Angry Doctor

Monday, March 24, 2008

Confidence Goods 12

A bit of news that will no doubt bring cheers or jeers from doctors (depending on their 'turf') to start the week with...

When govt's heavy hand isn't best fix
It's 'consumer beware', even as medical profession takes steps to regulate its own over aesthetic services
Tan Hui Leng

ON a black-white spectrum, many aesthetic quick fixes fall in the "gray" area as far as scientific corroboration is concerned. That is why it would not be "practical" for regulators to dictate what procedures doctors should or should not perform.

Instead, said Health Minister Khaw Boon Wan (picture) yesterday, consumers should take responsibility for their own choices, even as the medical profession is taking steps towards self-regulation on such matters.

Mr Khaw was addressing the misconception perpetuated by some recent media reports that said the ministry had banned certain aesthetic treatments deemed "scientifically unsubstantiated".

Making it clear that this was not so, Mr Khaw said: "Tightening up (regulations) means a lot of the treatments would have to be forbidden, which obviously is not practical, so I think our job as health (authorities) is to look at safety."

The challenge of regulating the vanity business, as the Ministry of Health (MOH) put it in a press statement, is that scientific evidence is often missing or inconclusive.

But where the MOH will step in, is when patient's lives may be at stake — particularly in invasive, high-risk procedures such as liposuction, where complications can result in death.

The MOH last month had raised concerns in Parliament about general practitioners (GPs) who perform liposuction procedure at outpatient clinics.

And as Today reported on March 11, plastic surgeons have seen more of such botched jobs by GPs that have resulted in serious complications for the patients.

Where highly invasive procedures are concerned, draft regulations are being formulated.

But "beyond that, the profession has to regulate themselves", Mr Khaw said on the sidelines of a book launch.

The Academy of Medicine and the College of Family Physicians are formulating guidelines governing the ethical practices of aesthetic procedures. These will draw from other countries with similar guidelines, said the MOH.

Common procedures include skin whitening injections and mesotherapy — an injection of a medicine, vitamins and plant extract cocktail to the layer of fat just below the skin to help get rid of fat.

For now, aesthetic services will be expected to practise with customers' interests in mind "and not allow greed to over-rule ethical considerations", said the MOH.

Doctors, in addition, will be bound by the Singapore Medical Council's ethical code and guidelines. Currently, the council is investigating six doctors following patients' complaints about their aesthetic treatments.

On their part, consumers were urged by Mr Khaw to exercise common sense and not be misled by marketing hype.

"There's no shortcut to things. If you insist on eating a lot yet don't want to exercise and hope that some procedure will instantaneously make you slim, take it with a pinch of salt," he said.

The MOH said customers should "go in with their eyes open, knowing that there will be disappointment and occasionally even accidents, not to mention the loss of money".

If offered treatments that appear to be new or unheard of, they should be "vigilant" and seek a second opinion from their regular family physician.

As for GPs, the ministry said they had been "unfairly represented" by the media recently in reports about aesthetic malpractices.

Singapore's primary healthcare services rank among the world's best, said the MOH, and "a few unethical doctors should not be allowed to taint the good reputation of our medical community".

You can read what the ministry's spokesperson said on aliendoc's post here, and decide for yourself if the ministry had been misrepresented.

You can also read the ministry's full press release here.

It seems to angry doc that the ministry has taken a specific position with regards to aesthetic 'medicine', which in this case translates to: it's OK to us for you to sell any unproven treatment to your clients as long as you don't kill or injure them.

That represents a step backwards for medicine in Singapore, and as noted by aliendoc, is a case of applying 'double standards'.

angry doc believes that the guiding principle when it comes to looking at what we offer our patients should not be how much it costs, whether it's therapeutic or cosmetic, or how much potential harm it can do to the patient, but whether it works. All those other things matter, but if we do not first and foremost know, or have good reason to think, based on evidence, that our treatment work, then we become quacks - professing an ability to heal that we do not in fact possess. A cheap quack who does not kill his patients while claiming to make them pretty is still a quack.

angry doc has said it before, and he thinks it bears repeating again: medicine, including aesthetic 'medicine' is a confidence goods; that we have to put the onus on the 'consumer' to "not be misled by marketing hype" speaks poorly of the medical profession in Singapore.

We do, however, have a chance to redeem ourselves: the minister has effectively left the field of aesthetic 'medicine' to be regulated by doctors ourselves. Self-regulation is a privilege, and whether we can hold ourselves to a higher standard than that which the ministry seems to expect of us on the subject of aesthetic 'medicine' will perhaps influence how much longer we will continue to have that privilege.



  • aesthetic 'medicine' - better profit than normal illness like flu / fever is it? doctor must also make money to survive what. if not GP how to continue business.

    By Anonymous Anonymous, At March 25, 2008 5:59 pm  

  • "aesthetic 'medicine' - better profit than normal illness like flu / fever is it? doctor must also make money to survive what. if not GP how to continue business."

    Yes, financial reward is probably one of the key motivators of aesthetic medicine.

    So, do doctors enter aesthetic medicine out of choice (profit motive) or out of desperation (unable to turn a decent dollar from practicing mainstream medicine)?

    Here is a link to an article written by a prominent member of the College of Family Physicians in Singapore. It offers a good read, and is an accurate reflection of what is actually going on in Primary Care locally. You'll need Adobe PDF in order to read it.

    By Blogger GuinnessDoc, At March 25, 2008 7:04 pm  

  • This comment has been removed by the author.

    By Blogger GuinnessDoc, At March 25, 2008 7:07 pm  

  • I think plastic surgeons are just defending their turf with the regulation of aesth med. because they are able to do liposucton and mesotherapy (for instance) while normal GPs cant, and patient have to pay alot more when they seek treatment at specialists'.

    By Anonymous Anonymous, At March 25, 2008 10:39 pm  

  • "I think plastic surgeons are just defending their turf with the regulation of aesth med. because they are able to do liposucton and mesotherapy (for instance) while normal GPs cant, and patient have to pay alot more when they seek treatment at specialists'."

    GDoc guesses that there is probably some truth in the "turf war" concept.

    Currently, mesotherapy, either performed by plastic surgeons or otherwise is embroiled in controversy due to insufficient clinical data to support the procedure.

    Who can perform Liposuction is being debated due to safety concerns. GDoc shares this concern. Complications can occur in liposuction, as seen in the current case being reviewed by the authorities. These procedures should be performed by individuals not only trained, but skilled in them. This increases the chances of a more aesthetic outcome, and also patient well being.

    Again, the question that pops into GDoc's mind is "Should doctors be catering to patients' wants instead of their needs?" For interested parties, the linked article in GDoc's pervious post attepmts to address this.

    Disclosure: GDoc does not practice aesthetic medicine.

    By Blogger GuinnessDoc, At March 26, 2008 8:24 am  

  • Really useful material, lots of thanks for your post.
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    By Anonymous Anonymous, At January 04, 2013 2:42 am  

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