Slimming pills - The Sunday Times picks up the cudgel

The issue of slimming pills gets elevated to editorial status in today's Sunday Times. Entitled "GPs' Unethical Fat Gains", it screams that it is 'time to wield the stick!'.

But while I share in the sentiments raised, there are a number of problems.

Firstly, as the title of the editorial points out, this is essentially a problem of ethics. Prescribing slimming pills inappropriately is not really a problem of a legal wrongdoing. This is lack of professionalism and unethical behaviour, but not anything that can be easily whacked by a big stick. The HSA regulates the product, so it only goes after those who market products inappropriately, or who imports and sells unlicensed products. Correspondingly, it does not regulate medical practice.

The body that is supposed to regulate ethical and professional behaviour of doctors, is the Singapore Medical Council. This august body however, appears to have a reluctance to act against members for issues like this. Off-label prescribing is however, legally allowed, and unethical behaviour is much harder to prove. Yet, I believe, if the SMC wishes to retain its professional credibility in the eyes of the public, it will need to find some way to deal with problems like this. It cannot be that when the public can recognize a practice as unethical, that the Council would prefer to look the other way.

So the ball is really in the SMC's court.

The related problem is that this is a really big ball to kick around, and nobody knows how the ball of yarn will unravel when you start tugging at the loose end. The problem is not just about slimming pills, but deeply entwined with a whole host of issues related to doctors offering treatments that have not been proven. I have posted extensively about this before. Off-labelling prescribing is just one manifestation of a range of unethical practices. Para 4.1.4 of the SMC ethical guideline makes its ethical position very clear :
"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."

Is it not apparent to the SMC that such practices are unethical?

So my challenge to the SMC is this - either amend your ethical guidelines, or find some way to deal with this. Looking the other way is not an option. The SMC should see that it has an increasingly critical responsibility to the public as Singapore gears up to be a medical supermarket.