The European Jewish Medical Forum took place from 31st August to 2nd September 2015 at Ort House in London. The Forum was organised by the Jewish Medical Association (UK) together with the Overseas Fellowship of the Israeli Medical Association.

Dr Zeev Feldman, World Fellowship Chairman of the Israeli Medical Association, and a paediatric neurosurgeon at Sheba Medical Centre / Tel Aviv University Medical School, welcomed participants, and highlighted his serious concerns about the delegitimisation of Israel in the academic world, including in European medicine.

There were four talks which addressed current medical issues that are topical and important to the Jewish community in the UK, and are also relevant to Jewish doctors from other parts of Europe, and from Israel.

Prof Tim Cox: “A Sad Tale of Three Cities” – Paris, London and New York

Prof Tim Cox (metabolic physician and researcher based at Addenbrooke’s Hospital and Cambridge University), has made significant contributions to the study of Gaucher’s Disease and Tay – Sachs disease, and has supported many UK Jewish affected families. His talk explored the association between neurological forms of Gaucher’s disease and other neurological diseases such as Parkinson’s, and described the enzyme replacement therapy now available. Tay Sachs and Sandhoff diseases, more common amongst Jews but also occurring in others, can be avoided by preventive screening. Gene therapy using a viral vector has dramatic results in animal models but there are many unresolved issues before this can be introduced in man.

Dr Adam Levine: Genetics of inflammatory bowel disease in Ashkenazi Jewish families

Dr Adam Levine did his research as an MBPhD student at University College London (UCL) under the supervision of Prof Tony Segal. He outlined why there must be a genetic component in inflammatory bowel disease (IBD) with failure to limit the inflammatory response. The recently described NOD2 variant distribution is not enough to explain the known high incidence in Ashkenazi Jews. This led him to recruit what is now the largest IBD family ever identified, and allowed him to define a novel variant in the Colony Stimulating Factor receptor B amongst them. Finding this variant not only helps to explain the high incidence in the Ashkenazi Jewish community, but also is informative: the type of variant is very consistent with the current model that a defect in acute inflammation is implicated in the pathogenesis of Crohn’s disease.

Dr Ranjit Manchanda: Population based screening approach(es) for BRCA 1/2 genes

Dr Ranjit Manchanda is a consultant and senior lecturer in Gynaecological Oncology at Bartshealth and Barts Cancer Institute, Queen Mary University, London. His research interests include risk prediction, screening and prevention of gynaecological cancer, and population based approaches to genetic testing. He was an investigator and research lead on the recent GCaPPS trial, which looked at these issues in relationship to the BRCA genes known to be implicated in cancer amongst Ashkenazi Jews. He described this work and reported that his study had shown that population testing in the community can be done, and is cost effective. This has enabled him to identify 18 / 30 women with mutations. These would not have been found on standard screens.

Prof Ian Roberts: Post mortem imaging as an alternative to medico-legal autopsy

Prof Ian Roberts is based in the Department of Cellular Pathology at John Radcliffe Hospital, Oxford, and Oxford University. He is the acknowledged UK authority on minimal invasive autopsy techniques, and has been responsible for rigorous research studies in this field based upon accurate standardisastion. Recently he has initiated a service which has been of considerable value to bereaved Jewish and Muslim families.

In Prof Roberts’ talk he described how he had become involved in this topic, and explained that in order to develop the service properly he had decided that there were five questions that needed to be addressed: (1) What is the accuracy of post-mortem imaging in diagnosis of cause of death in adults? (2) Can radiologists accurately identify which cases may be diagnosed using post-mortem imaging and do not therefore require full autopsy? (3) What is the relative accuracy of CT and MRI scans in detecting post-mortem pathologies? (4) What is the interobserver variation in radiological diagnosis of cause of death? (5) Does increased experience of reporting post-mortem imaging improve diagnostic accuracy? He showed data that post mortem CT was more accurate than MRI based upon discrepancy rate from autopsy of 32% versus 43%. The inter-observer variation between radiologists was 25%, and he discussed how this might be reduced. In addition he illustrated his talk with examples of the innovations he has introduced as part of his work, in particular post mortem coronary angiography followed by CT scanning, which has helped to improve the accuracy of the minimal invasive methods considerably in what had previously been a common problem area.

There were two talks which focussed in particular on the controversies about Israel and Israeli medicine that have emerged in Europe over the past few years. Two speakers analysed some of the fallacies and falsehoods that have been most widely disseminated.

Adv Leah Wapner: The Israeli Medical Association’s role in International Medicine

Adv Leah Wapner is Secretary – General and Legal Advisor to the Israeli Medical Association (IMA), and is also a legal advisor to the World Medical Association. In her talk she outlined described the background to the IMA’s work – how it is required to act as a professional union, self-regulatory body, evaluate ethics and maintain professional standards. Nationally the IMA advocates the rights of patients and helps shape national policy. Internationally the IMA not only represents Israel but also plays an active role in the World Medical Association (WMA), the European Federation of Medical Associations (EFMA), the Standing Committee of European Doctors (CPME) and the European Union of Medical Specialists (UEMS).

In the WMA IMA Dr Eidelman (IMA President) and Dr Blachar (former IMA President) have played leading roles. The IMA is represented on numerous work groups, and IMA statements on several subjects have been adopted by the WMA. These include Drug Prescription, Violence against Women and Girls, Violence in the Health Sector, Collective Action by Physicians, Aesthetic Treatments and Non-Commercialisation of Human Reproductive Material. Adv Wapner is Secretary General of EFMA, and the IMA has observer / associate member status with CPME and UEMS.

The strong relationships with other national medical associations which result from these links are valuable, as they help to ensure the IMA is aware of experience in other countries, and can learn from it. Regrettably, they are also important in combatting anti-Israel activities by supporters of the Boycott, Divestment and Sanctions (BDS) movement. There have been several such campaigns – in general attacking the IMA, and specifically accusing the IMA of complicity in torture and calling for Dr Blachar’s resignation when he was WMA President. Adv Wapner said that these campaigns are particularly pernicious because the involvement of Israeli doctors – for example, in provision of humanitarian aid to Gaza, and most recently in the handling of wounded and sick Syrians – is ongoing.

She concluded her talk with a discussion of the IMA’s position on force feeding, where the Association has taken a lead in Israel in opposition to it, telling Government that force feeding is recognised as a form of inhuman and degrading treatment, and should not be permitted.

Adv Wapner’s presentation to the Forum can be accessed at:–The IMA’s Role in International Medicine – Adv Leah Wapner

Prof David Stone: Has Israel damaged Palestinian health?

Prof David Stone is Emeritus Professor of Paediatric Epidemiology at Glasgow University, and has monitored and rebutted anti-Israel material that has appeared in the medical press.

In his talk Prof Stone said that the publication of this material represents a case study of the politicisation of medicine. He proposed that although Virchow had noted that “medicine is a social science, and politics is nothing else but medicine on a large scale”, nonetheless the explicit or implicit adoption of a strongly political position in an inappropriate medical context is politicisation and alien to medical values.

He gave three examples of such politicisation from Rita Giacaman (Lancet, 2009), Aimee Shalan (Spectator, 2013) and Richard Horton (Lancet, 2009). To explore his question further he asked (1) whether or not there was proof that Israeli policies and practices were indeed designed to degrade health services and infrastructure, and (2) what the resultant impact had been. He used a wide range of data sources available in the public domain, and pointed out that between 1967 and 2013 Israel and the Palestinian territories shared high birth rate, decreasing death rate with rise in life expectancy, and net inward migration from other countries. The UNICEF 2012 report showed that the fall in infant mortality / 100 live births between 1950-5 and 1985-90 was very similar in the two areas (87% versus 84%) and paralleled that seen in other Middle Eastern countries. Vaccination rates were the same; and underweight nutrition (where data are not available for Israel) amongst Palestinian children was similar to that seen in Jordan and Lebanon. He had also looked at provision of water and electricity supply in the West Bank and Gaza which had risen dramatically between 1972-5 and 1992.

His conclusions were that the central allegation – that Israel has systematically damaged Palestinian health/healthcare – is not evidence-based; on the contrary, Israel had substantially improved Palestinian public health from 1967 ground in the face of formidable obstacles; and that Israeli policies post-1967 had in fact been designed to improve healthcare/infrastructure in the West Bank and Gaza as rapidly as possible in keeping with WHO Alma Ata declaration (1981) (“Health For All by the Year 2000”). Yet, despite this evidence, anti-Israel “medical” rhetoric obscures reality, obstructs peace efforts and contributes nothing to Palestinian health; and thus the false allegations should be recognised as “politicised” medicine.

Prof Stone noted that this politicisation is not a new process. There have been mounting concerns about the role of the Lancet particularly since 2009, and this journal has become the most prestigious purveyor of a distorted narrative of Israeli culpability. He considered that the journal is failing to meet minimal standards of non-partisanship, accuracy and objectivity. He quoted from an NGO Monitor study which showed 264 items about Israel – Palestine in 2001-14: 221 of these were “Palestinian”, of which 65% were opinion and commentary, compared to “Israeli”, of which 26% were in that category, with 74% medical. He said that this was a pattern which had been exacerbated in 2014 with publication of the Manduca at al letter, and by the editor’s refusal to retract it. At least two of the authors of that letter had links to anti-Semitism and neo-Nazism. He believed that NGO ethical guidelines should prohibit exploitation of allegations to justify political positions and agendas and commended the principles expressed in the NGO Monitor document “The Political Abuse of Medicine, Morality and Science” (Jerusalem 2013) which is accessible at http://www.ngo-monitor.org/article/ngo_malpractice_the_political_abuse_of_medicine_morality_and_science

Prof Stone believed that there were very fundamental general medical principles at stake: (1) the damaging impact of propaganda that is masquerading as ‘humanitarian concern’ or ‘science’ needs to be recognised; (2) the role of medical scientists, professional bodies and journals in disseminating politicised and misleading analyses needs to be scrutinised better; and (3) the international medical community needs to hold individuals and organisations that abuse their positions to account.

Prof Stone’s presentation to the Forum can be accessed at:– Has Israel damaged Palestinian Health? – Prof David Stone

In addition a fuller version is also accessible:

http://fathomjournal.org/has-israel-damaged-palestinian-health/

There were two talks which focussed on the extraordinary – and often underestimated – medical challenges that doctors in Israel have had to meet in recent years.

Dr Tzaki Siev-Nir: Operation Tzuk Eitan, Summer 2014: Transferring from a Civilian Rehabilitation Department to Absorb the Injured

Dr Tzaki Siev-Nir, is director of the Orthopaedic Rehabilitation Department at Sheba Medical Centre. He was responsible for shifting from a civilian rehabilitation department to absorb the injured victims from Operation Tzuk Eitan – the war in Gaza – in summer 2014.

In his talk Dr Siev – Nir explained that there are no military hospitals in Israel, so that civilian hospitals have to be used to provide services. For such hospitals key challenges in planning and organisation are that you cannot estimate in advance the duration of the conflict, the number and flow of casualties, the civilians who meantime need “ordinary care”, and how often civilians as well as soldiers will be injured in densely populated areas. Hence you have to prepare to absorb a large number and to have facilities for rapid patient flow.

The principle of immediate involvement of rehabilitation services following admission, and more rapid transfer to rehabilitation care is important. Starting rehabilitation earlier gives a perspective of hope. The idea of a “new department” is always floated ignoring that it is difficult to identify, recruit and train new staff; but extra staff time is needed to address the complexity of injuries and changed patient mix. Therefore skilled retired personnel were used; and 16 additional psychologists were recruited.

Dr Siev-Nir said that the complexity of the injuries is important, but one should not underestimate the concurrent medical problems, the emotional issues including not only acute distress, but also depression and post – traumatic stress disorders. Family issues are important – the doctors need to recognise that you are dealing with children, or at most young adults, who are at the same time soldiers, and that family may have difficulty in the “letting go” which is an essential part of rehabilitation.

One of the problems of management in rehabilitation include coping with pain – training in staff about sedation, use of regional blocks, novel agents including cannabis – used where indicated in liquid form – and decisions about wound care – favouring primary and early closure, which decreases surface area, prevents secondary infection, eliminates the need for graft and leads to scars that are more flexible and allow for early movement sooner. This wound care can be facilitated using Regulated Negative Pressure Assisted Wound Therapy.

These problems have to be seen against a background of organizational problems – the department has to cope with the Israel Defence Forces and its spokespeople, with Palestinians who are either in the rehabilitation process when the war started, or are admitted during it, and with the Ministry of Defence,,who handle long term care issues but must not be brought in too soon because it can convey a poor image about recovery.

Dr Siev-Nir concluded his talk with some unusual examples. Virtual reality could help to engage the patient in real life situations – within a controlled environment one could learn to cope with challenges, and create an environment to treat phobias. In a soldier with a brachial plexus and arterial injury a cardiac arrest had led to a stroke with a resultant visual deficit, and training on a colour feedback monitor on movement proved useful – not only to the patient but also to the doctor involved in treatment..

Prof Anthony Luder: Syrian conflicts and casualties: a perspective from Ziv Hospital in Tzfat

Prof Anthony Luder is Director of Paediatrics at Ziv Medical Centre, Safed and Vice-Dean of the Faculty of Medicine in the Galilee (Bar Ilan University), with responsibility for clinical sciences. His research interests are in paediatrics, genetics and metabolic medicine. In his talk Prof Luder spoke about the recent experience of the medical centre in handling Syrian patients.

As background Prof Luder explained that Ziv is a 331 bed hospital, with 1200 staff. 77,000 patients per annum are seen in Accident and Emergency, and annually there are 220,000 out -patient attendances. He also summarised the humanitarian crisis of the Syrian civil war: the UN estimated 350,000 deaths, more than 1 million injured, and more than 6.5 million refugees. Many Syrian medical facilities have been destroyed and it is estimated that 70% of trained personnel have left the country.

The first time that Syrian patients were brought to Ziv was in February 2013. Since these initial seven civilian cases the trickle has become a steady flow. As a Haaretz editorial commented, this is basic humanitarian aid: one cannot “stand idly by while the injured suffer”. By 2015 ~500 Syrian patients have been treated. 17% are children, and 70% overall have orthopaedic problems, but the range is very wide – for example, ophthalmology, urology, and. even obstetrics and gynaecology. In a series of 100 of these patients the male: female distribution was 9:1 and the age range was 2-51 years. Roughly half of the trauma cases were “polyorgan trauma”. 41% were gunshot wounds, 23% were blast injury and 9% were related to road traffic accidents.

Prof Luder described some examples of the problems encountered. Certification of births had to be anonymised as “born in Israel” would not be acceptable. A 12 year old girl was admitted with sepsis which proved to be due to swabs in her abdomen left after a previous operation; at further surgery she was found to have a dysgerminoma of the ovary, and thus she remained at Ziv for three months to receive the requisite chemotherapy. An 8 year old girl who had pyoderma gangrenosa was found to be suffering from a rare leucocyte adhesion deficiency syndrome and treatment – bone marrow transplantation – was arranged. He showed some striking examples of orthopaedic rehabilitation, and of amputees who had been fitted with prostheses.

Prof Luder concluded his talk by asking the question: what has been the impact of these events on the healthcare professionals working with Syrian patients? To answer this question Ziv Medical Centre is supporting a research project based on interviews and questionnaires, and the outcome of this will be published in the future.

There were two panel discussions both of which were chaired by Dr Lawrence Buckman (former chair of the British Medical Association General Practice Committee and London President of the Jewish Medical Association (UK).

One of these discussions explored the current status of Brit Milah in Europe. This was introduced by Dr Simon Cohen (consultant physician, UCL), who showed that debate on this subject is not new, and gave cartoon examples where the borderline between criticism of Brit Milah and anti-semitism had been crossed. Prof David Katz (Prof of Immunopathology, UCL) discussed the legal and regulatory framework in which Brit Milah is practised in the UK, compared with Europe, and explained the details of the recent UK Family Law judgement which concluded that neonatal male circumcision for religious reasons is permissible. Prof Laurence Lovat (Professor of Gastroenterology and Laser Medicine, UCL; also a mohel) spoke about the Initiation Society, the UK’s oldest Jewish organisation, responsible for Brit Milah. Prof Giorgio Mortara (gastroenterologist and President of the Italian Jewish Medical Association) provided an Italian perspective and also tabled a report from Dr Refoel Guggenheim (Paediatrician, Switzerland). Prof Anthony Luder (Paediatrician, Ziv Hospital and Bar-Ilan Medical School, Tzfat) reported on a recent attempt to interfere with the traditional Jewish practice of neonatal male circumcision by European paediatric organisations and how these had been resisted successfully as a result of hard work by the Israeli paediatrics community.

The second discussion took up the theme posed by Dr Feldman at the beginning of the meeting with presentations from Mr Michael Whine, who is the Director of Government and International Affairs at the UK Community Security Trust (CST), and is the UK expert on racism and intolerance on the UK delegation to the Council of Europe. Mr Whine also acts as Consultant on Defence and Security to the European Jewish Congress, and represents it at the Organisation for Security and Cooperation in Europe. He gave an overview of how anti-Israel propaganda is promulgated and disseminated. Prof Daniel Hochhauser (Professor of Oncology, UCL) spoke about his experience in combatting anti-Israel and anti-Semitic prejudice in the medical press as well as in many other fora, and Prof David Stone presented his paper on “has Israel damaged Palestinian Health? A case study of the politicisation of medicine”, which is summarised above.

Throughout the Forum there was considerable discussion about how to take forward some of the important topics raised; about how better to educate and inform Jewish physicians; and about how to encourage them to participate in joint initiatives of mutual interest. All present were asked to put forward their priorities, and it was agreed that these would be circulated and used as a basis for a forward plan of European Jewish medical activities.

This year’s annual meeting of the Myers Brookdale Health Advisory committee (of which I am a member) was arranged helpfully to coincide with the 6th International Jerusalem Conference on Health Policy. Amongst the several hundred delegates were a dozen or so from the UK, including some eminent health policy and health services research academics. The US was more generously represented, and we were told by Orly Manor, Chairman of the Board of the Israel National Institute for Health Policy Research, which sponsors the Conference, in her welcoming address, that in all there were representatives of 43 countries present. Orly told us some of the medical history of the area, including about Sir Moses Montefiore’s physician, no less than one Dr Thomas Hodgkin [1798-1866; as in lymphoma], who is buried in Yafo.

The plenary presentations were mainly excellent, and overall the standard in parallel sessions was every bit as good as other quality international conferences I have attended.

We heard from Israel’s new Director General of the Ministry of Health, Moshe Bar Simon Tov, who summarised Israel’s demography and its democratic system of government. Demographically, Israel’s over 75 population is growing at five thousand per annum. In healthcare, he emphasised the diversity of both workforce and patients, with comments such as the routine care of elderly Holocaust survivors alongside wounded Syrians in the Northern hospitals. He also pointed out that Israel spend 7.5% GDP on health, compared with the OECD average of 8.9%. Israel is clearly pleased to be included in the OECD. Regarding healthcare, Moshe went on to describe the notably short length of stay in Israel, reflective in part at least of good after care, a well known stumbling block for the NHS. He also mentioned data – the largest Israeli Kupat Cholim [Health Plans], Clalit, apparently has the biggest medical database in the world: not only does that offer great opportunities for health research, but maybe it is something to show our NHS leaders, before the next massive speculative investment in Information Technology.

Other plenary speakers included Martin McKee (LSHTM, UK), Patricia Shaw (Herts, UK), Christian Lovis (Switzerland), David Hunter (Durham, UK), Victor Rodwin (NYU, USA) and Peter Smith (ICL, UK). Perhaps the lightest comment was the cautionary lesson about carelessly attributing causation to correlations – Christian Lovis gleefully told us that there is a strong correlation between countries with high chocolate consumption and the number of Nobel Prize winners: did I say he came from Switzerland?!

Between sessions, and even during them, as well as over lunch or coffee, or while peering at ePosters, there were lots of opportunities for networking. The atmosphere was very sociable, English was the common language and there were many new contacts to be made. During a social event at the Israel Museum, for example, I met a Vietnamese dentist who had completed her Public Health Masters at the Hebrew University the previous year and had returned to meet her tutors and other former students at the Conference, as well as to present her dissertation findings at a session. I asked her why she had chosen Israel to study and it seems she just fancied the idea, and her country had sponsored her to do so. Two young men from the US were studying medicine at Tel Aviv – one of the dedicated courses taught in English solely for overseas students, who are expected to leave Israel when they graduate.

The final plenary session took us away from health policy completely. We welcomed Professor Eliezer Rabinovici, a physicist from the Hebrew U, who has been heavily involved for 20 years in an international collaboration, SESAME, building a CERN-like synchrotron in Jordan. He emphasised the nature of the project, which relied on total trust between scientists from all over the world and, in particular, between scientists from several unlikely collaborating countries – including Iran, Jordan, Turkey and Israel. As he reminded us, at its inception, the former Egyptian president Hosni Mubarak had “taken politics out of science” in order for the collaboration to flourish.

Having attended the 5th International Conference three years ago, I had learned a bit about the dynamic of the meeting and the Israeli attitude to overseas visitors: along with the general good mood and friendliness, there was a widespread assumption that if you were attending the Conference from overseas, unless you had an obviously Jewish name or visible identifier such as a Yarmulke, you would not be Jewish. So, whilst as a tourist I had never recognised this phenomenon, at the Conference it became the norm to bring into conversation that yes, you had visited Israel many times before, that you had relatives living in Netanya {or wherever} and yes, that you were able to read/understand/speak {as applicable} Ivrit – and maybe some Yiddish for good measure. At the 5th Conference, I jokingly explained this experience to an Israeli delegate, whose advice was that I should go and buy a Magen David pendant and wear it prominently around my neck to make life easier for the Israelis!

I am looking forward to the 7th International Jerusalem Conference – hopefully in 2019. Overall, the standard is high and the Conference offers the opportunity to Israel to showcase some of the high quality research being undertaken there, to share the comparative achievements in terms of health outcomes and the inclusion of speakers from diverse communities in Israel, the PA and around the world. I would very much like to encourage expansion of the UK contingent in attendance on that occasion.

Fiona Sim

The 6th Anglo Israeli Cardiovascular Symposium took place on the 7-8th December 2016 in the beautiful setting of the Rimmonim Galei Kinneret Hotel, with a view over Lake Tiberias.

The Symposium displayed some of the very best of British and Israeli cardiology. A variety of wonderful speakers and leaders in their fields provided updates on their latest research and there were important take-home messages for clinical practice. Highlights included the talks given by Prof Ulrich Sigwart (University of Geneva, Switzerland) who spoke about alcohol septal ablation in hypertrophic obstructive cardiomyopathy (HOCM); Prof Sanjay Sharma (St George’s Hospital, London) who gave an update on the electrocardiographs (ECG) ) of young athletes: and Prof Michael Glikson (Sheba Hospital, Ramat Gan, Israel) who provided important lessons that could be learned from the comprehensive Israeli implantable cardioverter – defibrillator (ICD) registry.

The symposium provided an excellent opportunity for conversation and relationship building between Israeli and British cardiologists. The Israeli participants included both Jewish and non-Jewish doctors – the conference was opened by Dr. Ofer Amir, Director of Cardiology at Poriya Medical Centre, which was the hosting hospital, and in his talk he explained how Muslim, Christian and Jewish doctors in his department work together seamlessly, provide an example of religious co-existence in Israel. He said that there are Palestinian cardiologists in training at Poriya hospital and then transferring their expertise upon their return to their home hospital.

As an FY1 doctor, embarking upon a career in cardiology, I was honoured and delighted to have been invited to attend the conference. I thoroughly enjoyed both the subject matter, and the opportunity for networking with British and Israeli cardiologists alike. I feel that this opportunity will prove beneficial to me when embarking on specialty training in the UK, and will also allow me to consider future potential collaborative projects with contacts in Israel. These symposia, creating and fostering connections between Israeli and British cardiologists, are a wonderful opportunity and I would be delighted to help organise them in the future.

(Dr) Brett Bernstein

FY1, North Middlesex University Hospital

Organised by the Jewish Medical Association UK and BIRAX

The Britain Israel Research and Academic Exchange Partnership – known as BIRAX – is an initiative of the British Council and British Embassy in Israel, in collaboration with several funding bodies in the UK and in Israel.

BIRAX funds joint research projects between the two countries in the fields of stem cell and regenerative medicine therapies.

The Director of the British Council in Israel commented recently that “Through BIRAX, the best scientists in Britain and Israel are working together to develop therapies and find cures for diseases that affect millions of people. We are proud that in partnership with medical research foundations we are able to support this.”

Professor Chris Mason, co-Chair of the BIRAX Research Call and Professor of Regenerative Medicine Bioprocessing, UCL said: “Bringing together world-leading scientists from Israel and the UK will accelerate cures and transformative therapies for a number of serious conditions that impact the lives of millions of patients and their carers.”

The UK-Israel Science Counci co-chaired by Prof Raymond Dwek, Director of the Glycobiology Centre at Oxford University, provides the scientific oversight for the BIRAX programme.

The third BIRAX conference is taking place this year in Oxford on April 11th and 12th in association with OSCI.

As part of its charitable role in informing and educating about Israeli medical approaches and achievements, the Jewish Medical Association (UK) has invited some of the visiting Israeli physician scientists, that will be speaking at the BIRAX Conference, to tell a wider audience about their work, which makes such an important contribution not only to Israeli biomedical innovation but also to strengthening the medical academic links between the two countries.

Tuesday 12th April 2016

Welcome Reception 19:00:

Gavin de Beer Lecture Theatre, Anatomy Building, University College London, Gower St., London WC1E 6BT

Presentations and discussion 19:45:

Gustave Tuck Lecture Theatre, University College London, Gower St., London WC1E 6BT

Confirmed speakers are:

Prof Tamir Ben Hur (Professor of Neurology, Hadassah – Hebrew University Medical Centre), with research interests in the- therapeutic properties of stem cells, and their bilateral interactions with the nervous system in normal and pathologic states, and whose clinical work is in the field of general and neuro-immunology. Prof Ben Hur’s BIRAX project is together with Prof Siddharthan Chandran (University of Edinburgh) and is entitled “Towards regenerative medicine in multiple sclerosis”. They are exploring the therapeutic potential of cell therapy in an experimental model system for the progressive phase of multiple sclerosis. Further details can be accessed here.

Prof Jonathan Leor (Prof of Cardiology, Tel Aviv University – Sackler Faculty of Medicine and Sheba Medical Centre, Tel Hashomer) whose research interest is in the biology of myocardial infarction and myocardial regeneration, and whose clinical work is in cardiovascular medicine.

Prof Eli Lewis (Director, Clinical Islet Laboratory, Ben Gurion University of the Negev – Faculty of Health Sciences) whose research interest is in islet transplantation and immune diversion, and whose clinical work includes many treatment trials in diabetes.

There is no charge for this event (although donations from non-members of the Association would be welcome!) but in order to facilitate catering and security arrangements please notify info@jewishmedicalassociationuk.org that you will be attending.

A reception was held on 29th February 2016 to welcome the Israeli colorectal surgeons who were in the UK from 28th February to 4th March as part of the annual programme organised by Prof Alex Deutsch and supported by the Israel and British Commonwealth Association John Firman Fund.

The 2016 participants were:

Dr Reuven Weil (Group leader; Rabin Medical Centre, Petah Tikva)

Dr Ronen Ghinea (Meir Hospital, School, Kfar Saba)

Dr Haim Gilstein (Rambam Hospital, Haifa )`

Dr Nikolai Gurevich (Rabin Medical Centre, Petah Tikva)

Dr Aner Keinan (Shaarei Zedek Hospital, Jerusalem)

Dr Anton Kvasha (Western Galilee Hospital, Nahariya)

Dr Ahmad Mahamid (Hillel Yaffe Medical Centre, Hadera)

Dr Husam Menzal (Haemek Medical Centre, Afula)

Dr Forat Swaid (Bnai Zion Medical Centre, Haifa)

Dr Itay Zoarets (Sheba Medical Centre, Tel Hashomer, Ramat Gan)

Following the reception, there was a discussion meeting on the topic of “Colorectal Emergencies – Illustrative Clinical Cases from the UK and Israel”. The chair will be taken by Prof Alex Deutsch and Prof Irving Taylor, and the meeting was introduced by Mr Richard Cohen. Presentations were delivered by Dr Laura Gould and Dr Christopher Liao (from University College London Hospital), and by Dr Nikolai Gurevich and Dr Tzvi Zoarets.

During their visit the surgeons were hosted at Kings College Hospital, St Thomas’s Hospital and University College London Hospital, visited the Houses of Parliament (hosted by Lord Pollak) and then attended the international Basingstoke M25 Colorectal Surgeons course.

Prof Ora Paltiel (Hadassah / Hebrew University School of Public Health) organised a meeting on the theme of Medical Professionalism for the Israel National Institute for Health Policy Research (NIHPR).

The keynote speaker was Prof. Pali Hungin, President of the British Medical Association, and former Dean of Medicine at Durham University. He delivered what was described as “a thought provoking session regarding the current crisis faced by the profession, due in part to changing demands and expectations of the public, on the one hand, and the relative conservatism of the profession on the other”. He delineated the symptoms of this crisis, including attrition / dropout, burnout and even decreased enrolment in UK medical schools, and suggested some of their causes – including loss of status, time pressure and loss of clinical autonomy. He warned that “Medicine as an esteemed profession is threatened because of changes both in societal expectations and rapid technological transformation”. Despite genuine cause for concern, he predicted that as the use of digital technologies to their full potential, and as expertise is refined, medicine will evolve. The paradigm will shift and he foresaw enhanced professionalism, increased professional satisfaction, and improved patient outcomes in the long term.

Prof David Katz also spoke at the workshop on the theme of “Professional Regulation”.

A full meeting report has been published in the Israel Journal of Health Policy Research and can be accessed here.

A meeting took place on Monday 8th May 2017 to discuss the topic “Immunisation – a Jewish question? Problems and Solutions?”

This meeting arose following considerable recent publicity about the decline in uptake of the Measles – Mumps – Rubella (MMR) vaccine – and of other immunisations – in the strictly observant London Jewish community.

Prof David Katz opened the meeting, reporting that several Association members have been involved in this debate. In late 2016 representations were made to both local and national public health authorities about the best way to tackle the problem.Six months later we have been told that progress has been made, and the aim was that this discussion meeting will provide an opportunity to hear about it, ask questions, and draw lessons for the future.

Dr Tammy Rothenberg (Paediatrician at the Homerton Hospital) introduced the subject with an overview of the current UK vaccination schedule, explaining that the routine infant vaccinations are “5 in 1” (which covers Diphtheria, Tetanus, Pertussis, Polio and Haemophilus) as well as others (Pneumococcus, Meningococcus and Rotavirus) were also included. MMR is given at 12 months. She showed the historical dramatic effect of vaccination, highlighting that the introduction of measles vaccination (1967) had led to a drop in number of cases reported annually from >400,000 to 130.

With regard to Hackney and the Charedi community, she explained that London has one of the biggest Charedi city populations in the world. ~25 babies are born / week and the average number of children / woman is 7.

She showed data from the 4th quarter of 2014:

5 in 1 vaccination uptake at one year:

City and Hackney: 82%

Stamford Hill: 60%

Measles vaccination uptake at two years:

WHO target (to achieve herd immunity): 95%

UK: 92.5%

City and Hackney: 87.9%

Stamford Hill: 78.3%

During the recent measles outbreak (2013) there had been 1843 laboratory confirmedmeasles cases, of which 474 were 4 years old, 192 were in London and 73 were in Hackney.

The data / 100,000 during the 2006-13 period were alarming. In epidemic year 2007 there 276 cases in Hackney, and the population rate was 503 / 100,000 in the Charedim and 90 / 100,000 in the non-Charedi – i.e. a five fold difference. In 2013 there was a ten fold difference between the two groups.

From Dr Rothenberg’s perspective, based on research into this topic by the local Public Health department, the factors associated with poor vaccine uptake included vaccine hesitancy, lack of access to vaccines, place in birth order, health beliefs, maternal education and perception of risk. Disease outbreaks promoted uptake. Furthermore, cultural differences, and the lesser impact of internet communication made vaccination campaigns more difficult in this community.

Possible recommendations to resolve the problem in the Charedi community included community clinics, appointment of outreach nurses and health visiting teams, and using school based clinics. A balance between the community, commissioners, providers and health protection services needed to be struck.

Laura Sharpe (Chief Executive of the City and Hackney GP Confederation) introduced her presentation with background about City and Hackney, and then spoke about the vaccination problem and the role of the Confederation In attempting to address this.

There are 307,000 registered patients in the area; in the 0-5 age group in Hackney there were 20,400 children in 2014; in the City there were 370. Hackney has a 55% “white” population, of which more than a third are not British; the City has 79% “white”. Over 40% are born out of the UK; the area has the 5th highest number of residents who cannot speak English. The Charedi population is ~25,000 (<10%) but in the 0-19 age group they represent ~20%.

She provided update figures on all immunisations (using standard schedules) for children turning 5 during 2016/7 as at March 2017. There were wide differences between General Practice: in the north east (highest Charedi) area 63% to 85% were fully immunised; in other parts of Hackney 89%, and in the City 92%.

The City and Hackney GP Confederation is a Social Enterprise set up by the local GPs, aiming to improve practice performance and long term viability. Maximising practice income is also central.

The GP Confederation, and the Care Commissioning Group (CCG) both recognise the importance of the immunisation programme, and the CCG has provided £242,000 for the Confederation in order to develop a practical approach which will raise the profile of the problem, and do something about it.

An ex practice manager is now in post to co-ordinate this, and a nursing team is being recruited

Recruitment and training of staff needs to be a priority

Unfortunately the CHIMS system is not as robust as it should be ….all / recall systems need to be improved and clinical effectiveness group data generated

Catch-up clinics need to be provided in the community

Critical to success are the strong links and dialogue with the community; the trust of the general practices, a supportive no blame co-operative approach, and raising the profile of the programme and its evidence base.

Dr Joseph Spitzer (a local City and Hackney General Practitioner) welcomed these initiatives and described the problems he confronts on a day-to-day basis in the community in his role as immunisation promoter and advocate. Media reporting often does not help – vaccination is a victim of its own success, in that families will never have seen poliomyelitis, or hospitalisation for respiratory complications of measles.

Dr Spitzer described some of the arguments that are used against him. The media coverage of complications – as in the MMR / autism story – does have some impact. However, there are many other “excuses”.Parents are “waiting for the immune system to get more mature”, and should not have too much pressure on it. “The Rabbi says we should not do it” – although support for immunisation is almost universal amongst Rabbinic authorities. “We do not do it in our family” – coupled with “if others do it then the disease will not be in the community and we will not get it”. “I cannot remember exactly whether or not (this child) has had immunisations”. Perhaps the most damaging is the comment “you would say so wouldn’t you – you are paid to persuade us to have immunisations”.

Dr Jonathan Cohen (UCLH Paediatrician, involved particularly in handling infectious diseases) noted his experience handling complications of failure to vaccinate, which he said was a very disturbing problem. He felt that much more work is needed in this field, and that it was sad that little co-ordinated support had been available for this previously.

Dr Rilwan Raji (who trained at the Hebrew University School of Public Health, sponsored by the Pears Foundation) introduced his remarks by saying that he was struck by the fact that although from Nigeria the perception was that in the “developed Western world” problems about immunisation uptake did not occur, nonetheless many of the problems that he faces are very similar. He was struck by the similarity as he often heard the comment in Northern Nigeria “what the West is trying to do to you”. He highlighted that how he handles health promotion questions mall in a different context also involves faith communities and beliefs, and also involves small villages and communities where strong traditional approaches are dominant. His main framework was the elimination of poliomyelitis, but he also aims to promote other vaccines. Cultural leadership is important, and he uses a card system to encourage return visits. He has to be careful about accuracy of coverage rates and about adverse event reporting; and he also faces media reporting that may contain “fake news”.

Dr Fiona Sim (Past Association President, and past Chair, Royal Society for Public Health) said she believed the failure to achieve adequate uptake of immunisation in the Charedi community was a health inequalities issue. She suggested that what we had heard this evening could be considered through the four ethical principles: of justice, beneficence [and mentioned that, by the way, doctors’ remuneration does not detract from beneficence], nonmaleficence [“do no harm” – badly breached by Andrew Wakefield] and autonomy [which requires us to work with communities to gain their trust and lay no blame]. Fiona referred to a recent publication from Israel that described ‘social solidarity’ as central to gaining trust and confidence in boosting immunisation uptake.

Dr Sim summed up the evening by thanking all the speakers, who had presented a range of valid perspectives on this important topic. In particular, she congratulated the local CCG for recognising the importance of this issue and supporting the evidence-based project that had been so eloquently described by Laura Sharpe, which offered ground for optimism for the future.

On Monday 6th March 2017 the Association hosted a reception for a team of visiting Israeli colorectal surgeons.

The visit was organized by Prof Alex Deutsch and was led by Dr Reuven Weil from the Rabin Medical Centre (Golda).

The visit was supported by the Israel, Britain and the Commonwealth Association – John Furman Fund; and by the David Yanir Foundation for the Advancement of Colorectal Surgery in Israel.

The members of the visiting team were:

Dr Ofer Eldar (Hasharon Medical Centre, Petach Tikva)

Dr Dmitry Fadeev (Shaarei Zedek Hospital, Jerusalem)

Dr Bassel Haj (Bnai-Zion Medical Centre, Haifa)

Dr Aviel Meoded (Poria Medical Centre, Poria)

Dr Benjamin Raskin (Sheba Medical Centre, Ramat Gan)

Dr Gal Westrich (Sheba Medical Centre, Ramat Gan)

While in the UK they were the guests of Mr Richard Cohen (University College London Hospital), Mr Joseph Nunoo-Mensah (Kings College Hospital) and Mr Andrew Williams (St Thomas’s Hospital), and will be attending a course at Basingstoke Hospital.

Following the reception there was a panel discussion symposium chaired by Prof Irving Taylor on the topic of “Crohn’s Disease 2017”.

Crohn’s case studies were presented by the visiting Israeli surgeons, and recent genetic (Dr Adam Levine), medical (Prof Stuart Bloom) and surgical (Mr Richard Cohen and colleagues) aspects were discussed, with a concluding overview from Prof Deutsch.

The Association of Jewish Physicians in Germany is hosting a Jewish physicians conference in Düsseldorf, Germany from 17-19.11.2017 on the theme “Jewish Tradition and Israeli High-Tech”.

The meeting follows on the successful European Jewish Medical Forum which took place in London in 2015, and has been planned in cooperation with the Israeli Medical Association (IMA).

The President of the German Medical Association, Prof Frank Ulrich Montgomery, will take part in the meeting, as will the Chair of the German Jewish community, Dr Josef Schuster, who is himself a physician. Dr Leonid Eidelman (IMA President) and Dr Zeev Feldman (IMA World Fellowship chair) will be attending.

Keynote addresses will be delivered by Prof Efrat Levy – Lahat (Shaarei Zedek Hospital, Jerusalem who is Israel’s leading medical geneticist, and a world authority on genetic studies of Jewish populations, and by Prof Gabriel Krestin (Erasmus Medical Centre, Rotterdam) who is one of Europe’s leading radiologists and has played an important role both in the European Society of Radiology in in promoting strategic studies in the subject.

Contributions from the Israeli hi tech sector will come from Prof Rafael Beyar (Rambam Hospital / Technion) and Prof Chaim Lotan (Hadassah / Hebrew University)

The conference venue is the Radisson BLU Hotel (Düsseldorf-Golzheim), and the Jewish Community in Düsseldorf is supporting the event.

Prof Rotem Lanzman (Chairman of the Association of German Physicians), who is organising the conference and who has put together the programme, would welcome as many UK participants as possible, and in particular would like a UK speaker who will give an overview for students and junior doctors about possible job opportunities.

Further details and the provisional programme available here.