00:09Hi, welcome back to Consider This. I'm Melissa Idris. Let's continue our discussion about the
00:15rapid rise of aesthetic medicine in Malaysia and across the region as treatments and procedures
00:22are becoming more accessible than ever. Are safeguards keeping pace? Joining me to discuss
00:28this further is Dr. Stephen Chow Kim-Weng, who is a Senior Consultant Dermatologist at Pantai Hospital,
00:34Kuala Lumpur. He's also the Secretary General of the Asian Academy of Dermatology and the founding
00:39President of the Asian League of Dermatological Societies. Dr. Stephen, thank you so much for
00:45being on the show with me today. The aesthetics medicine industry has really been booming these
00:50past few years. I'm just wondering whether you think the industry safeguards are keeping pace with
00:56such rapid expansion. Is there anything that concerns you in terms of some of the risks that
01:02you're seeing in the industry? Thank you, Melissa. Thank you to have me on this show. As far as
01:10the evidence goes, in Asia, the expansion of aesthetic medicine has outpaced the design or the ability
01:25to protect and to regulate the patient. Globally, that means in Asia itself. And this industry is growing
01:33rapidly, year upon year. You're talking about 10, 15, sometimes in some places, 20% growth.
01:41And this industry is also driven by social media, driven by medical tourism and commercial demands.
01:51Okay. However, training standards. Okay. Regulatory oversight, ethical frameworks have not evolved
02:03at the same speed. I think we are still very much 20, 30 years ago. Okay. What are the risks?
02:10The risks are
02:11actually three. Okay. Broadly, first is the scope creep. In scope creep, what you're seeing is increasingly
02:18invasive procedures. Okay. Performed by individuals, both doctors and also doctors and non-doctors
02:29who have inadequate training. Okay. And secondly, is the erosion of informed consent where the patients
02:39or in some situations are called clients, okay, are not counsel about the risks. Okay. And what are the alternatives
02:48or the danger of cumulative procedures? Third, of course, is things that you and I know about. This distorted advertising.
02:59Hmm. And this is often driven by influencers, marketing people, huh, and exaggerated claims of risk-free results. This is
03:11very extremely
03:13encouraging or tempting for the uninformed public. Okay. So individually, these are issues. They may seem very small in individual
03:24countries.
03:25But when you do it collectively over Asia, you're going to create an environment where the patient harm becomes increasingly
03:33likely. Right. Okay.
03:35And then what will happen? The public trust in the profession will, you know, and that's the danger. Okay.
03:44Okay. I do notice that some professional bodies are also pointing out that the training standards, the scopes of practice
03:52for aesthetics medicine varies widely.
03:57I'm curious, Dr. Stephen, why it is that we need to look at this beyond just Malaysia?
04:02Why do we need to look at it regionally and think about harmonizing or standardizing some of these training standards,
04:09some of the benchmarks for the standard of care and practice?
04:14You see, Asia is a great place for this business. Okay. It's very interconnected. It's so easy to get from
04:22China to Kuala Lumpur, from China to Taiwan, or Japan to Kuala Lumpur, and likewise from Kuala Lumpur to Taiwan,
04:30etc.
04:30Okay. And very often, this group of patients will travel across borders and for treatment.
04:38And when they are across borders, you are not sure of which practitioner you're working with. Okay.
04:46Because they work in different areas, different jurisdiction. Okay. Different standards are set. Okay.
04:53So, therein lies the importance of having harmonized training. Okay. That means, you should have a system where anywhere you
05:01go in Asia, you see a doctor for an aesthetic procedure, you can be assured that this doctor has got
05:09this standard, be in Korea, Japan, Taiwan, or Malaysia, Singapore, Indonesia. Okay. And that's important.
05:16And without harmonized standards, unsafe practices tend to migrate to the areas of weakest regulatory environment. That's natural. Okay.
05:28So, what sort of harmonized training standards are we talking about? Okay. Because in different countries, there are different levels
05:37of competency.
05:38But when you do a harmonized training, you have minimum, minimum competency benchmarks. For instance, okay, someone doing laser surgery
05:51should have so many hours of training. Okay.
05:53Would have done so many patients duly locked. Okay. And hopefully, except for an examination, be it national or international,
06:02that say, hey, this guy is safe. Okay.
06:05But you know that in Malaysia, in Asia itself, the jurisdiction, the laws, every country tends to protect this one.
06:12But in Southeast Asia, in fact, this is one of the best place to start thinking about harmonized training.
06:18Because we have done this since 2009. Okay. We have been trying to establish some form of harmonized training in
06:29clinical dermatology.
06:30Why Southeast Asia? Because in 2010, our governments in Southeast Asia have signed a mutual recognition agreement.
06:41Now, this is enforceable. This is already law. Okay. All right.
06:45Whereby someone trained in Malaysia, okay, recognized by Malaysian regulatory authority, should also be able to register and practice in
06:56Thailand, for instance, in Indonesia, and likewise the other way around.
06:59So that is already a legal, international legal framework, which professionals can work on too, and share this common training
07:11of minimum training competency. Okay.
07:14We hope this is materialized because otherwise it's just a concept. Yeah. Okay.
07:23So the ASEAN framework is the one that you should follow up. All right.
07:29Dr. Steven, so harmonization of the training standards is one area.
07:33Is there anything else that you think this industry could benefit from being improved?
07:39Dr. Steven, you see the industry involves the user. It also involves the equipment or the product that's been used.
07:48And that's where manufacturers and professional bodies must come together. Okay.
07:55And together, they can set the kind of benchmarks, okay, which each and every manufacturer and professional body can say,
08:03for our members, this is what they should go through.
08:06Dr. Steven, because patient safety or safety in the aesthetic procedures cannot rest solely in regulators. You see, in many
08:15countries like Singapore, for instance, like Malaysia, there are very strict rules.
08:19Yet, yet, every year you're getting countless number of cases of complaints. Some of them very serious, some leading to
08:29death. Okay. All right.
08:31And some done by people who are not trained, not even medically qualified. So it's not just regulators itself. The
08:39manufacturers themselves must be involved.
08:43Right. Does that mean that when they sell a device, they also need to make sure that practitioners know how
08:51to use a device? Is that what you're referring to?
08:53Dr. Steven, they must be trained. Okay. There must be a transparent sort of syllabus, which everyone can say, yeah,
09:00this is how it's done, you see. Okay.
09:02Dr. Steven, you're not just selling the equipment and say, hey, you come and hang around this place for a
09:07day or two, then they'll sell you the equipment. Okay.
09:10Dr. Steven, I understand. Right. So what would be your advice? So you talked a little bit about the, I
09:17guess, the erosion of informed consent was one area that you talked about. And the other was the misinformation that
09:22surrounds this industry and damages, I think, patient expectations for the results of the outcomes.
09:32Dr. Steven, what takeaway message do you have for our audience today, be it members of the public or even
09:38policymakers who may be involved in this industry? What would you like us to think about today and to maybe
09:46hopefully bear in mind or consider the next time we're thinking about an aesthetics procedure or even, you know, part
09:54of how we view the industry in general?
09:56Dr. Steven, the human nature is such, everyone wants to look good, both males and females, young and old. Okay.
10:05The part we cannot change. All right. All right. So there will always be some procedure or someone who can
10:12do some procedure legitimately, okay, in a safe sort of environment. Okay.
10:19Dr. Steven, okay. But there's an intersection between this and consumerism. Okay. And that's where the drift comes in. Okay.
10:29It's so easy to drift away. It is purely profit orientated. Okay. So for the industry to go for the
10:36safely, okay, sustainably, the patient safety must be the central principle.
10:44Dr. Steven, there's no two ways. There's no two ways about it. It must be based on that. And that
10:50means very clear professional boundaries. Okay. When you train credible training standards, not just come, I send you somewhere. Okay.
11:02All right.
11:02Dr. Steven, okay. And the society, the professional society must set very clear professional boundaries. Okay. And comes to advertising,
11:12marketing, there must be some responsibility. Okay. And that's where the regulators come in with regulatory oversight. Okay.
11:21Dr. Steven, okay. You see, you see, growth, professionalism, they're actually not in conflict. Okay. And having regulations, in fact,
11:30it's a way to sustain growth, not to suppress, not sustain, so that the industry can proceed.
11:38Dr. Steven, as far as the public is concerned, they must always refer back to their family doctor.
11:47Dr. Steven, once there's a moment that involves, okay, what we call infiltration or injection, okay, interventive procedures, they must
12:00definitely refer back to their family doctor for advice.
12:03Dr. Steven, as far as they say, we like all these people on TikTok.
12:08Yeah. So primary care is always the first line of defense, isn't it? Yeah.
12:16Dr. Steven Chow, thank you so much for being on the show with me today.
12:19That wraps up our conversation on Consider This. I'm Melissa Idris, signing off for the evening.
12:25Thank you so much for watching and good night.
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