G 20438 World Medical Journal 52No. 4, December 2006 · WMA Directory of National Member Medical Associations Officers and Council Association and address/Officers WMA OFFICERS OF

WorldMedical Journal

Vol. No. 4,December 200652

OFFICIAL JOURNAL OF THE WORLD MEDICAL ASSOCIATION, INC.

G 20438

Contents

World Medical Association International

Code of Medical Ethics 87

Editorial

Regulation and Self-Regulation 88

New appointments and honours 89

Libyan Court Decision on

Bulgarian Doctor and Nurses 89

Medical Ethics and Human Rights

WMA Declaration on Hunger Strikers 90

WHO announces new standards for

registration of all human medical research 92

WMA Statement On Professional Responsibility

For Standards Of Medical Care 93

World Medical Association

WMA 57th General Assembly 93 Adjourned Meeting 97

175th WMA Council Meeting 99

WMA Statement on avian and

pandemic influenza 100

WMA Resolution on tuberculosis 103

WMA Resolution on medical assistance

in air travel 104

WMA Resolution on child safety in air travel 105

From the Secretary General

Self-governmental Structures are

endangered in many countries 106

Medical Science, Professional Practice

and Education

WMA Statement on the Physician’s role

in obesity 107

Obesity – A Growing Problem 107

Obesity – a condition of excess body fat;

not excess weight 108

The Hajj and Influenza risk 109

WHO

Dr. Margaret Chan to be WHO’s

next Director-General 110

Global polio eradication now hinges

on four countries 111

WHO Global Task Force outlines measures

to combat XDR-TB worldwide 111

Regional and NMA News 113

Website: http://www.wma.net

WMA Directory of National Member Medical Associations Officers and Council

Association and address/Officers

WMA OFFICERSOF NATIONAL MEMBER MEDICAL ASSOCIATIONS AND OFFICERS

i see page ii

President-Elect President Immediate Past-PresidentDr. J. Snaedal Dr. N. Arumagam Dr. Kgosi LetlapeIcelandic Medical Assn. Malaysian Medical Association The South African Medical AssociationHlidasmari 8 4th Floor MMA House P.O Box 74789 200 Kopavogur 124 Jalan Pahang Lynnwood Ridge 0040 Iceland 53000 Kuala Lumpur Pretoria 0153

Malaysia South Africa

Treasurer Chairman of Council Vice-Chairman of CouncilProf. Dr. Dr. h.c. J. D. Hoppe Dr. Y. Blachar Dr. K. IwasaBundesärztekammer Israel Medical Association Japan Medical AssociationHerbert-Lewin-Platz 1 2 Twin Towers 2-28-16 Honkomagome10623 Berlin 35 Jabotinsky Street Bunkyo-kuGermany P.O. Box 3566 Tokyo 113-8621

Ramat-Gan 52136 JapanIsrael

Secretary GeneralDr. O. KloiberWorld Medical AssociationBP 63 01212 Ferney-Voltaire CedexFrance

ANDORRA SCol’legi Oficial de MetgesEdifici Plaza esc. BVerge del Pilar 5,4art. Despatx 11, Andorra La VellaTel: (376) 823 525/Fax: (376) 860 793E-mail: [email protected]: www.col-legidemetges.ad

ARGENTINA SConfederación Médica ArgentinaAv. Belgrano 1235Buenos Aires 1093Tel/Fax: (54-11) 4381-1548/4384-5036E-mail:[email protected]: www.comra.health.org.ar

AUSTRALIA EAustralian Medical AssociationP.O. Box 6090Kingston, ACT 2604Tel: (61-2) 6270-5460/Fax: -5499Website: www.ama.com.auE-mail: [email protected]

AUSTRIA EÖsterreichische Ärztekammer(Austrian Medical Chamber)

Weihburggasse 10-12 - P.O. Box 2131010 WienTel: (43-1) 51406-931/Fax: -933E-mail: [email protected]

REPUBLIC OF ARMENIA EArmenian Medical AssociationP.O. Box 143, Yerevan 375 010Tel: (3741) 53 58-68Fax: (3741) 53 48 79E-mail:[email protected]: www.armeda.am

AZERBAIJAN EAzerbaijan Medical Association5 Sona Velikham Str.AZE 370001, BakuTel: (994 50) 328 1888Fax: (994 12) 315 136E-mail: [email protected] / [email protected]

BAHAMAS EMedical Association of the BahamasJavon Medical CenterP.O. Box N999NassauTel: (1-242) 328 1857/Fax: 323 2980E-mail: [email protected]

BANGLADESH EBangladesh Medical AssociationBMA Bhaban 5/2 Topkhana RoadDhaka 1000Tel: (880) 2-9568714/9562527Fax: (880) 2-9566060/9568714E-mail: [email protected]

BELGIUM FAssociation Belge des SyndicatsMédicauxChaussée de Boondael 6, bte 41050 BruxellesTel: (32-2) 644-12 88/Fax: -1527E-mail: [email protected]: www.absym-bras.be

BOLIVIA SColegio Médico de BoliviaCalle Ayacucho 630TarijaFax: (591) 4663569E-mail: [email protected]: colegiomedicodebolivia.org.bo

BRAZIL EAssociaçao Médica BrasileiraR. Sao Carlos do Pinhal 324 – Bela VistaSao Paulo SP – CEP 01333-903

Tel: (55-11) 317868-00/Fax: -31E-mail: [email protected]: www.amb.org.br

BULGARIA EBulgarian Medical Association15, Acad. Ivan Geshov Blvd.1431 SofiaTel: (359-2) 954 -11 26/Fax:-1186E-mail: [email protected]: www.blsbg.com

CANADA ECanadian Medical AssociationP.O. Box 86501867 Alta Vista DriveOttawa, Ontario K1G 3Y6Tel: (1-613) 731 8610/Fax: -1779E-mail: [email protected]: www.cma.ca

CHILE SColegio Médico de ChileEsmeralda 678 - Casilla 639SantiagoTel: (56-2) 4277800Fax: (56-2) 6330940 / 6336732E-mail: [email protected]: www.colegiomedico.cl

Title page: London School of Tropical Medicine and Hygiene, London U.K. Photo courtesy of LSTMH. Top view: front of the present bu-ilding. Bottom view: Headstone and window. This prestigious and internationally recognised centre of excellence in all aspects of inter-national health, health policy and public health, was founded in 1899 by Sir Robert Manson, as the London School of Tropical MedicineThis became the London School of Hygiene and Tropical Medicine (LSHTM) in 1924, formally opened by the Prince of Wales in 1929.

CHINA EChinese Medical Association42 Dongsi XidajieBeijing 100710Tel: (86-10) 6524 9989Fax: (86-10) 6512 3754E-mail: [email protected]: www.chinamed.com.cn

COLOMBIA SFederación Médica ColombianaCarrera 7 N° 82-66, Oficinas 218/219Santafé de Bogotá, D.E.Tel/Fax: (57-1) 256 8050/256 8010E-mail: [email protected]

DEMOCRATIC REP. OF CONGO FOrdre des Médecins du ZaireB.P. 4922Kinshasa – GombeTel: (243-12) 24589 Fax (Présidente): (242) 8846574

COSTA RICA SUnión Médica NacionalApartado 5920-1000San JoséTel: (506) 290-5490Fax: (506) 231 7373E-mail: [email protected]

CROATIA ECroatian Medical AssociationSubiceva 910000 ZagrebTel: (385-1) 46 93 300Fax: (385-1) 46 55 066E-mail: [email protected]: www.hlk.hr/default.asp

CZECH REPUBLIC ECzech Medical AssociationJ.E. PurkyneSokolská 31 - P.O. Box 88120 26 Prague 2Tel: (420-2) 242 66 201-4 Fax: (420-2) 242 66 212 / 96 18 18 69E-mail: [email protected]: www.cls.cz

CUBA SColegio Médico Cubano LibreP.O. Box 141016717 Ponce de Leon BoulevardCoral Gables, FL 33114-1016United StatesTel: (1-305) 446 9902/445 1429Fax: (1-305) 4459310

DENMARK EDanish Medical Association9 Trondhjemsgade2100 Copenhagen 0Tel: (45) 35 44 -82 29/Fax:-8505E-mail: [email protected]: www.laegeforeningen.dk

DOMINICAN REPUBLIC SAsociación Médica DominicanaCalle Paseo de los MedicosEsquina Modesto Diaz Zona UniversitariaSanto DomingoTel: (1809) 533-4602/533-4686/533-8700Fax: (1809) 535 7337E-mail: [email protected]

ECUADOR SFederación Médica EcuatorianaV.M. Rendón 923 – 2 do.Piso Of. 201P.O. Box 09-01-9848GuayaquilTel/Fax: (593) 4 562569E-mail: [email protected]

EGYPT EEgyptian Medical Association„Dar El Hekmah“42, Kasr El-Eini StreetCairoTel: (20-2) 3543406

EL SALVADOR, C.A SColegio Médico de El SalvadorFinal Pasaje N° 10Colonia MiramonteSan SalvadorTel: (503) 260-1111, 260-1112Fax: -0324E-mail: [email protected]@hotmail.com

ESTONIA EEstonian Medical Association(EsMA)Pepleri 3251010 TartuTel/Fax (372) 7420429E-mail: [email protected]: www.arstideliit.ee

ETHIOPIA EEthiopian Medical AssociationP.O. Box 2179Addis AbabaTel: (251-1) 158174Fax: (251-1) 533742E-mail: [email protected] /[email protected]

FIJI ISLANDS EFiji Medical Association2nd Fl. Narsey’s Bldg, Renwick RoadG.P.O. Box 1116SuvaTel: (679) 315388/Fax: (679) 387671E-mail: [email protected]

FINLAND EFinnish Medical AssociationP.O. Box 4900501 HelsinkiTel: (358-9) 3930 91/Fax-794E-mail: [email protected]: www.medassoc.fi

FRANCE FAssociation Médicale Française180, Blvd. Haussmann 75389 Paris Cedex 08Tel/Fax: (33) 1 45 25 22 68

GEORGIA EGeorgian Medical Association7 Asatiani Street380077 TbilisiTel: (995 32) 398686 / Fax: -398083E-mail: [email protected]

GERMANY EBundesärztekammer(German Medical Association)Herbert-Lewin-Platz 110623 BerlinTel: (49-30) 400-456 369/Fax: -387E-mail: [email protected]: www.bundesaerztekammer.de

GHANA EGhana Medical AssociationP.O. Box 1596AccraTel: (233-21) 670-510/Fax: -511E-mail: [email protected]

HAITI, W.I. FAssociation Médicale Haitienne1ère Av. du Travail #33 – Bois VernaPort-au-PrinceTel: (509) 245-2060Fax: (509) 245-6323E-mail: [email protected]: www.amhhaiti.net

HONG KONG EHong Kong Medical Association, Chi-naDuke of Windsor Building, 5th Floor15 Hennessy RoadTel: (852) 2527-8285Fax: (852) 2865-0943E-mail: [email protected]: www.hkma.org

HUNGARY EAssociation of Hungarian MedicalSocieties (MOTESZ)Nádor u. 36 – PO.Box 1451443 BudapestTel: (36-1) 312 3807 – 311 6687Fax: (36-1) 383-7918E-mail: [email protected]: www.motesz.hu

ICELAND EIcelandic Medical AssociationHlidasmari 8200 KópavogurTel: (354) 8640478Fax: (354) 5644106E-mail: [email protected]

INDIA EIndian Medical AssociationIndraprastha MargNew Delhi 110 002Tel: (91-11) 23370009/23378819/23378680Fax: (91-11) 23379178/23379470E-mail: [email protected]

INDONESIA EIndonesian Medical AssociationJalan Dr Sam Ratulangie N° 29Jakarta 10350Tel: (62-21) 3150679Fax: (62-21) 390 0473/3154 091E-mail: [email protected]

IRELAND EIrish Medical Organisation10 Fitzwilliam PlaceDublin 2Tel: (353-1) 676-7273Fax: (353-1)6612758/6682168Website: www.imo.ie

ISRAEL EIsrael Medical Association2 Twin Towers, 35 Jabotinsky St.P.O. Box 3566, Ramat-Gan 52136Tel: (972-3) 6100444 / 424Fax: (972-3) 5751616 / 5753303E-mail: [email protected]: www.ima.org.il

JAPAN EJapan Medical Association2-28-16 Honkomagome, Bunkyo-ku

Tokyo 113-8621Tel: (81-3) 3946 2121/3942 6489Fax: (81-3) 3946 6295E-mail: [email protected]

KAZAKHSTAN FAssociation of Medical Doctors of Kazakhstan117/1 Kazybek bi St.,AlmatyTel: (3272) 62 -43 01 / -92 92Fax: -3606E-mail: [email protected]

REP. OF KOREA EKorean Medical Association302-75 Ichon 1-dong, Yongsan-guSeoul 140-721Tel: (82-2) 794 2474Fax: (82-2) 793 9190E-mail: [email protected] Website: www.kma.org

KUWAIT EKuwait Medical AssociationP.O. Box 1202 Safat 13013Tel: (965) 5333278, 5317971Fax: (965) 5333276E-mail: [email protected]

LATVIA ELatvian Physicians AssociationSkolas Str. 3Riga1010 LatviaTel: (371-7) 22 06 61; 22 06 57Fax: (371-7) 22 06 57E-mail: [email protected]

LIECHTENSTEIN ELiechtensteinischer ÄrztekammerPostfach 529490 VaduzTel: (423) 231-1690Fax: (423) 231-1691E-mail: [email protected]: www.aerzte-net.li

LITHUANIA ELithuanian Medical AssociationLiubarto Str. 22004 VilniusTel/Fax: (370-5) 2731400E-mail: [email protected]: www.lgs.lt

LUXEMBOURG FAssociation des Médecins etMédecins Dentistes du Grand-Duché de Luxembourg29, rue de Vianden2680 LuxembourgTel: (352) 44 40 331Fax: (352) 45 83 49E-mail: [email protected]: www.ammd.lu

MACEDONIA EMacedonian Medical AssociationDame Gruev St. 3P.O. Box 17491000 SkopjeTel/Fax: (389-91) 232577E-mail: [email protected]

MALAYSIA EMalaysian Medical Association4th Floor, MMA House124 Jalan Pahang53000 Kuala LumpurTel: (60-3) 40413740/40411375


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Fax: (60-3) 40418187/40434444E-mail: [email protected]: http://www.mma.org.my

MALTA EMedical Association of MaltaThe Professional CentreSliema Road, Gzira GZR 06Tel: (356) 21312888Fax: (356) 21331713E-mail: [email protected]: www.mam.org.mt

MEXICO SColegio Medico de MexicoFenacomeHidalgo 1828 Pte. D-107Colonia Deportivo Obispado Monterrey, Nuevo LéonTel/Fax: (52-8) 348-41-55E-mail: [email protected]: www.cmm-fenacome.org

NAMIBIA EMedical Association of Namibia403 Maerua Park – POB 3369WindhoekTel: (264) 61 22 44 55/Fax: -48 26E-mail: [email protected]

NEPAL ENepal Medical AssociationSiddhi Sadan, Post Box 189Exhibition RoadKatmanduTel: (977 1) 4225860, 231825Fax: (977 1) 4225300E-mail: [email protected]

NETHERLANDS ERoyal Dutch Medical AssociationP.O. Box 200513502 LB UtrechtTel: (31-30) 28 23-267/Fax-318E-mail: [email protected]: www.knmg.nl

NEW ZEALAND ENew Zealand Medical AssociationP.O. Box 156Wellington 1 Tel: (64-4) 472-4741Fax: (64-4) 471 0838E-mail: [email protected]: www.nzma.org.nz

NIGERIA ENigerian Medical Association74, Adeniyi Jones Avenue IkejaP.O. Box 1108, MarinaLagosTel: (234-1) 480 1569, Fax: (234-1) 492 4179E-mail: [email protected]: www.nigeriannma.org

NORWAY ENorwegian Medical AssociationP.O.Box 1152 sentrum0107 OsloTel: (47) 23 10 -90 00/Fax: -9010E-mail: [email protected]: www.legeforeningen.no

PANAMA SAsociación Médica Nacionalde la República de PanamáApartado Postal 2020

Panamá 1Tel: (507) 263 7622 /263-7758Fax: (507) 223 1462Fax modem: (507) 223-5555E-mail: [email protected]

PERU SColegio Médico del PerúMalecón Armendáriz N° 791Miraflores, LimaTel: (51-1) 241 75 72Fax: (51-1) 242 3917E-mail: [email protected]: www.cmp.org.pe

PHILIPPINES EPhilippine Medical AssociationPMA Bldg, North AvenueQuezon CityTel: (63-2) 929-63 66/Fax: -6951E-mail: [email protected]: www.pma.com.ph

POLAND EPolish Medical AssociationAl. Ujazdowskie 24, 00-478 WarszawaTel/Fax: (48-22) 628 86 99

PORTUGAL EOrdem dos MédicosAv. Almirante Gago Coutinho, 1511749-084 LisbonTel: (351-21) 842 71 00/842 71 11Fax: (351-21) 842 71 99E-mail: [email protected]: www.ordemdosmedicos.pt

ROMANIA FRomanian Medical AssociationStr. Ionel Perlea, nr 10Sect. 1, BucarestTel: (40-1) 460 08 30Fax: (40-1) 312 13 57E-mail: [email protected]: ong.ro/ong/amr

RUSSIA ERussian Medical SocietyUdaltsova Street 85119607 Moscow Tel: (7-095)932-83-02E-mail: [email protected]: www.russmed.ru

SAMOA ESamoa Medical AssociationTupua Tamasese Meaole HospitalPrivate Bag – National Health ServicesApiaTel: (685) 778 5858E-mail: [email protected]

SINGAPORE ESingapore Medical AssociationAlumni Medical Centre, Level 22 College Road, 169850 SingaporeTel: (65) 6223 1264Fax: (65) 6224 7827E-Mail: [email protected]

SLOVAK REPUBLIC ESlovak Medical AssociationLegionarska 481322 BratislavaTel: (421-2) 554 24 015Fax: (421-2) 554 223 63E-mail: [email protected]

SLOVENIA ESlovenian Medical AssociationKomenskega 4, 61001 LjubljanaTel: (386-61) 323 469Fax: (386-61) 301 955

SOMALIA ESomali Medical Association14 Wardigley Road – POB 199MogadishuTel: (252-1) 595 599Fax: (252-1) 225 858E-mail: [email protected]

SOUTH AFRICA EThe South African Medical Associa-tionP.O. Box 74789, Lynnwood Rydge0040 PretoriaTel: (27-12) 481 2036/2063Fax: (27-12) 481 2100/2058E-mail: [email protected]: www.samedical.org

SPAIN SConsejo General de Colegios MédicosPlaza de las Cortes 11, Madrid 28014Tel: (34-91) 431 7780Fax: (34-91) 431 9620E-mail: [email protected]

SWEDEN ESwedish Medical Association(Villagatan 5)P.O. Box 5610, SE - 114 86 StockholmTel: (46-8) 790 33 00Fax: (46-8) 20 57 18E-mail: [email protected]: www.lakarforbundet.se

SWITZERLAND FFédération des Médecins SuissesElfenstrasse 18 – C.P. 1703000 Berne 15Tel: (41-31) 359 –1111/Fax: -1112E-mail: [email protected]: www.fmh.ch

TAIWAN ETaiwan Medical Association9F No 29 Sec1An-Ho RoadTaipeiTel: (886-2) 2752-7286Fax: (886-2) 2771-8392E-mail: [email protected]: www.med.assn.org.tw

THAILAND EMedical Association of Thailand2 Soi SoonvijaiNew Petchburi RoadBangkok 10320Tel: (66-2) 314 4333/318-8170Fax: (66-2) 314 6305E-mail: [email protected]: www.medassocthai.org

TUNISIA FConseil National de l’Ordredes Médecins de Tunisie16, rue de Touraine1002 Tunis Tel: (216-71) 792 736/799 041Fax: (216-71) 788 729E-mail: [email protected]

TURKEY ETurkish Medical AssociationGMK Bulvary

Sehit Danis Tunaligil Sok. N° 2 Kat 4Maltepe 06570AnkaraTel: (90-312) 231 –3179/Fax: -1952E-mail: [email protected]: www.ttb.org.tr

UGANDA EUganda Medical AssociationPlot 8, 41-43 circular rd.P.O. Box 29874 KampalaTel: (256) 41 32 1795Fax: (256) 41 34 5597E-mail: [email protected]

UNITED KINGDOM EBritish Medical AssociationBMA House, Tavistock Square London WC1H 9JPTel: (44-207) 387-4499Fax: (44- 207) 383-6710E-mail: [email protected] Website: www.bma.org.uk

UNITED STATES OF AMERICA EAmerican Medical Association515 North State StreetChicago, Illinois 60610Tel: (1-312) 464 5040Fax: (1-312) 464 5973Website: http://www.ama-assn.org

URUGUAY SSindicato Médico del UruguayBulevar Artigas 1515CP 11200 MontevideoTel: (598-2) 401 47 01Fax: (598-2) 409 16 03E-mail: [email protected]

VATICAN STATE FAssociazione Medica del VaticanoStato della Città del Vaticano 00120 Città del Vaticano Tel: (39-06) 69879300Fax: (39-06) 69883328E-mail: [email protected]

VENEZUELA SFederacion Médica VenezolanaAvenida OrinocoTorre Federacion Médica VenezolanaUrbanizacion Las MercedesCaracasTel: (58-2) 9934547Fax: (58-2) 9932890Website: www.saludfmv.orgE-mail: [email protected]

VIETNAM EVietnam Medical Association(VGAMP)68A Ba Trieu-StreetHoau Kiem DistrictHanoiTel/Fax: (84) 4 943 9323

ZIMBABWE EZimbabwe Medical AssociationP.O. Box 3671HarareTel: (263-4) 791553Fax: (263-4) 791561E-mail: [email protected]

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OFFICIAL JOURNAL OFTHE WORLD MEDICAL

ASSOCIATION

Hon. Editor in ChiefDr. Alan J. Rowe

Haughley Grange, StowmarketSuffolk IP14 3QT

UK

Co-EditorsProf. Dr. med. Elmar Doppelfeld

Deutscher Ärzte-VerlagDieselstr. 2

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Subscription fee € 22,80 per annum (incl. 7 %MwSt.). For members of the World MedicalAssociation and for Associate members thesubscription fee is settled by the membershipor associate payment. Details of AssociateMembership may be found at the WorldMedical Association website www.wma.net

Printed byDeutscher Ärzte-Verlag

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ISSN: 0049-8122

Adopted by the 3rd General Assembly of the World Medical Association, London, England, October1949 and amended by the 22nd World Medical Assembly Sydney, Australia, August 1968 and the 35thWorld Medical Assembly Venice, Italy, October 1983 and the WMA General Assembly, Pilanesberg,South Africa, October 2006.

Duties of Physician in General always exercise his/her independent professional judgment and maintain thehighest standards of professional conduct.respect a competent patient’s right to accept or refuse treatment. not allow his/her judgment to be influenced by personal profit or unfair discrim-ination.be dedicated to providing competent medical service in full professional andmoral independence, with compassion and respect for human dignity. deal honestly with patients and colleagues, and report to the appropriate authori-ties those physicians who practice unethically or incompetently or who engage infraud or deception. not receive any financial benefits or other incentives solely for referring patientsor prescribing specific products. respect the rights and preferences of patients, colleagues, and other health profes-sionals.recognize his/her important role in educating the public but should use due cau-tion in divulging discoveries or new techniques or treatment through non-profes-sional channels. certify only that which he/she has personally verified.strive to use health care resources in the best way to benefit patients and theircommunity. seek appropriate care and attention if he/she suffers from mental or physical illness.respect the local and national codes of ethics.

Duties of Physician to Patientsalways bear in mind the obligation to respect human life.act in the patient’s best interest when providing medical care.owe his/her patients complete loyalty and all the scientific resources available tohim/her. Whenever an examination or treatment is beyond the physician’s capacity,he/she should consult with or refer to another physician who has the necessary ability.respect a patient’s right to confidentiality. It is ethical to disclose confidentialinformation when the patient consents to it or when there is a real and imminentthreat of harm to the patient or to others and this threat can be only removed bya breach of confidentiality.give emergency care as a humanitarian duty unless he/she is assured that othersare willing and able to give such care.in situations when he/she is acting for a third party, ensure that the patient has fullknowledge of that situation.not enter into a sexual relationship with his/her current patient or into any otherabusive or exploitative relationship.

Duties of Physician to Colleagues behave towards colleagues as he/she would have them behave towards him/her. NOT undermine the patient-physician relationship of colleagues in order toattract patients.when medically necessary, communicate with colleagues who are involved in thecare of the same patient. This communication should respect patient confidentialityand be confined to necessary information

World Medical Association International Code of Medical Ethics

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

A PHYSICIAN SHALL

Editorial

88

providing professional services to themthrough whatever healthcare system is pro-vided. What is disturbing the profession isthe potential risk that the non-medicalmembers appointed by government to “rep-resent the consumer interest” may be influ-enced by the views of the governments whoappoint them or by their appointed advisers,thus diluting the professional voice of themain body of physicians, whose ethical andprofessional duty is to ensure that impartialinformed clinical and not political consider-ations are the basis of advice and action byphysicians in the best interests of theirpatients. This would be of particular con-cern if the balance between professionaland lay members were at or near parity anda deciding vote rested with a President,whose independence might be compro-mised through his appointment by one ofthe parties or by government , rather thanone appointed through the expressed wish-es of the majority of both elements of theRegulating Body, professional and lay, e.g.a senior member of the judiciary..

Whilst these concerns may appear to beunwarranted, they are very real and are notreflections of opposition to any reform oflong established traditions. Indeed, physi-cians are increasingly aware of the need toensure that professional competence shouldensure that the best possible quality of med-ical care provided by physicians is main-tained throughout active professional life,reaffirmed from time to time by continuingprofessional development, re-accreditationand licensing, as appropriate .Such trendsare actively being pursued in a number ofcountries. What is essential is that necessaryappropriate change is achieved throughopen transparent productive dialoguebetween the medical profession and theother interested parties, be they consumersor healthcare providing agencies, both gov-ernmental or non-governmental. In this waythe primary role of physicians, in preven-tive, diagnostic, therapeutic, advisory rolesor as advocates of the healthcare interests ofindividual patients and communities, can bemaintained by appropriate regulatory bod-ies established for this purpose.

As already indicated, it is just and properfor the views of the community (who useand finance health care services), through

Editorial

Regulation and Self-Regulation of the medical profession

At the General Assembly of the WMA, held in Pilansberg, South Africa, NMAs gaveexpression to their concerns on a number of topics of which they felt WMA should beaware. Two NMAs opened the discussions by expressing their disquiet at the increasingintrusion of governmental and healthcare authorities in the self regulation of the medicalprofession.

This trend has most recently been led notably by the English speaking countries, as, forexample, by the United Kingdom in the development of its body regulating the medicalprofession. In the UK, this is the General Medical Council, in which, for many years theChief Medical Officers England, Northern Ireland and Scotland and Wales, as governmentofficials, were ex-officio members of the Council (*). Over the past few decades however,initially a small number of Lay members were appointed to the Council. Then, in the morerecent reforms, the number of these has been increased and it has been suggested that thereshould not be a majority of the medical profession in the regulating body. Appointed Laymembers, as well as the physicians elected by the profession, all play their part in the activ-ities of the Council, including disciplinary hearings. The fundamental argument for all ofthis is the concern that the views of the consumers of healthcare professional servicesshould be represented in the regulation of the professional providers of medical services.

Self-regulation was commented on in the World Health Organisation Report 2006 onHuman Health Resources in which, while recognising that self-regulation could and hadworked well in a number of Member States and also setting out reasons why it had notworked well in others, the author(s) did not recommend that self-regulation of the profes-sion be further developed. Commenting on changing trends in the role of governments, ledby pressures for universal access and financial protection in relation to healthcare services,they write “Rather than relying on one single regulatory monopoly, national health work-force strategies should insist on cooperative governing e.g. between professional organisa-tions-self-regulatory professional organisations” indicating professional organisations deal-ing with entry to the professions, ethics, sanctions and training; institutional regulators(social health insurance/state managed employment contracts etc.) and civil organisations(relating to protecting the interests of citizens), and the behaviour of healthcare institutions,all as players influencing the behaviour of healthcare institutions and workers. (1)

It should be noted that, whilst in a number of countries regulation is not delegated byMinisters to self-regulating bodies such as the elected Medical Orders or Councils, in suchcountries the internal disciplinary determinations of the Medical Orders, Councils etc com-prising elected professional peers (commonly with legal advisers), frequently tend to playsome role in disciplinary and regulatory procedures. Indeed in some cases, decisions, otherthan withdrawing the licence to practice (although in a number of countries including sus-pension or withdrawal of the licence) rest with these bodies. In others, where the jurisdic-tion lies with special courts, the profession is present in a statutory role as advisers to thejudge considering the matter. (2)

There is little doubt that, in future, the age of absolute autonomy of the physician who islicensed to provide medical services to the public (which through social security/healthcaresystems consume a considerable part of GNP) will be modified, to permit lay representa-tion in the regulating and licensing bodies.. In the age of consumerism there is a demandthat the voice of consumers should play a role in the regulation of the standards of those

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appropriate government or other lay mem-bers of the public, to play some part inapproving the standards of care and behav-iour of those providing medical services.But once these have been approved, thejudgement of whether or not these standardshave been breached or abused should prop-erly be left to the judgement of professionalpeers and judged strictly by the agreed stan-dards of conduct, having regard to all therelevant circumstances.

In a paper on “The teaching of medicine asa service of healing”, (3) the authors write“The profession’s desire for autonomy ispredicated on its promise to police itself inthe public interest. These legal measures(laws governing registration and licensingin UK,USA and other English speakingcountries) granted medicine a broadmonopoly over healthcare – along with theunderstanding that in return, medicinewould concern itself with the health prob-lems of the society it served and wouldplace the welfare of society above its own.”.They continue “The primary obligation as aphysician is to act as a “healer”, but societyhas chosen professional status as the way toorganise the activities required from medi-cine and entrusted to the profession”.

In the changing modern world, whereadvances in knowledge and the ability tointervene in both life-threatening andchronic diseases has hugely increased,(with consequent changes in managementand treatment now requiring substantialteamwork with other professionals ratherthan individual action), some change in theregulation of the profession is inevitable.Nevertheless, the concerns expressed abovewhich are” in the best interests of patients”need to be met, not substantially jettisoned

in an enthusiastic rapid “politically correct”response to the changing circumstances ofthe 21st century.

In order to face up to these challenges themedical profession needs to inform the gen-eral public not only of nature of the prob-lems, but also of the threat to the freedom ofphysicians to provide them with indepen-dent impartial best advice, uninfluenced bythe constraints imposed by political consid-erations or the perceived need for instantreactions to particular circumstances. At the

same time the responsibilities outlinedabove, on which clinical autonomy and theright to give the best advice in the interestof the patient is granted, must be seen to beproperly governed by the regulating body, ifthe “self-disciplining” of the profession isto be retained.

Alan Rowe

* The National Chief Medical Officers(CMOs) were represented by the ChiefMedical Officer of England plus the CMO ofeither Scotland, Northern Ireland or Wales inalternation.

(1) Working together for Health. World HealthReport 2006, 121-124 Geneva

(2) Rowe A, Garcia-Barbero M, Regulation andLicensing of Physicians in the EuropeanRegion, WHO (2005) p. 21-22. WHOCopenhagen. WHOLIS numberEUR/05/5051794

(3) Creuss R and S “Teaching medicine as a pro-fession in the service of Healing“ Acad. Med.1997,72,941-52.

(See also page 106)

WHO new Director GeneralDr. Margaret Chan has been appointed as the new DirectorGeneral of the World Health Organisation. Dr. Chan wasearlier Director of Health for Hong Kong and she joinedWHO in 2003. Prior to her appointment as DirectorGeneral she was Assistant Director General forCommunicable Diseases and Representative of the DirectorGeneral for Pandemic Influenza. (for further details see page110)

Despite the huge international outcry andthe accumulated scientific evidence follow-ing the original outrageous decision con-cerning the accused during their first trial,in a second trial, in what has been describedas “a highly politicised retrial and agrotesque miscarriage of justice” the deathsentence has been imposed by a LibyanJudge.

The overwhelming scientific evidence, notonly of Montagnier – the discoverer of theHIV – who stated that the virus was activein the hospital before those accused startedto work there, and the most recent report ofthe Oxford Team on the Genetic history ofthe genetic subtype of the HIV virus fromthe infected children, has been disregardedby the court.

Libyan Court Decision on Bulgarian Doctor and Nurses

Dr. André Wynen honouredThe World Medical Association’s Secretary-General Emeritus, Dr.André Wynen has been honoured by his appointment as GrandOfficier de l’Ordre de Leopold, in recognition of his work and roleas Founder and Former President of the Chambres Syndicales desMédecins Belges, Secretary General of the World MedicalAssociation and President of the Groupe Memoire.


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In a joint statement about the decision bythe Libyan court, the International Councilof Nurses and the World MedicalAssociation said:

“We are appalled by the decision of theLibyan court to sentence the five Bulgariannurses and the Palestinian doctor to death.Today’s decision turns a blind eye to the sci-ence and evidence that points clearly to thefact that these children were infected wellbefore the medical workers arrived at thehospital.

How many children will go on dying inLibyan hospitals while the Governmentignores the root of the problem?

If there is any hope of justice for these nurs-es and this doctor, we appeal to the SupremeCourt to again quash these death sen-tences.”

As indicated above an appeal is to belodged once again and the Libyan Justice of

Minister, has been reported as saying“There could be a complete revision of thecase”. From the comments emanating fromthe rest of the world notably in the West, theoutcome of such review is likely to be morediplomatic or political rather than ensuringjustice to the accused and a verdict, basedon all the evidence.

The whole medical profession and the restof the civilised world must surely be horri-fied at this barbaric decision which clearlyflies in the face of the evidence and trans-parent impartial administration of justice.

(see also Secretary General’s comment p. 106)

WMA Policy RevisionWhilst it has not previously been our custom to reproduce all WMA Statements andDeclaration in the Journal, readers will have noted that we have recently published revi-sions to such document as the Geneva Declaration which have achieved general interna-tional acceptance as setting out fundamental principles relating to human rights and med-ical ethics. The WMA approved the result of the fundamental review of WMA Policy doc-ument which has been taking place over the past two years at its General Assembly inSouth Africa (see page 93). As a result we have decided to publish some of the otherimportant documents in their revised form in addition to listing all the documents revisedor archived, in addition to the new policy adopted at this General Asembly. (all policydocuments are, of course, accessible at www.wma.net) – Editor

Adopted by the 43rd World MedicalAssembly Malta, November 1991 and edi-torially revised at the 44th World MedicalAssembly Marbella, Spain, September1992 and revised by the WMA GeneralAssembly, Pilanesberg, South Africa,October 2006

Preamble

1. Hunger strikes occur in various contextsbut they mainly give rise to dilemmas insettings where people are detained (pris-ons, jails and immigration detention cen-tres). They are often a form of protest bypeople who lack other ways of makingtheir demands known. In refusing nutri-tion for a significant period, they usuallyhope to obtain certain goals by inflictingnegative publicity on the authorities.Short-term or feigned food refusals

rarely raise ethical problems. Genuineand prolonged fasting risks death or per-manent damage for hunger strikers andcan create a conflict of values for physi-cians. Hunger strikers usually do notwish to die but some may be prepared todo so to achieve their aims. Physiciansneed to ascertain the individual’s trueintention, especially in collective strikesor situations where peer pressure may bea factor. An ethical dilemma arises whenhunger strikers who have apparentlyissued clear instructions not to be resus-citated reach a stage of cognitive impair-ment. The principle of beneficence urgesphysicians to resuscitate them but respectfor individual autonomy restrains physi-cians from intervening when a valid andinformed refusal has been made. Anadded difficulty arises in custodial set-tings because it is not always clearwhether the hunger striker’s advance

instructions were made voluntarily andwith appropriate information about theconsequences. These guidelines and thebackground paper address such difficultsituations.

Principles

2. Duty to act ethically. All physicians arebound by medical ethics in their profes-sional contact with vulnerable people,even when not providing therapy.Whatever their role, physicians must tryto prevent coercion or maltreatment ofdetainees and must protest if it occurs.

3. Respect for autonomy. Physiciansshould respect individuals’ autonomy.This can involve difficult assessmentsas hunger strikers’ true wishes may notbe as clear as they appear. Any deci-sions lack moral force if made involun-


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tarily by use of threats, peer pressure orcoercion. Hunger strikers should not beforcibly given treatment they refuse.Forced feeding contrary to an informedand voluntary refusal is unjustifiable.Artificial feeding with the hunger strik-er’s explicit or implied consent is ethi-cally acceptable.

4. ‘Benefit’ and ‘harm’. Physicians mustexercise their skills and knowledge tobenefit those they treat. This is the con-cept of ‘beneficence’, which is comple-mented by that of ‘non-maleficence’ orprimum non nocere. These two con-cepts need to be in balance. ‘Benefit’includes respecting individuals’ wishesas well as promoting their welfare.Avoiding ‘harm’ means not only min-imising damage to health but also notforcing treatment upon competent peo-ple nor coercing them to stop fasting.Beneficence does not necessarilyinvolve prolonging life at all costs, irre-spective of other values.

5. Balancing dual loyalties. Physiciansattending hunger strikers can experi-ence a conflict between their loyalty tothe employing authority (such as prisonmanagement) and their loyalty topatients. Physicians with dual loyaltiesare bound by the same ethical principlesas other physicians, that is to say thattheir primary obligation is to the indi-vidual patient.

6. Clinical independence. Physicians mustremain objective in their assessmentsand not allow third parties to influencetheir medical judgement. They must notallow themselves to be pressured tobreach ethical principles, such as inter-vening medically for non-clinical rea-sons.

7. Confidentiality. The duty of confiden-tiality is important in building trust butit is not absolute. It can be overridden ifnon-disclosure seriously harms others.As with other patients, hunger strikers’confidentiality should be respectedunless they agree to disclosure or unlessinformation sharing is necessary to pre-vent serious harm. If individuals agree,their relatives and legal advisers shouldbe kept informed of the situation.

8. Gaining trust. Fostering trust betweenphysicians and hunger strikers is oftenthe key to achieving a resolution thatboth respects the rights of the hungerstrikers and minimises harm to them.Gaining trust can create opportunities toresolve difficult situations. Trust isdependent upon physicians providingaccurate advice and being frank withhunger strikers about the limitations ofwhat they can and cannot do, includingwhere they cannot guarantee confiden-tiality.

Guidelines For TheManagement Of HungerStrikers

9. Physicians must assess individuals’mental capacity. This involves verifyingthat an individual intending to fast doesnot have a mental impairment thatwould seriously undermine the person’sability to make health care decisions.Individuals with seriously impairedmental capacity cannot be considered tobe hunger strikers. They need to begiven treatment for their mental healthproblems rather than allowed to fast in amanner that risks their health.

10. As early as possible, physicians shouldacquire a detailed and accurate medicalhistory of the person who is intending tofast. The medical implications of anyexisting conditions should be explainedto the individual. Physicians should ver-ify that hunger strikers understand thepotential health consequences of fastingand forewarn them in plain language ofthe disadvantages. Physicians shouldalso explain how damage to health canbe minimised or delayed by, for exam-ple, increasing fluid intake. Since theperson’s decisions regarding a hungerstrike can be momentous, ensuring fullpatient understanding of the medicalconsequences of fasting is critical.Consistent with best practices forinformed consent in health care, thephysician should ensure that the patientunderstands the information conveyedby asking the patient to repeat backwhat they understand.

11. A thorough examination of the hungerstriker should be made at the start of thefast. Management of future symptoms,including those unconnected to the fast,should be discussed with hunger strik-ers. Also, the person’s values and wish-es regarding medical treatment in theevent of a prolonged fast should benoted.

12. Sometimes hunger strikers accept anintravenous saline solution transfusionor other forms of medical treatment. Arefusal to accept certain interventionsmust not prejudice any other aspect ofthe medical care, such as treatment ofinfections or of pain.

13. Physicians should talk to hunger strik-ers in privacy and out of earshot of allother people, including other detainees.Clear communication is essential and,where necessary, interpreters uncon-nected to the detaining authoritiesshould be available and they too mustrespect confidentiality.

14. Physicians need to satisfy themselvesthat food or treatment refusal is the indi-vidual’s voluntary choice. Hunger strik-ers should be protected from coercion.Physicians can often help to achievethis and should be aware that coercionmay come from the peer group, theauthorities or others, such as familymembers. Physicians or other healthcare personnel may not apply unduepressure of any sort on the hunger strik-er to suspend the strike. Treatment orcare of the hunger striker must not beconditional upon suspension of thehunger strike.

15. If a physician is unable for reasons ofconscience to abide by a hunger strik-er’s refusal of treatment or artificialfeeding, the physician should make thisclear at the outset and refer the hungerstriker to another physician who is will-ing to abide by the hunger striker’srefusal.

16. Continuing communication betweenphysician and hunger strikers is critical.Physicians should ascertain on a dailybasis whether individuals wish to con-tinue a hunger strike and what they want


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to be done when they are no longer ableto communicate meaningfully. Thesefindings must be appropriately recorded.

17. When a physician takes over the case, thehunger striker may have already lostmental capacity so that there is no oppor-tunity to discuss the individual’s wishesregarding medical intervention to pre-serve life. Consideration needs to begiven to any advance instructions madeby the hunger striker. Advance refusalsof treatment demand respect if theyreflect the voluntary wish of the individ-ual when competent. In custodial set-tings, the possibility of advance instruc-tions having been made under pressureneeds to be considered. Where physi-cians have serious doubts about the indi-vidual’s intention, any instructions mustbe treated with great caution. If wellinformed and voluntarily made, howev-er, advance instructions can only gener-ally be overridden if they become invalidbecause the situation in which the deci-sion was made has changed radicallysince the individual lost competence.

18. If no discussion with the individual ispossible and no advance instructionsexist, physicians have to act in what theyjudge to be the person’s best interests.This means considering the hunger strik-ers’ previously expressed wishes, theirpersonal and cultural values as well astheir physical health. In the absence ofany evidence of hunger strikers’ formerwishes, physicians should decidewhether or not to provide feeding, with-out interference from third parties.

19. Physicians may consider it justifiable togo against advance instructions refusingtreatment because, for example, therefusal is thought to have been madeunder duress. If, after resuscitation andhaving regained their mental faculties,hunger strikers continue to reiteratetheir intention to fast, that decisionshould be respected. It is ethical toallow a determined hunger striker to diein dignity rather than submit that personto repeated interventions against his orher will.

20. Artificial feeding can be ethicallyappropriate if competent hunger strikers

agree to it. It can also be acceptable ifincompetent individuals have left nounpressured advance instructions refus-ing it.

21. Forcible feeding is never ethicallyacceptable. Even if intended to benefit,feeding accompanied by threats, coer-

cion, force or use of physical restraintsis a form of inhuman and degradingtreatment. Equally unacceptable is theforced feeding of some detainees inorder to intimidate or coerce otherhunger strikers to stop fasting. ■

The World Health Organization was urgedresearch institutions and companies to reg-ister all medical studies that test treatmentson human beings, including the earlieststudies, whether they involve patients orhealthy volunteers. As part of theInternational Clinical Trials RegistryPlatform, a major initiative aimed at stan-dardizing the way information on medicalstudies is made available to the publicthrough a process called registration, WHOis also recommending that 20 key details bedisclosed at the time studies are begun.

The initiative seeks to respond to growingpublic demands for transparency regardingall studies applying interventions to humanparticipants, known as clinical trials. Beforemaking the recommendations, the RegistryPlatform initiative consulted with all con-cerned stakeholders, including representa-tives from the pharmaceutical, biotechnolo-gy and device industries, patient and con-sumer groups, governments, medical jour-nal editors, ethics committees, and acade-mia over a period of nearly two years.

“Registration of all clinical trials and fulldisclosure of key information at the time ofregistration are fundamental to ensuringtransparency in medical research and fulfill-ing ethical responsibilities to patients andstudy participants,“ said Dr Timothy Evans,Assistant Director-General of the WorldHealth Organization.

Although registration is voluntary, there is agroundswell of policies aimed at spurringregistration of all clinical trials. In July2005, for example, the InternationalCommittee of Medical Journal Editors, agroup representing 11 prestigious medicaljournals, instituted a policy whereby a sci-entific paper on clinical trial results cannotbe published unless the trial had beenrecorded in a publicly-accessible registry atits outset.

Some groups have raised concerns thatthese new requirements could jeopardizeacademic or commercial competitiveadvantage if they apply to preliminary trialsof new interventions. Similar concerns havebeen voiced about the requirement to dis-close certain items--such as the scientifictitle of the study, the name of the treatmentbeing tested and the outcomes expectedfrom the study--at the time of registration.

“Our aim is to make clinical research trans-parent and enhance public trust in science,but we are engaged in a fair and openprocess with all stakeholders. We look for-ward to continued dialogue about trial reg-istration and results reporting as we moveforward with the Registry Platform,“ saidDr Ida Sim, Associate Director for MedicalInformatics at the University of California,San Francisco and coordinator of theRegistry Platform initiative.

WHO announces new standards forregistration of all human medical research

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The planned Registry Platform will not be aregister itself, but rather will provide a setof standards for all registers. It has not onlystandardized what must be reported to reg-ister a trial but is creating a global trial iden-tification system that will confer a uniquereference number on every qualified trial.

Currently, there are several hundred regis-ters of clinical trials around the world butlittle coordination among them. TheRegistry Platform seeks to bring participat-ing registers together in a global network toprovide a single point of access to the infor-mation stored in them.

The WHO Registry Platform will launch aweb-based search portal where scientists,patients, doctors and anyone else who isinterested can search among participatingregisters for clinical trials taking place orcompleted throughout the world. ■

Adopted by the 48th WMA GeneralAssembly, Somerset West, Republic ofSouth Africa, October 1996, and editoriallyrevised at the 174th Council Session,Pilanesberg, South Africa, October 2006.

Recognising that:

1. The physician has an obligation to pro-vide his or her patients with competentmedical service and to report to theappropriate authorities those physicianswho practice unethically and incompe-tently or who engage in fraud or decep-tion (International Code of MedicalEthics); and

2. The physician should be free to makeclinical and ethical judgements withoutinappropriate outside interference; and

3. Ethics committees, credentials commit-tees and other forms of peer review havebeen long established, recognised andaccepted by organised medicine to scru-tinise physicians’ professional conductand, where appropriate, impose reason-able restrictions on the absolute profes-sional freedom of physicians; and

Reaffirming that:

4. Professional autonomy and the duty toengage in vigilant self-regulation areessential requirements for high qualitycare and therefore are patient benefitsthat must be preserved;

5. And, as a corollary, the medical profes-sion has a continuing responsibility tosupport, participate in, and accept appro-

WMA Statement On Professional Responsibility For Standards Of Medical Care

priate peer review activity that is con-ducted in good faith;

Position

6. A physician’s professional serviceshould be considered distinct from com-mercial goods and services, not leastbecause a physician is bound by specificethical duties, which include the dedica-tion to provide competent medical prac-tice (International Code of MedicalEthics).

7. Whatever judicial or regulatory processa country has established, any judgement

on a physician’s professional conduct orperformance must incorporate evalua-tion by the physician’s professionalpeers who, by their training and experi-ence, understand the complexity of themedical issues involved.

8. Any procedure for considering com-plaints from patients which fails to bebased upon good faith evaluation of thephysician’s actions or omissions by thephysician’s peers is unacceptable. Such aprocedure would undermine the overallquality of medical care provided to allpatients. ■

General Assembly Ceremonial Session

The General Assembly Ceremonial Sessionwas opened by the Chair of Council, Dr. Yoram Blachar, following which theofficial delegates from member states wereintroduced to the President by the SecretaryGeneral.

The President of the South African MedicalAssociation, Dr. J.P. Niekerk, in welcoming

participants, made reference to a statementmade by Archbishop Tutu that, while theChurch must not be an organ of the State itmust be the conscience of the State, like-wise, National Medical Associations mustserve as the medical conscience of the State.

Hon. Edna Molewa, Premier of the NorthWest Province was then introduced by thePresident, Dr. Letlape. Welcoming dele-gates to South Africa, she made reference to

World Medical Association

World Medical Association 57th GeneralAssembly, Pilansberg, South Africa, 13–14 October 2006

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the final report of the outgoing SecretaryGeneral of the United Nations, Kofi Anan,in which he emphasized the need for globalpartnerships and improved coordinationand cooperation between nations She saidthat the WMA was exactly the kind oforganisation needed to achieve this goal.The world has an ambitious agenda in theMillenium Development Goals. The healthprofession must lead the way, helping gov-ernments to understand that investing inhealth is critical. NMAs must be partnerswith governments in this regard, so thatbudgets, policies and programmes ade-quately prioritise the health of citizens.Alongside this priority must be a concertedeffort to address the complex and multidi-mensional problems of poverty. The rela-tionship between poverty and diseasemeans that meeting this challenge is a mat-ter of life and death. The Premier encour-aged the General Assembly to examinespecifically the problems created by med-ical migration, noting that Africa was suf-fering the effects of aggressive recruitmentof physicians from wealthy countries. Sheconcluded by stating that there is no invest-ment more important than the investment inhealth and that the world’s physicians mustwork with decision makers to ensure itshigh placement in national agendas.

Presentation of Past-President’s Medal

The Chair of Council,Dr. Blachar, payingtribute to the outgoing President of theWMA, Dr. Kgosi Letlape said:

“It is with great admiration that I look backupon Dr. Letlape’s career and variousachievements. Graduating MB., ChB at theUniversity of Natal and then pursuing hisspecialist training in Ophthalmology inEdinburgh, Scotland, Dr. Letlape becamethe first black South African ophthalmolo-gist in 1988, at a troubling time for thenation of South Africa which was at theheight of its Apartheid era.

Since being elected chairperson of theSouth African Medical Association in 2001,a position he still holds today, he has dili-gently worked towards providing publichealthcare for the 38 million South Africanswho cannot afford private funding.

In his attempts to address the HIV/AIDSepidemic and erase the stigma attached tothe disease, he spearheaded the establish-ment of the Tschepang Trust in 2002,together with the Nelson MandelaFoundation. The trust facilitates the treat-ment of HIV-positive patients at specificcentres all over South Africa. Dr. Letlapehas also been outspoken on the issue of theso-called “Brain Drain” phenomenon,advocating the improvement of workingconditions in order to retain doctors, partic-ularly those working in public health sys-tems.

As part of the WMA, he served on theworking group for one of the WMA’s mostrenowned documents, the Declaration ofHelsinki. Along with former WMASecretary General Dr. Delon Human, he hasmade tremendous headway in the foundingof the African Regional WMA offices,which will be holding their first annualmeeting next January. Dr. Letlape hasrelentlessly worked to bring together thevarious African Medical Associations, forthe purpose of getting Africa’s endemichealth problems placed on the internationalhealth agenda. The grave disparities inhealthcare can now be addressed at interna-tional level. As President of the WMA hehas been vocal in his support for includingTaiwan in the WHO, in order to forge aglobal health system that can bypass poli-tics and help countries around the worldprepare for and cope with pandemics. Hehas been equally outspoken on the topic ofmedical professionalism whereby he main-tains that physicians should always work inthe best interests of their patients, as well astraining doctors to be good leaders in theircommunities.”

Dr. Blachar formally thanking Dr. Letlapeon behalf of the World Medical Association,then presented Dr. Letlape with a PastPresident’s Medal and invited him to deliv-er his Valedictory Address.

Valedictory Adress Of Dr. K. Letlape

In his Valedictory Address, Dr. Letlape firstexpressed his gratitude to the organisation

and its members for the privilege of servingthem. Continuing, he asserted that theWMA must be the global champion of basichealth care for all, free at the point of deliv-ery and called for an increased emphasis onpubic health globally. Physicians mustengage in social and community affairs,directly influencing policy to the greatestextent possible. This includes involvementin areas such as working to prevent armedconflict, which is within the portfolio of thehealth profession because of the devastatingeffect of war on human health and onnational health systems. The professionmust not accept limited health careresources as an unfortunate fact of humanlife. Dr. Letlape stated that “We must bakea bigger cake and ensure that it is sharedequitably”. This will require resourceful-ness and leadership across medical disci-plines. There must be commitment byeveryone to be part of the solution to theglobal medical human resources problem.Modern medicine must represent progressacross all boundaries, engaging stakehold-ers at all levels, from national governmentsto patients.

Installation of President

Dr. N. Araguman of the Malaysian MedicalAssociation, who had been elected by the2005 General Assembly, then took thePresidential Oath and was installed as the58th President of the World Medical associ-ation.

Presidential Address Of TheNew President, Dr. N. Arumugam

“It is a great honour and privilege to beelected as the President of the WorldMedical Association. I would like to thankyou for electing me and giving me theopportunity to serve as the president of theassociation.

The WMA in its mission statement clearlystates the objective to provide a forum forits member associations to communicatefreely, to co-operate actively, to achieveconsensus on high standards of medicalethics and professional competence, and topromote the professional freedom of physi-

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cians worldwide. The WMA is committedto serve humanity by endeavouring toachieve the highest international standardsin Medical Education, Medical Science,Medical Art, Medical Ethics, and HealthCare for all people in the world.

The Association has been led by a series ofdistinguished presidents who have promot-ed the ideals of the WMA. Dr. KgosiLetlappe has continued in this tradition andon his visits to numerous national medicalassociation meetings, he has in his ferventspeeches appealed to the membership forstrong commitment to the profession andemphasised the importance of being unitedand proactive. Dr.Yank Coble the immedi-ate past president over the last couple ofyears, has through the “Caring Physiciansof the World” initiative organised regionalmeetings in different parts of the world tobring the different associations of the vari-ous regions together to communicate andlearn from one another. I would like tothank The South African MedicalAssociation, especially the organising com-mittee, for having successfully organisedthis year’s meetings and social events. Iwould also like to thank Dr. Otmar Kloiberthe Secretary General and the WMA secre-tariat for their committed service andsmooth running of the General Assembly.

The World Medical Association which wasestablished after the Second World War bytwenty seven national medical associations,now has a membership of over eightynational medical associations. Recognisingthe need to draw more of the many non-member nations, the council, after muchdeliberation, has revamped and streamlinedthe subscriptions payable by memberorganisations depending on economic statusof the country. It is earnestly hoped that thiswill help to draw more national associationsto join the WMA in the coming years, andboost the strength of the WMA and help toenhance the cause of medicine.

In any large organisation generally, the big-ger and more vocal members will tend todominate discussion and influence. Theestablishment of the recent regional meet-ings should provide opportunities and impe-tus for the smaller member national associ-ations to play a more active role in the

affairs of the WMA. As universal participa-tion is a necessity for any healthy organisa-tion in the coming year, I will work withcouncil to find ways to stimulate contribu-tion of some of the dormant and smallermembers of the association.

Many National Medical Associations areunable to allot sufficient time to the con-cerns and activities of the WMA as theyhave their own demanding schedules andactivities. Many individual physicians ofNational Medical Associations (NMAs) arenot aware of the workings and the signifi-cance of the WMA. Physicians nowadaysbelong to many different medical societies,especially specialist/subspecialty societiesrelated directly to their work and they donot see the immediate relevance of theWMA. It is important for the developmentand the importance of the WMA thatnational associations highlight the activitiesof the WMA in their newsletters, their web-sites and in their activities whenever possi-ble. It is also necessary to have prominentvisible links to the WMA website in thehomepages of member organisations. Itherefore strongly urge all of you to incor-porate the activities of the WMA in as manyways as possible in the activities of yournational associations, thus making theWMA more visible to the physicians of theworld.

Ethics derived from a basic view of human-ity, has been part of medical practice fromthe beginning. Ethical medical practicerefers to the appropriate treatment of apatient, maintaining a high standard ofmedical ability and skills with a caring andmoral obligation. Doctors are taught to bededicated to the service of humanity andsubscribe to the caring spirit when enteringthe profession of medicine. Medical prac-tice has attracted much criticism aboutunsympathetic personal uncaring attitudesand inappropriate treatments. That thisprobably applies to a small minority of doc-tors compared with the huge number ofdoctor-patient contacts each day, gets over-looked and the profession as a whole is dis-credited.

The WMA has emphasized the core valuesof the profession of caring, ethics, science,compassion and universal accessibility.

Over the years the association has achievedreasonable success in promoting these val-ues not only to the profession but also to thepublic and relevant authorities. During thelast two years under the Caring Physiciansof the World initiatives doctors from vari-ous countries were nominated, selected, andrecognised. A book published in conjunc-tion with the initiative highlighted theircontribution to society. This was a worthyproject as it highlighted the caring aspect ofthe profession. To continue this initiativeand to motivate more doctors to followthese exemplary footsteps and to recognizethose who have dedicated their life to thecare of the needy it is time we institute aWorld Physicians/Doctors Day. On this daythe WMA should honour a doctor from eachof the five regions of the world for theircare, compassion and contribution to soci-ety. The day will help to emphasize, pro-mote, develop and help to maintain the tra-dition of caring.

Since the end of the Second World War,more than half a century ago there havebeen remarkable discoveries and inventionsin medicine, which have led to unparalleledimprovement in the health of the world pop-ulation. We are able to control and treatdeadly infectious diseases, which werecausing fatalities and unthinkable sufferingaround the world, with newly discoveredmedications. Through innovative proce-dures and operations we are also able tocorrect congenital abnormalities andacquired disabilities. The medications andtreatment modalities have helped relievesuffering, improve the quality of life of theindividual, the family and the nation.Changes in the living standards of manycountries in the world further contributed tohealthier populations. Eradication of polioand the discovery of medicines to treatdeadly infections gave hope and optimismto the people of the world that they weregoing to enjoy uninterrupted improvinggood health.

These achievements and improvementsseem to have been short lived and the worldis again faced with new epidemics and chal-lenges. The health of the population of theworld seems more vulnerable and morehazardous than ever before in recent histo-ry. The last decade has not only seen emer-

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gence of deadly infections like AIDS(Acquired Immunodeficiency Syndrome)and SARS (Severe Acute RespiratorySyndrome) but also of a chronic serious epi-demic commonly termed as “life style dis-eases“. The number of patients afflictedwith Obesity, Hypertension, DiabetesMellitus, Dyslipidaemia and related dis-eases has been increasing at an alarmingrate the world over. This surge in life stylediseases has not been confined to thewealthier and more developed countries buthas been spreading at an alarming rate inthe developing and poorer countries. Thecurrent epidemic affecting people in theprime of life, causes untold misery to indi-viduals, families and countries. Theimmense drain on the financial resources offamilies and nations has jeopardised thedevelopment of sustainable heath care sys-tems in many countries.

As life style diseases are chronic in natureand progression insidious, patient’s atten-tion to the problem is delayed and aware-ness is only drawn to the disease at a latestage, making it complex and expensive totreat. In many countries life style diseasesaffect about 30% of the population, while insome it affects almost 60% of the popula-tion and is rising incessantly. Researchersand pharmaceutical companies are trying todevelop new therapeutic medicinal com-pounds to control and treat these conditions.

Though new medicines are necessary totreat those already afflicted, the only sus-tainable solution in overcoming this epi-demic will be by concerted lifestylechanges and instituting preventive mea-sures. The WMA should through its variousmember organisations lobby relevantauthorities and governments to emphasizethe necessity for change, as governmentsare not doing enough. They have either notrecognised the enormity of the problem orhave been reluctant to face reality.

While many organisations have highlightedthe problem there have only been limitedresults. It is now time for the WMA with theNational Medical Associations to launch arigorous effort to stress the importance, toboth the people and governments of theworld, of the need for global action.Advocacy for diet modification, encourag-

ing physical activity, anti-smoking mea-sures and regular medical examinationaimed at early preventive actions may lookdaunting but without the immediate institu-tion of these measures the world will with-in the next decade or two face such anenormous problem that it will not be able tohandle it.

The new millennium was awaited witheagerness and globalisation was the buzzword of the new century. Newer technolo-gies especially electronic communication,the internet, the media and air travel haveall contributed to shrinking the world at astaggering pace. Nations were being moreconnected and interdependent then everbefore. International business was thrivingand there was high expectation for improve-ment of international understanding, coop-eration and unity in the world. Increasingpace of international travel, liberalisation ofnational borders and increasing changingmigration patterns were moving the worldtowards to a more homogenous society.

Suddenly the world was shattered by eventsnever seen before, turmoil set in and nowterror reigns. Ideological differences, reli-gious extremism, racial confrontations, eco-nomic disagreements have resulted inextreme provocation and excessive retalia-tions. These actions have divided the worldand ushered in an era of anguish and unpre-dictability which has affected all of us inmany ways.

South Africa, which has probably experi-enced one of the most traumatic periods inmodern history under the apartheid regime,was liberated after a long and protractedstruggle. The liberation of South Africa andthe transition to a prosperous and successfuldemocracy gives hope that old differencescan be put aside and a new beginning bene-fiting all can be established. The Centenarycelebration of the start of the civil rightsstruggle, started by one of the pioneers inthe liberation struggles in South AfricaMohandas Karamchand Gandhi, was held afew weeks ago here in South Africa.Mahatma Gandhi, as he has now come to beknown, was the pioneer of Satyagraha –resistance through mass civil disobedience,strongly founded upon ahimsa – non-vio-lence, becoming one of the strongest

philosophies of freedom struggles world-wide. It has been noted that Gandhiremained committed to non-violence andtruth, even in the most extreme situations.

Numerous medical groups through theyears have served in areas of disasters andconflicts to help the needy and suffering,irrespective of their allegiance to any polit-ical or religious grouping. The events of thelast few years should make the professionreflect on its role as curing the sick and useits unique position to explore the greaterpossibility of helping to re-establish unityand harmony in the world and thus healingwounds of the people, both physical andmental.

Emergencies and crisis are a part of medicalpractice and intermittent outbreaks of epi-demics have occurred through out history.What was new in the recent emergencieswas the scale and ferocity. The world ingeneral and the Asia pacific region in par-ticular, has experienced unprecedentedcalamities over the last five years. Naturaldisasters – Tsunami and Katrina, the epi-demics of Severe Acute RespiratorySyndrome (SARS), Avian Flu, and manmade environmental disasters of flood andhaze – are continually threatening the healthof the world. Doctors and healthcare work-ers have always been in the frontline treat-ing and combating diseases with all theinherent dangers. These disasters in generaland SARS in particular have startled andalarmed the doctors and healthcare workers,as many of them were struck by the illness.

Affected and battered countries around theworld urgently announced measures toreduce the health consequences after eachepisode. As of today, forests are beingdestroyed and burned blatantly contrary tointernational agreements; the haze is chok-ing regions of the world, avian flu is smoul-dering, and raging floods are causing havocin many areas. All these have not onlycaused major damage and hardship but haveexposed huge populations to a myriad ofdiseases. Environmental degradation in thename of progress must be halted and healthmust be given the rightful priority itdeserves.

These are challenging times to practicemedicine as the widening gap between what

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medicine can do today and what the indi-vidual or the society can afford has shakenup the fundamentals of medical practice.The changes in the last few decades espe-cially in the mode of health care delivery,commercialisation of medicine and thegrowing disparity of medicine in popula-tions, due to the staggering cost of newdevelopments, all put the doctor in an unen-viable position between the patient and thesystems. Increasing public demand formedical services with counter demands bypayers to control costs, has put tremendouspressure on doctors and healthcare profes-sionals.

The patient’s quest for perfect results, oftennot fathoming the unpredictability of med-ical procedures, has put further tension onthe doctors while escalating medical indem-nity costs. The increasing control of the pro-fession by administrators, regulatoryauthorities, governments and third partypayers, has caused much annoyance anduneasiness. Private hospitals are generallymanaged by commercial interests and thedifference between commercial values andprofessional values often leads to conflicts.It is important for doctors to be objective,balanced and keep the interest of thepatients foremost at all times.

In spite of the uphill tasks and emergingchallenges, the profession must stand andwork together to achieve the best workingconditions for the profession while deliver-ing efficient and caring treatments topatients.”

The Chair of Council, then formallyadjourned the session.

General Assembly,Adjourned Plenary Session

The Session was formally opened by theChair of Council, Dr. Y. Blachar. Apologieswere received from Drs. Wynen andOdenbach.

The Credentials committee reported that 42NMAs were registered, recognised and ingood standing with full voting rights, thecollective number of votes being 93.

After the adoption of Standing Orders, theMinutes of the General Assembly inSantiago, Chile 2005 were adopted.

There were three nominations for the postof President 2007-2008 and Dr. J. Snaedel(Icelandic Medical Association) was elect-ed to this office.

Dr. Y.D. Coble, Past President, presented anupdate of the Caring Physicians of theWorld initiative. He reported that WMAregional meetings had been held in Africa,Latin America, Europe, North America andthe Asian and Pacific regions, under theauspices of the project. He introduced Dr.Malegapuru Makgoba, a South Africanphysician chosen for inclusion in the CPWbook and presented him with a copy of thebook.

The Assembly then received the Report ofCouncil. Under the reports of matters fromthe Socio-Medical Affairs and of theMedical Ethics Committees the recommen-dations arising from the huge review ofWMA statements, recommendations andpolicies occupied much of the time. Thedecisions on the recommendations for revi-sion adopted are listed below. Some recom-mendations involved rescinding and archiv-ing of previous statements. Details of therecommended changes adopted are avail-able on the WMA website (www.wma.net)or from the WMA office.

New proposals adopted are shown in boldbelow and the texts appear elsewhere in thisissue of the journal or the next issue. (Seealso page 100–106)

Socio-MedicalStatement on Obesity – new (see page 107)Statement on Medical Education –revisionStatement on Adolescent Suicide –revisionStatement on Traffic Injury – revisionResolution on Tuberculosis – newResolution on Medical Assistance in AirTravel – newStatement on the Role of Physicians inEnvironmental Issues – revision Statement on Physicians and Public Health– revision Statement on Injury Control – revisionStatement on Access to Health Care – revi-sion

Statement on Responsibilities of Physiciansin Preventing and Treating Opiate andPsychotrophic Drug Abuse – revision Statement on Alcohol and Road Safety –revision)Resolution on Child Safety in Airline Travel– newStatement on Avian and PandemicInfluenza – new

Medical EthicsStatement on HIV/AIDS and the MedicalProfession – revisionResolution on Combating HIV/AIDS – newDeclaration of Venice on Terminal Illness –revisionStatement on Human Organ Donation andTransplantation – revisionStatement on Ethical Issues ConcerningPatients with Mental Illness Statement ofSydney – revisionDeclaration of Sydney on determination ofDeath and the recovery of Organs – revisionDeclaration of Oslo on TherapeuticAbortion – revisionStatement on Assisted reproductiveTechnologies – newStatement on Animal Use in Biomedicalresearch – revisionStatement on Medical Ethics in the event ofDisasters – revisionStatement on Child Abuse and Neglect –revision

Statement on Patient Advocacy andConfidentiality – revisionInternational Code of Ethics – revision (seepage 87)Declaration of Malta on Hunger Strikers –revision (see page 90)

The Secretary General noted that there hadbeen no discernable consensus amongNMAs concerning rescinding the WMAResolution concerning Dr. RadovanKaracic. The German Medical Associationinformed the Assembly that the original rea-sons for adopting the resolution had notchanged, Dr. Karacic had not surrenderednor been captured and there had been nojustice for the crimes he is alleged to havecommitted. The recommendation to rescindand archive the Resolution Concerning Dr.Radovan Karacic was not accepted by theAssembly

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The following resolutions were rescinded/archived:

Education: the Declaration of RanchoMirage on Medical Education: Statementon Drug Treatment of Tuberculosis: theTwelve principles of Healthcare in anyNational healthcare system: Use and misuseof Psychotrophic drugs and on the prescrip-tion of substitute drugs in the outpatienttreatment of Addicts to opiate drugs.

After the Chair of Ethics had explained thata new document on telemedicine was beingprepared, the documents on Statements etc.rescinded and/or archived including theFifth World Conference in Medical Use ofcomputer in Medicine: Statement onAccountability, Responsibilities and EthicalGuidelines in the Practice of Telemedicineand the Statement on Home MedicalMonitoring, Telemedicine and MedicalEthics, were rescinded and archived.

Finance and Planning

In matters relating to Finance and Planningthe Assembly adopted recommendationsrelating to future General Assemblies

- that the theme for the Scientific Session ofthe 2007 Assembly to be held in Copen-hagen should be “Information Technologyin Health Care”

- that the 2009 General Assembly be held inIndia.

The applications for membership from theMedical Association of Namibia, theSamoa Medical Association and that of the Somali Medical Association wereapproved.

Following a detailed overview of the 2005Financial Statement and the 2007 Budget,both the 2005 Statement and the 2007Proposed Budget were approved.

The proposed amendment of the Bylaws toallow a new differentiated dues structureaccepted in principle in 2005 in Santiago,were formally adopted and the SecretaryGeneral reported that the new system wouldbe reviewed annually by Council and everyfive years by the General Assembly.

Despite some discussion as to whether theproposal to impose a six year limit on thenumber of consecutive years an individual

can serve as Chair or Vice-Chair of Councilor as Treasurer should be reduced to fouryears, the six year proposal was adopted.

The following Resolution introduced by theJapan Medical Association on NorthKorean Nuclear Testing was adopted by theAssembly

Following this, the rest of the CouncilReport was adopted.(for Resolutions adopted by the Council seepage 99)

Associate Members

The Associates’ members report presentedby Dr. Dumont, reported that in the absenceof Dr. Franzblau whose apologies werereceived, the motions he had submitted weredeferred. No new proposals from Associatemembers had been received. The Associatesnoted that their proposal for a statement on“Child Safety in Airline Travel” had beenforwarded to the Assembly for adoption.Drs. Fuchs and Mot were elected as the tworepresentatives. The report of the AssociateMembers’ meeting was received.

Open Session

During this session when delegates wereinvited to present matters of importance tothe medical profession which needed to bebrought to the attention of the WMA,NMAs made the following points:

The Hong Kong Medical Associationexpressed concern about the trend for gov-ernments to encroach on self-regulation bythe medical profession. This they consid-ered presents a serious threat to profession-al autonomy. These concerns were sharedby the Australian Medical Association whooffered to cooperate with WMA activity todefend medical professionalism.

The Bolivian Medical Association reportedconcerns about the by-passing of standardaccrediting processes as a consequence ofan agreement between the Bolivian andCuban governments. This was supported bythe Spanish and Uraguayan MedicalAssociations. The American MedicalAssociation announced its intention to sub-mit an emergency resolution on this topic tothe Council meeting immediately followingthe General Assembly (see page 99).

The New Zealand Medical Association, inrelation to the harvesting of organs andtransplantation in China, expressed concernthat the core issue, namely that informedconsent cannot be obtained from con-demned prisoners, was being lost in theWMA’s diplomatic approach to the prob-lem. It felt that the Chinese MedicalAssociation should publicise the positiontaken that condemned prisoners are in noposition to give informed consent, and pro-vide evidence of its efforts to educate itsmembers of this fact. The Chair of Councilinformed the Assembly that a WMA delega-tion will meet with members of the ChineseMedical Association to discuss many sub-jects, with the hope that the outcome of themeeting would be a documented mutualagreement or memorandum, which wouldbe presented to Council at its next session.

The Phillipine Medical Associationinformed the General Assembly that thepresent health care budget in their countrywas less than 1% of GDP. This underinvest-

World Medical AssociationResolution On North

Korean Nuclear Testing

Adopted by the WMA GeneralAssembly, Pilanesberg, South Africa,October 2006

“RECALLING the WMA Declarationon Nuclear Weapons adopted at theWMA General Assembly in Ottawa,Canada, in October 1998; the WMA:

Denounces North Korean nuclear testingconducted at a time of heightened globalvigilance on nuclear testing and arsenals;

1) Calls for the immediate abandonmentof the testing of nuclear weapons; and

2) Requests all member NationalMedical Associations to urge theirgovernments to understand theadverse health and environmentalconsequences of the testing and useof nuclear weapons.”

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ment was compromising patient care. It hasresulted in massive unemployment of healthprofessionals, causing some physicians toleave the country to work as nurses else-where.

The Canadian Medical Associationexpressed support for the establishment ofan annual “World Doctors’ Day” an idearaised in the WMA President’s speech.

The Secretary General referred to the factthat the American Medical Association(AMA) had provided important assistanceto the WMA for many years through offer-ing the services of various staff members toserve as the WMA Legal Advisor. Whilethey would continue to provide corporatelegal services to the WMA, especially onissues arising from WMA’s corporate statusas a US corporation, they would no longerprovide a legal adviser during WMA meet-ings. The Secretary General in thanking theAMA for its invaluable contributionreferred in particular to the work of themost recent WMA Legal Adviser, SharonOstrowski, who was no longer with theAMA. The General Assembly agreed a noteof appreciation to Ms Ostrowski which theSecretary General will convey to her. Healso thanked Ms Leah Wapner of the IsraelMedical Association for serving as theLegal adviser during this Assembly.

He also announced that that Dr. Alan Rowewho had served as Editor of the WorldMedical Journal had retired and that asearch for his replacement was almost com-pleted.

It was noted that Dr. Rowe could not attendthe meeting for health reasons. The GeneralAssembly thanked Dr. Rowe for hisengagement and dedication to the WMAand his excellent work in developing theWMJ. The General Assembly agreed a noteof warm appreciation to Dr. Rowe whichthe Secretary General agreed to convey tohim.

Informing the General Assembly that Dr.John Williams, WMA Ethics Adviser wouldend his tenure as a staff member at Ferney-Voltaire in December, although he wouldcontinue to advise the WMA on ethicalissues. Paying tribute to Dr. William’s, hesaid that Dr. William’s excellent work had

helped WMA to clarify its approach to pol-icy development, strengthening WMA poli-cy. The Secretary General expressed hishope that continuing to work togetherwould assist in eventually growing theEthics Unit into a WMA Ethics Institute.The Assembly joined in a Standing ovationto Dr. Williams for his tireless efforts andoutstanding contributions.

Closing the 2006 WMA General Assemblythe Chair of Council thanked the SouthAfrican Medical Association for its gener-ous hospitality. He also recognised the workof the Secretary General, the staff and theinterpreters.

During the meeting of the 175th Council inPilansberg,October 2006, the following twoCouncil resolutions were adopted:

Council Resolution In Sup-port Of The Bolivian MedicalAssociation

“There are credible reports that arrange-ments between the Cuban government andthe Bolivian government to supply Cubanphysicians to Bolivia are bypassing systemsestablished to protect patients that havebeen set up to verify physicians’ credentialsand competence.

The World Medical Association is signifi-cantly concerned that patients are put at riskby unregulated medical practices, includingthe provision of drugs and medical suppliesthat are improperly labelled and of uncer-tain origin.

There already exists a duly constituted andlegally authorized Bolivian MedicalAssociation, which is charged with the reg-istration of physicians and which is requiredto be consulted by the Bolivian Ministry ofHealth.

Therefore, the WMA:

1) Condemns any collusion of two coun-tries in policies and practices that disruptthe accepted standards of medical cre-dentialing and medical care;

175th WMA Council Meeting Pilansberg,South Africa 2006

2) Calls upon the Bolivian government towork with the Bolivian MedicalAssociation on all matters related tophysician certification and the practiceof medicine and to respect the role andrights of the Bolivian MedicalAssociation;

3) Urges, as a matter of utmost concern,that the Bolivian government respect theWMA International Code of MedicalEthics that guides the medical practice ofphysicians all over the world.“

Council Resolution On Legis-lation Banning Smoking InPublic Places

“Recognizing the abundant evidence link-ing adverse health outcomes and exposureto second-hand smoke; and

Nothing that despite this new evidence,many countries still allow smoking in pub-lic places

The World Medical Association:

Congratulates the French government andFrench physicians on the introduction oflegislation that would ban smoking in pub-lic areas; and

Urges other National Medical Associationsto advocate for similar legislative changesin their own countries if such legislationdoes not exist.“

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is common. It is anticipated that H5N1will continue to spread along the migra-tory pathways of wild birds. Mosthuman infections have occurred in ruralareas where freely-roaming small poul-try flocks are kept.

4. HPAI is controlled by rapidly destroy-ing all infected and/or exposed birds, byproper disposal of the carcasses, and byquarantining and rigorous disinfectionof farms. In order to contain an out-break, aggressive measures are neededimmediately after the outbreak is detect-ed.

5. Human pandemic influenza occurs threeto four times a century and can takeplace in any season, not just winter.Pandemic influenza results from theemergence of a new human influenzastrain to which no human immunityexists. This new human pandemic straincan arise from either avian influenzastrains or from influenza viruses infect-ing swine and potentially other mam-malian species. It is usually associatedwith a higher severity of illness and,consequently, a higher risk of death. Allage groups may be at risk, and expertspredict an infection rate of 25-50% ofthe population, depending on the sever-ity of the strain. Since the virus straincannot be accurately predicted, a vac-cine against pandemic flu may not beavailable until several months after thepandemic begins. A major factor in pro-tecting populations will be the timefrom emergence of a new strain to thedevelopment and manufacture of vac-cine. It is hypothesized that use of anti-virals may control the progression of apandemic following its emergence, soadequate supplies of anti-virals areimportant. At all phases of a pandemicoutbreak, but especially during the peri-od when vaccine is unavailable, infec-tion control is critical.

6. Health officials are concerned that avianinfluenza, if given the right opportuni-ties, could mutate to form a new strainof human influenza virus against whichhumans have no immunity or existingvaccine – a pandemic strain. It is appar-ent that H5N1 has the capacity to direct-ly jump the species barrier and causeserious disease in humans but thus far,H5N1 has demonstrated very limited, ifany, human transmission potential. Anew pandemic virus could develop if ahuman became simultaneously infectedwith H5N1 and a human influenzavirus, resulting in gene swapping. Also,the H5N1 virus could mutate on itsown. With this new virus strain, directhuman-to-human transmission couldresult, and if the virus remains highlypathogenic, a pandemic with high mor-tality rates could occur. This is believedto have happened in the worst pandem-ic of the 20th century, the “Spanish Flu”of 1918, that killed 50 million peopleworldwide.

7. Even though the H5N1 virus is not easi-ly transmitted to humans, any H5N1human infection provides an opportuni-ty for co-existence with a humaninfluenza virus. Consequently, the WorldHealth Organization (WHO) and otherhealth organizations recommend thatany person coming in contact withinfected poultry receive the currentannual flu vaccine. Since it is not yetknown whether residual immunity to theN1 component of the annual vaccineprovides any immunity to H5N1, there isno way to accurately predict the severityof the next pandemic. It is important torecognize that while there is current con-cern surrounding H5N1, a pandemicinfluenza strain may not arise fromH5N1 but may come from another HPAIstrain. Regardless of this, the odds aregreat that another pandemic will occur.

Principles of PandemicInfluenza Planning

The Role of Governments

8. The WHO has responsibility for co-ordinating the international response to

Adopted by the WMA General Assembly,Pilanesberg, South Africa, October 2006

1. This statement provides guidance toNational Medical Associations andphysicians on how they should beinvolved in their respective country’spandemic planning process. It alsoencourages governments to involvetheir National Medical Associationswhen planning for pandemic influenza.Finally, it provides broadly stated rec-ommendations about activities thatphysicians should consider in preparingthemselves for pandemic influenza.

Avian Influenza versusPandemic Influenza

2. Avian influenza (bird flu) is a conta-gious common viral infection of birdsand, less commonly, pigs. Two formshave been identified: less pathogenicavian influenza (LPAI) and highly path-ogenic avian influenza (HPAI), which isextremely contagious and has nearly a100% mortality rate in birds. Avianinfluenza viruses differ from humaninfluenza viruses. While avian influenzaviruses do not normally infect humans,since 1997 several cases of humaninfection have been documented.

3. The current H5N1 HPAI virus is a sub-type of influenza type A viruses and wasfirst isolated from South African terns in1961. The current outbreak started inlate 2003 and early 2004 in eight coun-tries in Asia. While originally reportedas controlled, since June 2004 new out-breaks of H5N1 have reappeared.Migratory and smuggled birds are like-ly to be responsible for the spread ofH5N1. The infected birds shed largequantities of virus in their feaces, andexposure to infected droppings or toenvironments contaminated by the virus

WMA New Statements

WMA Statement on avian and pandemic influenza

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an influenza pandemic. It has definedphases in the evolution of a pandemicthat allow an escalating approach to pre-paredness planning and response lead-ing up to a declaration of onset of a pan-demic.

9. The development of a national pandem-ic plan, will, by necessity, be led by thenational government, but physiciansshould be involved at all stages. Whileeach nation will have unique situationsto address, the following pandemic pre-paredness principles apply:

a) Define key preparedness issues,needs, and goals.i. The prioritization of one or two

goals for the nation’s pandemicplanning is essential. Dependingon these goals, the prioritizationand use of vaccines and antiviralswill vary. For example, a goal ofreducing morbidity and mortalitydue to influenza will have very dif-ferent planning criteria from a goalof preserving societal infrastruc-ture.

ii.Defining the nation’s needs in theevent of a pandemic will requiremaking some basic assumptionsabout the severity of the pandemicin the at nation. Based upon thatassumption, it will then be possibleto make some predictions aboutthe issues and needs facing thecountry. It will be useful to consultwith other nations that have pre-pared pandemic plans to see whatchallenges they faced in identify-ing their needs and issues.

b) In countries where there is a substan-tial presence of healthcare profes-sionals in the private sector, involvethose in the private sector who willbe managing the pandemic on theground, particularly physicians, inthe decision-making process.i. The administration of millions of

doses of antivirals and vaccine tothe management of surge capacityand hospital beds will all requirespecific participation of those mostknowledgeable and involved in theprocess.

c) Prepare risk communication and cri-sis communication strategies andmessages in anticipation of publicand media fear and anxiety.

d) Provide guidance and timely infor-mation to regional health depart-ments, health care organizations, andphysicians. Utilize physicians asspokespeople to explain the medicaland ethical issues to the public.Ensure that communications mecha-nisms and infrastructure continue tofunction efficiently.i. As planning proceeds, timely and

clear information not only of theplan, but also of the rationalebehind decisions, needs to be madeavailable to public health authori-ties and the medical establishmentas well as to the public. Physicianleaders in a community are well-respected and frequently can serveas excellent spokespersons to edu-cate the public about the issuessurrounding pandemic planning.Public feedback into importantdecisions that may have moral andethical implications will helpsecure public acceptance of theplan. For example, holding a pub-lic engagement process to assessthe public’s opinion aboutrationing of vaccine during a pan-demic can be useful.

ii.It is important that governmentrepresentatives and physiciansspeak with one voice in order toavoid confusion and panic during apandemic event.

e) Identify the legal issues and authori-ties for pandemic responses, e.g. lia-bility, quarantine, closing borders.i. Authorities will need to make

decisions that range in complexityfrom local decisions to close pub-lic areas, to national decisionsregarding border closings and/orquarantine/isolation of exposed/infected citizens. The legal andethical issues surrounding thesedecisions need to be in place priorto a pandemic.

f) Determine the order of importancefor use of scarce resources such asvaccines and antivirals, based on

pandemic response goals. Prioritygroups chosen for vaccine should bethose that help maintain essentialcommunity services and those athighest risk.

g) Do not put physicians in the positionof being responsible for decisionsregarding the rationing of vaccine,antivirals and other scarce resourcesduring a pandemic. Those decisionsmust be made by the government.

h) Outline coordination and implemen-tation of a response by stages of thepandemic.i. Depending on the size of a coun-

try, this response may be at anational level or at a regional level.Large countries may see the pan-demic occur in waves in whichcase affected regions will need tohave their own response ready tobe implemented.

i) Consider the surge capacity of hospi-tals, laboratories, and the publichealth infrastructure and improvethem if necessary. Prepare forabsences of key staff and the need tomaintain health services for condi-tions other than influenza.

j) Prepare for the psychosocial impacton health care workers in managingthe waves of a pandemic.

k) Consider whether the safety of thosein facilities managing the pandemicmust be ensured, such as police pro-tection of the supply chain for vac-cines and antivirals. Address whatmight be needed to control a pan-demic in the absence of a vaccine.

l) Assess whether there is sufficientfunding available to adequately pre-pare for pandemic influenza.i. Political will to fund public health

preparedness is essential. Resourcesspent on pandemic planning shouldbe framed in the context of generalpreparedness; pandemic prepared-ness and public health preparednessshare many of the same issues.

m)Identify key issues that remain to beresolved, which may include manage-ment of patients in the community,triage in hospitals, ventilation man-agement, safe handling of bodies, anddeath investigations and reports.

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The Role of the National MedicalAssociation (NMA)

10. In any disaster situation or infectiousdisease outbreak, physicians and theirprofessional organisations will be chal-lenged to continue to provide neededcare to the vulnerable and sick, as wellas to aid in the emergency responsecalled for in the specific situation. Thefollowing issues should be consideredin this regard:a) NMAs should have their own organi-

zation-specific business contingencyplan in place to ensure continuedsupport of their members.i. Many existing plans anticipate dis-

ruptions such as fires, earthquakes,and floods that are geographicallyrestricted and have fairly welldefined timeframes. However,pandemic influenza planningrequires assumptions that theinfluenza will be widely dispersedgeographically and will potentiallylast many months.

b) NMAs should clearly identify theirresponsibilities during a pandemic.i. The NMA should actively seek

participation in the nation’s pan-demic planning process. If this isachieved, the NMA’s responsibili-ties will also be clearly definedboth to its physicians as well as tothe government.

c) For effective global pandemicinfluenza planning, NMAs shouldcollaborate and network with NMAsfrom other countries.i. Many NMAs have already been

involved in their countries’ pan-demic planning process.Challenges and key roles for theNMA that have been identifiedshould be shared.

d) NMAs should have an essential rolein communicating vital information:i. to the public. As the authoritative

medical voice, an NMA engen-ders public trust and should usethat trust to communicate accurateand timely information regardingpandemic planning and the cur-rent state of the pandemic to thepublic;

ii. between authorities and physi-cians, and between physicians inaffected areas and their colleagueselsewhere;

iii.Between health care profession-als. NMAs should work withother health care provider organi-zations (e.g., nurses, hospitalgroups) to identify commonissues and congruent policies andmessages regarding pandemicpreparedness and response.

e) NMAs should offer training semi-nars and clinical support tools, suchas online and e-published self-helptraining materials, for physicians andregional medical associations.i. Such training/tools should consid-

er how, in a worst-case pandemicscenario, physicians will managerespiratory crises without intensiveor critical care facilities. Trainingshould also be given in triagestrategies and how infectedpatients should be counselled.

f) NMAs should consider what newprograms and services they mightoffer during a pandemic, such ascoordination or provision of mentalhealth crisis support programs foraffected members and their families,facilitation of health emergencyresponse teams, emergency locumrelief, and facilitation of equipmentsupply lines.

g) NMAs should be involved in andsupport the development and imple-mentation of government plans whilestill considering their own profes-sional code of ethics. They shouldmonitor and assess the implementa-tion of said plans to ensure that aspandemic outbreaks cycle throughtheir natural history, health interestsremain paramount.

h) NMAs should advocate for adequategovernment funding to prepare forpandemic influenza.

i) NMAs should anticipate the differentpractice environments that mayevolve during pandemic conditionsand be prepared to discuss liabilityand related issues with health author-ities and advise members on suchissues.

j) NMAs should be prepared to advo-cate on behalf of members who, dur-ing a pandemic, will have rapidlyemerging professional needs thatmust be met, and on behalf ofpatients and the public who will beaffected by the unfolding events.

The Role of the Physician

11. Physicians will be the first pointof contact and source for advice formany as a pandemic evolves. Thefollowing are broad issues thatphysicians should consider in theevent of a pandemic:

a) Be sufficiently educated about pan-demic influenza and transmissionrisks.i. Communication about the actual

risks of pandemic influenza isimportant to impart a sense ofurgency without creating unduepublic alarm. Consider activephysician participation in themedia response to a pandemic.

b) Be vigilant for the possibility ofsevere or emerging respiratory dis-eases, especially in patients whohave recently travelled international-ly.i. As with any emerging infection,

the astute physician is one of theimportant surveillance tools fordetecting and managing an out-break.

c) Plan for how to manage high-riskpatients in the office/clinic settingand communicate the plan to clinicstaff.i. Isolation and infection control

plans must be available and staffshould be well-versed in them. Beaware of what regional publichealth authorities are requesting bedone with potential patients andtheir exposed contacts.

d) Plan how to concurrently managepatients with chronic illnesses whorequire routine medical manage-ment.

e) Plan accordingly for possible inter-ruptions of essential services likesanitation, water, power, and disrup-tions to the food supply. Plan for thepossibility of staff shortages because

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of personal illness and/or the care ofnext-of-kin who are ill.i. It is vital to have contingency

plans in place to deal with possiblesocietal disruption. Recognize thatthe usual sources of these essentialservices may not be functioning sothat identifying alternative sourcesfor these essentials may be neces-sary.

f) Prepare educational materials forpatients and staff, including recom-mendations for proper infection con-trol.i. An educated patient/public that

recognizes the necessity for strin-gent measures such as quarantineand isolation will make a physi-cian’s job easier should s/he haveto utilize such procedures when apandemic occurs.

g) Remain involved in local pandemicplanning efforts and understand howthe plan will affect the physician.Participate in local simulation exer-cises.i. Since physicians will be on the

frontlines of monitoring, reporting,and eventually managing pandem-ic influenza patients, they must beclosely involved in the planningprocess. They must continuouslyprovide feedback as to what islogistically possible regardingphysicians’ efforts on the groundwhen a pandemic arrives.

h) Physicians have an ethical responsi-bility to provide services to theinjured or ill. They should haveresources in place in the event theyand/or their own families becomeinfected.i. A physician will have a strong

public health duty in the time of apandemic and his/her serviceswill be critical at a time whensurge capacity will be stressed.Physicians should make arrange-ments for the care of their familiesand dependents in the event of apandemic.

ii. Physicians should take all mea-sures necessary to protect theirown health and the health of theirstaff.

iii.Physicians can also consult theWMA Statement on MedicalEthics in the Event of Disastersfor additional guidance.

i) Develop a clinic plan to decreasepotential for contact including isola-tion areas for infected patients, use ofclose-fitting surgical masks, desig-nating separate blocks of time fornon-influenza-related patient care,and postponing non-essential med-ical visits.

j) Review staff infection control proce-dures and train staff in the use of per-sonal protective equipment. Providesignage in the office instructingpatients on respiratory hygiene prac-tices; provide tissues, receptacles fortheir disposal, and hand hygienematerials in waiting areas and exam-ination rooms.

k) Get vaccinated against annualinfluenza each year and urge all staffto be vaccinated.i. Annual influenza readiness goes a

long way for pandemic prepared-ness. Additionally, it is possiblethat components in the annual vac-cine (e.g., N1) may provide someimmunity against H5N1.

l) Work to ensure that the office/clinichas access to adequate supplies ofantibiotic and antiviral medicationsas well as commonly prescribeddrugs such as insulin or warfarin, incase the pharmaceutical supply lineis disrupted.

Recommendations12. That the WMA increase its collabora-

tion with the WHO on pandemic plan-ning and commit itself to becoming animportant participant in the decision-making process.

13. That the WMA communicate to theWHO its capabilities and the capabili-ties of its NMA members to provide acredible voice that can efficiently reachmany practising physicians.

14. That the WMA acknowledge thatalthough pandemic planning is a coun-try-specific task, it can provide generalprinciples for guidance. Additionally,the WMA can provide basic advice thatcan be given by its member NMAs topractising physicians.

15. That the WMA establish an operationalcapacity to develop and maintain emer-gency communication channelsbetween the WMA and NMAs during apandemic.

16. That the WMA provide timely evi-dence-based control measures to coun-tries with no or limited or no up-datedinformation about pandemics.

17. That NMAs be actively involved in thenational pandemic planning process.

18. That physicians participate in local pan-demic planning efforts and be involvedin communicating vital information tothe public.


Preamble

1. According to the World HealthOrganization, tuberculosis is a problemaffecting over 9 million people every

year and ranks among the leading infec-tious diseases with an annual incidencerate of 1%. The Eastern Europeanregion is particularly affected.

2. In developing countries, the incidenceof tuberculosis has risen dramaticallydue mainly to its prevalence in areaswith a high rate of HIV/AIDS. The

WMA Resolution on tuberculosis

4. Even well-trained flight personnel arelimited in their knowledge and experi-ence and cannot offer the same assis-tance as a physician or other certifiedhealth professional. Currently, continu-ing medical education courses are avail-able to physicians to train them specifi-cally for in-flight emergencies.

5. Physicians are often concerned aboutproviding assistance due to uncertaintyregarding legal liability, especially oninternational flights or flights within theUnited States. While numerous airlinesprovide some kind of liability insurancefor medical professionals and lay per-sons who will provide voluntary assis-tance during flight, this is not always thecase and even where it does exist, theterms of the insurance cannot always beadequately explained and understood ina sudden medical crisis. The financialand professional consequences of litiga-tion against physicians who offer assis-tance can be very costly.

6. Some important steps have been takento protect the life and health of airlinepassengers, yet the situation is far fromideal and needs improvement. Many ofthe major problems could be mitigatedby simple actions taken by both airlinesand national legislatures, ideally incooperation with one another and withthe International Air TransportAssociation (IATA) to arrive at coordi-nated and consensus-based internationalpolicies and programs.

7. National Medical Associations have animportant leadership role to play in pro-

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increased movement of populations hasalso exacerbated the problem.

3. The multi-resistant forms of tuberculo-sis, a by-product of original bacilliresistant to the action of the main tuber-culosis medicines, also present greatdifficulties in controlling the disease.

4. Radiological detection and sputumexamination targeted at high-risk sub-jects continues to be an essential ele-ment of tuberculosis prevention.

5. Among migrants, the homeless, prison-ers and other high risk groups, such astrategy is particularly efficient in pre-venting epidemics.

6. The reactivation of screening and fol-low-up programmes and the applicationon a large scale of rapid and strictlysupervised daily treatment should helpaddress the epidemic.

7. The vaccination policy for BCG (bacilleCalmette-Guérin) should be targeted atchildren from their first vaccination.

Resolutions

8. The World Medical Association, in con-sultation with the WHO and nationaland international health authorities andorganisations, will continue to work forthe improvement of tuberculosis treat-ment and surveillance and will also pro-mote surveys of individual cases, thereactivation of screening and surveil-lance programs, and the large-scaleapplication of daily care delivery andtreatment supervision.

9. The WMA supports calls for adequatefinancial, material and human resourcesfor tuberculosis and HIV/AIDS preven-tion, including adequately trained healthcare providers and adequate publichealth infrastructure, and will partici-pate with health professionals in provid-ing information on tuberculosis and itstreatment.

10. The WMA encourages continuing pro-fessional development for healthcareprofessionals in the field of tuberculo-

sis. Specialized courses on multi-drug-resistant TB are particularly important.

11. The WMA calls on its National MemberAssociations to support the WHO in its

DOTS strategy and in other work topromote the more effective manage-ment of tuberculosis. ■


1. Air travel is the preferred mode of longdistance transportation for people acrossthe world. The growing convenience andaffordability of air travel has led to anincrease in the number of air passengers,including older passengers and otherindividuals at increased risk for healthemergencies. In addition, long-durationflights are common, increasing the riskof in-flight medical emergencies.

2. The environment in normal passengerplanes is not conducive to the provisionof quality medical care, especially in thecase of medical emergencies. Noise andmovement of the plane, a very confinedspace, the presence of other passengerswho may be experiencing stress or fearas a result of the situation, the insuffi-ciency or complete lack of diagnosticand therapeutic materials and other fac-tors create extremely difficult condi-tions for diagnosis and treatment. Eventhe most experienced medical profes-sional is likely to be challenged by thesecircumstances.

3. Most airlines require flight personnel tobe trained in basic first aid. In addition,many provide some degree of trainingbeyond this minimum level and mayalso carry certain emergency medicinesand equipment on board. Some carrierseven have the capacity to provideremote ECG reading and medical coun-selling services.

WMA Resolution on medical assistance in air travel

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moting measures to improve the avail-ability and efficacy of in-flight medicalcare.

8. Therefore the World MedicalAssociation calls on its members toencourage national airlines providingmedium and long range passengerflights to take the following actions:a) Equip their airplanes with a suffi-

cient and standardised set of medicalemergency materials and drugs that:• are packaged in a standardised and

easy to identify manner;• are accompanied by information

and instructions in English as wellthe main languages of the coun-tries of departure and arrival; and

• include Automated ExternalDefibrillators, which are consid-ered essential equipment in non-professional settings.

b) Provide stand-by medical assistancethat can be contacted by radio or tele-phone to help either the flight atten-dants or to support a volunteeringhealth professional, if one is onboard and available to assist.

c) Develop medical emergency plans toguide personnel in responding to themedical needs of passengers.

d) Provide sufficient medical andorganisational instruction to flightpersonnel, beyond basic first aidtraining, to enable them to betterattend to passenger needs and toassist medical professionals who vol-unteer their services during emergen-cies.

e) Provide insurance for medical pro-fessionals and assisting lay personnelto protect them from damages andliabilities (material and non-materi-al) resulting from in-flight diagnosisand treatment.

9. The World Medical Association calls onits members to encourage their nationalaviation authorities to provide yearlysummarised reports of in-flight medicalincidents based on mandatory standard-ised incident reports for every medicalincident requiring the administration offirst aid or other medical assistanceand/or causing a change of the flight.

10. The World Medical Association calls onits members to encourage their legisla-tors to enact legislation to provideimmunity from legal action to physi-cians who provide emergency assis-tance in in-flight medical incidents.

11. In the absence of legal immunity, theairline must accept all legal and finan-cial consequences of providing assis-tance by a physician.

12. The World Medical Association calls onits members to:a) educate physicians about the prob-

lems of in-flight medical emergen-cies;

b) inform physicians of training oppor-tunities or provide or promote thedevelopment of training programswhere they do not exist; and encour-

age physicians to discuss potentialproblems with patients at high riskfor requiring in-flight medical atten-tion prior to their flight.

13. The World Medical Association calls onIATA to further develop precise stan-dards in the following areas and, whereappropriate, work with governments toimplement these standards as legalrequirements:a) medical equipment and drugs on

board medium and long rangeflights;

b) packaging and information materialsstandards, including multilingualdescriptions and instructions inappropriate languages;

c) medical emergency organisation pro-cedures and training programs formedical personal. ■


1. Whereas air travel is a common mode oftransportation and is used by people ofall ages every day;

2. Whereas high standards of safety foradult passengers in air travel have beenachieved;

3. Whereas strict safety procedures arebeing followed in air travel that greatlyincrease the chance of survival duringemergency situations for properlysecured adults;

4. Whereas infants and children are notalways guaranteed adequate and appro-priate safety measures during emer-gency situations in aircraft;

5. Whereas restraint and safety systems forinfants and children have been success-fully tested to reduce the risk of suffer-ing injuries during emergency situationsin aircraft;

6. Whereas child restraint systems havebeen approved for usage in standardpassenger aircrafts and successfullyintroduced by several airlines;

Therefore, the World Medical Association

7. Expresses grave concern regarding thefact that adequate safety systems forinfants and children have not been gen-erally implemented;

8. Calls on all airline companies to takeimmediate steps to introduce safe, thor-oughly tested and standardized childrestraint systems;

9. Calls on all airline companies to traintheir staff in the appropriate handlingand usage of child restraint systems;

10. Calls for the establishment of a univer-sal standard or specification for the test-ing and manufacturing of child restraintsystems; and

11. Calls on national legislators and airtransportation safety authorities to:

WMA Resolution on child safety in air travel


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a) require for infants and children, as amatter of law, safe individual childrestraint systems that are approvedfor use in standard passenger air-craft;

b) ensure that airlines provide childrestraint systems or welcome passen-gers using their own systems, if theequipment is qualified and approvedfor the specific aircraft;

c) ban the usage of inappropriate “LoopBelts” frequently used to secureinfants and children in passenger air-craft;

d) provide appropriate informationabout infant and child safety onboard of aircraft to all airline passen-gers. ■

health professions enjoying some degree offreedom for self-regulation the same dangerof dismantlement exists.

The argument for doing so is always thesame: Self-governing regulatory bodies arenot capable of doing the things necessary toregulate the profession and to protect thepublic.

And indeed, we often are desperate aboutour (in-)capabilities of self-regulation. Weknow where we failed and we sometimesfeel helpless ourselves. We tend to narrowregulation, to install systems of recertifica-tion, validation and assessment, we reviewand sometimes punish. But even so, all thisseems not to be enough.

As medicine gets more effective and effi-cient every day, the degree of complicationsand the concomitant dangers grow as well.While everybody accepts new treatmentsand new approaches to prevention as thenatural course of events, the concomitantdangers need someone be blame for them.

Certainly complexity is no waiver ofresponsibility and difficulties are no excusefor a lack of professionalism. On the otherhand blaming every risk and wrong devel-opment on individual health professionals isneither fair nor appropriate. To attributeindividual or system failures to the self-government is only fair if it has violated itsown responsibility. Self-government shouldnot be charged with deficits in health carefinancing caused by legal regulations or ashortage of resources. Parliaments and gov-ernments are responsible for that. Self-gov-ernments should not be charged for theirincapacity of dealing with criminal misbe-havior of professionals. This is a job for thelaw-enforcement agencies

The inclusion of patients in medical self-government is one option for cooperation.However government manipulations water-down self-government by installing repre-sentatives who have neither the competencenor a mandate from those to be regulated, isneither democratic nor helpful. But indeed,the achievement of more democracy orcompetence may not be intended in the firstplace, the real aim may be just another wayto silence a very active and critical part ofsociety.

profession, are watered down to lay bodies,or governments determine the members ofinstitutions.

In this way the respect for democraticprocesses and the sharing of powers getslost on a large scale. In history this is not anew political development, but the prece-dents are truly scaring. In the thirties theGerman Reichsregierung stopped anydemocratic decision making process withinthe physicians’ self-government and substi-tuted the formerly professionally electedbody by a government nominated “Reichs-Ärzteführer”. The communist governmentsin Europe dissolved, prohibited self-gov-ernment and/or seized their properties afterWorld War II. A democratic mandated, butyet extra-parliamentarian power – not to say“opposition” – was unwanted then and itseems to be becoming increasingly unpopu-lar with governments around the worldnow.

These changes do not affect us alone: otherpartners in the health care systems areaffected as well. All groups enjoying theright of self-regulation are being faced withthe same problem. For some liberal profes-sions, this may not be a first line item asthey may find their self-regulation to be amore technical process. However for those

Regardless whether your understanding of ajust state is based on Magna Carta or onMontesquieu, sharing power is an essentialelement. The horizontal separation ofpower results in the classical split into a leg-islative, executive and juridical branch. Butthere is – less visibly and often less regulat-ed – also a vertical separation of power.

We have associations and parties, groupsand families, which all have their formal orinformal power of regulation. In modernlanguage this is called “subsidiarity” and itgives way to allocation of power by socialor decisive factors. Issues are being dealtwith on the level of competence, in the fam-ily in the group, in the profession.

This vertical power sharing is now beingsilently reduced in many countries of theworld. With an amazing synchronicity, gov-ernments in the different parts of the worlddismantle the self-governments of our pro-fession. In Germany, Great Britain, NewZealand, in Romania or Hong Kong, allover the world and regardless of the politi-cal system, changes or attempts have beenmade or are underway to disrupt the demo-cratic representation of our interest throughour self-governments. Medical Councilswhich formerly were freely elected by the


Self-governmental Structures are endangered in many countries

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We tend to take democracy and freedom forgranted, but they are not! Actually, hard asthey were to obtain, we have no right togive them up. Democracy and freedom arenot ours: they belong first to the generationsto come. If we give them up, their chances

to get them back are extremely unlikely.Therefore it is our strict obligation andmoral imperative to fight for our democrat-ic rights and freedom.

Otmar Kloiber


Preamble

1. Obesity is one of the single most impor-tant health issues facing the world in thetwenty-first century, affecting all coun-tries and socio-economic groups andrepresenting a serious drain on healthcare resources.

2. Obesity has complex origins linked toeconomic and social changes in societyincluding the obesogenic environmentwithin which much of the populationlives.

3. Therefore the WMA urges physicians touse their roles as leaders to advocate forrecognition by national health authori-ties that reduction in obesity should be apriority, with culturally appropriatepolicies involving physicians and otherkey stakeholders.

The WMA recommends thatphysicians:

4. Lead the development of societalchanges that emphasize environmentswhich support healthy food choices andregular exercise or physical activity forall people;

5. Individually and through medical asso-ciations, express concern that excessive

television viewing and video gameplaying are impediments to physicalactivity among children and adolescentsin many countries;

6. Encourage individuals to make healthychoices;

7. Recognise the role of personal decisionmaking and the adverse influencesexerted by current environments;

8. Recognise that collection and evalua-tion of data can contribute to evidencebased management, and should be partof routine medical screening and evalu-ation throughout life;

9. Encourage the development of life skillsthat contribute to a healthy lifestyle inall persons and to better public knowl-edge of healthy diets, exercise and thedangers of smoking and excess alcoholconsumption;

10. Contribute to the development of betterassessment tools and databases toenable better targeted and evaluatedinterventions;

11. Ensure that obesity, its causes and man-agement remain part of continuing pro-fessional development programmes forhealth care workers, including physi-cians;

12. Use pharmacotherapy and bariatricsurgery consistent with evidence-basedguidelines and an assessment of therisks and benefits associated with suchtherapies.


WMA Statement on the Physician’s role in Obesity

Do others share my cynicism about thevalue of worthy statements emanating formgatherings of the “good and great” held insome salubrious resort?

Even the most hardened sceptic would con-ceeded that there are occasions when amajor health threat demands personal andcollective action. The pandemic of obesityevokes a guilt reaction – it seems to havetaken the medical world by surprise. Weshould be chastened to realise that in ourpreoccupation with rescuing patients fromindividual lethal diseases like cardiovascu-lar disease, cancer and diabetes, we haveneglected the root causes of such afflictions,of which obesity reigns supreme. Ironically,its domain extends to the developing worldwhere under-nutrition, at the opposite endof the spectrum of malnutrition, remainsprevalent.

Of course, there are genetic causes of obesi-ty including the mercifully uncommonAlstrom and Prader-Willi syndromes, aswell as the more common endocrine causessuch as hypothyroidism, whose victims areobviously exempt from the approbriumattached to the typical obese individualswhose plight is no less self-inflicted thanthose in thrall to tobacco or alcohol.

What then, can or should physicians andother health professionals do about obesity?The World Medical Association’s Statementis terse and clear. How then is Europe –where over 50% of adults and nearly 25%of children are already overweight and obe-sity in adults accounts for up to 6% of directhealth costs and 12% of indirect costs ofdisease(2) – responding to the challenge ?

Individual countries, with support fromNational Medical Associations (NMAs) aretaking specific and commendable initiativessuch as promoting healthy catering inschools and encouraging physical activityby prescribing exercise. Physicians are act-

Obesity – A Growing ProblemThis WMA statement has already provokedthe following comment from Sir AlexanderMacara. (ed.)


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ing on points 6 to 12 of the WMA mani-festo, but we also need to take politicalaction on points 4 and 5. Reassuringly,opinion polls show that physicians are stillthe most trusted professionals in society andour collective activity in collating and pre-senting evidence underpins our advocacy ofcommunal action and governmental respon-sibility.

The medical profession in Europe is inti-mately involved in initiatives by both theEuropean Union (EU) Commission throughDG Sanco and the European Region of theWorld Health Organisation (WHO). InDecember 2006, the EU adopted a “GreenPaper” signalling its intention to promotehealthy diets and physical activity, follow-ing advice from a network of experts fromMember states which had been set up twoyears previously. Contemporaneously inMarch 2005, it set up a “Platform” on Diet,Physical Activity and Health, involvingEuropean medical and consumer associa-tions including the Standing Committee ofDoctors in the EU (the CPME) and theEuropean Heart Network, the FoodIndustry, Non-governmental organisations(NGO’s) such as the International ObesityTask Force( IOTF) and individual experts “united by a common determination to playtheir part in the fight against obesity” (3)To quote the spokesman for the WorldFederation of Advertisers, ”the Platform haschanged the terms in which the stakeholders– the NGO’s and Industry among others -are talking”(4). Intergovernmental organi-sations are also involved, including theWHO and the European Food SafetyAuthority as observers. The Platform’schairman, Robert Madelin, who is theEuropean Commission’s Director Generalfor Health and Consumer Protection, is onrecord as saying “We are giving industrythe chance to show that it is committed tothe fight. We propose to start by avoidingregulation”. (5) A robust framework hasbeen constructed for monitoring and evalu-ating efforts and outcomes. CommissionerMarkos Kyprianou has identified projectson reformulation, portion sizes and con-sumer communication, especially to chil-dren, as key issues (6) and has declared hisintention to legislate if voluntary measuresfail. Given the reluctance of industry to

agree upon a clear system of labelling of thelevels of salt in cereals or to refrain fromadvertising junk food to children, theauthor, representing the COME in thePlatform fears that Kyprianou will be oblig-ed to act.

The EU also jointly organised with theWHO’s European Regional Office, aMinisterial Conference, held in Istanbul inNovember 2006, in which Health Ministerswere joined by colleagues from other sec-tors including Education, Transport,Agriculture and Environment and Sport. Asin the EU Platform, relevant NGOs partici-pated and public-private partners wereincluded (7). The outcome was a “EuropeanCharter on counteracting Obesity”,endorsed enthusiastically by all 53 MemberStates. Preventive actions, including thepromotion of breast feeding, a reduction inthe levels of salt, sugar and fat in processedfoods, and the design of environmentswhich will facilitate physical activity, wereagreed. Follow-up will involve a detailed“action plan” and triennial reviews ofprogress.

Is it realistic to expect meaningful evidenceof success? A leading article in the BritishMedical Journal has identified sources ofguidance which might deliver such evi-dence, but comments “the first people toseduce are Europe’s finance ministers” (8).There speaks the voice of reality!

Alexander Macara

Correspondence to:10 Cheyne RoadBishops StokeBristolB59 2DHUK

References1. World Medical Association Statement on the

Physician’s Role in Obesity, adopted by theWMA General assembly, Pilansberg, SouthAfrica, October 2006.

2. World Health Organisation Regional Office forEurope “Obesity swallos rising share of GDP inEurope up to 1% and counting” Press relaseEURO/10?06.London/Copenhagen:WHORowe,2 Nov. 2006.www.euro.who.int/mediacentre/PR/2002/20061101_5

3. Health and Consumer Voice – Special Edition“Uniting Key Players to fight Obesity in theEU”, Health and Consumer Protection DG,ISSN 1725-7400, May 2006.

4. Loerke, Stephan, Ibid.p.2

5. Madelin, Robert, Ibid. p.1.

6. Kyprianou, Marko, Ibid. p.1.

7. WorldHealth Organisation Ministerial Confe-rence on Counteracting Obesity. EuropeanCharter on Counteracting Obesity. EUR/06/5062700/8, Istanbul.www.euro. int /Document/NUT/Obesi ty_Chsrter_E_pdf

8. Groves,T. “Pandemic Obesity in Europe”,BMJ,330,1081-2,25 Nov. 2006

Most of your patients will be able to tell youtheir weight, albeit a little reluctantly!However, very few of these people will bemaking any clear distinction in their mindsbetween ‘weight’ and ‘fat’. This confusionhas contributed to the plethora of diet planswhich focus on different measures of suc-cess. Through this misconception,unhealthy patterns of eating have devel-

oped, resulting in often long-term unhappi-ness as a consequence of unstable andseemingly uncontrollable weight fluctua-tions, not to mention health risks.

Obesity is a condition of excess body fatand successful weight reduction mustinvolve a sustained decrease in fat and notjust weight. Dr Susan Jebb, Head of

Obesity

Obesity – a condition of excess body fat;not excess weight


109

Nutrition and Health at MRC HumanNutrition Research in Cambridge, has con-ducted research into body composition andobesity for many years. “The difficulty isthat it requires a reduction of 9,000 caloriesto remove ikg of fat, whereas you can loselkg of water without any calorie deficit atall. Changes in body fat occur much moreslowly than changes in weight”.

Unfortunately the popular and easy mea-surement of body mass index (BMI) onlygives a measure of relative weight-for-height and does not make any specificmeasurement of body fat. The most accu-rate methods to measure fat (such as under-water weighing or scanning techniques) aredifficult and expensive to use.

Simple, rapid and relatively cheap methodsof examining body composition (e.g. usingcalipers to measure the thickness of subcu-taneous fat, or the newer method of bioelec-trical impedance analysis (BIA)) can give abetter estimate of fatness than BMI alone.However, until recently these procedureshave needed the input of a health profes-sional, restricting the measure of body fatoutside the clinical setting.

In recent years there has been a break-through in impedance technology, led bythe electronic manufacturers Tanita. AllBIA operates on the principle that body fatacts as an insulator, whereas lean tissue,with its salt and water content, is an effec-tive conductor. Hence, the body impedancegives a measure of relative fatness.Traditional impedance measuring devicesinvolve attaching four electrodes to thepatient on the hand and foot on one side ofthe body and measuring the voltage dropacross the body when a small battery drivenelectric current is applied. In contrast, theTanita Body Fat monitor, resembles a set ofbathroom scales. It calculates an individ-ual’s percentage of body fat by passing asafe, low level electrical current through thebare feet and gives an immediate digital dis-play of the body fat percentage. This simpleprocedure allows patients to regularly mon-itor their own body composition at home.

The Tanita Body Fat Monitor can also beused by health professionals to identifypatients with excess body fat and moreimportantly to monitor the impact of treat-

ment programmes to reduce health risks.Excess fat is associated with an increasedrisk of many conditions, notably CHD anddiabetes. Sustained reductions in body fatlead to reductions in disease-related riskfactors.

By placing the emphasis on the measure-ment of body fat, health professionals can

help to encourage the public away from‘crash diets’ which promise rapid weightlosses and towards permanent changes intheir eating and exercise habits which willhelp them to achieve and maintain a healthybody composition. ■

In an editorial entitled “Hajj and the risk ofinfluenza” (Gatrad et al., BMJ 303, 1182-3)attention is drawn to the major risk of arampant spread of the influenza virus and aglobal pandemic “a potentially devastatingprospect that has been inadequately pre-pared for”.

Recalling that the Hajj attracts more than 2million pilgrims from almost every countryon earth – “the largest annual gathering inthe world” (1) (2) – to this deeply spiritualjourney which follows months or years ofpreparation. Nevertheless, it is stated “thatfrom a public health point of view such agathering makes possible rampant spread ofthe influenza virus and a global epidemic”.

The authors, while noting that the Saudiauthorities currently recommend vaccina-tion against influenza for pilgrims with highrisk chronic illnesses, quote data from a UKpilgrim survey indicating that manyremained unimmunised (3). They commentthat probably this picture is far worse

amongst pilgrims coming from the econom-ically developing world. Further, recallingthat following a previous epidemicmeningococcal immunisation is alreadymandatory for all pilgrims, they suggestthat mandatory influenza immunisation forall pilgrims should be considered. Callingon WHO, which is still developing its strat-egy to prevent an influenza pandemic, towork with the Saudi authorities, they statethat a “coherent international response willbe needed to ensure that resources andlogistics are in place so that strategies canbe implemented”.

(1) GatradAR. SheikhA. Hajj:journet of a life-time BMJ 2005.330,13-7.

(2) Ahmed Q, Arabi Y, Memish Z.,2 Health risksat the Hajj” Lancet 2006,267,1008-15

(3) Shafi S, Rashid H, Ali K, El-BashirH,Haworht E, Memish ZA, Booy R, “Influenzauptake among British Moslems attending Hajj,2005 BMJ 2005 and 2006

The Hajj and Influenza risk – The threat canno longer be ignored

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9 NOVEMBER 2006 | GENEVA – Dr.Margaret Chan of China will be the nextDirector-General of the World HealthOrganization (WHO).

In her acceptance speech, Dr. Chan said:“what matters most to me is people. Andtwo specific groups of people in particular.I want us to be judged by the impact wehave on the health of the people of Africa,and the health of women. … Improvementsin the health of the people of Africa and thehealth of women are key indicators of theperformance of WHO.“

“All regions, all countries, all people areequally important. This is a health organiza-tion for the whole world. Our work musttouch on the lives of everyone, every-where“. “But we must focus our attentionon the people in greatest need.“

Dr. Chan was nominated as Director-General on Wednesday by the WHOExecutive Board and her appointment wasconfirmed by the World Health Assembly.The Director-General is WHO’s chief tech-nical and administrative officer. She waspreviously WHO Assistant Director-General for Communicable Diseases andRepresentative of the Director-General forPandemic Influenza.

Dr. Chan obtained her Medical Degree fromthe University of Western Ontario inCanada and also has a degree in publichealth from the National University ofSingapore. She joined the Hong KongDepartment of Health in 1978, and wasappointed as Director of Health in 1994. AsDirector, she launched new services focus-ing on prevention of disease and promotionof health. She also introduced new initia-tives to improve communicable disease sur-veillance and response, enhance training forpublic health professionals, and to establishbetter local and international collaboration.She has effectively managed outbreaks ofavian influenza and the world’s first out-

break of severe acute respiratory syndr.ome(SARS).

Dr. Chan paid tribute to her predecessor.“We are all here because of the untimelydeath of Dr. LEE Jong-wook. We are alsoall here because of many millions ofuntimely deaths. I know Dr. Lee wouldhave wanted me to make this point. He willalways be remembered for his 3by5 initia-tive. That was all about preventing untime-ly deaths on the grandest scale possible.“

Dr. Chan told the Assembly that asDirector-General she would focus on sixkey issues for WHO: health development,security, capacity, information and knowl-edge, partnership, and performance.

She emphasized the importance of globalhealth security in her vision of theOrganization’s role: “Health security bringsbenefits at both the global and communitylevels. New diseases are global threats tohealth that also bring shocks to economiesand societies. Defence against these threatsenhances our collective security.“

Underlining the importance of strong sys-tems to deliver health care to the peoplewho need it, she said: “All the donateddrugs in the world won’t do any good with-out an infrastructure for their delivery. Youcannot deliver health care if the staff youtrained at home are working abroad.“

She especially praised the people whodeliver health care. “The true heroes thesedays are the health workers with their heal-ing, caring ethic. They are determined tosave lives and relieve suffering, and theywork with impressive dedication, oftenunder difficult conditions. The world needsmany, many more of them.“

Dr. Chan underlined the diverse approachesneeded to strengthen health and health carein different parts of the world. “Many coun-tries in Africa face the challenge of rebuild-ing social support systems. Others in central

Asia and Eastern Europe are undergoingtransition from planned to marketeconomies. They want WHO support. Theywant to make sure that equitable and acces-sible systems built on primary health careare not sacrificed in the process.“

She said she would strengthen WHO’s com-mitment to gather, analyse and build recom-mendations based on evidence: “I plan toset up a global health observatory to collect,collate and disseminate data on priorityhealth problems. I will integrate WHO’sresearch activities to more strategicallyaddr.ess a common health research agenda.“

There is a growing number of initiativesand players in the field of global health. Dr.Chan said she would work strategicallywith partners to deliver the best possibleresults for global health. “ Today, collabora-tion to achieve public health goals is nolonger simply an asset. It is a critical neces-sity. WHO needs to develop an approach tocollaboration that emphasizes managementof diversity and complexity.“

Turning her attention to the internal man-agement of WHO, Dr. Chan said: “I willalso accelerate human resource reform tobuild a work ethic within WHO that isbased on competence, and pride in achiev-ing results for health.“

She also addr.essed the challenges ahead ofthe Organization: “As we know, not all ofthe problems faced by WHO in its efforts toimprove world health are subject to scientif-ic scrutiny, or yield their secrets under amicroscope. You know the ones I mean:lack of resources and too little politicalcommitment. These are often the true‘killers’.“

Ending her address, Dr. Chan repeated herpledge to work hard to improve the healthof people around the world. “The work wedo together saves lives and relieves suffer-ing. I will work with you tirelessly to makethis world a healthier place.“

Dr. Anders Nordström, appointed by theExecutive Board as Acting Director-General of WHO in May, will continue inthis role until a new Director-General takesoffice.

WHO

Dr. Margaret Chan to be WHO’s next Director-General

WHO

Countries, WHO and partners to mobi-lize response teams to confront extensive-ly drug-resistant tuberculosis

GENEVA, 17 OCTOBER 2006 - Healthexperts have confirmed that the emergenceof extensively drug-resistant tuberculosis(XDR-TB) poses a serious threat to publichealth, particularly when associated withHIV. At its first meeting, the World HealthOrganization (WHO) Global Task Force onXDR-TB also outlined a series of measuresthat countries must put in place to effective-ly combat XDR-TB. In addition, the TaskForce will help mobilize teams that canrespond to requests for technical assistance

from countries, and be deployed at shortnotice to XDR-TB risk areas.

These were among a series of outcomesissued by the Global Task Force meetingheld on 9 and 10 October in Geneva. Themeeting was urgently convened to reviewthe latest available evidence on the impactof highly resistant tuberculosis, includingwhen associated with HIV.

Addressing the Task Force, ActingDirector-General of WHO, Dr AndersNordström, said the Organization was“absolutely committed“ to supporting coun-try efforts to fight TB in all forms.

Stop TB

WHO Global Task Force outlines measures to combat XDR-TB worldwide

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political will. The first three are in place.The last will make the difference,“ said DrRobert Scott, Chair of RotaryInternational’s PolioPlus Committee,speaking on behalf of the spearheadingpartners of the Global Polio EradicationInitiative. Rotary is the top private-sectorcontributor and volunteer arm of theInitiative, having contributed US$600 mil-lion and countless volunteer hours in thefield since 1985.

The ACPE advised the four polio-endemiccountries to set realistic target dates forstopping transmission, noting that improve-ments in reaching all children in these areashave been only incremental, and that these

GENEVA, 12 OCTOBER 2006 — Theworld’s success in eradicating polio nowdepends on four countries – Afghanistan,India, Nigeria, and Pakistan – according tothe Advisory Committee on PolioEradication (ACPE), the independent over-sight body of the eradication effort.

With a targeted vaccine and faster ways oftracking the virus, most countries thatrecently suffered outbreaks are again polio-free. In parts of the four endemic countries,however, there is a persistent failure to vac-cinate all children, and polio-free countriesare considering new measures to help pro-tect themselves from future outbreaks.

“With a more effective monovalent vaccineand accelerated lab processes for identify-ing poliovirus, these countries have the besttools we’ve ever had,“ noted Dr StephenCochi, Chair of the ACPE and SeniorAdviser to the Director of the GlobalImmunization Division at the US Centersfor Disease Control and Prevention..“Eradicating polio is no longer a technicalissue alone. Success is now more a questionof the political will to ensure effectiveadministration at all levels so that all chil-dren get vaccine.“ As an illustration, theoffice of Afghan President Hamid Karzaihas already taken direct oversight of poliovaccinations, following the sharp increasein cases in the Southern Region ofAfghanistan,.

Given that all children paralysed by polio inthe world this year were infected by virusoriginating in one of the four endemic coun-tries, polio-free countries are now takingnew measures to protect themselves. TheMinistry of Health of Saudi Arabia, forexample, will be enforcing stringent polioimmunization requirements for the upcom-ing pilgrimage to Mecca.

“Polio eradication hinges on vaccine sup-ply, community acceptance, funding and

Global polio eradication now hinges on fourcountriesPolio-free countries seek to protect themselves

countries will take more than 12 months toend polio.

Circulation of wild poliovirus: Since1988, global polio eradication effortsreduced the number of polio cases from350,000 annually to 1403 in 2006 (as at 10October 2006), of which 1300 are in thefour endemic countries (where poliovirustransmission has never been stopped):Nigeria, India, Afghanistan and Pakistan.This is the lowest number of endemic coun-tries in history.

Funding: In addition to strengthened polit-ical ownership in the remaining endemiccountries, key to success is the ongoingcommitment of the international donorcommunity. For 2006, a further US$50 mil-lion is urgently needed, to ensure plannedimmunization activities through to the restof the year can proceed. Additional fundingof US$390 million is needed for 2007-2008, of which US$100 million is neededfor activities in the first half of 2007.

WHO

“It is critical that urgent steps are taken toaddress XDR-TB, especially in areas ofhigh HIV prevalence,“ said Dr Nordström.“At the same time we should not lose sightof the need to make long-standing improve-ments to strengthen TB control, and buildthe necessary capacity in health services torespond to drug-resistant tuberculosis.“

Along with a call for countries to strengthenTB control – the key to preventing TB drugresistance – consensus was reached on an

XDR-TB case definition (see below). Inhigh HIV prevalence settings, there was alsoagreement that control of XDR-TB will notbe possible without close coordination of TBand HIV programmes and interventions.

The Task Force also made specific recom-mendations on drug-resistant TB surveil-lance methods and laboratory capacity mea-sures; implementing infection control mea-sures to protect patients, health care work-ers and visitors (particularly those who are

HIV infected); access to second-line anti-TB and antiretroviral drugs for countries;communication and information-sharingstrategies related to XDR-TB prevention,control, and treatment including co-man-agement with antiretroviral therapy; andresearch and development of new TB drugs,vaccines and diagnostic tests.

WHO and Task Force members will nowcoordinate with national and internationalpartners involved in TB as well as HIV pre-

Preventing XDR-TB through strength-ening TB and HIV control

To prevent the appearance and spread ofdrug-resistant TB, the Task Force under-lined as a priority the need for the immedi-ate strengthening of TB control in coun-tries, as detailed in the new Stop TBStrategy and Global Plan to Stop TB 2006-2015. This should be done in coordinationwith scaling up universal access to HIVtreatment and care. WHO and Task Forcemembers will help mobilize teams ofexperts that can be deployed in the field, atthe request of countries, to assist instrengthening TB control, and where rele-vant HIV control.

There were also specific recommendationson:

Management of XDR-TB suspects inhigh and low HIV prevalence settings:

Accelerate access to rapid tests forrifampicin resistance, to improve casedetection of all patients suspected of mul-tidrug-resistant TB (MDR-TB) so thatthey can be given treatment that is aseffective as possible. Rapid diagnosis ispotentially life saving to those who areHIV positive.

Programme management of XDR-TBand treatment design in HIV negativeand positive people:

• Adhere to WHO Guidelines for theProgrammatic Management of DrugResistant TB;

• Improve MDR-TB management condi-tions;

• Enable access to all MDR-TB second-line drugs, under proper conditions;

• Ensure all patients with HIV are ade-quately treated for TB and started onappropriate antiretroviral therapy.

Laboratory XDR-TB definition:

XDR-TB is defined as resistance to at leastrifampicin and isoniazid from among thefirst line anti-TB drugs (which is the defi-nition of MDR-TB) in addition to resis-tance to any fluoroquinolone, and to atleast one of three injectable second-lineanti-TB drugs used in TB treatment(capreomycin, kanamicin, and amikacin).

Infection control and protection ofhealth care workers with emphasis onhigh HIV prevalence settings:

Accelerate wide implementation of rec-ommended infection control measures inhealth care settings and other risk areas inorder to reduce the ongoing transmissionof drug-resistant TB, especially amongthose who are HIV positive.

Immediate XDR-TB surveillance activi-ties and needs:

Strengthen laboratory capacity to diag-nose, manage and survey drug resistance;Commence rapid surveys of drug-resistantTB so that the extent and size of the XDR-TB epidemic, and its association with HIV,can be determined.

Advocacy, communication and socialmobilization:

• Initiate information-sharing strategiesthat promote effective prevention, treat-ment, control of XDR-TB at global andnational levels and also in high HIVprevalence settings;

• Strengthen communication with affect-ed communities and individuals;

• Develop a fully-budgeted plan with theresources and funding required toaddress XDR-TB, including throughnecessary improvements in overall TBcontrol and HIV care in the immediateand medium term;

• Initiate resource mobilization.

Planning is also underway for a focusedmeeting in the near future on research anddevelopment issues relating to TB, includ-ing promoting the development of the newdiagnostics, drugs and vaccines that areurgently needed. A meeting on antiretrovi-ral therapy and XDR-TB is also planned.

WHO Global Task Force on XDR-TB, October 2006Outcomes and Recommendations

Regional and NMA News

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WMA Asian-Pacific RegionalConference: Day 1

The first day of the Asian-Pacific RegionalConference, held at Chinzan-so in Tokyo,began with an Open Session attended by Dr.Yank Coble, Chair of the Caring Physiciansof the World Initiative; Dr. YoshihitoKarasawa, President of the JMA; Dr. KgosiLetlape, President of the WMA; and Dr.Yoram Blachar, WMA Chair of Council.This session included addresses by Dr.Shigeru Omi, Regional Director of theWHO Regional Office for the WesternPacific, who spoke on “Current Situation ofPandemic Influenza”, and by Dr. JorgePuente, Vice President of Medical andRegulatory Affairs for Japan and Asia atPfizer, who spoke on “The State of theProfession in the World Today”. Dr. RossBoswell, Vice-Chair of Council ofCMAAO and Dr. Otmar Kloiber, WMASecretary General, both then reported onthe state of the medical profession in theirrespective countries.

Dr. Omi, who has a tremendous track recordin the eradication of polio and containmentof SARS, explained in his presentation thecurrent situation concerning highly-patho-genic avian influenza, the threat of a pan-demic, and measures to prevent the occur-rence of such a pandemic. He explained thatmigratory birds were not the only carriers ofthe infection, as was commonly believed,but that factors such as the export of domes-tic poultry were also extremely critical.

Giving the example of Vietnam andThailand, which were successful in contain-ing the spread of highly-pathogenic influen-za, Dr. Omi emphasized the importance ofmeasures such as the identification of earlysymptoms of infectious disease and theswift reporting of accurate information tothe WHO; precise evaluation of the situa-tion and decision-making; and a systematicresponse that includes monetary compensa-tion for the disposal of domestic poultry. Heparticularly emphasized the problem of los-ing opportunities to contain infectious dis-ease due to failure to promptly release andshare information.

Following they keynote speeches, a wel-come reception also attended by Mr. Jiro

Preceding the conference, in the early after-noon of September 10, a public lecture heldby the JMA and supported by the WMAwas held on the same themes as the confer-ence. Two lectures were presented: “CrisisManagement for Infectious Diseases”, byDr. Takeshi Kasai, WHO Regional Adviserin Communicable Disease Surveillance andResponse for the Western Pacific; and“Disaster Preparedness and Response”, byDr. Yasuhiro Yamamoto, Professor,Department of Emergency and Critical CareMedicine, Nippon Medical School. Held atthe JMA Auditorium as a satellite eventattended by nearly 700 people. President ofthe WMA, Dr. Kgosi Letlape and Chair ofCouncil Dr. Yoram Blachar addressed thelecture.

vention, care and treatment to take the rec-ommendations forward. They will alsodevelop a plan that identifies the resourcesrequired to implement these outcomes andthe overall emergency response.

Drug-resistant TB has emerged as anincreasing threat to TB control but a WHO/ US Centers for Disease Control andPrevention study, published earlier thisyear, documented for the first time cases oftuberculosis that were extensively resistantto current drug treatments. XDR-TB wasidentified in all regions of the world, thoughit is still thought to be relatively uncom-mon.

Last month, concerns about the emergenceof XDR-TB were heightened by reports and

studies from KwaZulu-Natal province inSouth Africa of high mortality rates in HIV-positive people with XDR-TB. This led towarnings that XDR-TB could seriouslythreaten the considerable progress beingmade in countries on TB control and thescaling up of universal access to HIV treat-ment and prevention.

Among the first countries to request assis-tance to strengthen its national emergencyXDR-TB response, and the extra challengesposed by HIV, is South Africa. The SouthAfrican Department of Health is to host anXDR-TB meeting on 17 and 18 October,with participation from WHO and represen-tatives from other affected southern Africancountries.

Special Public Lecture

The 1st WMA Asian-Pacific RegionalConference, held jointly by the WorldMedical Association (WMA) and the JapanMedical Association (JMA), opened auspi-ciously on the warm and sunny afternoon ofSeptember 10, 2006 in Tokyo. The confer-ence brought together participants from 18countries to discuss the themes of naturaldisasters such as earthquakes and tsunami,which occur virtually yearly in the Asianregion; infectious diseases, which pose anincreasing risk of a pandemic beginning inAsia and spreading throughout the world;and the state of the medical profession andmedical associations.


Asian Pacific Regional ConferenceHow to cope with Natural Disasters and Infectious Diseases –Caring Physicians of the World: 1st WMA Asian-Pacific RegionalConferenceDr. Masami IshiiSecretary General, CMAAO Executive Board Member, Japan Medical Association


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Kawasaki, Minister of Health, Labour, andWelfare, as well as several parliament mem-bers was held, allowing participants todeepen their friendships.

Asian-Pacific RegionalConference: Day 2

September 11 dawned with thunder show-ers but cleared to a sunny day. The programfor Day 2 of the conference covered threethemes.

Session 1: Disaster Preparedness andResponse – Earthquake and Tsunami;

Session 2: Disaster Preparedness andResponse – Infectious Disease; and

Session 3: The State of the Profession.

Session 1 began with an explanation by Dr.Yoshinobu Tsuji, Associate Professor at theEarthquake Research Institute at theUniversity of Tokyo, that the Asian-Pacificregion, collectively known as the PacificRim, is prone to earthquake and tsunamidisasters due to plate tectonics. Reviewingthe history of past earthquakes and tsunamiup until the present, he also brieflydescribed the tsunami warning systems andevacuation measures that have been used todate.

This presentation was followed by keynotespeeches by Dr. Yasuhiro Yamamoto andDr. Takeshi Kasai, who had both also spo-ken at the public lecture held the previousday. Dr. Yamamoto presented results ofanalysis of the case of the Great Hanshin-Awaji Earthquake in Japan in1995 thatshowed that in the 72 hours following theearthquake, over 80% of rescues were per-formed or assisted by family members orneighbors of trapped people or by trappedpeople themselves; less than 20% of rescueswere performed by professional rescueworkers in the line of duty.

Dr. Yamamoto also reported that with thepassage of time, the need for medical carefor chronic disease as well as psychologicalcare increases. This highlights the need forpre-hospital care and synchronization withrescue measures in other countries that pro-

mote training workshops on AED and otherresuscitation methods. Japan and the otherdeveloped countries are all expected to haveincreasingly aging populations. With theimportance of elderly people themselvestaking measures to prevent falls and keepwith them at all times a medical history andlist of their medications, as well asbystanders to an incident having learnedhow to respond to an emergency, not onlycross-border responses to major disastersbut also the further promotion of safety edu-cation and training in the future is vital.

Dr. Kasai spoke about measures against anew, highly infectious influenza strain, say-ing that there were three levels of response:measures against avian influenza; earlycontainment of a new human influenzavirus; and measures against a pandemic.Unlike in natural disasters, support fromneighboring countries or regions cannot beanticipated in the case of a pandemic, andso preparedness is the cornerstone of riskcontrol. It is vital that each region is as pre-pared as possible for a pandemic and thatinformation sharing is prompt.

Dr. Dongchun Shin of the Korean MedicalAssociation reported on the prompt rescueactivities of that medical association in coop-eration with Indonesian Medical Associationin the aftermath of the Sumatra Earthquake,and it was proposed that networks such asthe WMA and CMAAO could play a usefulrole in international disaster relief activities.

In Session 3, on the state of the medical pro-fession and medical associations, there wasa free discussion about the future directionof medical association activities based onreports of the current situation for eachnational medical association and reportspresented in this session.

In conclusion, Dr. Kazuo Iwasa, Vice-President of JMA and Vice-Chair ofCouncil of WMA, spoke about the signifi-cance of this conference and of medicalactivities that overcome national bound-aries and differences of race and religionunder the enduring values laid down in theWMA Declaration of Geneva and the Oathof Hippocrates, the fundamental principlesof all medical practitioners.

Conclusion

In enabling the sharing and discussion ofinformation about medical response to theextremely relevant themes of natural disas-ters, which are a very real risk in thisregion, and outbreaks of infectious disease,international regional meetings such as thisare deeply significant. Health care essen-tially should not be limited to healthcareservices provided by health insurance basedon assessments and agreements, but shouldcomprehensively involve all aspects of thehealth and lives of members of the public aswell as seek and find directions for prob-lems that cross national boundaries.

Looking at the unexpectedly great responseto the public lecture held in conjunctionwith this conference, it is clear that mem-bers of the public feel tremendous uncer-tainty about responses to major natural dis-asters and have even greater needs.Moreover, changing our perspective, thetwo themes of this conference – natural dis-asters and infectious diseases – both occuracross national and social boundaries andrequire a collective response by human andorganizational networks when they occur.

For this reason also, it is highly significantthat the results of this regional conferencewill be announced widely through theAsian-Pacific areas. We should note thatthis kind of conference is strongly neededby the NMAs which lack of nationalresources to cope with the natural disastersand infectious diseases. Information sharingwill be more increasingly required amongthe regional NMAs.

CHINA EChinese Medical Association42 Dongsi XidajieBeijing 100710Tel: (86-10) 6524 9989Fax: (86-10) 6512 3754E-mail: [email protected]: www.chinamed.com.cn

COLOMBIA SFederación Médica ColombianaCarrera 7 N° 82-66, Oficinas 218/219Santafé de Bogotá, D.E.Tel/Fax: (57-1) 256 8050/256 8010E-mail: [email protected]

DEMOCRATIC REP. OF CONGO FOrdre des Médecins du ZaireB.P. 4922Kinshasa – GombeTel: (243-12) 24589 Fax (Présidente): (242) 8846574

COSTA RICA SUnión Médica NacionalApartado 5920-1000San JoséTel: (506) 290-5490Fax: (506) 231 7373E-mail: [email protected]

CROATIA ECroatian Medical AssociationSubiceva 910000 ZagrebTel: (385-1) 46 93 300Fax: (385-1) 46 55 066E-mail: [email protected]: www.hlk.hr/default.asp

CZECH REPUBLIC ECzech Medical AssociationJ.E. PurkyneSokolská 31 - P.O. Box 88120 26 Prague 2Tel: (420-2) 242 66 201-4 Fax: (420-2) 242 66 212 / 96 18 18 69E-mail: [email protected]: www.cls.cz

CUBA SColegio Médico Cubano LibreP.O. Box 141016717 Ponce de Leon BoulevardCoral Gables, FL 33114-1016United StatesTel: (1-305) 446 9902/445 1429Fax: (1-305) 4459310

DENMARK EDanish Medical Association9 Trondhjemsgade2100 Copenhagen 0Tel: (45) 35 44 -82 29/Fax:-8505E-mail: [email protected]: www.laegeforeningen.dk

DOMINICAN REPUBLIC SAsociación Médica DominicanaCalle Paseo de los MedicosEsquina Modesto Diaz Zona UniversitariaSanto DomingoTel: (1809) 533-4602/533-4686/533-8700Fax: (1809) 535 7337E-mail: [email protected]

ECUADOR SFederación Médica EcuatorianaV.M. Rendón 923 – 2 do.Piso Of. 201P.O. Box 09-01-9848GuayaquilTel/Fax: (593) 4 562569E-mail: [email protected]

EGYPT EEgyptian Medical Association„Dar El Hekmah“42, Kasr El-Eini StreetCairoTel: (20-2) 3543406

EL SALVADOR, C.A SColegio Médico de El SalvadorFinal Pasaje N° 10Colonia MiramonteSan SalvadorTel: (503) 260-1111, 260-1112Fax: -0324E-mail: [email protected]@hotmail.com

ESTONIA EEstonian Medical Association(EsMA)Pepleri 3251010 TartuTel/Fax (372) 7420429E-mail: [email protected]: www.arstideliit.ee

ETHIOPIA EEthiopian Medical AssociationP.O. Box 2179Addis AbabaTel: (251-1) 158174Fax: (251-1) 533742E-mail: [email protected] /[email protected]

FIJI ISLANDS EFiji Medical Association2nd Fl. Narsey’s Bldg, Renwick RoadG.P.O. Box 1116SuvaTel: (679) 315388/Fax: (679) 387671E-mail: [email protected]

FINLAND EFinnish Medical AssociationP.O. Box 4900501 HelsinkiTel: (358-9) 3930 91/Fax-794E-mail: [email protected]: www.medassoc.fi

FRANCE FAssociation Médicale Française180, Blvd. Haussmann 75389 Paris Cedex 08Tel/Fax: (33) 1 45 25 22 68

GEORGIA EGeorgian Medical Association7 Asatiani Street380077 TbilisiTel: (995 32) 398686 / Fax: -398083E-mail: [email protected]

GERMANY EBundesärztekammer(German Medical Association)Herbert-Lewin-Platz 110623 BerlinTel: (49-30) 400-456 369/Fax: -387E-mail: [email protected]: www.bundesaerztekammer.de

GHANA EGhana Medical AssociationP.O. Box 1596AccraTel: (233-21) 670-510/Fax: -511E-mail: [email protected]

HAITI, W.I. FAssociation Médicale Haitienne1ère Av. du Travail #33 – Bois VernaPort-au-PrinceTel: (509) 245-2060Fax: (509) 245-6323E-mail: [email protected]: www.amhhaiti.net

HONG KONG EHong Kong Medical Association, Chi-naDuke of Windsor Building, 5th Floor15 Hennessy RoadTel: (852) 2527-8285Fax: (852) 2865-0943E-mail: [email protected]: www.hkma.org

HUNGARY EAssociation of Hungarian MedicalSocieties (MOTESZ)Nádor u. 36 – PO.Box 1451443 BudapestTel: (36-1) 312 3807 – 311 6687Fax: (36-1) 383-7918E-mail: [email protected]: www.motesz.hu

ICELAND EIcelandic Medical AssociationHlidasmari 8200 KópavogurTel: (354) 8640478Fax: (354) 5644106E-mail: [email protected]

INDIA EIndian Medical AssociationIndraprastha MargNew Delhi 110 002Tel: (91-11) 23370009/23378819/23378680Fax: (91-11) 23379178/23379470E-mail: [email protected]

INDONESIA EIndonesian Medical AssociationJalan Dr Sam Ratulangie N° 29Jakarta 10350Tel: (62-21) 3150679Fax: (62-21) 390 0473/3154 091E-mail: [email protected]

IRELAND EIrish Medical Organisation10 Fitzwilliam PlaceDublin 2Tel: (353-1) 676-7273Fax: (353-1)6612758/6682168Website: www.imo.ie

ISRAEL EIsrael Medical Association2 Twin Towers, 35 Jabotinsky St.P.O. Box 3566, Ramat-Gan 52136Tel: (972-3) 6100444 / 424Fax: (972-3) 5751616 / 5753303E-mail: [email protected]: www.ima.org.il

JAPAN EJapan Medical Association2-28-16 Honkomagome, Bunkyo-ku

Tokyo 113-8621Tel: (81-3) 3946 2121/3942 6489Fax: (81-3) 3946 6295E-mail: [email protected]

KAZAKHSTAN FAssociation of Medical Doctors of Kazakhstan117/1 Kazybek bi St.,AlmatyTel: (3272) 62 -43 01 / -92 92Fax: -3606E-mail: [email protected]

REP. OF KOREA EKorean Medical Association302-75 Ichon 1-dong, Yongsan-guSeoul 140-721Tel: (82-2) 794 2474Fax: (82-2) 793 9190E-mail: [email protected] Website: www.kma.org

KUWAIT EKuwait Medical AssociationP.O. Box 1202 Safat 13013Tel: (965) 5333278, 5317971Fax: (965) 5333276E-mail: [email protected]

LATVIA ELatvian Physicians AssociationSkolas Str. 3Riga1010 LatviaTel: (371-7) 22 06 61; 22 06 57Fax: (371-7) 22 06 57E-mail: [email protected]

LIECHTENSTEIN ELiechtensteinischer ÄrztekammerPostfach 529490 VaduzTel: (423) 231-1690Fax: (423) 231-1691E-mail: [email protected]: www.aerzte-net.li

LITHUANIA ELithuanian Medical AssociationLiubarto Str. 22004 VilniusTel/Fax: (370-5) 2731400E-mail: [email protected]: www.lgs.lt

LUXEMBOURG FAssociation des Médecins etMédecins Dentistes du Grand-Duché de Luxembourg29, rue de Vianden2680 LuxembourgTel: (352) 44 40 331Fax: (352) 45 83 49E-mail: [email protected]: www.ammd.lu

MACEDONIA EMacedonian Medical AssociationDame Gruev St. 3P.O. Box 17491000 SkopjeTel/Fax: (389-91) 232577E-mail: [email protected]

MALAYSIA EMalaysian Medical Association4th Floor, MMA House124 Jalan Pahang53000 Kuala LumpurTel: (60-3) 40413740/40411375


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Fax: (60-3) 40418187/40434444E-mail: [email protected]: http://www.mma.org.my

MALTA EMedical Association of MaltaThe Professional CentreSliema Road, Gzira GZR 06Tel: (356) 21312888Fax: (356) 21331713E-mail: [email protected]: www.mam.org.mt

MEXICO SColegio Medico de MexicoFenacomeHidalgo 1828 Pte. D-107Colonia Deportivo Obispado Monterrey, Nuevo LéonTel/Fax: (52-8) 348-41-55E-mail: [email protected]: www.cmm-fenacome.org

NAMIBIA EMedical Association of Namibia403 Maerua Park – POB 3369WindhoekTel: (264) 61 22 44 55/Fax: -48 26E-mail: [email protected]

NEPAL ENepal Medical AssociationSiddhi Sadan, Post Box 189Exhibition RoadKatmanduTel: (977 1) 4225860, 231825Fax: (977 1) 4225300E-mail: [email protected]

NETHERLANDS ERoyal Dutch Medical AssociationP.O. Box 200513502 LB UtrechtTel: (31-30) 28 23-267/Fax-318E-mail: [email protected]: www.knmg.nl

NEW ZEALAND ENew Zealand Medical AssociationP.O. Box 156Wellington 1 Tel: (64-4) 472-4741Fax: (64-4) 471 0838E-mail: [email protected]: www.nzma.org.nz

NIGERIA ENigerian Medical Association74, Adeniyi Jones Avenue IkejaP.O. Box 1108, MarinaLagosTel: (234-1) 480 1569, Fax: (234-1) 492 4179E-mail: [email protected]: www.nigeriannma.org

NORWAY ENorwegian Medical AssociationP.O.Box 1152 sentrum0107 OsloTel: (47) 23 10 -90 00/Fax: -9010E-mail: [email protected]: www.legeforeningen.no

PANAMA SAsociación Médica Nacionalde la República de PanamáApartado Postal 2020

Panamá 1Tel: (507) 263 7622 /263-7758Fax: (507) 223 1462Fax modem: (507) 223-5555E-mail: [email protected]

PERU SColegio Médico del PerúMalecón Armendáriz N° 791Miraflores, LimaTel: (51-1) 241 75 72Fax: (51-1) 242 3917E-mail: [email protected]: www.cmp.org.pe

PHILIPPINES EPhilippine Medical AssociationPMA Bldg, North AvenueQuezon CityTel: (63-2) 929-63 66/Fax: -6951E-mail: [email protected]: www.pma.com.ph

POLAND EPolish Medical AssociationAl. Ujazdowskie 24, 00-478 WarszawaTel/Fax: (48-22) 628 86 99

PORTUGAL EOrdem dos MédicosAv. Almirante Gago Coutinho, 1511749-084 LisbonTel: (351-21) 842 71 00/842 71 11Fax: (351-21) 842 71 99E-mail: [email protected]: www.ordemdosmedicos.pt

ROMANIA FRomanian Medical AssociationStr. Ionel Perlea, nr 10Sect. 1, BucarestTel: (40-1) 460 08 30Fax: (40-1) 312 13 57E-mail: [email protected]: ong.ro/ong/amr

RUSSIA ERussian Medical SocietyUdaltsova Street 85119607 Moscow Tel: (7-095)932-83-02E-mail: [email protected]: www.russmed.ru

SAMOA ESamoa Medical AssociationTupua Tamasese Meaole HospitalPrivate Bag – National Health ServicesApiaTel: (685) 778 5858E-mail: [email protected]

SINGAPORE ESingapore Medical AssociationAlumni Medical Centre, Level 22 College Road, 169850 SingaporeTel: (65) 6223 1264Fax: (65) 6224 7827E-Mail: [email protected]

SLOVAK REPUBLIC ESlovak Medical AssociationLegionarska 481322 BratislavaTel: (421-2) 554 24 015Fax: (421-2) 554 223 63E-mail: [email protected]

SLOVENIA ESlovenian Medical AssociationKomenskega 4, 61001 LjubljanaTel: (386-61) 323 469Fax: (386-61) 301 955

SOMALIA ESomali Medical Association14 Wardigley Road – POB 199MogadishuTel: (252-1) 595 599Fax: (252-1) 225 858E-mail: [email protected]

SOUTH AFRICA EThe South African Medical Associa-tionP.O. Box 74789, Lynnwood Rydge0040 PretoriaTel: (27-12) 481 2036/2063Fax: (27-12) 481 2100/2058E-mail: [email protected]: www.samedical.org

SPAIN SConsejo General de Colegios MédicosPlaza de las Cortes 11, Madrid 28014Tel: (34-91) 431 7780Fax: (34-91) 431 9620E-mail: [email protected]

SWEDEN ESwedish Medical Association(Villagatan 5)P.O. Box 5610, SE - 114 86 StockholmTel: (46-8) 790 33 00Fax: (46-8) 20 57 18E-mail: [email protected]: www.lakarforbundet.se

SWITZERLAND FFédération des Médecins SuissesElfenstrasse 18 – C.P. 1703000 Berne 15Tel: (41-31) 359 –1111/Fax: -1112E-mail: [email protected]: www.fmh.ch

TAIWAN ETaiwan Medical Association9F No 29 Sec1An-Ho RoadTaipeiTel: (886-2) 2752-7286Fax: (886-2) 2771-8392E-mail: [email protected]: www.med.assn.org.tw

THAILAND EMedical Association of Thailand2 Soi SoonvijaiNew Petchburi RoadBangkok 10320Tel: (66-2) 314 4333/318-8170Fax: (66-2) 314 6305E-mail: [email protected]: www.medassocthai.org

TUNISIA FConseil National de l’Ordredes Médecins de Tunisie16, rue de Touraine1002 Tunis Tel: (216-71) 792 736/799 041Fax: (216-71) 788 729E-mail: [email protected]

TURKEY ETurkish Medical AssociationGMK Bulvary

Sehit Danis Tunaligil Sok. N° 2 Kat 4Maltepe 06570AnkaraTel: (90-312) 231 –3179/Fax: -1952E-mail: [email protected]: www.ttb.org.tr

UGANDA EUganda Medical AssociationPlot 8, 41-43 circular rd.P.O. Box 29874 KampalaTel: (256) 41 32 1795Fax: (256) 41 34 5597E-mail: [email protected]

UNITED KINGDOM EBritish Medical AssociationBMA House, Tavistock Square London WC1H 9JPTel: (44-207) 387-4499Fax: (44- 207) 383-6710E-mail: [email protected] Website: www.bma.org.uk

UNITED STATES OF AMERICA EAmerican Medical Association515 North State StreetChicago, Illinois 60610Tel: (1-312) 464 5040Fax: (1-312) 464 5973Website: http://www.ama-assn.org

URUGUAY SSindicato Médico del UruguayBulevar Artigas 1515CP 11200 MontevideoTel: (598-2) 401 47 01Fax: (598-2) 409 16 03E-mail: [email protected]

VATICAN STATE FAssociazione Medica del VaticanoStato della Città del Vaticano 00120 Città del Vaticano Tel: (39-06) 69879300Fax: (39-06) 69883328E-mail: [email protected]

VENEZUELA SFederacion Médica VenezolanaAvenida OrinocoTorre Federacion Médica VenezolanaUrbanizacion Las MercedesCaracasTel: (58-2) 9934547Fax: (58-2) 9932890Website: www.saludfmv.orgE-mail: [email protected]

VIETNAM EVietnam Medical Association(VGAMP)68A Ba Trieu-StreetHoau Kiem DistrictHanoiTel/Fax: (84) 4 943 9323

ZIMBABWE EZimbabwe Medical AssociationP.O. Box 3671HarareTel: (263-4) 791553Fax: (263-4) 791561E-mail: [email protected]

Documents

G 20438 World Medical Journal 52No. 4, December 2006 · WMA Directory of National Member Medical Associations Officers and Council Association and address/Officers WMA OFFICERS OF