Grey Areas

2013 signifies 10 years from SARS

Ten years ago in February 2003, we have the first case of SARS in Kwong Wah Hospital. Shortly afterwards, I reported to Commercial Radio Hong Kong another case of SARS which involved one of our private colleagues and members, and this started the community awareness of uncontrolled spread of that infectious disease in the community of Hong Kong. The endemic lasted for 6 months during which we have lots of casualties including our beloved comrades in health. At this moment, I wish all of us remember them in our heart and pay our highest respect to them in saving lives of mankind.

Collaboration with Dr. Ko Wing Man

Unforgettably, I worked with Dr. Ko Wing Man in close collaboration during that period of SARS setting up reporting networks and mechanism of news spreading about SARS and developing preparedness plans. It was the courage and faith in the rescue of mankind that our colleagues got high respect in the community at that time. Unfortunately one of our members, Dr. Lau, succumbed to the infectious agent. We felt sorry for his wife and family members.

New collaboration in DR incident

In 2012, we have the tragedy of 4 women in the DR incident resulting in one death. This time, it was not due to natural disaster but errors of mankind. The Government has set up the Steering Committee to look into matters of private healthcare facilities, including this one. On 10th December 2012, we have the first meeting of the Working Group I (WG I) under the Steering Committee chaired by our Director of Health. I volunteered to be a member of the WG I from the Steering Committee.

As announced in the press, members of the WG I include:

1. Members from Steering Committee;

2. Representatives from the medical specialties: Ė Dermatologists, Plastic Surgeons, and Ophthalmologists;

3. Representatives from the Beauty industry;

4. Representatives from the Consumer Council;

5. Representatives from the administration;

6. Plus one general practitioner practicing Aesthetic Medicine nominated by Hong Kong Doctors Union.

The total membership is around 20.

Terms of reference of the WG I are:-

1. to differentiate between medical treatments and ordinary beauty services currently available in the market;

2. to formulate guidelines on procedures which should be performed by registered medical practitioners.

The main issues for discussion are to agree on cosmetic procedures available in local beauty centres which:

(a) Might fall within the boundaries of medical practice, and

(b) Might pose safety concerns.

The task of the WG I would focus on the types of procedures lying borderline or in Grey Areas between medical and beauty practice, conventional cosmetic procedures and clearly surgical operations are excluded from the review. Further the review focuses on safety rather than efficacy of such procedures in attaining their non-medical claims.

The discussions took into account of the potential risks of the procedures as well as other jurisdictionsí regulation of cosmetic medical procedures. Members of the medical profession agreed on the following principles:-

1. All procedures that involve skin puncture to inject, deliver, implant, or anchor any substances or objects into the body; or to withdraw or remove blood/body fluids/ tissues should be regarded as medical procedures;

2. All procedures that involve the penetration of the body orifices to deliver substances into or remove substances from the body should be regarded as medical procedures;

3. All procedures that involve the external application of energy which is capable of causing severe or irreversible injury should be regarded as medical procedures;

4. All procedures that involve mechanical/chemical exfoliation of the skin below the level of epidermis should be regarded as medical procedures.

Furthermore, all practitioners should be well trained and adopt infection control measures when performing the procedures.

However, members of the beauty industry differed. They were not satisfied with the composition of the WG I with the majority of doctors. They were not happy without any representation in the Steering Committee that might rule to endanger their livelihood. All they believed was what they did and had been practicing like Intense pulsed light, Laser etc should not be considered as just medical procedures and should be status quote for them to practice. Natural procedures like Colon hydrotherapy and Hyperbaric oxygen therapy should be continued as cosmetic and health procedures.

Of course, the proposals from the beauty industry were not agreeable by members of the medical profession. We believed that these proposals can cause harm to human beings and are simply medical procedures.

As such, there were hit arguments from the two sides. At the end, there was not much progress and agreement on the above controversies. The Chairman of the WG just uttered out that there should not be any voting involved and all she would do was just reporting what was said in the WG I to the Steering Committee for final decision making.

In the course of discussion, the Government representatives proposed those traditional procedures with remote harm like ear piercing, and tattoo should be allowed in the beauty industry even though they were disallowed in the beauty industry in other jurisdictions. I disagreed as it would open up floodgate for other procedures, like laser therapy, claimed to be done by the beauty industry for years without harm or minimal harm being reported so far to claim exemptions.

I would stop at this for the moment and letís see how it goes in the coming New Year. Letís see how the Grey Areas be clarified by the Working Group/Steering Committee!

Wish you all a Happy New Year!

Dr. Yeung Chiu Fat Henry