Malaysian medical council's code of professional conduct & guidelines 1


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Medical professionalism and ethics of medical information dissemination, what is permitted and what is not. Grey areas abound but care must be taken to ensure that the physician does not run foul of the Code of Professional Conduct of the Malaysian Medical Council (MMC), although some of the restrictions may be modified and relaxed over the next few months. Advertising in discount sites are prohibited as this is usually tantamount to fee-splitting frowned upon by almost all medical boards. Gross infringement of these guidelines might lead to MMC sanctions which include suspension or removal of rights to practice. Different nation's medical boards have different constrictions of medical advertisement, some of these are compared with our own local MMC.

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Malaysian medical council's code of professional conduct & guidelines 1

  1. 1. Dissemination of Information By The Medical Profession: Is There A Need To Amend Our Current Regulations & Code Of Practice? Dr David KL Quek,KMN MBBS (Mal), MRCP (UK), FRCP (Lon), FAMM (Mal), FCCP (USA), FNHAM (Mal), FASCC (ASEAN), FAPSC (Asia Pacific) FACC (USA), FAFPM (Hon) Elected MMC Member 2004-2016 Senior Consultant Cardiologist, Pantai Hospital Kuala Lumpur Seminar on Vetting of Medicines Advertisement Dewan Serai Wangi, Bahagian Perkhidmatan Farmasi, Lot 36, JalanUniversiti, 46350 Petaling Jaya, Selangor. 29 October 2013
  2. 2. THE CODE OF PROFESSIONAL CONDUCT AND GUIDELINES In RELATION TO THE MEDICAL ACT    The practice of Medicine is an ancient profession and the community has great expectations of its practitioners and places great trust in them. Without this trust it would be impossible to practise medicine and the profession expects a high standard of professional and personal conduct from its members. These are embodied in various Codes of Ethics, which vary in detail from country to country, but all place first and foremost the health and welfare of the individual and the family under the care of a practitioner.
  3. 3. THE CODE OF PROFESSIONAL CONDUCT AND GUIDELINES In RELATION TO THE MEDICAL ACT  The Medical Act 2012 is the legislation relating to the registration and practice of medical practitioners and the Medical Regulations to the Act empower it, to deal with all disciplinary matters involving registered medical practitioners.  The Code of Professional Conduct of the Malaysian Medical Council provides the yardstick for the conduct and behaviour of registered medical practitioners in their clinical practice and in all areas of professional activity.
  4. 4. 4. ADVERTISING, INFORMATION AND RELATED PROFESSIONAL MATTERS The medical profession has long accepted the convention that medical practitioners should refrain from selfadvertisement.  In the Council‟s opinion self-advertisement is not only incompatible with the principles which should govern relations between members of a profession but could be a source of danger to the public.  A practitioner successful at achieving publicity may not be the most appropriate doctor for a patient to consult.  Patients who are suffering from a serious illness are extremely vulnerable and advertising may raise illusory hopes of cure. 
  5. 5. 4.1 Advertising and Information   4.1.1 Advertising, whether directly or indirectly, for the purpose of  obtaining patients, or  promoting the practitioner‟s own professional advantage, or  to gain advantage over market competition, or,  for any such purpose, of procuring or sanctioning, or  acquiescing in, the publication of notices commending or directing attention to the practitioner‟s professional skill, knowledge, services, or qualifications, or  deprecating those of others, or
  6. 6. 4.1 Advertising and Information 4.1.1 Advertising, whether directly or indirectly, for the purpose of  obtaining patients,  of being associated with, or employed by, those who procure or sanction such advertising or publication, and canvassing, or employing any agent, or tout, or canvasser, for the purpose of obtaining patients, in any manner, channel or media; or  of sanctioning, or of being associated with or employed by those who sanction, or being a party to, abetting or condoning such employment e.g. by private hospitals, clinics and other medical institutions,  are in the opinion of the Council, contrary to the public interest and discreditable to the profession of Medicine.  Any registered medical practitioner who resorts to any such practice may be considered to have committed serious professional misconduct.  
  7. 7. 4.1 Advertising and Information    4.1.2 Providing Information in relation to the medical profession, is the act by which a healthcare provider disseminates factual information to the public generally on health promotion and specifically on diseases, their prevention, control and treatment, and on any other aspects related to these modalities, without the medical practitioner contravening the ethical codes of professional conduct, or without any designs to obtaining patients, profiting financially or, appearing directly or indirectly, to promoting his own professional advantage or product, or appearing to be for these purposes.
  8. 8. 4.1 Advertising and Information    4.1.3 The Council recognises that the profession has a duty to disseminate information about advances in medical sciences and therapeutics provided it is done in an ethical manner. Exceptions are when the information is of a confidential nature, or when it may be conceived to cause public panic or to affect national security.
  9. 9. 4.1 Advertising and Information      4.1.4 A medical practitioners should not claim to be the best or the only one in a particular field of practice or specialty. There are really no effective methods of determining whether a practitioner can claim to be so. Claims of „firsts‟ or „breakthroughs‟, although of considerable public interest, are also contentious. These types of announcements should not be made by the practitioner involved. It is best left to the academic and professional bodies and officers so authorised to verify such claims and make appropriate public announcements
  10. 10. 4.1 Advertising and Information  4.1.5 A practitioner should avoid discussions in the lay press on controversial points of medical science, or any new procedures and treatment. Such matters are more appropriate to medical journals and for discussion in professional societies.  4.1.6 A practitioner providing medical information in any media, including the electronic media, should adhere strictly to established codes of conduct. Frequent appearances by the same practitioner on the media, is discouraged as these raise the suspicion that the practitioner is seeking publicity for personal benefit. 
  11. 11. 4.1 Advertising and Information and Health Tourism  4.2 The Practitioner    Practitioners working in healthcare facilities which are accredited to participate in health tourism, which may necessitate the canvassing for patients in foreign countries, may, under special circumstances, and after approval from regulatory bodies in the Ministry of Health, will be allowed to provide information in brochures regarding their qualifications, experience and expertise in special procedures. Such brochures should only be distributed in foreign countries. Practitioners in such practice are still subject to the Medical Act, the Code of Professional Conduct and other related and relevant regulations when managing foreign patients in Malaysia.
  12. 12. 4.1 Advertising and Information 4.3 Announcement in the Lay Press Regarding Practice  An announcement by the Malaysian Medical Association (MMA), or any other recognized and approved professional body, on the commencement or change of address of practice is permissible as a service to the community. 
  13. 13. 4.1 Advertising and Information      4.4 Articles, Contributions and Books for the Lay Public 4.4.1 It is permissible for the practitioner‟s name to be published in articles, contributions and books for the lay public. The name can be followed by a brief description of qualifications and primary place of practice. These should not be unduly emphasised by large or heavy type 4.4.2 There must not be any laudatory editorial references to the practitioner‟s professional status or experience. 4.4.3 Where the publication has arisen as a result of research on any instrument or drug provided by a commercial firm, this should be stated and a disclaimer regarding any financial interest of the author(s) with the firm be inserted. 4.4.4 Photograph of the practitioner in connection with articles or contributions in the media are allowed. Photographs and testimonials of patients are not allowed.
  14. 14. 4.1 Advertising and Information      4.5 Lectures to Lay Public 4.5.1 A practitioner who proposes to deliver a lecture should request the chairman beforehand to be circumspect in any introductory remarks concerning his professional status or achievements. 4.5.2 Publicity about the lecture can be in any media to inform the public of the name and appointment of the practitioner as well as the venue, date and time of the lecture. The place of practice of the practitioner should not be published.
  15. 15. 4.1 Advertising and Informationto Colleagues  4.6 Lectures 4.6.1 A medical practitioner may be in a position to educate colleagues, or present some new method of treatment or innovation. Such talks must be organised only through professional bodies or hospitals and not through pharmaceutical or equipment firms. The practitioner must exercise caution when promoting a particular drug or product and should declare to the audience the practitioner‟s interest in the drug or product.  4.6.2 Information about such talks may be circulated through the professional bodies or hospitals only.  4.6.3 The practitioner must caution against any media reporting any unproven modalities of management or treatment such that it appears that the practitioner advocates such treatment to the public. 
  16. 16. 4.1 Advertising and Information  4.7 Press Interviews  4.7.1 Medical practitioners engaged in active medical or surgical practice should avoid giving interviews expounding their personal opinions on diseases and their treatment to reporters of the print, electronic or airwave media, except through an Association, an authorisedorganisation or institution. (Amended at MMC Meeting on 10/5/2005)  4.7.2 The medical practitioner in charge of the authorisedorganisation assumes full responsibility for any practitioner giving the interview and acting under its auspices.
  17. 17. 4.1 Advertising and Information     4.8 Professional Calling Cards, Letterheads and Rubber Stamps A practitioner may carry calling cards but should not distribute calling cards with the purpose of soliciting for patients. The calling cards/letterheads should only contain the name of the practitioner, registrable and accredited professional qualifications, designation, state and national awards, home, practice as well as e-mail address, telephone and facsimile numbers. Logos may be printed as long as they are appropriate for a medical practitioner. A recent photograph of the practitioner (passport size) may be allowed only on the calling card.
  18. 18. 4.1 Advertising and Information Calling Cards, Letterheads and  4.8 Professional Rubber Stamps  Medical etiquette demands that medical practitioners be circumspect about their qualifications, awards and honours. It is permissible to list all registered and accredited qualifications acquired by examinations or following an appropriate period of supervised training.  Practitioners must not print awards and honours awarded by bodies other than the national and state governments.  A medical practitioner may claim to practice as a specialist in two closely related specialties, but this information must be available on only the one and the same calling card.
  19. 19. 4.1 Advertising and Information  4.9 Signboards    A signboard should serve to provide guidance and information about a clinic. It should not be viewed as a means of soliciting for patients. The use of a large signboard to indicate a medical practice is considered unethical in many parts of the world. However as the custom is already prevalent in Malaysia and as a signboard does help patients to find a doctor, it is recommended that their use should continue, provided: 4.9.1 There shall not be more than two signboards on the premises of the clinic to indicate the identity of the practice. 4.9.2 Signboards may be illuminated in a style that is appropriate for a medical practice.
  20. 20. 4.1 Advertising and Information      4.9 Signboards 4.9.3 The total size of the signboard or signboards, if there are two shall not exceed 3.0 sq. meters. 4.9.4 Where signs are painted on walls, the perimeter of the lettering shall not enclose an area in excess of those specified above. 4.9.5 When the practice is within a commercial complex, there is no objection to the clinic name appearing in the general directory signboard in the lobby. 4.9.6 The use of the Red Crescent/Red Cross emblems on any private medical premise is not allowed.
  21. 21. 4.1 Advertising and Information  4.10  The use of directional signboard/s, with the word “Clinic” and an arrow pointing in the direction of the clinic leading from the main road, is permissible. The name of the clinic must not appear in such a directional signboard, which should be within 1 km on the main road before turning to the clinic. Only two such directional signboards are allowed, one each from each direction on the main road.   Directional Signboards
  22. 22. 4.1 Advertising and Information      4.11 Name Plates/Doorplates The name plates and door plates displayed outside a practice, should be plain and not exceed 1,000 sq cm. They may bear the practitioner‟s name, his registrable qualifications, and titles, if any. The consultation hours should be indicated on the same name plate. If there is more than one practitioner working in the same clinic, separate name plates will be permitted for each practitioner and the above rules will also apply. Visiting practitioners may have a name plate. Only those practitioners working in the clinic are allowed name plates.
  23. 23. 4.1 Advertising and Information 4.12 24 Hour Clinic  Notification of the availability of 24-hour professional service should be on the door plate pertaining to consultation hours.  A registered medical practitioner should be available at all times in the 24-Hour Clinic.  In the event that an emergency arises that requires the practitioner to be called away, the practitioner should instruct the clinic nurse to do the following:  (1) to inform patients turning up that the practitioner is away on emergency duty and is not available,  (2) not to accept any new patients until the practitioner is back in the clinic, and  (3) arrange for the patient to go to the nearest clinic for treatment where there is any degree of urgency. 
  24. 24. 4.1 Advertising and Information  4.13  A temporary banner to announce the opening of a new healthcare facility may be allowed for the purpose of public information. The size should conform to that allowed for a signboard. It should not be displayed for a period longer than one (1) calendar month prior to the date of opening. The banner is only permitted to be displayed at the entrance to the premise. It should only contain the date of the opening and the name of the clinic or hospital. Any other information is unethical.    Banners:
  25. 25. July 31, 2012
  26. 26. MOH, Singapore Medical Board
  27. 27. Are Corporate bodies (GLCs) and public institutions exempt from our advertising regulations and code of conduct? Is it One rule for some and another for others? Is there a Level Playing field? What about the profesisonal ethical concerns?
  29. 29. When does business entrepreneurship begin and medical professionalism end, or should it? Can a medical doctor become a named product of business?
  30. 30. Claims of beauty or herbal health products as ‘best’, ‘effective’ targetted at the public, from a Doctor… Online sales of health products linked to doctor…
  31. 31. Use of testimonials from famous people, newspaper advertorials, news with photos of patients, laudatory commentaries….
  32. 32. Where’re the internet boundaries? Facebook friendly info from a CEO of e.g. UMSC… Actual targetted advertisement, with related newspaper article…
  33. 33. Today’s Deal → All Groupon Healthcare offers have an approved KKLIU number by the Medicine Advertisement Board, Ministry of Health Malaysia Is this sort of advertisement allowed, or consistent with the times of medical information? Is there implied discount when people respond to these early or within a time frame given, as is wellknown with Groupon discounts?
  34. 34. Because Groupon‟s modus operandi or core practice methods are based on profit sharing usually as much as 50% or more, this is construed as FEE SPLITTING and therefore is UNETHICAL. No health advertisement can use such a method of medical information dissemination. Doctors who associate themselves with such practices are deemed to be carrying out unethical practices and therefore may be found to have breached the Code of Professional Conduct of the Malaysian Medical Council and may be sanctioned if found guilty!
  35. 35. Health care and health tourism as a dollar earner NKEA for MALAYSIA, says YB Health Minister Dato‟ Sri Liow
  36. 36. The Medical Board of Australia Guidelines for Advertising of regulated health services is one of the most comprehensive document available…
  37. 37. „Extract of relevant provisions from the Health Practitioner Regulation National Law Act 2009 (Qld)‟.  In particular, s. 133 of the Australian National Law states that a person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that  (a) is false, misleading or deceptive or is likely to be misleading or deceptive; or  (b) offers a gift, discount, or other inducement to attract a person to use the service or the business, unless the advertisement also sets out the terms and conditions of the offer; or  (c) uses testimonials or purported testimonials about the service or business; or  (d) creates an unreasonable expectation of beneficial treatment; or  (e) directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services.
  38. 38. What is acceptable advertising? Advertising used to inform the public of the availability of regulated health services may be considered to comply with these guidelines if it is information published in the public interest, and is factual, honest, accurate, clear, verifiable and not misleading.  Examples of the type of advertising of services that the boards consider to be acceptable. 
  39. 39. What is acceptable advertising? Advertising may contain:      (a) a factual and clear statement of the service(s) and/or any product(s) offered (b) contact details of the office of the practitioner, including email or website addresses, and telephone numbers (c) the gender of practitioners (d) a statement of office hours regularly maintained by the practitioner and the availability of after-hours services (e) for any surgical and/or invasive procedures, the appropriate warning statement in a clearly visible position
  40. 40. What is acceptable advertising? Advertising may contain:      (f) non-enhanced photos or drawings of the practitioner or his or her office (g) advice on the availability of wheelchair access to any premises to which the advertisements relate (h) a statement of any language(s) other than English fluently spoken by the practitioner or another person in his or her office (this does not affect other guidance provided by the national board about use of qualified interpreters where appropriate) (i) a statement about fees charged, bulk-billing arrangements, or other insurance plan arrangements and instalment fee plans regularly accepted (j) a statement of the names of schools and training programs from which the practitioner has graduated and the qualifications received, subject to Section 6.4, „Advertising of qualifications and titles‟
  41. 41. What is acceptable advertising? Advertising may contain:  (k) reference to any practitioners who hold specialist registration or endorsement under the National Law and their area of specialty or endorsement  (l) a statement of the teaching positions currently or formerly held by the practitioner in board-approved or accredited institutions, together with relevant dates  (m) a statement of the accreditation or certification of the practitioner with a public board or agency, including any affiliations with hospitals or clinics  (n) a statement of safety and quality accreditation of the practice or health care setting  (o) a list of the practitioner‟s peer reviewed publications  (p) any statement providing public health information encouraging preventative or corrective care (public health information should also be evidence based wherever possible).
  42. 42. Public Announcement of Research Discoveries      In this era of rapid communication, intense media and public interest in medical news, clinical investigators or their institutions commonly make public announcements of new research developments. Because media coverage of scientific developments can be fraught with misinterpretation, unjustified extrapolation, and unwarranted conclusions, researchers should approach public pronouncements with extreme caution, using precise and measured language. Press or media releases should be issued & press conferences held only after research has been published or presented in proper and complete form so that study details are available to the scientific community for evaluation. Statements of scientists receive great visibility. An announcement of preliminary results, even couched in the most careful terms, is frequently reported by the media as a “breakthrough.” Spokespersons must avoid raising false public expectations or providing misleading information, both of which reduce the credibility of the scientific community as a whole.
  43. 43. What is unacceptable advertising? Advertising Services must not:  (a) create or be likely to create unwarranted and unrealistic expectations about the effectiveness of the health services advertised  (b) encourage (directly or indirectly) inappropriate, indiscriminate, unnecessary or excessive use of health services; for example, references to a person improving their physical appearance and the use of phrases such as „don‟t delay‟, „achieve the look you want‟ and „looking better and feeling more confident‟ have the potential to create unrealistic expectations about the effectiveness of certain services and encourage unnecessary use of such services  (c) mislead, either directly, or by implication, use of emphasis, comparison, contrast or omission  (d) use testimonials or purported testimonials
  44. 44. What is unacceptable advertising? Advertising Services must not:      (e) compare different regulated health professions where there is no evidence on which to base the comparison and/or in a way that may mislead or deceive (f) claim that the services provided by a particular regulated health profession are better, as safe as or safer than others (g) refer to the recovery time following provision of a regulated health service that may lead to unrealistic expectations (h) lead to, or be likely to lead to, inappropriate selfdiagnosis or self-treatment (i) abuse the trust or exploit a lack of knowledge by patients or clients
  45. 45. What is unacceptable advertising? Advertising Services must not:      (j) fail to disclose that there are health risks associated with a treatment (k) omit the necessary warning statement (see Section 6.2, „Use of warning statements for surgical or invasive procedures‟) (l) contain language that could cause undue fear or distress (m) contain any information or material that is likely to make a person believe his or her health or wellbeing may suffer from not taking or undertaking the health service (n) contain price information that is inexact, or fails to specify any conditions or variables to an advertised price (see Section 6.5, „Advertising of price information‟), or offers time-limited discounts or inducements
  46. 46. What is unacceptable advertising? Advertising Services must not:  (o) contain any claim, statement or implication that  either expressly, or by omission, that the treatment is infallible, unfailing, magical, miraculous or a certain, guaranteed or sure cure  a practitioner has an exclusive or unique skill or remedy, or that a product is „exclusive‟ or contains a „secret ingredient‟  a practitioner provides superior services to those provided by other registered health practitioners  the results of the health service offered are always effective  the services can be a substitute for public health vaccination or immunisation
  47. 47. What is unacceptable advertising? Advertising Services must not: (p) purport to inform the public fully of the risks of undertaking a health procedure or to replace the process of informed consent  (q) provide a patient or client with an unsolicited appointment time that has not been requested by the patient or client  (r) promote tobacco products, smoking, alcohol, or any other addictive substances or products that are known to affect health adversely  (s) be vulgar, sensational, contrary to accepted standards of propriety or likely to bring a health profession into disrepute, for example, because the advertising is sexist. 
  48. 48. Use of graphic or visual representations    Practitioners should use any graphic or visual representations in health service advertising with caution. This includes photographs of patients, clients or models, diagrams, cartoons or other images. A „photograph‟ in relation to the advertised treatment includes images, graphic, or other visual representations or facsimiles. Practitioners should not use photographs of actual patients or clients if the patient or client is vulnerable as a result of the type of treatment involved or if their ability to consent may be otherwise impaired.
  49. 49. Use of graphic or visual representations Use of „before and after‟ photographs in advertising of regulated health services has a significant potential to be misleading or deceptive, to convey to a member of the public inappropriately high expectations of a successful outcome and to encourage the unnecessary use of health services.  If „before and after‟ photographs are used, care must be taken to ensure:   providing images that are as similar as possible in content,     camera angle, background, framing and exposure ensuring consistency in posture, clothing and make up ensuring consistency in lighting and contrast stating if photographs have been altered in any way confirming that the referenced procedure is the only visible change that has occurred for the person being photographed.
  50. 50. Use of warning statements for surgical or invasive procedures Where a surgical (or „an invasive‟) procedure is advertised directly to the public, the advertisement should include a clearly visible warning, with text along the following lines:  ‘Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.’ 
  51. 51. Use of comparative advertising It is difficult to include all required information to avoid a false or inaccurate comparison when comparing one health service or product with another.  Therefore, comparative advertising is at risk of misleading the public.  If practitioners use any form of comparative advertising, practitioners must not:  make unsubstantiated claims, or  deride or otherwise criticise the services or products offered by another practitioner, or  make sensational statements that cannot be corroborated. 
  52. 52. Advertising of qualifications and titles  A practitioner should state clearly his or her professional qualifications. Credentials and a practitioner‟s expertise in a particular field should be clear to the public. Use of titles in advertising  Section 117 of the National Law prohibits a practitioner from knowingly or recklessly taking or using any title that could be reasonably understood to induce a belief that the practitioner is registered in a health profession or a division of a health profession in which the practitioner is not registered.  Section 116 of the National Law prohibits a person who is not a practitioner from knowingly or recklessly taking or using a title that, having regard to the circumstances, indicates or could be reasonably understood to indicate the person is a registered health practitioner, or authorised or qualified to practise in a health profession.  Practitioners should avoid developing abbreviations of protected titles as these may be confusing.  There is no provision in the National Law that prohibits a practitioner from using titles such as „doctor‟ or  „professor‟.
  53. 53. Advertising of qualifications and titles Advertising of specialties and endorsements  Section 116 of the National Law prohibits an unregistered person from claiming to be registered under the National Law or holding himself or herself out as being registered under the National Law in any of the regulated health professions.  Section 115 of the National Law prohibits a person from knowingly or recklessly taking or using a specialist title for a recognised specialty unless the person is registered under the National Law in the specialty.  Section 118 of the National Law prohibits a person who is not a specialist health practitioner from taking or using a title, name, initial, symbol, word or description that, having regard to the circumstances indicates, or could be reasonably understood to indicate, that the person is a specialist health practitioner or is authorised or qualified to practise in a recognised specialty.  Section 119 of the National Law prohibits a registered health practitioner from claiming:  to hold a type of registration, or endorsement of registration that they do not hold, or  to be qualified to hold an endorsement they do not hold.
  54. 54. Advertising of qualifications and titles Practitioners are encouraged to ask themselves the following questions:      Why do I wish to use this title, qualification, membership, words or letters in advertising material? Am I well qualified in the areas of practice that I offer and promote with these words? Is the basis for my use of title, qualification, membership, or other words or letters  >> relevant to my area of health practice?  >> current?  >> verifiable?  >> credible? if I display or promote my qualifications in advertising materials, is it easy to understand? Is there any risk of people misunderstanding or misinterpreting the words, letters or titles that I use?
  55. 55. Advertising of price information   Information in advertising of regulated health services about the price of procedures must be clear and not misleading. Practitioners or other persons who advertise services:  must not use phrases like „as low as‟ or „lowest prices‟, or similar words or phrases when advertising fees for services, prices for products or price information, or stating an installment amount without stating the total cost should not compensate or give anything of value to a representative of the press, radio, television or other communication medium for professional publicity unless the fact of compensation is made known publicly  must not advertise time-limited and special offers.
  56. 56. Use of gifts or discounts in advertising The use of gifts or discounts in advertising is inappropriate, due to the potential for such inducements to encourage the unnecessary use of regulated health services.  If a practitioner or a person advertising a regulated health service does use a discount, gift or any other inducement to attract patients or clients to a service, the offer must be truthful, and the terms and conditions of that offer must be set out clearly in the advertisement.  Discounts, gifts or other inducements must not be used in advertising of medicines that have potential for abuse or misuse due to the greater potential for harm.  In relation to other medicines and therapeutic goods, the boards strongly discourage the use of prizes, bonuses, bulk purchases or other endorsements that may encourage the unnecessary consumption of medicines or other therapeutic goods. 
  57. 57. Use of scientific information in advertising   Urge caution when using scientific information in advertising of regulated health services. When a practitioner chooses to use scientific information in advertising, it should:  be presented in a manner that is accurate, balanced and not misleading  use terminology that is understood readily by the audience to whom it is directed  identify clearly the relevant researchers, sponsors and the academic publication in which the results appear  be from a reputable and verifiable source.
  58. 58. Advertising of therapeutic goods      Under the Therapeutic Goods Advertising Code 2007: • there are general prohibitions on advertisements for therapeutic products that  >> appeal to fear  >> are misleading  >> raise unrealistic expectation on claims to efficacy  >> claim to have miraculous properties, etc • advertising must not be directed to minors, with certain exceptions (e.g. sunscreen and condoms) • representations about abortifacient action, neoplastic disease (except in relation to the use of sunscreens), sexually transmitted diseases (except in relation to contraceptive devices), HIV/AIDS or mental illness are prohibited • approval must be obtained from the Therapeutic Goods Administration to advertise therapeutic goods for „serious diseases‟ that are listed in the Code.
  59. 59. Advertising of therapeutic goods Advertisements must contain:  • the trade name of the product  • a reference to its permitted indications only  • (where applicable) a list of the ingredients  • the following statements prominently displayed  >> always read the label  >> use only as directed  >> if symptoms persist, see your doctor/health care professional. Advertising of scheduled medicines  Almost all State and Territory drugs and poisons laws prohibit the advertising to the public of substances in Schedule 4 (prescription only medicines), Schedule 8 (controlled drugs) and Schedule 9 (prohibited substances) of the current Poisons Standard (the Standard for Uniform Scheduling of Drugs and Poisons).
  60. 60. Consequences of breach of advertising requirements Remind all practitioners of their legal and ethical responsibilities in providing the public with clear and accurate information about the availability of health services.  Practitioners are reminded that members of the public have limited understanding of many aspects of these services and thus vulnerable.  An advertisement is deemed misleading, when it creates an unreasonable expectation of beneficial treatment, or encourages (directly or indirectly) the indiscriminate or unnecessary use of regulated health services or medicines,  Most medical boards consider the overall impression of advertisement and likely impact the advertisement have on a member of the public. 
  61. 61. Consequences of breach of advertising requirements Specifically, a national board will consider what conclusions the public can reasonably infer from material contained within an advertisement and if the material is likely to mislead or deceive, (in)directly or by omission.  Qualifiers or disclaimers should be displayed obviously rather than contained in fine print.  National boards cannot give legal advice or opinion, and cannot „vet‟ or pre-approve advertisements for compliance with these guidelines.  If a person is in doubt about whether his or her advertisement might be in breach of the Law, that person should seek his or her own advice (e.g. from professional indemnity insurers or lawyers) before placing the advertisement (In Malaysia, this will be the LembagaIklanUbat [LIU], or Medical Advertisement Board) 
  62. 62. Failure to adhere to the guidelines Failure to adhere to the guidelines may be investigated by a national board (either in response to a notification or on its own motion).  A breach of the guidelines may constitute unprofessional conduct and/or professional misconduct, and as such, may be dealt with by the boards through the disciplinary mechanisms available under the National Law. 
  63. 63. Failure to adhere to the guidelines  When a practitioner is found to have engaged in unprofessional conduct and/or professional misconduct in relation to advertising of regulated health services, the determinations that may include, but are not limited to, one or more of the following:  • requiring the practitioner to undergo counselling  • cautioning the practitioner  • reprimanding the practitioner  • requiring the practitioner to undertake further education  • imposing conditions on the registration of the practitioner (e.g. requiring the practitioner to publish a retraction or correction)  • imposing a fine on the practitioner  • suspending or cancelling the practitioner’s registration.
  64. 64. ADVERTISING OF MEDICAL SERVICES  Provision of information about doctors and the services they provide is recognised as being of value to the public. For example, patients need information when choosing a general practitioner and deciding how best to utilise their services.  General practitioners need information on specialists to provide proper advice to patients and make appropriate medical referrals.  On the other hand, both patients and doctors can be particularly susceptible to persuasive influence and are entitled to appropriate protection from misleading or false advertisements.
  65. 65. ADVERTISING OF MEDICAL SERVICES  Australian competition law prohibits professional organisations from restraining advertising such that is likely to lessen competition. It also prohibits advertising that is false, misleading or deceptive or that which is likely to mislead or deceive.  The AMA does not condone advertising that tends to bring the profession into disrepute.  This stand is supported by some State and Territory laws and local Medical Boards that place restrictions on advertising that compromises the dignity or decorum of the profession.
  66. 66. The Australian Medical Association position The AMA Code of Ethics (2004) (revised November 2006) (at 2.2) sets out the standards of ethical advertising expected of medical practitioners 1. Confine advertising to the presentation of information reasonably needed by patients or colleagues to make an informed decision about medical services, 2. Ensure the advertisement is demonstrably true in all respects and 3. Ensure that it should not bring the profession into disrepute. 4. It also directs that there should be no endorsement of therapeutic goods contrary to the Therapeutic GoodsAdvertising Code, and recommends caution in endorsing any commercial product not covered by that code. Further information is available at the AMA website (
  67. 67. Medical Boards Guidelines…    The Medical Board of South Australia has published guidelines for the advertising of medical services. The guidelines specify:  The appointment of a registered medical practitioner who is to be responsible for the advertising of medical services  The appointment is to be notified to the Board  The notified medical practitioner is to be responsible for any breach of the advertising guidelines Electronic advertising (television, radio, internet etc.) is not permitted unless the advertisement includes a good health or preventable health message and the advertisement does not imply that the medical services provider is the only provider of the medical service
  68. 68.    Physicians who use online media, such as social networks, blogs, and video sites, should be aware of the potential to blur social and professional boundaries. They therefore must be careful to extend standards for maintaining professional relationships and confidentiality from the clinic to the online setting. Physicians must remain cognizant of the privacy settings for secure messaging and recording of patient– physician interactions as well as online networks and media and should maintain a professional demeanor in accounts that could be viewed by patients or the public.
  69. 69. Medical Boards Guidelines…    Acceptable content for advertising includes the name, qualifications, contact details, practice hours, availability of after-hours services, languages spoken, billing method, wheelchair access and specialist qualifications and fields of practice (as recognised by the Board) Unacceptable content includes anything which is false, misleading, deceptive, vulgar or sensational, includes claims of superiority or criticism of other doctors, contains testimonials, includes the use of identifiable patients or which might be likely to bring the profession into disrepute Records of advertising are required to be kept for three years.
  70. 70. Generally speaking, advertising is permitted, provided: It is not misleading or deceptive  It is true and verifiable  It does not create an unjustified expectation of beneficial treatment  It does not use testimonials from patients  It does not involve claims of superiority or criticism of other colleagues  It does not promote unnecessary and inappropriate use of medical services.  In October 2008, the Medical Practitioner Board of Victoria published extensive guidelines for advertising. These are available at
  71. 71. Principles of Prudent Resource Allocation: 1. As a physician performs his or her primary role as a patient‟s trusted advocate, he or she has a responsibility to use all health-related resources in a technically appropriate and efficient manner. 2. He or she should plan work-ups carefully and avoid unnecessary testing, medications, surgery, and consultations. 3. Resource allocation decisions are most appropriately made at the policy level rather than entirely in the context of an individual patient–physician encounter. Ethical allocation policy is best achieved when all affected parties discuss what resources exist, to what extent they are limited, what costs attach to various benefits, and how to equitably balance all these factors. 4. Physicians, patient advocates, insurers, and payers should participate together in decisions at the policy level; should emphasize the value of health to society; should promote justice in the health care system; and should base allocations on medical need, efficacy, cost-effectiveness, and proper distribution of benefits and burdens in society.
  72. 72. “Medicine, law and social values are not static…”
  73. 73. Definition of medical profession
  74. 74. “Medicine, law and social values are not static…” Should we not seriously consider amending our advertising (medical information dissemination), our code of conduct and regulations to address these changes in perceptions and social values of this day and age?
  75. 75. Thank You…