NON-EVIDENCE-BASED MEDICAL OR ALTERNATE TREATMENTS

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NON-EVIDENCE-BASED MEDICAL OR ALTERNATE TREATMENTS: 18.

Ms Denise Phua Lay Peng asked the Minister for Health what measures are being taken to protect the interests of patients with special needs/disabilities from practitioners offering non-evidence-based medical or alternate treatments.

Mr Khaw Boon Wan: Sir, there are two main levels of protection against such unethical exploitation of patients.

First, the Medical Registration Act requires the doctors to practise ethically.

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They will be subject to disciplinary action if they use treatments which are not in the interest of their patients.

Second, patients and their caregivers must exercise due diligence and consult the right practitioners. When in doubt, they should first check it out with their trusted family physician. Alternatively, they could seek a second opinion from the practitioners in the public clinics for patients with special needs, before accepting any unconventional or unusual treatment.

Helping patients with special needs is often a very long journey. It is understandable why some families become anxious, embarking on remedies that promise them hope of a rapid "cure". The Internet has further promoted the dissemination of theories and practices, many of which are questionable and without scientific basis. For instance, the use of controversial Complementary and Alternative Medicine (CAM) treatment for children with Autistic Spectrum Disorder (ASD) is popular in the West, despite an absence of scientific support. My Ministry will work with MCYS and its VWOs concerned to educate the families on how to evaluate such information and not be taken in by pseudo-science and unsubstantiated theories. Meanwhile, my Ministry is also collaborating with the Academy of Medicine to formulate Clinical Practice Guidelines to assist doctors in Singapore in diagnosing and managing children with autistic spectrum disorders. The efforts will include compiling the evidence for the various treatments and to disseminate a layman's version to patients and their caregivers.

Ms Denise Phua Lay Peng (Jalan Besar): First, I want to register my thanks to the Minister for initiating the Clinical Practice Guidelines project. I think it will be very useful for the families and other

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practitioners as well. Two supplementary questions for the Minister.

Sir, cosmetic treatments such as liposuction, currently performed on willing adults, are regulated by the Ministry. Does the Minister think that the same should be done for this non-mainstream treatment for helpless children or adults with disabilities, especially those performed by non-medical professionals or non-medically trained practitioners? Would the Minister consider registering these practitioners, putting them on probation first, and maybe confirming them and renewing their licences on a regular basis?

Secondly, would he also consider developing a whistle-blowing policy so that those who have suffered from irresponsible practitioners will have a platform to have their cases heard and, at least, have the Government look into their issues?

Mr Khaw Boon Wan: Indeed, I am taking a similar approach for liposuction that the Member has talked about, which is to identify those procedures or practices which are high-risk and to regulate them. I do not regulate all aesthetic medicine practices but those which are high-risk, like liposuction, we regulate it tightly. In the case of CAM practices on ASD, for example, one treatment modality that is being promoted in the West is Chelation Therapy. But it is high-risk, so we regulate it because only doctors can prescribe chelating agents. Hence, it is not as if it is unregulated. If a non-doctor practitioner decides to provide such a treatment, he will then have to face the law.

For those that are high-risk, we tightly control them. For those which are low-risk, but of questionable basis, it is hard to regulate. Like in aesthetic medicine, we leave it to the practitioners to self-regulate

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because while there is no hard evidence to prove efficacy, there are practitioners who swear by it. They say that some of their patients have benefited from it. If we were to regulate it, we will have to ban these practices and I am quite sure there will be objections from some parents, who will claim that their children have benefited from it.

I think this differentiated risk management approach to tightly-control the high-risk practices and lighter regulation for others is the most practical way going forward. Where the practitioners involved are doctors, I am quite relaxed because they know they have to face the SMC, if they were to engage in unethical practices. But if they are non-doctors, then my hope and our public education are for the parents to help to regulate. The best way is to consult a trusted family GP. When in doubt, consult your GP. If you want a specialist opinion, consult the specialist in NUH or KKH for a second opinion.

As for parents of children who feel that they have received unethical treatment, they can whistle-blow to us. Let us know and we will investigate all such incidents. Unfortunately, for ASD, there is still no cure and parents would just have to be patient with conventional treatment practices.

In our own experience in KK and NUH clinics, it used to be that 20% of the children patients will end up having to attend special schools. But, if they follow the advice of the doctors and work together with us, we have been able to half the rate, from 20% to 10%. So, only 10% of the patients now need to be admitted to special schools. There are proper ways of treating autism. Do not be taken in by promises of a “cure” which often can cost lots of money and emotional ups and downs, with very poor results. Our doctors in our specialist clinics told me that often, some of these

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parents would come with all kinds of medicine, costing them thousands of dollars a month, and they say, "My previous practitioner prescribes all these. Please supply all these to me now at subsidised rate." But when we look at it, those are based on unconventional practices without scientific evidence and which we do not prescribe.