Tuesday, September 22, 2009

The problem with slimming pills.....

The Straits Times recently reported on the problem with slimming pills. Strangely it is reproduced in full only in the Malaysian Insider.

But the report confuses a range of issues. Firstly there is the problem with the illegal selling on such pills. This is a relatively straightforward legal issue. People who buy such pills online are pretty dumb anyway and shouldn't be crying too much if anything happens to them.

Of more concern to me is the participation of doctors in the wanton prescribing of such medications to patients who do not really require them. This to me, is unscrupulous exploitation of patient's anxieties by medical professionals who should know better. There is an ethical (or lack of) dimension here, which the Singapore Medical Council seems reluctant to wade into.

Can it be regulated?

Unfortunately not at the moment. Such practices, unsavoury though they may be, are perfectly legal. This is an perfect example of how the loophole with respect to off-label prescribing can be exploited for crass commercial returns.

Slimming pills are not without toxicities, and their use is generally directed only to those situations where diet and exercise regiments have been ineffective, or where co-morbidities make weight reduction a medically (relatively) urgent procedure. But their off-label use for indications that are relatively trivial, is not prohibited by law. It is only unethical because it is exploitative and not usually in the patient's interest. Otherwise there is more than an element of caveat emptor in the process.

So what can do we do about it?

Not much really. Caveat emptor. Perhaps if more exploited patients take their doctors to court, ... but more likely it will just up the cost of medical practice insurance.

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