“…Although it would be costly to rejoin (see box), it is hard to play the cannot afford it card when countries such as India, Romania, Macedonia, Latvia, and the Ukraine are coming forward. To maintain that no amount of internal reform will ever enable this unwieldy international organisation to acquire the vision, purpose, foresight, and effectiveness it has been seen (and continues) to lack5 seems unduly pessimistic. Clearly the WMA must define, adopt, and implement more realistic objectives, but with the focus on medical ethics the BMA could make a valuable contribution.…”