Replies to LegCo questions

LCQ11: Regulations on prescription of weight-loss drugs

        Following is a question by the Hon Fred Li and a written reply by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, in the Legislative Council today (March 3):

 

Question :

 

        It has been reported that some beauty/slimming centres employ registered medical practitioners so that they can provide customers with prescribed weight-loss drugs.  In this connection, will the Government inform this Council:

 

(a)    of the respective total numbers of complaints received by government departments and the Consumer Council in each of the past three years about the provision or prescription of weight-loss drugs by beauty/slimming centres and their doctors, together with breakdowns of the cases;

 

(b)    whether it knows if the World Health Organisation has issued any guidelines on the prescription of weight-loss drugs; if so, of the details of such guidelines;

 

(c)    whether the relevant authorities have issued regulations on the prescription of weight-loss drugs by registered medical practitioners; if so, of the details of such regulations; if not, how the Government and the Medical Council of Hong Kong (MCHK) prevent the abuse of weight-loss drugs; and

 

(d)    whether it knows if MCHK has assessed whether registered medical practitioners are in breach of the Professional Code and Conduct for the Guidance of Registered Medical Practitioners when they run businesses jointly with beauty/slimming centres or allow their names and titles to be published in advertisements or promotional materials of such centres; if MCHK has assessed this, of the results?

 

Reply :

 

(a)    In the three years between 2001 and 2003, the Government and the Consumer Council received a total of three complaints relating to the provision or prescription of weight-loss drugs by beauty/slimming centres and their doctors.  Of these three complaints which were all received in 2003, two were on inappropriate prescription by slimming centres or their doctors and one was on the side-effects of the drugs prescribed.  Meanwhile, the Medical Council of Hong Kong (MCHK) has not received any similar complaint over the past three years.

 

(b)    The World Health Organisation and its Western Pacific Regional Office (WPRO) have organised workshops on obesity prevention and control strategies.  It is considered that diet, exercise and behaviour modification are the mainstay for management of obesity. 

 

        In particular, WPRO issued a report entitled "Redefining Obesity and its Treatment" in February 2000.  The report contained detailed information on obesity, including its prevalence in the Asian Pacific region, definition of obesity, its diagnostic criteria in different ethnic groups, associated health risks, burden of diseases, economic costs to the community and individuals, prevention and treatment strategies, and current research areas about obesity.  Albeit not regarded as detailed guidelines on the prescription of weight-loss drugs by doctors, the report stated that drug treatment for obesity should only be used as an adjunct to diet and exercise for obese patients with special indications, and weight-loss drugs should not be recommended for children, pregnant and lactating women and patients who are concurrently taking certain kinds of antidepressants.

       

(c)    In Hong Kong, weight-loss drugs are controlled medicines and the majority of them have to be prescribed by a registered medical practitioner.  Under the Pharmacy and Poisons Ordinance (PPO) (Cap.138), all pharmaceutical products are required to be registered before sale.  The criteria for registration are based on efficacy, safety and quality of the product concerned.  In addition, the PPO requires that pharmaceutical products supplied by a registered medical practitioner for the purpose of medical treatment be distinctly labeled with the name and address of the doctor concerned, and particulars relating to the supply of such medicines be properly recorded.  Mechanism is also in place to allow the subsequent deletion or deregistration of any pharmaceutical product if there is a safety concern.  For instance, the Pharmacy and Poisons Board, being the statutory authority established under the PPO, deregistered two weight-loss drugs, fenfluramine and dexfenfluramine, in 1998 when they were found to be linked with valvular heart disease.

       

        Moreover, a few weight-loss drugs have further been classified as dangerous drugs under the Dangerous Drugs Ordinance (DDO) (Cap 134) and are subject to more stringent control because of their abuse potential.  Examples are the inclusion of phentermine in 1994, and amfepramone and cathine in 1999.  Whenever there is a new drug being classified under this category, letters will be issued to doctors to inform them of the ensuing legislative requirements.  It is a statutory requirement for doctors to keep full records regarding the receipt and supply of such drugs, and to keep all dangerous drugs in locked receptacles.

       

        Specifically with regard to prescription of pharmaceutical products by doctors, all registered medical practitioners are required to observe the Professional Code and Conduct (the Code) issued by the MCHK.  The Code provides that a registered medical practitioner has the responsibility to decide, after proper consultation, the proper medications with appropriate duration.  According to paragraph 11 of the Code, which governs the supply of dangerous drugs or scheduled drugs, doctors are advised to acquaint themselves with the Guidelines on the Proper Prescription and Dispensing of Dangerous Drugs issued by the MCHK, in addition to ensuring compliance with the PPO and the DDO.  Disciplinary proceedings will be taken against doctors found guilty of non-compliance with the relevant provisions of the Code.

 

(d)    Paragraphs 14 and 15 of the Code (copied at Annex) contain guidelines on the relationship between doctors and organisations providing medical or related services.  For instance, it is stipulated that a doctor who has any financial or professional relationship with such an organisation, or who uses its facilities, shall bear the responsibility to ensure the organisation's advertising conforms to the principles and rules set out in the Code.  It is further stated that if a doctor has financial or commercial interests in organisations providing health care services or in pharmaceutical or other biomedical companies, these must not affect the way he prescribes for, treats or refers patients.  Moreover, a doctor may not receive from, or offer to, another doctor or organisation any payment by way of commission, rebate or otherwise for referring a patient for consultation or treatment.

 

        Whether relationship between a doctor and a commercial organisation and its related promotion practice is in contravention of provisions in the Code can only be judged depending on the facts of individual cases.  Complaints against registered medical practitioners are dealt with by the MCHK in accordance with provisions of the Medical Registration Ordinance (Cap 161).  If a registered medical practitioner is found guilty of misconduct in a professional respect, the MCHK will exercise its disciplinary power under the Ordinance and take appropriate disciplinary actions.

 

Ends/Wednesday, March 3, 2004

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