Discussion Forum—A Way with Words, a fun radio show and podcast about language

Raffee asks about "not least as" in the following:

The issue of CME or continuing professional devel- opment is one that is likely to be further debated in the pursuit of high – quality professional conduct and patient care, not least as the relationships between the various stakeholders, such as the individual doctor, the employer, the profession and the patient, must been taken into account.

What may be confusing is the word "as", which here I think means "because".

Take the sentence, reduce it to essentials, and change "as" to "because" and you get: "The issue is likely to be debated not least [because] the relationships must been taken into account." 

With a bit of irony and understatement "not least" or "not least because" suggest that what follows really is quite important. Brits use "not least" quite a bit more than we Yanks do. Here's a nice example I found online:

"He had many faults, not the least of which was finding fault in everybody else." Come to think of it that's how Americans would phrase it. A British speaker might say "He had many faults, not least finding fault in everybody else."

Rhetoric nerds will apparently recognize this as litiotes: "ironical understatement in which an affirmative is expressed by the negative of its contrary (e.g., you won't be sorry, meaning you'll be glad )" from The Oxford Dictionary of Difficult Words.

So your sentence could have been written: "The issue will be debated, an impotant reason being the relationships must be taken into account."