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OBJECTIVES The aims of the study were to assess lessons learned on patient safety in Organization for Economic Cooperation and Development (OECD) countries and to assess whether they are applied or can be applied to the humanitarian medicine. METHODS This is (a) a 2013-2018 rapid literature review of reviews and systematic reviews articles (PubMed database) on "patient safety" and "medical error" to look for lessons learned regarding patient safety in OECD countries and (b) a rapid literature review (PubMed and Embase databases) on "humanitarian medicine" and "patient safety," from their creation to 2018, to find any articles related to patient safety in humanitarian medicine. In both reviews were excluded articles specifically related to one device, disease, or medical act. These reviews were complemented by a Google search. RESULTS Of the 245 references retrieved, 104 met the inclusion criteria. Of 308 references, 39 respected the inclusion criteria. In OECD countries, patient safety comprises correlated measures taken at three levels. The micro level focuses on individual staff involved in healthcare provision or management; the meso level focuses on medical institutions; the macro level focuses on national healthcare systems. Only one reference mentioned the implementation of a medical error reporting and analysis system in medical humanitarian organization. CONCLUSIONS The adoption of strategies and a culture of safety will need to be adapted to address the variety of intervention contexts and to respond first to the fears and expectations of humanitarian staff. Medical humanitarian organizations, in the absence of an overarching authority for the sector, have a major responsibility in the development of a general patient safety policy applicable in all their operations.

The article describes the 10-year experience of distributing the TRREE project (Training and Resources in Research Ethics Evaluation). This is a free open e-learning program for specialists from the Clinical Research Ethics Committees on regulatory standards in this field. The survey of these specialists showed that there are similar needs for training in fundamental ethical principles related to human research, in accordance with the laws and regulations applicable in the respective countries, and in conducting an ethical assessment of the research protocol. TRREE operates in seven languages, providing access to national laws in ten languages related to research ethics and standards of GCP (Good Сlinical Рractice). The author asks whether the module should be created in Russian.

Personalization is at the center of medical practice. With the sequencing of the genome, the rise in technologies and big data processing capacities, it was then envisioned in an even more precise way, for more targeted treatments on patients' distinctive features. In the last few years, prospects for this personalization went in the direction of public health. Beyond patients, the aim is thus to pursue the entire population, to identify and adjust action on the social, environmental, and biomedical factors that make individuals vulnerable in a health perspective. This is referred as personalized health. Its objective is to better understand the interactions between these factors for a more efficient approach of healthcare and interventions on the social conditions for maintaining the good health of all.La personnalisation des soins est au centre de la pratique médicale. Avec le séquençage du génome, l’essor des technologies et du traitement de données massives, elle est maintenant envisagée de manière encore plus précise pour des soins toujours plus ciblés sur les caractéristiques des patients. Depuis quelques années, ces techniques déploient aussi leur potentiel en matière de santé publique. Au-delà des patients, il s’agit ici de viser toute la population, pour identifier et ajuster l’action sur les facteurs sociaux, environnementaux et biomédicaux qui rendent les individus vulnérables du point de vue de la santé. On parle de santé personnalisée. Son objectif est de mieux comprendre les interactions entre ces facteurs pour une approche plus efficace des soins et des interventions sur les conditions sociales du maintien de la bonne santé pour tous.

Background Patient safety, a major component of quality of care, is now an attribute of health care systems in developed countries at least. Although there is ever more research on this subject in developed countries, humanitarian medicine, mainly implemented in resource-poor countries, has yet to structure its own set of policies and strategies on patient safety and the management of medical errors. Objectives We assessed the knowledge, attitudes, and expectations of medical humanitarian staff regarding the development of policies and strategies related to patient safety and medical error management in medical humanitarian action. Methods We conducted 36 semistructured interviews with international medical and paramedical staff active in 6 medical humanitarian organizations after having interviewed the medical directors or the person in charge of quality of care and the legal advisors. Interviews were transcribed verbatim and subjected to a thematic analysis. Results The interviews confirmed the current absence of clear investments in dealing with safety risks in the selected medical humanitarian organizations. The difficulties experienced by medical staff in reporting medical errors such as blame culture, lack of training, and absence of leadership committed on patient safety are nonspecific. Other arguments are related to the specific conditions of humanitarian settings: coexistence of different medical culture, absence of international or local regulations or external pressures, and great diversity of activities and contexts. Conclusions Interviewed staff expressed high expectations of receiving guidance from their organizations and support to adopt clear patient safety and medical error management policies adapted to their complex operational and clinical realities.

Background In February 2020, international controversy arose about the ethical acceptability of the WHO Malaria Vaccine Implementation Program (MVIP). Whereas some have argued that this program must be seen as research that is not in line with international ethical standards, notably regarding informed consent and local ethical review, some WHO representatives consider the MVIP as a public health implementation program that need not adhere to these standards. Methods We performed a case analysis in light of the 2016 CIOMS International Ethical Guidelines for Health-related Research involving Humans. Findings We argue that the MVIP has a substantial research component, and that it is prudent to therefore apply ethical norms for research involving humans, such as the CIOMS guidelines. Accordingly, we agree that the ethical requirements of informed consent and independent ethical review have not been met. In addition, we are concerned that the study might not meet CIOMS’s social value requirement. Recommendations We urge WHO to release more details about the process that led to the MVIP program and make the MVIP protocol publicly available. The full protocol should be assessed by the relevant ethics committees, new and already enrolled parents should be informed about the uncertainties under investigation and given a real opportunity to consent or refuse (continued) participation, communities should be engaged, and aspects of MVIP that require alteration in light of ethical review should be altered, if possible. Furthermore, in order to improve good ethical practices, it is necessary to engage in international debate regarding the integration of research and public health programs. Procedurally, vaccine implementation programs that combine both prevention and research should involve the wider international ethics community and ensure participation of the target populations in setting the proper conditions for launching such programs.

Background: In respect of the principle of autonomy and the right of self-determination, obtaining an informed consent of potential participants before their inclusion in a study is a fundamental ethical obligation. The variations in national laws, regulations, and cultures contribute to complex informed consent documents for patients participating in clinical trials. Currently, only few ethics committees seem willing to address the complexity and the length of these documents and to request investigators and sponsors to revise them in a way to make them understandable for potential participants. The purpose of this work is to focus on the written information in the informed consent documentation for drug development clinical trials and suggests (i) to distinguish between necessary and not essential information, (ii) to define the optimal format allowing the best legibility of those documents., SCOPUS: ar.j, info:eu-repo/semantics/published

This chapter discusses the International Military Tribunal (IMT) trial and the “Principles of Nuremberg”. It explores the influence of these principles on the doctor’s trial, as well as the trial’s international character. The chapter focuses on an evaluation of the legal valence of the “Nuremberg Code” in public international law. It assesses the relationship between the “Nuremberg Code” and codes of medical ethics, in particular the Helsinki Declaration. To understand the “Nuremberg Code’s” significance in public international law, it is necessary to analyze the post-World War II trials at Nuremberg. The practice of public international law in the post-IMT era has in large part confirmed the validity of the Principles of Nuremberg. The greatest contribution of the Nuremberg trial was that for the first time war criminals were condemned before an international tribunal under rules of public international law.

A robust health infrastructure in every country is the most effective long-term preparedness strategy for global health emergencies. This includes not only health systems and their human resources, but also countries' legal infrastructure for health: the laws and policies that empower, obligate and sometimes limit government and private action. The law is also an important tool in health promotion and protection. Public health professionals play important roles in health law - from the development of policies, through their enforcement, to the scientific evaluation of the health impact of laws. Member States are already mandated to communicate their national health laws and regulations to the World Health Organization (WHO). In this paper we propose that WHO has the authority and credibility to support capacity-building in the area of health law within Member States, and to make national laws easier to access, understand, monitor and evaluate. We believe a strong case can be made to donors for the funding of a public health law centre or unit, that has adequate staffing, is robustly networked with its regional counterparts and is integrated into the main work of WHO. The mission of the unit or centre would be to define and integrate scientific and legal expertise in public health law, both technical and programmatic, across the work of WHO, and to conduct and facilitate global health policy surveillance.Avoir une infrastructure sanitaire solide dans chaque pays est la meilleure stratégie à long terme de préparation aux urgences sanitaires mondiales. Il s'agit non seulement des systèmes de santé et de leurs ressources humaines, mais aussi de l'infrastructure juridique des pays en matière de santé: les lois et les politiques qui permettent, obligent et parfois limitent l'action du gouvernement et du secteur privé. La législation est également un outil important pour la promotion et la protection de la santé. Les professionnels de la santé publique jouent un rôle important vis-à-vis de la législation sanitaire - de l'élaboration des politiques à leur application, en passant par l'évaluation scientifique de l'impact des lois sur la santé. Les États membres sont déjà chargés de faire part de leurs lois et règlements nationaux en matière de santé à l'Organisation mondiale de la Santé (OMS). Le présent article suggère que l'OMS, qui dispose de l'autorité et de la crédibilité pour le faire, participe au renforcement des capacités dans le domaine de la législation sanitaire des États membres et facilite l'accès, la compréhension, le contrôle et l'évaluation des lois nationales. Des arguments convaincants peuvent être présentés aux bailleurs de fonds pour le financement d'un centre ou d'une unité de législation de la santé publique qui disposerait du personnel nécessaire, entretiendrait de solides relations avec ses homologues régionaux et serait intégré aux principaux travaux de l'OMS. La mission de cette unité ou de ce centre consisterait à définir et intégrer l'expertise scientifique et juridique dans la législation de la santé publique, sur le plan technique et programmatique, dans le cadre des travaux de l'OMS, et à réaliser et faciliter la surveillance des politiques sanitaires mondiales.Una infraestructura sanitaria firme en todos los países es la estrategia de preparación más eficaz a largo plazo para tratar las emergencias sanitarias en todo el mundo. Esto no solo incluye los sistemas sanitarios y sus recursos humanos, sino también la infraestructura legal para la salud de cada país: las leyes y políticas que facultan, obligan y, en ocasiones, limitan la acción privada y del gobierno. La legislación también es una herramienta importante para el fomento y la protección de la salud. Los profesionales de la salud pública tienen funciones fundamentales en la legislación sanitaria: desde el desarrollo de políticas a través de su puesta en vigor, hasta la evaluación científica del impacto sanitario de las leyes. Ya se ha encomendado a los Estados Miembros que comuniquen sus leyes y normativas de salud nacionales a la Organización Mundial de la Salud (OMS). Este artículo propone que la OMS tenga la autoridad y credibilidad para dar apoyo a la creación de capacidad de las leyes sanitarias de los Estados Miembros, y para facilitar el acceso, la comprensión, la supervisión y la evaluación de las leyes nacionales. Creemos que hay argumentos firmes a favor de las contribuciones para la financiación de un centro o unidad de derecho de salud pública que cuente con el personal adecuado, tenga un sistema de redes sólido con sus contrapartes regionales y esté integrado con el trabajo principal de la OMS. La misión de la unidad o centro sería definir e integrar la experiencia científica y legal en la ley de salud pública, tanto en el aspecto técnico como programático, a través del trabajo de la OMS, así como dirigir y facilitar el control de las políticas sanitarias globales.إن إنشاء بنية تحتية قوية للصحة في كل بلد يمثل استراتيجية التأهب الأكثر فعالية على المدى الطويل لحالات الطوارئ الصحية العالمية. وهذا الأمر لا يشمل فقط أنظمة الصحة والموارد البشرية الخاصة بها، وإنما يمتد أيضًا ليشمل البنية التحتية القانونية للصحة في البلدان، بما يشمل: القوانين والسياسات التي تعمل على تمكين وفرض الإجراءات الحكومية والخاصة وأحيانًا الحد من تأثيرها. ويمثل القانون أيضًا أداةً مهمة في مجال حماية الصحة وتشجيع الحفاظ عليها. ويؤدي المتخصصون في مجال الصحة العامة أدوارًا هامة في قانون الصحة – بداية ًمن وضع السياسات، حتى إنفاذها، ونهايةً بإجراء التقييم العلمي عن التأثير الصحي للقوانين. تم إلزام الدول الأعضاء بالفعل بإعلام منظمة الصحة العالمية بقوانينها الصحية الوطنية ولوائحها التنظيمية. نقترح في هذه الدراسة منح منظمة الصحة العالمية الصلاحية والمصداقية لدعم بناء القدرات في مجال القوانين الصحية داخل نطاق الدول الأعضاء، وتسهيل الاطلاع على القوانين الوطنية وفهمها ومتابعتها وتقييمها بشكلٍ أكبر. ونحن نعتقد أنه يمكن تقديم عرض مُقنِع للجهات المانحة لتمويل مركز أو وحدة قانون الصحة العامة، التي يتواجد فيها عدد كافٍ من الموظفين، والتي يتم توصيلها بشبكة قوية بنظيراتها الإقليمية، مع دمجها في نطاق العمل الرئيسي لمنظمة الصحة العالمية. وعلى أن تتمثل مهمة الوحدة أو المركز في تحديد ودمج الخبرات العلمية والقانونية في قانون الصحة العامة، لكل من الخبرات التقنية والبرمجية، وذلك عبر نطاق الأعمال التي تؤديها منظمة الصحة العالمية، والعمل على إجراء أعمال مراقبة السياسة الصحية العالمية وتسهيلها.在每个国家建立稳健的卫生基础设施是应对全球性卫生突发事件最有效的长期准备战略。 这不仅包括卫生系统及其人力资源,而且还包括各国有关卫生的法律基础设施: 赋予权力、义务并且有时限制政府和民间活动的法律和政策。 法律也是促进卫生和卫生防护的重要工具。 从政策的制定、执行,到科学评估法律对卫生的影响——公共卫生专业人员在卫生法律中发挥重要的作用。 成员国必须将其国家卫生法律和法规传达给世界卫生组织。 在本文中,我们建议世界卫生组织凭借其权威性和公信力在成员国中支持卫生法律领域的能力建设,并且使国家法律更加便于查阅、了解、监控和评估。 我们认为应强力主张捐助方为公共卫生法律中心或部门提供经费,使这些中心或部门配备足够的工作人员,与区域内的同行稳健地联网并且融入世界卫生组织的主要工作中。 这些部门或中心的任务将是在世界卫生组织的整个工作范围内确定与整合公共卫生法律中的科学与法律专业知识(包括技术和程序知识),并且开展和促进全球卫生政策监督。.Поддержание сильной инфраструктуры системы здравоохранения в каждой стране является наиболее эффективной долгосрочной стратегией обеспечения готовности к чрезвычайным ситуациям в области мирового здравоохранения. В данном случае под инфраструктурой понимаются не только системы здравоохранения и их людские ресурсы, но и правовая инфраструктура стран в области здравоохранения, а именно законы и положения, которые расширяют возможности, налагают обязательства и иногда вводят ограничения для деятельности правительств и частных лиц. Законодательство также является важным инструментом укрепления и охраны здоровья. Профессиональные работники сферы общественного здравоохранения играют важные роли в сфере здравоохранительного права, от разработки стратегий, их реализации до научной оценки воздействия законов на здоровье. Государства-участники уже приняли на себя обязательство сообщать Всемирной организации здравоохранения (ВОЗ) о своих национальных законах и правилах, относящихся к области здравоохранения. В данной статье высказывается предположение, что ВОЗ обладает достаточным авторитетом и репутацией для поддержки наращивания потенциала в сфере здравоохранительного права государств-участников и для облегчения доступа к внутренним законам, их понимания, отслеживания и оценки. Авторы уверены, что существуют веские доводы, которые можно привести донорам, в пользу финансирования ориентированного на сферу общественного здравоохранения юридического центра или группы, которые располагали бы кадровым составом соответствующего уровня подготовки, прочными связями со своими региональными партнерами и были бы вовлечены в основную деятельность ВОЗ. Миссия этой группы или центра заключалась бы в определении научных и юридических знаний (как технических, так и программных), их внедрении в законодательство, относящееся к общественному здравоохранению, во всех областях деятельности ВОЗ, а также в осуществлении надзора за политикой в сфере мирового здравоохранения и содействии ему.

The extent of medicines sales and consumption in the informal market in Togo raises many ethical and public health issues. In order to report on the situation of public action in the fight against this practice, we conducted a qualitative survey from 15 to 25 February 2016 in the commune of Lomé and in the Maritime Region among the actors of control system and resource people in the general population. This was supplemented by an analysis of Togo's pharmaceutical and health policy documents and a literature review on the illicit drug market issues relating to public health, political science, the social sciences applied to health. In spite of the existence of national and international tools, household poverty, cultural self-medication, ignorance of the population concerning the health risks of informal market medicines, weak political commitment, weakness regulation and enforcement, corruption, constitute obstacles to the success of actions to combat this practice.

‘‘Switzerland does not exist’’ or ‘‘La Suisse n’existe pas’’ was the statement the French artist Ben Vautier featured in the Swiss Pavilion at the World Exposition 1992 in Seville. It provoked an outcry in Switzerland, in particular in the political arenas of parliaments and the media. The Swiss School of Public Health (SSPH ?)—proud owner of the International Journal of Public Health—celebrated the 10th anniversary in 2015. Why would the SSPH? Directorate refer to Ben Vautier’s provocation to ask whether SSPH? does exist? As SSPH? moves into the second decade it will face the challenges of puberty and the years as a teenager. These are times of transitions, changes and reflections too. Table 1 summarizes the major achievements and highlights of the first 10 years of SSPH?. These successes, achieved under the leadership of the past Directors were also the result of the solid funding structure. SSPH?, initiated in July 2005 through funds from the Swiss University Conference (SUC), was transformed into a Foundation as of 2008. At that time, SSPH? expanded its network from six to eight Swiss universities, including all universities with major academic institutions of public health, namely Basel, Bern, Geneva, Lausanne, Lucerne, Lugano, Neuchâtel and Zurich. The SUC support for SSPH? was reserved for the first 12 years to then adopt a new financing model. Indeed, as of 2017, the SUC funds—in the past some 1–3 Mio CHF per year—will be replaced by a model where all the universities that carry SSPH? would become its direct funding bodies. This visionary model for a School of Public Health being a network of all academic public health constituencies rather than a classic central ‘‘school’’ is intriguing for a small country like Switzerland. The model gives a promising structure to strengthen public health in a country where excessively federalistic structures resulted so far in rather weak public health systems and infrastructures— comparable to the situation in Germany where an expert panel properly identified the need for strengthening the field (German National Academy of Sciences Leopoldina et al. 2015). Whether we will accomplish this goal in the next decade will depend on the future willingness to collaborate, which in turn will also depend on sustainable funds. At this stage, the foundation has neither been set on balanced nor stable grounds for its upcoming time as a teenager. As the budget will be lower than in the past and commitments of the eight university partners unequal (contributions of each university range between 5 and 60 % of the future budget) one primary strategic goal of the Directorate will be to strengthen the financial pillars of SSPH?. This Editorial was published on occasion of the 10th anniversary of the Swiss School of Public Health.

This article was migrated. The article was marked as recommended. Usage of and investment in e-learning has also grown in the field of research ethics. There are currently several distance capacity building programs on this theme, although few are translated to the language and adapted to the legislation of countries with less resources to implement local training. Translating and adapting an already existing e-learning is a more accessible strategy, since it makes use of an already existing online platform and capacity building strategies that were previously tested and are recognized in the scientific community and society in general. This training needs to be adapted to local needs and there must be guidelines for the translation and adaptation stages of the distance education programs for ethics in research involving human beings. In this article, we put forward 12 steps for the translation and adaptation of e-learning on research ethics, based on our experience of implementing the Brazilian version of TRREE e-learning.

The right to health of migrant populations, whether they are foreign nationals, foreign workers, tourists, asylum seekers or refugees, is enshrined in international human rights treaties. The effectiveness of the implementation of this fundamental right thus lies in national legal frameworks. In spite of its long humanitarian tradition, Switzerland has a strict migration policy, and while it has established a non-discriminatory legal framework for the protection and promotion of the right to health, its laws and regulations sometimes codify differences in treatment between foreign nationals and Swiss residents based on distinct situations. On the basis of shared responsibilities between the Federal State and the 26 cantons, this article describes the Swiss legal and regulatory approach to the right to health, the ways it is currently implemented and the possible vectors for an improved integration of migrants into the health system.

Die Schweizerische Akademie der Medizinischen Wissenschaften hat kurzlich ihre medizinisch-ethischen Richtlinien zu medizinischen Zwangsmassnahmen aktualisiert. Die Revision will die Richtlinien den Anforderungen des am 1. Januar 2013 in Kraft getretenen Kindes- und Erwachsenenschutzrechts anpassen.

The evolution of ‘omics technologies implies consideration of at least five dimensions: (1) the value and relevance of the scientific question; (2) the origin of the biological sample; (3) sample q...

Unter dem Titel «Mythen und Realitaten» hatten Steffen Lau und Josef Sachs in der SAZ das Arztgeheimnis bei der Behandlung gefahrlicher Haftlinge thematisiert. Die Rechtsprofessoren Sprumont und Ducor nehmen hierzu kritisch Stellung. Sie betonen die Unterschiede zwischen der arztlichen Rolle als Therapeut und der als Experte. Fur Therapeuten sei das Arztgeheimnis Eckpfeiler des Vertrauensverhaltnisses von Arzt und Patient.

The industrialization and internationalization of biomedical research is not without consequences on the regulation of research or, at least, on the interpretation of that regulation. As more research is done at the international level, the pharmaceutical industry and the research community are calling for a harmonized regulation to limit the administrative burden of controlling clinical trials and to fasten the R&D process. The purpose of this paper is to analyse briefly the role of the national laws in that process. Part I will outline the structure and the nature of the international regulation of research in a European perspective. Using the examples of research ethics committees (RECs), informed consent and the question of liability and liability insurance, Part II will analyze the importance of the national laws in the implementation of this international regulation.

Sous le titre Mythen und Realitaten, Steffen Lau et Josef Sachs ont recemment revisite la question du secret medical dans la prise en charge de detenus dangereux. Leur intention etait de recentrer le debat sur la realite de la psychiatrie forensique en reponse au discours «emotionnel» qui, selon eux, predomine en Suisse romande. Malheureusement, loin de combattre les mythes, l’article ne fait que les accentuer tout en prenant quelques libertes avec le cadre legal de la pratique medicale en prison.

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This paper reports the results of a workshop held in January 2013 to begin the process of establishing standards for e-learning programmes in the ethics of research involving human participants that could serve as the basis of their evaluation by individuals and groups who want to use, recommend or accredit such programmes. The standards that were drafted at the workshop cover the following topics: designer/provider qualifications, learning goals, learning objectives, content, methods, assessment of participants and assessment of the course. The authors invite comments on the draft standards and eventual endorsement of a final version by all stakeholders.

An increasing number of private companies are now offering direct-to-consumer (DTC) genetic testing services. Although a lot of attention has been devoted to the regulatory framework of DTC genetic testing services in the USA, only limited information about the regulatory framework in Europe is available. We will report on the situation with regard to the national legislation on DTC genetic testing in seven European countries (Belgium, the Netherlands, Switzerland, Portugal, France, Germany, the United Kingdom). The paper will address whether these countries have legislation that specifically address the issue of DTC genetic testing or have relevant laws that is pertinent to the regulatory control of these services in their countries. The findings show that France, Germany, Portugal and Switzerland have specific legislation that defines that genetic tests can only be carried out by a medical doctor after the provision of sufficient information concerning the nature, meaning and consequences of the genetic test and after the consent of the person concerned. In the Netherlands, some DTC genetic tests could fall under legislation that provides the Minister the right to refuse to provide a license to operate if a test is scientifically unsound, not in accordance with the professional medical practice standards or if the expected benefit is not in balance with the (potential) health risks. Belgium and the United Kingdom allow the provision of DTC genetic tests.European Journal of Human Genetics advance online publication, 25 January 2012; doi:10.1038/ejhg.2011.278.

As actors with the key responsibility for the protection of human research participants, Research Ethics Committees (RECs) need to be competent and well-resourced in order to fulfil their roles. Despite recent programs designed to strengthen RECs in Africa, much more needs to be accomplished before these committees can function optimally.To assess training needs for biomedical research ethics evaluation among targeted countries.Members of RECs operating in three targeted African countries were surveyed between August and November 2007. Before implementing the survey, ethical approvals were obtained from RECs in Switzerland, Cameroon, Mali and Tanzania. Data were collected using a semi-structured questionnaire in English and in French.A total of 74 respondents participated in the study. The participation rate was 68%. Seventy one percent of respondents reported having received some training in research ethics evaluation. This training was given by national institutions (31%) and international institutions (69%). Researchers and REC members were ranked as the top target audiences to be trained. Of 32 topics, the top five training priorities were: basic ethical principles, coverage of applicable laws and regulations, how to conduct ethics review, evaluating informed consent processes and the role of the REC.Although the majority of REC members in the targeted African countries had received training in ethics, they expressed a need for additional training. The results of this survey have been used to design a training program in research ethics evaluation that meets this need.

The Olympic Games is the largest sport event in the world. In Beijing, 10 500 athletes competed, selected from a large group of elite athletes in 204 countries. Sports participation on the elite level, aside from winning medals, fame and other rewards, is also important from a health perspective. There is no longer any doubt that regular physical activity reduces the risk of premature mortality in general, and of coronary heart disease, hypertension, colon cancer, obesity and diabetes mellitus in particular. The question is whether the health benefits of sports participation outweigh the risk of injury and long-term disability, especially in high-level athletes. Sarna et al 1 have studied the incidence of chronic disease and life expectancy of former male world-class athletes from Finland in endurance sports, power sports and team sports. The overall life expectancy was longer in the high-level athlete compared with a reference group (75.6 vs 69.9 years). The same group also showed that the rate of hospitalisation later in life was lower for endurance sports and power sports compared with the reference group.2 This resulted from a lower rate of hospital care for heart disease, respiratory disease and cancer. However, the athletes were more likely to have been hospitalised for musculoskeletal disorders. Thus, the evidence suggests that although there is a general health benefit from sports participation, injuries represent a significant side effect. One priority of the International Olympic Committee (IOC) is to protect the health of the athlete. During recent years, prevention of injuries and illnesses has been high on the IOC agenda. During the Athens Games, an injury surveillance system was applied for all team sports.3 During the Beijing Games, the IOC ran, for the first time, an injury surveillance system covering all the athletes, showing a 10% incidence of injuries.4 In …