Wednesday, January 13, 2010

Dr Devathasan's run in with the Singapore Medical Council

Dr Devathasan's recent run in with the Singapore Medical Council is being watched with great interest. Although the details are scanty, and the SMC proceedings are not publicly available, you can read about the case here and here.

It is also interesting as one of the chief complainant is apparently a 'professional rival'. Dr Devathasan was supposed to have offered an unproven therapeutic option to a 77 year old woman. Remember Para 4.1.4 of the SMC ethical guideline?

Curious.

A number of questions need answers:

a] How does the SMC decide if a therapy is 'unproven'. I have pointed out in previous postings that many doctors offer unproven therapies, in the form of off-label prescribing of drugs, various untrialed medical devices etc. Why was Dr Devathasan singled out?

b] What would constitute a 'proven' therapy? How many trials and what quality of trials are needed?

c] What do we do about Tradition and Complementary Medicine practitioners who are free to make outlandish claims and offer a host of unproven therapies..... some of which may be actually 'endorsed' by the Minister of Health. So if TCM practitioners are championed because they offer unproven options which 'complement' proven western remedies, why is it wrong for Dr Devathasan to do so?

I am all in favour of a greater level of scrutiny of how doctors behave, but SMC need to show it has a rational system in place, and not just engage in random cherry picking of cases to prosecute.

6 comments:

RAM said...

It boils down to the basis of having all these regulatory framework in place.

I believe fundamentally that it should probably be along the ideas of protecting the interests of laymen/patients whenever they visit a SMC-registered practitioner.

Therein lies a major discrepancy.

A patient walking in to a GP/specialist clinic will have the comfort that the doctor he/she is seeing is operating under a specific set of professional/ethical guidelines set up and fine-tuned by the SMC over the years.

But the very same patient can also be seeing a TCM/naturalist/faith healer who may or may not be on a similar equivalent 'register'.

The very same patient may jolly well be prescribed and given the same herbal concotion/supplements/therapy (perhaps a unproven therapy) from both the SMC-registered clinic and the non-SMC registered healthcare/wellness establishment.

Therein lies the great discrepancy.
It seems that in the former, the doctor may be taken to task for prescribing an unproven therapy.
But in the latter case, there's still no formal regulatory framework for the consumers/patients to seek redress should there be any complaints.

If we are looking into consumer protection and patient safety per se, it would seem more urgent and important to reduce the seemingly obvious gap in regulatory framework of the latter rather then spending valuable time in the ministry and Parliament debating on the rationale to improve the existing SMC processes which have been refined many times over the decades.

This is especially so when we recognise the growing numbers seeking services from TCM/non-SMC registered practitioners.

I'm personally all in for measures on improving patient safety and consumer protection, being one myself.

At a macro level, why keep chiseling and fine-tuning existing processes when there is still another big area of health/wellness services which is largely 'unregulated' till date?

I have heard countless anecdotals complaints personally from friends and relatives about beauty treatments gone wrong, naturalist treatments causing more adverse outcomes etc. Only recourse so these consumers so far have been CASE/civil proceedings which may still be lacking somewhat if consumer protection/patient safety is what we are aiming to achieve.

gigamole said...

It probably wasn't very smart of me to lump the TCM issues together with the post on SMC.... 'cos they are really quite different issues. The SMC cannot be responsible for TCM issues. One can hope nonetheless that they can be systematic and transparent when dealing with doctor related problems.

For TCM problems, the responsibility really lie squarely with the MoH. It was a political decision to bring TCM practitioners into mainstream. They are increasingly being recognised as playing a complementary role to western medicine,and the Minister of Health has even endorsed such alternative claims and procedures. It scores political points with the electorate, but has created a whole range of problems as these alternative medicine approaches are neither tested, validated scientifically or regulated in any way. Essentially one can claim 'caveat emptor', but often the 'emptor' is rather misled by inappropriate endorsements based on anecdotal experiences.

auntielucia said...

Actually, I thought Dr Devathasan's approach showed him to be more open and innovative than the average doctor/specialist. One of my mum's doctors (OK, he's just a GP!) has never even heard of echinacea, fr heaven's sake!

(Btw, missed yr posts. Thot MOH had silenced u 4 gd over yr h1N1 heresy!)

RAM said...

I am all for new innovative and complementary treatments for health/wellness.

However, the practitioners administering it should satisfy themselves that the treatments they are administering are safe for their patients.
This is only the most basic professionalism expected of them when patients/clients consult them.

It is not just in Asia but the use of traditional/complementary treatment is on the rise globally, even in the US.
http://www.the-hospitalist.org/details/article/518459/Growth_Spurt.html

Many of these complementary/alternative treatment methods have not been proven in multi-centre trials just as the new treatment method given by Dr Devathasan. But it does not mean that these treatment methods do not work for some of the patients.

We should have an open mind and explore new innovations/existing traditional methods of healing which may have been around for the last couple of hundreds of years!

As long as patient safety/choice is not compromised at the end of the day...

gigamole said...

Hi AuntieL,

:) Just took a slightly long much deserved break. Also had a few things to look after, so that eant a bit less time on the computer.

But good to be back!

gigamole said...

AuntieL and RAM,

I am all for trying new stuff, and innovations in therapeutics, but the proper place for that is in a scientifically conducted trial where results can be systematically documented and statistically analyzed. Otherwise, it will just be anecdotal claims of success...and anybody can claim those. Or endorse them...

I guess there are two issues here....a] the safety concerns of new treatments. Many of the play play claims and treatments are quite safe so the impact really is not great. The problem is that without systematically collected data, one can not be certain of the safety even it does appear to be so; b] the commercial exploitation of vulnerable and gullible patients of doctors who peddle snake oil. This is also something that we need to put a stop to.