Friday, August 7, 2009

Stem-Cell challenge for the Singapore Medical Council

I was offline for a while for various reasons, and came back today to this curious flurry of reports in My Paper (1, 2 , 3 & 4) about the use of 'stem cells' for the treatment of aging and heart failure (many thanks to Ms Dawn Tay!!). The reports refer to two clinics, one in Parkway's Mt Elizabeth (TheraVitae), and the other in Paragon Medical Centre (Clinique Suisse). Clinique Suisse's Dr YM Wong, incidentally was also featured in a previous blog-post about another whacko scheme.

I must admit I don't know too much about these fancy therapies but a number of bizarre and confused things pop up in the reports:

a] The inconsistent picture of whether these were offered as part of a clinical trial. Both Dr Wong himself and Dr Eugene Sim of Parkway, offerred that these were not part of clinical trials, yet Dr Sim said that these were approved by the Parkway ethics board and the HSA (which would only happen if they were formal trials).

b] These therapies are 'unproven' and are not currently acceptable methods of treatment. Dr YM Wong was quoted as saying:
"We don't talk about clinical trials. We're not reducing people to digits and statistics. We treat people as a whole. I don't think like most doctors do. I'm different. Singapore doctors don't believe that stem cells can be used to delay ageing. They're very conservative and feel that stem cells should be used only in leukaemia and other incurable diseases."

c] Most importantly, the offering of unproven therapies is strictly deemed unethical. Para 4.1.4 of the SMC Ethical Code and Ethical Guidelines state very explicitly: "A doctor shall treat patients according to generally accepted methods and use only licensed drugs for appropriate indications. A doctor shall not offer to patients, management plans or remedies that are not generally accepted by the profession, except in the context of a formal and approved clinical trial."
MOH and HSA was quick to point out that doctors who flout these guidelines are liable for disciplinary action. (The SMC was however, strangely silent.)

But what was really disturbing was that this was going on for about 10 years.

So here is what I believe is an important and very timely challenge for the Singapore Medical Council, especially in the wake of recent discussions about her ability to 'self-regulate'. Did she know about the offering of unaccepted therapies? Or did she conveniently blind herself to the violations and clung obstinately to the mantra that she cannot act unless someone complained officially?

Time for a serious re-boot of the system?


angry doc said...

I tend to think that not acting unless a complaint is received is an important safeguard against abuse of power.

As it is the council play investigator, prosecutor, and judge (and jury) - if they played complainant too then it will be as a 'police state'.

I believe the roles of watchdog and complainant should be played by HSA, which already cover a number of offences that form the majority of cases brought up to the council (misuse of drugs, false advertising, clinical trials, etc.). This way there is a clear separation between those who bring up a case, and those who investigate the case and prosecute and rule - although ideally I think complaining, investigation and prosecution should be done by the HSA, while the SMC hears and rules.

The HSA don't do too badly (see their annual report), but I think they can and should do more.

The problem (as I understand it) is that currently there is little political will for HSA to play its watchdog role - they do not have enough manpower or muscle to deal with the fake-drug problem happening on the streets, let alone find out what happens in each doctor's clinic.

As far as the state is concerned, non-subsidised healthcare spending is as any other discretionary spending - good for business and taxation - as long as nobody gets obviously hurt. Compared to the other problems the government have to solve, a few doctors providing unproven therapy to a few rich people hardly constitutes a priority item. Let's face it - it's a mountain only to us doctor-bloggers who have too much time and self-righteousness to care about it. :)

If the political will is there, sufficient funding to ensure manpower and training plus effective legislation to expand the powers of investigation (think CNB) will surely allow wider coverage - if one reporter hungry for a story can uncover so much, think what a team of investigators with legal backing and background knowledge of medicine can do.

If they do beef up the HSA to have a quack-busting division, I may give up my current job to join. Will you?

gigamole said...

I think there are at least 2 dimensions here - one with respect to the product itself, and the other, the ethics (or lack of) in the offering of an 'unproven therapy'.

The former is what HSA best does, although I am not sure the actual legislative muscle it has at the moment with respect to stem cells. I believe there is some major revision of the Act under way, but where they are now....I am not quite sure.

The latter is what the SMC should be doing. One can talk about there being gray areas but here is something that is clearly articulated under para 4.1.4. A bit like a judge who looks the other way as he stumbles upon a crime scene because he is off duty. Here your question about HSA's political will might best be directed to SMC. Is there any political will for them to want to do something about a practice that brings the profession into disrepute?

gigamole said...

"If they do beef up the HSA to have a quack-busting division, I may give up my current job to join. Will you?"

Why not But might have to fix those bunions, and get that hip replacement first.
Hmmmmm....come to think of it, perhaps those stem cells might not be such a bad idea........

angry doc said...

"A bit like a judge who looks the other way as he stumbles upon a crime scene because he is off duty."

But what if there is only one judge in the town? What happens when the same judge who accuses a person of a crime is the same judge who tires the case?

gigamole said...

Yup, either that or a whole posse of back slapping old boys.

Hmmm ... now all of a sudden that possibility of getting an out of town non-medical sheriff to lead that posse doesn't seem so ridiculous after all.