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Medical Journal
World 53 Vol. No. 4, December 2007

Contents
Editorial
The challenge to medical care 85
Make medicines child size 86

Medical Ethics and Human Rights


Medical Research on Child Subjects 87
China affirms its commitment to
WMA Transplantation policy 87
World Health Professions Alliance Conference
on Regulation of Health Professions display 90
WMA Statement On The Ethics Of Telemedicine 91
WMA resolution on the responsibility
of physicians 92
WMA Resolution On Health And Human Rights
Abuses In Zimbabwe 94

Medical Science, Medical Practice


and Medical Education
WMA Statement on Health Hazards Dr. Jon Snaedel
of Tobacco Products 95
Avicenna Directories to replace World Directory WMA-President 2007-2008
of Medical Schools 97
Global Standards for Quality Improvement
in Medical Education 97

Point of view
A Worldwide Tour of Medical Degrees
and Qualifications 97

From the WMA Secretary General


Trust me, I’m a Doctor! 99

WMA
WMA General Assembly 100
Plenary Session of the Assembly
6th October 2007 103
Resolution in Support of the Medical Associations
in Latin America and the Caribbean 104
178th WMA Council meeting 107
Inter-professional training seminar on infection
control in South Africa 108

WHO 108–110 Report on WMA General


R e v i e w a n d L e t t e r 111–112 Assembly, Copenhagen 2007

OFFICIAL JOURNAL OF THE WORLD MEDICAL ASSOCIATION, INC.


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WMA OFFICERS
OF NATIONAL MEMBER MEDICAL ASSOCIATIONS AND OFFICERS

President-Elect President Immediate Past-President


Dr. Yoram Blachar Dr. J. Snaedal Dr. N. Arumagam
Israel Medical Association Icelandic Medical Assn. Malaysian Medical Association
2 Twin Towers, 35 Jabotinsky St. Hlidasmari 8 4th Floor MMA House
P.O. Box 3566, Ramat-Gan 52136 200 Kopavogur 124 Jalan Pahang
Israel Iceland 53000 Kuala Lumpur
Malaysia
Treasurer Chairman of Council Vice-Chairman of Council
Prof. Dr. Dr. h.c. J. D. Hoppe Dr. J. E. Hill Dr. K. Iwasa
Bundesärztekammer American Medical Association Japan Medical Association
Herbert-Lewin-Platz 1 515 North State Street 2-28-16 Honkomagome
10623 Berlin Chicago, ILL 60610 Bunkyo-ku
Germany USA Tokyo 113-8621
Japan
Secretary General
Dr. O. Kloiber
World Medical Association
BP 63
01212 Ferney-Voltaire Cedex
France

Website: http://www.wma.net

WMA Directory of National Member Medical Associations Officers and Council

Association and address/Officers

ANDORRA S REPUBLIC OF ARMENIA E BELGIUM F CANADA E


Col’legi Oficial de Metges Armenian Medical Association Association Belge des Syndicats Canadian Medical Association
Edifici Plaza esc. B P.O. Box 143, Yerevan 375 010 Médicaux P.O. Box 8650
Verge del Pilar 5, Tel: (3741) 53 58-68 Chaussée de Boondael 6, bte 4 1867 Alta Vista Drive
4art. Despatx 11, Andorra La Vella Fax: (3741) 53 48 79 1050 Bruxelles Ottawa, Ontario K1G 3Y6
Tel: (376) 823 525/Fax: (376) 860 793 E-mail:info@armeda.am Tel: (32-2) 644-12 88/Fax: -1527 Tel: (1-613) 731 8610/Fax: -1779
E-mail: coma@andorra.ad Website: www.armeda.am E-mail: absym.bras@euronet.be E-mail: monique.laframboise@cma.ca
Website: www.col-legidemetges.ad Website: www.absym-bras.be Website: www.cma.ca
AZERBAIJAN E
ARGENTINA S Azerbaijan Medical Association BOLIVIA S
Confederación Médica Argentina 5 Sona Velikham Str. Colegio Médico de Bolivia
Av. Belgrano 1235 AZE 370001, Baku Calle Ayacucho 630
Buenos Aires 1093 Tel: (994 50) 328 1888 Tarija Cabo Verde S
Tel/Fax: (54-11) 4381-1548/4384-5036 Fax: (994 12) 315 136 Fax: (591) 4663569 Ordem Dos Medicos du Cabo Verde
E-mail: E-mail: Mahirs@lycos.com / E-mail: colmed_tjo@hotmail.com Avenue OUA N°6 – B.P. 421
comra@confederacionmedica.com.ar azerma@hotmail.com Website: colegiomedicodebolivia.org.bo Achada Santo António, Ciadade de
Website: www.comra.health.org.ar Praia, Cabo Verde
AUSTRALIA E BAHAMAS E BRAZIL E Tel : (238) 262 2503
Australian Medical Association Medical Association of the Bahamas Associaçao Médica Brasileira Fax : (238) 262 3099
P.O. Box 6090 Javon Medical Center R. Sao Carlos do Pinhal 324 – Bela Vista E-mail: omecab@cvtelecom.cv
Kingston, ACT 2604 P.O. Box N999 Sao Paulo SP – CEP 01333-903
Tel: (61-2) 6270-5460/Fax: -5499 Nassau Tel: (55-11) 317868-00/Fax: -31
Website: www.ama.com.au Tel: (1-242) 328 1857/Fax: 323 2980 E-mail: presidente@amb.org.br
E-mail: ama@ama.com.au E-mail: mabnassau@yahoo.com Website: www.amb.org.br
CHILE S
AUSTRIA E BANGLADESH E BULGARIA E Colegio Médico de Chile
Österreichische Ärztekammer Bangladesh Medical Association Bulgarian Medical Association Esmeralda 678 - Casilla 639
(Austrian Medical Chamber) BMA Bhaban 5/2 Topkhana Road 15, Acad. Ivan Geshov Blvd. Santiago
Weihburggasse 10-12 - P.O. Box 213 Dhaka 1000 1431 Sofia Tel: (56-2) 4277800
1010 Wien Tel: (880) 2-9568714/9562527 Tel: (359-2) 954 -11 26/Fax:-1186 Fax: (56-2) 6330940 / 6336732
Tel: (43-1) 51406-931/Fax: -933 Fax: (880) 2-9566060/9568714 E-mail: usbls@inagency.com E-mail: rdelcastillo@colegiomedico.cl
E-mail: international@aek.or.at E-mail: bma@aitlbd.net Website: www.blsbg.com Website: www.colegiomedico.cl

i see page ii
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OFFICIAL JOURNAL OF
THE WORLD MEDICAL
ASSOCIATION Editorial
Hon. Editor in Chief
Dr. Alan J. Rowe
Haughley Grange, Stowmarket
The challenge to medical care
Suffolk IP14 3QT
UK The Tobacco Control Resource Centre, a resource supported by the British Medical
Association, the European Commission and the European Regional Office of the World
Co-Editors Health Organisation, published in 2000 a report in the context of Tobacco Control
Prof. Dr. med. Elmar Doppelfeld Programme under the title “Tobacco – Medicine’s Big Challenge.” Now at the end of 2007,
Deutscher Ärzte-Verlag
Dieselstr. 2
while Tobacco remains a problem and the great scourges of disease still challenge medi-
D–50859 Köln cine, a huge challenge (possibly “The Challenge” for the medical profession) faces the
Germany health professionals providing medical care, namely the problem of the supply and distrib-
ution of health care workers. The 2006 World Health Report of WHO* highlighted the
Dr. Ivan M. Gillibrand problem, notably the huge discrepancies in the distribution of Physicians, Dentists, Nurses,
19 Wimblehurst Court Midwives and other Health care workers, not only within countries but more significantly
Ashleigh Road
Horsham between countries. Scientific advances have made great contributions in our knowledge of
West Sussex RH12 2AQ the nature and causes of many diseases, accompanied by discovery and development of
UK many new drugs to cure or ameliorate the effects of disease. All of these call for increasing
skills and increased demands on all sectors of the medical workforce in developed coun-
Business Managers tries It places increased demands on the sparse, sometimes almost non-existent supply of
J. Führer, D. Weber
50859 Köln
health care workers in underdeveloped countries, where healthcare was already minimal,
Dieselstraße 2 obstructing any implementation of advances in healthcare available elsewhere.
Germany
Hitherto the limited attempts to address manpower problems in the healthcare workforce
Publisher had, unsurprisingly, concentrated on workforce problems within national health care sys-
THE WORLD MEDICAL tems, substantially disregarding the huge disparities between countries, regions and even
ASSOCIATION, INC. continents. At the same time concern has been expressed by both the profession and by
BP 63 some other authorities about the recruiting of physicians in developed countries from devel-
01212 Ferney-Voltaire Cedex, France oping countries who are already under-doctored, Codes of practice and statements of poli-
Publishing House cy to change this have been issued by the World Medical Association** and by some gov-
Deutscher Ärzte-Verlag GmbH, ernments and authorities.
Dieselstr. 2, P. O. Box 40 02 65,
50832 Köln/Germany,
While a great tribute should be paid to those organisations and governments who, in one
Phone (0 22 34) 70 11-0, way or another have, over many years, encouraged the provision of doctors, nurses and
Fax (0 22 34) 70 11-2 55, other medical assistance to those countries in need, and to those health professionals who
Postal Cheque Account: Köln 192 50-506, undertook to meet the needs, it was effectively only with the arrival of HIV/AIDS and,
Bank: Commerzbank Köln No. 1 500 057, more recently the risk of pandemic disease, coupled with increasing political awareness of
Deutsche Apotheker- und Ärztebank,
the need to deal with poverty, inequity and human rights, that the need to address the prob-
50670 Köln, No. 015 13330.
At present rate-card No. 3 a is valid. lems associated with the global health workforce have been forced to the forefront of dis-
cussion.
The magazine is published quarterly.
In previous editorials in the World Medical Journal, WMJ 52 (1) and (2) we have drawn
Subscriptions will be accepted by attention to emerging trends not only in the changing or expanding role of individual health
Deutscher Ärzte-Verlag or the World
Medical Association.
professions, but also to problems of training, mobility and availability of health profession-
als. Further problems complicating the whole issue relate to the changes in role and func-
Subscription fee € 22,80 per annum (incl. 7 % tions of health professionals, reflecting not only the increasing aspirations of the individual
MwSt.). For members of the World Medical
Association and for Associate members the health professional, but also the increasing specialisation within individual health profes-
subscription fee is settled by the membership sions.
or associate payment. Details of Associate
Membership may be found at the World
In the first part of 2008 at least two conferences will address some of the issues involved.
Medical Association website www.wma.net The first is a World Health Organisation Global Conference to be held in Addis Ababa
Ethiopia in January 2008, when the conference will address the topic of Task Shifting (see
Printed by p. 90). “Task Shifting” is defined in a number of WHO documents as “the name given to a
Deutscher Ärzte -Verlag
Köln – Germany

ISSN: 0049-8122 * “Working together for health” The World Health Report 2006 WHO, Geneva, ISBN 92 4 156317 6
** WMA Statement on Ethical Guidelines for the Recruitment of Physicians, Helsinki 2003

WMJ 53, December 2007 85


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Editorial

process of delegation whereby tasks are 200,000 physicians to meet their needs, their distribution. With the calls for “task
moved, where appropriate, to less spe- more than the current need of the rest of the shifting” as part of the solution, this may
cialised health workers”. world! also call for radical changes in the career
cycle of physicians, nurses, pharmacists,
The second conference, organised by the The WMA Secretary General in his column
including professional practice in foreign
World Health Professions Alliance in the refers to another problem associated with
countries as a normal part of the profession-
week preceding the WHO Assembly, is the the changes in role and functions of physi-
al career structure. All of these considera-
First World Conference the Role and cians, namely the need for clarity in identi-
tions require urgent attention at a time when
Regulation of Health Professions which fying the roles of health professionals and
the very nature of the regulation of the
will be held in Geneva (see p. 90). Both the titles used to identify them to the public.
health professions in also under review,
Conferences are of huge importance in rela- The differences in titles used for physicians
including the question of the degree to
tion to the provision of health care across across the world are illustrated in an article
which the professions themselves should
the globe in both developed and developing by Dr. Doren, to which Dr. Kloiber refers.
play a role in regulation, a matter of major
countries. (see p. 97).
concern to those professions whose proud
The Health Workforce problem which the role has for millennia been that of “Caring
The conferences have great relevance to the
2006 World Health Report highlighted is Professions”. It is to this end that the med-
future role and functions of the Medical
now being actively pursued and it is essen- ical profession defends its position in self-
Profession. Whereas previously, physicians,
tial that, as indicated in the editorials regulation of standards of care and its ethi-
when recognised for full registration as a
referred to above, both individual physi- cal code of conduct in the interests of both
medical practitioner, held the sole licence to
cians and their representative organisations patients and profession. All of this must be
carry out certain specific acts such as the
actively address these issues. The distribu- urgently considered both in discussions at
right to prescribe and to engage in the prac-
tion of certain diseases has been radically individual, at national level and in the glob-
tice of medicine, in an increasingly sophisti-
changed as a result of greatly increased al conferences referred to above. There is
cated and technical world it is clear that
international travel, with the potential for no time to be lost. Just as the profession has
some of these reserved functions can be car-
wider dissemination of communicable dis- taken a stand on Tobacco so it must face up
ried out by other health professionals under
eases including newly emerging diseases, to this Big Challenge to the profession
regulation, after appropriate technical spe-
and the risk of major pandemics need to be itself. Both individual physicians and their
cialist training. This has substantial implica-
balanced with attention to the global prob- leaders must act. Time waits for no man!
tions for changes in the protected role that
lems of inequitable distribution of physi-
physicians have previously held in certain
cians, with such huge disproportions in Alan Rowe
areas, while possibly calling for new roles in
other areas, essentially calling for a reassess-
ment of the role and functions of physicians
in society. In some countries such changes
have already occurred in areas such as the
extension of limited prescribing rights to Make medicines child size
other health professionals such as nurses,
and extending the acts carried out by other
health professionals By enhancing the role
of some health professionals, such changes On 6. December 2007, the WHO launched of childrens medicines and the actual need
increase the provision of certain health ser- a five years initiative to raise awareness and and that this gap is global even if it is most
vices to a much wider population in both accelerate action on medicines for children. evident in poor income countries. In indus-
developed and developing countries. This project is based on a document which trialized societies more than half of the chil-
was accepted at the 60th World Health dren are prescribed medicines authorised
Nevertheless, as indicated earlier, if there is
Assembly in May 2007. At the same time and dosed for adults but not authorized or
a basic shortage of health care workers in
the WHO released the first international dosed for children. In developing countries,
all the health professions, the world is faced
List of Essential Medicines for Children the problem is compounded by lower
with a major problem. This shortage does
(WMJ 53(2), 50). The list contains 206 access.
not only apply to underdeveloped countries.
medicines that are deemed safe for children
In more developed countries as scientific
and address priority conditions. On this list In this project there are three main priori-
and technical knowledge and development
a number of existing medicines are howev- ties.
have increased there is also increased
er lacking because they have not been
demand for the implementation of these dis- 1. To improve access where proper medi-
adapted for childrens use.
coveries and a consequent demand for more cines for children exist but they are not
health workers. Thus the USA estimates It has been known for a long time that there reaching those in need due to cost and
that by 2020 they will require at least is a substantial gap between the availability inefficient distribution systems.

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Medical Ethics and Human Rights

2. To increase development of medicines This issue should also be kept in mind dur-
which exist for adults but are either in ing the process of revision of the China affirms its
unsuitible forms for children or have not Declaration of Helsinki and in conjunction
been developed for children taken into to that a new document on research of chil- commitment to
account the different pharmacokinetics dren which has been circulated to NMA´s
in children of various ages. for comments. Lastly we should take this WMA Transplan-
opportunity to work closely with the WHO
3. To facilitate research into areas where
there are very few or even no medicines
as this is one of many topics where it is of tation policy
obvious value that these International
and where the efficacy of existing medi-
organisations join forces. Following the visit of a WMA delegation
cines is unknown. This applies specially
earlier this year (see report in WMJ 53,2),
to medicines for various infectious, trop-
the Chinese Medical Association, in a let-
ical disease. Jon Snaedal
ter from the Secretary General, Dr. Wang
This project has received a wide acceptance President of the WMA affirmed its commitment to WMA poli-
and backup from many stakeholders such as cy and wrote as follows:
Editorial note:
UNICEF, the pharmaceutical industry, regu-
“… after discussions in the Chinese
latory agencies and various NGO´s such as The text of many of the statements etc.
Medical Association, a consensus has
Save the children. WMA most certainly will adopted by the WMA General Assembly,
been reached, that is, the Chinese
do its utmost to facilitate this project. The while referred to in the Report (see p. 103)
Medical Association agrees to the
project starts at a time when WMA is have been printed in the appropiate sec-
World Medical Association Statement
adressing the special situation of children in tions e.g. Ethics. Due to constraints on
on Human Organ Transplantation,
two areas. One is the upcoming revision of available space, those on Noise and
which states that organs of prisoners
the existing document on Health of Family Planning will appear in the next
and other individuals in custody must
Children since 1998, by many considered issue. They can also be accessed at
not be used for transplantation except
one of the best documents of the WMA. www.wma.net.
for members of their immediate family.
The Chinese Medical Association will,
through its influence, further promote
the strengthening of the management of
human organ transplantation and pre-
vent possible violations of the regula-
tions made by the Chinese
Medical Ethics and Human Rights Government. We also hope to work
more closely with the WMA and
exchange information and views on the
Medical Research on Child Subjects management of human organ trans-
plantation”.

Dr. James Appleyard, MD, FRCPCH, being introduced . The most public and con- undertake the relevant trials in children.
Past President WMA troversial research study on children during Practicing pediatricians faced the dilemma
(see also pp. 86 and 109) the second half of the 20th century was the of knowing how effective a new chemical
‘Willowbrook Hepatitis Study’ started in substance has been found in adult studies
Children worldwide bear the greatest bur-
1956 at a New York State Institution for and feeling duty bound to try them on their
den of disease. Medical research on child
mentally defective persons. (3,4) Such child patients ‘off label’
subjects is essential to identify effective and
examples led to the persistence of a pre-
sustainable action that will lead to
dominantly protective approach towards In the 90’s this had reached such a propor-
improvements in child health (1,2). There
research in children.. So much so that ,with tion that pediatricians were pressing for
is a natural reluctance to involve children in
the increasing number of medications avail- changes in the system. (5,6) The ‘Children’s
any risk associated with such research.
able to adults in the last half century, chil- rule, evolved in the USA, has had a positive
Testing in adults has rightly to precede any
dren were increasingly being ‘left behind’. effect on promoting children’s research. (7,
trial of new approaches to treatment
The market for new drugs amongst children 12) and Europe has followed with the E.U.
amongst children.
was much smaller and that a combination Directive 2001/20/ECBoth the Food and
Children, however, have been subject to of the inherent protective environment with Drug Administration and the E.U.
research studies in residential institutions the increased cost of clinical trials meant Commission have been consulting further
prior to any independent ethical review that pharmaceutical companies did not on their existing regulations

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Medical Ethics and Human Rights

Regulations are important within the legal dren to assent and consent to the process, Draft Proposed Statement
framework of each country. Medical their need for special protection with the
research is increasingly a global imperative avoidance of harm, are essential.These are
Preamble
and the relevant common ethical standards of particular importance in relation to mat-
need to be international. (6) ters referred to ethical review committees, Advances in medical care are based on the
which must include in their membership scientific evaluation of preventative, diag-
The WMA’s Declaration of Helsinki (9)
specialist paediatric expertise in study nostic and therapeutic measures.
has underpinned the guidelines from the
design when considering paediatric
Council for International Organisations of Children should share in the benefits from
research.
Medical Sciences (CIOMS) (7) and ICH scientific research relevant to their individ-
GCP (8) It has also been the reference doc- It is difficult to incorporate all these essen- ual age related health needs.
ument for many national pediatric guide- tial points within the Declaration of
Research on children is essential for the
lines. (5) The paragraphs specifically relat- Helsinki even though there is an opportuni-
development of scientifically based med-
ed to children are paras. 24 and 25, regard- ty to do so now that revisions are being con-
ical knowledge that will ensure the effective
ing consent and/or assent of ‘minors’ sidered. The WMA has already accepted
promotion of child health and the well
the special needs of Children in their previ-
“24 For a research subject who is legally being of children worldwide.
ous agreement to a separate Declaration on
incompetent, physically or mentally inca-
the Right of a Child to Health Care, in addi- Children involved in research need special
pable of giving consent or is a legally
tion to the general rights of all patients. The protection. They differ from adults biologi-
incompetent minor, the investigator must
Associate Members Meeting at the General cally. –with their increased vulnerability,
obtain informed consent from the legally
Assembly of the WMA, with the particular age specific needs and growth and develop-
authorized representative in accordance
support of representatives from the USA, ment potential.
with applicable law. These groups should
Germany and Nigeria, recommended that a
not be included in research unless the Children must be subject to the safeguards
separate Statement on Medical Research on
research is necessary to promote the health applicable to all research subjects in the
Child Subjects be considered by the WMA
of the population represented and this Declaration of Helsinki, together with para-
Assembly in Copenhagen with a view to its
research cannot instead be performed on graphs 24 and 25 concerning legally incom-
being circulated for comment by national
legally competent persons”. petent minors.
medical associations (NMAs). The
“25 When a subject deemed legally incom- Assembly agreed and the Statement has The Declaration of Ottawa defines the right
petent, such as a minor child, is able to been sent out to nmas by the WMA of a child to health care, which includes the
give assent to decisions about participation Secretariat. principles of consent and self determination
in research, the investigator must obtain amongst children in paragraphs 9-13.
The Statement has been drafted from the
that assent in addition to the consent of the
principles underlying the key guidelines on Physicians should respect international
legally authorized representative.”
pediatric research in Europe (10, 12) and national professional guidelines on
In the WMA’s Declaration of Ottawa on the United States (11) and Japan (13) and research in children which conform to
Right of a Child to Healthcare, a precau- relates directly to the Declaration of these principles.
tionary protective approach to research is Helsinki. The Statement should form a tem-
adopted as one of the General Principles: plate for the development of local national
guidelines in each country to provide both a Need for Protection
Para 4 V1 states “In particular every effort
positive and protective environment for the
‘should be made to protect every child from
promotion of child health and welfare Biomedical studies involving children as
unnecessary diagnostic procedures, treat-
research subjects should be focused on the
ment and research”;
The Preamble summaries the importance of knowledge of epidemiology, pathogenesis,
We need to change the emphasis about the medical research for children and the need diagnosis and treatment of diseases or con-
need for research on children for their own to protect them from harm. The five main ditions of childhood.
benefit while maintaining full protection paragraphs highlight issues which are
A child should not be involved in research
The WMA should provide leadership for either specific to children or must be con-
that can be carried out on laboratory mod-
the benefit of children worldwide. Most of sidered in the context of childhood. Each
els, animal subjects or adult persons, or that
the burden of disease affecting children is statement underlines a principle and each
serves only a scientific interest The knowl-
outside the rich countries of the USA, sentence is both self standing and to be
edge to be gained from the research must
Europe and Japan, where regulations and taken in context. Further clarification of
form a necessary contribution to the health-
guidelines have moved to a more positive these principles need to be expanded in
care of children.
approach to research in children. local national guidelines. Thus the docu-
Principles recognizing the importance of ment has been constructed to be a succinct Different physiological, psychological and
research and the growing maturity of chil- as possible pathogenic features occur at the different

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Medical Ethics and Human Rights

ages and stages of the growth ,development, gender or religion, except in cases where All personal and health related information
sex and ethnicity in childhood. from the one or more of these attributes relate to the about the child and the family, collected and
premature newborn infant through adoles- objective of the research stored, must remain confidential.
cence.
The performance of a study must be guaran-
There is a need to balance the potential ben- teed to be conducted by experts competent Research Ethics Committees
efits to children against any risk involved in childhood diseases and disorders, empa-
in the research. thetic and truly conversant with children, The interests of children should always be
parents, and all legal requirements where represented on independent research ethics
Physicians must respect the integrity and
the interests of the child are paramount committees when research on children is
relative autonomy of a child and strive to
being considered. The membership must
attain the maximal achievable benefit, with Child specific protocols should be drawn up
include children’s physicians experienced
the avoidance of unnecessary risks, discom- by experienced experts and the study should
in paediatric research and trained in the spe-
fort and stress. be carried out under the supervision of pae-
cial needs of children. Other members
diatricians
should be well acquainted with the needs of
Avoidance of harm Age specific informed consent/assent forms children .
need to be available for child subjects, their
parents and legal representatives.
Risks should be minimised and potential Further work on this Statement
harm leading to physical, psychological, The study protocols should be evaluated by
social, spiritual impairment should be independent research ethics committees on A detailed scrutiny by national medical
avoided which there are paediatric health profes- associations and other interested ‘stake-
sionals. holders’ is welcomed. The W.M.A has set
Minimal risk involves procedures, ques-
up an electronic working group to receive
tionnaires, observation and measurements
comments and suggestions both on the need
even being carried out in a child sensitive Consent/Assent for a document such as this which is specif-
way.
ic for children and on the core principles in
Greater than minimal risk is can be associ- Children are minors who have not reached the statement which can be used to develop
ated with invasive procedures or therapies. the age for self responsible consent. both international and local national guide-
These should be carried out only when the lines.
Informed consent means the approval of the
research is concerned with diagnosis and
child’s parents or legal representative for Please send your comments to your
treatment and the expected benefits to the
the participation of the child in a research National Medical Association or as individ-
child participant outweigh the known or
study, following sufficient information to uals to the WMA office secretariat@
anticipated risks involved where the
enable them to make an informed judgment. wma.net
research is likely to yield justifiable gener-
alisable knowledge of vital importance Informed Assent means the acquiescence of James Appleyard MD FRCPCH
about the child’s disorder or condition and the child to participate in the research fol- Children’s Physician
research that provides the only opportunity lowing information being provided in a Past President
to identify, prevent or alleviate a rare dis- form understandable to their age group. World Medical Association
ease confined to childhood November 2007
The consent of both parents should be
sought prior to enrolling a child in a bio-
medical research project.
Study Designs References
There must be no forced or undue influ-
Study protocols and study designs must be ence, financial or otherwise, on the child’s
1. Child Health Research – A foundation for
child specific. In addition to including the decision to participate in the research or on
improving Child Health. World Health
safeguards for adult subjects , they should the parents/legal representative’s consent.
Organisation 2001
justify the necessity of the research on chil-
The refusal to participate in the research by
dren 2. Global Forum for Health Research 2005
an informed child must be respected .
World Health Organisation
Preclinical safety and efficacy data are pre-
conditions for the start of paediatric clinical 3. Krugman S Experiments at the
trials. Privacy Willowbrook State School . Lancet 1971
1 966-967
The selection of children to participate in a
biomedical research project should not The privacy if the child must be fully 4. Burns J.P. ‘Research in Children’ Crit
depend upon the child’s race, nationality, assured throughout the research project. Care Med 2003 31 No 3 (Suppl)

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5. Guidelines for the Ethical Conduct of 9. Additional Safeguards for Children in 14. International Ethical Guidelines for
Medical Research involving children. Clinical investigations of FDA-regulated Biomedical Research Involving Human
Royal College of Paediatrics and Child Products – Interim Rule Food and Drug Subjects Prepared by the Council for
Health: Ethics Advisory Committee Administration, Health and Human International Organizations of Medical
Arch. Dis. Child. 2000 82 177-182 Services 2007 www.fda.gov. Sciences (CIOMS) in collaboration
with the World Health Organization
6. Appleyard W.J The Challenge of building 10. ‘Ethical Principles for Medical
(WHO) CIOMS Geneva 2002
an International Framework for Research Research Involving Human Subjects’
on Medicines for Children. The Joseph J WMA Declaration of Helsinki 2002 15. ‘Clinical Investigation of medicinal
Hoet Lecture 2005 The European Forum products in the paediatric population’.
11. Ethical Principles and Operational
for Good Clinical Practice Bruxelles International Committee on
Guidelines for Good Clinical Practice in
Harmonisation E 11
7. International Ethical Guidelines for Paediatric Research in Ethics Working
Biomedical Research involving Human Group Confederation of European 16. Guideline on Ethical considerations for
Subjects, Council for International Specialists in Paediatrics 2002 Clinical Trials performed in children
Organisations of Medical Sciences with within the scope of the E.U Clinical
12. Committee on Drugs, American
the WHO Geneva 2002 Trials Directive 2001/20/EC . The
Academy of Pediatrics Guidelines for
European Agency for the Evaluation of
the ethical conduct of studies to evalu-
8. Department of Health and Human Medicinal Products (EMEA) 2006
ate drugs in pediatric populations
Services, Food and Drug Administration.
Pediatrics 1995 286-294 17. Improving Child Health : The role of
Regulations requiring manufacturers to
Research Working Group on Women
assess the safety and effectiveness of new 13. Ethical Considerations for Clinical tri-
and Child Health BMJ 2002 324 1444-
drugs and biological products in pediatric als performed in Children - Guidelines
7
patients; final rule Ref Reg 1998 by an Ad Hoc Group for E U Directive
63(231):666 32-72 2001/20/EC 2006 18. Forest CB, Shipman SA , Dougherty D,
Miller MR ‘Outcomes Research in
Pediatric Settings’ Pediatrics 2003 111
171-8
World Health Professions Alliance 19. Homan R ‘Problems with Codes’
Conference on Regulation of Health Research Ethics Review 2006 2 No3
98-103
Professions display 20. Appleyard W.J.’ The Rights of Children
to Healthcare’ Medical Ethics 1998 24
The World Medical Association will join with its partners in the World Health 293-4
Professions Alliance (WHPA)* and the World Confederation for Physical Therapy in
21. Ross L.F ‘Do healthy children deserve
hosting a conference in the Regulation of Health Professions.
greater protection in Medical Research
The Conference will be held in Geneva, Switzerland on May 17-18 2008 and discuss ?’ J.Pediatr 2003 142 108-12
the role and future of health professions’ regulation. It will focus on models of health
22. Ondrusek N., Abramovitch R.,
professions’ regulation, examples of best practice in regulatory body governance and
Pencharz P and Koren G ‘Empirical
a discussion of trade in services and its implications for regulation.
examination of the ability of children to
The Conference, intended to bring together regulators, leaders of health consent to clinical research’ Journal of
professions.policy makers, health system managers and administrators; researchers Medical Ethics 1998 24 158-165
and scientists and other interested parties, will take place prior to the World Health
23. Steinbrook R Testing Medications in
Assembly (19–23 May 2008).
Children N Eng J Med 2002 347 1642-
For full details of speakers, programme, registration and submission of abstracts visit: 1470
www.whpa.org/reg/index.htm
*The World Health Professions Alliance is a unique alliance of dentistry, medicine, nursing and
pharmacy aiming to address global health issues and striving to help deliver cost effective qual-
ity health care worldwide. The WHPA member organisations are: the International Council of
Nurses (ICN), the International Pharmaceutical Federation (FIP), the World Dental federation
(FDI) and the World Medical Association (WMA). WHPA will be joined by the World
Confederation for Physical Therapy (WPTC).

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WMA Statement On The Ethics Of Telemedicine


Adopted by the WMA General Assembly, Copenhagen, Denmark, October 2007

DEFINITION The patient-physician relationship must responsible for treatment and other deci-
be based on mutual trust and respect. It is sions and recommendations given to the
Telemedicine is the practice of medicine therefore essential that the physician and patient.
over a distance, in which interventions, patient be able to identify each other reli-
diagnostic and treatment decisions and ably when telemedicine is employed. A physician should be aware of and
recommendations are based on data, doc- respect the special difficulties and uncer-
Ideally, telemedicine should be employed tainties that may arise when he/she is in
uments and other information transmitted
only in cases in which a prior in-person contact with the patient through means of
through telecommunication systems.
relationship exists between the patient and tele-communication. A physician must be
the physician involved in arranging or prepared to recommend direct patient-
providing the telemedicine service.
PREAMBLE doctor contact when he/she feels that the
The physician must aim to ensure that situation calls for it.
The development and implementation of patient confidentiality and data integrity Quality of care
information and communication technol- are not compromised. Data obtained dur-
ogy are creating new modalities for pro- ing a telemedical consultation must be Quality assessment measures must be
viding care for patients. These enabling secured through encryption and other used regularly to ensure the best possible
tools offer different ways of practising security precautions must be taken to pre- diagnostic and treatment practices in
medicine. The adoption of telemedicine is vent access by unauthorized persons. telemedicine.
justified because of its speed and its
Responsibilities of the physician The possibilities and weaknesses of
capacity to reach patients with limited
telemedicine in emergencies must be
access to medical assistance, in addition A physician whose advice is sought
to its power to improve health care. through the use of telemedicine should acknowledged. If it is necessary to use
keep a detailed record of the advice he/she telemedicine in an emergency situation,
Physicians must respect the following eth- the advice and treatment suggestions are
delivers as well as the information he/she
ical guidelines when practising telemedi- influenced by the level of threat to the
received and on which the advice was
cine. patient and the know-how and capacity of
based.
the persons who are with the patient.
It is the obligation of the physician to
PRINCIPLES ensure that the patient and the health pro-
fessionals or family members caring for RECOMMENDATION
Patient-physician relationship and confi- the patient are able to use the necessary
dentiality telecommunication system and necessary The WMA and National Medical
instruments. The physician must seek to Associations should encourage the devel-
The patient-physician relationship should
ensure that the patient has understood the opment of national legislation and inter-
be based on a personal encounter and suf-
advice and treatment suggestions given national agreements on subjects related to
ficient knowledge of the patient's person-
and that the continuity of care is guaran- the practise of telemedicine, such as e-
al history. Telemedicine should be
teed. prescribing, physician registration, liabili-
employed primarily in situations in which
a physician cannot be physically present The physician asking for another physi- ty and the legal status of electronic med-
within a safe and acceptable time period. cian's advice or second opinion remains ical records.

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WMA resolution on the responsibility of physicians in the documen-


tation and denunciation of acts of torture or cruel or inhuman or
degrading treatment
Initiated: September 2002, Adopted by the WMA General Assembly, Helsinki 2003 and amended
by the WMA General Assembly, Copenhagen, Denmark, October 2007

The World Medical Association, 8. Considering the Principles of Medical Medical Association in November 1997
Ethics Relevant to the Role of Health during the 49th General Assembly, call-
1. Considering the Preamble to the United
Personnel, Particularly Physicians, in the ing on physicians to protest individual-
Nations Charter of 26 June 1945 solemn-
Protection of Prisoners and Detainees ly against ill-treatment and on national
ly proclaiming the faith of the people of
the United Nations in the fundamental Against Torture and Other Cruel, and international medical organizations
human rights, the dignity and value of Inhuman or Degrading Treatment or to support physicians in such actions,
the human person, Punishment, adopted by the United
Nations General Assembly on 18 13. Considering the Istanbul Protocol
2. Considering the Preamble to the Universal December 1982, and particularly (Manual on the Effective Investigation
Declaration of Human Rights of 10 Principle 2, which states: "It is a gross and Documentation of Torture and
December 1948 which states that disre- contravention of medical ethics… for Other Cruel, Inhuman or Degrading
gard and contempt for human rights have health personnel, particularly physicians, Treatment or Punishment), adopted by
resulted in barbarous acts which have out- to engage, actively or passively, in acts the United Nations General Assembly
raged the conscience of mankind, which constitute participation in, com- on 4 December 2000,
3. Considering Article 5 of that Declaration plicity in, incitement to or attempts to
commit torture or other cruel, inhuman 14. Considering the Convention on the
which proclaims that no one shall be sub- Rights of the Child, which was adopted
jected to torture or cruel, inhuman or or degrading treatment…",
by the United Nations on 20 November
degrading treatment, 9. Considering the Convention Against 1989 and entered into force on 2
4. Considering the American Convention Torture and Other Cruel, Inhuman or September 1990, and
on Human Rights, which was adopted by Degrading Treatment or Punishment,
the Organization of American States on which was adopted by the United 15. Considering the World Medical
22 November 1969 and entered into Nations General Assembly on December Association Declaration of Malta on
force on 18 July 1978, and the Inter- 1984 and entered into force on 26 June, Hunger Strikers, adopted by the 43rd
American Convention to Prevent and 1987, World Medical Assembly Malta,
Punish Torture, which entered into force November 1991and amended by the
10. Considering the European Convention
on 28 February 1987, for the Prevention of Torture and WMA General Assembly, Pilanesberg,
Inhuman or Degrading Treatment or South Africa, October, 2006,
5. Considering the Declaration of Tokyo,
adopted by the World Medical Association Punishment, which was adopted by the
in 1975, which reaffirms the prohibition of Council of Europe on 26 June 1987 and
any form of medical involvement or pres- entered into force on 1 February 1989, Recognizing
ence of a physician during torture or inhu- 11. Considering the Resolution on Human
man or degrading treatment, 16. That careful and consistent documenta-
Rights adopted by the World Medical tion and denunciation by physicians of
6. Considering the Declaration of Hawaii, Association in Rancho Mirage, in cases of torture and of those responsi-
adopted by the World Psychiatric October 1990 during the 42nd General ble contributes to the protection of the
Association in 1977, Assembly and amended by the 45th, physical and mental integrity of vic-
46th and 47th General Assemblies, tims and in a general way to the strug-
7. Considering the Declaration of Kuwait,
adopted by the International Conference 12. Considering the Declaration of gle against a major affront to human
of Islamic Medical Associations in 1981, Hamburg, adopted by the World dignity,

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17. That physicians, by ascertaining the 4. Promote training of physicians on the with the subject's consent, but in certain
sequelae and treating the victims of tor- identification of different modes of tor- circumstances where the victim is
ture, either early or late after the event, ture, in recognizing physical and psycho- unable to express him/herself freely,
are privileged witnesses of this viola- logical symptoms following specific without explicit consent.
tion of human rights, forms of torture and in using the docu-
mentation techniques foreseen in the 9.3 cautioning physicians to avoid putting
18. That the victims, because of the psycho- Istanbul Protocol to create documenta- individuals in danger by reporting on a
logical sequelae from which they suffer tion that can be used as evidence in legal
or the pressures brought on them, are named basis a victim who is deprived of
or administrative proceedings. freedom, subjected to constraint or
often unable to formulate by themselves
complaints against those responsible for 5. Promote awareness of the correlation threat or in a compromised psychologi-
the ill-treatment they have undergone, between the examination findings, cal situation
understanding torture methods and the
19. That the absence of documenting and patients' allegations of abuse; 10. Place at their disposal all useful infor-
denouncing acts of torture may be con- mation on reporting procedures, partic-
sidered as a form of tolerance thereof 6. Facilitate the production of high-quality ularly to the national authorities, non-
and of non-assistance to the victims, medical reports on torture victims for
governmental organizations and the
submission to judicial and administrative
20. That nevertheless there is no consistent bodies; International Criminal Court.
and explicit reference in the profession-
7. Attempt to ensure that physicians Istanbul Protocol, paragraph 68: "In some
al codes of medical ethics and legisla-
tive texts of the obligation upon physi- observe informed consent and avoid cases, two ethical obligations are in con-
cians to document, report or denounce putting individuals in danger while flict. International codes and ethical princi-
acts of torture or inhuman or degrading assessing or documenting signs of torture ples require the reporting of information
treatment of which they are aware, and ill-treatment; concerning torture or maltreatment to a
8. Attempt to ensure that physicians include responsible body. In some jurisdictions, this
assessment and documentation of symp- is also a legal requirement. In some cases,
Recommends that National toms of torture or ill-treatment in the however, patients may refuse to give con-
Medical Associations medical records using the necessary pro- sent to being examined for such purposes or
cedural safeguards to prevent endanger- to having the information gained from
1. Attempt to ensure that detainees or vic- ing detainees. examination disclosed to others. They may
tims of torture or cruelty or mistreatment 9. Support the adoption in their country of be fearful of the risks of reprisals for them-
have access to immediate and indepen- ethical rules and legislative provisions: selves or their families. In such situations,
dent health care. Attempt to ensure that health professionals have dual responsibili-
physicians include assessment and docu- 9.1 aimed at affirming the ethical obligation
on physicians to report or denounce acts ties: to the patient and to society at large,
mentation of symptoms of torture or ill-
treatment in the medical records using of torture or cruel, inhuman or degrad- which has an interest in ensuring that jus-
the necessary procedural safeguards to ing treatment of which they are aware; tice is done and perpetrators of abuse are
prevent endangering detainees. depending on the circumstances, the brought to justice. The fundamental princi-
report or denunciation would be ple of avoiding harm must feature promi-
2. Promote awareness of the Istanbul addressed to medical, legal, national or
Protocol and its Principles on the Effective nently in consideration of such dilemmas.
international authorities, to non-govern-
Investigation and Documentation of mental organizations or to the Health professionals should seek solutions
Torture and Other Cruel, Inhuman or International Criminal Court. Doctors that promote justice without breaking the
Degrading Treatment. This should be done should use their discretion in this mat- individual's right to confidentiality. Advice
at country level using different methods of ter, bearing in mind paragraph 68 of the should be sought from reliable agencies; in
information dissemination; including Istanbul Protocol. some cases this may be the national medical
trainings, publications and web docu- association or non-governmental agencies.
9.2 establishing, to that effect, an ethical
ments. Alternatively, with supportive encourage-
and legislative exception to profession-
3. Disseminate to physicians the Istanbul al confidentiality that allows the physi- ment, some reluctant patients may agree to
Protocol. cian to report abuses, where possible disclosure within agreed parameters."

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WMA Resolution On Health And Human Rights Abuses In Zimbabwe


Adopted by the WMA General Assembly, Copenhagen, Denmark, October 2007

PREAMBLE • Supporting physicians who are persecut- 5. Uphold its commitment to the WMA
ed because of their adherence to medical Declarations of Tokyo, Hamburg and
Noting information and reports of system- ethics Madrid as well as the WMA Statement
atic and repeated violations of human on Access to Health Care
rights, interference with the right to health 6. Facilitate an environment where all
in Zimbabwe, failure to provide resources
RECOMMENDATION
Zimbabweans have equal access to qual-
essential for provision of basic health care, Therefore, the World Medical Association, ity health care and medical treatment,
declining health status of Zimbabweans, recognizing the collapsing health care sys- irrespective of their political affiliations
dual loyalties and threats to health care tem and public health crisis in Zimbabwe, 7. Commit to eradicating torture and inhu-
workers striving to maintain clinical inde- calls on its affiliated national medical asso-
mane, degrading treatment of citizens
pendence, denial of access to health care ciations to:
in Zimbabwe
for persons deemed to be associated with 1. Publicly denounce all human rights
opposition political parties and escalating abuses and violations of the right to 8. Reaffirm their support for the clinical
state torture, the WMA wishes to confirm health in Zimbabwe independence of physicians treating
its support of, and commitment to: any citizen of Zimbabwe
2. Actively protect physicians who are
• Attaining the World Health Organization threatened or intimidated for actions 9. Obtain and publicize accurate and nec-
principle that the "enjoyment of the which are part of their ethical and pro- essary information on the state of
highest attainable standard of health is fessional obligations health services in Zimbabwe
one of the fundamental rights of every 3. Engage with the Zimbabwean Medical 10. Advocate for inclusion in medical cur-
human being" Association (ZiMA) to ensure the ricula, teachings on human rights and
autonomy of the medical profession in the ethical obligations of physicians to
• Defending the fundamental purpose of Zimbabwe maintain full and clinical indepen-
physicians to alleviate distress of dence when dealing with patients in
patients and not to let personal, collec- 4. Urge and support ZiMA to invite an
international fact finding mission to vulnerable situations
tive or political will prevail against such
Zimbabwe as a means for urgent action The WMA encourages ZiMA to seek assis-
purpose to address the health and health needs tance in achieving the above by engaging
• Supporting the role of physicians in of Zimbabweans with the WMA, the Commonwealth
upholding the human rights of their In addition, the WMA encourages ZiMA, Medical Association and the NMAs of
patients as central to their professional as a member organization of the WMA, neighboring countries and to report on its
obligations to: progress from time to time.

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Medical Science, Medical Practice and Medical Education

WMA Statement on Health Hazards of Tobacco Products


Adopted by the 40th World Medical Assembly, Vienna, Austria, September 1988 amended by the
49th WMA General Assembly, Hamburg, Germany, November 1997 and the WMA General
Assembly, Copenhagen, Denmark, October 2007

PREAMBLE ucts, and eliminating illegal trade in and believes strongly that the medical
tobacco products. associations themselves must provide a
More than one in three adults worldwide firm leadership role in the campaign
Exposure to secondhand smoke occurs
(more than 1.1 billion people) smokes, 80 against tobacco.
anywhere smoking is permitted: homes,
percent of whom live in low- and middle- The tobacco industry and its subsidiaries
workplaces, and other public places.
income countries. Smoking and other have for many years supported research
According to the WHO, some 200,000
forms of tobacco use affect every organ and the preparation of reports on various
workers die each year due to exposure to
system in the body, and are major causes smoke at work, while about 700 million aspects of tobacco and health. By being
of cancer, heart disease, stroke, chronic children, around half the world's total, involved in such activities, individual
obstructive pulmonary disease, fetal dam- breathe air polluted by tobacco smoke, researchers and/or their organizations
age, and many other conditions. Five mil- particularly in the home. Based on the evi- give the tobacco industry an appearance
lion deaths occur worldwide each year dence of three recent comprehensive of credibility even in cases where the
due to tobacco use. If current smoking reports (the International Agency for industry is not able to use the results
patterns continue, it will cause some 10 Research on Cancer's Monograph 83, directly in its marketing. Such involve-
million deaths each year by 2020 and 70 Tobacco Smoke and Involuntary ment also raises major conflicts of interest
percent of these will occur in developing Smoking; the United States Surgeon with the goals of health promotion.
countries. Tobacco use was responsible General's Report on The Health
for 100 million deaths in the 20th century Consequences of Involuntary Exposure to
and will kill one billion people in the 21st Tobacco Smoke; and the California RECOMMENDATIONS
century unless effective interventions are Environmental Protection Agency's
implemented. Furthermore, secondhand Proposed Identification of Environmental The WMA urges the national medical
smoke - which contains more than 4000 Tobacco Smoke as a Toxic Air associations and all physicians to take the
chemicals, including more than 50 car- Contaminant), on May 29, 2007, the following actions to help reduce the
cinogens and many other toxins - causes WHO called for a global ban on smoking health hazards related to tobacco use:
lung cancer, heart disease, and other ill- at work and in enclosed public places.
nesses in nonsmokers.
The tobacco industry claims that it is 1. Adopt a policy position opposing
The global public health community, committed to determining the scientific smoking and the use of tobacco prod-
through the World Health Organization truth about the health effects of tobacco, ucts, and publicize the policy so adopt-
(WHO), has expressed increasing concern both by conducting internal research and ed.
about the alarming trends in tobacco use by funding external research through
and tobacco-attributable disease. As of 20 jointly funded industry programs. 2. Prohibit smoking at all business, social,
September 2007, 150 countries had rati- However, the industry has consistently scientific, and ceremonial meetings of
fied the Framework Convention on denied, withheld, and suppressed infor- the National Medical Association, in
Tobacco Control (FCTC), whose provi- mation concerning the deleterious effects line with the decision of the World
sions call for ratifying countries to take of tobacco smoking. For many years the Medical Association to impose a simi-
strong action against tobacco use by industry claimed that there was no conclu- lar ban at all its own such meetings.
increasing tobacco taxation, banning sive proof that smoking tobacco causes 3. Develop, support, and participate in
tobacco advertising and promotion, pro- diseases such as cancer and heart disease. programs to educate the profession and
hibiting smoking in public places and It has also claimed that nicotine is not the public about the health hazards of
worksites, implementing effective health addictive. These claims have been repeat- tobacco use (including addiction) and
warnings on tobacco packaging, improv- edly refuted by the global medical profes- exposure to secondhand smoke.
ing access to tobacco cessation treatment sion, which because of this is also res- Programs aimed at convincing and
services and medications, regulating the olutely opposed to the massive advertis- helping smokers and smokeless tobac-
contents and emissions of tobacco prod- ing campaigns mounted by the industry co users to cease the use of tobacco

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products and programs for non-smok- researchers to do the same, in order to d. ban all advertising and promotion of
ers and non-users of smokeless tobacco avoid giving any credibility to that tobacco products.
products aimed at avoidance are both industry.
important. e. prohibit the sale, distribution, and
10. Urge national governments to ratify accessibility of cigarettes and other
4. Encourage individual physicians to be and fully implement the Framework tobacco products to children and
role models (by not using tobacco prod- Convention on Tobacco Control in adolescents.
ucts) and spokespersons for the cam- order to protect public health.
paign to educate the public about the f. prohibit smoking on all commercial
deleterious health effects of tobacco 11. Speak out against the shift in focus of airline flights within national borders
use and the benefits of tobacco-use ces- tobacco marketing from developed to and on all international commercial
sation. Ask all medical schools, bio- less developed nations and urge airline flights, and prohibit the sale of
medical research institutions, hospitals, national governments to do the same.
tax-free tobacco products at airports
and other health care facilities to pro- 12. Advocate the enactment and enforce- and all other locations.
hibit smoking on their premises. ment of laws that:
g. prohibit all government subsidies for
5. Introduce or strengthen educational a. provide for comprehensive regula- tobacco and tobacco products.
programs for medical students and tion of the manufacture, sale, distrib-
physicians to prepare them to identify ution, and promotion of tobacco h. provide for research into the preva-
and treat tobacco dependence in their products, including the specific pro- lence of tobacco use and the effects
patients. of tobacco products on the health sta-
visions listed below.
6. Support widespread access to evi- tus of the population.
b. require written and pictorial warn-
dence-based treatment for tobacco i. prohibit the promotion, distribution,
ings about health hazards to be print-
dependence - including counseling and and sale of any new forms of tobacco
ed on all packages in which tobacco
pharmacotherapy - through individual
products are sold and in all advertis- products that are not currently avail-
patient encounters, cessation classes,
ing and promotional materials for able.
telephone quit-lines, web-based cessa-
tion services, and other appropriate tobacco products. Such warnings
j. increase taxation of tobacco products,
means. should be prominent and should refer
using the increased revenues for pre-
those interested in quitting to avail-
7. Develop or endorse a clinical practice able telephone quit-lines, websites, vention programs, evidence-based
guideline on the treatment of tobacco or other sources of assistance. cessation programs and services, and
use and dependence. other health care measures.
c. prohibit smoking in all enclosed pub-
8. Join the WMA in urging the World lic places (including health care k. curtail or eliminate illegal trade in
Health Organization to add tobacco facilities, schools, and education tobacco products and the sale of
cessation medications with established facilities), workplaces (including smuggled tobacco products.
efficacy to the WHO's Model List of restaurants, bars and nightclubs) and
Essential Medicines. l. help tobacco farmers switch to alter-
public transport. Mental health and native crops.
9. Refrain from accepting any funding or chemical dependence treatment cen-
educational materials from the tobacco ters should also be smoke-free. m. urge governments to exclude tobac-
industry, and to urge medical schools, Smoking in prisons should not be co products from international trade
research institutions, and individual permitted. agreements.

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Medical Science, Medical Practice and Medical Education / Point of view

Education

Avicenna Directories to replace World Directory of Medical Schools


Discussions have been taking place on schools' accreditation, number of admis- Pharmaceutical Federation and other part-
between WHO and the University of sions, students, graduates , Faculty, educa- ners.
Copenhagen with a view to replacing the tional resources, address, and national offi-
World Directory of Medical Schools with cial recognition. The database will be run The database will be based in the Faculty
the establishment of a Global database of by the University of Copenhagen in collab- of Health Sciences in the University of
health professions. It is planned is to oration with WHO, the World Federation Copenhagen with the close collaboration
include other academic health institutions for Medical Education (WFME), the of WFME. These electronic resources will
relating to the other health professions such Foundation for the4 Advancement of be called the Avicenna Directories. It
as dentistry, midwifery, nursing, pharmacy, International Medical Education and is understood that the work has already
public health and will include information Research (FAIMER), the International started.

Global Standards for Quality Improvement in Medical Education


The World Federation of Medical Education European Region of WHO. It is directed of value to all physicans who have respon-
has published European Specifications for towards national and international authori- sibilities in medical education,
Basic and Postgraduate Medical Education ties, institutions and organisations with
WFME Global Standards for Quality
and Continuing Professional Development. responsibility for medical education and
Improvement in Medical Education
represents a valuable tool in planning qual-
European Specifications.
These have been developed by a WFMA/ ity improvement in medical education, set-
ISBN 978-87-989108-6-2
AMSE international task force set up by ting out the essential elements which need
Publication facilitated by WHO EURO
MEDINE, chaired by WFME and ASME, to be considered in planning necessary
sponsored by the European Commission, reforms in medical education. While this is Information from:
and provides a valuable tool adapting the an essential tool for authorities and institu- World Federation of Medical Educuation
global standards in medical education to the tions concerned with medical education it is www.wfme.org

Point of view

A Worldwide Tour of Medical Degrees and Qualifications


Dr. Denis Doran MD Another problem that Boards, Medical ies, dental committees and residency pro-
Councils and Colleges have had to deal with gramme applications. It is not intended to
In recent years, attempting to recognise a
for many years, is to differentiate and recog- provide an official or exhaustive list of
medical degree or qualification can be chal-
nise which degrees relate to clinical prac- medical qualifications but merely to reflect
lenging With the reunification of East and
tice, which ones are linked to academic on the great variety of titles for medical
West Germany, the opening of the European
careers and which ones are honorary. The diplomas and qualifications.
Community to several new member states,
increase in international migration has made
the break-up of the Soviet Union and the
this problem even more pressing.
fragmentation of Yugoslavia into several EUROPE
individual nations, medical degrees and This article will review the broad range of
qualifications which were not familiar medical degrees and evidence of qualifica- In Europe, the medical degrees awarded
before are now more commonly seen. tion presented nowadays to licensing bod- vary from country to country (and also

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Point of view

within countries), of which the following Varieties of the same degree exist through- and Peru, a Titulo de Medico Cirujano.
are examples. out Britain and the rest of the Surinam awards an Arts or Geneesheren
Commonwealth. These are BM BCh , MB diploma.
In Belgium, the French university diploma
ChB, MB BChir, MB, BS. In the UK, an
is Docteur en Medicine,Chirugie et
Accouchement. The Flemish university
MD could be awarded to one who does NORTH AMERICA
research and submits a thesis in the field of
degree is Aerts, Arts (Physician).
medicine, or as an honorary degree, to a In Canada, francophone universities award
In the countries of the former Soviet Union senior or academic physician. Throughout a Docteur/ Doctorat en Médecine diploma:
Russia, Ukraine, Moldova, Armenia and the world, many countries with former edu-
Anglophone universities offer the MD diplo-
Estonia all issue a Doctor in Medicine cational associations with Britain award
ma. In the USA, most graduates of medical
Diploma; Uzbekistan awards a General degrees reflecting the British type of med-
schools receive an MD. Another medical
Practitioner diploma and the rest of the 15 ical degree.
degree awarded by 19 medical schools is the
republics award a Vrach (Physician) diploma.
The Conjoint Diploma LRCP, MRCS , and Doctor of Osteopathy or DO diploma.
In the nations of the former Yugoslavia, the LMSSA (Licentiate of the Royal College
Croatia and Macedonia award a Doctor of of Physicians of London, Member of the
Medicine diploma, while Bosnia- Royal College of Surgeons of England, and ASIA
Herzegovina, Serbia and Slovenia formerly the Licentiate in Medicine, Surgery of the
issued a Lekar (or Zdravnik) diploma - now Society of Apothecaries) were registrable China and Taiwan offer a Bachelor of
a Doctor of Medicine diploma. qualifications with the General Medical Medicine degree. China also offers a
Council (where all practising physicians Bachelor of Traditional Medicine and Japan
The graduates from medical schools in
have to be registered if they wish to prac- offers an Igaku (Bachelor of Medicine). In
Austria, The Czech Republic and Slovakia
tice) until 1999. The Scottish Triple Malaysia following the British system the
receive a Medicinae Universae Doctor
Conjoint Diplomas, LRCPE, LRCSE, MB,BS or MB,ChB are awarded as well as
Diploma.
LRCPSG are similar qualifications which the Doctor “Perubatan”. North Korea offers
In Scandinavia, Norwegian and Danish were registrable with the GMC until 1999. a Doctor diploma and South Korea, earlier a
medical schools award a Candidatus Hak Sa diploma and now a Bachelor of
In Ireland, the basic medical degree is MB,
Medicinae diploma; Iceland - a Candidatus Medicine; Indonesia awards a Doktor diplo-
ChB, BAO (Baccalaureus in Arte
Medicinae et Chirurgiae diploma; Sweden - ma and Mongolia a Physician diploma.
Obstetrician). The LRCPI, LRCSI diplo-
a Lakaexamen diploma and in Finland - a
mas, unlike England and Scotland are still
“Lisensiatti (Licence in Medicine). The
registrable with the Irish Medical Council.
degree Laaketieteen Tohtori (Doctor of
Also recognised is the LM (Licence in
AFRICA
Medicine) is a traditional university doctor-
Midwifery)
ate, the highest degree and is a requirement Angola and Mozambique ex-Portuguese
for the position of Professor.. For Germany there is a State Examination colonies offer the same diplomas as
Certificate , either on passing a three part Portugal; the Democratic Republic of
In the Netherlands an Arts (or Artsexamen)
State exam (Dritter Abschnitt Certificate ) or Congo, an ex-Belgian colony, awards a
diploma is awarded, in Luxembourg a
a two part State exam, (Zweiter Abschnitt Docteur en Med., Chir et Accouchement
Bachelor Academique en Sciences de la
Certificate).which are recognised for basic diploma, as well as a number of others,
Vie-Medicine, and in Bulgaria, a
licensing purposes. Italy awards a Laurea in which are accepted for basic medical licens-
Master’s/Physician or State Examination
Medecina e Chirurgia diploma) (Bachelor of ing purposes. Gabon, Benin and Ivory
certificate is awarded
Medicine and Surgery), Portugal awards a Coast have a Doctorat d’Etat en Medicine.
A few degrees have unusual sounding Licenciatura em Medecina diploma and
Most other countries of the world issue
names: in Albania Mjek I Prerjithshem; in Spain, a Licenciado en Medecina y Cirurgia.
either an MD, Doctorat en Medecine or
Greece, Psycho Iatrikes; Belarus currently
Switzerland awards a Diploma Federal. MBBS/MB ChB degree.
Kvaliifi Kaciya (Physician diploma ) for-
merly a Vrach.)
Romania awards a Doctor-Medic diploma; LATIN AMERICA NON-MEDICAL QUALIFI-
Poland, a Lekarz diploma; Hungary – an
Brazil awards a Medico (or MD) diploma; CATIONS
Orvos doctor or MD diploma, and Turkey –
Bolivia a Titulo en Provision Nacional de
a Doctor of Medicine diploma.
Medico Cirujano; Costa Rica,Venezuela The PhD is a university awarded research
In the United Kingdom, the basic British and Chile, a Medico Chirujano diploma: Doctorate, not necessarily associated with
medical degree is the MB, BCh, (Medicinae Ecuador, Honduras and Nicaragua, a clinical practice, awarded after supervised
Baccalaureus, Baccalaureus Chirugiae). Doctor en Medicina y Chirugia; Mexico academic research and the submission of a

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From the WMA Secretary General

thesis. (Often Clinical Psychologists, who FELLOWSHIP CONCLUSION


unlike Psychiatrists cannot prescribe med-
ications have a PhD.).
e.g FAAP Fellow of the American Academy It is not the purpose of this article to discuss
of Paediatrics. the details of qualifications associated with
the great variety of medical degrees listed
MEMBERSHIP/FELLOW- FRCP Fellow of the Royal College of
above.
SHIP OF COLLEGES AND Physicians.
OTHER SPECIALIST Nevertheless, licensing bodies have the role
Fellowships require a much higher distinc-
of recognising (or not) these medical
INSTITUTIONS tion and status. They are usually awarded
degrees and qualifications and to suggest,
after passing a very difficult examination or
when necessary, updates to qualify for a
are elected for distinction in the relevant
Medical Colleges and Academic Institutions, licence to practice.
branch of medicine.
many of which have existed many or for
Accordingly, the public at large need to
hundreds of years, award fellowships. The In many countries of Europe and to a cer-
accept the fact that physicians qualified to
Colleges are normally concerned with spe- tain extent throughout the world, physicians
practice in their region may not necessarily
cialities, although, as, mentioned above, appointed as Professors prefer to be called
have the usual MD after their name.
some conduct examinations related to their Professor rather than Doctor and in
own specialty which are recognised for basic England, Fellows of the Royal College of Address for communication
licensing purposes to practice medicine e.g. Surgeons are referred to as Mister In fact all Dr Denis Doren
LRCPI, LRCPI. Fellowships, on the other surgeons are called Mister but “Obstetric Box70 1 Hastings St N,
hand normally require the passing of a high- and Gynaecologist” specialists if they hold Bancroft. KOL 1CO
er examination or assessment and election an MD, may use the title Doctor. Canada
by the College as Fellows. Honorary
Fellowships are mostly awarded for excep-
tional and distinguished practice in medicine
Such Colleges have as their aim the develop-
ment of the specialty and the maintenance of
high standards and excellence, a condition
which their members are bound to fulfil as a
condition of Membership or Fellowship. The
use of titles varies greatly between countries
and institutions. From the WMA Secretary General

MEMBERSHIP Trust me, I’m a Doctor!


e.g MCCFP Membership of Canadian
College of Family Physicians;
Although you never should say this to your trained persons but they may well be doc-
MACP Membership of American College patients – you often will enjoy exactly the tors of podology. This not a joke! There is
of Physicians; desired high degree of confidence in what an economic war and we are about to lose it,
you do and what you are – a physician. because as it looks as if we have not even
MRCGP Membership of the Royal College
However, we are about to lose this! understood that it is going on.
of General Practitioners.
No, I am not referring to the sermon-like The battles our associations are fighting
Membership of these bodies, while not
repeated “doctor bashing” of politicians and about scope of practice and task shifting,
obligatory in some countries, often marks
media, I am referring to what may be are not an academic entertainment.
the end point of specialist training and is
thought to be advertising, but may be large- Politicians and economists are trying to de-
awarded after an examination This type of
ly a lack of precision and carelessness in professionalize medicine and make it a
Membership is, in certain countries, recog-
communication, with which we are endan- cheap commodity for the masses.
nised as achieving formal specialist qualifi-
gering our image.
cation, notably in the UK where for exam- Why? Is it – at least partially – our fault
ple, the MRCP is the recognised basic spe- More and more people are reaching out because we have produced the confusion, or
cialist qualification in medicine, whereas their hands to patients saying „Hallo! I am at least we let it happen? . Not only does a
the FRCS is the basic specialist qualifica- your doctor.“ But what kind of doctors are normal person already have a hard time to
tion for surgery. they? At best they may be scientifically understand what an Endocrinologist is and

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From the WMA Secretary General / WMA

does, we even top-up this non-communica- he found as a sign of pluralism, cultural health care, neglecting the additional quali-
tion with academic degrees, titles and diversity and tradition. But let’s face it, for ties implicit in a practicing profession.
abbreviations that are cryptic, confusing our patients it is simply a mess. To make
Do we want to maintain a special role in
and worst of all – misleading. this more transparent, at least to the con-
health care? Do we want to remains advo-
sumer (the patient), is there not some justi-
Appendices of titles, consisting of dozens cates for our patients? Do we want to keep
fication for simplifying the whole thing to “
of apparently randomly combined letters our leadership role in healthcare teams? If
Licensed Medical Practitioner”, with the
make us look like amateurs rather than seri- the answer is “yes” we should avoid the
addition “and Licensed xxxxx Specialist”,
ous professionals. Yes, we may be proud to ridiculous variety of titles and acronyms we
where appropriate. If then, the letters indi-
be a fellow of a college or society and why are currently using and should make sure
cating qualifications degrees e.g. MD, and
not talk about it. Yes, it is more than correct that patients can identify us as what we are:
Fellowships of Colleges etc are added, they
to display specialist qualifications. But physicians. This still permits the nomina-
will be less confusing.
titles that even our colleagues can only tion of a speciality, provided the qualifica-
decipher when they hold exactly the same In this day and age, access to the computer tion has been earned and awarded, but we
title could be considered vain advertising. surely permits patients to find the meaning should do it with the degree of transparency
Whom are medical titles good for? Should and significance of the letters. and clarity we owe our patients and the pub-
they not serve our patients to find the right lic.
And of course there are others who wel-
physician, to find the right treatment from a
come our own confusion. While we don’t Only then we will be able to protect our
qualified physician?
delivery clarity – they do it by simply clas- titles. This will not be enough as a sufficient
In this issue, Denis Doren, MD, from sifying us as “service providers” or “health strategy to protect our scope of practice, but
Ontario (Canada) has taken a look at the workers”. Separating us from our patients is we have to realize that it is a necessary
medical degrees, qualifications and titles made easy by our use of terms and abbrevi- requirement.
that are being awarded and used around the ations and making physicians accede to the
world. One might attribute the wide variety generic group of “service providers” in Trust me, I’m a doctor!

WMA General Assembly


The General Assembly of the World Medical Association was held in the Marriott Hotel,
Copenhagen on 5th and 6th October 2007

Ceremonial Session 5th October2007 Committee of the Red Cross, CIOMS, Copenhagen. He congratulated Dr. Snædel,
Confemel, the Danish Nursing Association, the incoming President on his election and
The President, Dr. N. Arumugam formally
the Federal Council of Brazilian Doctors, paid tribute to his work, notably for his con-
opened the Session.
the International Dental Federation, the tribution in the revision of the International
The Secretary General Dr. Otmar Kloiber International Federation of Medical Code of Ethics. He thanked the outgoing
reported the death on 10th of June of Dr. Students, the International Federation of President Dr. Arumugam for all is work
André Wynen, former Chair of Council and Pharmaceutical Manufacturers and over the past year.
Secretary General Paying a tribute, he said Associations, the Medical Women’s
The Chair of Council Dr. Hill warmly
”André Wynen was our friend, teacher and International Association, the Standing
thanked Dr. Jensen and the Danish Medical
leader, serving the World Medical Committee of European Doctors, the World
Association for the invitation to return to
Association and the whole medical profes- Federation of Medical Education, the
Copenhagen for this year’s Assembly and
sion with dedication and passion. World Psychiatric Association, the
for the hospitality, which was greatly appre-
International Rehabilitation Council for
ciated. Proposing a vote of thanks to the
The meeting stood in silent tribute. Torture Victims and the World Self-
President, he reminded the meeting that Dr.
Medication Industry.
The Secretary General, then took the Roll Arumugam, a cardiologist in Malaysia, was
Call, introducing the Delegates and the Dr. Jensen, President of the Danish Medical a champion of Public Health, had played a
Observers of other organisations present Association welcomed World Medical major role in the introduction of Tobacco
which included the International Association and all the participants to Legislation in that country.

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Retiring President’s Address Obesity was a major problem and the loom- few years the WMA has revised many of its
ing epidemic needed addressing with a pre- old documents in ethics as well as in other
Dr. Arumugam said that it had been a ter- ventive healthy diet and food labelling. fields. It has been a privilege to participate
rific year in which it had been an honour in the solution of many of these dilemmas,
The problems of tobacco continue. While
and a privilege to represent the World not least when the International Code of
the Framework Convention on Tobacco
Medical Association. He had tried to Medical Ethics was revised after a process
Control was welcomed, he felt that it so far
advance the views of WMA, had witnessed of 2 years and finally finished in South-
had had a limited effect and the World
the challenges facing Health Care Services Africa last year. To take an example of how
Medical Association must continue its
and Medicine in different countries and new thoughts are integrated in such a docu-
efforts to encourage Tobacco Control activ-
met fellow doctors across the world. He ment I will mention one paragraph of the
ities.
expressed his thanks both to Council and Code.
to his fellow Officers for their work and Turning to the World Health Professions
One of the paragraphs has been unchanged
support during the past year. His main task Alliance he commented that the Presidents
since its earliest version in 1949:“A PHYSI-
had been to emphasise the work of the of these professions met to discuss the prob-
CIAN SHALL always bear in mind the
WMA and improve its visibility. He had lem of Health Personnel Migration and
obligation to preserve human life.” In the
visited and attended the Annual meetings Task shifting, where areas of difference still
last revision one word was changed and the
of many National Medical Associations need to be addressed.
word preserve was replaced by the word
and referred to the problems of the profes-
The President referred to his presence in respect and now it reads: “A PHYSICIAN
sion such as increasing regulation reducing
India, the Philippines and most recently at a SHALL always bear in mind the obligation
the time for professional work. Focusing
meeting of CONFEMEL, finally comment- to respect human life.” The change of just
on Continuing Professional Development,
ing that at the recent AMA meeting there one word reflects a fundamental change in
he noted that this had been a special prob-
was concern over the development of clin- our way of thinking of our duties. Our abil-
lem over the past 10 years where there
ics in supermarkets and that in Australia ities to treat our fellow human beings have
were many hurdles in developing coun-
there was a need for vigilance over the issue vastly increased as we are now able to pre-
tries. Addressing the problems in South
of what is being called “Task Shifting“. He serve live for a long time even if this life is
East Asia in particular, he referred to the
closed by stating that the most unforgettable without any obvious quality. There is a say-
development of a points system for CPD in
event for him had been the reading and ing that life is a disease with 100% mortali-
that region.
affirmation of the WMA Oath of the ty, a saying that medicalises life itself. We
Patient Safety was also an important prob- Medical Profession. have to acknowledge the fact that death is
lem especially in hospitals. This had been The Assembly rose in a Standing Ovation. inevitable and that in its last phases it is of
addressed by the Hospitals Association in more value to the person to treat the symp-
Installation of the new President
Malta which had recognised the WMA toms rather than the disease. In this phase of
Statement on this issue. A Conference of Dr. Hill in thanking Dr. Arumugam for all life our obligation is thus to respect the
Medical Associations in SEA had included his work for the profession referred to the patient rather than to preserve his life.
CME on Ethics in Medicine and Clinical wisdom, care and understanding he had
There are many other ethical questions we
Practice. Dr. Arugunam also referred to shown as President. He then presented Dr.
have to address and the WMA is working
the increasing problem of medical litiga- Arumugam with the Past President’s medal.
constantly on these. Just to mention two
tion.
Introducing Dr. Snædel as the new issues we are dealing with in the coming
Turning to China he reported that the seven President, Dr. Hill said he had been elected months – a revision of the Helsinki declara-
persons in the delegation had discussed the in recognition of his many services to the tion on research involving human subjects
problems of Organ Transplants and harvest- profession and the WMA. Dr. Snædel took and a new document on stem cell research.
ing organs from prisoners, the shortage of the oath on assuming the office of President Every now and then we are faced with ethi-
organs and other problems with the Chinese and was invested with the Presidents Badge cal dilemmas we did not foresee. I will give
Medical Association and the Minister of of Office. you an example of such an issue which
Health. At the end of the meeting it was unfolded in my country just 3 weeks ago. A
concluded that Trade in Organs must stop. Presidential Address by Dr. Jon Snædel private company in genetic research has
He was encouraged by the recent accep- now offered those who wish for and are
“Dear colleagues, distinguished guests.
tance of the WMA Code on Transplantation willing to pay, an analysis of their genetic
of Organs by the Chinese Medical During the last decades new discoveries in makeup. The whole genome is analyzed by
Association. He commented that the prob- clinical research as well as in basic research half a million markers and the person will
lems of transplantation, including ethical have been stretching the ethical boundaries get a report on his chances of getting a num-
and legislative aspects had been discussed of medicine. The World Medical ber of diseases. But is it not just wonderful
by the German Medical Association whose Association has managed to be at the fore- that we have a technique that can provide us
meeting he had addressed. front of this evolution and during the past with such information of your health and

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health risks? In our view there are, howev- collaboration with very important organisa- echo the words of our past president,
er, obvious problems with this type of infor- tions in this field such as the Red Cross, Kgosi Letlape, when he said in his address
mation. One is clearly that you are not able Amnesty International and not least the in South-Africa that the solution to this
to change your genes, which means that if International Council for Torture Victims problem is to “keep the pastures green in
you know that your chances of getting say a which actually have their main office here our countries.”
certain type of cancer; you will not be able in Copenhagen. The important task of pre-
Doctors are not working alone. Team work
to affect that chance. Another is that this venting torture by using a tool called the
is an increasing issue in our daily routine
technique will obviously be very interesting Istanbul Protocol in ten countries has now
and we are accustomed to work alongside
to insurance companies who could then been underway during the last 4 years. It is
other health professionals, most often nurs-
insist that you will go through such a test my hope that the WMA will continue to
es and pharmacists. The WMA participates
whether you like or not. There are even work for this important human rights issue
in an international collaboration with the
more obstacles to this idea than I have in all possible ways during the coming
respective organisations of these two pro-
accounted for and this is just one example years.
fessions as well as the dentists. However,
of many of what medical ethics is about.
The WMA has during the last years dis- we need to address the collaboration of
cussed advocacy because that is the means these professionals on the ground better.
During my year of presidency of the World
by which the association will have effect. Another task of mine will be to work on that
Medical Association my main concerns will
The WMA aims its work mainly towards in a task looking specifically at collabora-
therefore be medical ethics and its manifold
three types of receivers, the individual tion for better pharmacological treatment.
tasks. I will build on the traditions of our
doctor, the association of doctors, mainly More tasks of this kind are obvious and will
Association and work in harmony with the
the NMA’s of the WMA, and towards most likely be looked at in the near future.
Council and the Secretariat, as it is of great
international organisations. The main
importance that we work together for our Lastly I will mention the specific group of
receivers of the work of the WMA
mutual cause even if I have chosen this spe- patients I care for and treat in my daily
throughout the years have been the
cific part of work of our Association for my work as a geriatrician, persons with demen-
NMA’s. That is of course good, but to have
mission. There are many means to achieve tia, more specifically Alzheimer’s disease.
a real effect on health issues, ethics and
our goals. At this Assembly we will discuss Even if I feel some urge to place their prob-
international politics of medicine our
the future of the World Medical Journal. I lems on the agenda I realize that the prob-
Association needs more visibility. By
would like to see this Journal, and thereby lems of specific group of patients are not an
revamping the WMJ we will increase our
the WMA itself, have a much greater role in issue for the WMA. We work for all of
visibility towards the individual doctor.
medical ethics and public health than it has them. However I will use this opportunity
Doctors will hopefully go to our new
had up to now. When I asked the librarian in to correct a prevalent misunderstanding,
Journal for advice and inspiration and we
my University hospital to take a look into that this is a specific problem for the devel-
will reach out with a printed version as
the accessible Journals of Medical Ethics it oped world. In fact most demented persons
well as an electronic one to all parts of the
became clear to me that there is a place for are found today in the developing world and
world in spite of language barriers.
one more. The Journals are far less in num- the greatest increase of this patient group is
Another important and imminent task is to
ber than in many specific fields of medi- without question in Asia and Africa.
increase our presence and influence in
cine, even subspecialties, and the distribu-
international organisations. One specific During the coming year I hope to bring
tion of most of them seems to be confined
task will be to work to preserve our educa- some benefit to the WMA but I acknowl-
to the society they are published for. This
tion and training because it has been on the edge that one person will not be able to
can be seen by their limited impact factor. A
agenda of the WHO to solve the problem achieve much. It is therefore my sincere
new international journal on medical ethics
of shortage of doctors by proposing a hope that I will be able to collaborate with
and public health published by the WMA
shorter training, some kind of technical as many of you as possible during my pres-
will in my mind not only be an asset to the
doctor trained for limited purposes. Even idency. May the WMA continue to thrive
association but more importantly, of clear
if we can understand that some countries and prosper for many years.”
benefit to the clinical doctor which this new
need to address this difficult problem
journal should be aimed at.
urgently, we feel that in the long run this The President then thanked the Assembly
Closely linked to ethics are human rights. I method will undermine the health service members and their guests for attending and
feel that the WMA is on the right track in its in these countries. I would therefore like to formally closed the Ceremonial Session.

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Plenary Session of the Assembly 6th October 2007

Dr. Hill, Chair of Council, opened the Dr. Aerden said that it was important to col- been elected to the office of President-elect
meeting and the Secretary General, Dr. lect data on oral health because of its value, for the year 2008-2009.
Kloiber referred to the sad death of Dr. particularly in developing countries where
Dr Blachar, responding to this said that he
André Wynen and informed the Assembly projects had been set up.
was deeply touched by the trust place in
that a Memorial Book was open for signa-
Turning to the importance of ethics she him and thanked those who had elected
ture.
stressed that this was also true of Dentistry. him, expressing in particular his thanks to
He also reminded the Assembly that the She spoke of the importance of defending his wife and to Ms. Leah Wapner for their
World Health Professions Association’s the position of the profession in recognising great continuing support and help.
Leadership would take place in November. the dignity of individual and the well-being
There were 30 places on the course and 24 of patients. Speaking of the effects of oral
applications had so far been received and disease on morbidity and mortality, she Report of Council
approved. There were still six vacancies and referred the effects of pain on the quality of
(Much of the written report of Council cir-
he invited applications for these places, life and to the link between oral disease and
culated before the November meeting
preferably female candidates. the rest of the body
appears in the report of the 176th Council
Dr. Hill, after listing the apologies for A proposal was being made in WHPA for meeting in WMJ52(2): matters other than
absence, stated that there were three nomi- action to make things HAPPEN. There was the statements and resolutions adopted by
nations for the Presidency of the World a “Health in Africa” Vision. In Africa, the Assembly which are set out below, are
Medical Association for 1908-9 and opened where there were major gaps in health care, set out in the account of the 178th Council
the floor for further nominations. In the conferences were planned in Africa in 2007 meeting (see page 107).
absence of any other proposals he declared and in America in 2008, to address the prob-
Finance and Planning
the three candidates to be Drs. Blachar lems of health access policy and also educa-
(Israel), Desai(India) and Boswell(New tion in health promotion and disease pre- Dr. Hill presenting the report, turned first to
Zealand). vention. Action by the WHPA would make recommendations arising from the Finance
a difference. and Planning Committee business.
Dr. Hill then referred to the presence as an
observer of the President of the Dr. Hill thanked Dr. Aerden and reminded Cabo Verde
International Dental Federation (FDI), Dr. the meeting that Dr. Letlape had been sit-
The application for constituent membership
Michéle Aerden, and invited her to address ting on the working group in WHPA for the
of the Ordem dos Medical de Capo Verde
the meeting. past year.
was approved.
Dr. Aerden referring to the FDI as one of the Dr. Haikerwald presented the report of the
Scientific Session, Seoul 2008
partners in the World Health Professions’ Credentials Committee. 45 Delegations
Alliance (WHPA), said that it was the third were present of which 43 had the right to The theme of “Health and Human Rights”
oldest health professional organisation in vote. was approved for the 2008 scientific meet-
the world. As a worldwide independent ing in Seoul.
The Standing Orders and the Minutes of the
organisation representing 140 Dental
Pilanesberg meeting were both adopted, Treasurer’s Report
Associations FDI it was the voice of den-
following which each of the three candi-
tistry and was represented at the UN, WHO The Treasurer, Dr. J. D. Hoppe presenting
dates in the presidential election addressed
and ISO. Recognising that Health was a his report reviewing the period 2005-2006,
the meeting. At the conclusion of these pre-
fundamental human right she pointed out referred to the Financial Statement prepared
sentations delegations proceeded to a for-
that this included the need for Oral Health. with Mr. Hallmayr which had been
mal ballot for the electing the President-
In 1981 WHO recognised the goal of glob- approved by the auditors KPMG, and then
elect 2008-2009.
al oral health. In 2007 Oral Health was on spoke to the document in some detail. He
the Agenda of the World Health Assembly reported that the net balance, reversing the
President-elect
and the important role of prevention in Oral deficit of the years 2004-5 which had been
Health was recognised, including the role of The Secretary General declared the result of overcome through the efforts and actions of
Fluoride. the ballot was that Dr. Yoram Blachar had the Secretary General, had continued to

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improve, both from Dr Kloiber’s continuing Dr. Hoppe then presented the Budget for the new dues categories had been approved
actions, from the improvement in income 2008 which, in the absence of any questions and sent to delegations.
from members dues and other financial from the floor, was approved unanimously.
Before turning to Medical Ethics Dr. Hill
earnings.
Dr. Hill expressed his thanks both to Dr. put to the Assembly the following Council
The Financial Statement for 2006 was unan- Hoppe and to Mr Hallmayr for their work Resolution which was adopted unanimous-
imously approved. during the year.He reminded delegates that ly by the Assembly.

Resolution in Support of the Medical Associations


in Latin America and the Caribbean
Adopted by the WMA General Assembly, There exist already duly constituted and with the medical associations on all
Copenhagen, Denmark, October 2007 legally authorized medical associations matters related to physician certifica-
within this region that are charged with tion and the practice of medicine and to
There are credible reports that arrange-
the registration of physicians and which respect the role and rights of these
ments between the Cuban government
should be consulted by their respective medical associations and the autonomy
and certain Latin American and Caribbean
Ministries of Health. of the medical profession.
governments to supply Cuban health
workers as physicians to these countries Therefore, the WMA:
are bypassing systems, established to pro-
1) Condemns any actions by governments 3) Urges, as a matter of utmost concern,
tect patients, that have been set up to ver-
in policies and practices that subvert or that the governments in Latin America
ify physicians’ credentials and compe-
bypass the accepted standards of med- and the Caribbean respect the WMA
tence.
ical credentialing and medical care; International Code of Medical Ethics
The World Medical Association is signifi- and the Declaration of Madrid that
cantly concerned that patients are put at 2) Calls upon the governments in Latin guide the medical practice of physi-
risk by unregulated medical practices. America and the Caribbean to work cians all over the world.

Medical Ethics and Human Council for Torture Victims (IRCTV) to The Istambul Protocol and Guidelines help
address the meeting. in producing good reports to be used in
Rights court. IRCTV is carrying out advocacy and
Britte Sydhoff, introducing the IRCTV as
training activities and she stressed that
Dr. Hill then put to the Assembly the fol- an international NGO said that it was a plea-
Prevention through documentation can help
lowing statements and resolutions arising sure to stand before the WMA and thank
both the Health and Legal professions. The
from Medical Ethics Committee business. them for their support. She explained that
collaboration of National Medical
Telemedicine the ICRTV had 130 rehabilitation centres in
Associations has been a real part of the suc-
78 countries.
A proposed Statement on the Ethics of cess of the training about the Istambul
Telemedicine (see medical ethics page 91 ) She was very pleased with the WMA stand Protocol.
was unanimously approved. on Torture, as exemplified by the Tokyo and
Dr. Hill thanked the IRCTV for its work and
Hamburg Statements. The proposed
Human Tissue for Transplantations. cooperation, in which Dr. Snaedel had been
improvements in the Statement on
deeply involved.
A proposed Statement on Human Tissue for Documentation of Torture constituted a
Transplantation was approved unanimous- strong supplement to the existing statement. The proposed revision of the WMA
ly The need for proof of torture is vital and Resolution on the Responsibility of
specific training in how to note and provide Physicians in the Documentation and
Documentation and Denunciation of Acts
such documentation is important, as physi- Denunciation of Acts of Torture or Cruel or
of Torture
cians do not know how to do this. She com- Inhuman or Degrading Treatment (see
Dr. Hill asked Britte Sydhoff, Secretary mented that often victims are detained until Medical Ethics p. 92) was approved unani-
General of the International Rehabilitation the evidence is gone. mously.

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Socio-Medical Affairs The Chair drew attention again to the rec- Dr. Letlape considered the matter to be very
ommendation that this be referred to complex. It would be difficult to produce a
Dr. Hill put to the Assembly the following
Council and Dr. Kloiber commented that it resolution to cover the whole area of needs
recommendations arising from the Socio-
could be considered by Council at its post- for prescribing, as we have to consider the
Medical committee business:
Assembly meeting and then be processed. challenges of areas in which there are no
Noise Pollution qualified physicians and patients need care
The proposal that the Statement be referred
there; people are specially trained to diag-
The proposed revision of the WMA to Council for processing was approved.
nose and prescribe in such areas.
Statement on Noise Pollution was adopted
Dr. Johnson further reported that the
unanimously. The responsibilities which go with prescrib-
Associates meeting had appointed two rep-
ing need to be included in the training. The
Family Planning and Right to resentatives and deputies to the Assembly
President, Dr. Snaedel, thanked the Spanish
Contraception expressed the hope that this would be to the
Medical Association for raising this issue.
advantage of the Associates, requesting that
The WMA Statement on Family Planning While Dr. Nathansen had indicated that “the
their role be examined when the analasys
and the Right of a woman to Contraception ball was lost”, he felt that it was not lost – we
Associates’ Membership is considered The
was adopted. can dialogue with the professions and rele-
report was adopted.
vant authorities. The International Federation
Health Hazards of Tobacco Products
of Pharmacists was looking at this issue and
The proposed Statement on Health Hazards Open session we must dialogue with them. The matter
of Tobacco Products (see page 95) was would be on the agenda of Council.
Dr. Siguero wished to propose a resolution
adopted unanimously.
that the writing of prescriptions must be Dr. Haikerwal (Aust) expressed sympathy
Dr. Hill announced that in the Spring, an limited to physicians. He was concerned for Spain, stating, however, that” the train
exciting new project on Tobacco will be that with pending elections in Spain the has moved on”. In Australia physicians,
announced. nurses asked that they might prescribe. nurses and optometrists are moving in this
Currently there was a fear of a nurses strike direction. Dialogue is vital. Task substitu-
Health and Human Rights Abuses in
and Dr. Siguero pointed out that the tion must be avoided and medical supervi-
Zimbabwe
International Council of Nurses supported sion was essential in any such job substitu-
The proposed Resolution on Health and the concept of nurse prescribing. He con- tion. Dr. Mckie (Canada) reported that in
Human Rights Abuses in Zimbabwe (see siders that prescribing must be limited to Alberta and some other provinces, allied
Human Rights (see page 94). physicians exclusively, as only physicians, health professionals have the right to pre-
because of their education, can diagnose scribe. The Alberta Medical Association set
The rest of the Council report was
and ensure the quality of the appropriate out generic guidelines for allied health pro-
approved.
drug prescription. Only the qualified physi- fessionals including provisions on conflict
cian has the knowledge of both the appro- of interest. There was a need to ensure ade-
Associates Meeting priate drug and of the risks associated with quate records. Collaborative care was based
their prescription. He appealed to the on the skills of the provider. The CMA
In the absence of the Chair, Dr. DuMont,
WMA to defend the right to prescribe for would provide further information to the
Dr. D. Johnson gave the report of the
physicians. There was a need to appeal to WMA. A speaker from the Japanese delega-
Associate’s meeting. He indicated that there
health authorities to ensure this through tion agreed with others that this was a fun-
were very spirited discussions although
appropriate legislation. Dr. Nathansen damental issue. Dr. Montgomery (Germany)
only one Resolution was adopted. This was
(UK) said that a number of physician’s sup- agreed with others that the train had left. He
a Statement on “Ethical Principles for
port nurse prescribing from a Limited List felt that the Ministry of Health was using
Research on Child Subjects” which, it
and that the UK is about to move to nurse this concept as a means of breaking down
requested, should be referred to Council for
prescribing from the National Formulary. physicans’ domination. While he understood
processing.
The BMA is opposed to this. There is a the situation in some countries he felt that a
Dr. J. Appleyard who had made the original need for very great care in the drafting of Council Working group should be set up.
proposal said he appreciated the support of legislation to ensure that the intended nurse The Adminstrators think that by using this
the Associates’ meeting in referring it to the prescribing is restricted to a Limited mechanism they will save money. Dr.
Assembly with the suggestion of referral to Formulary. There are many problems Lemye (Belg.) also agreed that “the train
Council. He also urged the Assembly and which are related to “Task Shifting”. had left”. Such extension of the right to pre-
NMAs to take this matter forward. It was Prescribing by non-physicians is a world scribe could be useful in, for example,
parallel to Helsinki and reflected the con- wide trend. WMA must express its posi- Disaster Medicine, but these powers should
cern about child subjects and research in tion, we have generally enough physicians be provided by the use of exemption mech-
America, Europe and Japan. to deal with prescribing needs. anisms. Governments, however, do not only

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consider the lack of qualified physicians as Dr. Chan (Hong Kong) thanked Dr. Kloiber to come to Seoul and extending a warm
the problem. but also look at curtailing the for supporting a small survey on the regula- invitation to delegates to go to Korea.
prerogatives of physicians. Dr. Figueredo tion of the Profession in South East Asia and
(Uraguay) supported this. There was no lack welcomed the article on Medical
of qualified physicians in South America but Professional in the WMJ. He would like it to Closure
nevertheless the other health professionals be translated into other languages, notably
There being no other business the
were being used to treat some sections of the Chinese, and would also like it to be fol-
Secretary General, Dr. Otmar Kloiber,
population even where patently there were lowed up by a survey, perhaps by other
expressed his appreciation of the support
enough physicians, and he proceeded to NMAs, concerning the right to prescribe. He
received from NMAs, notably in paying
quote a case illustrating this situation. also felt that it would be most helpful if we
their Dues on time. He said that the change
could see the results of follow-up of
Dr. Blachar (IMA and President-elect) felt in the Dues structure had gone smoothly.
Resolutions and Statements issued by WMA.
the situation to be both fundamental and We have never had such strong representa-
Finally he suggested that the effects of air
threatening. He strongly supported setting tion from some parts of the world. We need
pollution should be studied in the profession,
up a Working Group to produce a paper for to continue to strengthen this. In thanking
both in developed and developing countries
the May meeting of Council. NMAs, he particularly mentioned the out-
considering that this would also need both
standing commitments of Japan and of
Dr. Siguero (Spain) thanked contributors mid and long term surveys.
India in responding to the increases in
for their support and said that he supported
The Secretary General commented that dues. He expressed warm thanks to all
Dr. Montgomery’s proposal. He had a feel-
there were strict limitations on what WMA, NMAs who had supported projects on
ing that some physicians were helping the
with a limited staff of seven could do. Advocacy including the AMA and the
train to leave! There was no lack of quali-
Speaking of Resolutions and Statements BAK, also the DMA for acting as hosts to
fied physicians in Spain, politics and some
etc, he said that implementation was in the the Assembly – observing that this impos-
professionals were behind this move. WHO
hands of NMAs. Developing this he said es costs on the host NMAs. He reminded
should not be promoting it.
would like feedback, giving as examples: the Assembly that the WMA office was a
Dr. Hill said this had been a good debate small one and had to depend on members
a) Work on Task-shifting. (He had been
and the issue would be placed on the for support.
asked by WHPA to seek this.)
Council agenda.
Turning to direct support, he particularly
b) Discussion of the White Paper on
Dr. Sabilli (Philippines) referred to a recent mentioned the CMA’s engagement in
Regulation (WMJ 53(3) p. 58).
television broadcast in which comments Advocacy, Information Technology, and
were made about Philippine doctors in Dr. Kloiber then referred to the forthcoming Ethics. He continued that, while it was
derogatory chauvinistic terms. He pointed WHPA conference next year on not possible to identify all contributions,
out that his country was spending its own International Regulation of Health he had to mention the Officers, Chairs of
money training physicians who then went Professions. It was essential that we achieve committees etc and the Chair of Council –
abroad to assist in providing healthcare. At a common understanding on Self all of whom contribute a great deal. The
the same time, he thanked those countries Regulation. Some of the problems he had BMA, Norwegian MA, SAMA and BAK
who had assisted his country with sec- reported to the WHO. NMAs must also take had all supported projects or given techni-
ondary care. However he appealed to other up this issue. At the Chief Executive cal support, such as the legal advice pro-
NMAs to assist in stopping the derogatory Officer’s conference concerns over issues vided by the Israel MA. Finally, he
remarks being made suggesting that diplo- of regulation and licensing were expressed thanked most warmly Dr. Jensen and his
mas of Philippine physicians could not be and he was looking to NMAs to act on this. Vice Chair Dr. Buhl, the DMA and its
checked etc. Such remarks were deplorable. staff for the splendid organisation,
Dr. Hill, closing the session, thanked all
Philippine physicians are asking for an arrangements and hospitality we had
those who had contributed to what had been
apology from those who do this. experienced during the meeting in
a very valuable session.
Copenhagen.
Dr. Hill assured the speaker that the AMA
General Assembly – 2008
had found the TV statement distasteful. Dr. Hill finally gave a warm thanks to the
Yesterday the AMA had approached the TV Dr. Shin then presented a film on Korea and interpreters and to delegates for all their
programme supporting the Philippine the forthcoming General Assembly, 15-18 enthusiasm and hard work and formally
Doctors in their desire for an apology. October 2008, thanking WMA for agreeing closed the Assembly.

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178th WMA Council Meeting


178th Council took place in the Marriott Hotel, Copenhagen on 6th October 2007

The Chairman, Dr. Hill opened the meeting also for them to take this forward”. Dr. making Helsinki larger while Dr. Vilmar
with business arising from the General Bagenholm, Chair of Ethics, thought that considered that we should concentrate on
Assembly and sought the views of Council this should be a separate statement, children first. We “lack knowledge about
on the subject of “task shifting” which was although it might eventually be part of research in children. It might in the end
a matter of major concern to NMAs. He Helsinki. She supported its referral to have to be taken up in the general review”.
said that there were considerable differ- NMAs for their comments.
In response to a call by Dr. Hill, expressions
ences in the degree to which this was occur- The Council agreed that the proposed state- of interest in working on this were made by
ring in different parts of the world and ment should be circulated to NMAs for Israel,Brazil, Canada, South Africa and the
called for expressions of interest in mem- their views and that the Helsinki working UK.
bership of a working group on this topic. group should co-ordinate the comments of
NMAs for the next Council meeting. Under Any Other Business, Dr. Hakerwal
Prof. Nathanson was interested, in particu-
Amongst the views expressed there (Aust) raised the issue of corporate gover-
lar because this was a matter of special
appeared to be a consensus that the state- nance. He asked who were directors –
importance in the UK and members from
ment should be a separate one but should be which countries? Dr. Hill said that WMA
Canada, Israel, Belgium, Germany,
linked to the Helsinki Declaration. was a USA state registered organisation and
Norway, Brazil, Korea, Spain, Iceland indi-
that Council members are directors.
cated an interest. After the Chair pointed Dr. Williams (Ethics consultant) said that
out that working groups were limited to six the issue had not been dealt with adequate- Dr. Plested (AMA) referred to the new
members and it was agreed that the Chair ly in Helsinki up to the present. Now there advocacy adviser’s contract needed for the
would select the group of six. was a new interest in research ethics. new Advocacy position, which would have
Helsinki set out the principles but WMA to be in France. He pointed out that if the
Dr. Davis (AMA) wondered whether it was
did not want to go any further than that. It person was hired in another country this
too late to set up a working group. Had the
was a question of why stop here with chil- might be illegal in France. He wondered
train not already left the station?
dren? Suggestions had been received whether it would be possible for a third
Council considered a proposed Statement which included vulnerable populations, member association to do the hiring or if he
on “Research and Children” from the concerns about women etc – would we not could be made a 90 day adviser, as we have
Associates’ group, referred to the Council be asked to include the aged and deprived to use French rules. Dr. Davies queried
by the Assembly. Dr. Kloiber pointed out populations? Dr. Hill expressed his per- whether he could be hired in Geneva, or an
that the Assembly’s wish was that this be sonal view that the issues relating to chil- NMA could second someone.
referred to NMAs, was there a need for a dren were really different. Dr. Kloiber Dr. Kloiber indicated that similar problems
working group? Dr. Nathanson said that this pointed out that the request before Council would arise in Geneva as in France and that
was an important area, it overlapped was whether to include something, exclude he had sought legal advice on how to deal
Helsinki. She wondered whether there it or include other areas. The Working with the employment in the most efficient
should be a self – standing group or that this Group could come back with a considered and legal manor
be included in the Helsinki group remit. Dr. view, taking into account the views of
Appleyard, a Past President, who had made NMAs. Finally the Council considered how the
the original proposition agreed that this was WMA in its activities could be more inclu-
important -a feeling which was reflected at Mr Tholl pointed out that the Canadian sive and how the Associate members could
the Associates’ meeting. Helsinki was an Medical Association already had a state- participate in a more productive way..The
“umbrella” declaration. The concerns about ment. The issue could go into Helsinki or, Chair said that he would look into all issues
as in Canada, be a separate document. It
children were difficult to incorporate in concerning the Associates, and refered to
should be left to the working group to come
Helsinki. The proposal was specifically the valuable Open Session of the Assembly
forward with a suggestion.
geared to the needs of children it would not which we had experienced earlier. In the
interfere with Helsinki. He would welcome Dr. Bagenholm felt that it might be better to absence of any other business the meeting
this going to NMAs for their comments and have separate working groups rather than was closed.

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Inter-professional training seminar on infection control in South Africa


Health care workers safety in the context of drug resistant TB in low and middle-income countries

The World Medical Association (WMA) together South African community support suade health providers from accepting
initiated together with the International workers, hospital managers, nurses and assignments in these settings. The workshop
Council of Nurses (ICN), the International physicians working in the context of drug- programme, therefore addressed administra-
Hospital Federation (IHF) and the resistant TB to jointly examine and address tive, environmental and personal respiratory
International Federation of Red Cross and these issues. This common seminar for all protection with the objective of identifying
Red Crescent Societies (IFRC)/South four health care professions was the first good practices and challenges to the imple-
African Red Cross Society, members of the one held in South Africa. mentation of joint recommendations for
Lilly MDR-TB Partnership, a workshop in Given the already critical shortage of health facilities and health workers It drew up rec-
Cape Town, South Africa, on health care providers and the generally weak health sys- ommendations for implementing guidelines
worker safety and infection control, in the tems in the regions most affected by XDR- in their hospitals and suggested establishing
context of drug-resistant TB in low and TB and MDR-TB, particularly in southern a common working group with a plan of
middle income countries. The 2-day work- Africa, anxiety about safety in the health action to communicate the identified prac-
shop,12-13.November 2007, brought care environment runs high and can dis- tices and recommendations.

WHO publishes new standard for documenting


the health of children and youth

GENEVA/VENICE – WHO published the Classification of Functioning, Disability ability on a continuum within the context of
first internationally agreed upon classifica- and Health (ICF), the precursor to the their everyday life and activities. In this
tion code for assessing the health of chil- ICF–CY. The launch of the ICF–CY way it enables the accurate and constructive
dren and youth in the context of their stages addresses this important developmental description of children’s health and identi-
of development and the environments in period with greater detail. Its new standard- fies the areas where care, assistance and
which they live. ized coding system will assist clinicians, policy change are most needed,“ said Ros
educators, researchers, administrators, poli- Madden, Australian Commission on Safety
The International Classification of and Quality in Health Care, and, Chair of
cy makers and parents to document and
Functioning, Disability and Health for the Functioning and Disability Reference
measure the important growth, health and
Children and Youth (ICF–CY) confirms Group of the WHO Family of International
development characteristics of children and
the importance of precise descriptions of Classifications (WHO-FIC) Network.
youth.
children’s health status through a methodol-
ogy that has long been standard for adults. Children who are chronically hungry, The ICF–CY has important implications
Viewing children and youth within the con- thirsty or insecure, for example, are often globally for research, standard setting and
text of their environment and development not healthy and have trouble learning and mobilizing resources. “For the first time, we
continuum, the ICF–CY applies classifica- developing normally. This classification now have a tool that enables us to track and
tion codes to hundreds of bodily functions provides a way to capture the impacts of the compare the health of children and youth
and structures, activities and participation, physical and social environment so that between countries and over time,“ said
and various environmental factors that these can be addressed through social poli- Nenad Kostanjsek of WHO’s Measurement
restrict or allow young people to function in cy, health care and education systems to and Health Information team. “The
an array of every day activities. improve children’s well-being. ICF–CY will allow countries and the inter-
national community to take informed action
The rapid growth and changes that occur in “The ICF-CY will help us get past simple to improve children’s health, education and
first two decades of life were not sufficient- diagnostic labels. It will ground the picture rights, by treating their health as a function
ly captured in the International of children and youth functioning and dis- of the environment that adults provide.“

108 WMJ 53, December 2007


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WHO

The classification also covers developmen- and Health (ICF-CY) was launched in For further information,
tal delay. Children who achieve certain Venice, with international praise: please contact:
milestones later than their peers may be at
increased risk of disability. Using this clas- “The publication of the ICF-CY by the Lina Reinders
sification, health practitioners, parents and WHO provides, for the first time, a standard Communications Officer
teachers can describe these delays precisely language to unify health, education and WHO,
in order to plan for health and educational social services for children,“ said Dr. Geneva
needs and frame policy debates. The chil- Margaret Giannini, Director of the Office of Tel.: +41 22 791 1828
dren and youth version of the International Disability, U.S. Department of Health and Fax: +41 22 791 1967
Classification of Functioning, Disability Human Services. E-mail: reindersl@who.int

First List of Essential Medicines for Children released –


WHO increases efforts to ensure appropriate medicines for children

WHO launched a new research and devel- ditions. More than half of the medicines been adapted for childrens’ use or are not
opment campaign entitled “Make prescribed for children in industrialised available when needed”.
Medicinces Child Size”, launched in countries are medicines prescribed and
WHO will also work with governments to
London intensifies efforts to ensure that dosed for adults and are not authorised for
promote changes in their legal and regula-
children have better access to medicines children. Lower access to medicines in
tion requirements for childrens’ medi-
which are appropriate for them. developing countries adds to the problems
cines.
there.
The campaign also coincided with the
release by WHO of the first International Dr. Hans Hogerzeil, Director of Medicines Information contact:
List of Essential Medicines for Children. Policy and Standards at WHO emphasized WHO Geneva:
The List contains 206 medicines deemed this saying “A lot more needs to be done. Daniela Bagozzi
safe for children and addresses priority con- There are priority medicines that have not e-mail: bagozzid@who.int

Projected supply of pandemic influenza vaccine sharply increases

23 OCTOBER 2007 | GENEVA – Recent “With influenza vaccine production capaci- This year, manufacturers have been able to
scientific advances and increased vaccine ty on the rise, we are beginning to be in a step up production capacity of trivalent
manufacturing capacity have prompted much better position vis-à-vis the threat of (three viral strains) seasonal influenza vac-
experts to increase their projections of how an influenza pandemic,“ Dr Marie-Paule cines to an estimated 565 million doses,
many pandemic influenza vaccine courses Kieny, Director of the Initiative for Vaccine from 350 million doses produced in 2006,
can be made available in the coming years. Research at WHO, said today. „However, according to the International Federation of
although this is significant progress, it is Pharmaceutical Manufacturers &
Last spring, the World Health Organization
still far from the 6.7 billion immunization Associations. According to experts working
(WHO) and vaccine manufacturers said that
courses that would be needed in a six month in this field, the yearly production capacity
about 100 million courses of pandemic
period to protect the whole world.“ for seasonal influenza vaccine is expected
influenza vaccine based on the H5N1 avian
“Accelerated preparedness activities must to rise to 1 billion doses in 2010, provided
influenza strain could be produced immedi-
continue, backed by political impetus and corresponding demand exists.
ately with standard technology. Experts
now anticipate that global production financial support, to further bridge the still This would help manufacturers to be able to
capacity will rise to 4.5 billion pandemic substantial gap between supply and deliver around 4.5 billion pandemic
immunization courses per year in 2010. demand,“ she said. influenza vaccine courses because a pan-

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WHO

demic vaccine would need about eight times lished in the WHO Global pandemic influen- vated vaccines to live attenuated vaccines.
less antigen, the substance that stimulates za action plan to increase vaccine supply. Due to the higher yields obtained with live
an immune response. Vaccine production attenuated influenza vaccine technology,
At the Advisory Group meeting, other
capacity is linked to the amount of antigen facility conversion could, by 2012, bridge
progress on the Global Action Plan was dis-
that has to be used to make each dose of the the expected supply-demand gap and pro-
cussed. WHO reported it is setting up a
vaccine. Scientists have recently discovered duce enough vaccine to protect the global
training hub that would serve as a source of
they can reduce the amount of antigen used population within six months of the declara-
technology transfer to developing countries.
to produce pandemic influenza vaccines by tion of a pandemic.
using water-in-oil substances that enhance The Advisory Group also discussed a new
the immune response. business plan which assessed options for
further increasing vaccine production
The progress was reported at the first meeting For further information, please contact:
capacity and reviewed priority next steps.
of a WHO Advisory Group on pandemic The three most valuable options include Hayatee Hasan
influenza vaccine production and supply. The continuing to promote seasonal influenza Department of Immunization, Vaccines and
Global Action Plan Advisory Group, an inde- vaccine programmes, supporting the indus- Biologicals
pendent, international committee of 10 mem- try to sustain production capacity beyond WHO, Geneva
bers, met at WHO headquarters one year after seasonal demand and enabling some vac- Tel.: +41 22 791 2103
eight new strategies to increase pandemic cine production facilities to change, at the Mobile: +41 79 351 6330
influenza vaccine were identified and pub- onset of a pandemic, from producing inacti- hasanh@who.int

Protecting health from climate change – World Health Day 2008


WHO has announced that the topic for health is essential. Dr. Chan, Director holders to collaborate on strengthening sur-
World Health Day 2008 will be “Protecting General of WHO comments “Health profes- veillance and control of infectious diseases,
Health from climate change”. Sixty years sionals are on the front line in dealing with safer use of diminishing water supplies, and
ago WHO was founded as part of the inter- the impacts of climate change. The most health action in emergencies”.
national commitment to build global secu- vulnerable populations are those who live in
On World Health Day, 7th April 2008, mark-
rity and peace In the same spirit of univer- countries where the health sector already
ing the Sixtieth anniversary of the World
sal solidarity, WHO is seeking to unite the struggles to prevent, detect, control and
Health Organisation, communities and
nations of the world in combating the threat treat diseases and health conditions includ-
organisations around the world will host
to public health safety from climate ing malaria, malnutrition and diarrhoea.
activities to create greater awareness and
change. Climate change will highlight and exacer-
public understanding of the health conse-
bate these weaknesses by bringing new
In parallel with the increasing international quences of climate change and the impact
pressures on public health, wit h greater fre-
emphasis on the need to place the reduction and interdependency of health with other
quency.”
of environmental climate change high on measures taken to reduce and control the
the international agenda to maintain sus- She added “We need to put public health at effects of climate change in policy deci-
tainable development, the need to also the heart of the climate change agenda. This sions and policies taken at national and
address the environmental effects on public includes mobilising governments and stake- international level.

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Review

New Internet course on multidrug-resistant tuberculosis MDR-TB


Multi Drug Resistant Tuberculosis is difficult to treat and knowledge about it is scattered around the world. Thanks to WHO there
is not only a strategy to treat tuberculosis the “DOT Strategy” but now there are also WHO guidelines on how to prevent and treat
MDR-TB using the existing evidence in the world.
Guidelines however are theoretical knowledge that doesn’t easily transfer into practice in the real world. The WMA therefore volun-
teered, together with its member organizations, the South African Medical Association, the Norwegian Medical Association, to pro-
duce a learning programme for the MDR-TB Guidelines and offer it electronically though the Internet.
This course is a free self-learning tool allowing physicians in all parts of the world to learn and test their knowledge about MDR-TB
using the Internet. The Foundation for Professional Development of South Africa wrote the learning programme, which subsequent-
ly has been reviewed by an international advisory committee and then transformed into an Internet-based course by the Norwegian
Medical Association. A first testing phase with an evaluation was implemented in South Africa. The CME accredited MDR-TB online
training course is now accessible from the WMA web page www.wma.net.
The course is free of charge and is available in English. Soon it will be translated into French, Spanish, Chinese and Russian.

Review *

Human Rights and Prisons – a training programme on


human rights for prison officials
Professional Training Series No. 11, UN Publications, UN New York and Geneva 2005, ISBN 92-1-15416-3

Prisons are places where a higher propor- undermine human rights are not reviewed and to relate these to their day-to-day expe-
tion of people with significant physical and or changed. rience. An important and measurable out-
mental health problems are incarcerated, come must be to change attitudes, so that
It is therefore welcome that the European
but also where the health care they receive prejudice is replaced with an understanding
Regional Office of WHO has published a
is likely to be substandard. Pressures on of the need to protect the dignity of the vul-
modular course on human rights training for
medical staff, lack of funding, uncertainty nerable.
people who have a responsibility for
about the ethical duties of doctors and the
detainee care. While its focus is prison Much of the success of the courses that are
potentially restrictive attitude of prison gov-
detention, it is equally applicable to other based on these documents will depend on
ernors can all reduce access to good quality
forms of custody, such as police stations the quality of those delivering the training.
and impartial healthcare.
and detention centres. It has direct rele- It is not suggested that these should include
Although the rights of prisoners, and the vance to doctors, but unfortunately does not doctors, and this is a gap that should be
duties of those who supervise them are well suggest that prison medical staff, who are filled, since the relationship between doc-
established, and comprehensively set out in often as much in need of human rights and tor, prisoner and institution is fertile ground
a variety of declarations, treaties, covenants ethics teaching, should be exposed to the for highlighting human rights and ethical
and conventions, these are often poorly principles that the document promotes. dilemmas that are real and practical.
understood by prison officials. Either they Through their relevance and familiarity
Designed in modular form, and backed by a
are not seen as applicable to a particular they can provide a good basis for the group
manual, listing standards, sources and sys-
institution, or inflexible procedures that discussions that form a major part of the
tems, a compilation of relevant human
training.
rights instruments, and a condensed pocket
* This is the first of two reviews on Prison guide, the training is designed to be deliv- The section on health is adequate, but not
Health. The second will review a recent ered over a period of five days. While aspir- fully complete. There is little reference to
publication by the WHO European Office ing to a variety of aims, a key purpose is to assessment of self-harm risk – a major
on Health in Prisons and will appear in equip students with a broad knowledge of cause of death in custody being suicide -
the next issue WMJ 54 (1). human rights practice in relation to prisons, and the monitoring of prisoners with psy-

WMJ 53, December 2007 111


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Review / Letter

chiatric problems. In any prison in the doctor more opportunities to provide care, tor begins and ends. While there is a clear
world, there will be a relatively high pro- along with reassurance that confidentiality condemnation of physician involvement in
portion of inmates with alcohol and/or drug will usually be kept. torture, current examples such as force-
dependence, and a range of psychiatric dis- feeding and the provision of advice on
Welcome elements in the training package
orders. Prison staff can be very influential interrogation should be illustrated. At a time
are the need for prisoners to undergo a med-
in helping patients to develop a willingness when the ethical duties of doctors have been
ical examination as soon as possible after
to address their addiction, and more could redefined in the interests of national securi-
arrival, respect for cultural beliefs, and the
be taught on the often simple and accessible ty, these contemporary situations deserve
risks that HIV/AIDS sufferers will be iso-
services that prisons can provide. Alcohol more reflection.
lated through ignorance and fear of infec-
and drug misuse are common causes of
tion. However, more could be said about the An essential part of training is evaluating its
recurrent, often petty crime, and more
need to be alert to signs of abuse and inap- effect, and the course recognises that this
understanding about the nature of the dis-
propriate restraint measures, and on the should be built in over the long-term, using
ease of addiction, and the capacity for the
duty of medical staff to report abuse. attitudes and system change as key markers
addict to change, would be welcome. The
Doctors have the benefit of independence of progress. As the manual states, there is a
sections on drug misuse are written in disci-
and an ethical duty to report abuse, so are lot more to the teaching of human rights
plinary, rather than therapeutic terms.
well-placed to speak out when they than a “lecture and a wave”. Participants
Backed by high-level declarations, and encounter abusive behaviour. They also need to be challenged, and their attitudes
written in the language of rights, the start- have an obligation to record, not just the and behaviour changed, if our prisons are to
ing point for the training module on health nature of the abuse and the injuries sus- become more humane places.
is that prisoners, like other members of their tained, but also the action they take as a
Michael Wilks
society, deserve access to the highest avail- result.
able standard of health. Given that a prison
The training manual will not help doctors
population is disproportionately unhealthy,
looking for more certainty on the issue of Michael Wilks is a forensic physician, and
and that resources, particularly in secondary
gross abuse. Definitions of torture and Chairman of the Rehabilitation of Addicted
care are limited, the realisation of that right
degrading treatment are not sufficiently Prisoners Trust in the UK. He is President
is often a distant aspiration. Prison staff
robust or clear, leaving the student in some of the Standing Committee of European
who carry an attitude that equates a loss of
doubt as to where the involvement of a doc- Doctors (CPME) for 2008/9.
liberty with a removal of basic rights, add
fuel to the fires of resentment and stigmati-
sation, thereby increasing a sense of help-
lessness in those for whom they are respon-
sible. An institution run on principles that Letter
acknowledges rights is more likely to be
one in which staff have a higher level of
work satisfaction and esteem. Training in
Correspondence “Freely Given Informed Consent” is the
human rights may not turn them into advo-
Hon. Editor sine quo non of all activities by physicians
cates for change, but may help them to
World Medical Journal in dealing with patients.
operate in a way that promotes decency and
dignity. Sir, I would suggest that this practice be stopped
immediately.
For doctors who access the training manual, The September 7 , 2007 issue of the
th

there is much to challenge attitudes that in Medical Journal of the World Medical I would also suggest that physicians all over
my experience have developed more as a Association is carrying a story about “pre- the world should sign the donor card and
result of a lack of knowledge than through sumed Consent” for the removal of organs carry it in their wallets and stipulate to their
outright discrimination. Prison medical from dead for transplantation. loved ones that they want their organs har-
staff frequently assume that the "dual rela- vested for transplantation.
The U.K. Chief Medical Officer, Sir Liam
tionship" that exists in their specialty (and
Donaldson is quoted as saying that the prac- Unless we, physicians show by example the
in others), implies a reduction in their fun-
tice of “presumed Consent” would increase importance of the donation of organs there
damental medical ethical duties. While the
the number of organs available for trans- is little chance that there will ever be
need to consider the interests of the prison
plantation to the betterment of the health of enough organs available to help the living.
is ever-present in the doctor's mind, it
the recipients.
should only rarely lead to breaches of con- Michael J. Franzblau MD, FAAD
sent and confidentiality. A relationship of I am troubled by the apparent violation of Clinical Professor of Dermatology
trust between the detained patient and the the first tenet of the Nuremberg Code of (emeritus)
doctor has therapeutic value, allowing the Medicas Ethics which clearly states that University of California

112 WMJ 53, December 2007


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Association and address/Officers

CHINA E ECUADOR S GHANA E Tokyo 113-8621


Chinese Medical Association Federación Médica Ecuatoriana Ghana Medical Association Tel: (81-3) 3946 2121/3942 6489
42 Dongsi Xidajie V.M. Rendón 923 – 2 do.Piso Of. 201 P.O. Box 1596 Fax: (81-3) 3946 6295
Beijing 100710 P.O. Box 09-01-9848 Accra E-mail: jmaintl@po.med.or.jp
Tel: (86-10) 6524 9989 Guayaquil Tel: (233-21) 670-510/Fax: -511
Fax: (86-10) 6512 3754 Tel/Fax: (593) 4 562569 E-mail: gma@ghana.com KAZAKHSTAN F
E-mail: suyumu@cma.org.cn E-mail: fdmedec@andinanet.net Association of Medical Doctors
HAITI, W.I. F of Kazakhstan
Website: www.chinamed.com.cn
EGYPT E Association Médicale Haitienne 117/1 Kazybek bi St.,
COLOMBIA S Egyptian Medical Association 1ère Av. du Travail #33 – Bois Verna Almaty
Federación Médica Colombiana „Dar El Hekmah“ Port-au-Prince Tel: (3272) 62 -43 01 / -92 92
Carrera 7 N° 82-66, Oficinas 218/219 42, Kasr El-Eini Street Tel: (509) 245-2060 Fax: -3606
Santafé de Bogotá, D.E. Cairo Fax: (509) 245-6323 E-mail: sadykova-aizhan@yahoo.com
Tel/Fax: (57-1) 256 8050/256 8010 Tel: (20-2) 3543406 E-mail: amh@amhhaiti.net REP. OF KOREA E
E-mail: federacionmedicacol@ Website: www.amhhaiti.net Korean Medical Association
sky.net.co EL SALVADOR, C.A S 302-75 Ichon 1-dong, Yongsan-gu
Colegio Médico de El Salvador HONG KONG E Seoul 140-721
DEMOCRATIC REP. OF CONGO F Final Pasaje N° 10 Hong Kong Medical Association, Chi- Tel: (82-2) 794 2474
Ordre des Médecins du Zaire Colonia Miramonte naDuke of Windsor Building, 5th Floor Fax: (82-2) 793 9190
B.P. 4922 San Salvador 15 Hennessy Road E-mail: intl@kma.org
Kinshasa – Gombe Tel: (503) 260-1111, 260-1112 Tel: (852) 2527-8285 Website: www.kma.org
Tel: (243-12) 24589 Fax: -0324 Fax: (852) 2865-0943
Fax (Présidente): (242) 8846574 E-mail: comcolmed@telesal.net E-mail: hkma@hkma.org KUWAIT E
marnuca@hotmail.com Website: www.hkma.org Kuwait Medical Association
COSTA RICA S P.O. Box 1202
Unión Médica Nacional ESTONIA E HUNGARY E Safat 13013
Apartado 5920-1000 Estonian Medical Association Association of Hungarian Medical Tel: (965) 5333278, 5317971
(EsMA)Pepleri 32 Societies (MOTESZ) Fax: (965) 5333276
San José
51010 Tartu Nádor u. 36 – PO.Box 145 E-mail: aks.shatti@kma.org.kw
Tel: (506) 290-5490
Tel/Fax (372) 7420429 1443 Budapest
Fax: (506) 231 7373 LATVIA E
E-mail: eal@arstideliit.ee Tel: (36-1) 312 3807 – 311 6687
E-mail: unmedica@sol.racsa.co.cr Fax: (36-1) 383-7918 Latvian Physicians Association
Website: www.arstideliit.ee
E-mail: motesz@motesz.hu Skolas Str. 3
CROATIA E Website: www.motesz.hu Riga
Croatian Medical Association ETHIOPIA E
1010 Latvia
Subiceva 9 Ethiopian Medical Association
ICELAND E Tel: (371-7) 22 06 61; 22 06 57
10000 Zagreb P.O. Box 2179
Icelandic Medical Association Fax: (371-7) 22 06 57
Tel: (385-1) 46 93 300 Addis Ababa
Hlidasmari 8 E-mail: lab@parks.lv
Fax: (385-1) 46 55 066 Tel: (251-1) 158174
Fax: (251-1) 533742 200 Kópavogur
E-mail: hlz@email.htnet.hr LIECHTENSTEIN E
E-mail: ema.emj@telecom.net.et / Tel: (354) 8640478
Website: www.hlk.hr/default.asp Liechtensteinischer Ärztekammer
ema@eth.healthnet.org Fax: (354) 5644106
Postfach 52
E-mail: icemed@icemed.is
CZECH REPUBLIC E 9490 Vaduz
FIJI ISLANDS E Tel: (423) 231-1690
Czech Medical Association INDIA E
Fiji Medical Association Fax: (423) 231-1691
J.E. Purkyne Indian Medical Association
2nd Fl. Narsey’s Bldg, Renwick Road E-mail: office@aerztekammer.li
Sokolská 31 - P.O. Box 88 Indraprastha Marg
G.P.O. Box 1116 Website: www.aerzte-net.li
120 26 Prague 2 New Delhi 110 002
Suva
Tel: (420-2) 242 66 201-4 Tel: (91-11) 23370009/23378819/ LITHUANIA E
Tel: (679) 315388/Fax: (679) 387671
Fax: (420-2) 242 66 212 / 96 18 18 69 E-mail: fijimedassoc@connect.com.fj 23378680 Lithuanian Medical Association
E-mail: czma@cls.cz Fax: (91-11) 23379178/23379470 Liubarto Str. 2
Website: www.cls.cz FINLAND E E-mail: inmedici@vsnl.com 2004 Vilnius
Finnish Medical Association Tel/Fax: (370-5) 2731400
CUBA S P.O. Box 49 INDONESIA E E-mail: lgs@takas.lt
Colegio Médico Cubano Libre 00501 Helsinki Indonesian Medical Association Website: www.lgs.lt
P.O. Box 141016 Tel: (358-9) 3930 91/Fax-794 Jalan Dr Sam Ratulangie N° 29
717 Ponce de Leon Boulevard Jakarta 10350 LUXEMBOURG F
E-mail: fma@fimnet.fi Association des Médecins et
Coral Gables, FL 33114-1016 Tel: (62-21) 3150679
Website: www.medassoc.fi Médecins Dentistes du Grand-
United States Fax: (62-21) 390 0473/3154 091
Tel: (1-305) 446 9902/445 1429 E-mail: pbidi@idola.net.id Duché de Luxembourg
FRANCE F 29, rue de Vianden
Fax: (1-305) 4459310 Association Médicale Française
IRELAND E 2680 Luxembourg
180, Blvd. Haussmann Tel: (352) 44 40 331
DENMARK E Irish Medical Organisation
75389 Paris Cedex 08 Fax: (352) 45 83 49
Danish Medical Association 10 Fitzwilliam Place
Tel/Fax: (33) 1 45 25 22 68 E-mail: secretariat@ammd.lu
9 Trondhjemsgade Dublin 2
2100 Copenhagen 0 Tel: (353-1) 676-7273Fax: (353-1) Website: www.ammd.lu
GEORGIA E 6612758/6682168
Tel: (45) 35 44 -82 29/Fax:-8505 Georgian Medical Association MACEDONIA E
E-mail: er@dadl.dk Website: www.imo.ie
7 Asatiani Street Macedonian Medical Association
Website: www.laegeforeningen.dk 380077 Tbilisi Dame Gruev St. 3
ISRAEL E
Tel: (995 32) 398686 / Fax: -398083 Israel Medical Association P.O. Box 174
DOMINICAN REPUBLIC S E-mail: Gma@posta.ge 91000 Skopje
2 Twin Towers, 35 Jabotinsky St.
Asociación Médica Dominicana Tel/Fax: (389-91) 232577
P.O. Box 3566, Ramat-Gan 52136
Calle Paseo de los Medicos GERMANY E E-mail: mld@unet.com.mk
Tel: (972-3) 6100444 / 424
Esquina Modesto Diaz Zona Bundesärztekammer Fax: (972-3) 5751616 / 5753303
Universitaria (German Medical Association) E-mail: doritb@ima.org.il MALAYSIA E
Santo Domingo Herbert-Lewin-Platz 1 Website: www.ima.org.il Malaysian Medical Association
Tel: (1809) 533-4602/533-4686/ 10623 Berlin 4th Floor, MMA House
533-8700 Tel: (49-30) 400-456 369/Fax: -387 JAPAN E 124 Jalan Pahang
Fax: (1809) 535 7337 E-mail: renate.vonhoff-winter@baek.de Japan Medical Association 53000 Kuala Lumpur
E-mail: asoc.medica@codetel.net.do Website: www.bundesaerztekammer.de 2-28-16 Honkomagome, Bunkyo-ku Tel: (60-3) 40413740/40411375

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Association and address/Officers

Fax: (60-3) 40418187/40434444 Panamá 1 SLOVENIA E Sehit Danis Tunaligil Sok. N° 2 Kat 4
E-mail: mma@tm.net.my Tel: (507) 263 7622 /263-7758 Slovenian Medical Association Maltepe 06570
Website: http://www.mma.org.my Fax: (507) 223 1462 Komenskega 4, 61001 Ljubljana Ankara
Fax modem: (507) 223-5555 Tel: (386-61) 323 469 Tel: (90-312) 231 –3179/Fax: -1952
MALTA E E-mail: amenalpa@cwpanama.net Fax: (386-61) 301 955 E-mail: Ttb@ttb.org.tr
Medical Association of Malta Website: www.ttb.org.tr
The Professional Centre PERU S SOMALIA E
Sliema Road, Gzira GZR 06 Colegio Médico del Perú Somali Medical Association
UGANDA E
Tel: (356) 21312888 Malecón Armendáriz N° 791 14 Wardigley Road – POB 199
Fax: (356) 21331713 Uganda Medical Association
Miraflores, Lima Mogadishu
E-mail: mfpb@maltanet.net Tel: (252-1) 595 599 Plot 8, 41-43 circular rd.
Tel: (51-1) 241 75 72
Website: www.mam.org.mt Fax: (51-1) 242 3917 Fax: (252-1) 225 858 P.O. Box 29874
E-mail: decano@cmp.org.pe E-mail: drdalmar@yahoo.co.uk Kampala
MEXICO S Website: www.cmp.org.pe Tel: (256) 41 32 1795
Colegio Medico de Mexico SOUTH AFRICA E Fax: (256) 41 34 5597
Fenacome PHILIPPINES E The South African Medical Associa- E-mail: myers28@hotmail.com
Hidalgo 1828 Pte. D-107 Philippine Medical Association tionP.O. Box 74789, Lynnwood Rydge
Colonia Deportivo Obispado PMA Bldg, North Avenue 0040 Pretoria UNITED KINGDOM E
Monterrey, Nuevo Léon Quezon City Tel: (27-12) 481 2036/2063 British Medical Association
Tel/Fax: (52-8) 348-41-55 Tel: (63-2) 929-63 66/Fax: -6951 Fax: (27-12) 481 2100/2058 BMA House, Tavistock Square
E-mail: rcantum@doctor.com E-mail: medical@pma.com.ph E-mail: sginterim@samedical.org London WC1H 9JP
Website: www.cmm-fenacome.org Website: www.pma.com.ph Website: www.samedical.org Tel: (44-207) 387-4499
Fax: (44- 207) 383-6710
NAMIBIA E POLAND E SPAIN S
E-mail: vivn@bma.org.uk
Medical Association of Namibia Polish Medical Association Consejo General de Colegios Médicos
403 Maerua Park – POB 3369 Plaza de las Cortes 11, Madrid 28014 Website: www.bma.org.uk
Al. Ujazdowskie 24, 00-478 Warszawa
Windhoek Tel/Fax: (48-22) 628 86 99 Tel: (34-91) 431 7780
Tel: (264) 61 22 44 55/Fax: -48 26 Fax: (34-91) 431 9620 UNITED STATES OF AMERICA E
E-mail: man.office@iway.na E-mail: internacional1@cgcom.es American Medical Association
PORTUGAL E
515 North State Street
Ordem dos Médicos
NEPAL E SWEDEN E Chicago, Illinois 60610
Av. Almirante Gago Coutinho, 151
Nepal Medical Association 1749-084 Lisbon Swedish Medical Association Tel: (1-312) 464 5040
Siddhi Sadan, Post Box 189 Tel: (351-21) 842 71 00/842 71 11 (Villagatan 5) Fax: (1-312) 464 5973
Exhibition Road Fax: (351-21) 842 71 99 P.O. Box 5610, SE - 114 86 Stockholm Website: http://www.ama-assn.org
Katmandu E-mail: intl@omcne.pt Tel: (46-8) 790 33 00
Tel: (977 1) 4225860, 231825 Website: www.ordemdosmedicos.pt Fax: (46-8) 20 57 18 URUGUAY S
Fax: (977 1) 4225300 E-mail: info@slf.se Sindicato Médico del Uruguay
E-mail: nma@healthnet.org.np Website: www.lakarforbundet.se Bulevar Artigas 1515
ROMANIA F
Romanian Medical Association CP 11200 Montevideo
NETHERLANDS E SWITZERLAND F
Str. Ionel Perlea, nr 10 Tel: (598-2) 401 47 01
Royal Dutch Medical Association Fédération des Médecins Suisses
Sect. 1, Bucarest Fax: (598-2) 409 16 03
P.O. Box 20051 Elfenstrasse 18 – C.P. 170
Tel: (40-1) 460 08 30 E-mail: secretaria@smu.org.uy
3502 LB Utrecht 3000 Berne 15
Tel: (31-30) 28 23-267/Fax-318 Fax: (40-1) 312 13 57
Tel: (41-31) 359 –1111/Fax: -1112
E-mail: j.bouwman@fed.knmg.nl E-mail: AMR@itcnet.ro E-mail: fmh@hin.ch VATICAN STATE F
Website: www.knmg.nl Website: ong.ro/ong/amr Website: www.fmh.ch Associazione Medica del Vaticano
Stato della Città del Vaticano
NEW ZEALAND E RUSSIA E TAIWAN E 00120 Città del Vaticano
New Zealand Medical Association Russian Medical Society Taiwan Medical Association Tel: (39-06) 69879300
P.O. Box 156 Udaltsova Street 85 9F No 29 Sec1 Fax: (39-06) 69883328
Wellington 1 119607 Moscow An-Ho Road
Tel: (7-095)932-83-02 E-mail: servizi.sanitari@scv.va
Tel: (64-4) 472-4741 Taipei
Fax: (64-4) 471 0838 E-mail: info@rusmed.ru Tel: (886-2) 2752-7286
Website: www.russmed.ru VENEZUELA S
E-mail: nzma@nzma.org.nz Fax: (886-2) 2771-8392 Federacion Médica Venezolana
Website: www.nzma.org.nz E-mail: intl@med-assn.org.tw
SAMOA E Avenida Orinoco
Website: www.med.assn.org.tw
Samoa Medical Association Torre Federacion Médica Venezolana
NIGERIA E
Nigerian Medical Association Tupua Tamasese Meaole Hospital THAILAND E Urbanizacion Las Mercedes
74, Adeniyi Jones Avenue Ikeja Private Bag – National Health Services Medical Association of Thailand Caracas
P.O. Box 1108, Marina Apia 2 Soi Soonvijai Tel: (58-2) 9934547
Lagos Tel: (685) 778 5858 New Petchburi Road Fax: (58-2) 9932890
Tel: (234-1) 480 1569, E-mail: vialil_lameko@yahoo.com Bangkok 10320 Website: www.saludfmv.org
Fax: (234-1) 492 4179 Tel: (66-2) 314 4333/318-8170 E-mail: info@saludgmv.org
E-mail: info@nigeriannma.org SINGAPORE E Fax: (66-2) 314 6305
Website: www.nigeriannma.org Singapore Medical Association E-mail: math@loxinfo.co.th VIETNAM E
Alumni Medical Centre, Level 2 Website: www.medassocthai.org Vietnam Medical Association
NORWAY E 2 College Road, 169850 Singapore (VGAMP)68A Ba Trieu-Street
Norwegian Medical Association Tel: (65) 6223 1264 TUNISIA F Hoau Kiem District
P.O.Box 1152 sentrum Fax: (65) 6224 7827 Conseil National de l’Ordre Hanoi
0107 Oslo E-Mail: sma@sma.org.sg des Médecins de Tunisie
www.sma.org.sg Tel/Fax: (84) 4 943 9323
Tel: (47) 23 10 -90 00/Fax: -9010 16, rue de Touraine
E-mail: ellen.pettersen@ 1002 Tunis
legeforeningen.no SLOVAK REPUBLIC E Tel: (216-71) 792 736/799 041 ZIMBABWE E
Website: www.legeforeningen.no Slovak Medical Association Fax: (216-71) 788 729 Zimbabwe Medical Association
Legionarska 4 E-mail: ordremed.na@planet.tn P.O. Box 3671
PANAMA S 81322 Bratislava Harare
Asociación Médica Nacional Tel: (421-2) 554 24 015 TURKEY E Tel: (263-4) 791553
de la República de Panamá Fax: (421-2) 554 223 63 Turkish Medical Association Fax: (263-4) 791561
Apartado Postal 2020 E-mail: secretarysma@ba.telecom.sk GMK Bulvary E-mail: zima@zol.co.zw

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