The Singapore Health Ministry has decided to ban the practice of unsubstantiated aesthetic procedures carried out by doctors here. The official reason given was that "As professionals bound by ethical codes, they should know they are not doing the right thing if they are practising unsubstantiated procedures that have no scientific basis in terms of efficacy or safety." In addition, it was feared that "doctors who sell snake oil pose greater danger to the public than lay persons selling snake oil because the public tursts doctors more" because patients rarely question such procedure when carried out by doctors.
I agree with the Ministry that unsubstantiated procedure should not be carried out by doctors just as unsubstantiated medical treatment should not be practiced. This is because nowadays, the practice of medicine is evidence-based. This means that all treatments must be backed up by studies as to the efficacies. This is the accepted mode of practice and is used as the yardstick in the courts of law. Therefore to practice unproven procedures should strongly be discouraged.
However, is targetting the practice of these unproven methods on doctors logical? Are they being unfairly targetted? After all, many of such practices had been carried out by beauticians, and doctors are only jumping into this lucrative bandwagon. Are they being discriminated just because they have "Dr" in front of their names?
Although I agree with the Ministry, I feel that the ban is too drastic and too sudden. This is because by banning such practices among doctors, it created a vacuum which will be filled up by beauticians instead. And if the main aim of the Ministry is to prevent the practice of such questionable methods, then this problem had not been solved. It merely just shift the focus from one of ethics to one of safety. This is because if any untowards happen to the 'patient' in the course of the 'treatment', at least a doctor is better equiped to handle the complications. Furthermore, a doctor has a heavier responsibility towards his patient, merely because of licensing requirements. This is not so with beauticians.
What the Ministry should do is to regulate the whole aesthetic industry; for it does not matter whether the procedures were carried out by doctors or beauticians. Currently, doctors and beauticians have been using all manner of aesthetic treatments, ranging from the non-invasive methods of skin peelings, to the minimally-invasive methods of skin laser to the overtly-invasive method of mesotherapy and colonic washouts. There is no regulation as to who can do what. In the interest of "patient's" safety, guidelines should be drawn up with clear definition as to what procedures a beautician can do, what a general practitioner doctor can do and what a specialist can do with a breakdown of specialty. Just because one is a specialist does not mean that one can claim specialist right to do aesthetic medicine, because he can only be a specialist in his own specialty. His skill level in aesthetic medicine should only be expected to be on par with that of a general practitioner. In the same vein, the differentiation in criteria for beautician and doctors should not be based on medical background but should be based on the risk involved and the ability of managing any potential emergency complications by the practitioner. This will ensure that everyone is given a level playing field.
One of the defence often cited by doctors is that procedure such as mesotherapy had been widely practiced in France and South America. While mesotherapy had been practiced since it was first pioneered by French physician, Dr Michel Pistor in 1952, its use in aesthetic medicine had a shorter history. And the few studies on the effect of mesotherapy on fat cells had not been conclusive. If this method is so effective, I find it strange that drug companies do not fall over themselves to come up with studies that will prove conclusively once and for all the efficacy of this method and get the treatment mainstream. More likely, most of the studies funded did not show statistically significant positive results.
With the banning of doctors from practicing such unproven procedures, I wonder what will happen if doctors choose to close their clinics and convert it into a beauty saloon instead and do away with their official title; effectively be a beautician. After all, the practice of aesthetic medicine is so lucrative that I am sure these doctors do not need the run-of-the-mill practice of seeing cough and cold. Technically they are doctors but they do not run a clinic; in other words, a medically-trained beautician, just like a medically-trained Minister. What will be the Ministry's stand in such cases? Hence, instead of pushing such doctors 'underground', a full regulation of the industry seemed a better option.
I purposely steer clear from any ethical issues. If a patient finds that his doctor seemed to be more preoccupied with aesthetic medicine, then change your doctor. There are so many doctors in Singapore, and I am sure some of them will actually be appreciative for the chance to see you. However, if your choice is limited by the Managed Health Care scheme, then I can only sympathise with you. And that issue belongs to another blog!
Updates on 24 March 2008
The Health Minister yesterday reiterated that the Ministry will leave the professional bodies - College of Family Medicine and Academy of Medicine - to look into various mode of treatment. However the Ministry will draft guidelines on high-risk procedures. This seemed to be a change in stand by the Ministry and is in-line with what happened in the US where although the cocktail of medication for mesotherapy is not approved by the FDA, mesotherapy itself is not deemed illegal by the medical professional body.
P.S.: I am a practicing doctor not involved with aesthetic medicine.
Links:
College Pharmacy - Mesotherapy treatment
Caring Medical - Mesotherapy
Consumer Guide to Plastic Surgery - Lipo-Dissolve under Investigations
DermNet - Mesotherapy Suture for a Living - Mesotherapy/Lipodissolve
WebMD - Fat-busting Injections under Scrutiny 
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