ous aspects of insecurity doctors in many
areas around the world have to face were
revealed.
On November 19th
, in Panama, several
NMAs from Latin-American nations met.
Among the problems that threaten the
quality of medical services and particularly,
the Medicine, there were brought out the
repeated political interferences in doctor
organizations, mainly in Bolivia and Ven-
ezuela. In Bolivia today, the government
tries to disassemble the medical profession
and regulate it, as well as decide on ethi-
cal issues and technical competences which
qualify different specialties.The objective of
the government is to take total control of
the profession. Still, on 25–26 November,
Portuguese medical students met to debate
the European economic crisis viewing it
from the professional perspective of young
doctors in a continent that is going through
major challenges.
From January 30th
through February 1, in
São Paulo, at the headquarters of the Medi-
cal Association of the State of São Paulo
and in Rio de Janeiro, doctors announced
the worldwide campaign for 2012 – “Global
appeal” against the discrimination faced by
persons affected by leprosy.
One year after the earthquake followed by
a tsunami and nuclear accident in Japan, on
March 11th
, 2012, the “Montevideo State-
ment” was presented, which deals with the
role of medical association and physicians
in response to disaster situations. At the
Japanese Medical Association, in Tokyo, the
successful mobilization of Japanese physi-
cians around this key issue, sharing such
experience, carry enormous benefits for
diminishing the impact upon the lives of
people of the less and less infrequent cata-
strophic events.
In April this year, in Taiwan, at the open-
ing of the 20th
International Conference
on Health Promoting Hospitals, the op-
portunity to approach the role of hospitals
and health services for the promotion of
health and tackling social determinants of
health was underlined. The experience of
two hospitals from the city of São Paulo
was presented. One of them was Pirajussara
General Hospital which was built 13 years
ago in a poor area of the city and which has
successfully contributed to the improve-
ment of local social conditions. Similarly,
the experience of Hospital Israelita Albert
Einstein was presented, demonstrating rel-
evant social actions to the community of
Paraisópolis, a poor community with almost
60 thousand inhabitants. At the same event,
the meeting for “Health without Danger”
took place, which is oriented to manage-
ment processes of health institutions and
preservation of the environment. The envi-
ronmental impact of modern hospitals has
been capturing more and more the atten-
tion of society.
Also past April in Ankara and Istanbul,
Turkey, the WMA was represented by the
President and the Council Chair for the
intermediation of physicians and parlia-
mentary group of that country because of
the crisis caused by a decree recently pro-
Activities of WMA since October 2011
Jose Luiz Gomes do Amaral
43
WMA news
mulgated and brutally restricting the inde-
pendence and authority of doctors concern-
ing their professional, ethical and technical
self-regulation. The growing animosity of
the Turkish government against medical
profession, creating a hostile environment
against health professionals, has gener-
ated serious situations: physicians have been
blamed responsible for the consequences of
an erroneous public system; dissemination
of false information on the lack of doctors
as a justification for “importing” physicians
from the neighboring countries or other
parts of the world and which, to a great ex-
tent, has been influenced by the crisis. The
crisis culminated in the murdering of a 30-
year old doctor, followed by a great demon-
stration throughout the country. In Istanbul
the President of the WMA participated in
the demonstration of more than 20 thou-
sand doctors, bringing the city of Istanbul
into a halt and raising a popular outcry as a
response to this tragedy.
In April 23, the President of the WMA
and its Council participated in the meet-
ing of “Health Care in Danger”, an initia-
tive, convening such organizations as the
World and the British Medical Associa-
tion, the International Red Cross/Crescent
and Doctors without Borders to discuss the
growing violence wave against health pro-
fessionals in several regions of the world,
e.g. Somalia, Libya, Egypt, Bahrain, Syria,
Iraq, Afghanistan, Israel, Mexico, Colom-
bia, the civil and military conflicts. Using
the opportunity, the WMA presented its
position in the field of ethics and medical
neutrality in conflict situations. Physicians
and other medical professionals have been
arrested, kidnapped, tortured and murdered
in retaliation for assisting people that even-
tually belong to an opponent group. Hospi-
tals have been bombed and invaded. Such
incidents have interrupted humanitarian
actions, causing the withdrawal of volun-
tary teams whose security could not be en-
sured and, thus, leaving a great amount of
unassisted people behind.
At the end of April, namely April 24–29,
a Council Meeting of the World Medical
Association took place in Prague,the Czech
Republic. In addition to the problems men-
tioned above, other important issues were
tackled as well, such as opening of one more
revising of the Declaration of Helsinki,
an initiative started by Dr.Urban Wiesing
from Tubingen University and Dr.Ramin
Parsa-Parsi from the German Medical As-
sociation. The Meeting also dealt with the
prohibition of physician participation in
death penalty and the repudiation of the
organ use from sentenced prisoners-donors
for transplanting, which is unacceptable,
since it contradicts the professional ethical
foundations of medicine.
Dr.José Luiz Gomes do Amaral,
President of WMA
The 191st
Council meeting of the World
Medical Association opened with
Dr.  Mukesh Haikerwal, Chair of the
Council, presiding. Almost 150 delegates
from 40 National Medical Associations
attended the meeting, which was held at
the Marriott Hotel in Prague, the Czech
Republic.
The President Dr. José Gomes do Amaral
began by giving an oral report on his activi-
ties and the many meetings he had attended.
He said that he and Dr. Haikerwal had been
able to give particular support to the Turkish
Medical Association on their recent visit to
Istanbul, joining a demonstration of doctors
after the death of a young Turkish physician.
The Secretary General Dr. Otmar Kloiber
presented a detailed report on his activities
and the activities of the WMA staff.He said
the WMA was still being asked to do more
than it could do. However, the organisation
was growing in its networking activity and
partnership with other organisations.
191st
WMA Council Meeting
Prague, the Czech Republic (April 26–28, 2012)
44
WMA news
Declaration of Helsinki
Dr. Ramin Parsa-Parsi (Germany), Chair
of the Workgroup on the revision of the
Declaration of Helsinki, reported on the
preparation for two conferences, the first in
Rotterdam in June and the second in Cape
Town in December, Prof. Urban Wiesing,
the WMA’s ethics adviser on the Declara-
tion, gave an oral report on the Workgroup’s
progress.
The committee agreed to recommend to the
Council that an invitation for a public con-
sultation be sent out after the Council had
approved a draft version of a revised Dec-
laration, possibly as early as Spring 2013;
that National Medical Associations should
be asked to put forward suggested topics
for the revision process; and that the Work-
group be authorised to continue planning
the two conferences.
Finance and planning 
Dr. Leonid Eidelman (Israel), Chair of the
Finance and Planning Committee, pre-
sided.
Membership Dues
Mr Addy Hällmyer, the WMA’s Financial
Adviser, said that there were still substan-
tial amounts of dues outstanding for 2012
membership payments.  He thanked all
those NMAs who had paid their dues.
Financial Report
Presenting the financial report,Mr Hällmy-
er said that 2011 had been another year of
financial turbulence. But despite this the
WMA had not suffered any loss in its fi-
nancial assets. Dr. Frank Montgomery
(Germany),the Treasurer,assured the meet-
ing that the Association was financially in
good standing.
Business Development
Mr Tony Bourne (United Kingdom), Chair
of the Business Development Group, said
the main topic of discussion at the Group’s
latest meeting was the idea of setting up a
round table of outside organisations. But
the proposal now was for it to be a non-rev-
enue raising forum.There would be no spe-
cific fees derived from these organisations.
What would be required from them would
be a registration fee designed to cover the
costs of administering a round table.  The
idea for the composition of a round table
would be that it should be a mixture of non-
governmental organisations, multilateral
organisations and commercial companies.
Ideally it would meet initially once a year at
the time of the WMA General Assembly.
He said the British Medical Association
had undertaken to draft a charter or memo-
randum of understanding about the rules of
engagement.This would be circulated to the
Council Executive. He hoped that between
ten and fifteen organisations would be ap-
proached in a pilot scheme over the next
one to two months. 
Disaster Preparedness
Dr.Miguel Jorge (Brazil) gave an oral report
from the Workgroup on Disaster Prepared-
ness and Medical Response. The group was
continuing to work with other bodies, such
as the Red Cross and the World Health
Professional Alliance,and it was now think-
45
WMA news
ing of conducting a survey among NMAs
to identify their programmes and activities.
It was also considering an online course for
the WMA’s website. To do this he asked
that the Workgroup’s mandate should be
extended.
The committee agreed to recommend this
to the Council.
Future WMA Meetings
Dr. Kloiber said there had been many appli-
cations from NMAs to host future General
Assemblies. Applications had been received
from Argentina, Columbia, Indonesia, Lat-
via, Russia, South Africa and Taiwan.
Short oral presentations were then given by
each NMA to the meeting, and after a vote
it was decided to hold the 2014 Assembly in
Durban, South Africa.
Strategic Plan
Dr. Robert Ouellet (Canada), Chair of the
Strategic Planning Group, reported on
progress of the three-year rolling strategic
plan that had been discussed at the last
General Assembly. He introduced Emman-
uelle Morin from the Canadian Medical
Association who said they had now moved
to the stage of preparing a final strategic
plan. She spoke about the results of the sur-
vey of members and stakeholders. This had
identified the core business areas of ethics
and guidance, advocacy and representation,
and networking and outreach. What now
had to be decided were the priority strategic
objectives, such as operational excellence,
and partnership and collaborations. Mem-
bers had to ask themselves whether this
plan would provide the direction needed for
the WMA over the next 3–5 years.
The committee decided that the latest doc-
ument on the strategic plan should be cir-
culated to NMAs for further consideration.
Membership
Junior Doctors Network
Dr. Xaviour Walker, Chair of the Network,
gave an oral report about the Network’s
activities. He said the Network had been
in existence now for two years as the first
global organisation of its kind. It was plan-
ning to network with other junior doctors’
organisations and to work with NMAs that
did not have junior representation.The Net-
work was involved in developing two papers
for the WMA, one on physician wellbeing
and the other on ethical global health train-
ing.
Membership 
Applications for membership were received
from the Myanmar Medical Association
and from the Sri Lanka Medical Associa-
tion.The committee decided to recommend
the Council to forward the applications to
the General Assembly for acceptance
France
An application for membership was re-
ceived from the Conseil de l’Ordre Na-
tional des Medecins to replace the French
Medical Association. Dr. Michel Legmann
(Conseil de l’Ordre National des Medecins)
said that the 270,000 French physicians had
to be registered with the Conseil in order to
be able to practice. 
The committee recommended the Council
to forward the request to the General As-
sembly for adoption.
Election Procedure
Dr. Ouellet proposed an amendment to
the WMA’s election and voting procedures,
stating that in order to be elected a candi-
date must be present at the time of the elec-
tion.This would be in line with the election
requirements of most national medical as-
sociations.
In the debate that followed, a number of
concerns were identified, and Dr. Ouellet
decided to withdraw the amendment for
further consideration.
WMA Awards
A proposal was considered for a new WMA
awards scheme to recognise physicians and
lay persons who had helped to improve
medical care. The idea was put forward by
Dr. Peteris Apinis (Latvia), but after the de-
tails were explained, it was decided that the
idea should not be pursued.
World Medical Journal
Dr. Peteris Apinis, editor in chief of the
Journal, said the WMJ had been published
for 58 years. Since 2010 it had been pub-
lished bi-monthly. He said he would like to
publish the Journal 12 times a year, but this
would be financially challenging. His ideas
for developing a scientific edition would
also depend on finding the necessary re-
sources.
Socio-Medical Affairs
Committee 
Social Determinants
Sir Michael Marmot (United Kingdom),
Chair of the Socio-Medical Affairs Com-
mittee, opened the proceedings of his com-
mittee, by giving a report on social determi-
nants. He said he was conducting a review
of social determinants and the health divide
in the European region and there would be
a report to the WHO later this year. The
WMA had an important role to play about
46
WMA news
what doctors and other health professionals
could do in this arena.
Health and the Environment
Dr.Dongchun Shin (Korea) gave an oral re-
port about the UN Climate Change Sum-
mit which he attended in Durban, South
Africa last year and the parallel Global Cli-
mate and Health Summit. These brought
together key health sector people to dis-
cuss the impact of climate change on pub-
lic health and solutions to promote greater
health. The WMA was one of the partners
in the event.
Dr.Vivienne Nathanson (United Kingdom)
said she had attended a follow up Health
Sector Climate Strategy discussion held
to build on the work of the Durban Sum-
mit. She said there was a worrying trend of
health repeatedly slipping from the agenda
when talking about climate change. There
was a need to produce a resource which
identified what the health environmental
and economic cases were for averting cli-
mate change.
Sir Michael Marmot referred to the forth-
coming UN Conference on Sustainable
Development in June and expressed his
concern that there was almost no health
component in it. People were going to dis-
cuss climate change without looking at the
impact of health.
Health and Mercury
Dr. Peter Orris (USA) reported on the UN
Mercury Treaty negotiations which he had
been following for the WMA. Although
the process was moving forward slowly, a
health perspective was missing from this
discussion and delegates from Environment
Ministries had little understanding of the
topic. However, there had been tremendous
progress in phasing out mercury thermom-
eters.
Protection of Health Personnel
The committee considered the proposed re-
vision of the WMA Regulations in Times
of Armed Conflict and Other Situations of
Violence.
Dr. Vivienne Nathanson reported on the
project “Healthcare in Danger” launched
by the International Committee of the
Red Cross to raise public awareness about
attacks on health care personnel and insti-
tutions and find solutions to the problem.
The ICRC had carried out research on
the extent of the problem in a selection of
countries. The aim of the project was to try
to get a global movement to push hard at
governments to give to those institutions,
their workers and patients legal protections.
She also spoke about a conference organised
that week jointly by the ICRC, the WMA
and the British Medical Association on the
issue. The key message of the conference
was that every time a doctor was kidnapped,
injured or killed it was patients, often the
poorest and most vulnerable, who suffered.
It was often the case that healthcare provi-
sion was withdrawn.
The committee considered the revised poli-
cy on Regulations in Times of Armed
Conflict and decided to forward it to the
Council for sending it to the General As-
sembly for adoption.
The committee also considered a Resolu-
tion on Danger in Health Care in Syria and
Bahrain which it agreed should go to the
Council for (see p. 55) approval.
Ethical Implications of
Physician Strikes
Leah Wapner (Israel) spoke about the pro-
posed Statement on Physician Strikes, pre-
sented by the Israeli Medical Association
last year after the physicians’ strike in Is-
rael. She said there was a lot of controversy
surrounding the issue and the role that the
WMA should have in this area. As a re-
sult it was clear that the Statement needed
further discussion. She  proposed that a
Workgroup should be set up to consider
the whole issue.
The committee agreed to recommend this
to the Council.
Electronic Cigarettes
The committee considered the proposed
Statement on Electronic Cigarettes.
Dr.  Jeremy Lazarus (USA) introduced
the paper and said it had undergone some
amendments since the last discussion in
Montevideo.
Dr.Vivienne Nathanson said that some to-
bacco companies in the United Kingdom
were branding their electronic cigarettes
with the brand names of high selling ciga-
rettes, hoping that people would switch
between the two. She wanted to see the
WMA deplore the idea of brand stretch-
ing.
It was agreed to amend the document ac-
cordingly and forward it to the Council
with the recommendation that it should go
to the General Assembly for adoption.
Violence in the Health Sector
Malke Borrow (Israel) introduced the pro-
posed Statement on Violence in the Health
Sector paper which was first presented in
2010 and had since been amended to ad-
dress the issue of mental health.
The committee decided to recommend to
the Council that the document be sent to
the General assembly for adoption. 
Forced Sterilisation
Dr. Vivienne Nathanson introduced a new
proposal for a Statement on Forced and
Coerced Sterilisation that had arisen out of
47
WMA news
discussions with the International Health
and Human Rights Organisations. Around
the world, forced sterilisation was extremely
common, and this was not an issue that ap-
plied only to women. Men were also sub-
ject to it. She said the proposed Statement
declared that no-one should be sterilised
without their consent and she asked that
the document be circulated to NMAs for
consideration.
The committee agreed to recommend this
to the Council. 
Turkish Medical Association
The meeting heard a plea for help from the
Turkish Medical Association. Dr. Feride
Tanik (Turkey) said that as a result of a
decree from the Turkish Government last
year the medical association was facing fi-
nancial and political pressures. The author-
ity of the association on self-regulation had
been transferred into a new bureaucratic
body of the Ministry of Health. As a result
the association no longer had the authority
to establish and issue ethical guidelines for
physicians, conduct investigations about al-
leged malpractice by physicians, determine
disciplinary sanctions against physicians or
develop core curricula for medical educa-
tion, post-graduate medical education.
They were particularly concerned that the
Government had removed from the medi-
cal association’s mandate the words to en-
sure “that the medical profession is prac-
ticed and promoted in line with public and
individual well-being and benefit”. As a
result of this, the association could no lon-
ger challenge actions that adversely affected
the right to health, the provision of health
care, public health, and individual patient
well-being. This diminished the indepen-
dence of physicians, as well as the health of
their patients.
The committee considered a Resolution
expressing concern about the Turkish Gov-
ernment’s action and urging it to restore
to the Turkish Medical Association the
responsibilities for professional autonomy
and self-regulation that it took from them.
It called on all physician members of the
Turkish Parliament to remember their du-
ties as physician leaders and to support the
right of the medical profession to autono-
my and self-regulation. And it commend-
ed the Turkish Medical Association and
those members of the Turkish Parliament
who had challenged their Government.
It was agreed to forward the Resolution to
the Council for approval.
Autonomy of Professional
Orders in West Africa
A proposed Resolution was submitted by
the Medical Association of Senegal re-
questing that the professional autonomy
and self-regulation be guaranteed within
the countries of the Economic and Mon-
etary Union of West Africa, which brought
together eight countries of West Africa.
It was agreed to forward the Resolution to
the Council for approval.
Vaccination
Dr. Jon Snaedal (Iceland) introduced a
proposed new Statement on the Prioriti-
sation of Vaccination that had come from
the Iceland and Irish Medical Associations.
He said the WMA had a multitude of poli-
cies on public health but nothing on vac-
cination which was one of the most effec-
tive interventions. The proposed Statement
endorsed the global vision on vaccination
of the World Health Organisation and
UNICEF and emphasised the importance
and effectiveness of vaccination. But it also
pointed to the dangers arising from many
ill thought out ideas about the risks, leading
to a decrease in vaccination in some parts of
the world, thereby increasing the prevalence
of diseases.
It was agreed that the paper should be cir-
culated to NMAs for consideration.
Counterfeit, Falsified and
Substandard Medicines
The Secretary General, Dr. Kloiber, intro-
duced a paper, entitled “How to Achieve
International Action on Falsified Medicine:
A Consensus Statement”, that had been
received by the WMA for endorsement
from outside the organisation. The paper
had been written against the background
of the large amount of substandard, fake
and counterfeit medicines that existed in
the world. But Dr. Kloiber said the issue
was dominated by questions of intellectual
property rights which were a minefield and
he doubted whether it would be helpful for
the WMA to endorse the paper.
After a debate, during which delegates ex-
pressed strong reservations about the docu-
ment, it was agreed that no further action
should be taken.
Advocacy 
Paul Emile-Cloutier (Canada), newly ap-
pointed Chair of the Advocacy Advisory
Workgroup, highlighted some of the advo-
cacy developments of the WMA which he
said were reaping some positive results. The
Group had discussed some of the challenges
the WMA was facing, such as how to bet-
ter align the strategy on advocacy with the
strategic plan and how to assist the NMAs
with their advocacy by providing them with
the necessary tools.The Group would even-
tually come forward with some concrete
proposals.
Health Care in Danger
Dr. Jorge (Brazil) said that given the in-
creasing concern about doctors being
threatened around the world and the new
ICRC campaign “Health Care in Danger”
that a WMA Workgroup should be set up
to identify and follow up events in this area.
This was agreed and the proposal was for-
warded to the Council for approval.
48
WMA news
Bolivia
The committee heard a plea from CON-
FEMEL (the Medical Confederation of
Latin America and the Caribbean) for doctors
in Bolivia to be supported by the WMA in a
dispute with their Government.It was report-
ed that doctors’ leaders in the country were
currently involved in a hunger strike in pro-
test at recent Government actions to change
the laws governing the practice of medicine.
These included changing the presumption of
innocence in cases of malpractice. In addition
doctors’salaries and income had been reduced,
theirworkinghoursincreasedandworkcondi-
tions had deteriorated.The WMA was urged
to send a letter of support to the Bolivian doc-
tors.The proposal was deferred to the Council.
Medical ethics committee
Dr. Torunn Janbu (Norway), Chair of the
Medical Ethics Committee, presided.
Ethical Organ Procurement
Dr. Vivienne Nathanson, Chair of a Work-
group on the issue, presented a revised ver-
sion of the proposed Statement on Organ
and Tissue Donation. Significant amend-
ments had been made about prisoners being
organ donors with a prohibition on organs
being taken from executed prisoners. A new
section had also been added about living
donors, the biggest increasing section in
many countries.
The committee debated the document at
some length and made a number of amend-
ments relating to the description that should
be given to decision makers, on transplant
co-ordinators and the wording on oppos-
ing the commercialisation of donation and
transplantation.
It then agreed to send the amended State-
ment to the Council for forwarding to the
General Assembly for adoption.
Ethics in Palliative Medicine
Dr. Fernando Rivas (Spain), Chair of the
Worgroup on Ethics and Palliative Seda-
tion, said the Group had concluded that
the WMA’s existing Declarations on Eu-
thanasia, Terminal Illness and End-of-Life
Medical Care were sufficiently relevant and
that no new Declaration was required. The
Spanish Medical Association had offered to
circulate guidelines to help NMAs promote
education on palliative care and relation-
ships between physicians and patients, and
to write an article in the World Medical
Journal on this topic.
Dr. Marco Gomez Sancho (Spain) said
the purpose of suggesting a new Declara-
tion had been to allow members to make a
distinction between two things that were
totally different – palliative sedation, which
was a medical process that was universally
accepted all over the world and euthanasia
which was a process that was absolutely
rejected by a strong majority of doctors,
though not all of them.
The committee thanked the Workgroup for
their work.
Capital Punishment
Dr. Cecil Wilson (USA)  presented a new
Resolution on Capital Punishment reaf-
firming the WMA’s prohibition on physi-
cians participating in capital punishment.
He reminded the committee that the Work-
group had been set up to evaluate whether
the WMA should have a mandate to exam-
ine the options for developing a Statement
opposing capital punishment.
The proposed Resolution,including a prohi-
bition on physicians facilitating the impor-
tation or prescription of drugs for execution,
was debated and after several amendments
were agreed it was decided to send the doc-
ument to the Council for forwarding to the
General Assembly for adoption.
Human Rights
Ms Clarisse Delorme, the WMA’s advocacy
adviser,updated the meeting on the situation
in Bahrain of the trial of a number of physi-
cians and on the continuing conflict in Syria.
Person Centered Medicine
Dr. Jon Snaedal (Iceland) introduced a pro-
posed new Statement on Person Centred
Medicine. He said one reason for this was
the fragmentation of health which tended
to be more and more organ specific. The
WMA was now involved in various initia-
tives on person centred medicine and it was
time the Association developed policy on
the issue.
The committee decided to circulate the doc-
ument to NMAs for consideration.
Council
The third and final day of the meeting was
taken up with the Council considering the
reports from the three committees.
It approved three Resolutions: on Threats to
Professional Autonomy and Self-Regula-
tion in Turkey,on Danger in Health Care in
Syria and Bahrain, and on the Autonomy of
Professional Orders in West Africa.
From the Socio-Medical Affairs Commit-
tee it decided to forward to the General
Assembly for adoption the following docu-
ments:
• Revised Regulations in Times of Armed
Conflict.
• Statement on Electronic Cigarettes.
• Statement on Violence in the Health
Sector.
The Council agreed to the setting up of a
Workgroup on physician strikes and to cir-
culating to NMAs papers on forced sterili-
sation and vaccination.
49
WMA news
From the Medical Ethics Committee it de-
cided to forward to the General Assembly
for adoption:
• Revised Statement on Organ and Tissue
Donation.
• Resolution on Capital Punishment.
The Council also agreed to the idea of a
public consultation on the revision of the
Declaration of Helsinki after the Council
had approved a draft proposal and to circu-
lating a paper to NMAs on person centred
medicine
From the Finance and Planning Commit-
tee it decided to forward to the General As-
sembly for adoption:
• Membership applications from the
Myanmar and Sri Lankan Medical As-
sociations.
• Membership of the Conseil de l’Ordre
National des Medecins to replace the
French Medical Association.
The Council also agreed to extend the
mandate of the Workgroup on disaster pre-
paredness and to circulate to NMAs the
amended paper on the strategic plan.
Bolivia
CONFEMEL proposed an emergency
Resolution urging the WMA to express its
support for the doctors in Bolivia who were
on hunger strike in protest at the actions
that the Bolivian Government had taken
against the Bolivian Medical Association.
One suggestion was that the WMA should
help to mediate between the two sides.
The Council decided that this issue should
be sent to the Council Executive to take
forward.
World Veterinary Association
Dr. Tjeerd Jorna, Past President of the
World Veterinary Association, addressed
the meeting about the history and work
of his association. Its mission was to en-
sure animal health and animal welfare at
a global level and to protect public health.
He said he hoped the WMA and the WVA
could co-operate more on issues such as
anti-microbial resistance and the control of
zoonotic diseases, such as rabies and avian
influenza. He hoped the two organisations
could agree a memorandum of understand-
ing and he had sent a draft memorandum to
the WMA’s Secretary General.
Disaster Preparedness
The Council agreed to extend the mandate
of the Workgroup to explore developments
in terms of specialisation and online train-
ing courses and other possibilities by sur-
veying constituent members.
Primary Care Conference
The Chair, Dr. Haikerwal said it was hoped
to have a primary care conference early in
2013.
World Health Assembly
Dr. Kloiber said that the forthcoming
World Health Assembly would give the
WMA the chance for some advocacy ac-
tivities. One topic coming up at the WHA
was a report on intellectual property which
in part called for the lifting of patents
for drugs for poor countries. He said the
WMA had a tradition of asking for equi-
table access to drugs which was extremely
important for the provision of drugs to
patients in poor countries. However, the
way the report was being proposed was
questionable because a lifting of patents
would lead immediately to a production of
drugs which would flood the market.There
would be no more protection for produc-
ing new drugs. This was something the
WMA would have to monitor closely and
he suggested that the WMA might even-
tually have to consider policy on the whole
area of the sustainability of the pharma-
ceutical supply in the world, equitable ac-
cess to drugs and how innovations would
be financed in the future.
Election Procedure
Dr. Ouellet put forward a revised amend-
ment to the WMA’s election and voting
procedures, having taken into consideration
concerns expressed in the Finance Com-
mittee.
The new amendment read that “In cases of
officers elected by the Council and commit-
tee chairs elected by committee, candidates
must to the degree possible be present at
the time of the election, except in circum-
stances deemed acceptable by the electing
body. Candidates will have the opportunity
to speak to their candidacy”.The Council
accepted the proposal.
The Council meeting ended with thanks
to the Czech Medical Association for their
hospitality.
50
WMA news
Secretary General’s Report
Non-communicable diseases
Non-communicable diseases have emerged as one of the most
important topics on the public health agenda. The WMA has
concerns regarding the WHO’s identification of four specific
NCDs – cardiovascular disease, cancer, lung and respiratory dis-
ease, and diabetes – as a focus of the initiative. The risk of this is
returning to a silo-based approach to public health. If govern-
ments concentrate only on improving health outcomes in these
identified areas, other critical NCD threats will not receive ad-
equate attention. Therefore the WMA, together with the other
health professionals, has been lobbying to revise the WHO’s ap-
proach to make it more holistic and suggesting that targets should
address the elimination of inequalities in health care.
Together with our partners in the World Health Professions Al-
liance (WHPA) the WMA has participated in the development
of the NCD toolkit to assess the risk level in life style behaviours
and bio measures in form of NCD indicators.The Brazilian Med-
ical Association has translated this into Portuguese.
Multi drug resistant tuberculosis project
The WMA has launched the revised MDR-TB online course, up-
dating the original 2006 course.Printed courses have been translat-
ed into Azeri,Chinese,French,Georgian,Russian and Spanish.All
courses can be accessed free of charge from the WMA webpage.
The printed TB refresher course has been nominated by the Unit-
ed States Center for Disease Control (CDC) as an educational
highlight and has received an award.
Tobacco project
The WMA was involved in the implementation process of the
WHO Framework Convention on Tobacco Control (FCTC)
http://www.who.int/tobacco/framework/en,the international treaty
condemning tobacco as an addictive substance and imposing bans
on the advertising and promotion of tobacco.
The WMA is also cooperating with the public private partnership
“QuitNowTXT program”to develop information for tobacco ces-
sation via mobile phones to reach people at risk for preventable
NCDs.
Alcohol
The WMA continues to monitor activities relating to the Global
Strategy to Reduce the Harmful Use of Alcohol. This requires
concerted action by countries, effective global governance, and
appropriate engagement of all relevant stakeholders, including
health actors.The WMA Secretariat has monitored the process in
this direction, so that medical associations at national and global
levels continue to be engaged in this area.
Counterfeit medical products
The WMA and the members of the WHPA have stepped up their
activities on counterfeit medical issues and developed an Anti-
Counterfeit campaign with an educational grant from Pfizer Inc.
and Eli Lilly. The basis of the campaign is the ‘Be Aware’ toolkit
for health professionals and patients to increase awareness of this
topic and provide practical advice for actions to take in case of a
suspected counterfeit medical product.
Health and the environment
Climate change
The WMA had had observer status to the UN Climate Change
Conference in Durban in December 2011, which brought to-
gether representatives of the world’s governments, international
organizations and civil society. The discussions aimed to advance
the implementation of the Climate Change Convention and the
Kyoto Protocol. The WMA Secretariat has been able to facilitate
the participation of medical associations interested in the Summit.
The Association also agreed to be a partner for a Global Climate
and Health Summit in December 2011 organised by Health Care
Without Harm, the Climate and Health Council, the World
Federation of Public Health Associations and Nelson R. Man-
dela School of Medicine (University of KwaZulu-Natal). The
purpose of the event was to galvanize health sector work around
climate change. A Declaration and Plan of Action were adopted
by all partners. Prof. Dong Chun Shin (Korean Medical Associa-
tion), a member of the former WMA working group on health
and the environment represented the WMA at the Summit. As
a follow-up to the Durban Summit, a Health Sector Climate
Strategy discussion of the partners was held in London in March
to build on the success of the work achieved in Durban. Professor
Vivienne Nathanson represented the WMA at the meeting. The
WMA had also continued its work in the areas of mercury and
chemicals.
51
WMA news
Social determinants of health
Council Member,Sir Michael Marmot (British Medical Associa-
tion), was a member of the advisory Committee for the World
Conference on Social Determinants of Health in Rio de Janeiro.
The goal of the Conference was to bring Member States and oth-
er actors together and engage high-level political support to make
progress on national policies that address social determinants of
health, with the objective of reducing health inequities.The Con-
ference adopted the Rio Declaration at the end of the meeting,
which emphasized the role of the health sector in reducing health
inequities.
Health systems
Global health systems face the challenges of delivering high qual-
ity, accessible care under increasing budgetary pressure. Health
data has a critical role to play in improving the quality, accessibil-
ity and efficiency of health services and, therefore, an important
role in ensuring that health systems continue to improve.Howev-
er, across all health systems there are situations in which accurate
health data are not available. The lack of availability and access
to health data can result in unsafe or ineffective services or lead
to a waste of resources.The World Economic Forum organized a
working group to develop and define the principles of a Global
Charter on Health Data. The WMA represented the physicians’
perspective in this working group and demanded the anonymity
and aggregation of data and the right of the patient’s ownership
of the data.
Positive Practice Environment Campaign (PPE)
The WMA has continued its close involvement in this global
5-year campaign, which aims to ensure high-quality health work-
places for quality care. Activities are taking place in Uganda, Mo-
rocco and Zambia, which are among the fifty-seven countries
worldwide suffering from a critical shortage of health care work-
ers. The PPE Partners and Secretariat are working with nation-
al health professional and hospital organisations in these three
countries to develop country projects and improve their practice
environments.
Migration and retention
The WHO has developed the Guidelines on Retention Strategies
for Health Professionals in Rural Areas and the WMA took part
in the drafting process. The guidelines are based on three pillars:
educational and regulatory incentives, monetary incentives and
management, and environment and social support.
Workplace Violence in the Health Sector
Preparations for the 3rd
Conference on Workplace Violence in the
Health Sector (24–26 October,2012,Vancouver) have started and
the WMA is a member of the planning committee.The Chair of
Council, Dr. Mukesh Haikerwal, will be opening the conference
with a keynote speech.
Education and Research
The World Federation for Medical Education (WFME) has
started a discussion process about the future role of the physician,
in which the WMA will be involved. There will be a WFME
World Conference on medical education in Malmö,Sweden from
November 14–16, 2012 and all medical associations are invited to
attend and participate.
The WMA participated as a member of steering groups in two
projects commissioned by the European Union on the Mobility
and Migration of Health Professionals, one led by the European
Health Care Management Association and the other by the Re-
search Institute of the German Hartmann Bund, a private physi-
cians’ organization.The objective of the projects was to assess the
current trends of mobility and migration of health professionals
to, from, and within the European Union, including their reasons
for moving. Research will also be conducted in non-European
sending and receiving countries, but the focus lies within the EU.
In December, the two research projects came to an end and an
International Conference, “Ensuring Tomorrow’s Health: Work-
force Planning and Mobility”, was held 7–9 December, 2011 to-
gether with the launch of the final research publication: ‘Health
Professional Mobility and Health Systems – Evidence from 17
European Countries. The WMA presented the physicians’ per-
spective on this topic and actively took part in the workshop or-
ganisation.
Patient safety
The WMA had been involved in the issue of patient safety and
was a member of the WHO reviewing committee for the multi-
professional guidelines.
Caring physicians of the world
initiative leadership course
The CPW Project, which began with the Caring Physicians of
the World book, published in October 2005 in English and in
52
WMA news
Spanish, has continued with regional conferences and leadership
courses organized by the INSEAD Business School.
Speaking book
The speaking book on clinical trials, a collaborative effort with
the South African Medical Association, the SADAG (South
African Depression & Anxiety Group) and the Steve Biko
Center for Bioethics in Johannesburg and the publisher “Books
of Hope”, had been launched during the General Assembly in
Seoul, 2008. In 2010, Books of Hope, with the support of Pfizer,
the Chinese Center of Disease Control, the Chinese Medical
Doctors Association, the Chinese Association on Tobacco Con-
trol and the WMA, presented a speaking book on the dangers
of smoking.
Health politics
The WMA has intervened several times on health politics matter
at the request of member associations:
In Slovakia the government put hospitals in a state of emergency
in order to stop protests and industrial action by physicians fight-
ing for better working conditions and against the privatisation
of public hospitals. In consultation with the Slovak Medical As-
sociation, the WMA wrote to the Prime Minister and the Presi-
dent of the Republic to ensure proper working conditions and
fair payment.
In Poland the physicians were made liable for managing the reim-
bursement entitlements for the insured. All people in Poland are
insured under a state insurance scheme which gives various en-
titlements for reimbursement. These different entitlements were
at least in part non-transparent to the physicians, who should not
be held liable for wrongly assigning reimbursement statuses for
drug on prescriptions.Together with the Polish Chamber of Phy-
sicians and Dentists the WMA protested against this measure,
which later was revoked.
At the end of 2011, the Turkish Government removed from the
Turkish Medical Associations and other self-governing institu-
tions key functions such as supervision of physicians and the
regulation of post graduate education. Interestingly, these insti-
tutional rights were assigned by law and the government is trying
to lift them by a government order. Together with the Turkish
Medical Association the WMA will stage public events in An-
kara and Istanbul April 16th
and 17th
respectively to fight for re-
taining these critical rights of physician self-governance.
Human rights
In January 2011, the Special Rapporteur launched a public con-
sultation on the right to health of older persons, and the WMA
Secretariat coordinated the consultation with national medical
associations, encouraging them to contribute to the process and
increase the visibility of medical associations’action in the area of
health and human rights.
Bahrain
For more than a year the WMA Secretariat and its members have
been monitoring the situation in Bahrain, where assaults by secu-
rity forces on health professionals were reported by Amnesty In-
ternational. Several letters were sent to the authorities of Bahrain
expressing deep concerns on the access to appropriate healthcare
for victims, as well as on health professionals’ independence. The
WMA Secretariat and its members have been closely following
the trial of physicians.
Syria
The Association has also issued press releases about the situation
in Syria and are closely watching the situation.
Protection of health professionals in armed-conflicts
areas
The growing threats to health personnel in armed conflicts areas
and other situations of violence had been the subject of increasing
global debate and actions over the last year, in which the WMA
had been closely involved. The Association was now supporting
the International Committee of the Red Cross four-year cam-
paign “Healthcare in Danger” about the security and delivery of
effective and impartial health care in armed conflict and other sit-
uations of violence.
Detention
As an elected member of the Executive Committee (ExCo) of
the IRCT, Clarisse Delorme attended the ExCo meeting which
took place last November in London. Issues discussed included
the preparations for the coming General Assembly (November
2012, Copenhagen) as well as the activities of the UN Subcom-
mittee on Prevention of Torture (SPT) and more generally the
Human Rights Council.
53
WMA news
The WMA Secretariat had contacted the United Nations Of-
fice on Drugs and Crime about the possible revision of the UN
Standard Minimum Rules for the Treatment of Prisoners with
suggestions for recommendations and these were welcomed by
the UN office.
Woman and children, and health
A joint press release has been issued with the International Fed-
eration of Human Rights and Health Organisations in which the
practice of forced/coerced sterilization was denounced and con-
demned.
In 2009, the WMA amended its Declaration of Ottawa to foster
the protection of children. With the ‘Fit for School’ project, the
WMA had an implementation activity to increase the health sta-
tus of children. Currently, the German Development Aid Agency
GIZ together with the South East Asian Ministers of Educa-
tion Organisation (SEAMEO) and the WMA are developing
the ‘fit for school course’, which aims to promote and facilitate
effective school health programmes worldwide through build-
ing conceptual, implementation, and management capacity with
governments, international organisations and NGOs in low and
middle-income countries.
The course will be developed in a comprehensive yet modular way
allowing for adaptation to different target audiences and country
settings. It will cover a broad range of topics related to effective
school health programmes, including concept development to
implementation, child health, evidence-based interventions, day-
to-day management, and to evaluation and monitoring–all with a
strong practical approach.
Ethics
The WMA Workgroup on the Declaration of Helsinki was con-
tinuing to examine ways in which the Declaration might be re-
vised.
The Chair of the WMA Medical Ethics Committee, Dr.Torunn
Janbu, had participated as the WMA representative in a work-
shop organised by the Council for International Organisations of
Medical Science on the ethical aspects of clinical research con-
ducted in developing countries and community consultation in
the preparation of research. The workshop covered areas such as
community customs and codes,community engagement,multiple
communities, traditional knowledge, authority structures and the
role of elders.
Medical and health policy development
The Center for the Study of International Medical Policies and
Practices, George-Mason-University, which is one of the WMA’s
Cooperating Centers, has studied the need for educational sup-
port in the field of policy creation. The surveys performed with
cooperation of the WMA found a demand for education and ex-
change. The Center invited the WMA to participate in the cre-
ation of a scientific platform for international exchange on medi-
cal and health policy development. In the fall of 2009, the first
issue of a scientific journal, the World Medical & Health Policy,
was published by Berkeley Electronic Press as an online journal.
In the meantime Berkley Electronic Press has been obtained by
De Gruiter. The World Medical & Health Policy Journal can be
accessed at: http://www.psocommons.org/wmhp.
World health professions alliance
Together with the other members of WHPA,the WMA launched
the WHPA NCD campaign, the core of which is a simple, uni-
versal educational tool allowing everyone to assess and record
their lifestyle/behavioural and biometric risk factors. The infor-
mation obtained through using the Health Improvement Card
can help the individual and health professional develop specific
interventions to address individuals risk factors and actively im-
prove health and well-being.
In a second phase, the card will be piloted and evaluated.The ob-
jective of the project is to develop a tool that is usable in all health
care settings throughout the world and that increases awareness
of the individual responsibility of each person for their health,
and serves as an advocacy tool for improved health care systems.
Membership
The Medical Association of Myanmar and the Sri Lanka Medical
Association have both applied to join the WMA and the Italian
Order of Physicians has also indicated its intention to rejoin.
Dr. Otmar Kloiber
54
WMA news
Introduction
The WMA is extremely concerned about recent actions by the
Turkish government that drastically reduce the self-governing au-
thority and professional autonomy of the medical profession in
Turkey. In particular, the newly enacted Government Decree 663
on the Organization and Duties of the Ministry of Health and its
Associated Organizations establishes a Health Professions Board,
controlled by the Ministry of Health, and delegates authority to
this Board for certain critical functions that should remain with
the Turkish Medical Association in keeping with the principles of
professional autonomy and physician self governance.The Turkish
Medical Association was established by the Turkish Parliament in
1953,while Decree 663 was passed by the government ministers of
Turkey in an extraordinary process that bypassed the Parliament.
Of grave concern is the fact that the Turkish Medical Association
no longer has the authority to:
• Establish and issue ethical guidelines concerning physician
conduct
• Conduct investigations regarding alleged malpractice by physi-
cians
• Determine disciplinary sanctions again=st physicians in cases
of malpractice
• Develop core curricula for medical education, post-graduate
medical specialty curricula, and content and accreditation for
continuing medical education (all of which were previously
done in partnership between the TMA and universities)
In addition, Decree 663 amends Article 1 of the Constituting
Law of the Turkish Medical Association (originally drafted and
adopted by the Parliament) by removing the following language
in the TMA’s mandate: “ensuring that medical profession is prac-
ticed and promoted in line with public and individual well-being
and benefit”. As a result of this restriction of its mandate, the
TMA no longer has the right to legally challenge actions and
regulations that adversely affect the right to health, the provision
of health care, public health, and individual patient well-being.
Examples might include, for instance, efforts against restrictions
on which medical procedures would be reimbursed under the
national health system or initiation of action to address public
health hazards such as the use of cyanide in silver and gold min-
ing and processing. The narrowing of the TMA’s mandate in this
regard not only diminishes the independence of physicians, but
also jeopardizes the health of their patients.
Therefore
Reaffirming its unequivocal commitment to the independence
and professional self-governance of the medical profession, as
defined in the WMA Declaration of Madrid on Professional
Autonomy and Self-Regulation, and the WMA Resolution on
the Independence of National Medical Associations, the WMA
Council:
1. Urges the Turkish government to rescind Decree 663 and
restore to the Turkish Medical Association its duties and re-
sponsibilities for professional autonomy and self regulation,
properly established by the Parliament in 1953 through the
legitimate and transparent national democratic process.
2. Urges all physician members of Parliament, regardless of po-
litical affiliation, to recall their duties as physician leaders and
support the right of the medical profession to autonomy and
self-regulation.
3. Supports and commends the Turkish Medical Association
and those members of the Turkish Parliament who have chal-
lenged these recent actions and requested a legal review of this
Decree by the Constitutional Court.
4. Calls on all physicians in Turkey and around the world to join
actively in advocacy efforts to promote and support profes-
sional independence, the right to health, and the health of the
people of Turkey.
WMA Council Resolution on Threats to Professional
Autonomy and Self-Regulation in Turkey
Adopted by the 191st
 WMA Council Session, Prague, April 2012
55
WMA news
Preamble
The Economic and Monetary Union of West Africa (Union
Economique et Monétaire Ouest Africaine; UEMOA) brings
together eight countries of West Africa using CFA Franc as a
currency.This tool of integration advocates for the free circulation
and settlement of physicians in the countries of UEMOA.
There is a College of the Orders of Physicians, bringing together
the Orders of member countries of the Union. The Orders are
often under the supervision of the health ministries. This situ-
ation often confines the technical and administrative autonomy
and impedes the good management of the medical mapping of
the region, undermining access to health care for the populations.
Recommendation
Reiterating its Declaration of Madrid on Professional Autonomy
and Self-Regulation and its Resolution on the Independence of
National Medical Associations,the WMA requests that the inde-
pendence, professional autonomy and self-regulation be guaran-
teed within the countries of the Economic and Monetary Union
of West Africa
WMA Council Resolution on the Autonomy
of Professional Orders in West Africa
Adopted by the 191st
 WMA Council Session, Prague, April 2012
The WMA recognises that attacks on health care facilities, health
care workers and patients are an increasingly common problem
and the WMA Council denounces all such attacks in any country.
These often occur during armed conflict and also in other situations
of violence, including protests against the state.  Patients, including
those injured during protests,often come from the poorest and most
marginalised parts of the community and suffer a higher proportion
of serious health problems than those from wealthier backgrounds.
Governments have an obligation to ensure that health care facili-
ties and those working in them can operate in safety and without
interference either from state or non-state actors, and to protect
those receiving care.
Where services are not available to patients due to government
action or inaction, the government, not the health practitioners,
should be held responsible. Noting that recent and ongoing con-
flicts in Bahrain and Syria have seen physicians, other health care
personnel and their patients attacked while in health care facili-
ties, the WMA demands:
1. That states fulfill their obligations to all their citizens and resi-
dents, including political protestors, patients and health care
workers, and protect health care facilities and their occupants
from interference, intimidation or attack.
2. That governments enter into meaningful negotiations wher-
ever such attacks are possible, likely or already occurring to
stop the attacks and protect the institutions and their occu-
pants, and
3. That governments consider how they can contribute posi-
tively to the work of the International Committee of the
Red Cross on promoting the safety of health care provision
through awareness of the concepts within their project Health
Care in Danger.
WMA Council Resolution on Danger in Health Care
in Syria and Bahrain
Adopted by the 191st
 WMA Council Session, Prague, April 2012
56
WMA news
The first ever consultative event on the
problem of safely and effectively delivering
healthcare to people in situations of conflict
and violence took place in London in April.
A symposium at BMA House, jointly or-
ganised by the International Committee
of the Red Cross (ICRC), the British Red
Cross, the World Medical Association and
the British Medical Association, was held
to discuss the ICRC’s project ‘Health Care
in Danger’ that was launched last year.
It was the first of a series of global work-
shops, attended by health care workers and
key stakeholders from around the world,
to brainstorm solutions and possible ways
forward for the project. As part of the
project, the ICRC is also running a public
campaign, ‘It’s a Matter of Life and Death’,
which seeks to raise public awareness of
the problem and mobilise a community of
concern among health care workers, armed
forces, states and weapons carriers.
The conference was opened by Geoff Loane,
Head of Mission for the ICRC, who said
the threat to health personnel, to ambu-
lances, hospitals and clinics from direct at-
tacks and kidnapping in armed conflicts was
one of the biggest and most unacknowl-
edged humanitarian challenges today. This
was particularly the case in North Africa
and the Middle East. The ICRC’s recent
16-country study had analysed 655 inci-
dents of attacks against health care between
mid 2008 and late 2010, leading to 1,834
people being killed or injured. The analysis
gave them a clearer picture of the type of
activities causing health care to be impeded
as well as who was doing this and how it
was happening. The purpose of the ICRC’s
campaign was to ensure the security of the
delivery of effective and impartial health
care in armed conflict.
He said the conference was a call for action,
although at the moment the action that
was required was not entirely obvious. The
solution did not lie with the health com-
munity alone.The responsibility for security
lay with governments, military bodies, po-
lice forces and local communities and the
purpose of the conference was to examine
possible solutions and actions.
Mr Paul-Henri Arni, the head of the ICRC
project, said the symposium was the first
of several planned conferences to look for
practical recommendations. Some sugges-
tions included urging the states to develop
appropriate military and police practices
for managing checkpoints for ambulances
and other vehicles evacuating the wounded
and for entering health facilities. Another
was for states to develop domestic law to
assure greater security of health care and
a third idea was for the health community
to extend research and to develop teaching
modules on the implications of insecurity
for health care.
Dr. Unni Karunakara, International Presi-
dent of Médecins Sans Frontières, gave
several examples of the effects of attacks on
medical personnel on the delivery of health
care. MSF staff had been kidnapped and
attacked in several countries, leading the
organisation having to scale back or even
evacuate its work in refugee camps. Medical
teams had had to be withdrawn in a number
of places resulting in thousands of consul-
tations with patients not taking place. He
explained how his organisation had had to
suspend services in its recently opened ma-
ternity hospital in Khost, Afghanistan, af-
ter an explosion in the hospital compound.
And in Somalia alone since 1979 there had
been more than one thousand incidents
against MSF teams.
Carolyn Miller, chief executive of the medi-
cal charity Merlin, set three challenges to
the meeting, calling on health professionals
and the NGO community to take practical
action quickly, for local people to be given a
strong voice in fashioning responses and for
charities to work in forgotten and under-
served places, such as the Central African
Republic. She said that Merlin had cam-
paigned vigorously on the risks to health
care, and she expressed the hope that build-
ing sets of ‘communities of concern’ would
deliver the critical mass of attention that
was needed for policy makers to be per-
suaded to respond.
Professor Sir Michael Marmot, chair of the
WMA’s Social and Medical affairs commit-
tee, spoke about insecurity in health and
inequality. He said conflicts could cause
deprivation and deprivation could cause
conflict. Conflict disempowered people. He
gave examples of maternal mortality rates
in Afghanistan and death rates in Russia
resulting from social disruption and con-
flict. While only one in 46,500 women in
Europe died during childbirth, the figure in
Afghanistan was one in ten. So, when a ma-
ternity hospital had to close the loss could
be devastating.
He said it was also vital to examine the
causes of the causes of ill health, includ-
Health Care in Danger Symposium
Nigel Duncan
57
WMA news
ing education, deprivation and general in-
equity. The issue of the social determinants
of health was now being taken up in many
countries throughout the world.
Sir Michael suggested that the Red Cross
was such a highly admired organisation
worldwide that it could and should play a
greater role in dealing with the wider issue
of health in the population.
Nick Young, Chief Executive of the Brit-
ish Red Cross, said the aim of the confer-
ence was to raise awareness throughout the
world. What was needed was a united and
coherent voice to mobilise action, more evi-
dence about the extent of violence against
health that was going on throughout the
world and then a set of practical recom-
mendations that could be actioned. He em-
phasised that this was not just a case of “a
launch, a lunch and a logo”.
Professor Sir Andrew Haines, Professor
of Public Health and Primary Care at the
London School of Hygiene and Tropical
Medicine, said there was a need for the sys-
tematic collection of data on this subject.
He urged academic institutions to get in-
volved in this issue and for the subject to
be incorporated in medical school curricula.
Carolyn Miller, Chief Executive of Merlin,
spoke of her organisation’s work in this area,
in particular the need to create a commu-
nity of concern around the issue of health
workers.
Ms Mohini Ghai Kramer, Head of Corpo-
rate Communication at the ICRC, said that
the target audiences for the ICRC’s cam-
paign were political authorities and arms
carriers, public opinion and affected popu-
lations.She said they wanted to focus on the
victims of violence rather than presenting
medical personnel as heroes.
Panel discussions were held throughout the
day to follow up the speeches with ideas
for practical action. Speakers from the floor
emphasised the current lack of awareness
of the problem among non-governmental
organisations, the fact that there were too
many initiatives and also the need to target
arms suppliers.
The conference heard from Gilles Thai
Larsen, International Law Adviser with the
British Red Cross, about the legal frame-
work governing military hostilities and he
said there already was a legal framework for
protecting healthcare workers and patients.
This derived from international humanitar-
ian law and international human rights law,
and was often also addressed in domestic
law.The rules declared that measures should
be taken to provide health care to the
wounded and sick on a non-discretionary
basis and that access to health care facilities
should not be denied or limited. The rules
also stated that health care personnel should
not be hindered in the performance of their
medical tasks and that the wounded, the
sick and health care personnel should be
protected against interference by third par-
ties.
Dr. Peter Hill, Associate Professor from
the Australian Centre for International
and Tropical Health at the University of
Queensland, spoke about the impact on
health systems of violence against health
personnel. This included the effect on the
supply of drugs and vaccine and on tech-
nology. Dr. Rudi Coninx, from the World
Health Organisation, said one of the most
frequently asked questions put to him on
this subject was “Is the WHO doing any-
thing?” His reply was that the WHO was
doing many things – expressing concern
publicly, documenting evidence and get-
ting involved in diplomacy. There was also
a resolution requiring the organisation to
develop methodologies for collecting health
attack data. But he emphasised that health
facilities must be treated as neutral premises
and should not be used by one side or the
other in conflicts.
Professor Len Rubenstein, from the Cen-
tre for Public Health and Human Rights
at the Johns Hopkins Bloomberg School
of Public Health, said there was only epi-
sodic reporting by human rights groups on
health attacks and there was limited sharing
of internal security information among hu-
manitarian organisations. However, the US
State Department was now collecting data
for annual country reports on human rights
practices of attacks on health care and there
was the WHO resolution on the need for
assuming leadership in this field.
He said that despite the current lack of evi-
dence, the lack of integration and the rarity
of prosecutions, there had been promising
developments. But what was needed now
was a global coalition, an integrated and
collaborative approach to this whole prob-
lem from international bodies.
Dr. Jose Gomes do Amaral, President of the
WMA, spoke about the Association’s policy
on the protection of medical personnel in
armed conflicts, emphasising the impor-
tance of the Declaration of Geneva. He said
the WMA had been active in condemning
documented attacks on medical person-
nel. Surgeon Rear Admiral Lionel Jarvis,
Medical Director General for the UK Navy,
spoke about the role of the medical defence
services and the ethical challenges faced by
military personnel in Afghanistan. He said
the medical defence service was absolutely
committed to treating only on the basis of
prioritisation by clinical need, with total
impartiality and without any discrimina-
tion whatsoever.And he added that those in
the medical defence services must know the
laws of armed conflict and to this end they
underwent training in medical ethics.
He said that the 21st
century conflict was
very different from the situation in the two
world wars. There was now rapid electronic
communication, enhanced media inter-
est and increasing multinational coalitions.
Dilemmas for medics on the front line in-
cluded self defence, protection of comrades
and casualties, triage, disposal of casualties
and the use of protective emblems.
58
Veterinary Medicine
Dr. Vivienne Nathanson, from the British
Medical Association, who chaired the final
session, emphasised the importance of the
WMA’s statement that medical ethics in
time of war were the same as medical ethics
in peace.
Summing up the day’s discussion, Dr.
Robin Coupland, medical adviser at the
ICRC, said the main points he drew from
the day were the need to gather more data
about violence against health care, the need
to raise awareness of the problem, getting
greater academic attention to the problem
and improving co-ordination between all
those involved. He said it was important to
avoid competition between different agen-
cies. A mosaic of measures was needed, but
what was critical now was to build aware-
ness of the threats to health care. Without
awareness nothing would be done by poli-
cymakers.
Although he said it was clear there was no
need for the development of international
human rights law, since it already existed, it
might now be time for the appointment of a
special rapporteur on the security of health
care.
Dr. Coupland ended by saying that the
results of the conference would eventually
be summarised in a public document that
would be posted on the website of the four
organising associations and would form the
basis of a dialogue with policy makers.
Nigel Duncan
WMA Public Relations consultant
Antimicrobial resistance is a problem that
threatens both animal health and public health.
Resistance to antimicrobials has the potential
to take away this tool to protect animal health
in two ways: 1) loss of effectiveness due to the
development of resistance to antimicrobials by
animal pathogens, and 2) through the loss of
approval to use important antimicrobials in
animals in order to preserve their use in hu-
man medicine. Therefore to protect the ef-
fectiveness of antimicrobials to treat animal
and human diseases, the World Veterinary
Association (WVA) has developed responsible
use guidelines for veterinarians. The WVA be-
lieves that the use of the guidelines will lessen
the development and spread of antimicrobial
resistance. The guidelines recognize and ac-
knowledge the fact that veterinarians must
balance the sometimes competing needs of ani-
mal health and public health. Human medical
providers are not challenged with achieving
that balance. Instead they only need to con-
cern themselves with protecting the health of
humans. Decisions must be science-based and
risk-based. Risk analysis needs to consider both
the benefits and the risks to human health that
are created through the use of antimicrobials to
treat, control and prevent diseases in animals.
The use of the risk analysis process (risk assess-
ment, risk communication, and risk manage-
ment) can result in different risk management
decisions in different countries or regions in the
world because of differences in risk tolerances
Tjeerd Jorna
Responsible Use of Antimicrobials – World
Veterinary Association Perspective
Lyle Vogel
WVA members
WVA is an umbrella organisation for:
– national veterinary associations
– international assocations of veteri-
narians working in different areas of
veterinary medicine
59
Veterinary Medicine
and in the respective importance given to hu-
man health over animal health. For example,
in the United States, the previously approved
use of fluoroquinolones to treat colibacillosis in
poultry has been withdrawn while other coun-
tries and regions continue to use fluoroquino-
lones. Similarly, Europe and other regions have
banned the use of antimicrobials to promote
feed efficiency and growth in animals while
other countries and regions have not.These dif-
ferences are due to a multitude of factors such as
differing animal production systems, different
patterns of antimicrobial use in animals and
humans, differing acceptance of risk by differ-
ent cultures, different values placed on the im-
portance of animal health, different recognition
of the benefits to human health from the use of
antimicrobials in animals.
Antimicrobial resistance is a growing pub-
lic health concern worldwide. Antimicro-
bial resistance creates problems for animal
health as well. Infections caused by antimi-
crobial-resistant microorganisms can fail
to respond to standard treatments, thereby
reducing the possibilities of effective treat-
ment and increasing the risk of morbidity
and mortality in serious diseases. Both the
public health and animal health concern is
the response to the loss of effectiveness of
antimicrobials because of resistance.But the
animal health concern is also the response
to the existing or proposed restrictions on
the use of effective antimicrobials by veteri-
narians. For example, in the United States
veterinarians are no longer allowed to use
the previously approved fluoroquinolone to
treat colibacillosis in poultry because of sus-
picion that this use was the cause of resis-
tant Campylobacter infections in humans.
In Europe there is a total ban on growth
promoters to prevent the development of
antimicrobial resistance.
The reason for growing problems with anti-
microbial resistance can be explained easily.
It is a fact of nature that bacteria may mu-
tate or acquire genetic material from other
bacteria and develop the ability to survive
treatment. Through selective pressure im-
posed by the use of antimicrobials, these
bacteria, starting as a tiny fraction of the
overall population, may become an increas-
ingly dominant part of the population over
time.
But not all bacteria are the same.The likeli-
hood of developing resistance varies among
the different genus and species of bacteria.
There are also differences in the likelihood
of certain antimicrobials to cause the devel-
opment of resistance. There are also differ-
ences in the importance of specific classes
of antimicrobials for both animals and hu-
mans. There is also a variety in the way the
antimicrobials are used, such as the reason
for the use for treatment,prevention or con-
trol of disease, as well as in the frequency of
use, the length of use, and the total quanti-
ties that are used over time.
These differences cause difficulties in de-
termining the appropriate risk manage-
ment actions that are effective in protecting
public health without unnecessarily elimi-
nating a valuable tool for protecting ani-
mal health. Actions to eliminate or restrict
certain antimicrobials or certain classes of
antimicrobials from use in animals may
sacrifice the health of animals. And public
health may not be improved. For example,
the previously mentioned ban in the United
States in 2005 on the use by veterinarians
of a fluoroquinolone to treat colibacillosis in
poultry has not improved public health.The
surveillance data show that the ban has not
decreased the prevalence of resistant infec-
tions in humans. In fact, the prevalence has
increased since the ban.
For a long time, the World Veterinary As-
sociation has addressed the problem of an-
timicrobial resistance in multiple ways, such
as participation in international working
groups that were working on solutions in
order to protect public health and animal
health. For example, the president of the
WVA at that time, Dr. Herbert Schneider,
chaired the World Organization for Ani-
mal Health/OIE Ad Hoc Working Group
on Antimicrobial Resistance. That group
developed the list of antimicrobials that
are important in veterinary medicine. The
list was approved by the OIE in 2007. The
WVA also participated in the Codex Ali-
mentarius Commission Intergovernmental
Task Force on Antimicrobial Resistance.
Over the last 3 years, Past President Leon
Russell and current president Dr.Jorna,rep-
resented the WVA in the discussions that
resulted in Guidelines for Risk Analysis of
Foodborne Antimicrobial Resistance. The
Guidelines for Risk Analysis were approved
earlier this year.
Previously, in about 1998, the WVA devel-
oped policies that addressed antimicrobial
resistance to guide both the organization
and the veterinary profession. The policies
included a position statement on responsi-
ble use of antimicrobials. More recently the
WVA decided it was time to review those
policies and update them as necessary. The
review and update was carried out during
the last 18 months.It included development
of a policy, proposed by the members of the
EXCOM and the Council and the publica-
tion of the draft policy on the WVA Web
site with a request for review and input from
the WVA members and other interested or-
ganizations. The process has resulted in the
current policy, the WVA Position on Re-
sponsible Use of Antimicrobials.
As explained in the introduction to the re-
sponsible use principles, the policy incorpo-
rates several premises or ideas that form the
basis of the principles:
1. Good animal health and welfare always
starts with good care and management.
The animals must be provided with a
proper diet, clean water, and sufficient
space.Stress must be minimized includ-
ing minimizing exposure to adverse en-
vironmental factors.
2. Prevention, control and treatment of
animal diseases are necessary parts of
successful animal husbandry.
3. The availability and use of a variety of
antimicrobials for animals is essential
60
to assure animal health and welfare.
Protecting animal health, through the
prevention and relief of conditions that
cause animal suffering, is an essential
part of ensuring good animal welfare.
4. However, there is a risk that the use of
antimicrobials in animals can result in
resistance to antimicrobials which nega-
tively affects public and animal health.
5. Therefore, the availability and use of
antimicrobials in animals must be bal-
anced to achieve both good animal
health and public health.
6. Veterinarians must consider both hu-
man and animal health when deciding
on the use of antimicrobials. Neither
human health nor animal health and
welfare can be ignored. It differs from
human health practitioners who do not
consider animal health when they advo-
cate for restrictions on veterinary medi-
cines.
7. Decisions on how to manage the risk
of antimicrobial resistance must be
based on risk analysis. The three com-
ponents of risk analysis are risk assess-
ment, risk communication and risk
management. All three components
must be incorporated into the decision
process.Through the process of risk as-
sessment the available scientific infor-
mation can be gathered and evaluated.
Then risk communication is applied
to inform all of the stakeholders of
the results of the risk assessment. Risk
communication must occur among all
of the affected stakeholders including
public health officials, veterinarians,
physicians, farmers, the general public,
and officials responsible for regulation
of veterinary medicines. This should
lead to discussions regarding the levels
of expected risk compared to the lev-
els of acceptable risk among the vari-
ous stakeholders. Decisions regarding
whether to take or impose risk man-
agement actions and the extent of the
risk management actions, if imposed,
must be based on risk assessment and
risk communication. Then, if neces-
sary, risk management techniques can
be applied that balance the appropriate
measures for public health and animal
health. Because of the importance of
antimicrobials for both animal health
and public health, risk analysis must be
comprehensive. The risk analysis must
include evaluations of the risk to both
animal health and public health, as well
as the benefits to public health, animal
health and animal welfare from the use
of antimicrobials in animals. Healthy
animals create healthy food and conse-
quently improved public health.
8. The WVA recognizes that different
countries and regions have chosen dif-
ferent risk management actions based
on risk analysis. For example, some
countries license certain antimicrobials
to be used in food-producing animals
to enhance production through growth
promotion and feed efficiency, although
such use is prohibited in other countries
and regions. And as previously men-
tioned, the United States has chosen to
ban the use of enrofloxacin by veterinar-
ians to treat colibacillosis in chickens
and turkeys. These differences between
countries and regions can occur because
of cultural differences in the level of risk
acceptance or tolerance, and as well as
because of differences on the emphasis
placed on risks versus benefits to public
health from the use of antimicrobials in
animals.
9. Risk analysis cannot be generalized to
evaluate broad categories, such as the
reason for use, prevention of disease,
control of disease, or growth promo-
tion. Instead, the particulars such as
class of antimicrobial, ability to confer
resistance, frequency of use, method of
administration, and importance in vet-
erinary and human medicine need to be
considered.
10. Responsible use of antimicrobials by
veterinarians plays an important role
in protecting public health. Veterinar-
ians play a key role in helping to mini-
mize and prevent the development
and spread of antimicrobial resistance.
Therefore, veterinarians need to be in-
volved in antimicrobial use decisions as
well as policy and regulatory decisions.
The foregoing premises form the basis of
principles of the WVA position on respon-
sible use of antimicrobials. The following
are the 12 principles:
1. In case of animal disease, the animals
should be examined by a veterinarian,
who makes a diagnosis, and recom-
mends and plans an effective treatment
programme. If a decision is reached
to use antimicrobials for therapy, vet-
erinarians should strive to optimize
therapeutic effectiveness and minimize
resistance to antimicrobials in order to
protect public and animal health.
2. Antimicrobials used for therapy are
health management tools that are li-
censed to be used for the purposes of:
a. disease treatment;
b. disease control;
c. disease prevention.
3. Codes of good veterinary practice, qual-
ity assurance programmes, herd health
control and surveillance programmes,
and education programmes should pro-
mote responsible and prudent use of
antimicrobials. Veterinarians must as-
sume responsibility to possess current
information on resistance because they
are accountable for safe and effective use
of these medicines.
4. Antimicrobials should be used only
with veterinary involvement. Regular,
close veterinary involvement is essential
for informed advice concerning the ef-
fective use of antimicrobials. Regardless
of the distribution system available in
the country, the use of antimicrobials
should be subject to appropriate profes-
sional advice of a veterinarian.
5. The availability of effective antimicro-
bials should be based on risk analysis
that considers the OIE list of Antimi-
crobials of Veterinary Importance. The
OIE International Committee adopted
the list of Antimicrobials of Veterinary
Veterinary Medicine
61
Importance in May, 2007. Veterinary
antimicrobials are classified according
to their importance as critical, highly
important or important. Risk analysis
should consider the OIE list, as well as
the list developed by the World Health
Organization, that classifies the impor-
tance of human antimicrobials.
6. Therapeutic antimicrobials may be used
when it is known or suspected that an
infectious agent is present which will be
susceptible to therapy. It is the respon-
sibility of the veterinarian to choose
the antimicrobial product, based on
his or her informed professional judg-
ment balancing the risks and benefits
for humans and animals. The veterinar-
ian shall have due regard to the public
health risks because of using veterinary
medicines. At the same time, benefits
shall be taken into account, such as pro-
moting the health and welfare of ani-
mals, assuring safe and affordable food
from healthy animals, while reducing
human exposure to bacteria of animal
origin.
7. When antimicrobials need to be used
for therapy, bacteriological diagnosis
with antimicrobial sensitivity testing
should, whenever possible, be part of
the informed professional clinical judg-
ment. Ideally, the antimicrobial sensi-
tivity of the causal organism should be
determined before therapy is started.
However, in disease outbreaks involv-
ing rapid transmission of disease among
contact animals or with high case mor-
tality rates, treatment may be started on
the basis of clinical diagnosis. But even
in this case, the antimicrobial sensitivity
should be determined so that, if treat-
ment fails, the regimen can be changed
in the light of the results of sensitivity
testing. Surveillance or monitoring sys-
tems should be established to measure
antimicrobial sensitivity trends over
time so that the trends can guide clini-
cal judgment on antimicrobial use.
8. Label instructions should be carefully
followed and due attention paid to spe-
cies and disease indications and contra-
indications, dosage regimen, withdrawal
periods, storage instructions, and expi-
ration dates for products. Off label or
extra-label use of antimicrobials should
be exceptional and under the profes-
sional responsibility of a veterinarian,
with careful justification, written pre-
scription or instructions, and in accord
with the governmental regulations and
guidance.
9. Antimicrobials used for therapy should
be used for as long as needed, over as
short a dosage period as possible, and
at the appropriate dosage regimen. It is
essential to administer the antimicrobial
in accordance with the recommended
dosage regimen. This will minimize
therapy failures and exploit fully the ef-
fective potential of the product. Insuf-
ficient duration of administration can
allow the infection to break out again.
This may increase the likelihood of
selecting bacteria with reduced anti-
microbial sensitivity. But limiting the
duration of use to only that required
for therapeutic effect will minimize the
exposure of the bacterial population to
the antimicrobial.The adverse effects on
the surviving commensal microflora are
minimized. Theoretically, antimicrobial
use should be stopped as soon as the
animal’s own host defense system can
control the infection itself.
10. Records should be kept of all antimicro-
bial administrations.
11. Coordinated susceptibility monitoring
and surveillance should be conducted
and the results should be provided to
the prescriber/supervising veterinarian
and other relevant parties. Monitoring
and surveillance should target micro-
organisms of both veterinary and pub-
lic health importance. Data should be
quickly provided to allow timely modi-
fication of veterinary recommendations
for treatment in order to balance the
benefits with the risks.
12. Efficacious, scientifically proven alter-
natives to antimicrobials are needed as
an important part of good husbandry
practices. Some of the potential alterna-
tives include vaccines, probiotics, com-
petitive exclusion products, nutrition,
and improved livestock management.
Research is needed to further develop
these alternatives and to evaluate the
impact of these alternatives on selection
for resistance.
Continued availability of all classes of effec-
tive antimicrobials for veterinary medicine
is a critical component of safe food supply
and optimal animal health and welfare.
Safeguarding animal health is of paramount
importance to the economic welfare, pub-
lic health, and food supply of nations and
states. Animal and human health are inex-
tricably linked.
Responsible use of antimicrobials by veteri-
narians is in the best interests of both ani-
mal health and public health.The WVA be-
lieves that the implementation of the WVA
principles for responsible use will decrease
the selective pressures that cause the spread
of antimicrobial resistance and will help re-
tain both the effectiveness and the availabil-
ity of veterinary antimicrobials.
Dr.Tjeerd Jorna,
Immediate Past President, WVA
Dr. Lyle Vogel,
Councillor, WVA
e-mail: t.jorna3@upcmail.nl
Veterinary Medicine
62
During the 191st
Council Session of the
WMA Dr. Tjeerd Jorna, Past-President of
the WVA, presents his global organisation:
On a global scale the World Veterinary As-
sociation (WVA) is a small organisation
and therefore it has to be presented as one
profession with one vision and one voice in
the perspective of veterinary medicine and
animal and public health.
In 2011 the veterinary profession marked
its 250 years of activity and that was a good
reason to look back and evaluate what has
been achieved and even a better reason to
become inspired and look ahead. Therefore,
the slogan Vet for Health-Vet for Food-
Vet for the Planet.
The WVA is an umbrella organisation for
national veterinary organisations and in-
ternational associations of veterinarians
working in different areas of veterinary
medicine. The structure of the WVA in-
cludes Presidential Assembly represented
by all members; the Council represented
by elected representatives of six regions
[the five continents and North Africa and
the Middle East]; the Associate members
and the WVA EXCOM, consisting of an
elected President, two Vice Presidents and
Past-President.
The WVA sees its Mission in cooperation
of its member organisations for the sup-
port of veterinarians of different positions
and all over the world for promoting the
health and welfare of animals and people,
because Healthy Animals mean Healthy
People. The Vision of the WVA is to be
the global voice for veterinarians in order
to strengthen their position in promoting
animal health and well-being and protect-
ing public health.
In 2013 the WVA will celebrate its 150th
anniversary as in 1863 Dr. John Gamgee
organized an international veterinary con-
gress, a body that was professionalized in
1959 bearing the new name WVA. The
themes discussed at the first congresses did
not differ much from those of today: zoo-
noses, food safety, veterinary law, education
and the application of veterinary medicines.
The main goals of WVA include the follow-
ing: to be recognized as the global veterinary
voice, to promote high quality veterinary ed-
ucation, to win recognition of the veterinary
profession as Global Public Good,to support
veterinarians in delivering their responsibili-
ties by optimising the preconditions required
for full filling their tasks and to ensure and
safeguard long-term viability of the WVA.
Veterinary medicine rests on three pillars:
animal health, animal welfare and public
health,and if to draw a parallel with a build-
ing, be it a temple, a church or a mosque,
any building needs to have a good founda-
tion, and in our case the foundation is high
quality veterinary education. The veterinar-
ian is the mediator between the animals,
the animal owners and society and his/her
performance should be science based, using
knowledge and skills accompanied with the
proper attitude and ethical principles. He/
she has to work objectively, independently
and impartially. The veterinarian’s roles are
different for a practitioner,a hygienist (meat
inspection), a state veterinary officer (policy
control and public health inspector), in in-
dustry and institutes, in education (Veteri-
nary faculties and Agricultural schools), in
military and in environment and climate
change disease monitoring.
The responsibilities of veterinarians include
meeting the requirements set by society,
controlling animal health, animal welfare
and public health [including zoonoses]
and participating in environmental and
eco-system health. The veterinary duties
are to prevent and early detect outbreaks
of animal diseases and zoonotic diseases; to
certify healthy animals for trade; to ensure
the safety of products of animal origin; to
investigate and diagnose animal diseases
and to decide upon correct intervention and
treatment.
To perform this duties by veterinarians
all over the globe and in all countries the
WVA has to strengthen the veterinary
profession by encouraging all countries to
develop robust veterinary legislation and
an autonomous statutory body, encourag-
ing the veterinary profession to establish
a representative well-organized veterinary
Association and to adopt and act upon a
veterinary act and a code of conduct, pro-
moting public-private collaboration and
continuously creating preconditions aimed
at the vets meeting their responsibilities in
the best possible way. As regards Animal
Health it implies promoting of prevention
which is better than cure; encouraging vets
to perform monitoring, surveillance, early
diagnosis and reporting of animal and zoo-
notic diseases; supporting of global disease
control programs and promotion of avail-
ability of veterinary medicines [drugs] ,en-
couraging responsible use and preventing
antimicrobial resistance. Regarding Public
Health it means to continuously emphasise
the role vets play in food safety; to maintain
control of zoonotic diseases; to control food
World Veterinary Association meets World
Medical Association
Veterinary Medicine
63
security and food safety and to support the
structure of National Veterinary Services.
As already mentioned above, the veterinary
medicine needs a good foundation that is
ensured by Veterinary Education and Life
Long Learning. The WVA has to develop
and implement a strategy for enhancing vet-
erinary education and skills development;
to analyse the accreditation/evaluation sys-
tems; to work towards all newly graduates
acquiring the necessary “Day-One Compe-
tences”; to promote institutionalisation of
Life Long Learning programs and to be an
active partner in global veterinary education
projects. The definition of Day-One Com-
petences are the combination of knowledge,
skills/experience, attitude and aptitude that
veterinary graduates need to possess for safe
entering the veterinary profession and en-
abling them to perform most of their duties.
The expectations of society include the fol-
lowing: the veterinarian has to act as a link
between animals,animal owners and society
in the interests of society that needs to have
confidence and trust in the high standards
of veterinary education and professional
implementation. Thereby we have to ensure
that society knows the practitioner and is
aware of all his/her public health-related
duties.To meet the expectations of the Vet-
erinary Profession there is required a level
of education/training provided by schools
that ensure that the young graduates have
acquired solid Day-One Competences to
start real professional independent activities
by performing the various daily duties of
vets, at the same time being aware that the
Day-One Competences are only the start-
ing competences.
The collaboration between veterinarians
and physicians is promoted by the ONE
HEALTH concept that means a unified
approach between veterinary and human
medicine to improve Global Health. This
concept is not new as the founder of the
first veterinary school in Lyon [France] in
1761 cooperated with the physicians of that
time. Later this concept was renewed by
Virchow and in the new millenium by Rog-
er Mahr [the former president of AVMA]
in North America. Cooperation can be of
great importance in the control of zoonoses
and the prevention of antimicrobial resis-
tance. Examples of physicians and vets co-
operating nowadays is the control of rabies,
a very severe disease in Africa and India,
taking more than 60.000 deaths per year
and most of them being children; or the
control of avian influenza and all kinds of
food poisonings by salmonellosis or campy-
lobacteriosis.The WVA likes to confirm this
collaboration with the WMA in a Memo-
randum of Understanding and the WVA
has submitted the first draft to the board
of WMA. Your President Elect will make
the first comments helping to reach the fi-
nal draft in the nearest future. The Memo-
randum focuses on the control of zoonoses,
food safety and security and the prevention
of antimicrobial resistance. The use of anti-
microbials cannot be only risk-based, but it
could be that we have to separate antimi-
crobials for the use in humans. The WVA
has written a position paper about the re-
sponsible use of antimicrobials that reflects
its meaning on a global level in 2011. In the
World Veterinary Congress 2011 in Cape
Town the WVA, supported by WHO, FAO
and OIE [the World Animal Health Or-
ganization in Paris], organized the Global
Summit “Lessons Learned and Future Ap-
proaches on the Use of Antimicrobials”.
The WVA is communicating its policies
through its website www.worldvet.org and
through newsletters by website and mail.
New is our communication through direct
mail of short WVA news and by organiz-
ing regional meetings as on-site meetings
of congresses and symposia/conferences
organized even by related organizations.
Our experience has revealed that many
vets in the world do not read websites or
newsletters and cannot afford the congress-
related expenses in expensive venues. It is
more beneficial if the WVA board visits the
members in their own region.
I would like to finish by inviting the WMA
to visit our Assembly and Congress next
year, the year of our 150th
anniversary, and
I would like to cooperate fruitfully in the
future and thank everybody for your hos-
pitality.
Dr.Tjeerd Jorna,
Immediate Past President, WVA
Veterinary Medicine
64
Regional and NMA news
The International Health Economics As-
sociation (iHEA) www.healtheconomics.org
is an academic society of 2,600 health econ-
omists in 73 countries worldwide that has
become the central source for professional
activity and critical evaluation of health
economic research. iHEA focuses on the
colleagueship and advancement of indi-
vidual health economics scholars, students,
and researchers, with a mission “to increase
communication among health economists across
the globe, foster a higher standard of debate in
the application of economics to health and to
healthcare systems, and to assist young health
economists conduct high quality researcher at
the start of their careers.”
Background
Although as early as the 1920s economists
began getting together to review each oth-
er’s work in the area of health and to trade
ideas on the subject, there was no formal
field of health economics until the 1970s.
Over the years various regional and na-
tional health economics associations were
started, many of those in Europe and An-
glophone countries following the Health
Economics Study Group (HESG) model
in the UK. There were discussions among
health economists about the need for cre-
ating an international membership society
to encourage communication among health
economics worldwide, and in 1994 the In-
ternational Health Economics Association
(iHEA) was established following meeting
in Zurich and Boston.
Regional and National Affiliates of iHEA
• African Health Economics and Policy
Association (AfHEA)
• American Society of Health Economists
(ASHEcon)
• Asociacion de Economia de la Salud
Latinoamerica y Caribe (AES LAC)
• Australian Health Economics Society
(AHES)
• China Health Economics Association
(CHEA)
• Collège des Economistes de la Santé
(CES)
• Colombian Health Economics Associa-
tion (ACOES)
• Croatian Society for Pharmacoeconomics
and Health Economics (CSPHE)
• European Committee on Health Eco-
nomics (ECHE)
• Finnish Society for Health Economics
(TTTS)
• German Association for Health Eco-
nomics (DGGOE)
• Health Economics Study Group (HESG)
• Indian Health Economics and Policy As-
sociation (IHEPA)
• Health Economics Association of India
(HEAI)
• Italian Association of Health Economics
(AIES)
• Japan Health Economics Association
(JHEA)
• Portuguese Health Economics Associa-
tion (APES)
• Spanish Health Economics Association
(AES)
• Swedish Health Economics Association
(SHEA)
• Swiss Association for Health Economics
(SAG)
• Taiwan Society of Health Economics
(TaiSHE)
• Turkish Health Economics and Policy
Association (THEPA);
• Young Researchers in Health (YRH)
Funding and Organizational
Structure
The International Health Economics As-
sociation (iHEA) is a charitable non-profit
organization largely self-funded through
individual dues and fees, which helps it to
maintain independence from the specific
interests of industry, government agencies
or medical organizations. Its organizational
structure consists of: an executive director;
a president, who is elected by the member-
ship; a secretary/treasurer; a board of direc-
tors; program chairs for the biennial meet-
ing; and the association’s operational staff,
which consists of three individuals. Mem-
bers of the board of directors serve four-year
overlapping terms.
International Health Economics Association
(iHEA)
Thomas E. Getzen Anne Mills
65
Regional and NMA news
In March 2012 the International Federa-
tion of Pharmaceutical Manufacturers and
Associations (IFPMA) expanded the IF-
PMA Code of Practice which governs how
member companies interact with health-
care professionals, medical institutions and
patient organizations. IFPMA requires all
members, which comprise the research-
based pharmaceutical industry, to adopt and
implement this Code around the world.
Advancing medical knowledge and improv-
ing public health depend on information-
sharing interactions by the entire medical
community – from researcher to attending
physician, nurse, pharmacist and patient –
and integrity is essential to these exchanges.
In these interactions, it is vital that health-
care providers, patients, and governments
are confident that pharmaceutical compa-
nies act in an ethical and professional man-
ner wherever they operate in the world.
Such ethical practices should apply not only
to the promotion of medicines, but more
broadly to all interactions with the health-
care community.The Code is a public state-
ment of the standards of practice to which
the healthcare community and others can
expect our industry to adhere.
Concerning our industry’s interactions with
healthcare professionals, the IFPMA Code
of Practice clarifies which promotional aids
and medical products, such as pharmaceuti-
cal product samples, are permitted while re-
confirming that personal and cash gifts are
not.  It prohibits pre-approval promotional
activities for pharmaceutical products while
providing clear guidance for supporting
continuing medical education.This includes
ensuring that meetings are held in appro-
priate venues that are conducive to scientific
or educational objectives.
Beyond interactions, the Code now also
includes high-level guiding principles for
practice, a requirement for member com-
panies to train employees, a provision on
disclosure of clinical trial information, and
clear guidance for filing complaints.
The research-based pharmaceutical indus-
try highly values trust in interactions with
healthcare professionals and others.
Ensuring trust promotes high quality ex-
changes of medical information which, in
turn, benefit patients’ health. This expanded
IFPMA Code of Practice is one more ele-
ment of our commitment to patients and
healthcare professionals.
By September 2012, IFPMA members will
have implemented this Code wherever they
operate in the world. This includes align-
ing national industry codes and ensuring
that employees receive training and adhere
to these high ethical and professional stan-
dards.
We encourage others – doctors, nurses,
pharmacists, academics, patients and con-
sumers – to not only be aware of this ex-
panded Code, but also to ensure equally
high ethical and practice standards across
the healthcare sector. By working together,
we can continue to improve the lives of peo-
ple around the world.
The Research-Based Pharmaceutical Industry Expands its Code of
Practice Governing Interactions with the Healthcare Community
Eduardo Pisani
Main Activities
The Association’s main activities include:
presenting the annual Kenneth J. Arrow
Award in Health Economics for the best
published paper in health economics; edit-
ing and maintaining HEN-the Health Eco-
nomic Network electronic archive in col-
laboration with the Social Science Research
Network at SSRN.com; distributing health
economics related information to its mem-
bers including a weekly online newsletter;
maintaining a world directory of health
economics; and conducting the World
Congress of Health Economists. The first
“iHEA Congress” was held in Vancouver,
B.C., Canada in 1996. Subsequent confer-
ences were held in Rotterdam, Holland in
1999; York, England 2001; San Francisco,
California 2003; Barcelona, Spain 2005;
and Copenhagen, Denmark 2007; Beijing,
China 2009; and Toronto, Canada 2011.
Upcoming Congresses are scheduled for
Sydney, Australia in 2013; Dublin, Ireland
in 2014, and Milan, Italy in 2015.
Prof. Thomas E. Getzen,
Executive Director
Prof. Anne Mills,
President 2012–2013
66
The International Federation of Biomedical
Laboratory Science (IFBLS) is an indepen-
dent non-governmental association of na-
tional societies in 40 countries, representing
more than 185,000 biomedical laboratory
scientists, technologists and technicians
worldwide. Providing a critical service as-
sisting physicians in the diagnosis and
treatment of human diseases, these health
professionals serve as key personnel by
maintaining medical laboratories and pro-
viding needed medical laboratory services.
In a recent report the Institute of Medicine
in the United States has documented an
excess of 70 percent of the information in
a typical patient’s chart in hospital at any
time is information generated by the bio-
medical laboratory from testing performed
by biomedical laboratory scientists.
The IFBLS (originally called the Inter-
national Association of Medical Labora-
tory Technologists – IAMLT) was founded
in 1954 when Ms. Elizabeth Pletscher
and her Swiss colleagues invited national
medical technology associations, from a
number of countries, to meet in Zurich,
The International Federation of Biomedical
Laboratory Science (IFBLS)
About IFPMA:
IFPMA represents the research-based phar-
maceutical companies and associations across
the globe. The research-based pharmaceuti-
cal industry’s 1.3 million employees research,
develop and provide medicines and vaccines
that improve the life of patients worldwide.
Based in Geneva, IFPMA has official rela-
tions with the United Nations and contrib-
utes industry expertise to help the global
health community find solutions that im-
prove global health.
IFPMA manages several global initia-
tives including: the IFPMA Developing
World Health Partnerships which stud-
ies and identifies trends for the research-
based pharmaceutical industry’s long-term
partnership programs to improve health in
developing countries; the IFPMA Code of
Practice (http://www.ifpma.org/ethics/ifp-
ma-code-of-practice/ifpma-code-of-practice.
html) which sets unsurpassed standards for
interactions with the healthcare commu-
nity; and the IFPMA Clinical Trials Portal
helps patients and health professionals learn
out about clinical trials and trial results.
IFPMA Guiding Principles on
Ethical Conduct and Promotion
The International Federation of Pharmaceu-
tical Manufacturers and Associations (IFP-
MA) member companies engage in medical
and biopharmaceutical research in order to
benefit patients and support high-quality
patient care. Pharmaceutical companies,
represented by IFPMA, promote, sell and
distribute their products in an ethical man-
ner and in accordance with all the rules and
regulations for medicines and healthcare.
The following Guiding Principles set out
the basic standards to inform on the 2012
IFPMA Code of Practice which applies to
the conduct of IFPMA Member Compa-
nies and their agents.This helps ensure that
their interactions with stakeholders are ap-
propriate.
1. The healthcare and well-being of pa-
tients are the first priority for pharma-
ceutical companies.
2. Pharmaceutical companies will conform
to high standards of quality, safety and
efficacy as determined by regulatory au-
thorities.
3. Pharmaceutical companies’ interactions
with stakeholders at all times must be
ethical, appropriate and professional.
Nothing should be offered or provided
by a company in a manner or on condi-
tions that would have an inappropriate
influence.
4. Pharmaceutical companies are respon-
sible for providing accurate, balanced,
and scientifically valid data on products.
5. Promotion must be ethical, accurate,
balanced and must not be misleading.
Information in promotional materials
must support proper assessment of the
risks and benefits of the product and its
appropriate use.
6. Pharmaceutical companies will respect
the privacy and personal information of
patients.
7. All clinical trials and scientific research
sponsored or supported by compa-
nies will be conducted with the intent
to develop knowledge that will ben-
efit patients and advance science and
medicine. Pharmaceutical companies
are committed to the transparency of
industry sponsored clinical trials in pa-
tients.
8. Pharmaceutical companies should ad-
here to both the spirit and the letter of
applicable industry codes. To achieve
this, pharmaceutical companies will en-
sure that all relevant personnel are ap-
propriately trained.
Eduardo Pisani, Director General
International Federation of Pharmaceutical
Manufacturers and Associations
Regional and NMA news
67
Switzerland. The response to the invita-
tion was so great that the decision was
made to create an international association.
Ms. Pletscher became the first Secretary
and later the Honorary Executive Secre-
tary and was in office from 1954 to 1973.
At the Triennial Conference of the Insti-
tute of Medical Laboratory Technology
(now the Institute of Biomedical Science)
in Nottingham, United Kingdom, in 1955,
a meeting was held and the first draft con-
stitution of the future International Asso-
ciation was discussed. A further meeting
was held on the occasion of the first Inter-
American Convention in Quebec, Canada,
the following year.
In 1957 a delegates meeting was held in
Amsterdam, Holland, when study groups
were formed by different nations to make
enquiries on the situation of medical labo-
ratory technologists all over the world. In
addition, the legal status of the Association
was discussed. On the occasion of the Tri-
ennial Conference of the IFBLS in Bristol,
United Kingdom, in 1958, the draft stat-
utes were discussed and the first Council
was elected. Mr. R. J. Broomfield from the
United Kingdom became the first Presi-
dent.
The following year a General Assembly of
Delegates (GAD) was held in Hamburg,
Germany; the statutes were finally adopted
and the preliminary reports of the study
groups were discussed. In 1960 the Ameri-
can Society of Medical Technologists and
the Canadian Association joined IFBLS,
making it truly a “World” organization.
The first week-long international Congress,
with a large participation from all over the
world, was held in Stockholm, Sweden, in
1961.Two years later saw the publication of
the first Newsletter of the IFBLS. 1964 saw
the 10th
anniversary Congress being held in
Lausanne, Switzerland. Over 400 delegates
from 16 countries attended. For the future a
decision was reached to hold the Congress
biennially.
Congress was held in Berlin, Germany in
1966; Helsinki, Finland 1968; Copenha-
gen, Denmark 1970; Vienna, Austria 1972;
Paris, France 1974; Chicago, USA 1976;
Edinburgh, Scotland 1978; Durban, South
Africa 1980; Amsterdam, The Netherlands
1982; Perth, Australia 1984; Stockholm,
Sweden 1986; Kobe, Japan 1988; Geneva,
Switzerland 1990, Dublin, Ireland 1992;
Hong Kong 1994; Oslo, Norway 1996;
Singapore 1998; Vancouver, Canada 2000.
Orlando, USA 2002; Stockholm, Sweden
2004; Seoul,South Korea 2006; New Delhi,
India 2008; Nairobi, Kenya 2010; and will
take place in Berlin, Germany later in 2012.
In 1965 the IFBLS became a consultative
member of the Council of Europe in Stras-
bourg. A resolution was introduced to the
Secretary General of the Council of Europe
in 1966, asking for a committee of experts
to be formed to investigate the standardiza-
tion of training, in order to issue diplomas
acceptable to other countries.The resolution
was accepted and the committee of experts
formed. In the same year the IFBLS News-
letter (Med Tech International – MTI) be-
gan twice yearly publication.
The IFBLS was approved as a non-gov-
ernmental organization in official relation-
ship with the World Health Organization
(WHO) in 1972. On her retirement, at the
Vienna Congress, Elizabeth Pletscher was
awarded the first Honorary Membership of
the Association, having served 19 years as
Executive Secretary.
At the World Congress in Orlando in
2002 the General Assembly of Delegates –
GAD  – voted to change the name of the
organization from IAMLT to IFBLS, this
latter title being more reflective of the educa-
tional standards and role of the members of
the profession.It was also agreed to move the
registered office from Stockholm to Hamil-
ton, Canada where it is presently located.
The Mission of IFBLS is:
• To support, advance and promote good
laboratory practice through the develop-
ment and adherence to high quality stan-
dards in diverse environments through-
out the world;
• To support, advance and promote the
education, training and professional de-
velopment of Biomedical Laboratory
Scientists and technologists;
• To support, advance and promote ethical
and professional values in the biomedical
laboratory profession;
• To promote the exchange of ideas and the
active participation of biomedical labora-
tory professionals through seminars, re-
search and educational forums;
• To promote the coordination of activi-
ties within the healthcare and biomedical
laboratory professions through the devel-
opment of international partnerships and
programs and;
• To support, promote and advance such
activities of IFBLS as are incidental and
ancillary to the foregoing objects.
For more information on IFBLS please
contact our website at www.ifbls.org
Vincent S. Gallicchio,
PhD, Dp (hon), MT(ASCP),
FRSA, FASAHP
President, IFBLS
Vincent S. Gallicchio
Regional and NMA news
68
Mission: To promote, among all peoples and
nations, the highest possible level of mental
health in its broadest biological, medical, edu-
cational and social aspects.
The Federation was founded in 1948 as an
international multi-disciplinary organization
to bring together health professions to work
for the improved treatment of mental illness-
es. The founders saw a great need to expand
understanding of mental illnesses at govern-
ment level and with the general public. The
need for advocacy is real, and it can change
attitudes.Mental illnesses are not rare,yet in-
dividuals and families are often reluctant to
speak about them. According to the World
Health Organization just one of these dis-
orders, unipolar depression, is the third lead-
ing cause of the global burden of disease–and
will rise to the first place by 2030.
Evidence-based treatments are available,
but even in developed countries many peo-
ple who could benefit do not receive them
for various reasons. In low- and middle-in-
come countries the situation is much worse.
In low-income countries public knowledge
of mental disorders is often lacking and
government spending on their treatment
within the health budget is very limited,
even although low-cost treatments exist.
The Federation believes in fostering positive
mental health as well as improving care for ill-
ness.WFMH believes that good mental health
is a valuable asset for individuals and their
communitiesandshouldbesupportedanden-
couraged in society. For every age group good
mental health is a part of overall well-being.
The goals of the Federation are:
• To heighten public awareness about the
importance of mental health, and to gain
understanding and improve attitudes
about mental disorders.
• To promote mental health and optimal
functioning.
• To prevent mental, neurological and psy-
chosocial disorders.
• To improve the care and treatment of
those with mental, neurological and psy-
chosocial disorders.
The Federation’s Board of Directors
WFMH currently has a Board of 22 Direc-
tors from 16 countries, headed by the Presi-
dent, Deborah Wan of Hong Kong. The
Executive Committee consists of 8 Officers
from 6 countries. The Board members have
extensive, varied experience in the mental
health field and offer broad international
perspectives from their regional viewpoints.
They consult by email, Skype, and confer-
ence calls and confer once a year in person.
Advocacy
WFMH maintains a strong role in civil so-
ciety advocacy. It founded World Mental
Health Day (10 October),which is celebrat-
ing its 20th
anniversary in 2012. Each year
the WFMH Board selects a theme,material
is developed and translations are made into
a number of languages. The information is
circulated via email and post to organiza-
tions and individuals who arrange their own
local events of many kinds for public educa-
tion.The flexible campaign format has been
successful in reaching many levels from
villages to government ministries, as it can
be easily adapted to suit requirements. For
2012 the theme is “Depression”and the ma-
terial will provide basic information about
this common illness.
The WFMH Congress held every two years
in a different part of the world also promotes
public attention for mental health issues,with
a diverse program of presentations by inter-
national speakers together with numerous
parallel sessions and additional activities.The
Congress in 2011 was held in Cape Town,
South Africa. In 2013 it will be in Buenos
Aires, Argentina, and in 2015 in Singapore.
The “Great Push for Mental Health” pro-
gram has built up a network of over 500
organizations from 110 countries that have
indicated their support for this new advo-
cacy program (including individuals, the
network currently numbers 1,428 contacts).
The “Great Push” has adopted a slogan of
“unity, visibility, rights and recovery” with
the aim of providing a platform for the
views of civil society. It is planning to use
a survey this year to obtain the opinions of
the organizations about priorities for the
World Health Organization’s proposed Ac-
tion Plan for Mental Health.
Recent Activities at the United Nations
and World Health Organization
WFMH is a non-profit organization with
Consultative Status at the United Nations
and maintains official relations with the
World Health Organization.Volunteer rep-
resentatives participate in NGO activities
Deborah Wan
The World Federation for Mental Health
(WFMH)
Regional and NMA news
69
The Mozambican
Medical Association
How do you protect the legal, judicial and fi-
nancial interests of your colleagues?
Most of the Mozambican physicians work
for the government and they are protected
by the General Statute of the agents and
public workers.
Do you have a legal counsel?
At the Mozambican Medical Association
(AMM) we do have a legal counsel that
advises on different matters needing legal
counselling.
Are the rights to protect your colleagues includ-
ed in your countries’ legislation?
Yes. In Chapter II Article 3 and Article 5g)
of the Mozambican Medical Association
and it reads as follows: Article 3 – AMM
promotes, with independence and responsi-
bility,the defense of its associates’legitimate
interests, fights for the dignification of the
medical class, and assumes an active posi-
tion regarding all issues that affect or may
affect the health condition of the popula-
tion in the Country, the Continent or the
World. Article 5g) – Care for the full com-
pliance with the law and respective regula-
tions, namely in what concerns the doctor’s
title and profession.
Have you organised strikes, rallies and other
activities?
The AMM had never had the need to orga-
nize strikes. Sometimes it makes statements
in the public and private newspapers about
matters that need a position from the medi-
cal class.
Do you turn to the government?
We turn to the government for matters that
are of interest to the AMM, for support to
some issues (like the Physicians Statute),
to advise on some law proposals (e.g., the
Transplant Law) and as a partner in some
activities, such as the continuous medical
education.
The Slovak Medical
Association
How do you protect the legal, judicial and fi-
nancial interests of your colleagues?
The Slovak Medical Association (SkMA) is
a non-profit, non-governmental organisa-
tion with voluntary membership. We pro-
tect the interests of our organization and
our members, if their activity is related to
the subject of our activities.
The mission of the SkMA is to make broad
medical circles aware of the latest scien-
tific findings and professional observations
through organised scientific events and
other professional meetings, to support the
involvement of our own experts in similar
events abroad and to publish and support
the issue of professional magazines and
publications.
Do you have a legal counsel?
Yes, one of the employees of the Secretariat
of the SkMA is a lawyer.
Are the rights to protect your colleagues includ-
ed in your countries’ legislation?
Yes
Have you organised strikes, rallies and other
activities?
No, but last year we supported the strike of
health workers.
Do you turn to the government?
Yes
The Macedonian
Medical Association
How do you protect the legal, judicial and fi-
nancial interests of your colleagues?
In general, issues arising from legal and ju-
ridical regulations are left to be solved by
the individuals themselves, the physicians
and other health personnel.
Exemptions are the rights arising from col-
lective agreements that are coordinated and
signed by trade unions and employers, i.e.
the minister of health.These are issues from
work-related legislation. Physicians can ap-
ply to the Administrative Court for legal
acts arising from legal and juridical regula-
tions and approved by the managing bodies
or organs of the state.
There is another possibility, which is very
often used by individuals. Physicians and
citizens use the Supreme Court for explor-
ing the constitutionality of legal decisions
Protecting the Rights and Interests of Physicians
in New York and Geneva, and work with
Board members and staff to monitor UN
and WHO developments related to mental
health. In 2011 WFMH participated in ef-
forts to have mental health included in the
international discussion on non-commu-
nicable diseases which led to a UN High-
Level Meeting on the topic.The Federation
succeeded in organizing a symposium for
an invited audience in New York just before
the High-Level Meeting, where key gov-
ernment officials from Brazil, India, Guy-
ana and the United States stated the case
for the inclusion of mental health.
To read more about our other important
activities and programs, please, go to our
website at www.wfmh.org.
Dr. Deborah Wan,
Board President
Regional and NMA news
70
that refer to the rights of the physicians and
their work.
Trade Unions and their institutions and
bodies play the key role in financial mat-
ters. Attorneys are being engaged to repre-
sent the interests of trade union members
in front of the Administrative and regular
courts.
Do you have a legal counsel?
There is no legal advice although gen-
eral practitioners or the Society of Private
Physicians has its attorney with restricted/
limited rights. For example, he/she is not
allowed to be present at debates about sign-
ing contracts between the Fund for Health
Care and physicians. In this context the
Medical Chamber is not involved, and as a
rule, the Chamber represents the rights of
the physicians not only verbally but in front
of legitimate and state institutions.
Are the rights to protect your colleagues includ-
ed in your countries’ legislation?
There is no legal or any other obligation for
protection of the rights included or deter-
mined in the state laws.
Have you organised strikes, rallies and other
activities?
Over the last two decades there was one
strike interrupting the work for several
hours. A few demonstrations and similar
activities, mostly manifested by interrup-
tion of the work, have taken place, but they
referred to the work organization and not to
the rights of the employed.
Do you turn to the government?
Communication with the Government has
been initiated,although still without any re-
sults. Suggestions from the doctors’associa-
tions, representing the interests of the phy-
sicians, are not accepted in most instances.
It has also to be emphasized that physicians
who are members of the State Parliament/
Republic’s Assembly represent the interests
of the political parties and not of the pro-
fession.
The Hong Kong Medical
Association
How do you protect the legal, judicial and fi-
nancial interests of your colleagues?
Partnering with the Medical Protection
Society in the UK, we help our colleagues
defend professional negligence and mis-
conduct cases. All expenses and compensa-
tions for damages are paid out of the funds
pooled in this Society so that colleagues can
practice medicine having peace of mind.
Our Duty Council Member scheme helps
answer questions from colleagues who have
problems in their daily practice.
Do you have a legal counsel?
To advise us on legal matters, several legal
counsels are retained by the Association on
a pro bono basis.
Are the rights to protect your colleagues includ-
ed in your countries’ legislation?
The rights to practice medicine are mainly
written in the Medical Registration Ordi-
nance.Others include the Pharmacy & Poi-
sons Ordinance, the Supplementary Medi-
cal Professions Ordinance, the Medical
Clinics Ordinance and related ordinances
and regulations.
Have you organised strikes, rallies and other
activities?
One of the main objectives of the Hong
Kong Medical Association is to promote
the welfare and protect the lawful interests
of the medical profession.
At times, we have to resort to strikes, ral-
lies or sit-in demonstrations to get ourselves
heard or turn to the government if required.
In 2007,we had a sit-in protest and a march
against the “unequal pay for equal work”
wage scale of the junior doctors working in
public hospitals. In 2008, we had another
march against the sharp increase in rents of
clinics in public housing estates.
Do you turn to the government?
We collect views of the profession by con-
ducting surveys and then present them to
the authorities via the media or via our rep-
resentatives in the respective government
and non-governmental organizations.
FMH Swiss Medical
Association
How do you protect the legal, judicial and fi-
nancial interests of your colleagues?
The Swiss legislation on social insurance
asks for collective tariffs (http://www.admin
.ch/ch/f/rs/832_10/a46.html) which gives
some protection to the practitioner.
FMH can asssit members in financing legal
procedures of general interest to the medi-
cal community.
Do you have a legal counsel?
FMH has a legal department.
Are the rights to protect your colleagues includ-
ed in your countries’ legislation?
The Swiss legislation grants its inhabit-
ants the right to found private associa-
tions. FMH as a private association is free
to define its aims. SIWF-ISFM as a part
of FMH which regulates the postgraduate
training (http://www.fmh.ch/bildung-siwf.
html) has a mandate of the state and does
not interfere with the political branches of
FMH.
Have you organised strikes, rallies and other
activities?
The FMH is currently, like it already did in
2008, taking a leading role in federal refer-
endums (see referendum on managed care
legislation of June 17th
, 2012, http://www.
parlament.ch/f/dokumentation/dossiers/care/
pages/default.aspx).
Do you turn to the government?
FMH has regular contacts with members of
the government and the public administra-
tion
Regional and NMA news
71
The Serbian Medical Chamber
How do you protect the legal, judicial and fi-
nancial interests of your colleagues?
The legal interests of our colleagues are
protected in health system via proposed
laws and bylaws that the Serbian Medical
Chamber suggests or in some cases disputes
in front of the Constitutional Court of the
Republic of Serbia. Financial interests of
medical doctors in Serbia are protected by
health care trade unions.Currently there are
six medicine trade unions in Serbia. We are
not pleased with this sort of disunion.
Do you have a legal counsel?Are the rights to
protect your colleagues included in your coun-
tries’ legislation?
Referring to the judicial protection of Ser-
bian physicians,the Serbian Medical Cham-
ber takes actions via an official lawyer and le-
gal adviser. Furthermore, the Ethical Board
works on the Serbian Medical Chamber
Litigation Rule Book. The Serbian Medical
Chamber,therefore,has its legal counsel and,
at the same time,the legal team that consists
of 16 lawyers. The rights to protect medical
doctors in Serbia are defined in the Serbian
Medical Chamber Statute and in the Law
on Health Care Professionals Chambers of
the Republic of Serbia.
Have you organised strikes, rallies and other
activities?
We have not organized strikes and rallies.
However, the Serbian Medical Chamber
officials very often meet with Government
and Ministry of Health representatives.
Do you turn to the government?
Those meetings result with variable out-
comes.
The Icelandic Medical
Association
Background information
Iceland is a small country with the popula-
tion of approx. 320,000. In 2010 there were
around 1070 practicing medical doctors in
the country, thereof 860 with specialist li-
cences. Approx. ¾ of the medical workforce
worked full time or part time in the public
health sector; in hospitals, health care cen-
tres and health institutions. Over 90% of
the doctors are members of the Icelandic
Medical Association (IMA), established in
1918.
Legal Provisions on Icelandic Medical Doctors
For decades there has been in force a spe-
cial legislation on doctors, defining their
obligations and basic rights. The legislation
does not give IMA any legal role, neither
to protect nor assist its members when legal
matters arise.
However, IMA has from early on given its
members legal advice and in some instances
provided legal assistance to them. IMA
has a lawyer among its staff members and
when needed attorneys are engaged to bring
cases to court. Most such cases are due to
the employers‘ failure to comply with wage
contracts or other work related agreements.
Working Conditions and the Right to Strike
One of the roles of IMA is to negotiate
wage agreements. A legislation on wage
agreements within the public sector stipu-
lates that all salaried employees,who receive
salaries based on wage agreements reached
by their association, are either obliged to be
a member of their association or pay a yearly
fee to it. Consequently, doctors who receive
salaries based on IMA‘s wage agreements
need either be a member of IMA or pay a
fee to it.
Within IMA a negotiating committee is
responsible for the negotiation process
and other work related matters within the
public health care sector. If the negotiating
parties do not reach an agreement IMA has
the legal right to call for a general strike of
doctors. However, this happens very rarely,
mainly due to very extensive legal exemp-
tions to the right of doctors to strike. Fur-
thermore, many Icelandic doctors believe it
is unethical to strike and are of the opinion
that other measures are to be used to raise
wages, shorten working hours and improve
working conditions.
IMA continuously has a dialogue with the
relevant health authorities on issues relating
to health and the situation of doctors.
Belgium
The Belgian Association of Medical Trade
Unions has been set up in 1963.
The Belgian Medical Body wanted to be a
liberal profession and had to fight against
the government’s will to nationalize health
care.
After a 3 week’s medical strike, the gov-
ernment withdrew the law. Medical prac-
tice would remain liberal and every year
a mutual agreement would be made be-
tween doctors and insurance companies,
about medical fare in order to insure fare
security for the patient in a social funded
system.
Since then,we have set up a complex system
of concertation which allows us to give our
opinion on any medical matter or on public
health.This system gives us a real power but,
if we achieve a reasonable consensus, and it
has happened very often, we take action
against such measures as strikes, demon-
strations, etc.
Of course,to have a fair balance between ac-
tions and negotiations we need to have legal
advisors. It is more difficult to come to the
same opinion in the whole medical body.
Every speciality often sees to its own inter-
ests. We have to conciliate the two commu-
nities (the Flemish and French speaking)
hospitals and ambulatory care, etc.
But, up to now, we manage to keep a strong
solidarity. And, anyway, don’t forget that the
government decides eventually.
Regional and NMA news
72
The Royal Dutch Medical
Association (KNMG)
KNMG is a federation of associations of
doctors: GPs, medical specialists (consul-
tants), occupational health doctors, nursing
home doctors and doctors working in the
public health domain. KNMG represents
about 60% of all doctors in the country.The
federation defends the so-called immaterial
interests of all doctors, in the fields of qual-
ity and safety of care,professional behaviour
standards, medical ethics, legal and judicial
aspects, education, lifelong learning, career
planning, prevention and public health.
KNMG has 25 policy advisors working on
these issues, among whom 5 legal advisors.
KNMG intensively lobbies stakeholders,
ministries and parliament in order to realize
its objectives. High KNMG officials regu-
larly meet with government officials, the
minister of health and members of parlia-
ment. We have a high profile in the media
due to a very active media policy.
Material interests (wages, fees, insurance
rates) are looked after by the separate profes-
sional associations, which also cover the spe-
cific quality aspects for their own profession-
al communities. There is close cooperation
between KNMG and its federation partners
to take joint action wherever possible, and
in case of common interests to jointly move
toward stakeholders, government and parlia-
ment and thus reinforce the message.
The Canadian Medical
Association
The Canadian Medical Association is a vol-
untary, member-driven physician represen-
tative organization.We advocate actively on
behalf of our members with the government
and other important stakeholders at the na-
tional level and through our Provincial and
Territorial Medical Associations (PTMA’s)
at the provincial and territorial level. In
Canada, health care provision and fund-
ing is a provincial and territorial obligation,
although the federal government plays an
important role in transfer funding, care of
certain populations (such as Canadian Ab-
originals) and policy setting.
Physician malpractice insurance is provid-
ed mainly through the Canadian Medical
Protective Association (CMPA). This asso-
ciation is separate from the CMA, although
we share close ties. Members receive legal
advice and representation through their
membership in the CMPA. Further infor-
mation is available at www.cmpa-acpm.ca.
Financial interests are primarily addressed
by the PTMA’s through their negotiations
for physician fee schedules and billing codes
with their respective provincial govern-
ments. On occasion, PTMA’s have had to
organize targeted strikes and job actions in
the past although this has thankfully been
quite rare.
Cyprus Medical Association
The Cyprus Medical Association was es-
tablished in 1967 and represents all practic-
ing physicians in Cyprus. According to the
Cypriot legislation, a physician who is prac-
ticing in the island is obliged to become a
member of the Association. At present, the
Cyprus Medical Association has approxi-
mately 2650 members.
The main aims of the Association are to unite
all members of the medical profession who
are practicing in Cyprus and to safeguard
their interests.Furthermore,CyMA provides
consultation and assistance to its members in
their mutual relations, in their relations with
the State or other authorities and organisa-
tions. Additionally to that, CyMA cooper-
ates with other national and international
bodies in order to foster its aims.
Moreover, the Cyprus Medical Association
is not only a professional body but also acts
in various ways for the benefit of patients
and the general. public The Association
aims at the protection of medical ethics, the
development of a health care system so that
every patient enjoys the right to adequate
treatment, enhancement of its members
professional training and advancement op-
portunities, introduction of new legislation
and regulations governing health issues and
the management of its members’ pension
fund and life insurance schemes.
The Association has an administrative board
of 24 members. It meets once a month and
appoints its eight sub-committees. These
sub-committees are the Ethics Committee,
the Continuing Medical Education Com-
mittee, the Scientific Committee, the Law
and Regulations Committee, the Commu-
nication Committee, the National Health
Insurance Scheme Committee, the Trade-
Union Committee for the Private sector
and the Trade-Union Committee for the
Public sector.
The Cyprus Medical Association secures the
legal and judicial interests of its members
through a multilayered and coherent policy
that is based on the one hand, on full imple-
mentation of the Cypriot Law in relation to
the physician profession, and on the other
hand on intensive cooperation and dialogue
with the Cypriot Government and Parlia-
ment. Moreover, the Cyprus Medical Asso-
ciation buys services from a legal counsel and,
in close cooperation with him, the members
of the Law and Regulations Committee par-
ticipate in open discussions at the Cypriot
Parliament concerning healthcare issues.
The financial interests of the CyMA mem-
bers are secured through the operation of
two Committees, the Trade-Union Com-
mittee for the Private sector and the Trade-
Union Committee for the Public sector.The
Trade-Union Committee for the Private
sector organizes and coordinates all of the
local medical specialities boards and every
two years on behalf of its members negoti-
ates with insurances companies and specific
employers insurance funds the price of med-
ical acts. It has to be noted that according to
Regional and NMA news
73
the Cypriot Law all the bilateral contracts
are signed between each individual doctor
and the insurance companies. CyMA acts
as the representative of the physicians dur-
ing the negotiations for the content of the
bilateral agreement.
Since the establishment of CyMA and until
today the Association has not organised a
strike or rallies as there has been no need for
it. The main diachronic philosophy of the
Association is to maintain excellent rela-
tions with the state decision makers in order
to secure the interests of its members. Until
today, any problems the medical profession
has been facing were resolved through dia-
logue and lobbying.
Nevertheless, CyMA supported a number
of strikes that were organised by the Union
of the Public Doctors aiming to improve
their rights at work. During those strikes
CyMA had a constructive role in the reso-
lution of the problems due to the strikes by
transferring patients from the public to the
private sector.
According to the World Health Organiza-
tion, health care in Cyprus meets high stan-
dards. Today CyMA has a leading role and
supports the creation and establishment of
a National Health Plan that will combine
all the medical services from the private
and public sector. It will further improve
the service provided to the patients of the
island.
Introduction
The CPME spring meetings in Brussels on
3–5 May saw many new developments:
Firstly, the CPME together with the
ECDC (European Centre for Disease
Prevention and Control) hold a joint con-
ference on vaccination and prevention, en-
titled: “Prevention through Childhood Vac-
cination – Defining Doctors’ Roles in the
Stakeholder Debate”.
On the following day, at its Board meeting
in Brussels on 5 May 2012, the CPME ad-
opted policies concerning professional regu-
lation as well as public health which demon-
strates the variety of health policy of interest
to the European Medical Profession.
The General Assembly on the same day
elected the new Executive Committee for
the period 2013–2015.
CPME/ECDC conference
on childhood vaccination
The half day conference gathered together
speakers from ECDC, WHO-Europe,
the European Commission, Médecins du
Monde, the European Patients Forum and
delegates from the National Medical Asso-
ciations. European Doctors and policy mak-
ers agreed that high quality, evidence-based
information and good communication be-
tween doctors and patients/parents as well
as modern media tools are key for preven-
tion and form part of the recommendations
for future policy actions and joint action. In
conclusion, it was stated that doctors should
engage more in supporting vaccination pro-
grams for children. Special emphasis was
put on the importance of vaccination against
measles which is a condition for near eradi-
cation of this disease in the world.
Outcome of CPME’s Board
and Executive Committee
meeting in May 2012
Professional Qualifications Directive
As previously reported,the CPME is very ac-
tive on the revision of the professional quali-
fication directive (Dir.2005/36 EC)1
to which
1 http://eurlex.europa.eu/LexUriServ/LexUriServ.
do?uri=OJ:L:2005:255:0022:0142:en:PDF
the Commission in December 2011 pub-
lished its proposal COM (2011) 883 final2
.
TheCPMEBoardendorsedtheamendments
of the Executive Committee to the Europe-
an Commission’s proposal to revise the Pro-
fessional Qualification’s Directive (PQD)3
.
The main issues of concern in a nutshell
are that competent authorities must not be
restricted in the capacity to grant recogni-
tion of qualifications; for the sake of legal
certainty and patient safety “tacit recogni-
tion” cannot be accepted. Partial access (ac-
cess without fulfilling the minimum train-
ing requirements) is not appropriate for the
medical profession, otherwise patient safety
and quality of care is at high risk. While
alert mechanisms should apply to all health
care professionals, data protection standards
and the principle of the presumption of in-
nocence must be respected. There should
be no change to the minimum training re-
quirement of basic medical training as set
out in the current directive (stipulating 6
years or 5500 hours) in order to safeguard
the quality of the increasingly complex
education and training. Initiatives to de-
velop and elaborate the minimum training
requirements must be driven by the medi-
2 http://ec.europa.eu/internal_market/qualifica-
tions/docs/policy_developments/modernising/
COM2011_883_en.pdf
3 http://cpme.dyndns.org:591/adopted/2012/
CPME_AD_EC_27032012_009_Final_EN.pdf
News from the Standing Committee of
European Doctors (CPME)
Regional and NMA news
74
cal profession, in particular the competent
authorities.
Doctors’ knowledge of the language must
be sufficient to safely communicate with
patients as well as consult with their profes-
sional, regulatory, administrative and com-
mercial infrastructure. Language verifica-
tions shall not be used as barriers to mobility.
Apart from its own amendments, the
CPME also adopted a draft statement on
PQD to be signed together with all main
European Medical Organisations.
Medical devices
The Board approved also a statement on
medical devices1
in which CPME welcomes
the statement of the European Health and
Consumer Policy Commissioner John Dalli
made on 9 February 2012 where he called on
EU Member States for immediate action to
be taken at national level to ensure full and
stringent implementation of the current legis-
lation on medical devices. Going further than
this,CPME calls for legislation which follows
the same principles as Pharmacovigilance,
since medical devices have reached a degree of
complexity that easily compares with the one
in use in the pharmaceutical industry. Also, a
centralised monitoring mechanism to ensure
the highest safety standards of the notified
bodies across the EU is considered desirable.
Alcohol and Youth policy
The new CPME statement reaffirms Euro-
pean doctors’ commitment to actively con-
tributing to the prevention of alcohol-related
harm to this vulnerable group. One of the
actions highlighted is the pro-active engage-
ment with children and young people on the
topic of alcohol. These ‘brief interventions’
1 http://cpme.dyndns.org:591/database/2012/
EC_2012_026%20CPME.FOR.BOARD.
Statement.Medical.Devices.pdf
by doctors have been proven a highly effec-
tive tool in preventing harm. Also, doctors
up-hold their call for regulatory action to be
taken both on maximum blood alcohol levels
for drivers and on the advertising of alcohol
products. In addition, the statement address-
es the need for more effective enforcement
of legislation on alcohol sales to minors and
highlights the importance of choosing a par-
ticipatory approach in school-based training
programmes on alcohol related harm.
Ethical and fair patents
At its Executive Committee meeting on 3
May, the CPME adopted a policy which
calls for ethical and fair patents2
. While the
regulation implementing enhanced coop-
eration in the area of the creation of unitary
patent protection is currently blocked in the
Council of Ministers,since there is no agree-
ment as to whether the future European
Patent court shall be established in London,
Munich or Paris, in the view of European
Doctors a clearer defined exemption in the
regulation on the human genome is of high
importance. Also, development as well as
fair pricing of new treatment should not be
impeded by the regulation; otherwise health
care itself will be endangered in the future.
New CPME Executive
Committee and Internal
Auditor for 2013–2015
The CPME members at their General As-
sembly on 5 May 2012 elected the new
CPME Executive Committee 2013–2015
• CPME President:
Dr. Katrín Fjeldsted
Dr. Fjeldsted completed her general prac-
tice training in 1979 in London, United
2 http://cpme.dyndns.org:591/database/2012/
EC_2012_053.Draft.CPME_Statement_Pat-
enting.Human.Genome.pdf
Kingdom after receiving her Medical De-
gree from the University of Iceland in 1973.
She has been a family physician at the Ef-
staleiti Health Centre since 1980 and was
the medical director from 1980 to 1982
and again from 1997 to 2003. She has fur-
thermore held inter alias the following of-
fices: Chairman of the Icelandic College
of Family Physicians 1995–1999, Member
of National Parliament from 1999–2003,
Member of the Icelandic parliamentary
delegation to the United Nations General
Assembly in 1999 and 2000, CPME Vice
President for 2006–2007 and 2008–2009
and CPME Treasurer for 2010–2012. At
the CPME General Assembly in May 2012,
Dr. Fjeldsted was elected CPME President
for 2013–2015.
• Vice-President 2013–2015:
Dr. Heikki Pälve (Finland)
• Vice-President 2013–2015:
Dr. Milan Kubek (Czech Republic)
• Vice-President 2013–2015:
Dr. Jacques de Haller (Switzerland)
• Vice-President 2013–2015:
Dr. Istvan Éger (Hungary)
• CPME Treasurer:
Dr. Frank Ulrich Montgomery (Ger-
many)
• CPME Immediate Past President:
Dr. Konstanty Radziwill (Poland)
Internal Auditor
Dr. Gordana Kalan-Živčec (Slovenia) was
elected CPME Internal Auditor 2013–
2015.
Next CPME general meetings
The next CPME general meetings will take
place in Limassol (Cyprus) on 23–24 No-
vember 2012.
Dr. Konstanty Radziwill
CPME President
Birgit Beger
CPME Secretary General
Regional and NMA news
75
WMA newsCOUNTRY
Educated
Haughley Grange Stowmarket Suffolk IP
14 QT
Brentwood School
Kings College,University of London (Vice-
President Union Society)
Charing Cross Hospital
LMSSA(Lond) 1950 MRCGP 1968: FR-
CGP 1988
Occupation
Consultant European Health Affairs
Hon. Editor in Chief World Medical Jour-
nal 2004–2008,
Hon. Co-Editor 2009–2012
JHO/SHO Royal East Sussex Hospital
1950–1951
Medical Registrar Royal East Suffolk Hos-
pital 1953
Junior Specialist in Pathology RAMC
(DADP War Office 1952/1953) 2 I/C No 1
Blood Transfusion Unit, (Reserve) RAMC
1993–1999)
Medical Registrar Hastings and Bexhill
Group 1953–1954
General Practitioner, Ixworth, Suffolk
l954–1988
Hospital Practitioner Rheumatology & Re-
habilitation
Addenbrooke’s Hospital, Cambridge 1960–
1986
Consultant DG V European Commission
1988–1992
Adviser in General Practice, Course Direc-
tor, European School of Oncology 1988–
1998
Secretary Suffolk Local Medical Commit-
tee 1992–1996
Founding Editor Oncology in Practice
1991–1994
Secretary-General EFMA/WHO 1984–
2001 (see below)
Consultant WHO (see below)
Temp. Adviser WHO (see below)
Honours
Officer of the British Empire (OBE) 1976
Gold Medal Giornata Nazionale del Med-
ico (Italy) 1978
Hippocrates Medal (S.I.M.G.) 1986
Fellow British Medical Association 1986
Medaille de Mérité Européen (Gold)1993
Silver (1988)
Hon. Member Ordern dos Medicos (Por-
tugal) 1988
Hartmann-Thieding Medal (Hartmann-
bund, Germany) 1988
Hon.Specialist Clinica Geral (Portugal) 1988
Vice-President, British Medical Associa-
tion 1998–2012
Papal Bene Merente Medal 1999
Bereinstein Medal, Polish Medical Cham-
ber 1999
Ehrenzeichen der Deutschen Ärzteschaft
(Medal of Merit of theGerman Medical
Association) 2000
Hon Member: Medical Association of Ka-
zakhstan 2000
Hon. Member: European Forum of Medi-
cal Associations &WHO 2001
Hon Member: Romanian Medical Associa-
tion 2001
Kaspar Roos Ehrenmedaille, NAV-Yir-
chowbundes 2002
Macedonian Medical Chamber for service
to Macedonia Health Services – 2004
Appointments
• Member Jury (National Secretary) Prix
“Europe et Medecine” 1992–2004
• Member of Livery, Worshipful Society of
Apothecaries,
• Freeman of City of London
Medical Defence Union
• Member of Council, Medical Defence
Union 1986–1996
• Member of Cases Committee 1986–1996
• Adviser on EEC 1980–1990
National Health Service (UK)
• Member Executive (Health) Council,
West Suffolk 1962–
• Suffolk “DHSS Best Buy Hospital”Plan-
ning Group
• Member Clothier Committee on Rural
Dispensing (DHSS) 1979–1983
• Member of East Anglia Regional Health
Authority (DHSS) 1974–1982
• Chairman Rural Practice Payments
Committee 1980–1982 (DHSS)
• Member East Anglia RHA General
Practice Advisory Committee 1984–1988
• Member RHA/Cambridge University
Liaison Committee
• Member General Practice Postgraduate
Medical Training Committee (RHA)
1987–1993
• Black Interprofessional Working Group
on Data Protection and access to medical
records 1984–1990 Dept. Health & Soc.
Serv. (DHSS)
• Member UK Council for Postgraduate
Medical Education 1978–1986
• Member C.M.O’s (DHSS) Working
Group on Specialist Training) (Liaison
with EEC group) 1999
UK Government and European Parliament
• 1975 Adviser to H. M. Government Op-
position on Draft Doctors’ Directives
(EEC/75/362/363) on Mutual Recogni-
tion of Medical Qualifications
• Expert to H M Opposition Rapporteur,
House of Commons, Alan Tyrell
• Expert to Amedee Turner MEP Euro-
pean Parliament Rapporteur on Directive
General Practice (86/457/EEC) (see also
European Community)
Europe
Medical Profession
Chairman BMA Committee on European
Economic Community (EEC) 1971–73,
1975–1990, (Vice-Chairman 1974–5).
Standing Committee of Doctors (CPME)
• Head of UK Delegation 1971–1990
(Observer 1968–71)
• Chairman “Health Professions”Commit-
tee
In memoriam Alan John Rowe
3 February 1926 – 30 April 2012
76
WMA news COUNTRY
• Vice-Chairman Ethics Committee 1980–
1985
• Member Juristes Committeel971–1990,
Education Committee 1972–1990, So-
cial Security 1975–90 General Practice
(1971–1988)
• Rapporteur various topics including
Pharmaceutical Directives, Liability for
Defective Products, Radiological Safety,
the Elderly population in the EEC etc.
• UEMO Liaison Officer to CP (vide infra)
European Union of General Practitioners
(UEMO)
• President 1982–1986 (adoption of EU
Directive Specific Training for General
Practice 1986)
• Head of UK delegation 1971–1990 (Ob-
server 1969–71)
• Liaison Officer with the European Com-
mission, Council of Europe & the World
Health Organisation (1972–1982; 1986–
1990), Standing Committee of Doctors
of EEC 1974– 1982;1986–1990
• Chairman various working groups
European Community (EU)
European Commission
• Consultant DGV 1988–1992); (Europe
against Cancer Programme);
• Member GP Organisations’ Representa-
tives Group DGV 1992– 98;
• Member Advisory Committee on Medi-
cal Training (ACMT) 1983–93: Chair-
man Working Group “ACMT visiting
system for Medical Schools & Faculties”
• Consultant Europe against Cancer Gen-
eral Practice Strategy 1994
AIM Programme DGXIII
• Member of Committee on “Computer
Security and Legal issues in Medical In-
formation”
• Presentation on Medical Confidentiality”
AIM European
• Parliamentary Hearing on Confidential-
ity 1989
Economic and Social Committee (EEC)
• Rapporteur’s Expert various health top-
ics – consolidation of directives on mutual
recognition of professional qualifications,
product liability, Drug consumption etc.
European Parliament
• Consultant to Rapporteur (Amedee
Turner EMP) on G. P. Directive (457/86
EC) 1985–86
World Health Organisation
• General Secretary, European Forum of
Medical Associations & WHO 1991–
2001, Secretary General 1984–1991
• Organisation of Oncology Services (Pri-
mary Care) in Bulgaria
• Consultant: Health Professionals’ recogni-
tion,licensing&regulationinKosovo(1999)
• Consultant-Organisation of PHC On-
cology Services in Bulgaria
• Consultant – Relations between WHO &
Health Professions NGOs (Geneva – 2000)
• Consultant  – Regulation and Licensing
of Physicians in Europe 2001–2002 (see
bibiliography 46)
• Temporary Adviser – various topics, CIN-
DI, Appropriate Health Care Technology,
General Practice,CME,Cancer Prevention
and Control, Tobacco Control(various),
Youth & Alcohol, Inter-ministerial Con-
ference on Tobacco 2001, Family Medi-
cine/GP- definition and future develop-
ment,Patient empowerment,etc.
• Member European Tobacco Partnership
Group EURO 1998–2002
• Inter-Ministerial Conf. Tobacco and
Health, “Doctors and Tobacco” Work-
shop, Stockholm, Sweden
• Consultant TCRC Symposium (E. U.,
WHO TCRC.) Edinburgh 2004
Other European
• Director European Seminars on Specific
Training for General Practice (Oncology)
SEMG Florence 1993
• Director European Seminars on Specific
Training for General Practice-Florence
1994 (Eng/Fr)
• Director ESO/EEC French and English
Workshops for GP Trainers on Oncology
in General Practice Training-Venice, Orta,
Florence, Coimbra, Antwerp. 1990–96
• Consultant Workshop Primary Preven-
tion of Cancer in Genffi®k Practice, Uni-
versity of Southampton 1993
• BIS/World Bank Consultant on Reform
of Health Care Law- Macedonia 2001–
2002.
British Medical Association
• Vice-President 1997–2012
• Fellow 1988
• Member of BMA Council 1971–1990
• Past President Suffolk Branch
• Past President West Suffolk Division
• Chairman East Anglian Regional Council
• Chairman EEC Committee 1971–1974,
1976–1990 (vice-chairman1975–1976)
• Member Central Ethical Committee
1971–1990 (vice-chairman 1978–1990)
• Chair Working Party and contributor
Handbook of Medical Ethics (1984–
1988)
• Member(Chair) BMA/Life Offices Assn.
Committee
• Member General Medical Services
Committee 1965–1990 (Negotiator
1968–1973)
• Chairman Rural Practices Committee
UK 1968–1974
• Chairman ABPI/BMA Liaison Com-
mittee 1986–1990
• Member:
Health Services Financing Advisory Pan-
el 1967–1970; Review Body Joint Evi-
dence Committee 1968–1973; Medicines’
Legislation Working Party (Tunbridge)
1968–1970; In-vitro Fertilisation Commit-
tee: various, other committees and work-
ing parties; National Joint Committee on
Dispensing (BMA/R Pharm Soc); Clothier
Committee on Rural Dispensing; GMS
Education Committee
• Member Interprofessional Working
Group on Access to Personal Health
Information Black Committee (Dept..
of Health/BMA) Chairman Handbook
Working Party “Philosophy & Practice of
Medical Ethics” – BMA 1988
• BMA representative Presidency of Pro-
fessions 1976, 1979, 1980
• Founding Member Board,Tobacco Con-
trol Resource Centre 1997–2012
• Consultant 2002–2005 (Editorial body
“Doctors and Tobacco” 2004–2005
77
WMA newsCOUNTRY
Royal College of General
Practitioners
• Fellow 1982
• Observer on Council
• Member of GMSC/RCGP Liaison Com-
mittee
• UK Representative, European Commis-
sion. “Europe against Cancer”
• GP committee 1994–95
World Medical Association
• HonEditorWorldMedicalJournal2003–
2008
• Member BMA delegation General As-
semblies Honolulu, Venice, Lisbon, Ma-
drid:
• EFMA/WHO Observer General As-
sembly, Edinburgh, Hamburg, Helsinki;
• Observer various Council meetings
• Expert Adviser Ethics Committee
• Past Chairman Associates Group
Other
• Member Interprofessional Group on
EEC (Law Society) 1978–1982
• World Congress on Medical Law 1979
• Member of UK Cancer Co-ordinating
Committee,EuropeagainstCancer1994–
2002
• Member of Council, Queen’s Institute of
District Nursing
• Member of Advisory Group on SEN
role in local authority nursing services
(Q.I.D.N)
• Member Advisory Panel, Association of
Occupational Therapists 1989–1991
• Member of Jury (UK National Secretary)
“Prix Medicine Europeene” (Institut Sci-
ences de la Sante) Paris 1980–2005
• Member of Livery, Worshipful Society of
Apothecaries of London. Freeman City
of London
Societies
• Ethics in Health Care Forum
• Medico-Legal Society
• Fellow Royal Society of Medicine
• Past Fellow Royal Society Tropical Medi-
cine and Hygiene
Publications/Reports/Lectures
• EpidemicHaemorrhagic Fever Lancet,
Nov 15, 980.1952
• Memorandum on Immunological Proce-
dures (edit) – HMSO (1953)
• Epidemic Haemorrhagic Fever – R.Soc.
Trop.Med.& Hyg 1953
• “Implications for general practice of Brit-
ain’s entering the Common Market”,
BMA Junior Members Forum, Cam-
bridge 1971, BMA
• “General Practice and the Common Mar-
ket”, Proc.Roy.Soc.Med. 65,927–9,1972
• “Psychosomatic factor in Rheumatoid Ar-
thritis”The Practitioner 1972,208,81–85
• “Libre Circulation des Médecins” – Ca-
hiers de Droit Européene 1976 Nos
5–6,733–66
• “The EEC Commission,Health and Med-
icine – a new Directorate General for Yt-
edXÙf!”.summary in BMJ 1977,12th
March
• “Institutions of the European Communi-
ty & Occupational Health”Royal Society
of Medicine 1977
• “Collaboration and cooperation between
the professions in the EEC”International
Seminar “Background to nursing in the
EEC”Royal College of Nursing,UK 1977
• “Formazione complementare del medico
generico nel Paesi délia CEE” Inter-
national Conference “Europa Bianco”,
FNOOM, Naples, 20 May 1978
• “Primary health care in Europe” – Bristol
Postgraduate Centre 1978
• “Local Ethics Research Committees”
Rutgers University USA1979
• “Problems of Ethics & Research – Local
Ethical Research Committees”. National
Academy of Medical Sciences, Washing-
ton, DC, US A, April 3rd
1980
• Local Ethical Research Committees
“Presentation” Institutional Review
Boards Symposium-Rutgers University,
USA, 11 April 1980.
• “Why Social Policy in the EEC?” Wil-
son School of Political Science, Princeton
University, USA
• “The UK National Health Service”,Hast-
ings on Hudson Ethics Centre USA,^10
April 1980
• “Medicina General y Salud Publica en
Europa” Congresso Nacional de Medi-
cos Titulares Espagnole, Torremolinos.
Spain. 1988
• “Quelle vérité faut il dire au malade?” –
Ligue Nationale Française contre le Can-
cer, Paris, 1983
• ”Technological, Scientific Progress and
Human Rights: Genetic Engineering”
WMJ 31,25-26,1984”
• “Formation continue aux Royaumme
Uni” Europe Blanche, Inst des Sciences
de la Santé, Paris 1985
• “Role et Formation Spécifique du Mede-
cin Generaliste selon le le CEE – Col-
loque International de l’Universite de
Bobigny, Paris.
• “L’organisation de la formation Medical
Continue – Angleterre” l’Institut des Sci-
ences de la Santé, Paris 1986
• “Continuing Medical Education in the
United Kingdom”, Europe Blanche (Par-
is) 1988.
• “La jurisdiction professionelle en Grand
Bretagne” – Colloque “Ordre des Méde-
cins et son devenir”, Ordre des Médecins,
Oct 1981
• “Health and the European Community”
WHO (EUR/ICP/ Cor.010103) 1986
• “Raising Standards through Common
Action – The Battle for Health” The Eu-
ropean, 1 No 6,1987
• “Les systèmes de Soins étrangers”  –
Pays du Nord-Systèmes Nationalisées”
l’Institut d’Études Politiques, Paris, 1991
• “The EEC and the Internal Market in
Medicine”, Postgraduate Centre, Col-
chester, 1991
• Europe against Cancer – the role of gen-
eral Practitioners. Europe Social, Euro-
pean Communities 1/1991
• “The EEC and Medicine”  – European
Society of Parkinsons Organisations,
Glasgow 1991
• “Specific Training in Family Medicine
and the European CommunityHealth
Services” – Ministry of Health Sympo-
sium, Madrid 1991
• “Role of G. P’s in Female Cancer Screen-
ing” – SIMG/EEC Florence 1991
78
WMA news COUNTRY
• “Medicine in the European Union and
Greater Europe”– Hertford Postgraduate
Centre 1991
• “Overview of EEC Professional Direc-
tives” in Standards of Excellence (Health
Care delivery in the European Commu-
nity) NHS Training Directorate. 1992
• “La Medicine de Famille dans les Pays du
Nord” – l’Institut d’Études Sciences Poli-
tiques, Paris 1993.
• “Regard sur d’autres systèmes de santé –
Systeme de Santé Anglais” l’Institut
d’Etudes Politiques Paris 20 June 1993
• “Health and the European Commu-
nity”  – EFMA/WHO Meeting 1988-
WHO Copenhagen E 65564 pp 67–70
• “Europe against Cancer Programme – an
overview” UEMO Handbook 199
• Reports of Annual meetings of Eu-
ropean Forum of Medical Associa-
tions and the World Health Organisa-
tion, 1986,1987,1988, 1990,1991,1992,
1993,1994, 1995,1996, 1997, 1998,1999,
2000, 2001 – WHO European Regional
Office/ICP/EXM 019
• “Le Cancer et les styles de vie” – III ieme
Cours Européen d’Oncologie pour les
Maitres de Stage Médecins Generali-
stes – Univ. Coimbra 1995
• “Europe against Cancer GP Strategy”
UEMO Handbook 1999,115–118
• “The General Practice Directive 86/457/
EEC  – the end of 30 years struggle?”
UEMO Handbook Kensington Publica-
tions 1994
• “Core content of cancer in specific train-
ing for general practice” – Proceedings of
Consensus Conference on cancer train-
ing for General Practitioners Copenha-
gen 1991 EEC/UEMO
• “Role of General Practitioners in Tobacco
Control” – Europe against Cancer, Ath-
ens 1992
• “Cancer”, UEMO Handbook, Kensing-
ton Publications 1993
• “Primary and Secondary Cancer Preven-
tion in General Practice”  – European
Commission Symposium, Brussels 1990
• “Medical Education in the EEC” – Karo-
linska Managers – Univ. Sussex 1982
• “Medicine and the EEC” Karolinska
Managers – Univ. Sussex 1983
• “Les Personnes Agées dans la Commu-
nauté Européene  – present et l’avenir”–
Bonnel, Hennigan & Rowe IPSEN 1990
• “Europe against cancer – the role of general
practitioners” – Social Europe 1/91,p94–95.
European Commission ISSN 0255-9776
• “European Code against Cancer  – a
booklet for general practitioners” Scand.
J. Prim. Health Care 1994 Suppl. 1 (and
3M first version of Code) 1993)
• “Title IV of the E.U. Council Directive:
Specific training in General Medical
Practice”UEMO Handbook, Kensington
Publications l995
• “Dispensing of Medicines by General
Practitioners”  – an overview of trends
in the European Union – Austrian Arz-
tekammer, Vienna-1995
• “The European Medical Profession  –
problems, challenges and opportunities
at the beginning of the 21st
century.” Bull
2/02 Société des Sciences Médicales du
Grand-Duche de Luxembourg 2002.p
• “European Legislation” in “The Law and
General Practice” 1992, Radcliffe Press.
• “International Partnerships for Health”,
WHO address General Assembly, Polish
Medical Chamber, Warsaw 1997
• Editorials in World Medical Journal
50 (1–4), 2004, 51 (l–4)–2005,52 (1–4),
2006, 5J-(1–4), 2007.
• Licensing and Regulation of Physicians in
theWHOWorld Health European Region
Copenhagen. EUR/05/5051794C 2005
• Licensing and Regulation of Physicians
EuroMed, Barcelona 2005
• Handbook European Forum of National
Medical Associations & WHO(Rowe &
Vigen) 1981–2001
• Clinica Geral, 1985
Other activities
Kings College, University of London Vice
President Union Society
Music
• Organist St Michael’s Church, Gidea
Park 1941–1944
• Organ Scholar, Kings College, London,
1945–1947, President and Conductor
• Music & Dramatic Society
• Sub-Organist St. Martins in the Fields
1947–1950
• Organ recitals in UK & abroad, includ-
ing, St. David’s Cathedral, St. Margaret’s
Westminster, Oude Kirke Amsterdam,
Basilica Wilten, Innsbrook, St., Inns-
brook, Cathedrals in Santiago da Com-
postella, Toledo and Lisbon, San’ Gior-
gio Basilica Venice, Wilten Innsbruck
Basilica, Du PresConcert Hall Meudon,
Paris:, Ljubljana and Chapel, Princeton
University
Harpsichord /Organ Continuo
• Ipswich Bach Choir-harpsichord con-
tinuo Bach Matthew & John Passions,
Christmas Oratorio, Magnificat, Mozart
Requiem, Monteverdi Vespers
• Cheltenham Bach Choir-harpsichord
& organ continuo (Christmas Oratorio)
Kidderminster Bach Choir-harpsichord
continuo
• Eye Bach Choir-organ continuo
Haydn”Spazen Messe”,“Messe de Minu-
it, Messiah. (many) Clerambaut etc.
• Various orchestral works Handel’ Messi-
ah, Israel in Egypt, Hoist Hymn of Jesus
• Organist Gustav Holst Centenary Me-
morial Service Aldborough with Aldbor-
ough Festival Choir.
• Holst Hymn of Jesus,(keyboard) St Mar-
tin in the Field
Conducting
• Appointed conductor Ipswich Orchestral
society
• Other conducting Handel, Acis and
Galatea, J. S, Bach B minor Mass, Haydn
Harpsichord concerto in D, etc.. Cantata
51, Mozart 12th
Mass and Mozart Re-
quiem, Haydn “Nelson”, “Harmonie” and
“Sparrow” Masses, Schultz Passion etc.
Vaughan Williams Coronation Te Deum
• Director of Music St Edmunds Church,
Bury St. Edmunds 1958–1993
• Organist l958–2011
79
Medical profession
(WMJ 2007, Vol 53. Nr 1)
Wherever one looks the medical profes-
sion it seems to be facing more and more
problems despite, or sometimes due to,
advances in medical science and their in-
troduction into medical practice. They
range from the global problems of human
resources and health professionals includ-
ing physicians, inequities in their distribu-
tion across the world, continuing efforts to
maintain standards for professional prac-
tice and ensuring maximum patient safety,
the changing face of medical practice with
increasing emphasis on prevention, huge
increases in the intrusion of management
and administrative bureaucracy associated
with medical practice both in hospitals and
the communities.
As these problems are addressed, it is vital
that the profession in each country is seen
to have considered them and prepared its
own position, rather than reacting to short
term policies proposed by others which
may be neither in the best interests of the
community, of individuals, or of the pro-
fession.
The contents of this issue of WMJ reflects
the diversity of both the positive develop-
ments in medicine, science and in disease
control, strategic plans and health policy
developments, as well as some of the prob-
lems which still need to be solved.
It includes some further WMA policy state-
ments,one of which,that on medical educa-
tion, is also the subject of a report on a new
strategic partnership between the World
Health Organisation and the World Fed-
eration of Medical Education. There is also
a report on the first meeting of the Task-
force of the Global Health Workforce Al-
liance (GHWA) to seek practical solutions
to the health workforce problems, including
investment in education and training of all
healthcare workers. The WMA Secretary
General comments on one particular effort
seeking to persuade physicians who have
emigrated to return to practice in their own
country where there is a grave shortage of
physicians. Another article addresses the
problems of medical research ethics posing
a question as to whether or not there are
limits to the possible har- monisation of ac-
tivities of ethical research committees. Two
papers given at the WMA scientific meet-
ing in South Africa address the important
topic of “Health as an investment”
In the context of the problems of shortage
of physicians it is interesting to note the
results of a ten year cohort study of 545 of
doctors who graduated in one country in
1995 1
. Of approximately 1400 of the final
year students who expressed willingness to
participate in the survey, a sample of 600
were drawn and of these 545 participated
in the questionnaire which was sent to all
participants each year for ten years. This
was combined with focus groups which
were random sub-samples each year, where
questions could be more deeply examined.
Apart from information on type of work,
career choice and training, questions were
asked about working conditions and about
participants’ attitudes to medicine as a ca-
reer, in the light of their experience year by
year.
While all the results of this study are inter-
esting, as will be those of the next ten year
cohort study, in the context of the debate
on human health resources (particularly re-
cruitment and retention of physicians), it is
interesting to note that in this study
• 2 in every 5 doctors in the cohort study
(40%) found that the reality of a career
1 BMA Cohort Study W report 2005
in medicine was very different from that
envisaged on graduation in 1995;
• While three quarters (75%) of the co-
hort doctors ten years after graduating
were satisfied with practising medicine, a
fifth (20%) reported a lukewarm desire to
practice medicine.
• The rest (5%) had little or no desire to
practise medicine. (3% of the cohort had
left medicine during the 10 years of the
study, the most common reason being
dissatisfaction with medicine as a career.
• 15% had changed their career choice dur-
ing the study period, a key factor in this
being “hours of work and working con-
ditions” followed by working/pay condi-
tions.
While these findings are disturbing (20%
having a weak desire to practice medicine
after 10 years), when planning to educate
more physicians to meet needs it is unfor-
tunate that no other countries have carried
out comparable extensive cohort studies.
If the profession is to address its future in
the light of the problems it faces, then such
studies could contribute valuable informa-
tion in the formulation of such plans.
Medical professionalism
(WMJ 2007, Vol 53. Nr 3)
The second half of the 20th
century and
the beginning of this one have experienced
unprecedented and ever increasing rapid-
ity of technological development, scientific
discovery, research and the production of
innovative diagnostic tools and therapeu-
tic agents. All have had enormous impact
on medical practice, some have posed ma-
jor ethical problems and – not to be disre-
garded  – increased public expectations of
scientific discoveries and their application
in medicine, together with calls for, and
the need of consequent changes in medical
practice.
In parallel, the huge expansion in the avail-
ability and accessibility of information
Publications by Alan J. Rowe in WMJ
In Memoriam
80
about medicine, medicines and medical
research through the growth of communi-
cation via the mass media and IT develop-
ment, has played a major role in changes
taking place in the organisation and the
conduct of medical practice. At the same
time it has also, through the instant avail-
ability on information via the media (both
TV and the web) supplied compelling in-
formation about the increasing instances
of natural disasters and their consequences.
The instant availability of information has
also highlighted to a wider public the prob-
lems of disparity in the provision of health
care in differing parts of the world.The im-
pact of information about the incidence of
infectious diseases and the reality of the role
of poverty in disease, relayed through media
readily accessible in the home, conveys an
even more realistic and compelling image of
catastrophes, diseases and poverty, than that
previously available through the spoken or
written word.
The impact of these developments has had
substantial political, social and economic
effects in both developed and developing
countries, leading to consequent changes
in medical practice and its organisation, as
well as challenges to the nature of the role
of physicians in health care.
These developments have had far reach-
ing impacts on the medical profession, in-
cluding effects on basic medical education,
postgraduate education, licensing and regu-
lation,continuing professional development
and re-accreditation,not to mention the na-
ture of health care and the delivery of medi-
cal care. All of this has been accompanied
by the increasing burden of administrative,
managerial functions and economic con-
straints.
On a number of occasions in these columns
we have commented on these trends, the
challenges which they are producing and
the increasing need for the medical profes-
sion to address them. Indeed, some of the
issues have already been addressed in vari-
ous parts of the world1,2
, and a Charter3
en-
dorsed by a number of organisations in at
least 28 countries.
At its next meeting in October, the WMA
Council will be considering these issues
and with this in mind , the current issue
of WMJ is substantially devoted to a pa-
per on the issue of Medical Professional-
ism, in particular the role of the National
Medical Associations. As will be seen, this
paper highlights important problems which
should be considered urgently by individual
physicians in whatever aspect of medical
practice as well as NMA’s.
The inclusion of this substantial paper has
substantial constraints on the normal contents
of the journal which we will include in the
next issue. While this topic has already been
addressed in some parts of the world,we hope
that it will stimulate further debate and con-
tribute, to a clear-affirmation of the qualities
of medical professionalism in the 21st
century.
The challenge to medical care
(WMJ 2007, vol 53 Nr. 4)
The Tobacco Control Resource Centre, a
resource supported by the British Medi-
cal Association, the European Commis-
sion and the European Regional Office of
the World Health Organisation, published
in 2000 a report in the context of Tobacco
Control Programme under the title “To-
bacco – Medicine’s Big Challenge.” Now at
the end of 2007, while Tobacco remains a
problem and the great scourges of disease
1 Royal College of Physicians “Doctors’ in Society:
Medical Professionalism in a changing World.
Report of a Working Party of the Royal College
of Physicians, London: RCP 2005
2 Rosen R, Dewar S., On being a doctor Medical
Professionalism in a changing world Kings Fund
Publications 2004
3 Medical Professional Project. Medical Profes-
sionalism in the new millennium. A physician
charter. Ann. Intern. Med 2002 136 (3) 243-246
still challenge medicine, a huge challenge
(possibly “The Challenge” for the medical
profession) faces the health professionals
providing medical care, namely the problem
of the supply and distribution of health care
workers. The 2006 World Health Report of
WHO4
highlighted the problem, notably
the huge discrepancies in the distribution
of Physicians, Dentists, Nurses, Midwives
and other Health care workers, not only
within countries but more significantly be-
tween countries. Scientific advances have
made great contributions in our knowledge
of the nature and causes of many diseases,
accompanied by discovery and development
of many new drugs to cure or ameliorate the
effects of disease.All of these call for increas-
ing skills and increased demands on all sec-
tors of the medical workforce in developed
countries It places increased demands on
the sparse, sometimes almost non-existent
supply of health care workers in underdevel-
oped countries,where healthcare was already
minimal, obstructing any implementation of
advances in healthcare available elsewhere.
Hitherto the limited attempts to address
manpower problems in the healthcare work-
force had, unsurprisingly, concentrated on
workforce problems within national health
care systems, substantially disregarding the
huge disparities between countries, regions
and even continents. At the same time con-
cern has been expressed by both the profes-
sion and by some other authorities about the
recruiting of physicians in developed coun-
tries from developing countries who are al-
ready under-doctored, Codes of practice and
statements of policy to change this have been
issued by the World Medical Association5
and by some governments and authorities.
While a great tribute should be paid to those
organisations and governments who, in one
way or another have, over many years, en-
4 “Working together for health” The World Health
Report 2006 WHO,Geneva,ISBN 92-4-156317-6
5 WMA Statement on Ethical Guidelines for the
Recruitment of Physicians, Helsinki 2003
In Memoriam
couraged the provision of doctors, nurses and
other medical assistance to those countries in
need, and to those health professionals who
undertook to meet the needs,it was effectively
only with the arrival of HIV/AIDS and,more
recently the risk of pandemic disease, coupled
with increasing political awareness of the need
to deal with poverty, inequity and human
rights, that the need to address the problems
associated with the global health workforce
have been forced to the forefront of discussion.
In previous editorials in the World Medical
Journal, WMJ 52 (1) and (2) we have drawn
attention to emerging trends not only in the
changing or expanding role of individual
health professions, but also to problems of
training, mobility and availability of health
professionals. Further problems complicat-
ing the whole issue relate to the changes in
role and functions of health professionals,
reflecting not only the increasing aspira-
tions of the individual health professional,
but also the increasing specialisation within
individual health professions.
In the first part of 2008 at least two con-
ferences will address some of the issues
involved. The first is a World Health Or-
ganisation Global Conference to be held
in Addis Ababa Ethiopia in January 2008,
when the conference will address the topic
of Task Shifting. “Task Shifting” is de-
fined in a number of WHO documents as
“the name given to a process of delegation
whereby tasks are moved, where appropri-
ate, to less specialised health workers”.
The second conference, organised by the
World Health Professions Alliance in the
week preceding the WHO Assembly, is the
First World Conference the Role and Reg-
ulation of Health Professions which will be
held in Geneva. Both Conferences are of
huge importance in relation to the provi-
sion of health care across the globe in both
developed and developing countries.
The conferences have great relevance to
the future role and functions of the Medi-
cal Profession. Whereas previously, physi-
cians, when recognised for full registration
as a medical practitioner, held the sole li-
cence to carry out certain specific acts such
as the right to prescribe and to engage in
the practice of medicine, in an increasingly
sophisticated and technical world it is clear
that some of these reserved functions can
be carried out by other health professionals
under regulation, after appropriate techni-
cal specialist training. This has substantial
implications for changes in the protected
role that physicians have previously held
in certain areas, while possibly calling for
new roles in other areas, essentially calling
for a reassessment of the role and functions
of physicians in society. In some countries
such changes have already occurred in areas
such as the extension of limited prescribing
rights to other health professionals such as
nurses, and extending the acts carried out
by other health professionals By enhancing
the role of some health professionals, such
changes increase the provision of certain
health services to a much wider population
in both developed and developing countries.
Nevertheless, as indicated earlier, if there is
a basic shortage of health care workers in
all the health professions, the world is faced
with a major problem. This shortage does
not only apply to underdeveloped coun-
tries. In more developed countries as scien-
tific and technical knowledge and develop-
ment have increased there is also increased
demand for the implementation of these
discoveries and a consequent demand for
more health workers. Thus the USA esti-
mates that by 2020 they will require at least
200,000 physicians to meet their needs,
more than the current need of the rest of
the world!
The WMA Secretary General in his column
refers to another problem associated with
the changes in role and functions of physi-
cians, namely the need for clarity in identi-
fying the roles of health professionals and
the titles used to identify them to the public.
The differences in titles used for physicians
across the world are illustrated in an article
by Dr. Doren, to which Dr. Kloiber refers.
The Health Workforce problem which the
2006World Health Report highlighted is now
being actively pursued and it is essential that,
as indicated in the editorials referred to above,
both individual physicians and their repre-
sentative organisations actively address these
issues. The distribution of certain diseases has
been radically changed as a result of greatly in-
creased international travel, with the potential
for wider dissemination of communicable dis-
eases including newly emerging diseases, and
the risk of major pandemics need to be bal-
anced with attention to the global problems
of inequitable distribution of physicians, with
such huge conditions.On this list a number of
existingmedicinesarehoweverlackingbecause
they have not been adapted for childrens use.
It has been known for a long time that there
is a substantial gap between the availability
their distribution. With the calls for “task
shifting”as part of the solution, this may also
call for radical changes in the career cycle of
physicians, nurses, pharmacists, including
professional practice in foreign countries as a
normal part of the professional career struc-
ture. All of these considerations require ur-
gent attention at a time when the very nature
of the regulation of the health professions
in also under review, including the ques-
tion of the degree to which the professions
themselves should play a role in regulation, a
matter of major concern to those professions
whose proud role has for millennia been that
of “Carmg Professions”. It is to this end that
the medical profession defends its position
in self-regulation of standards of care and
its ethical code of conduct in the interests of
both patients and profession.All of this must
be urgently considered both in discussions at
individual, at national level and in the glob-
al conferences referred to above. There is no
time to be lost. Just as the profession has
taken a stand on Tobacco so it must face up
to this Big Challenge to the profession itself.
Both individual physicians and their leaders
must act.Time waits for no man!
In Memoriam
IV
Contents
A Brief History
Founded in 1978 by “Le Quotidien du
Medecin” (a magazine for the medical
professions) and initiated by the journalist
Liliane Laplaine-Montheard, the Medi-
cine and Health World Games (aka Me-
digames) have become the most important
international athletic event exclusively for
health professionals. The World Medical
and Health Games (WMHG) gather more
than 2000 participants from 40 countries.
They are open to all health professionals:
doctors, dentists, pharmacists, nurses, vet-
erinarians and students in those fields. The
games offer a unique ambiance where the
participants can exchange both their pro-
fessional ideas and life experiences as well
as compete in their favourite sports.
23 Sports, one Rallying Philosophy…
For the baron Pierre de Coubertin, found-
er of the modern Olympic Games, the
beauty of sports and the pure joy in the
athletic effort was paramount. It is in this
“Olympic” spirit that every year the par-
ticipants meet in the Medigames. There is
a choice of individual sports (tennis, judo,
swimming, half marathon, squash, golf,
athletics…) or team sports (volley-ball,
beach volley, soccer, basket-ball…). As in
the Olympics the Medigames tradition-
ally start with a “parade of nations” and an
“opening ceremony”. The week that fol-
lows not only offers many athletic compe-
titions but also a variety of entertainments.
It ends with a “closing ceremony” in hon-
our of the Games.
Sport… For the Neurons
Every year since their creation, and beyond
the focus on sports, the Medigames have
always been a international forum where
several medical themes are studied and
discussed, thus allowing the participants to
ally sport with a furthering of their profes-
sional expertise.This year it will presided by
Dr. André Monroche (France). Finally, the
Medigames offer an opportunity to discov-
er a new part of the world every year. After
Germany (2008), Spain (2009), Croatia
(2010) and Las Palmas-Spain (2011), it is
now the turn of Antalya to host the games.
Antalya, real pearl of the Turkish Riviera,
is a really nice seaside city. Its charming
little port, Mediterranean weather, warm
welcome from its habitants, as well as great
sport facilities, will make the participants
have a wonderful stay in this city.
The rendez-vous is set from July 7th
till July
14th
in Antalya!
Press Contact:
Jérémie ROUALET
Marketing & Communication Manager
Tel : +33 (0)1 777 065 23/Fax : +33 (0)1
777 065 14
Email : roualet@medigames.com
Site Internet : www.medigames.com
33rd
World Medical and Health Games from July 7th
to July 14th
2012 in Antalya!
Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Activities of WMA since October 2011 . . . . . . . . . . . . . . . 42
191st
WMA Council Meeting . . . . . . . . . . . . . . . . . . . . . . 43
Secretary General’s Report . . . . . . . . . . . . . . . . . . . . . . . . . 50
WMA Council Resolution on Threats to Professional
Autonomy and Self-Regulation in Turkey . . . . . . . . . . . . . 54
WMA Council Resolution on the Autonomy
of Professional Orders in West Africa . . . . . . . . . . . . . . . . 55
WMA Council Resolution on Danger in Health Care
in Syria and Bahrain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Health Care in Danger Symposium . . . . . . . . . . . . . . . . . . 56
Responsible Use of Antimicrobials – World Veterinary
Association Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
World Veterinary Association meets World Medical
Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
International Health Economics Association (iHEA) . . . . 64
The Research-Based Pharmaceutical Industry Expands
its Code of Practice Governing Interactions with the
Healthcare Community . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
The International Federation of Biomedical Laboratory
Science (IFBLS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
The World Federation for Mental Health (WFMH) . . . . . 68
Protecting the Rights and Interests of Physicians . . . . . . . 69
News from the Standing Committee of European
Doctors (CPME) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
In Memoriam Alan John Rowe . . . . . . . . . . . . . . . . . . . . . 75
Publications by Alan J. Rowe in WMJ . . . . . . . . . . . . . . . . 79