wmj12

WorldMedical Journal
Vol. No.4,December200652
OFFICIAL JOURNAL OF THE WORLD MEDICAL ASSOCIATION, INC.
G 20438
Contents
World Medical Association International
Code of Medical Ethics 87
Editorial
Regulation and Self-Regulation 88
New appointments and honours 89
Libyan Court Decision on
Bulgarian Doctor and Nurses 89
Medical Ethics and Human Rights
WMA Declaration on Hunger Strikers 90
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: https://www.wma.net
WMA Directory of National Member Medical Associations Officers and Council
Association and address/Officers
WMA OFFICERS
OF NATIONAL MEMBER MEDICALASSOCIATIONS AND OFFICERS
i see page ii
President-Elect President Immediate Past-President
Dr. J. Snaedal Dr. N. Arumagam Dr. Kgosi Letlape
Icelandic Medical Assn. Malaysian Medical Association The South African Medical Association
Hlidasmari 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 Council
Prof. Dr. Dr. h.c. J. D. Hoppe Dr. Y. Blachar Dr. K. Iwasa
Bundesärztekammer Israel Medical Association Japan Medical Association
Herbert-Lewin-Platz 1 2 Twin Towers 2-28-16 Honkomagome
10623 Berlin 35 Jabotinsky Street Bunkyo-ku
Germany P.O. Box 3566 Tokyo 113-8621
Ramat-Gan 52136 Japan
Israel
Secretary General
Dr. O. Kloiber
World Medical Association
BP 63
01212 Ferney-Voltaire Cedex
France
ANDORRA S
Col’legi Oficial de Metges
Edifici Plaza esc. B
Verge del Pilar 5,
4art. Despatx 11, Andorra La Vella
Tel: (376) 823 525/Fax: (376) 860 793
E-mail: coma@andorra.ad
Website: www.col-legidemetges.ad
ARGENTINA S
Confederación Médica Argentina
Av. Belgrano 1235
Buenos Aires 1093
Tel/Fax: (54-11) 4381-1548/4384-5036
E-mail:
comra@confederacionmedica.com.ar
Website: www.comra.health.org.ar
AUSTRALIA E
Australian Medical Association
P.O. Box 6090
Kingston, ACT 2604
Tel: (61-2) 6270-5460/Fax: -5499
Website: www.ama.com.au
E-mail: ama@ama.com.au
AUSTRIA E
Österreichische Ärztekammer
(Austrian Medical Chamber)
Weihburggasse 10-12 – P.O. Box 213
1010 Wien
Tel: (43-1) 51406-931/Fax: -933
E-mail: international@aek.or.at
REPUBLIC OF ARMENIA E
Armenian Medical Association
P.O. Box 143, Yerevan 375 010
Tel: (3741) 53 58-68
Fax: (3741) 53 48 79
E-mail:info@armeda.am
Website: www.armeda.am
AZERBAIJAN E
Azerbaijan Medical Association
5 Sona Velikham Str.
AZE 370001, Baku
Tel: (994 50) 328 1888
Fax: (994 12) 315 136
E-mail: Mahirs@lycos.com /
azerma@hotmail.com
BAHAMAS E
Medical Association of the Bahamas
Javon Medical Center
P.O. Box N999
Nassau
Tel: (1-242) 328 1857/Fax: 323 2980
E-mail: mabnassau@yahoo.com
BANGLADESH E
Bangladesh Medical Association
BMA Bhaban 5/2 Topkhana Road
Dhaka 1000
Tel: (880) 2-9568714/9562527
Fax: (880) 2-9566060/9568714
E-mail: bma@aitlbd.net
BELGIUM F
Association Belge des Syndicats
Médicaux
Chaussée de Boondael 6, bte 4
1050 Bruxelles
Tel: (32-2) 644-12 88/Fax: -1527
E-mail: absym.bras@euronet.be
Website: www.absym-bras.be
BOLIVIA S
Colegio Médico de Bolivia
Calle Ayacucho 630
Tarija
Fax: (591) 4663569
E-mail: colmed_tjo@hotmail.com
Website: colegiomedicodebolivia.org.bo
BRAZIL E
Associaçao Médica Brasileira
R. Sao Carlos do Pinhal 324 – Bela Vista
Sao Paulo SP – CEP 01333-903
Tel: (55-11) 317868-00/Fax: -31
E-mail: presidente@amb.org.br
Website: www.amb.org.br
BULGARIA E
Bulgarian Medical Association
15, Acad. Ivan Geshov Blvd.
1431 Sofia
Tel: (359-2) 954 -11 26/Fax:-1186
E-mail: usbls@inagency.com
Website: www.blsbg.com
CANADA E
Canadian Medical Association
P.O. Box 8650
1867 Alta Vista Drive
Ottawa, Ontario K1G 3Y6
Tel: (1-613) 731 8610/Fax: -1779
E-mail: monique.laframboise@cma.ca
Website: www.cma.ca
CHILE S
Colegio Médico de Chile
Esmeralda 678 – Casilla 639
Santiago
Tel: (56-2) 4277800
Fax: (56-2) 6330940 / 6336732
E-mail: rdelcastillo@colegiomedico.cl
Website: 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 Medicine
This became the London School of Hygiene and Tropical Medicine (LSHTM) in 1924, formally opened by the Prince of Wales in 1929.
CHINA E
Chinese Medical Association
42 Dongsi Xidajie
Beijing 100710
Tel: (86-10) 6524 9989
Fax: (86-10) 6512 3754
E-mail: suyumu@cma.org.cn
Website: www.chinamed.com.cn
COLOMBIA S
Federación Médica Colombiana
Carrera 7 N° 82-66, Oficinas 218/219
Santafé de Bogotá, D.E.
Tel/Fax: (57-1) 256 8050/256 8010
E-mail: federacionmedicacol@
sky.net.co
DEMOCRATIC REP. OF CONGO F
Ordre des Médecins du Zaire
B.P. 4922
Kinshasa – Gombe
Tel: (243-12) 24589
Fax (Présidente): (242) 8846574
COSTA RICA S
Unión Médica Nacional
Apartado 5920-1000
San José
Tel: (506) 290-5490
Fax: (506) 231 7373
E-mail: unmedica@sol.racsa.co.cr
CROATIA E
Croatian Medical Association
Subiceva 9
10000 Zagreb
Tel: (385-1) 46 93 300
Fax: (385-1) 46 55 066
E-mail: hlz@email.htnet.hr
Website: www.hlk.hr/default.asp
CZECH REPUBLIC E
Czech Medical Association
J.E. Purkyne
Sokolská 31 – P.O. Box 88
120 26 Prague 2
Tel: (420-2) 242 66 201-4
Fax: (420-2) 242 66 212 / 96 18 18 69
E-mail: czma@cls.cz
Website: www.cls.cz
CUBA S
Colegio Médico Cubano Libre
P.O. Box 141016
717 Ponce de Leon Boulevard
Coral Gables, FL 33114-1016
United States
Tel: (1-305) 446 9902/445 1429
Fax: (1-305) 4459310
DENMARK E
Danish Medical Association
9 Trondhjemsgade
2100 Copenhagen 0
Tel: (45) 35 44 -82 29/Fax:-8505
E-mail: er@dadl.dk
Website: www.laegeforeningen.dk
DOMINICAN REPUBLIC S
Asociación Médica Dominicana
Calle Paseo de los Medicos
Esquina Modesto Diaz Zona
Universitaria
Santo Domingo
Tel: (1809) 533-4602/533-4686/
533-8700
Fax: (1809) 535 7337
E-mail: asoc.medica@codetel.net.do
ECUADOR S
Federación Médica Ecuatoriana
V.M. Rendón 923 – 2 do.Piso Of. 201
P.O. Box 09-01-9848
Guayaquil
Tel/Fax: (593) 4 562569
E-mail: fdmedec@andinanet.net
EGYPT E
Egyptian Medical Association
„Dar El Hekmah“
42, Kasr El-Eini Street
Cairo
Tel: (20-2) 3543406
EL SALVADOR, C.A S
Colegio Médico de El Salvador
Final Pasaje N° 10
Colonia Miramonte
San Salvador
Tel: (503) 260-1111, 260-1112
Fax: -0324
E-mail: comcolmed@telesal.net
marnuca@hotmail.com
ESTONIA E
Estonian Medical Association
(EsMA)Pepleri 32
51010 Tartu
Tel/Fax (372) 7420429
E-mail: eal@arstideliit.ee
Website: www.arstideliit.ee
ETHIOPIA E
Ethiopian Medical Association
P.O. Box 2179
Addis Ababa
Tel: (251-1) 158174
Fax: (251-1) 533742
E-mail: ema.emj@telecom.net.et /
ema@eth.healthnet.org
FIJI ISLANDS E
Fiji Medical Association
2nd Fl. Narsey’s Bldg, Renwick Road
G.P.O. Box 1116
Suva
Tel: (679) 315388/Fax: (679) 387671
E-mail: fijimedassoc@connect.com.fj
FINLAND E
Finnish Medical Association
P.O. Box 49
00501 Helsinki
Tel: (358-9) 3930 91/Fax-794
E-mail: fma@fimnet.fi
Website: www.medassoc.fi
FRANCE F
Association Médicale Française
180, Blvd. Haussmann
75389 Paris Cedex 08
Tel/Fax: (33) 1 45 25 22 68
GEORGIA E
Georgian Medical Association
7 Asatiani Street
380077 Tbilisi
Tel: (995 32) 398686 / Fax: -398083
E-mail: Gma@posta.ge
GERMANY E
Bundesärztekammer
(German Medical Association)
Herbert-Lewin-Platz 1
10623 Berlin
Tel: (49-30) 400-456 369/Fax: -387
E-mail: renate.vonhoff-winter@baek.de
Website: www.bundesaerztekammer.de
GHANA E
Ghana Medical Association
P.O. Box 1596
Accra
Tel: (233-21) 670-510/Fax: -511
E-mail: gma@ghana.com
HAITI, W.I. F
Association Médicale Haitienne
1ère
Av. du Travail #33 – Bois Verna
Port-au-Prince
Tel: (509) 245-2060
Fax: (509) 245-6323
E-mail: amh@amhhaiti.net
Website: www.amhhaiti.net
HONG KONG E
Hong Kong Medical Association, Chi-
naDuke of Windsor Building, 5th Floor
15 Hennessy Road
Tel: (852) 2527-8285
Fax: (852) 2865-0943
E-mail: hkma@hkma.org
Website: www.hkma.org
HUNGARY E
Association of Hungarian Medical
Societies (MOTESZ)
Nádor u. 36 – PO.Box 145
1443 Budapest
Tel: (36-1) 312 3807 – 311 6687
Fax: (36-1) 383-7918
E-mail: motesz@motesz.hu
Website: www.motesz.hu
ICELAND E
Icelandic Medical Association
Hlidasmari 8
200 Kópavogur
Tel: (354) 8640478
Fax: (354) 5644106
E-mail: icemed@icemed.is
INDIA E
Indian Medical Association
Indraprastha Marg
New Delhi 110 002
Tel: (91-11) 23370009/23378819/
23378680
Fax: (91-11) 23379178/23379470
E-mail: inmedici@vsnl.com
INDONESIA E
Indonesian Medical Association
Jalan Dr Sam Ratulangie N° 29
Jakarta 10350
Tel: (62-21) 3150679
Fax: (62-21) 390 0473/3154 091
E-mail: pbidi@idola.net.id
IRELAND E
Irish Medical Organisation
10 Fitzwilliam Place
Dublin 2
Tel: (353-1) 676-7273Fax: (353-1)
6612758/6682168
Website: www.imo.ie
ISRAEL E
Israel Medical Association
2 Twin Towers, 35 Jabotinsky St.
P.O. Box 3566, Ramat-Gan 52136
Tel: (972-3) 6100444 / 424
Fax: (972-3) 5751616 / 5753303
E-mail: doritb@ima.org.il
Website: www.ima.org.il
JAPAN E
Japan Medical Association
2-28-16 Honkomagome, Bunkyo-ku
Tokyo 113-8621
Tel: (81-3) 3946 2121/3942 6489
Fax: (81-3) 3946 6295
E-mail: jmaintl@po.med.or.jp
KAZAKHSTAN F
Association of Medical Doctors
of Kazakhstan
117/1 Kazybek bi St.,
Almaty
Tel: (3272) 62 -43 01 / -92 92
Fax: -3606
E-mail: sadykova-aizhan@yahoo.com
REP. OF KOREA E
Korean Medical Association
302-75 Ichon 1-dong, Yongsan-gu
Seoul 140-721
Tel: (82-2) 794 2474
Fax: (82-2) 793 9190
E-mail: intl@kma.org
Website: www.kma.org
KUWAIT E
Kuwait Medical Association
P.O. Box 1202
Safat 13013
Tel: (965) 5333278, 5317971
Fax: (965) 5333276
E-mail: aks.shatti@kma.org.kw
LATVIA E
Latvian Physicians Association
Skolas Str. 3
Riga
1010 Latvia
Tel: (371-7) 22 06 61; 22 06 57
Fax: (371-7) 22 06 57
E-mail: lab@parks.lv
LIECHTENSTEIN E
Liechtensteinischer Ärztekammer
Postfach 52
9490 Vaduz
Tel: (423) 231-1690
Fax: (423) 231-1691
E-mail: office@aerztekammer.li
Website: www.aerzte-net.li
LITHUANIA E
Lithuanian Medical Association
Liubarto Str. 2
2004 Vilnius
Tel/Fax: (370-5) 2731400
E-mail: lgs@takas.lt
Website: www.lgs.lt
LUXEMBOURG F
Association des Médecins et
Médecins Dentistes du Grand-
Duché de Luxembourg
29, rue de Vianden
2680 Luxembourg
Tel: (352) 44 40 331
Fax: (352) 45 83 49
E-mail: secretariat@ammd.lu
Website: www.ammd.lu
MACEDONIA E
Macedonian Medical Association
Dame Gruev St. 3
P.O. Box 174
91000 Skopje
Tel/Fax: (389-91) 232577
E-mail: mld@unet.com.mk
MALAYSIA E
Malaysian Medical Association
4th Floor, MMA House
124 Jalan Pahang
53000 Kuala Lumpur
Tel: (60-3) 40413740/40411375
Association and address/Officers
ii
Association and address/Officers
iii
Fax: (60-3) 40418187/40434444
E-mail: mma@tm.net.my
Website: http://www.mma.org.my
MALTA E
Medical Association of Malta
The Professional Centre
Sliema Road, Gzira GZR 06
Tel: (356) 21312888
Fax: (356) 21331713
E-mail: mfpb@maltanet.net
Website: www.mam.org.mt
MEXICO S
Colegio Medico de Mexico
Fenacome
Hidalgo 1828 Pte. D-107
Colonia Deportivo Obispado
Monterrey, Nuevo Léon
Tel/Fax: (52-8) 348-41-55
E-mail: rcantum@doctor.com
Website: www.cmm-fenacome.org
NAMIBIA E
Medical Association of Namibia
403 Maerua Park – POB 3369
Windhoek
Tel: (264) 61 22 44 55/Fax: -48 26
E-mail: man.office@iway.na
NEPAL E
Nepal Medical Association
Siddhi Sadan, Post Box 189
Exhibition Road
Katmandu
Tel: (977 1) 4225860, 231825
Fax: (977 1) 4225300
E-mail: nma@healthnet.org.np
NETHERLANDS E
Royal Dutch Medical Association
P.O. Box 20051
3502 LB Utrecht
Tel: (31-30) 28 23-267/Fax-318
E-mail: j.bouwman@fed.knmg.nl
Website: www.knmg.nl
NEW ZEALAND E
New Zealand Medical Association
P.O. Box 156
Wellington 1
Tel: (64-4) 472-4741
Fax: (64-4) 471 0838
E-mail: nzma@nzma.org.nz
Website: www.nzma.org.nz
NIGERIA E
Nigerian Medical Association
74, Adeniyi Jones Avenue Ikeja
P.O. Box 1108, Marina
Lagos
Tel: (234-1) 480 1569,
Fax: (234-1) 492 4179
E-mail: info@nigeriannma.org
Website: www.nigeriannma.org
NORWAY E
Norwegian Medical Association
P.O.Box 1152 sentrum
0107 Oslo
Tel: (47) 23 10 -90 00/Fax: -9010
E-mail: ellen.pettersen@
legeforeningen.no
Website: www.legeforeningen.no
PANAMA S
Asociación Médica Nacional
de la República de Panamá
Apartado Postal 2020
Panamá 1
Tel: (507) 263 7622 /263-7758
Fax: (507) 223 1462
Fax modem: (507) 223-5555
E-mail: amenalpa@cwpanama.net
PERU S
Colegio Médico del Perú
Malecón Armendáriz N° 791
Miraflores, Lima
Tel: (51-1) 241 75 72
Fax: (51-1) 242 3917
E-mail: decano@cmp.org.pe
Website: www.cmp.org.pe
PHILIPPINES E
Philippine Medical Association
PMA Bldg, North Avenue
Quezon City
Tel: (63-2) 929-63 66/Fax: -6951
E-mail: medical@pma.com.ph
Website: www.pma.com.ph
POLAND E
Polish Medical Association
Al. Ujazdowskie 24, 00-478 Warszawa
Tel/Fax: (48-22) 628 86 99
PORTUGAL E
Ordem dos Médicos
Av. Almirante Gago Coutinho, 151
1749-084 Lisbon
Tel: (351-21) 842 71 00/842 71 11
Fax: (351-21) 842 71 99
E-mail: intl@omcne.pt
Website: www.ordemdosmedicos.pt
ROMANIA F
Romanian Medical Association
Str. Ionel Perlea, nr 10
Sect. 1, Bucarest
Tel: (40-1) 460 08 30
Fax: (40-1) 312 13 57
E-mail: AMR@itcnet.ro
Website: ong.ro/ong/amr
RUSSIA E
Russian Medical Society
Udaltsova Street 85
119607 Moscow
Tel: (7-095)932-83-02
E-mail: info@rusmed.ru
Website: www.russmed.ru
SAMOA E
Samoa Medical Association
Tupua Tamasese Meaole Hospital
Private Bag – National Health Services
Apia
Tel: (685) 778 5858
E-mail: vialil_lameko@yahoo.com
SINGAPORE E
Singapore Medical Association
Alumni Medical Centre, Level 2
2 College Road, 169850 Singapore
Tel: (65) 6223 1264
Fax: (65) 6224 7827
E-Mail: sma@sma.org.sg
www.sma.org.sg
SLOVAK REPUBLIC E
Slovak Medical Association
Legionarska 4
81322 Bratislava
Tel: (421-2) 554 24 015
Fax: (421-2) 554 223 63
E-mail: secretarysma@ba.telecom.sk
SLOVENIA E
Slovenian Medical Association
Komenskega 4, 61001 Ljubljana
Tel: (386-61) 323 469
Fax: (386-61) 301 955
SOMALIA E
Somali Medical Association
14 Wardigley Road – POB 199
Mogadishu
Tel: (252-1) 595 599
Fax: (252-1) 225 858
E-mail: drdalmar@yahoo.co.uk
SOUTH AFRICA E
The South African Medical Associa-
tionP.O. Box 74789, Lynnwood Rydge
0040 Pretoria
Tel: (27-12) 481 2036/2063
Fax: (27-12) 481 2100/2058
E-mail: sginterim@samedical.org
Website: www.samedical.org
SPAIN S
Consejo General de Colegios Médicos
Plaza de las Cortes 11, Madrid 28014
Tel: (34-91) 431 7780
Fax: (34-91) 431 9620
E-mail: internacional1@cgcom.es
SWEDEN E
Swedish Medical Association
(Villagatan 5)
P.O. Box 5610, SE – 114 86 Stockholm
Tel: (46-8) 790 33 00
Fax: (46-8) 20 57 18
E-mail: info@slf.se
Website: www.lakarforbundet.se
SWITZERLAND F
Fédération des Médecins Suisses
Elfenstrasse 18 – C.P. 170
3000 Berne 15
Tel: (41-31) 359 –1111/Fax: -1112
E-mail: fmh@hin.ch
Website: www.fmh.ch
TAIWAN E
Taiwan Medical Association
9F No 29 Sec1
An-Ho Road
Taipei
Tel: (886-2) 2752-7286
Fax: (886-2) 2771-8392
E-mail: intl@med-assn.org.tw
Website: www.med.assn.org.tw
THAILAND E
Medical Association of Thailand
2 Soi Soonvijai
New Petchburi Road
Bangkok 10320
Tel: (66-2) 314 4333/318-8170
Fax: (66-2) 314 6305
E-mail: math@loxinfo.co.th
Website: www.medassocthai.org
TUNISIA F
Conseil National de l’Ordre
des Médecins de Tunisie
16, rue de Touraine
1002 Tunis
Tel: (216-71) 792 736/799 041
Fax: (216-71) 788 729
E-mail: ordremed.na@planet.tn
TURKEY E
Turkish Medical Association
GMK Bulvary
Sehit Danis Tunaligil Sok. N° 2 Kat 4
Maltepe 06570
Ankara
Tel: (90-312) 231 –3179/Fax: -1952
E-mail: Ttb@ttb.org.tr
Website: www.ttb.org.tr
UGANDA E
Uganda Medical Association
Plot 8, 41-43 circular rd.
P.O. Box 29874
Kampala
Tel: (256) 41 32 1795
Fax: (256) 41 34 5597
E-mail: myers28@hotmail.com
UNITED KINGDOM E
British Medical Association
BMA House, Tavistock Square
London WC1H 9JP
Tel: (44-207) 387-4499
Fax: (44- 207) 383-6710
E-mail: vivn@bma.org.uk
Website: www.bma.org.uk
UNITED STATES OF AMERICA E
American Medical Association
515 North State Street
Chicago, Illinois 60610
Tel: (1-312) 464 5040
Fax: (1-312) 464 5973
Website: http://www.ama-assn.org
URUGUAY S
Sindicato Médico del Uruguay
Bulevar Artigas 1515
CP 11200 Montevideo
Tel: (598-2) 401 47 01
Fax: (598-2) 409 16 03
E-mail: secretaria@smu.org.uy
VATICAN STATE F
Associazione Medica del Vaticano
Stato della Città del Vaticano
00120 Città del Vaticano
Tel: (39-06) 69879300
Fax: (39-06) 69883328
E-mail: servizi.sanitari@scv.va
VENEZUELA S
Federacion Médica Venezolana
Avenida Orinoco
Torre Federacion Médica Venezolana
Urbanizacion Las Mercedes
Caracas
Tel: (58-2) 9934547
Fax: (58-2) 9932890
Website: www.saludfmv.org
E-mail: info@saludgmv.org
VIETNAM E
Vietnam Medical Association
(VGAMP)68A Ba Trieu-Street
Hoau Kiem District
Hanoi
Tel/Fax: (84) 4 943 9323
ZIMBABWE E
Zimbabwe Medical Association
P.O. Box 3671
Harare
Tel: (263-4) 791553
Fax: (263-4) 791561
E-mail: zima@zol.co.zw
87
OFFICIAL JOURNAL OF
THE WORLD MEDICAL
ASSOCIATION
Hon. Editor in Chief
Dr. Alan J. Rowe
Haughley Grange, Stowmarket
Suffolk IP14 3QT
UK
Co-Editors
Prof. Dr. med. Elmar Doppelfeld
Deutscher Ärzte-Verlag
Dieselstr. 2
D–50859 Köln
Germany
Dr. Ivan M. Gillibrand
19 Wimblehurst Court
Ashleigh Road
Horsham
West Sussex RH12 2AQ
UK
Business Managers
J. Führer, D. Weber
50859 Köln
Dieselstraße 2
Germany
Publisher
THE WORLD MEDICAL
ASSOCIATION, INC.
BP 63
01212 Ferney-Voltaire Cedex, France
Publishing House
Deutscher Ärzte-Verlag GmbH,
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ISSN: 0049-8122
Adopted by the 3rd General Assembly of the World Medical Association, London, England, October
1949 and amended by the 22nd World Medical Assembly Sydney, Australia, August 1968 and the 35th
World 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 the
highest 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 and
moral 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 in
fraud or deception.
not receive any financial benefits or other incentives solely for referring patients
or 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 their
community.
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 Patients
always 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 to
him/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 confidential
information when the patient consents to it or when there is a real and imminent
threat of harm to the patient or to others and this threat can be only removed by
a breach of confidentiality.
give emergency care as a humanitarian duty unless he/she is assured that others
are willing and able to give such care.
in situations when he/she is acting for a third party, ensure that the patient has full
knowledge of that situation.
not enter into a sexual relationship with his/her current patient or into any other
abusive 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 to
attract patients.
when medically necessary, communicate with colleagues who are involved in the
care of the same patient. This communication should respect patient confidentiality
and 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 them
through whatever healthcare system is pro-
vided. What is disturbing the profession is
the potential risk that the non-medical
members appointed by government to “rep-
resent the consumer interest” may be influ-
enced by the views of the governments who
appoint them or by their appointed advisers,
thus diluting the professional voice of the
main body of physicians, whose ethical and
professional duty is to ensure that impartial
informed clinical and not political consider-
ations are the basis of advice and action by
physicians in the best interests of their
patients. This would be of particular con-
cern if the balance between professional
and lay members were at or near parity and
a deciding vote rested with a President,
whose independence might be compro-
mised through his appointment by one of
the parties or by government , rather than
one appointed through the expressed wish-
es of the majority of both elements of the
Regulating Body, professional and lay, e.g.
a senior member of the judiciary..
Whilst these concerns may appear to be
unwarranted, they are very real and are not
reflections of opposition to any reform of
long established traditions. Indeed, physi-
cians are increasingly aware of the need to
ensure that professional competence should
ensure 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 continuing
professional development, re-accreditation
and licensing, as appropriate .Such trends
are actively being pursued in a number of
countries. What is essential is that necessary
appropriate change is achieved through
open transparent productive dialogue
between the medical profession and the
other interested parties, be they consumers
or healthcare providing agencies, both gov-
ernmental or non-governmental. In this way
the primary role of physicians, in preven-
tive, diagnostic, therapeutic, advisory roles
or as advocates of the healthcare interests of
individual patients and communities, can be
maintained by appropriate regulatory bod-
ies established for this purpose.
As already indicated, it is just and proper
for the views of the community (who use
and 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 gave
expression to their concerns on a number of topics of which they felt WMA should be
aware. Two NMAs opened the discussions by expressing their disquiet at the increasing
intrusion of governmental and healthcare authorities in the self regulation of the medical
profession.
This trend has most recently been led notably by the English speaking countries, as, for
example, by the United Kingdom in the development of its body regulating the medical
profession. In the UK, this is the General Medical Council, in which, for many years the
Chief Medical Officers England, Northern Ireland and Scotland and Wales, as government
officials, 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 more
recent reforms, the number of these has been increased and it has been suggested that there
should not be a majority of the medical profession in the regulating body. Appointed Lay
members, 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 of
this is the concern that the views of the consumers of healthcare professional services
should be represented in the regulation of the professional providers of medical services.
Self-regulation was commented on in the World Health Organisation Report 2006 on
Human Health Resources in which, while recognising that self-regulation could and had
worked well in a number of Member States and also setting out reasons why it had not
worked 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, led
by 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 by
Ministers to self-regulating bodies such as the elected Medical Orders or Councils, in such
countries the internal disciplinary determinations of the Medical Orders, Councils etc com-
prising elected professional peers (commonly with legal advisers), frequently tend to play
some role in disciplinary and regulatory procedures. Indeed in some cases, decisions, other
than 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 the
judge considering the matter. (2)
There is little doubt that, in future, the age of absolute autonomy of the physician who is
licensed to provide medical services to the public (which through social security/healthcare
systems 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 demand
that the voice of consumers should play a role in the regulation of the standards of those
Editorial
89
appropriate government or other lay mem-
bers of the public, to play some part in
approving the standards of care and behav-
iour of those providing medical services.
But once these have been approved, the
judgement of whether or not these standards
have been breached or abused should prop-
erly be left to the judgement of professional
peers and judged strictly by the agreed stan-
dards of conduct, having regard to all the
relevant circumstances.
In a paper on “The teaching of medicine as
a service of healing”, (3) the authors write
“The profession’s desire for autonomy is
predicated on its promise to police itself in
the public interest. These legal measures
(laws governing registration and licensing
in UK,USA and other English speaking
countries) granted medicine a broad
monopoly over healthcare – along with the
understanding that in return, medicine
would concern itself with the health prob-
lems of the society it served and would
place the welfare of society above its own.”.
They continue “The primary obligation as a
physician is to act as a “healer”, but society
has chosen professional status as the way to
organise the activities required from medi-
cine and entrusted to the profession”.
In the changing modern world, where
advances in knowledge and the ability to
intervene in both life-threatening and
chronic diseases has hugely increased,
(with consequent changes in management
and treatment now requiring substantial
teamwork with other professionals rather
than individual action), some change in the
regulation of the profession is inevitable.
Nevertheless, the concerns expressed above
which 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 of
the 21st century.
In order to face up to these challenges the
medical profession needs to inform the gen-
eral public not only of nature of the prob-
lems, but also of the threat to the freedom of
physicians to provide them with indepen-
dent impartial best advice, uninfluenced by
the constraints imposed by political consid-
erations or the perceived need for instant
reactions to particular circumstances. At the
same time the responsibilities outlined
above, on which clinical autonomy and the
right to give the best advice in the interest
of the patient is granted, must be seen to be
properly governed by the regulating body, if
the “self-disciplining” of the profession is
to be retained.
Alan Rowe
* The National Chief Medical Officers
(CMOs) were represented by the Chief
Medical Officer of England plus the CMO of
either Scotland, Northern Ireland or Wales in
alternation.
(1) Working together for Health. World Health
Report 2006, 121-124 Geneva
(2) Rowe A, Garcia-Barbero M, Regulation and
Licensing of Physicians in the European
Region, WHO (2005) p. 21-22. WHO
Copenhagen. WHOLIS number
EUR/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 General
Dr. Margaret Chan has been appointed as the new Director
General of the World Health Organisation. Dr. Chan was
earlier Director of Health for Hong Kong and she joined
WHO in 2003. Prior to her appointment as Director
General she was Assistant Director General for
Communicable Diseases and Representative of the Director
General for Pandemic Influenza. (for further details see page
110)
Despite the huge international outcry and
the 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 described
as “a highly politicised retrial and a
grotesque miscarriage of justice” the death
sentence has been imposed by a Libyan
Judge.
The overwhelming scientific evidence, not
only of Montagnier – the discoverer of the
HIV – who stated that the virus was active
in the hospital before those accused started
to work there, and the most recent report of
the Oxford Team on the Genetic history of
the genetic subtype of the HIV virus from
the infected children, has been disregarded
by the court.
Libyan Court Decision on Bulgarian
Doctor and Nurses
Dr. André Wynen honoured
The World Medical Association’s Secretary-General Emeritus, Dr.
André Wynen has been honoured by his appointment as Grand
Officier de l’Ordre de Leopold, in recognition of his work and role
as Founder and Former President of the Chambres Syndicales des
Médecins Belges, Secretary General of the World Medical
Association and President of the Groupe Memoire.
Medical Ethics and Human Rights
90
In a joint statement about the decision by
the Libyan court, the International Council
of Nurses and the World Medical
Association said:
“We are appalled by the decision of the
Libyan court to sentence the five Bulgarian
nurses and the Palestinian doctor to death.
Today’s decision turns a blind eye to the sci-
ence and evidence that points clearly to the
fact that these children were infected well
before the medical workers arrived at the
hospital.
How many children will go on dying in
Libyan hospitals while the Government
ignores the root of the problem?
If there is any hope of justice for these nurs-
es and this doctor, we appeal to the Supreme
Court to again quash these death sen-
tences.”
As indicated above an appeal is to be
lodged once again and the Libyan Justice of
Minister, has been reported as saying
“There could be a complete revision of the
case”. From the comments emanating from
the rest of the world notably in the West, the
outcome of such review is likely to be more
diplomatic or political rather than ensuring
justice to the accused and a verdict, based
on all the evidence.
The whole medical profession and the rest
of the civilised world must surely be horri-
fied at this barbaric decision which clearly
flies in the face of the evidence and trans-
parent impartial administration of justice.
(see also Secretary General’s comment
p. 106)
WMA Policy Revision
Whilst it has not previously been our custom to reproduce all WMA Statements and
Declaration 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 in
South Africa (see page 93). As a result we have decided to publish some of the other
important documents in their revised form in addition to listing all the documents revised
or archived, in addition to the new policy adopted at this General Asembly. (all policy
documents are, of course, accessible at www.wma.net) – Editor
Adopted by the 43rd World Medical
Assembly Malta, November 1991 and edi-
torially revised at the 44th World Medical
Assembly Marbella, Spain, September
1992 and revised by the WMA General
Assembly, Pilanesberg, South Africa,
October 2006
Preamble
1. Hunger strikes occur in various contexts
but they mainly give rise to dilemmas in
settings where people are detained (pris-
ons, jails and immigration detention cen-
tres). They are often a form of protest by
people who lack other ways of making
their demands known. In refusing nutri-
tion for a significant period, they usually
hope to obtain certain goals by inflicting
negative publicity on the authorities.
Short-term or feigned food refusals
rarely raise ethical problems. Genuine
and prolonged fasting risks death or per-
manent damage for hunger strikers and
can create a conflict of values for physi-
cians. Hunger strikers usually do not
wish to die but some may be prepared to
do so to achieve their aims. Physicians
need to ascertain the individual’s true
intention, especially in collective strikes
or situations where peer pressure may be
a factor. An ethical dilemma arises when
hunger strikers who have apparently
issued clear instructions not to be resus-
citated reach a stage of cognitive impair-
ment. The principle of beneficence urges
physicians to resuscitate them but respect
for individual autonomy restrains physi-
cians from intervening when a valid and
informed refusal has been made. An
added difficulty arises in custodial set-
tings because it is not always clear
whether the hunger striker’s advance
instructions were made voluntarily and
with appropriate information about the
consequences. These guidelines and the
background paper address such difficult
situations.
Principles
2. Duty to act ethically. All physicians are
bound by medical ethics in their profes-
sional contact with vulnerable people,
even when not providing therapy.
Whatever their role, physicians must try
to prevent coercion or maltreatment of
detainees and must protest if it occurs.
3. Respect for autonomy. Physicians
should respect individuals’ autonomy.
This can involve difficult assessments
as hunger strikers’ true wishes may not
be as clear as they appear. Any deci-
sions lack moral force if made involun-
Medical Ethics and Human Rights
World Medical Association Declaration on Hunger Strikers
Medical Ethics and Human Rights
91
tarily by use of threats, peer pressure or
coercion. Hunger strikers should not be
forcibly given treatment they refuse.
Forced feeding contrary to an informed
and 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 must
exercise their skills and knowledge to
benefit those they treat. This is the con-
cept of ‘beneficence’, which is comple-
mented by that of ‘non-maleficence’ or
primum non nocere. These two con-
cepts need to be in balance. ‘Benefit’
includes respecting individuals’ wishes
as well as promoting their welfare.
Avoiding ‘harm’ means not only min-
imising damage to health but also not
forcing treatment upon competent peo-
ple nor coercing them to stop fasting.
Beneficence does not necessarily
involve prolonging life at all costs, irre-
spective of other values.
5. Balancing dual loyalties. Physicians
attending hunger strikers can experi-
ence a conflict between their loyalty to
the employing authority (such as prison
management) and their loyalty to
patients. Physicians with dual loyalties
are bound by the same ethical principles
as other physicians, that is to say that
their primary obligation is to the indi-
vidual patient.
6. Clinical independence. Physicians must
remain objective in their assessments
and not allow third parties to influence
their medical judgement. They must not
allow themselves to be pressured to
breach ethical principles, such as inter-
vening medically for non-clinical rea-
sons.
7. Confidentiality. The duty of confiden-
tiality is important in building trust but
it is not absolute. It can be overridden if
non-disclosure seriously harms others.
As with other patients, hunger strikers’
confidentiality should be respected
unless they agree to disclosure or unless
information sharing is necessary to pre-
vent serious harm. If individuals agree,
their relatives and legal advisers should
be kept informed of the situation.
8. Gaining trust. Fostering trust between
physicians and hunger strikers is often
the key to achieving a resolution that
both respects the rights of the hunger
strikers and minimises harm to them.
Gaining trust can create opportunities to
resolve difficult situations. Trust is
dependent upon physicians providing
accurate advice and being frank with
hunger strikers about the limitations of
what they can and cannot do, including
where they cannot guarantee confiden-
tiality.
Guidelines For The
Management Of Hunger
Strikers
9. Physicians must assess individuals’
mental capacity. This involves verifying
that an individual intending to fast does
not have a mental impairment that
would seriously undermine the person’s
ability to make health care decisions.
Individuals with seriously impaired
mental capacity cannot be considered to
be hunger strikers. They need to be
given treatment for their mental health
problems rather than allowed to fast in a
manner that risks their health.
10. As early as possible, physicians should
acquire a detailed and accurate medical
history of the person who is intending to
fast. The medical implications of any
existing conditions should be explained
to the individual. Physicians should ver-
ify that hunger strikers understand the
potential health consequences of fasting
and forewarn them in plain language of
the disadvantages. Physicians should
also explain how damage to health can
be minimised or delayed by, for exam-
ple, increasing fluid intake. Since the
person’s decisions regarding a hunger
strike can be momentous, ensuring full
patient understanding of the medical
consequences of fasting is critical.
Consistent with best practices for
informed consent in health care, the
physician should ensure that the patient
understands the information conveyed
by asking the patient to repeat back
what they understand.
11. A thorough examination of the hunger
striker should be made at the start of the
fast. 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 the
event of a prolonged fast should be
noted.
12. Sometimes hunger strikers accept an
intravenous saline solution transfusion
or other forms of medical treatment. A
refusal to accept certain interventions
must not prejudice any other aspect of
the medical care, such as treatment of
infections or of pain.
13. Physicians should talk to hunger strik-
ers in privacy and out of earshot of all
other people, including other detainees.
Clear communication is essential and,
where necessary, interpreters uncon-
nected to the detaining authorities
should be available and they too must
respect confidentiality.
14. Physicians need to satisfy themselves
that food or treatment refusal is the indi-
vidual’s voluntary choice. Hunger strik-
ers should be protected from coercion.
Physicians can often help to achieve
this and should be aware that coercion
may come from the peer group, the
authorities or others, such as family
members. Physicians or other health
care personnel may not apply undue
pressure of any sort on the hunger strik-
er to suspend the strike. Treatment or
care of the hunger striker must not be
conditional upon suspension of the
hunger strike.
15. If a physician is unable for reasons of
conscience to abide by a hunger strik-
er’s refusal of treatment or artificial
feeding, the physician should make this
clear at the outset and refer the hunger
striker to another physician who is will-
ing to abide by the hunger striker’s
refusal.
16. Continuing communication between
physician and hunger strikers is critical.
Physicians should ascertain on a daily
basis whether individuals wish to con-
tinue a hunger strike and what they want
Medical Ethics and Human Rights
92
to be done when they are no longer able
to communicate meaningfully. These
findings must be appropriately recorded.
17. When a physician takes over the case, the
hunger striker may have already lost
mental capacity so that there is no oppor-
tunity to discuss the individual’s wishes
regarding medical intervention to pre-
serve life. Consideration needs to be
given to any advance instructions made
by the hunger striker. Advance refusals
of treatment demand respect if they
reflect the voluntary wish of the individ-
ual when competent. In custodial set-
tings, the possibility of advance instruc-
tions having been made under pressure
needs to be considered. Where physi-
cians have serious doubts about the indi-
vidual’s intention, any instructions must
be treated with great caution. If well
informed and voluntarily made, howev-
er, advance instructions can only gener-
ally be overridden if they become invalid
because the situation in which the deci-
sion was made has changed radically
since the individual lost competence.
18. If no discussion with the individual is
possible and no advance instructions
exist, physicians have to act in what they
judge to be the person’s best interests.
This means considering the hunger strik-
ers’ previously expressed wishes, their
personal and cultural values as well as
their physical health. In the absence of
any evidence of hunger strikers’ former
wishes, physicians should decide
whether or not to provide feeding, with-
out interference from third parties.
19. Physicians may consider it justifiable to
go against advance instructions refusing
treatment because, for example, the
refusal is thought to have been made
under duress. If, after resuscitation and
having regained their mental faculties,
hunger strikers continue to reiterate
their intention to fast, that decision
should be respected. It is ethical to
allow a determined hunger striker to die
in dignity rather than submit that person
to repeated interventions against his or
her will.
20. Artificial feeding can be ethically
appropriate if competent hunger strikers
agree to it. It can also be acceptable if
incompetent individuals have left no
unpressured advance instructions refus-
ing it.
21. Forcible feeding is never ethically
acceptable. Even if intended to benefit,
feeding accompanied by threats, coer-
cion, force or use of physical restraints
is a form of inhuman and degrading
treatment. Equally unacceptable is the
forced feeding of some detainees in
order to intimidate or coerce other
hunger strikers to stop fasting. ■
The World Health Organization was urged
research institutions and companies to reg-
ister all medical studies that test treatments
on human beings, including the earliest
studies, whether they involve patients or
healthy volunteers. As part of the
International Clinical Trials Registry
Platform, a major initiative aimed at stan-
dardizing the way information on medical
studies is made available to the public
through a process called registration, WHO
is also recommending that 20 key details be
disclosed at the time studies are begun.
The initiative seeks to respond to growing
public demands for transparency regarding
all studies applying interventions to human
participants, known as clinical trials. Before
making the recommendations, the Registry
Platform 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 full
disclosure of key information at the time of
registration are fundamental to ensuring
transparency in medical research and fulfill-
ing ethical responsibilities to patients and
study participants,“ said Dr Timothy Evans,
Assistant Director-General of the World
Health Organization.
Although registration is voluntary, there is a
groundswell of policies aimed at spurring
registration of all clinical trials. In July
2005, for example, the International
Committee of Medical Journal Editors, a
group representing 11 prestigious medical
journals, instituted a policy whereby a sci-
entific paper on clinical trial results cannot
be published unless the trial had been
recorded in a publicly-accessible registry at
its outset.
Some groups have raised concerns that
these new requirements could jeopardize
academic or commercial competitive
advantage if they apply to preliminary trials
of new interventions. Similar concerns have
been voiced about the requirement to dis-
close certain items–such as the scientific
title of the study, the name of the treatment
being tested and the outcomes expected
from 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 open
process with all stakeholders. We look for-
ward to continued dialogue about trial reg-
istration and results reporting as we move
forward with the Registry Platform,“ said
Dr Ida Sim, Associate Director for Medical
Informatics at the University of California,
San Francisco and coordinator of the
Registry Platform initiative.
WHO announces new standards for
registration of all human medical research
WMA
93
The planned Registry Platform will not be a
register itself, but rather will provide a set
of standards for all registers. It has not only
standardized what must be reported to reg-
ister a trial but is creating a global trial iden-
tification system that will confer a unique
reference number on every qualified trial.
Currently, there are several hundred regis-
ters of clinical trials around the world but
little coordination among them. The
Registry Platform seeks to bring participat-
ing registers together in a global network to
provide a single point of access to the infor-
mation stored in them.
The WHO Registry Platform will launch a
web-based search portal where scientists,
patients, doctors and anyone else who is
interested can search among participating
registers for clinical trials taking place or
completed throughout the world. ■
Adopted by the 48th WMA General
Assembly, Somerset West, Republic of
South Africa, October 1996, and editorially
revised 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 competent
medical service and to report to the
appropriate authorities those physicians
who practice unethically and incompe-
tently or who engage in fraud or decep-
tion (International Code of Medical
Ethics); and
2. The physician should be free to make
clinical and ethical judgements without
inappropriate outside interference; and
3. Ethics committees, credentials commit-
tees and other forms of peer review have
been long established, recognised and
accepted by organised medicine to scru-
tinise physicians’ professional conduct
and, where appropriate, impose reason-
able restrictions on the absolute profes-
sional freedom of physicians; and
Reaffirming that:
4. Professional autonomy and the duty to
engage in vigilant self-regulation are
essential requirements for high quality
care and therefore are patient benefits
that must be preserved;
5. And, as a corollary, the medical profes-
sion has a continuing responsibility to
support, 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 service
should be considered distinct from com-
mercial goods and services, not least
because a physician is bound by specific
ethical duties, which include the dedica-
tion to provide competent medical prac-
tice (International Code of Medical
Ethics).
7. Whatever judicial or regulatory process
a country has established, any judgement
on a physician’s professional conduct or
performance must incorporate evalua-
tion by the physician’s professional
peers who, by their training and experi-
ence, understand the complexity of the
medical issues involved.
8. Any procedure for considering com-
plaints from patients which fails to be
based upon good faith evaluation of the
physician’s actions or omissions by the
physician’s peers is unacceptable. Such a
procedure would undermine the overall
quality of medical care provided to all
patients. ■
General Assembly Ceremonial Session
The General Assembly Ceremonial Session
was opened by the Chair of Council,
Dr. Yoram Blachar, following which the
official delegates from member states were
introduced to the President by the Secretary
General.
The President of the South African Medical
Association, Dr. J.P. Niekerk, in welcoming
participants, made reference to a statement
made by Archbishop Tutu that, while the
Church must not be an organ of the State it
must be the conscience of the State, like-
wise, National Medical Associations must
serve as the medical conscience of the State.
Hon. Edna Molewa, Premier of the North
West Province was then introduced by the
President, Dr. Letlape. Welcoming dele-
gates to South Africa, she made reference to
World Medical Association
World Medical Association 57th General
Assembly, Pilansberg, South Africa,
13–14 October 2006
WMA
94
the final report of the outgoing Secretary
General of the United Nations, Kofi Anan,
in which he emphasized the need for global
partnerships and improved coordination
and cooperation between nations She said
that the WMA was exactly the kind of
organisation needed to achieve this goal.
The world has an ambitious agenda in the
Millenium Development Goals. The health
profession must lead the way, helping gov-
ernments to understand that investing in
health is critical. NMAs must be partners
with governments in this regard, so that
budgets, policies and programmes ade-
quately prioritise the health of citizens.
Alongside this priority must be a concerted
effort to address the complex and multidi-
mensional problems of poverty. The rela-
tionship between poverty and disease
means that meeting this challenge is a mat-
ter of life and death. The Premier encour-
aged the General Assembly to examine
specifically the problems created by med-
ical migration, noting that Africa was suf-
fering the effects of aggressive recruitment
of physicians from wealthy countries. She
concluded by stating that there is no invest-
ment more important than the investment in
health and that the world’s physicians must
work with decision makers to ensure its
high placement in national agendas.
Presentation of Past-President’s Medal
The Chair of Council,Dr. Blachar, paying
tribute to the outgoing President of the
WMA, Dr. Kgosi Letlape said:
“It is with great admiration that I look back
upon Dr. Letlape’s career and various
achievements. Graduating MB., ChB at the
University of Natal and then pursuing his
specialist training in Ophthalmology in
Edinburgh, Scotland, Dr. Letlape became
the first black South African ophthalmolo-
gist in 1988, at a troubling time for the
nation of South Africa which was at the
height of its Apartheid era.
Since being elected chairperson of the
South African Medical Association in 2001,
a position he still holds today, he has dili-
gently worked towards providing public
healthcare for the 38 million South Africans
who cannot afford private funding.
In his attempts to address the HIV/AIDS
epidemic and erase the stigma attached to
the disease, he spearheaded the establish-
ment of the Tschepang Trust in 2002,
together with the Nelson Mandela
Foundation. The trust facilitates the treat-
ment of HIV-positive patients at specific
centres all over South Africa. Dr. Letlape
has also been outspoken on the issue of the
so-called “Brain Drain” phenomenon,
advocating the improvement of working
conditions in order to retain doctors, partic-
ularly those working in public health sys-
tems.
As part of the WMA, he served on the
working group for one of the WMA’s most
renowned documents, the Declaration of
Helsinki. Along with former WMA
Secretary General Dr. Delon Human, he has
made tremendous headway in the founding
of the African Regional WMA offices,
which will be holding their first annual
meeting next January. Dr. Letlape has
relentlessly worked to bring together the
various African Medical Associations, for
the purpose of getting Africa’s endemic
health problems placed on the international
health agenda. The grave disparities in
healthcare can now be addressed at interna-
tional level. As President of the WMA he
has been vocal in his support for including
Taiwan in the WHO, in order to forge a
global health system that can bypass poli-
tics and help countries around the world
prepare for and cope with pandemics. He
has been equally outspoken on the topic of
medical professionalism whereby he main-
tains that physicians should always work in
the best interests of their patients, as well as
training doctors to be good leaders in their
communities.”
Dr. Blachar formally thanking Dr. Letlape
on behalf of the World Medical Association,
then presented Dr. Letlape with a Past
President’s Medal and invited him to deliv-
er his Valedictory Address.
Valedictory Adress Of
Dr. K. Letlape
In his Valedictory Address, Dr. Letlape first
expressed his gratitude to the organisation
and its members for the privilege of serving
them. Continuing, he asserted that the
WMA must be the global champion of basic
health care for all, free at the point of deliv-
ery and called for an increased emphasis on
pubic health globally. Physicians must
engage in social and community affairs,
directly influencing policy to the greatest
extent possible. This includes involvement
in areas such as working to prevent armed
conflict, which is within the portfolio of the
health profession because of the devastating
effect of war on human health and on
national health systems. The profession
must not accept limited health care
resources as an unfortunate fact of human
life. Dr. Letlape stated that “We must bake
a bigger cake and ensure that it is shared
equitably”. This will require resourceful-
ness and leadership across medical disci-
plines. There must be commitment by
everyone to be part of the solution to the
global medical human resources problem.
Modern medicine must represent progress
across all boundaries, engaging stakehold-
ers at all levels, from national governments
to patients.
Installation of President
Dr. N. Araguman of the Malaysian Medical
Association, who had been elected by the
2005 General Assembly, then took the
Presidential Oath and was installed as the
58th President of the World Medical associ-
ation.
Presidential Address Of The
New President,
Dr. N. Arumugam
“It is a great honour and privilege to be
elected as the President of the World
Medical Association. I would like to thank
you for electing me and giving me the
opportunity to serve as the president of the
association.
The WMA in its mission statement clearly
states the objective to provide a forum for
its member associations to communicate
freely, to co-operate actively, to achieve
consensus on high standards of medical
ethics and professional competence, and to
promote the professional freedom of physi-
WMA
95
cians worldwide. The WMA is committed
to serve humanity by endeavouring to
achieve the highest international standards
in Medical Education, Medical Science,
Medical Art, Medical Ethics, and Health
Care for all people in the world.
The Association has been led by a series of
distinguished presidents who have promot-
ed the ideals of the WMA. Dr. Kgosi
Letlappe has continued in this tradition and
on his visits to numerous national medical
association meetings, he has in his fervent
speeches appealed to the membership for
strong commitment to the profession and
emphasised the importance of being united
and proactive. Dr.Yank Coble the immedi-
ate past president over the last couple of
years, has through the “Caring Physicians
of the World” initiative organised regional
meetings in different parts of the world to
bring the different associations of the vari-
ous regions together to communicate and
learn from one another. I would like to
thank The South African Medical
Association, especially the organising com-
mittee, for having successfully organised
this year’s meetings and social events. I
would also like to thank Dr. Otmar Kloiber
the Secretary General and the WMA secre-
tariat for their committed service and
smooth running of the General Assembly.
The World Medical Association which was
established after the Second World War by
twenty seven national medical associations,
now has a membership of over eighty
national medical associations. Recognising
the need to draw more of the many non-
member nations, the council, after much
deliberation, has revamped and streamlined
the subscriptions payable by member
organisations depending on economic status
of the country. It is earnestly hoped that this
will help to draw more national associations
to join the WMA in the coming years, and
boost the strength of the WMA and help to
enhance the cause of medicine.
In any large organisation generally, the big-
ger and more vocal members will tend to
dominate discussion and influence. The
establishment 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 with
council to find ways to stimulate contribu-
tion of some of the dormant and smaller
members of the association.
Many National Medical Associations are
unable to allot sufficient time to the con-
cerns and activities of the WMA as they
have their own demanding schedules and
activities. Many individual physicians of
National Medical Associations (NMAs) are
not aware of the workings and the signifi-
cance of the WMA. Physicians nowadays
belong to many different medical societies,
especially specialist/subspecialty societies
related directly to their work and they do
not see the immediate relevance of the
WMA. It is important for the development
and the importance of the WMA that
national associations highlight the activities
of the WMA in their newsletters, their web-
sites and in their activities whenever possi-
ble. It is also necessary to have prominent
visible links to the WMA website in the
homepages of member organisations. I
therefore strongly urge all of you to incor-
porate the activities of the WMA in as many
ways as possible in the activities of your
national associations, thus making the
WMA more visible to the physicians of the
world.
Ethics derived from a basic view of human-
ity, has been part of medical practice from
the beginning. Ethical medical practice
refers to the appropriate treatment of a
patient, maintaining a high standard of
medical ability and skills with a caring and
moral obligation. Doctors are taught to be
dedicated to the service of humanity and
subscribe to the caring spirit when entering
the profession of medicine. Medical prac-
tice has attracted much criticism about
unsympathetic personal uncaring attitudes
and inappropriate treatments. That this
probably applies to a small minority of doc-
tors compared with the huge number of
doctor-patient contacts each day, gets over-
looked and the profession as a whole is dis-
credited.
The WMA has emphasized the core values
of the profession of caring, ethics, science,
compassion and universal accessibility.
Over the years the association has achieved
reasonable success in promoting these val-
ues not only to the profession but also to the
public and relevant authorities. During the
last two years under the Caring Physicians
of the World initiatives doctors from vari-
ous countries were nominated, selected, and
recognised. A book published in conjunc-
tion with the initiative highlighted their
contribution to society. This was a worthy
project as it highlighted the caring aspect of
the profession. To continue this initiative
and to motivate more doctors to follow
these exemplary footsteps and to recognize
those who have dedicated their life to the
care of the needy it is time we institute a
World Physicians/Doctors Day. On this day
the WMA should honour a doctor from each
of the five regions of the world for their
care, 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 have
been remarkable discoveries and inventions
in medicine, which have led to unparalleled
improvement in the health of the world pop-
ulation. We are able to control and treat
deadly infectious diseases, which were
causing fatalities and unthinkable suffering
around the world, with newly discovered
medications. Through innovative proce-
dures and operations we are also able to
correct congenital abnormalities and
acquired disabilities. The medications and
treatment modalities have helped relieve
suffering, improve the quality of life of the
individual, the family and the nation.
Changes in the living standards of many
countries in the world further contributed to
healthier populations. Eradication of polio
and the discovery of medicines to treat
deadly infections gave hope and optimism
to the people of the world that they were
going to enjoy uninterrupted improving
good health.
These achievements and improvements
seem to have been short lived and the world
is again faced with new epidemics and chal-
lenges. The health of the population of the
world seems more vulnerable and more
hazardous than ever before in recent histo-
ry. The last decade has not only seen emer-
WMA
96
gence of deadly infections like AIDS
(Acquired Immunodeficiency Syndrome)
and SARS (Severe Acute Respiratory
Syndrome) but also of a chronic serious epi-
demic commonly termed as “life style dis-
eases“. The number of patients afflicted
with Obesity, Hypertension, Diabetes
Mellitus, Dyslipidaemia and related dis-
eases has been increasing at an alarming
rate the world over. This surge in life style
diseases has not been confined to the
wealthier and more developed countries but
has been spreading at an alarming rate in
the developing and poorer countries. The
current epidemic affecting people in the
prime of life, causes untold misery to indi-
viduals, families and countries. The
immense drain on the financial resources of
families and nations has jeopardised the
development of sustainable heath care sys-
tems in many countries.
As life style diseases are chronic in nature
and progression insidious, patient’s atten-
tion to the problem is delayed and aware-
ness is only drawn to the disease at a late
stage, making it complex and expensive to
treat. In many countries life style diseases
affect about 30% of the population, while in
some it affects almost 60% of the popula-
tion and is rising incessantly. Researchers
and pharmaceutical companies are trying to
develop new therapeutic medicinal com-
pounds to control and treat these conditions.
Though new medicines are necessary to
treat those already afflicted, the only sus-
tainable solution in overcoming this epi-
demic will be by concerted lifestyle
changes and instituting preventive mea-
sures. The WMA should through its various
member organisations lobby relevant
authorities and governments to emphasize
the necessity for change, as governments
are not doing enough. They have either not
recognised the enormity of the problem or
have been reluctant to face reality.
While many organisations have highlighted
the problem there have only been limited
results. It is now time for the WMA with the
National Medical Associations to launch a
rigorous effort to stress the importance, to
both the people and governments of the
world, of the need for global action.
Advocacy for diet modification, encourag-
ing physical activity, anti-smoking mea-
sures and regular medical examination
aimed at early preventive actions may look
daunting but without the immediate institu-
tion of these measures the world will with-
in the next decade or two face such an
enormous problem that it will not be able to
handle it.
The new millennium was awaited with
eagerness and globalisation was the buzz
word of the new century. Newer technolo-
gies especially electronic communication,
the internet, the media and air travel have
all contributed to shrinking the world at a
staggering pace. Nations were being more
connected and interdependent then ever
before. International business was thriving
and there was high expectation for improve-
ment of international understanding, coop-
eration and unity in the world. Increasing
pace of international travel, liberalisation of
national borders and increasing changing
migration patterns were moving the world
towards to a more homogenous society.
Suddenly the world was shattered by events
never seen before, turmoil set in and now
terror reigns. Ideological differences, reli-
gious extremism, racial confrontations, eco-
nomic disagreements have resulted in
extreme provocation and excessive retalia-
tions. These actions have divided the world
and ushered in an era of anguish and unpre-
dictability which has affected all of us in
many ways.
South Africa, which has probably experi-
enced one of the most traumatic periods in
modern history under the apartheid regime,
was liberated after a long and protracted
struggle. The liberation of South Africa and
the transition to a prosperous and successful
democracy gives hope that old differences
can be put aside and a new beginning bene-
fiting all can be established. The Centenary
celebration of the start of the civil rights
struggle, started by one of the pioneers in
the liberation struggles in South Africa
Mohandas Karamchand Gandhi, was held a
few weeks ago here in South Africa.
Mahatma Gandhi, as he has now come to be
known, 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 Gandhi
remained committed to non-violence and
truth, even in the most extreme situations.
Numerous medical groups through the
years have served in areas of disasters and
conflicts to help the needy and suffering,
irrespective of their allegiance to any polit-
ical or religious grouping. The events of the
last few years should make the profession
reflect on its role as curing the sick and use
its unique position to explore the greater
possibility of helping to re-establish unity
and harmony in the world and thus healing
wounds of the people, both physical and
mental.
Emergencies and crisis are a part of medical
practice and intermittent outbreaks of epi-
demics have occurred through out history.
What was new in the recent emergencies
was the scale and ferocity. The world in
general and the Asia pacific region in par-
ticular, has experienced unprecedented
calamities over the last five years. Natural
disasters – Tsunami and Katrina, the epi-
demics of Severe Acute Respiratory
Syndrome (SARS), Avian Flu, and man
made environmental disasters of flood and
haze – are continually threatening the health
of the world. Doctors and healthcare work-
ers have always been in the frontline treat-
ing and combating diseases with all the
inherent dangers. These disasters in general
and SARS in particular have startled and
alarmed the doctors and healthcare workers,
as many of them were struck by the illness.
Affected and battered countries around the
world urgently announced measures to
reduce the health consequences after each
episode. As of today, forests are being
destroyed and burned blatantly contrary to
international agreements; the haze is chok-
ing regions of the world, avian flu is smoul-
dering, and raging floods are causing havoc
in many areas. All these have not only
caused major damage and hardship but have
exposed huge populations to a myriad of
diseases. Environmental degradation in the
name of progress must be halted and health
must be given the rightful priority it
deserves.
These are challenging times to practice
medicine as the widening gap between what
WMA
97
medicine can do today and what the indi-
vidual or the society can afford has shaken
up 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 the
growing disparity of medicine in popula-
tions, due to the staggering cost of new
developments, all put the doctor in an unen-
viable position between the patient and the
systems. Increasing public demand for
medical services with counter demands by
payers to control costs, has put tremendous
pressure on doctors and healthcare profes-
sionals.
The patient’s quest for perfect results, often
not fathoming the unpredictability of med-
ical procedures, has put further tension on
the doctors while escalating medical indem-
nity costs. The increasing control of the pro-
fession by administrators, regulatory
authorities, governments and third party
payers, has caused much annoyance and
uneasiness. Private hospitals are generally
managed by commercial interests and the
difference between commercial values and
professional values often leads to conflicts.
It is important for doctors to be objective,
balanced and keep the interest of the
patients foremost at all times.
In spite of the uphill tasks and emerging
challenges, the profession must stand and
work together to achieve the best working
conditions for the profession while deliver-
ing efficient and caring treatments to
patients.”
The Chair of Council, then formally
adjourned the session.
General Assembly,
Adjourned Plenary Session
The Session was formally opened by the
Chair of Council, Dr. Y. Blachar. Apologies
were received from Drs. Wynen and
Odenbach.
The Credentials committee reported that 42
NMAs were registered, recognised and in
good standing with full voting rights, the
collective number of votes being 93.
After the adoption of Standing Orders, the
Minutes of the General Assembly in
Santiago, Chile 2005 were adopted.
There were three nominations for the post
of President 2007-2008 and Dr. J. Snaedel
(Icelandic Medical Association) was elect-
ed to this office.
Dr. Y.D. Coble, Past President, presented an
update of the Caring Physicians of the
World initiative. He reported that WMA
regional meetings had been held in Africa,
Latin America, Europe, North America and
the Asian and Pacific regions, under the
auspices of the project. He introduced Dr.
Malegapuru Makgoba, a South African
physician chosen for inclusion in the CPW
book and presented him with a copy of the
book.
The Assembly then received the Report of
Council. Under the reports of matters from
the Socio-Medical Affairs and of the
Medical Ethics Committees the recommen-
dations arising from the huge review of
WMA statements, recommendations and
policies occupied much of the time. The
decisions on the recommendations for revi-
sion adopted are listed below. Some recom-
mendations involved rescinding and archiv-
ing of previous statements. Details of the
recommended changes adopted are avail-
able on the WMA website (www.wma.net)
or from the WMA office.
New proposals adopted are shown in bold
below and the texts appear elsewhere in this
issue of the journal or the next issue. (See
also page 100–106)
Socio-Medical
Statement on Obesity – new (see page 107)
Statement on Medical Education –revision
Statement on Adolescent Suicide –revision
Statement on Traffic Injury – revision
Resolution on Tuberculosis – new
Resolution on Medical Assistance in Air
Travel – new
Statement on the Role of Physicians in
Environmental Issues – revision
Statement on Physicians and Public Health
– revision
Statement on Injury Control – revision
Statement on Access to Health Care – revi-
sion
Statement on Responsibilities of Physicians
in Preventing and Treating Opiate and
Psychotrophic Drug Abuse – revision
Statement on Alcohol and Road Safety –
revision)
Resolution on Child Safety in Airline Travel
– new
Statement on Avian and Pandemic
Influenza – new
Medical Ethics
Statement on HIV/AIDS and the Medical
Profession – revision
Resolution on Combating HIV/AIDS – new
Declaration of Venice on Terminal Illness –
revision
Statement on Human Organ Donation and
Transplantation – revision
Statement on Ethical Issues Concerning
Patients with Mental Illness Statement of
Sydney – revision
Declaration of Sydney on determination of
Death and the recovery of Organs – revision
Declaration of Oslo on Therapeutic
Abortion – revision
Statement on Assisted reproductive
Technologies – new
Statement on Animal Use in Biomedical
research – revision
Statement on Medical Ethics in the event of
Disasters – revision
Statement on Child Abuse and Neglect –
revision
Statement on Patient Advocacy and
Confidentiality – revision
International Code of Ethics – revision (see
page 87)
Declaration of Malta on Hunger Strikers –
revision (see page 90)
The Secretary General noted that there had
been no discernable consensus among
NMAs concerning rescinding the WMA
Resolution concerning Dr. Radovan
Karacic. The German Medical Association
informed the Assembly that the original rea-
sons for adopting the resolution had not
changed, Dr. Karacic had not surrendered
nor been captured and there had been no
justice for the crimes he is alleged to have
committed. The recommendation to rescind
and archive the Resolution Concerning Dr.
Radovan Karacic was not accepted by the
Assembly
WMA
98
The following resolutions were rescinded/
archived:
Education: the Declaration of Rancho
Mirage on Medical Education: Statement
on Drug Treatment of Tuberculosis: the
Twelve principles of Healthcare in any
National healthcare system: Use and misuse
of Psychotrophic drugs and on the prescrip-
tion of substitute drugs in the outpatient
treatment of Addicts to opiate drugs.
After the Chair of Ethics had explained that
a new document on telemedicine was being
prepared, the documents on Statements etc.
rescinded and/or archived including the
Fifth World Conference in Medical Use of
computer in Medicine: Statement on
Accountability, Responsibilities and Ethical
Guidelines in the Practice of Telemedicine
and the Statement on Home Medical
Monitoring, Telemedicine and Medical
Ethics, were rescinded and archived.
Finance and Planning
In matters relating to Finance and Planning
the Assembly adopted recommendations
relating to future General Assemblies
– that the theme for the Scientific Session of
the 2007 Assembly to be held in Copen-
hagen should be “Information Technology
in Health Care”
– that the 2009 General Assembly be held in
India.
The applications for membership from the
Medical Association of Namibia, the
Samoa Medical Association and that of
the Somali Medical Association were
approved.
Following a detailed overview of the 2005
Financial Statement and the 2007 Budget,
both the 2005 Statement and the 2007
Proposed Budget were approved.
The proposed amendment of the Bylaws to
allow a new differentiated dues structure
accepted in principle in 2005 in Santiago,
were formally adopted and the Secretary
General reported that the new system would
be reviewed annually by Council and every
five years by the General Assembly.
Despite some discussion as to whether the
proposal to impose a six year limit on the
number of consecutive years an individual
can serve as Chair or Vice-Chair of Council
or as Treasurer should be reduced to four
years, the six year proposal was adopted.
The following Resolution introduced by the
Japan Medical Association on North
Korean Nuclear Testing was adopted by the
Assembly
Following this, the rest of the Council
Report was adopted.
(for Resolutions adopted by the Council see
page 99)
Associate Members
The Associates’ members report presented
by Dr. Dumont, reported that in the absence
of Dr. Franzblau whose apologies were
received, the motions he had submitted were
deferred. No new proposals from Associate
members had been received. The Associates
noted that their proposal for a statement on
“Child Safety in Airline Travel” had been
forwarded to the Assembly for adoption.
Drs. Fuchs and Mot were elected as the two
representatives. The report of the Associate
Members’ meeting was received.
Open Session
During this session when delegates were
invited to present matters of importance to
the medical profession which needed to be
brought to the attention of the WMA,
NMAs made the following points:
The Hong Kong Medical Association
expressed concern about the trend for gov-
ernments to encroach on self-regulation by
the medical profession. This they consid-
ered presents a serious threat to profession-
al autonomy. These concerns were shared
by the Australian Medical Association who
offered to cooperate with WMA activity to
defend medical professionalism.
The Bolivian Medical Association reported
concerns about the by-passing of standard
accrediting processes as a consequence of
an agreement between the Bolivian and
Cuban governments. This was supported by
the Spanish and Uraguayan Medical
Associations. The American Medical
Association announced its intention to sub-
mit an emergency resolution on this topic to
the Council meeting immediately following
the General Assembly (see page 99).
The New Zealand Medical Association, in
relation to the harvesting of organs and
transplantation in China, expressed concern
that the core issue, namely that informed
consent cannot be obtained from con-
demned prisoners, was being lost in the
WMA’s diplomatic approach to the prob-
lem. It felt that the Chinese Medical
Association should publicise the position
taken that condemned prisoners are in no
position to give informed consent, and pro-
vide evidence of its efforts to educate its
members of this fact. The Chair of Council
informed the Assembly that a WMA delega-
tion will meet with members of the Chinese
Medical Association to discuss many sub-
jects, with the hope that the outcome of the
meeting would be a documented mutual
agreement or memorandum, which would
be presented to Council at its next session.
The Phillipine Medical Association
informed the General Assembly that the
present health care budget in their country
was less than 1% of GDP. This underinvest-
World Medical Association
Resolution On North
Korean Nuclear Testing
Adopted by the WMA General
Assembly, Pilanesberg, South Africa,
October 2006
“RECALLING the WMA Declaration
on Nuclear Weapons adopted at the
WMA General Assembly in Ottawa,
Canada, in October 1998; the WMA:
Denounces North Korean nuclear testing
conducted at a time of heightened global
vigilance on nuclear testing and arsenals;
1) Calls for the immediate abandonment
of the testing of nuclear weapons; and
2) Requests all member National
Medical Associations to urge their
governments to understand the
adverse health and environmental
consequences of the testing and use
of nuclear weapons.”
WMA
99
ment was compromising patient care. It has
resulted in massive unemployment of health
professionals, causing some physicians to
leave the country to work as nurses else-
where.
The Canadian Medical Association
expressed support for the establishment of
an annual “World Doctors’ Day” an idea
raised in the WMA President’s speech.
The Secretary General referred to the fact
that the American Medical Association
(AMA) had provided important assistance
to the WMA for many years through offer-
ing the services of various staff members to
serve as the WMA Legal Advisor. While
they would continue to provide corporate
legal services to the WMA, especially on
issues arising from WMA’s corporate status
as a US corporation, they would no longer
provide a legal adviser during WMA meet-
ings. The Secretary General in thanking the
AMA for its invaluable contribution
referred in particular to the work of the
most recent WMA Legal Adviser, Sharon
Ostrowski, who was no longer with the
AMA. The General Assembly agreed a note
of appreciation to Ms Ostrowski which the
Secretary General will convey to her. He
also thanked Ms Leah Wapner of the Israel
Medical Association for serving as the
Legal adviser during this Assembly.
He also announced that that Dr. Alan Rowe
who had served as Editor of the World
Medical Journal had retired and that a
search for his replacement was almost com-
pleted.
It was noted that Dr. Rowe could not attend
the meeting for health reasons. The General
Assembly thanked Dr. Rowe for his
engagement and dedication to the WMA
and his excellent work in developing the
WMJ. The General Assembly agreed a note
of warm appreciation to Dr. Rowe which
the Secretary General agreed to convey to
him.
Informing the General Assembly that Dr.
John Williams, WMA Ethics Adviser would
end his tenure as a staff member at Ferney-
Voltaire in December, although he would
continue to advise the WMA on ethical
issues. Paying tribute to Dr. William’s, he
said 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 his
hope that continuing to work together
would assist in eventually growing the
Ethics Unit into a WMA Ethics Institute.
The Assembly joined in a Standing ovation
to Dr. Williams for his tireless efforts and
outstanding contributions.
Closing the 2006 WMA General Assembly
the Chair of Council thanked the South
African Medical Association for its gener-
ous hospitality. He also recognised the work
of the Secretary General, the staff and the
interpreters.
During the meeting of the 175th Council in
Pilansberg,October 2006, the following two
Council resolutions were adopted:
Council Resolution In Sup-
port Of The Bolivian Medical
Association
“There are credible reports that arrange-
ments between the Cuban government and
the Bolivian government to supply Cuban
physicians to Bolivia are bypassing systems
established to protect patients that have
been set up to verify physicians’ credentials
and competence.
The World Medical Association is signifi-
cantly concerned that patients are put at risk
by unregulated medical practices, including
the provision of drugs and medical supplies
that are improperly labelled and of uncer-
tain origin.
There already exists a duly constituted and
legally authorized Bolivian Medical
Association, which is charged with the reg-
istration of physicians and which is required
to be consulted by the Bolivian Ministry of
Health.
Therefore, the WMA:
1) Condemns any collusion of two coun-
tries in policies and practices that disrupt
the accepted standards of medical cre-
dentialing and medical care;
175th WMA Council Meeting Pilansberg,
South Africa 2006
2) Calls upon the Bolivian government to
work with the Bolivian Medical
Association on all matters related to
physician certification and the practice
of medicine and to respect the role and
rights of the Bolivian Medical
Association;
3) Urges, as a matter of utmost concern,
that the Bolivian government respect the
WMA International Code of Medical
Ethics that guides the medical practice of
physicians all over the world.“
Council Resolution On Legis-
lation Banning Smoking In
Public Places
“Recognizing the abundant evidence link-
ing adverse health outcomes and exposure
to 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 and
French physicians on the introduction of
legislation that would ban smoking in pub-
lic areas; and
Urges other National Medical Associations
to advocate for similar legislative changes
in their own countries if such legislation
does not exist.“
WMA
100
is common. It is anticipated that H5N1
will continue to spread along the migra-
tory pathways of wild birds. Most
human infections have occurred in rural
areas where freely-roaming small poul-
try flocks are kept.
4. HPAI is controlled by rapidly destroy-
ing all infected and/or exposed birds, by
proper disposal of the carcasses, and by
quarantining and rigorous disinfection
of farms. In order to contain an out-
break, aggressive measures are needed
immediately after the outbreak is detect-
ed.
5. Human pandemic influenza occurs three
to four times a century and can take
place in any season, not just winter.
Pandemic influenza results from the
emergence of a new human influenza
strain to which no human immunity
exists. This new human pandemic strain
can arise from either avian influenza
strains or from influenza viruses infect-
ing swine and potentially other mam-
malian species. It is usually associated
with a higher severity of illness and,
consequently, a higher risk of death. All
age groups may be at risk, and experts
predict an infection rate of 25-50% of
the population, depending on the sever-
ity of the strain. Since the virus strain
cannot be accurately predicted, a vac-
cine against pandemic flu may not be
available until several months after the
pandemic begins. A major factor in pro-
tecting populations will be the time
from emergence of a new strain to the
development and manufacture of vac-
cine. It is hypothesized that use of anti-
virals may control the progression of a
pandemic following its emergence, so
adequate supplies of anti-virals are
important. At all phases of a pandemic
outbreak, but especially during the peri-
od when vaccine is unavailable, infec-
tion control is critical.
6. Health officials are concerned that avian
influenza, if given the right opportuni-
ties, could mutate to form a new strain
of human influenza virus against which
humans have no immunity or existing
vaccine – a pandemic strain. It is appar-
ent that H5N1 has the capacity to direct-
ly jump the species barrier and cause
serious disease in humans but thus far,
H5N1 has demonstrated very limited, if
any, human transmission potential. A
new pandemic virus could develop if a
human became simultaneously infected
with H5N1 and a human influenza
virus, resulting in gene swapping. Also,
the H5N1 virus could mutate on its
own. With this new virus strain, direct
human-to-human transmission could
result, and if the virus remains highly
pathogenic, a pandemic with high mor-
tality rates could occur. This is believed
to have happened in the worst pandem-
ic of the 20th century, the “Spanish Flu”
of 1918, that killed 50 million people
worldwide.
7. Even though the H5N1 virus is not easi-
ly transmitted to humans, any H5N1
human infection provides an opportuni-
ty for co-existence with a human
influenza virus. Consequently, the World
Health Organization (WHO) and other
health organizations recommend that
any person coming in contact with
infected poultry receive the current
annual flu vaccine. Since it is not yet
known whether residual immunity to the
N1 component of the annual vaccine
provides any immunity to H5N1, there is
no way to accurately predict the severity
of the next pandemic. It is important to
recognize that while there is current con-
cern surrounding H5N1, a pandemic
influenza strain may not arise from
H5N1 but may come from another HPAI
strain. Regardless of this, the odds are
great that another pandemic will occur.
Principles of Pandemic
Influenza 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 to
National Medical Associations and
physicians on how they should be
involved in their respective country’s
pandemic planning process. It also
encourages governments to involve
their National Medical Associations
when planning for pandemic influenza.
Finally, it provides broadly stated rec-
ommendations about activities that
physicians should consider in preparing
themselves for pandemic influenza.
Avian Influenza versus
Pandemic Influenza
2. Avian influenza (bird flu) is a conta-
gious common viral infection of birds
and, less commonly, pigs. Two forms
have been identified: less pathogenic
avian influenza (LPAI) and highly path-
ogenic avian influenza (HPAI), which is
extremely contagious and has nearly a
100% mortality rate in birds. Avian
influenza viruses differ from human
influenza viruses. While avian influenza
viruses do not normally infect humans,
since 1997 several cases of human
infection have been documented.
3. The current H5N1 HPAI virus is a sub-
type of influenza type A viruses and was
first isolated from South African terns in
1961. The current outbreak started in
late 2003 and early 2004 in eight coun-
tries in Asia. While originally reported
as controlled, since June 2004 new out-
breaks of H5N1 have reappeared.
Migratory and smuggled birds are like-
ly to be responsible for the spread of
H5N1. The infected birds shed large
quantities of virus in their feaces, and
exposure to infected droppings or to
environments contaminated by the virus
WMA New Statements
WMA Statement on avian and
pandemic influenza
WMA
101
an influenza pandemic. It has defined
phases in the evolution of a pandemic
that 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 the
national government, but physicians
should be involved at all stages. While
each nation will have unique situations
to 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 pandemic
planning is essential. Depending
on these goals, the prioritization
and use of vaccines and antivirals
will vary. For example, a goal of
reducing morbidity and mortality
due to influenza will have very dif-
ferent planning criteria from a goal
of preserving societal infrastruc-
ture.
ii.Defining the nation’s needs in the
event of a pandemic will require
making some basic assumptions
about the severity of the pandemic
in the at nation. Based upon that
assumption, it will then be possible
to make some predictions about
the issues and needs facing the
country. It will be useful to consult
with other nations that have pre-
pared pandemic plans to see what
challenges 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, involve
those in the private sector who will
be managing the pandemic on the
ground, particularly physicians, in
the decision-making process.
i. The administration of millions of
doses of antivirals and vaccine to
the management of surge capacity
and hospital beds will all require
specific participation of those most
knowledgeable and involved in the
process.
c) Prepare risk communication and cri-
sis communication strategies and
messages in anticipation of public
and media fear and anxiety.
d) Provide guidance and timely infor-
mation to regional health depart-
ments, health care organizations, and
physicians. Utilize physicians as
spokespeople to explain the medical
and ethical issues to the public.
Ensure that communications mecha-
nisms and infrastructure continue to
function efficiently.
i. As planning proceeds, timely and
clear information not only of the
plan, but also of the rationale
behind decisions, needs to be made
available to public health authori-
ties and the medical establishment
as well as to the public. Physician
leaders in a community are well-
respected and frequently can serve
as excellent spokespersons to edu-
cate the public about the issues
surrounding pandemic planning.
Public feedback into important
decisions that may have moral and
ethical implications will help
secure public acceptance of the
plan. For example, holding a pub-
lic engagement process to assess
the public’s opinion about
rationing of vaccine during a pan-
demic can be useful.
ii.It is important that government
representatives and physicians
speak with one voice in order to
avoid confusion and panic during a
pandemic 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 complexity
from local decisions to close pub-
lic areas, to national decisions
regarding border closings and/or
quarantine/isolation of exposed/
infected citizens. The legal and
ethical issues surrounding these
decisions need to be in place prior
to a pandemic.
f) Determine the order of importance
for use of scarce resources such as
vaccines and antivirals, based on
pandemic response goals. Priority
groups chosen for vaccine should be
those that help maintain essential
community services and those at
highest risk.
g) Do not put physicians in the position
of being responsible for decisions
regarding the rationing of vaccine,
antivirals and other scarce resources
during a pandemic. Those decisions
must be made by the government.
h) Outline coordination and implemen-
tation of a response by stages of the
pandemic.
i. Depending on the size of a coun-
try, this response may be at a
national level or at a regional level.
Large countries may see the pan-
demic occur in waves in which
case affected regions will need to
have their own response ready to
be implemented.
i) Consider the surge capacity of hospi-
tals, laboratories, and the public
health infrastructure and improve
them if necessary. Prepare for
absences of key staff and the need to
maintain health services for condi-
tions other than influenza.
j) Prepare for the psychosocial impact
on health care workers in managing
the waves of a pandemic.
k) Consider whether the safety of those
in facilities managing the pandemic
must be ensured, such as police pro-
tection of the supply chain for vac-
cines and antivirals. Address what
might be needed to control a pan-
demic in the absence of a vaccine.
l) Assess whether there is sufficient
funding available to adequately pre-
pare for pandemic influenza.
i. Political will to fund public health
preparedness is essential. Resources
spent on pandemic planning should
be framed in the context of general
preparedness; pandemic prepared-
ness and public health preparedness
share many of the same issues.
m)Identify key issues that remain to be
resolved, which may include manage-
ment of patients in the community,
triage in hospitals, ventilation man-
agement, safe handling of bodies, and
death investigations and reports.
WMA
102
The Role of the National Medical
Association (NMA)
10. In any disaster situation or infectious
disease outbreak, physicians and their
professional organisations will be chal-
lenged to continue to provide needed
care to the vulnerable and sick, as well
as to aid in the emergency response
called for in the specific situation. The
following issues should be considered
in this regard:
a) NMAs should have their own organi-
zation-specific business contingency
plan in place to ensure continued
support of their members.
i. Many existing plans anticipate dis-
ruptions such as fires, earthquakes,
and floods that are geographically
restricted and have fairly well
defined timeframes. However,
pandemic influenza planning
requires assumptions that the
influenza will be widely dispersed
geographically and will potentially
last many months.
b) NMAs should clearly identify their
responsibilities during a pandemic.
i. The NMA should actively seek
participation in the nation’s pan-
demic planning process. If this is
achieved, the NMA’s responsibili-
ties will also be clearly defined
both to its physicians as well as to
the government.
c) For effective global pandemic
influenza planning, NMAs should
collaborate and network with NMAs
from other countries.
i. Many NMAs have already been
involved in their countries’ pan-
demic planning process.
Challenges and key roles for the
NMA that have been identified
should be shared.
d) NMAs should have an essential role
in communicating vital information:
i. to the public. As the authoritative
medical voice, an NMA engen-
ders public trust and should use
that trust to communicate accurate
and timely information regarding
pandemic planning and the cur-
rent state of the pandemic to the
public;
ii. between authorities and physi-
cians, and between physicians in
affected areas and their colleagues
elsewhere;
iii.Between health care profession-
als. NMAs should work with
other health care provider organi-
zations (e.g., nurses, hospital
groups) to identify common
issues and congruent policies and
messages regarding pandemic
preparedness and response.
e) NMAs should offer training semi-
nars and clinical support tools, such
as online and e-published self-help
training materials, for physicians and
regional medical associations.
i. Such training/tools should consid-
er how, in a worst-case pandemic
scenario, physicians will manage
respiratory crises without intensive
or critical care facilities. Training
should also be given in triage
strategies and how infected
patients should be counselled.
f) NMAs should consider what new
programs and services they might
offer during a pandemic, such as
coordination or provision of mental
health crisis support programs for
affected members and their families,
facilitation of health emergency
response teams, emergency locum
relief, and facilitation of equipment
supply lines.
g) NMAs should be involved in and
support the development and imple-
mentation of government plans while
still considering their own profes-
sional code of ethics. They should
monitor and assess the implementa-
tion of said plans to ensure that as
pandemic outbreaks cycle through
their natural history, health interests
remain paramount.
h) NMAs should advocate for adequate
government funding to prepare for
pandemic influenza.
i) NMAs should anticipate the different
practice environments that may
evolve during pandemic conditions
and be prepared to discuss liability
and related issues with health author-
ities and advise members on such
issues.
j) NMAs should be prepared to advo-
cate on behalf of members who, dur-
ing a pandemic, will have rapidly
emerging professional needs that
must be met, and on behalf of
patients and the public who will be
affected by the unfolding events.
The Role of the Physician
11. Physicians will be the first point
of contact and source for advice for
many as a pandemic evolves. The
following are broad issues that
physicians should consider in the
event of a pandemic:
a) Be sufficiently educated about pan-
demic influenza and transmission
risks.
i. Communication about the actual
risks of pandemic influenza is
important to impart a sense of
urgency without creating undue
public alarm. Consider active
physician participation in the
media response to a pandemic.
b) Be vigilant for the possibility of
severe or emerging respiratory dis-
eases, especially in patients who
have recently travelled international-
ly.
i. As with any emerging infection,
the astute physician is one of the
important surveillance tools for
detecting and managing an out-
break.
c) Plan for how to manage high-risk
patients in the office/clinic setting
and communicate the plan to clinic
staff.
i. Isolation and infection control
plans must be available and staff
should be well-versed in them. Be
aware of what regional public
health authorities are requesting be
done with potential patients and
their exposed contacts.
d) Plan how to concurrently manage
patients with chronic illnesses who
require routine medical manage-
ment.
e) Plan accordingly for possible inter-
ruptions of essential services like
sanitation, water, power, and disrup-
tions to the food supply. Plan for the
possibility of staff shortages because
WMA
103
of personal illness and/or the care of
next-of-kin who are ill.
i. It is vital to have contingency
plans in place to deal with possible
societal disruption. Recognize that
the usual sources of these essential
services may not be functioning so
that identifying alternative sources
for these essentials may be neces-
sary.
f) Prepare educational materials for
patients 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 quarantine
and isolation will make a physi-
cian’s job easier should s/he have
to utilize such procedures when a
pandemic occurs.
g) Remain involved in local pandemic
planning efforts and understand how
the 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 be
closely involved in the planning
process. They must continuously
provide feedback as to what is
logistically possible regarding
physicians’ efforts on the ground
when a pandemic arrives.
h) Physicians have an ethical responsi-
bility to provide services to the
injured or ill. They should have
resources in place in the event they
and/or their own families become
infected.
i. A physician will have a strong
public health duty in the time of a
pandemic and his/her services
will be critical at a time when
surge capacity will be stressed.
Physicians should make arrange-
ments for the care of their families
and dependents in the event of a
pandemic.
ii. Physicians should take all mea-
sures necessary to protect their
own health and the health of their
staff.
iii.Physicians can also consult the
WMA Statement on Medical
Ethics in the Event of Disasters
for additional guidance.
i) Develop a clinic plan to decrease
potential for contact including isola-
tion areas for infected patients, use of
close-fitting surgical masks, desig-
nating separate blocks of time for
non-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. Provide
signage in the office instructing
patients on respiratory hygiene prac-
tices; provide tissues, receptacles for
their disposal, and hand hygiene
materials in waiting areas and exam-
ination rooms.
k) Get vaccinated against annual
influenza each year and urge all staff
to be vaccinated.
i. Annual influenza readiness goes a
long way for pandemic prepared-
ness. Additionally, it is possible
that components in the annual vac-
cine (e.g., N1) may provide some
immunity against H5N1.
l) Work to ensure that the office/clinic
has access to adequate supplies of
antibiotic and antiviral medications
as well as commonly prescribed
drugs such as insulin or warfarin, in
case the pharmaceutical supply line
is disrupted.
Recommendations
12. That the WMA increase its collabora-
tion with the WHO on pandemic plan-
ning and commit itself to becoming an
important participant in the decision-
making process.
13. That the WMA communicate to the
WHO its capabilities and the capabili-
ties of its NMA members to provide a
credible voice that can efficiently reach
many practising physicians.
14. That the WMA acknowledge that
although pandemic planning is a coun-
try-specific task, it can provide general
principles for guidance. Additionally,
the WMA can provide basic advice that
can be given by its member NMAs to
practising physicians.
15. That the WMA establish an operational
capacity to develop and maintain emer-
gency communication channels
between the WMA and NMAs during a
pandemic.
16. That the WMA provide timely evi-
dence-based control measures to coun-
tries with no or limited or no up-dated
information about pandemics.
17. That NMAs be actively involved in the
national pandemic planning process.
18. That physicians participate in local pan-
demic planning efforts and be involved
in communicating vital information to
the public.
Adopted by the WMA General Assembly,
Pilanesberg, South Africa, October 2006
Preamble
1. According to the World Health
Organization, tuberculosis is a problem
affecting over 9 million people every
year and ranks among the leading infec-
tious diseases with an annual incidence
rate of 1%. The Eastern European
region is particularly affected.
2. In developing countries, the incidence
of tuberculosis has risen dramatically
due mainly to its prevalence in areas
with a high rate of HIV/AIDS. The
WMA Resolution on tuberculosis
4. Even well-trained flight personnel are
limited in their knowledge and experi-
ence and cannot offer the same assis-
tance as a physician or other certified
health 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 about
providing assistance due to uncertainty
regarding legal liability, especially on
international flights or flights within the
United States. While numerous airlines
provide some kind of liability insurance
for medical professionals and lay per-
sons who will provide voluntary assis-
tance during flight, this is not always the
case and even where it does exist, the
terms of the insurance cannot always be
adequately explained and understood in
a sudden medical crisis. The financial
and professional consequences of litiga-
tion against physicians who offer assis-
tance can be very costly.
6. Some important steps have been taken
to protect the life and health of airline
passengers, yet the situation is far from
ideal and needs improvement. Many of
the major problems could be mitigated
by simple actions taken by both airlines
and national legislatures, ideally in
cooperation with one another and with
the International Air Transport
Association (IATA) to arrive at coordi-
nated and consensus-based international
policies and programs.
7. National Medical Associations have an
important leadership role to play in pro-
WMA
104
increased movement of populations has
also exacerbated the problem.
3. The multi-resistant forms of tuberculo-
sis, a by-product of original bacilli
resistant to the action of the main tuber-
culosis medicines, also present great
difficulties in controlling the disease.
4. Radiological detection and sputum
examination 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 a
strategy is particularly efficient in pre-
venting epidemics.
6. The reactivation of screening and fol-
low-up programmes and the application
on a large scale of rapid and strictly
supervised daily treatment should help
address the epidemic.
7. The vaccination policy for BCG (bacille
Calmette-Guérin) should be targeted at
children from their first vaccination.
Resolutions
8. The World Medical Association, in con-
sultation with the WHO and national
and international health authorities and
organisations, will continue to work for
the improvement of tuberculosis treat-
ment and surveillance and will also pro-
mote surveys of individual cases, the
reactivation of screening and surveil-
lance programs, and the large-scale
application of daily care delivery and
treatment supervision.
9. The WMA supports calls for adequate
financial, material and human resources
for tuberculosis and HIV/AIDS preven-
tion, including adequately trained health
care providers and adequate public
health infrastructure, and will partici-
pate with health professionals in provid-
ing information on tuberculosis and its
treatment.
10. The WMA encourages continuing pro-
fessional development for healthcare
professionals in the field of tuberculo-
sis. Specialized courses on multi-drug-
resistant TB are particularly important.
11. The WMA calls on its National Member
Associations to support the WHO in its
DOTS strategy and in other work to
promote the more effective manage-
ment of tuberculosis. ■
Adopted by the WMA General Assembly,
Pilanesberg, South Africa, October 2006
1. Air travel is the preferred mode of long
distance transportation for people across
the world. The growing convenience and
affordability of air travel has led to an
increase in the number of air passengers,
including older passengers and other
individuals at increased risk for health
emergencies. In addition, long-duration
flights are common, increasing the risk
of in-flight medical emergencies.
2. The environment in normal passenger
planes is not conducive to the provision
of quality medical care, especially in the
case of medical emergencies. Noise and
movement of the plane, a very confined
space, the presence of other passengers
who may be experiencing stress or fear
as a result of the situation, the insuffi-
ciency or complete lack of diagnostic
and therapeutic materials and other fac-
tors create extremely difficult condi-
tions for diagnosis and treatment. Even
the most experienced medical profes-
sional is likely to be challenged by these
circumstances.
3. Most airlines require flight personnel to
be trained in basic first aid. In addition,
many provide some degree of training
beyond this minimum level and may
also carry certain emergency medicines
and equipment on board. Some carriers
even have the capacity to provide
remote ECG reading and medical coun-
selling services.
WMA Resolution on medical assistance
in air travel
WMA
105
moting measures to improve the avail-
ability and efficacy of in-flight medical
care.
8. Therefore the World Medical
Association calls on its members to
encourage national airlines providing
medium and long range passenger
flights to take the following actions:
a) Equip their airplanes with a suffi-
cient and standardised set of medical
emergency materials and drugs that:
• are packaged in a standardised and
easy to identify manner;
• are accompanied by information
and instructions in English as well
the main languages of the coun-
tries of departure and arrival; and
• include Automated External
Defibrillators, which are consid-
ered essential equipment in non-
professional settings.
b) Provide stand-by medical assistance
that can be contacted by radio or tele-
phone to help either the flight atten-
dants or to support a volunteering
health professional, if one is on
board and available to assist.
c) Develop medical emergency plans to
guide personnel in responding to the
medical needs of passengers.
d) Provide sufficient medical and
organisational instruction to flight
personnel, beyond basic first aid
training, to enable them to better
attend to passenger needs and to
assist medical professionals who vol-
unteer their services during emergen-
cies.
e) Provide insurance for medical pro-
fessionals and assisting lay personnel
to protect them from damages and
liabilities (material and non-materi-
al) resulting from in-flight diagnosis
and treatment.
9. The World Medical Association calls on
its members to encourage their national
aviation authorities to provide yearly
summarised reports of in-flight medical
incidents based on mandatory standard-
ised incident reports for every medical
incident requiring the administration of
first aid or other medical assistance
and/or causing a change of the flight.
10. The World Medical Association calls on
its members to encourage their legisla-
tors to enact legislation to provide
immunity from legal action to physi-
cians who provide emergency assis-
tance in in-flight medical incidents.
11. In the absence of legal immunity, the
airline must accept all legal and finan-
cial consequences of providing assis-
tance by a physician.
12. The World Medical Association calls on
its 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 the
development of training programs
where they do not exist; and encour-
age physicians to discuss potential
problems with patients at high risk
for requiring in-flight medical atten-
tion prior to their flight.
13. The World Medical Association calls on
IATA to further develop precise stan-
dards in the following areas and, where
appropriate, work with governments to
implement these standards as legal
requirements:
a) medical equipment and drugs on
board medium and long range
flights;
b) packaging and information materials
standards, including multilingual
descriptions and instructions in
appropriate languages;
c) medical emergency organisation pro-
cedures and training programs for
medical personal. ■
Adopted by the WMA General Assembly,
Pilanesberg, South Africa, October 2006
1. Whereas air travel is a common mode of
transportation and is used by people of
all ages every day;
2. Whereas high standards of safety for
adult passengers in air travel have been
achieved;
3. Whereas strict safety procedures are
being followed in air travel that greatly
increase the chance of survival during
emergency situations for properly
secured adults;
4. Whereas infants and children are not
always guaranteed adequate and appro-
priate safety measures during emer-
gency situations in aircraft;
5. Whereas restraint and safety systems for
infants and children have been success-
fully tested to reduce the risk of suffer-
ing injuries during emergency situations
in aircraft;
6. Whereas child restraint systems have
been approved for usage in standard
passenger aircrafts and successfully
introduced by several airlines;
Therefore, the World Medical Association
7. Expresses grave concern regarding the
fact that adequate safety systems for
infants and children have not been gen-
erally implemented;
8. Calls on all airline companies to take
immediate steps to introduce safe, thor-
oughly tested and standardized child
restraint systems;
9. Calls on all airline companies to train
their staff in the appropriate handling
and 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 restraint
systems; and
11. Calls on national legislators and air
transportation safety authorities to:
WMA Resolution on child safety
in air travel
From the Secretary General
106
a) require for infants and children, as a
matter of law, safe individual child
restraint systems that are approved
for use in standard passenger air-
craft;
b) ensure that airlines provide child
restraint systems or welcome passen-
gers using their own systems, if the
equipment is qualified and approved
for the specific aircraft;
c) ban the usage of inappropriate “Loop
Belts” frequently used to secure
infants and children in passenger air-
craft;
d) provide appropriate information
about infant and child safety on
board of aircraft to all airline passen-
gers. ■
health professions enjoying some degree of
freedom for self-regulation the same danger
of dismantlement exists.
The argument for doing so is always the
same: Self-governing regulatory bodies are
not capable of doing the things necessary to
regulate the profession and to protect the
public.
And indeed, we often are desperate about
our (in-)capabilities of self-regulation. We
know where we failed and we sometimes
feel helpless ourselves. We tend to narrow
regulation, to install systems of recertifica-
tion, validation and assessment, we review
and sometimes punish. But even so, all this
seems not to be enough.
As medicine gets more effective and effi-
cient every day, the degree of complications
and the concomitant dangers grow as well.
While everybody accepts new treatments
and new approaches to prevention as the
natural course of events, the concomitant
dangers need someone be blame for them.
Certainly complexity is no waiver of
responsibility and difficulties are no excuse
for a lack of professionalism. On the other
hand blaming every risk and wrong devel-
opment on individual health professionals is
neither fair nor appropriate. To attribute
individual or system failures to the self-
government is only fair if it has violated its
own responsibility. Self-government should
not be charged with deficits in health care
financing caused by legal regulations or a
shortage of resources. Parliaments and gov-
ernments are responsible for that. Self-gov-
ernments should not be charged for their
incapacity of dealing with criminal misbe-
havior of professionals. This is a job for the
law-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 competence
nor a mandate from those to be regulated, is
neither democratic nor helpful. But indeed,
the achievement of more democracy or
competence may not be intended in the first
place, the real aim may be just another way
to silence a very active and critical part of
society.
profession, are watered down to lay bodies,
or governments determine the members of
institutions.
In this way the respect for democratic
processes and the sharing of powers gets
lost on a large scale. In history this is not a
new political development, but the prece-
dents are truly scaring. In the thirties the
German Reichsregierung stopped any
democratic decision making process within
the physicians’ self-government and substi-
tuted the formerly professionally elected
body by a government nominated “Reichs-
Ärzteführer”. The communist governments
in Europe dissolved, prohibited self-gov-
ernment and/or seized their properties after
World War II. A democratic mandated, but
yet extra-parliamentarian power – not to say
“opposition” – was unwanted then and it
seems to be becoming increasingly unpopu-
lar with governments around the world
now.
These changes do not affect us alone: other
partners in the health care systems are
affected as well. All groups enjoying the
right of self-regulation are being faced with
the same problem. For some liberal profes-
sions, this may not be a first line item as
they may find their self-regulation to be a
more technical process. However for those
Regardless whether your understanding of a
just state is based on Magna Carta or on
Montesquieu, sharing power is an essential
element. The horizontal separation of
power results in the classical split into a leg-
islative, executive and juridical branch. But
there is – less visibly and often less regulat-
ed – also a vertical separation of power.
We have associations and parties, groups
and families, which all have their formal or
informal power of regulation. In modern
language this is called “subsidiarity” and it
gives way to allocation of power by social
or decisive factors. Issues are being dealt
with on the level of competence, in the fam-
ily in the group, in the profession.
This vertical power sharing is now being
silently reduced in many countries of the
world. With an amazing synchronicity, gov-
ernments in the different parts of the world
dismantle the self-governments of our pro-
fession. In Germany, Great Britain, New
Zealand, in Romania or Hong Kong, all
over the world and regardless of the politi-
cal system, changes or attempts have been
made or are underway to disrupt the demo-
cratic representation of our interest through
our self-governments. Medical Councils
which formerly were freely elected by the
From the Secretary General
Self-governmental Structures are
endangered in many countries
Medical Science and Professional Practice
107
We tend to take democracy and freedom for
granted, but they are not! Actually, hard as
they were to obtain, we have no right to
give them up. Democracy and freedom are
not ours: they belong first to the generations
to come. If we give them up, their chances
to get them back are extremely unlikely.
Therefore it is our strict obligation and
moral imperative to fight for our democrat-
ic rights and freedom.
Otmar Kloiber
Adopted by the WMA General Assembly,
Pilanesberg, South Africa, October 2006
Preamble
1. Obesity is one of the single most impor-
tant health issues facing the world in the
twenty-first century, affecting all coun-
tries and socio-economic groups and
representing a serious drain on health
care resources.
2. Obesity has complex origins linked to
economic and social changes in society
including the obesogenic environment
within which much of the population
lives.
3. Therefore the WMA urges physicians to
use their roles as leaders to advocate for
recognition by national health authori-
ties that reduction in obesity should be a
priority, with culturally appropriate
policies involving physicians and other
key stakeholders.
The WMA recommends that
physicians:
4. Lead the development of societal
changes that emphasize environments
which support healthy food choices and
regular exercise or physical activity for
all people;
5. Individually and through medical asso-
ciations, express concern that excessive
television viewing and video game
playing are impediments to physical
activity among children and adolescents
in many countries;
6. Encourage individuals to make healthy
choices;
7. Recognise the role of personal decision
making and the adverse influences
exerted by current environments;
8. Recognise that collection and evalua-
tion of data can contribute to evidence
based management, and should be part
of routine medical screening and evalu-
ation throughout life;
9. Encourage the development of life skills
that contribute to a healthy lifestyle in
all persons and to better public knowl-
edge of healthy diets, exercise and the
dangers of smoking and excess alcohol
consumption;
10. Contribute to the development of better
assessment tools and databases to
enable better targeted and evaluated
interventions;
11. Ensure that obesity, its causes and man-
agement remain part of continuing pro-
fessional development programmes for
health care workers, including physi-
cians;
12. Use pharmacotherapy and bariatric
surgery consistent with evidence-based
guidelines and an assessment of the
risks and benefits associated with such
therapies.
Medical Science and Professional Practice
WMA Statement on the Physician’s role
in Obesity
Do others share my cynicism about the
value of worthy statements emanating form
gatherings of the “good and great” held in
some salubrious resort?
Even the most hardened sceptic would con-
ceeded that there are occasions when a
major health threat demands personal and
collective action. The pandemic of obesity
evokes a guilt reaction – it seems to have
taken the medical world by surprise. We
should be chastened to realise that in our
preoccupation with rescuing patients from
individual lethal diseases like cardiovascu-
lar disease, cancer and diabetes, we have
neglected the root causes of such afflictions,
of which obesity reigns supreme. Ironically,
its domain extends to the developing world
where under-nutrition, at the opposite end
of the spectrum of malnutrition, remains
prevalent.
Of course, there are genetic causes of obesi-
ty including the mercifully uncommon
Alstrom and Prader-Willi syndromes, as
well as the more common endocrine causes
such as hypothyroidism, whose victims are
obviously exempt from the approbrium
attached to the typical obese individuals
whose plight is no less self-inflicted than
those in thrall to tobacco or alcohol.
What then, can or should physicians and
other health professionals do about obesity?
The World Medical Association’s Statement
is 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 direct
health costs and 12% of indirect costs of
disease(2) – responding to the challenge ?
Individual countries, with support from
National Medical Associations (NMAs) are
taking specific and commendable initiatives
such as promoting healthy catering in
schools and encouraging physical activity
by prescribing exercise. Physicians are act-
Obesity –
A Growing Problem
This WMA statement has already provoked
the following comment from Sir Alexander
Macara. (ed.)
Medical Science and Professional Practice
108
ing on points 6 to 12 of the WMA mani-
festo, but we also need to take political
action on points 4 and 5. Reassuringly,
opinion polls show that physicians are still
the most trusted professionals in society and
our collective activity in collating and pre-
senting evidence underpins our advocacy of
communal action and governmental respon-
sibility.
The medical profession in Europe is inti-
mately involved in initiatives by both the
European Union (EU) Commission through
DG Sanco and the European Region of the
World Health Organisation (WHO). In
December 2006, the EU adopted a “Green
Paper” signalling its intention to promote
healthy diets and physical activity, follow-
ing advice from a network of experts from
Member states which had been set up two
years previously. Contemporaneously in
March 2005, it set up a “Platform” on Diet,
Physical Activity and Health, involving
European medical and consumer associa-
tions including the Standing Committee of
Doctors in the EU (the CPME) and the
European Heart Network, the Food
Industry, Non-governmental organisations
(NGO’s) such as the International Obesity
Task Force( IOTF) and individual experts “
united by a common determination to play
their part in the fight against obesity” (3)
To quote the spokesman for the World
Federation of Advertisers, ”the Platform has
changed the terms in which the stakeholders
– the NGO’s and Industry among others –
are talking”(4). Intergovernmental organi-
sations are also involved, including the
WHO and the European Food Safety
Authority as observers. The Platform’s
chairman, Robert Madelin, who is the
European Commission’s Director General
for Health and Consumer Protection, is on
record as saying “We are giving industry
the chance to show that it is committed to
the fight. We propose to start by avoiding
regulation”. (5) A robust framework has
been constructed for monitoring and evalu-
ating efforts and outcomes. Commissioner
Markos Kyprianou has identified projects
on reformulation, portion sizes and con-
sumer communication, especially to chil-
dren, as key issues (6) and has declared his
intention to legislate if voluntary measures
fail. Given the reluctance of industry to
agree upon a clear system of labelling of the
levels of salt in cereals or to refrain from
advertising junk food to children, the
author, representing the COME in the
Platform fears that Kyprianou will be oblig-
ed to act.
The EU also jointly organised with the
WHO’s European Regional Office, a
Ministerial Conference, held in Istanbul in
November 2006, in which Health Ministers
were joined by colleagues from other sec-
tors including Education, Transport,
Agriculture and Environment and Sport. As
in the EU Platform, relevant NGOs partici-
pated and public-private partners were
included (7). The outcome was a “European
Charter on counteracting Obesity”,
endorsed enthusiastically by all 53 Member
States. Preventive actions, including the
promotion of breast feeding, a reduction in
the levels of salt, sugar and fat in processed
foods, and the design of environments
which will facilitate physical activity, were
agreed. Follow-up will involve a detailed
“action plan” and triennial reviews of
progress.
Is it realistic to expect meaningful evidence
of success? A leading article in the British
Medical Journal has identified sources of
guidance which might deliver such evi-
dence, but comments “the first people to
seduce are Europe’s finance ministers” (8).
There speaks the voice of reality!
Alexander Macara
Correspondence to:
10 Cheyne Road
Bishops Stoke
Bristol
B59 2DH
UK
References
1. World Medical Association Statement on the
Physician’s Role in Obesity, adopted by the
WMA General assembly, Pilansberg, South
Africa, October 2006.
2. World Health Organisation Regional Office for
Europe “Obesity swallos rising share of GDP in
Europe up to 1% and counting” Press relase
EURO/10?06.London/Copenhagen:WHO
Rowe,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 the
EU”, 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. European
Charter on Counteracting Obesity. EUR/06/
5062700/8, Istanbul.
www.euro.int/Document/NUT/Obesity_
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 you
their weight, albeit a little reluctantly!
However, very few of these people will be
making any clear distinction in their minds
between ‘weight’ and ‘fat’. This confusion
has contributed to the plethora of diet plans
which 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 and
seemingly uncontrollable weight fluctua-
tions, not to mention health risks.
Obesity is a condition of excess body fat
and successful weight reduction must
involve a sustained decrease in fat and not
just weight. Dr Susan Jebb, Head of
Obesity
Obesity – a condition of excess body fat;
not excess weight
Medical Science and Professional Practice
109
Nutrition and Health at MRC Human
Nutrition Research in Cambridge, has con-
ducted research into body composition and
obesity for many years. “The difficulty is
that it requires a reduction of 9,000 calories
to remove ikg of fat, whereas you can lose
lkg of water without any calorie deficit at
all. Changes in body fat occur much more
slowly than changes in weight”.
Unfortunately the popular and easy mea-
surement of body mass index (BMI) only
gives a measure of relative weight-
for-height and does not make any specific
measurement of body fat. The most accu-
rate methods to measure fat (such as under-
water weighing or scanning techniques) are
difficult and expensive to use.
Simple, rapid and relatively cheap methods
of examining body composition (e.g. using
calipers to measure the thickness of subcu-
taneous fat, or the newer method of bioelec-
trical impedance analysis (BIA)) can give a
better estimate of fatness than BMI alone.
However, until recently these procedures
have needed the input of a health profes-
sional, restricting the measure of body fat
outside the clinical setting.
In recent years there has been a break-
through in impedance technology, led by
the electronic manufacturers Tanita. All
BIA operates on the principle that body fat
acts as an insulator, whereas lean tissue,
with its salt and water content, is an effec-
tive conductor. Hence, the body impedance
gives a measure of relative fatness.
Traditional impedance measuring devices
involve attaching four electrodes to the
patient on the hand and foot on one side of
the body and measuring the voltage drop
across the body when a small battery driven
electric current is applied. In contrast, the
Tanita Body Fat monitor, resembles a set of
bathroom scales. It calculates an individ-
ual’s percentage of body fat by passing a
safe, low level electrical current through the
bare feet and gives an immediate digital dis-
play of the body fat percentage. This simple
procedure allows patients to regularly mon-
itor their own body composition at home.
The Tanita Body Fat Monitor can also be
used by health professionals to identify
patients with excess body fat and more
importantly to monitor the impact of treat-
ment programmes to reduce health risks.
Excess fat is associated with an increased
risk of many conditions, notably CHD and
diabetes. Sustained reductions in body fat
lead to reductions in disease-related risk
factors.
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 weight
losses and towards permanent changes in
their eating and exercise habits which will
help them to achieve and maintain a healthy
body composition. ■
In an editorial entitled “Hajj and the risk of
influenza” (Gatrad et al., BMJ 303, 1182-3)
attention is drawn to the major risk of a
rampant spread of the influenza virus and a
global pandemic “a potentially devastating
prospect that has been inadequately pre-
pared for”.
Recalling that the Hajj attracts more than 2
million pilgrims from almost every country
on earth – “the largest annual gathering in
the world” (1) (2) – to this deeply spiritual
journey which follows months or years of
preparation. Nevertheless, it is stated “that
from a public health point of view such a
gathering makes possible rampant spread of
the influenza virus and a global epidemic”.
The authors, while noting that the Saudi
authorities currently recommend vaccina-
tion against influenza for pilgrims with high
risk chronic illnesses, quote data from a UK
pilgrim survey indicating that many
remained unimmunised (3). They comment
that probably this picture is far worse
amongst pilgrims coming from the econom-
ically developing world. Further, recalling
that following a previous epidemic
meningococcal immunisation is already
mandatory for all pilgrims, they suggest
that mandatory influenza immunisation for
all pilgrims should be considered. Calling
on WHO, which is still developing its strat-
egy to prevent an influenza pandemic, to
work with the Saudi authorities, they state
that a “coherent international response will
be needed to ensure that resources and
logistics are in place so that strategies can
be implemented”.
(1) GatradAR. SheikhA. Hajj:journet of a life-
time BMJ 2005.330,13-7.
(2) Ahmed Q, Arabi Y, Memish Z.,2 Health risks
at the Hajj” Lancet 2006,267,1008-15
(3) Shafi S, Rashid H, Ali K, El-Bashir
H,Haworht E, Memish ZA, Booy R, “Influenza
uptake among British Moslems attending Hajj,
2005 BMJ 2005 and 2006
The Hajj and Influenza risk – The threat can
no longer be ignored
WHO
110
9 NOVEMBER 2006 | GENEVA – Dr.
Margaret Chan of China will be the next
Director-General of the World Health
Organization (WHO).
In her acceptance speech, Dr. Chan said:
“what matters most to me is people. And
two specific groups of people in particular.
I want us to be judged by the impact we
have on the health of the people of Africa,
and the health of women. … Improvements
in the health of the people of Africa and the
health of women are key indicators of the
performance of WHO.“
“All regions, all countries, all people are
equally important. This is a health organiza-
tion for the whole world. Our work must
touch on the lives of everyone, every-
where“. “But we must focus our attention
on the people in greatest need.“
Dr. Chan was nominated as Director-
General on Wednesday by the WHO
Executive Board and her appointment was
confirmed by the World Health Assembly.
The Director-General is WHO’s chief tech-
nical and administrative officer. She was
previously WHO Assistant Director-
General for Communicable Diseases and
Representative of the Director-General for
Pandemic Influenza.
Dr. Chan obtained her Medical Degree from
the University of Western Ontario in
Canada and also has a degree in public
health from the National University of
Singapore. She joined the Hong Kong
Department of Health in 1978, and was
appointed as Director of Health in 1994. As
Director, she launched new services focus-
ing on prevention of disease and promotion
of health. She also introduced new initia-
tives to improve communicable disease sur-
veillance and response, enhance training for
public health professionals, and to establish
better local and international collaboration.
She has effectively managed outbreaks of
avian 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 untimely
death of Dr. LEE Jong-wook. We are also
all here because of many millions of
untimely deaths. I know Dr. Lee would
have wanted me to make this point. He will
always 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 as
Director-General she would focus on six
key issues for WHO: health development,
security, capacity, information and knowl-
edge, partnership, and performance.
She emphasized the importance of global
health security in her vision of the
Organization’s role: “Health security brings
benefits at both the global and community
levels. New diseases are global threats to
health that also bring shocks to economies
and societies. Defence against these threats
enhances our collective security.“
Underlining the importance of strong sys-
tems to deliver health care to the people
who need it, she said: “All the donated
drugs in the world won’t do any good with-
out an infrastructure for their delivery. You
cannot deliver health care if the staff you
trained at home are working abroad.“
She especially praised the people who
deliver health care. “The true heroes these
days are the health workers with their heal-
ing, caring ethic. They are determined to
save lives and relieve suffering, and they
work with impressive dedication, often
under difficult conditions. The world needs
many, many more of them.“
Dr. Chan underlined the diverse approaches
needed to strengthen health and health care
in 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 undergoing
transition from planned to market
economies. They want WHO support. They
want to make sure that equitable and acces-
sible systems built on primary health care
are 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 to
set up a global health observatory to collect,
collate and disseminate data on priority
health problems. I will integrate WHO’s
research activities to more strategically
addr.ess a common health research agenda.“
There is a growing number of initiatives
and players in the field of global health. Dr.
Chan said she would work strategically
with partners to deliver the best possible
results for global health. “ Today, collabora-
tion to achieve public health goals is no
longer simply an asset. It is a critical neces-
sity. WHO needs to develop an approach to
collaboration that emphasizes management
of diversity and complexity.“
Turning her attention to the internal man-
agement of WHO, Dr. Chan said: “I will
also accelerate human resource reform to
build a work ethic within WHO that is
based on competence, and pride in achiev-
ing results for health.“
She also addr.essed the challenges ahead of
the Organization: “As we know, not all of
the problems faced by WHO in its efforts to
improve world health are subject to scientif-
ic scrutiny, or yield their secrets under a
microscope. You know the ones I mean:
lack of resources and too little political
commitment. These are often the true
‘killers’.“
Ending her address, Dr. Chan repeated her
pledge to work hard to improve the health
of people around the world. “The work we
do together saves lives and relieves suffer-
ing. I will work with you tirelessly to make
this world a healthier place.“
Dr. Anders Nordström, appointed by the
Executive Board as Acting Director-
General of WHO in May, will continue in
this role until a new Director-General takes
office.
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 – Health
experts have confirmed that the emergence
of extensively drug-resistant tuberculosis
(XDR-TB) poses a serious threat to public
health, particularly when associated with
HIV. At its first meeting, the World Health
Organization (WHO) Global Task Force on
XDR-TB also outlined a series of measures
that countries must put in place to effective-
ly combat XDR-TB. In addition, the Task
Force will help mobilize teams that can
respond to requests for technical assistance
from countries, and be deployed at short
notice to XDR-TB risk areas.
These were among a series of outcomes
issued by the Global Task Force meeting
held on 9 and 10 October in Geneva. The
meeting was urgently convened to review
the latest available evidence on the impact
of highly resistant tuberculosis, including
when associated with HIV.
Addressing the Task Force, Acting
Director-General of WHO, Dr Anders
Nordström, 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
111
political will. The first three are in place.
The last will make the difference,“ said Dr
Robert Scott, Chair of Rotary
International’s PolioPlus Committee,
speaking on behalf of the spearheading
partners of the Global Polio Eradication
Initiative. Rotary is the top private-sector
contributor and volunteer arm of the
Initiative, having contributed US$600 mil-
lion and countless volunteer hours in the
field since 1985.
The ACPE advised the four polio-endemic
countries to set realistic target dates for
stopping transmission, noting that improve-
ments in reaching all children in these areas
have been only incremental, and that these
GENEVA, 12 OCTOBER 2006 — The
world’s success in eradicating polio now
depends on four countries – Afghanistan,
India, Nigeria, and Pakistan – according to
the Advisory Committee on Polio
Eradication (ACPE), the independent over-
sight body of the eradication effort.
With a targeted vaccine and faster ways of
tracking the virus, most countries that
recently 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 countries
are considering new measures to help pro-
tect themselves from future outbreaks.
“With a more effective monovalent vaccine
and accelerated lab processes for identify-
ing poliovirus, these countries have the best
tools we’ve ever had,“ noted Dr Stephen
Cochi, Chair of the ACPE and Senior
Adviser to the Director of the Global
Immunization Division at the US Centers
for Disease Control and Prevention..
“Eradicating polio is no longer a technical
issue alone. Success is now more a question
of the political will to ensure effective
administration at all levels so that all chil-
dren get vaccine.“ As an illustration, the
office of Afghan President Hamid Karzai
has already taken direct oversight of polio
vaccinations, following the sharp increase
in cases in the Southern Region of
Afghanistan,.
Given that all children paralysed by polio in
the world this year were infected by virus
originating in one of the four endemic coun-
tries, polio-free countries are now taking
new measures to protect themselves. The
Ministry of Health of Saudi Arabia, for
example, will be enforcing stringent polio
immunization 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 four
countries
Polio-free countries seek to protect themselves
countries will take more than 12 months to
end polio.
Circulation of wild poliovirus: Since
1988, global polio eradication efforts
reduced the number of polio cases from
350,000 annually to 1403 in 2006 (as at 10
October 2006), of which 1300 are in the
four endemic countries (where poliovirus
transmission 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 endemic
countries, key to success is the ongoing
commitment of the international donor
community. For 2006, a further US$50 mil-
lion is urgently needed, to ensure planned
immunization activities through to the rest
of the year can proceed. Additional funding
of US$390 million is needed for 2007-
2008, of which US$100 million is needed
for activities in the first half of 2007.
WHO
“It is critical that urgent steps are taken to
address XDR-TB, especially in areas of
high HIV prevalence,“ said Dr Nordström.
“At the same time we should not lose sight
of the need to make long-standing improve-
ments to strengthen TB control, and build
the necessary capacity in health services to
respond to drug-resistant tuberculosis.“
Along with a call for countries to strengthen
TB control – the key to preventing TB drug
resistance – consensus was reached on an
XDR-TB case definition (see below). In
high HIV prevalence settings, there was also
agreement that control of XDR-TB will not
be possible without close coordination of TB
and 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-sharing
strategies related to XDR-TB prevention,
control, and treatment including co-man-
agement with antiretroviral therapy; and
research and development of new TB drugs,
vaccines and diagnostic tests.
WHO and Task Force members will now
coordinate with national and international
partners involved in TB as well as HIV pre-
Preventing XDR-TB through strength-
ening TB and HIV control
To prevent the appearance and spread of
drug-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 TB
Strategy and Global Plan to Stop TB 2006-
2015. This should be done in coordination
with scaling up universal access to HIV
treatment and care. WHO and Task Force
members will help mobilize teams of
experts that can be deployed in the field, at
the request of countries, to assist in
strengthening TB control, and where rele-
vant HIV control.
There were also specific recommendations
on:
Management of XDR-TB suspects in
high and low HIV prevalence settings:
Accelerate access to rapid tests for
rifampicin resistance, to improve case
detection of all patients suspected of mul-
tidrug-resistant TB (MDR-TB) so that
they can be given treatment that is as
effective as possible. Rapid diagnosis is
potentially life saving to those who are
HIV positive.
Programme management of XDR-TB
and treatment design in HIV negative
and positive people:
• Adhere to WHO Guidelines for the
Programmatic Management of Drug
Resistant 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 on
appropriate antiretroviral therapy.
Laboratory XDR-TB definition:
XDR-TB is defined as resistance to at least
rifampicin and isoniazid from among the
first line anti-TB drugs (which is the defi-
nition of MDR-TB) in addition to resis-
tance to any fluoroquinolone, and to at
least one of three injectable second-line
anti-TB drugs used in TB treatment
(capreomycin, kanamicin, and amikacin).
Infection control and protection of
health care workers with emphasis on
high HIV prevalence settings:
Accelerate wide implementation of rec-
ommended infection control measures in
health care settings and other risk areas in
order to reduce the ongoing transmission
of drug-resistant TB, especially among
those 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-resistant
TB so that the extent and size of the XDR-
TB epidemic, and its association with HIV,
can be determined.
Advocacy, communication and social
mobilization:
• Initiate information-sharing strategies
that promote effective prevention, treat-
ment, control of XDR-TB at global and
national levels and also in high HIV
prevalence settings;
• Strengthen communication with affect-
ed communities and individuals;
• Develop a fully-budgeted plan with the
resources and funding required to
address XDR-TB, including through
necessary improvements in overall TB
control and HIV care in the immediate
and medium term;
• Initiate resource mobilization.
Planning is also underway for a focused
meeting in the near future on research and
development issues relating to TB, includ-
ing promoting the development of the new
diagnostics, drugs and vaccines that are
urgently needed. A meeting on antiretrovi-
ral therapy and XDR-TB is also planned.
WHO Global Task Force on XDR-TB, October 2006
Outcomes and Recommendations
Regional and NMA News
113
WMA Asian-Pacific Regional
Conference: Day 1
The first day of the Asian-Pacific Regional
Conference, held at Chinzan-so in Tokyo,
began with an Open Session attended by Dr.
Yank Coble, Chair of the Caring Physicians
of the World Initiative; Dr. Yoshihito
Karasawa, President of the JMA; Dr. Kgosi
Letlape, President of the WMA; and Dr.
Yoram Blachar, WMA Chair of Council.
This session included addresses by Dr.
Shigeru Omi, Regional Director of the
WHO Regional Office for the Western
Pacific, who spoke on “Current Situation of
Pandemic Influenza”, and by Dr. Jorge
Puente, Vice President of Medical and
Regulatory Affairs for Japan and Asia at
Pfizer, who spoke on “The State of the
Profession in the World Today”. Dr. Ross
Boswell, Vice-Chair of Council of
CMAAO and Dr. Otmar Kloiber, WMA
Secretary General, both then reported on
the state of the medical profession in their
respective countries.
Dr. Omi, who has a tremendous track record
in the eradication of polio and containment
of SARS, explained in his presentation the
current 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 that
migratory birds were not the only carriers of
the 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 and
Thailand, which were successful in contain-
ing the spread of highly-pathogenic influen-
za, Dr. Omi emphasized the importance of
measures such as the identification of early
symptoms of infectious disease and the
swift reporting of accurate information to
the WHO; precise evaluation of the situa-
tion and decision-making; and a systematic
response that includes monetary compensa-
tion for the disposal of domestic poultry. He
particularly emphasized the problem of los-
ing opportunities to contain infectious dis-
ease due to failure to promptly release and
share 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 held
by the JMA and supported by the WMA
was held on the same themes as the confer-
ence. Two lectures were presented: “Crisis
Management for Infectious Diseases”, by
Dr. Takeshi Kasai, WHO Regional Adviser
in Communicable Disease Surveillance and
Response for the Western Pacific; and
“Disaster Preparedness and Response”, by
Dr. Yasuhiro Yamamoto, Professor,
Department of Emergency and Critical Care
Medicine, Nippon Medical School. Held at
the JMA Auditorium as a satellite event
attended by nearly 700 people. President of
the WMA, Dr. Kgosi Letlape and Chair of
Council Dr. Yoram Blachar addressed the
lecture.
vention, care and treatment to take the rec-
ommendations forward. They will also
develop a plan that identifies the resources
required to implement these outcomes and
the overall emergency response.
Drug-resistant TB has emerged as an
increasing threat to TB control but a WHO
/ US Centers for Disease Control and
Prevention study, published earlier this
year, documented for the first time cases of
tuberculosis that were extensively resistant
to current drug treatments. XDR-TB was
identified in all regions of the world, though
it is still thought to be relatively uncom-
mon.
Last month, concerns about the emergence
of XDR-TB were heightened by reports and
studies from KwaZulu-Natal province in
South Africa of high mortality rates in HIV-
positive people with XDR-TB. This led to
warnings that XDR-TB could seriously
threaten the considerable progress being
made in countries on TB control and the
scaling up of universal access to HIV treat-
ment and prevention.
Among the first countries to request assis-
tance to strengthen its national emergency
XDR-TB response, and the extra challenges
posed by HIV, is South Africa. The South
African Department of Health is to host an
XDR-TB meeting on 17 and 18 October,
with participation from WHO and represen-
tatives from other affected southern African
countries.
Special Public Lecture
The 1st
WMA Asian-Pacific Regional
Conference, held jointly by the World
Medical Association (WMA) and the Japan
Medical Association (JMA), opened auspi-
ciously on the warm and sunny afternoon of
September 10, 2006 in Tokyo. The confer-
ence brought together participants from 18
countries to discuss the themes of natural
disasters such as earthquakes and tsunami,
which occur virtually yearly in the Asian
region; infectious diseases, which pose an
increasing risk of a pandemic beginning in
Asia and spreading throughout the world;
and the state of the medical profession and
medical associations.
Regional and NMA News
Asian Pacific Regional Conference
How to cope with Natural Disasters and Infectious Diseases –
Caring Physicians of the World: 1st
WMA Asian-Pacific Regional
Conference
Dr. Masami Ishii
Secretary General, CMAAO Executive Board Member, Japan Medical Association
Regional and NMA News
114
Kawasaki, Minister of Health, Labour, and
Welfare, as well as several parliament mem-
bers was held, allowing participants to
deepen their friendships.
Asian-Pacific Regional
Conference: Day 2
September 11 dawned with thunder show-
ers but cleared to a sunny day. The program
for Day 2 of the conference covered three
themes.
Session 1: Disaster Preparedness and
Response – Earthquake and Tsunami;
Session 2: Disaster Preparedness and
Response – Infectious Disease; and
Session 3: The State of the Profession.
Session 1 began with an explanation by Dr.
Yoshinobu Tsuji, Associate Professor at the
Earthquake Research Institute at the
University of Tokyo, that the Asian-Pacific
region, collectively known as the Pacific
Rim, is prone to earthquake and tsunami
disasters due to plate tectonics. Reviewing
the history of past earthquakes and tsunami
up until the present, he also briefly
described the tsunami warning systems and
evacuation measures that have been used to
date.
This presentation was followed by keynote
speeches by Dr. Yasuhiro Yamamoto and
Dr. Takeshi Kasai, who had both also spo-
ken at the public lecture held the previous
day. Dr. Yamamoto presented results of
analysis of the case of the Great Hanshin-
Awaji Earthquake in Japan in1995 that
showed that in the 72 hours following the
earthquake, over 80% of rescues were per-
formed or assisted by family members or
neighbors of trapped people or by trapped
people themselves; less than 20% of rescues
were performed by professional rescue
workers in the line of duty.
Dr. Yamamoto also reported that with the
passage of time, the need for medical care
for chronic disease as well as psychological
care increases. This highlights the need for
pre-hospital care and synchronization with
rescue measures in other countries that pro-
mote training workshops on AED and other
resuscitation methods. Japan and the other
developed countries are all expected to have
increasingly aging populations. With the
importance of elderly people themselves
taking measures to prevent falls and keep
with them at all times a medical history and
list of their medications, as well as
bystanders to an incident having learned
how to respond to an emergency, not only
cross-border responses to major disasters
but also the further promotion of safety edu-
cation and training in the future is vital.
Dr. Kasai spoke about measures against a
new, highly infectious influenza strain, say-
ing that there were three levels of response:
measures against avian influenza; early
containment of a new human influenza
virus; and measures against a pandemic.
Unlike in natural disasters, support from
neighboring countries or regions cannot be
anticipated in the case of a pandemic, and
so preparedness is the cornerstone of risk
control. It is vital that each region is as pre-
pared as possible for a pandemic and that
information sharing is prompt.
Dr. Dongchun Shin of the Korean Medical
Association reported on the prompt rescue
activities of that medical association in coop-
eration with Indonesian Medical Association
in the aftermath of the Sumatra Earthquake,
and it was proposed that networks such as
the WMA and CMAAO could play a useful
role in international disaster relief activities.
In Session 3, on the state of the medical pro-
fession and medical associations, there was
a free discussion about the future direction
of medical association activities based on
reports of the current situation for each
national medical association and reports
presented in this session.
In conclusion, Dr. Kazuo Iwasa, Vice-
President of JMA and Vice-Chair of
Council of WMA, spoke about the signifi-
cance of this conference and of medical
activities that overcome national bound-
aries and differences of race and religion
under the enduring values laid down in the
WMA Declaration of Geneva and the Oath
of Hippocrates, the fundamental principles
of all medical practitioners.
Conclusion
In enabling the sharing and discussion of
information about medical response to the
extremely relevant themes of natural disas-
ters, which are a very real risk in this
region, and outbreaks of infectious disease,
international regional meetings such as this
are deeply significant. Health care essen-
tially should not be limited to healthcare
services provided by health insurance based
on assessments and agreements, but should
comprehensively involve all aspects of the
health and lives of members of the public as
well as seek and find directions for prob-
lems that cross national boundaries.
Looking at the unexpectedly great response
to the public lecture held in conjunction
with 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, the
two themes of this conference – natural dis-
asters and infectious diseases – both occur
across national and social boundaries and
require a collective response by human and
organizational networks when they occur.
For this reason also, it is highly significant
that the results of this regional conference
will be announced widely through the
Asian-Pacific areas. We should note that
this kind of conference is strongly needed
by the NMAs which lack of national
resources to cope with the natural disasters
and infectious diseases. Information sharing
will be more increasingly required among
the regional NMAs.
CHINA E
Chinese Medical Association
42 Dongsi Xidajie
Beijing 100710
Tel: (86-10) 6524 9989
Fax: (86-10) 6512 3754
E-mail: suyumu@cma.org.cn
Website: www.chinamed.com.cn
COLOMBIA S
Federación Médica Colombiana
Carrera 7 N° 82-66, Oficinas 218/219
Santafé de Bogotá, D.E.
Tel/Fax: (57-1) 256 8050/256 8010
E-mail: federacionmedicacol@
sky.net.co
DEMOCRATIC REP. OF CONGO F
Ordre des Médecins du Zaire
B.P. 4922
Kinshasa – Gombe
Tel: (243-12) 24589
Fax (Présidente): (242) 8846574
COSTA RICA S
Unión Médica Nacional
Apartado 5920-1000
San José
Tel: (506) 290-5490
Fax: (506) 231 7373
E-mail: unmedica@sol.racsa.co.cr
CROATIA E
Croatian Medical Association
Subiceva 9
10000 Zagreb
Tel: (385-1) 46 93 300
Fax: (385-1) 46 55 066
E-mail: hlz@email.htnet.hr
Website: www.hlk.hr/default.asp
CZECH REPUBLIC E
Czech Medical Association
J.E. Purkyne
Sokolská 31 – P.O. Box 88
120 26 Prague 2
Tel: (420-2) 242 66 201-4
Fax: (420-2) 242 66 212 / 96 18 18 69
E-mail: czma@cls.cz
Website: www.cls.cz
CUBA S
Colegio Médico Cubano Libre
P.O. Box 141016
717 Ponce de Leon Boulevard
Coral Gables, FL 33114-1016
United States
Tel: (1-305) 446 9902/445 1429
Fax: (1-305) 4459310
DENMARK E
Danish Medical Association
9 Trondhjemsgade
2100 Copenhagen 0
Tel: (45) 35 44 -82 29/Fax:-8505
E-mail: er@dadl.dk
Website: www.laegeforeningen.dk
DOMINICAN REPUBLIC S
Asociación Médica Dominicana
Calle Paseo de los Medicos
Esquina Modesto Diaz Zona
Universitaria
Santo Domingo
Tel: (1809) 533-4602/533-4686/
533-8700
Fax: (1809) 535 7337
E-mail: asoc.medica@codetel.net.do
ECUADOR S
Federación Médica Ecuatoriana
V.M. Rendón 923 – 2 do.Piso Of. 201
P.O. Box 09-01-9848
Guayaquil
Tel/Fax: (593) 4 562569
E-mail: fdmedec@andinanet.net
EGYPT E
Egyptian Medical Association
„Dar El Hekmah“
42, Kasr El-Eini Street
Cairo
Tel: (20-2) 3543406
EL SALVADOR, C.A S
Colegio Médico de El Salvador
Final Pasaje N° 10
Colonia Miramonte
San Salvador
Tel: (503) 260-1111, 260-1112
Fax: -0324
E-mail: comcolmed@telesal.net
marnuca@hotmail.com
ESTONIA E
Estonian Medical Association
(EsMA)Pepleri 32
51010 Tartu
Tel/Fax (372) 7420429
E-mail: eal@arstideliit.ee
Website: www.arstideliit.ee
ETHIOPIA E
Ethiopian Medical Association
P.O. Box 2179
Addis Ababa
Tel: (251-1) 158174
Fax: (251-1) 533742
E-mail: ema.emj@telecom.net.et /
ema@eth.healthnet.org
FIJI ISLANDS E
Fiji Medical Association
2nd Fl. Narsey’s Bldg, Renwick Road
G.P.O. Box 1116
Suva
Tel: (679) 315388/Fax: (679) 387671
E-mail: fijimedassoc@connect.com.fj
FINLAND E
Finnish Medical Association
P.O. Box 49
00501 Helsinki
Tel: (358-9) 3930 91/Fax-794
E-mail: fma@fimnet.fi
Website: www.medassoc.fi
FRANCE F
Association Médicale Française
180, Blvd. Haussmann
75389 Paris Cedex 08
Tel/Fax: (33) 1 45 25 22 68
GEORGIA E
Georgian Medical Association
7 Asatiani Street
380077 Tbilisi
Tel: (995 32) 398686 / Fax: -398083
E-mail: Gma@posta.ge
GERMANY E
Bundesärztekammer
(German Medical Association)
Herbert-Lewin-Platz 1
10623 Berlin
Tel: (49-30) 400-456 369/Fax: -387
E-mail: renate.vonhoff-winter@baek.de
Website: www.bundesaerztekammer.de
GHANA E
Ghana Medical Association
P.O. Box 1596
Accra
Tel: (233-21) 670-510/Fax: -511
E-mail: gma@ghana.com
HAITI, W.I. F
Association Médicale Haitienne
1ère
Av. du Travail #33 – Bois Verna
Port-au-Prince
Tel: (509) 245-2060
Fax: (509) 245-6323
E-mail: amh@amhhaiti.net
Website: www.amhhaiti.net
HONG KONG E
Hong Kong Medical Association, Chi-
naDuke of Windsor Building, 5th Floor
15 Hennessy Road
Tel: (852) 2527-8285
Fax: (852) 2865-0943
E-mail: hkma@hkma.org
Website: www.hkma.org
HUNGARY E
Association of Hungarian Medical
Societies (MOTESZ)
Nádor u. 36 – PO.Box 145
1443 Budapest
Tel: (36-1) 312 3807 – 311 6687
Fax: (36-1) 383-7918
E-mail: motesz@motesz.hu
Website: www.motesz.hu
ICELAND E
Icelandic Medical Association
Hlidasmari 8
200 Kópavogur
Tel: (354) 8640478
Fax: (354) 5644106
E-mail: icemed@icemed.is
INDIA E
Indian Medical Association
Indraprastha Marg
New Delhi 110 002
Tel: (91-11) 23370009/23378819/
23378680
Fax: (91-11) 23379178/23379470
E-mail: inmedici@vsnl.com
INDONESIA E
Indonesian Medical Association
Jalan Dr Sam Ratulangie N° 29
Jakarta 10350
Tel: (62-21) 3150679
Fax: (62-21) 390 0473/3154 091
E-mail: pbidi@idola.net.id
IRELAND E
Irish Medical Organisation
10 Fitzwilliam Place
Dublin 2
Tel: (353-1) 676-7273Fax: (353-1)
6612758/6682168
Website: www.imo.ie
ISRAEL E
Israel Medical Association
2 Twin Towers, 35 Jabotinsky St.
P.O. Box 3566, Ramat-Gan 52136
Tel: (972-3) 6100444 / 424
Fax: (972-3) 5751616 / 5753303
E-mail: doritb@ima.org.il
Website: www.ima.org.il
JAPAN E
Japan Medical Association
2-28-16 Honkomagome, Bunkyo-ku
Tokyo 113-8621
Tel: (81-3) 3946 2121/3942 6489
Fax: (81-3) 3946 6295
E-mail: jmaintl@po.med.or.jp
KAZAKHSTAN F
Association of Medical Doctors
of Kazakhstan
117/1 Kazybek bi St.,
Almaty
Tel: (3272) 62 -43 01 / -92 92
Fax: -3606
E-mail: sadykova-aizhan@yahoo.com
REP. OF KOREA E
Korean Medical Association
302-75 Ichon 1-dong, Yongsan-gu
Seoul 140-721
Tel: (82-2) 794 2474
Fax: (82-2) 793 9190
E-mail: intl@kma.org
Website: www.kma.org
KUWAIT E
Kuwait Medical Association
P.O. Box 1202
Safat 13013
Tel: (965) 5333278, 5317971
Fax: (965) 5333276
E-mail: aks.shatti@kma.org.kw
LATVIA E
Latvian Physicians Association
Skolas Str. 3
Riga
1010 Latvia
Tel: (371-7) 22 06 61; 22 06 57
Fax: (371-7) 22 06 57
E-mail: lab@parks.lv
LIECHTENSTEIN E
Liechtensteinischer Ärztekammer
Postfach 52
9490 Vaduz
Tel: (423) 231-1690
Fax: (423) 231-1691
E-mail: office@aerztekammer.li
Website: www.aerzte-net.li
LITHUANIA E
Lithuanian Medical Association
Liubarto Str. 2
2004 Vilnius
Tel/Fax: (370-5) 2731400
E-mail: lgs@takas.lt
Website: www.lgs.lt
LUXEMBOURG F
Association des Médecins et
Médecins Dentistes du Grand-
Duché de Luxembourg
29, rue de Vianden
2680 Luxembourg
Tel: (352) 44 40 331
Fax: (352) 45 83 49
E-mail: secretariat@ammd.lu
Website: www.ammd.lu
MACEDONIA E
Macedonian Medical Association
Dame Gruev St. 3
P.O. Box 174
91000 Skopje
Tel/Fax: (389-91) 232577
E-mail: mld@unet.com.mk
MALAYSIA E
Malaysian Medical Association
4th Floor, MMA House
124 Jalan Pahang
53000 Kuala Lumpur
Tel: (60-3) 40413740/40411375
Association and address/Officers
ii
Association and address/Officers
iii
Fax: (60-3) 40418187/40434444
E-mail: mma@tm.net.my
Website: http://www.mma.org.my
MALTA E
Medical Association of Malta
The Professional Centre
Sliema Road, Gzira GZR 06
Tel: (356) 21312888
Fax: (356) 21331713
E-mail: mfpb@maltanet.net
Website: www.mam.org.mt
MEXICO S
Colegio Medico de Mexico
Fenacome
Hidalgo 1828 Pte. D-107
Colonia Deportivo Obispado
Monterrey, Nuevo Léon
Tel/Fax: (52-8) 348-41-55
E-mail: rcantum@doctor.com
Website: www.cmm-fenacome.org
NAMIBIA E
Medical Association of Namibia
403 Maerua Park – POB 3369
Windhoek
Tel: (264) 61 22 44 55/Fax: -48 26
E-mail: man.office@iway.na
NEPAL E
Nepal Medical Association
Siddhi Sadan, Post Box 189
Exhibition Road
Katmandu
Tel: (977 1) 4225860, 231825
Fax: (977 1) 4225300
E-mail: nma@healthnet.org.np
NETHERLANDS E
Royal Dutch Medical Association
P.O. Box 20051
3502 LB Utrecht
Tel: (31-30) 28 23-267/Fax-318
E-mail: j.bouwman@fed.knmg.nl
Website: www.knmg.nl
NEW ZEALAND E
New Zealand Medical Association
P.O. Box 156
Wellington 1
Tel: (64-4) 472-4741
Fax: (64-4) 471 0838
E-mail: nzma@nzma.org.nz
Website: www.nzma.org.nz
NIGERIA E
Nigerian Medical Association
74, Adeniyi Jones Avenue Ikeja
P.O. Box 1108, Marina
Lagos
Tel: (234-1) 480 1569,
Fax: (234-1) 492 4179
E-mail: info@nigeriannma.org
Website: www.nigeriannma.org
NORWAY E
Norwegian Medical Association
P.O.Box 1152 sentrum
0107 Oslo
Tel: (47) 23 10 -90 00/Fax: -9010
E-mail: ellen.pettersen@
legeforeningen.no
Website: www.legeforeningen.no
PANAMA S
Asociación Médica Nacional
de la República de Panamá
Apartado Postal 2020
Panamá 1
Tel: (507) 263 7622 /263-7758
Fax: (507) 223 1462
Fax modem: (507) 223-5555
E-mail: amenalpa@cwpanama.net
PERU S
Colegio Médico del Perú
Malecón Armendáriz N° 791
Miraflores, Lima
Tel: (51-1) 241 75 72
Fax: (51-1) 242 3917
E-mail: decano@cmp.org.pe
Website: www.cmp.org.pe
PHILIPPINES E
Philippine Medical Association
PMA Bldg, North Avenue
Quezon City
Tel: (63-2) 929-63 66/Fax: -6951
E-mail: medical@pma.com.ph
Website: www.pma.com.ph
POLAND E
Polish Medical Association
Al. Ujazdowskie 24, 00-478 Warszawa
Tel/Fax: (48-22) 628 86 99
PORTUGAL E
Ordem dos Médicos
Av. Almirante Gago Coutinho, 151
1749-084 Lisbon
Tel: (351-21) 842 71 00/842 71 11
Fax: (351-21) 842 71 99
E-mail: intl@omcne.pt
Website: www.ordemdosmedicos.pt
ROMANIA F
Romanian Medical Association
Str. Ionel Perlea, nr 10
Sect. 1, Bucarest
Tel: (40-1) 460 08 30
Fax: (40-1) 312 13 57
E-mail: AMR@itcnet.ro
Website: ong.ro/ong/amr
RUSSIA E
Russian Medical Society
Udaltsova Street 85
119607 Moscow
Tel: (7-095)932-83-02
E-mail: info@rusmed.ru
Website: www.russmed.ru
SAMOA E
Samoa Medical Association
Tupua Tamasese Meaole Hospital
Private Bag – National Health Services
Apia
Tel: (685) 778 5858
E-mail: vialil_lameko@yahoo.com
SINGAPORE E
Singapore Medical Association
Alumni Medical Centre, Level 2
2 College Road, 169850 Singapore
Tel: (65) 6223 1264
Fax: (65) 6224 7827
E-Mail: sma@sma.org.sg
www.sma.org.sg
SLOVAK REPUBLIC E
Slovak Medical Association
Legionarska 4
81322 Bratislava
Tel: (421-2) 554 24 015
Fax: (421-2) 554 223 63
E-mail: secretarysma@ba.telecom.sk
SLOVENIA E
Slovenian Medical Association
Komenskega 4, 61001 Ljubljana
Tel: (386-61) 323 469
Fax: (386-61) 301 955
SOMALIA E
Somali Medical Association
14 Wardigley Road – POB 199
Mogadishu
Tel: (252-1) 595 599
Fax: (252-1) 225 858
E-mail: drdalmar@yahoo.co.uk
SOUTH AFRICA E
The South African Medical Associa-
tionP.O. Box 74789, Lynnwood Rydge
0040 Pretoria
Tel: (27-12) 481 2036/2063
Fax: (27-12) 481 2100/2058
E-mail: sginterim@samedical.org
Website: www.samedical.org
SPAIN S
Consejo General de Colegios Médicos
Plaza de las Cortes 11, Madrid 28014
Tel: (34-91) 431 7780
Fax: (34-91) 431 9620
E-mail: internacional1@cgcom.es
SWEDEN E
Swedish Medical Association
(Villagatan 5)
P.O. Box 5610, SE – 114 86 Stockholm
Tel: (46-8) 790 33 00
Fax: (46-8) 20 57 18
E-mail: info@slf.se
Website: www.lakarforbundet.se
SWITZERLAND F
Fédération des Médecins Suisses
Elfenstrasse 18 – C.P. 170
3000 Berne 15
Tel: (41-31) 359 –1111/Fax: -1112
E-mail: fmh@hin.ch
Website: www.fmh.ch
TAIWAN E
Taiwan Medical Association
9F No 29 Sec1
An-Ho Road
Taipei
Tel: (886-2) 2752-7286
Fax: (886-2) 2771-8392
E-mail: intl@med-assn.org.tw
Website: www.med.assn.org.tw
THAILAND E
Medical Association of Thailand
2 Soi Soonvijai
New Petchburi Road
Bangkok 10320
Tel: (66-2) 314 4333/318-8170
Fax: (66-2) 314 6305
E-mail: math@loxinfo.co.th
Website: www.medassocthai.org
TUNISIA F
Conseil National de l’Ordre
des Médecins de Tunisie
16, rue de Touraine
1002 Tunis
Tel: (216-71) 792 736/799 041
Fax: (216-71) 788 729
E-mail: ordremed.na@planet.tn
TURKEY E
Turkish Medical Association
GMK Bulvary
Sehit Danis Tunaligil Sok. N° 2 Kat 4
Maltepe 06570
Ankara
Tel: (90-312) 231 –3179/Fax: -1952
E-mail: Ttb@ttb.org.tr
Website: www.ttb.org.tr
UGANDA E
Uganda Medical Association
Plot 8, 41-43 circular rd.
P.O. Box 29874
Kampala
Tel: (256) 41 32 1795
Fax: (256) 41 34 5597
E-mail: myers28@hotmail.com
UNITED KINGDOM E
British Medical Association
BMA House, Tavistock Square
London WC1H 9JP
Tel: (44-207) 387-4499
Fax: (44- 207) 383-6710
E-mail: vivn@bma.org.uk
Website: www.bma.org.uk
UNITED STATES OF AMERICA E
American Medical Association
515 North State Street
Chicago, Illinois 60610
Tel: (1-312) 464 5040
Fax: (1-312) 464 5973
Website: http://www.ama-assn.org
URUGUAY S
Sindicato Médico del Uruguay
Bulevar Artigas 1515
CP 11200 Montevideo
Tel: (598-2) 401 47 01
Fax: (598-2) 409 16 03
E-mail: secretaria@smu.org.uy
VATICAN STATE F
Associazione Medica del Vaticano
Stato della Città del Vaticano
00120 Città del Vaticano
Tel: (39-06) 69879300
Fax: (39-06) 69883328
E-mail: servizi.sanitari@scv.va
VENEZUELA S
Federacion Médica Venezolana
Avenida Orinoco
Torre Federacion Médica Venezolana
Urbanizacion Las Mercedes
Caracas
Tel: (58-2) 9934547
Fax: (58-2) 9932890
Website: www.saludfmv.org
E-mail: info@saludgmv.org
VIETNAM E
Vietnam Medical Association
(VGAMP)68A Ba Trieu-Street
Hoau Kiem District
Hanoi
Tel/Fax: (84) 4 943 9323
ZIMBABWE E
Zimbabwe Medical Association
P.O. Box 3671
Harare
Tel: (263-4) 791553
Fax: (263-4) 791561
E-mail: zima@zol.co.zw