Opinion

WMA shares common concerns of world's physicians

A message to all physicians from Joseph M. Heyman, MD, chair of the AMA Board of Trustees.

By Joseph M. Heyman, MDis an obstetrician-gynecologist in private practice in Amesbury, Mass. He served as chair of the AMA Board of Trustees during 2008-09. Posted Dec. 1, 2008.

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Some problems know no boundaries. Physicians across the globe surprisingly share very similar concerns. The rising cost of health care, access to care, scope of practice, aging infrastructure, nursing shortages, pandemics, and the proper balance between public and private financing are just a few.

I had the good fortune last month to attend the World Medical Assn. General Assembly in Seoul, South Korea, alongside AMA President Nancy H. Nielsen, MD, PhD, Past President Edward Hill, MD (who now serves as the WMA's chair of council), and AMA Executive Vice President and CEO Michael Maves, MD, MBA.

A quick bit of background: The WMA is not to be confused with the World Health Organization of the United Nations. The WMA came into being at roughly the same time (shortly after World War II), but it is instead made up of national medical associations, not national governments.

So although the WMA sometimes works with WHO on public health problems, it is less likely than is a government-funded organization to be politically influenced, and it is better able to put patients' interests first. The WMA strives for the best possible health care for all, with neither boundaries nor limits.

As a response to the medical abuses of the Nazi regime, the WMA's purpose became "to serve humanity by endeavoring to achieve the highest international standards in medical education, medical science, medical art, and medical ethics and health care for all people of the world."

Since 1947, WMA membership has grown from 27 national medical associations to those from 94 countries, many of them developing nations.

Its immediate past president is from Iceland, the president is from Israel, and the president-elect is from Canada. The last president from the U.S. was former AMA President Yank Coble Jr., MD, who served from 2004 to 2005, and was responsible for the incredible Caring Physicians of the World, a book I hope you own.

When the WMA met Oct. 15-18, much of the talk concerned turbulence in the world economy. The representative from Iceland (which is facing national bankruptcy) introduced a late resolution that warned of the risks from upcoming cuts in health care expenditures resulting from poor economic conditions. He called on all the national medical associations to advocate for medical and psychological support for their patients, and to pressure our governments to maintain their current funding levels for health care.

The agenda was dominated by revisions to the Declaration of Helsinki, WMA's seminal policy statement on ethical principles for biomedical research involving human subjects. The declaration has been updated over the years, and following 18 months of commentary from research experts, the WMA General Assembly approved language allowing for use of placebos in clinical trials involving human subjects (as opposed to only using a current proven therapy).

You can see information about the recent meeting at the WMA Web site (link). Three new policies were introduced by the AMA.

The assembly approved a new statement that antibiotics should be available by prescription and only through licensed and qualified health care or veterinary professionals. This approval came after a warning about the global increase in resistance to antimicrobial drugs. Member organizations were urged to push for strict restrictions on antimicrobial agents as feed additives for animals.

A second AMA-sponsored policy concluded with a call to phase out mercury in health care equipment, including "thermometers, sphygmomanometers, gastrointestinal tubes, batteries, lamps, electrical supplies, thermostats, pressure gauges, and other laboratory reagents and devices." Physicians around the world are encouraged to counsel patients about eating fish, advocating for seafood low in mercury contamination, but high in omega 3 fatty acids.

I was heartened that the assembly approved a statement from the AMA that calls for a minimum 50% reduction in the sodium content of processed foods, fast-food products and restaurant meals over the next decade, because of clear links to increases in hypertension and cardiovascular diseases.

In the assembly's open forum, Dr. Maves made a presentation about the AMA's activities regarding scope of practice. The issue has generated international interest, and the WMA will host a seminar on this topic in cooperation with the Icelandic Medical Assn. next March.

There were, of course, other important discussions outside the formal agenda, including the WMA working to support the WHO Framework Convention on Tobacco Control. Those of us from the AMA were delighted to participate in a special seminar on the role of physicians in helping smokers quit, and the highlight of the program was a videotaped presentation by AMA Immediate Past President Ron Davis, MD. His videotape will be broadcast on national TV in Brazil, and there were multiple requests for his remarkable presentation by members from around the world. It is only a small part of the amazing legacy he leaves.

As a public health physician, Ron knew far better than most of us about pandemics and the threats from tsunamis, hurricanes, earthquakes and floods. He realized that none of them respects boundaries, which tells us that our mutual caring for our patients should know no boundaries, either. It is also why cooperation among our associations and within the WMA is more important than ever. When we discuss the strengths and weaknesses of our own nations' health care systems, we can learn from each other, identifying both the best practices and the worst pitfalls.

Because of that, beyond its original purpose as a shining beacon for ethical behavior among physicians, the World Medical Assn. is an outstanding and worthy forum. I loved experiencing the meetings with their simultaneous translation. I loved the give and take with brilliant physicians and medical society executives with diverse backgrounds, cultures and opinions. And yet we all share the same professional ethical center. I was proud to represent the AMA there, and I look forward to future interactions with new friends from around the globe.

Joseph M. Heyman, MD is an obstetrician-gynecologist in private practice in Amesbury, Mass. He served as chair of the AMA Board of Trustees during 2008-09.

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