Tuesday, May 5, 2009

STI: When pursuing beauty can be in vain

May 6, 2009


When pursuing beauty can be in vain

By Lee Wei Ling


THROUGHOUT history, humans have attempted to enhance their appearance. Archaeologists have unearthed ornaments of various types worn by ancient peoples. Today, though, the pursuit of beauty seems to have gone way beyond reason.


Most people feel that looking good will enhance their self-confidence and happiness as well as improve their social standing and career. One plastic surgeon has been quoted saying: 'Cosmetic surgery is no longer seen as an exercise in vanity. It is a valid means of self-improvement. Post-operation, the psychological effects in my patients have been largely positive - ranging from mild pleasure to (ecstasy).'


But there is another side to this alleged ecstasy. A 2004 study in the United States, comparing cosmetic-surgery patients with those undergoing general surgery, found that 19 per cent of the former had mental-health histories and 18 per cent were on psychiatric medications, compared to only 5 per cent of non-cosmetic patients.


There has recently been much discussion about aesthetic medicine in Singapore. Many doctors, both general practitioners (GPs) as well as specialists like dermatologists and plastic surgeons, have been trying to protect and enlarge their turfs. The layperson has been confused and not infrequently misled by promises - by word of mouth or dishonest advertisement - of having his or her appearance enhanced by various procedures.


A workgroup convened by the Ministry of Health (MOH) tried to introduce some common sense and safeguards into the area. It defined aesthetic practice as involving 'operations and other procedures that revise or change the appearance, colour, texture, structure, or position of bodily features, which most would consider otherwise to be within the broad range of 'normal' for that person'.


Aesthetic procedures were divided into two groups. Procedures on list A have good evidence of efficacy, with local medical experts agreeing that they are well-established and acceptable. Procedures on list B have little if any evidence of efficacy, with local medical experts agreeing that they are neither well-established nor acceptable.


Patients contemplating procedures under list A should ask themselves how they would benefit from the procedures. Even if there is evidence of efficacy, that does not mean the results of the procedure are guaranteed. Most procedures are costly and need to be repeated. Hence the doctors performing them are assured healthy profits.


Take, for instance, intense pulsed light, a powerful polychromatic light source that acts like a weak laser and is useful for removing superficial pigmentation, superficial telangiectasia (tangle of small blood vessels) and extremely mild superficial surface wrinkles. It is also used for hair removal.


The cost of the machine ranges from $20,000 to $180,000. The usual course of treatment is one session every four weeks for six months at a cost of $400-$500 per session. The procedure can involve the whole face and usually takes about 20 minutes. The treatment can cause severe burns if the machine is used improperly. In other words, even procedures on list A carry some adverse effects and most are very costly.


I would strongly discourage anyone from undergoing the procedures on list B. Because of a lack of evidence of efficacy, these procedures are to be conducted in the same way clinical trials are conducted. Only, they are not to be called 'clinical trials' so the patients can be charged - though the MOH workgroup urged that 'patients must not be charged highly profitable fees for such procedures of low evidence, but a fair fee representing the cost of the procedures plus the cost of providing and administering them'.


I have always been aesthetically challenged myself. But I have never thought it a major issue. I don't judge people by their physical appearance. And though I know some people do judge me by my physical appearance, they are not people who matter to me. So I find it difficult to empathise with otherwise healthy people, willing to part with large sums of money in the hope of 'improving' some feature of their body that was not harming their health in any way.


Moreover, the procedures that people are willing to submit themselves to often carry risks of adverse effects, especially if the person performing it is not adequately trained or if an accident occurs.


As for the doctors practising aesthetic medicine, while I cannot approve of all the years of their taxpayer-subsidised medical training being wasted on procedures that do not directly improve the health of patients, I can understand the temptation of easy money.


People are gullible; society puts psychological pressure on those who are aesthetically challenged; they turn to whoever sells hope. It is easy for doctors, especially a GP, to profit from this situation. Why sign up for the Primary Care Partnership Scheme (PCPS), which provides subsidies to Singaporeans aged 65 or above, with chronic diseases, to see their neighbourhood GP? One single session of intense pulsed light can bring in $400 to $500.


If the GP signs on with the PCPS, the extra he makes for taking care of an elderly patient with chronic illness is only slightly more than $360. Also, he will need to put in time for administrative work, including making computerised submissions of clinical data and claims.


None of us has a right to impose our values on others. Most people do care about their physical appearance. The fact that I do not is immaterial. Aesthetic medicine is an unstoppable tide and one would be swimming against extremely strong currents if one were to oppose it.


I can only appeal to doctors who are tempted by easy money to abide by their conscience. As for the layperson, I implore you to get full information on what you are submitting yourself to, and to know what risks you are taking in the hopes of correcting an aesthetic defect that is not affecting your health.


Nature did not intend all of us to look like Princess Diana or the latest Bollywood screen goddess. Humans tamper with nature at their own risk.


The writer is director of the National Neuroscience Institute. Think-Tank is a weekly column rotated among eight leading figures in Singapore's research and tertiary institutions.


The pursuit of beauty seems to have gone way beyond reason... Nature did not intend all of us to look like Princess Diana or the latest Bollywood screen goddess. Humans tamper with nature at their own risk.

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