AESTHETIC MEDICINE

AESTHETIC MEDICINE:

(Regulations and guidelines): 21.

Mdm Halimah Yacob asked the Minister for Health (a) when will the regulations and guidelines on aesthetic medicine be issued; (b) what will the regulations and guidelines cover; and (c) in the interim, whether doctors are allowed to continue with such procedures and how will the safety of patients be protected.

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The Minister for Health (Mr Khaw Boon Wan): Sir, there is a wide range of practices which constitute the so-called "aesthetic medicine". They range from high-risk procedures like liposuction to relatively low-risk practices like chemical skin peeling. Our major concern is over high-risk procedures which can lead to severe complications including death, if they are carried out by operators without proper training or in ill-equipped clinics. We will regulate these high-risk procedures, in the interest of protecting patient safety. We are studying the regulatory regimes in other countries and our regulatory measures will cover the training required, the practice standards, the premises where they can perform the procedure, and the quality assurance framework that must be in place.

We target to complete the draft regulations for public consultation within a month.

As for the low-risk procedures, the international practice is to let the professional bodies regulate them. At our request, the Academy of Medicine and the College of Family Physicians are working together to draw up guidelines to govern the practice of such procedures. Their guidelines will similarly cover training requirements, practice standards, and so on. Achieving consensus is likely to take longer and they expect a few months to complete their work.

With or without explicit regulations, doctors have to comply with the Singapore Medical Council’s Ethical Code and Ethical Guidelines. If they fail to do so and should their patients complain to the Singapore Medical Council, they will have to justify their action to their peers. Our doctors are largely ethical and competent and we should strive to preserve this high clinical and ethical standard among our doctors.

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Mdm Halimah Yacob: I thank the Minister for the clarification. I would like to ask the Minister whether in the MOH's view the low-risk procedures are therefore safe and what would be the MOH's advice to patients and members of the public wanting to go for such treatment.

My second question is: what about the beauty salons? If they are not covered under the proposed regulations or guidelines for doctors, is this not a loophole which can compromise patient safety?

Mr Khaw Boon Wan: Sir, I will interpret "low risk" as what the English word means. It means it is low risk. Is it safe? Nothing is completely safe. So there is a range of risks.

As regulators, worldwide, it is not just Singapore, we have to be practical and focus on where the regulatory measures can be most effective. Where maximum damage can be done, this is where we really must focus on high-risk procedures. This is what we will do. But for low-risk procedures, I think consumers will have to also play their part. We will of course educate as much as we can. But at the end of the day, they have to decide.

The best advice the Ministry of Health can give to them is to get a second opinion. If you do not even understand what the procedure is, all the more do not part with the money until you are clear what you are getting into. If you are getting the service from a doctor, he is obliged by his ethical standards to provide the full information of the risks and the benefits. You may get better looks but there could be other harm that may be incurred as a result of it. So I think getting informed consent for the kind of procedure is important.

As for beauticians, we should not get the impression they are operating in a

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cowboy town where it is unregulated. There are regulations. For example, if beauticians were to make use of lasers and there is a wide range of lasers being made use of, the powerful lasers are highly regulated. Likewise, if they want to offer liposuction, that will not be allowed. And only doctors and pharmacists can make use of prescription drugs. So if non-doctors and non-pharmacists proceed to do so, the law will go after them.

Mr Sin Boon Ann (Tampines): Sir, I understand that some doctors, in their desire to meet market demand, bring in machines and experiment with medicines that meet with different standards of approval around the world. So from a consumer's point of view, while the machine may meet a certain regulator's standard in other countries, it may not have met the US standard which is, to many of our minds, a gold standard. So how would you expect a consumer to form his own judgment about the treatment procedures if they are not sure which standard it is would be safe for them? Could the Minister enlighten us on this?

Mr Khaw Boon Wan: There are two key safeguards here. One is the doctors themselves. The doctors are under oath and under the SMC's ethical rulings. They have to perform under that kind of framework and if they misbehave and go beyond what ethical practice demands, they have to answer to their peers in due course if a complaint were to crop up and an accident occurs. So that is one level of safeguard.

The second level of safeguard will fall on the consumers themselves. Yes, I take the Member's point that there is asymmetry of information, ie, the doctors know more than the consumers. And that is why I promote "one Singaporean, one family GP". Every Singaporean should have his own GP whom he trusts, whom

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he has relationship for many years, who understands his problems and the needs of his family. And whenever in doubt, get a second opinion and the best second opinion will be from this family GP whom he has developed years of trust.

* *Dr Lam Pin Min (Ang Mo Kio): I would like to ask the Minister what was the impetus behind this aesthetic medicine debacle recently. Was it because there was an alarming increase in the number of complaints with regard to the complications arising from such procedures to SMC or to the Ministry of Health?

* *Mr Khaw Boon Wan: I have been watching this trend on the growth of aesthetic medicine for quite some time. It is one of those activities that is correlated with GDP because these are discretionary consumption and unless you have extra money in the pocket, you may prefer a particular body contour but you may not be able to afford it. So as people become richer, this demand is bound to grow, whether they are provided by doctors or non-doctors.

As for "impetus", I have been watching with concern over the complication rates elsewhere of high-risk procedures like liposuction and there have been deaths associated with it. Even in our neighbouring region, there have been severe complications. At least there is one case of a patient in her 40s, I think, who went in to reduce her waistline but ended up now in coma for almost two months.

So serious complications can occur and so I asked former Minister of State Heng Chee How to give a statement here during the Budget Debate highlighting our intention to regulate this area. That was how it started, but as things went, other procedures got into the picture like mesotherapy that I did not even fully understand.

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I look at it from the risk angle. If it is high risk, we must understand it and we must know how to regulate it. For those which are low risk, they may be of questionable value, but I think we leave it to the profession to decide whether they should provide such procedures at all. That is why I use the word "so-called aesthetic medicine" because, to many traditional doctors, they regard many of these procedures that are being provided by beauticians as not medicine and they reacted violently to classifying those procedures as aesthetic "medicine". If those procedures are done by beauticians, that is fine with them, because these are not medical procedures.

So among the guidelines that we have to look at is also labelling. The other day I took a walk in a shopping centre and I saw a signboard outside a shop which looked like a medical clinic but when I looked closer, there were no doctors listed on the signboard. But they call themselves "medical clinic". So we should see whether non-doctors are abusing, for example, the use of "medical clinics" label. "Health clinics" may be harder to define, but "medical clinics" should, I think, be restricted to doctors' clinics. This way, we avoid consumers walking in thinking that they are going to get their skin "peeled" by doctors, only to end up being served by beauticians instead.

Mdm Halimah Yacob: Sir, I would like to ask the Minister whether MOH will now label procedures as high risk or low risk so that the public and patients are aware and know what to expect from high risk and low risk treatments which will help to enhance their safety. Second, I would like to seek a clarification on the status of high risk procedures between now and the time the regulations are implemented. Are these procedures now prohibited or illegal?

The third question I would like to ask is whether the Ministry is concerned

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whether resources are efficiently allocated because if more and more doctors perform aesthetic medicine, if we have a major outbreak of infectious diseases, do we have enough doctors who are experienced in terms of clinical practice to deal with such outbreaks? This is a concern of Singaporeans. We have invested a lot in educating doctors and they are therefore rightly concerned over whether there will be enough experienced doctors to take care of patient needs when there is a major outbreak of infectious diseases or to support the chronic disease management programme.

Mr Khaw Boon Wan: I do not think it is possible to have a comprehensive list and a clear classification of what is high risk and what is low risk or medium risk. But internally,

as regulators, we must be clear which are the commonly provided procedures in Singapore which belong to the high-risk group, which we will regulate. I think it could be a shortlist which probably will grow in time as new procedures are being provided, which may prove to be of high risk and which may cause severe complications.

Until the regulations are in place, are the procedures being prohibited? As I said, for procedures which are provided by doctors, they operate under the SMC Ethical Rules. Doctors know that they operate within that framework. If they go beyond their competence, they can get into serious trouble.

As for non-doctors (beauticians), for practically all these procedures, I doubt they are allowed to practise, to begin with. You cannot be performing surgery, for example, if you are not a surgeon.

The last point about what if all doctors start going into aesthetic medicine and nobody wants to look after the patients, I hope that will not happen. I doubt it will happen because I think the doctors went

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into this profession for a purpose and took their oaths seriously. This is the season for admissions to medical schools, and hearing from the doctors who do the interviews, we know the students are passionate in expressing their wish to save the world and help relieve sufferings and save lives. So, I will be very sad if, having given that kind of interview answers and then got into medical school and graduated, a vast majority of them decide to go into aesthetic medicine, only to peel skin or to contour body.