Review into cosmetic industry safety due next week

A joint AHPRA and Medical Board of Australia (MBA) review of the cosmetic sector will be published next week, following another round of damaging publicity about the industry.
 
The review, which an AHPRA spokesperson told newsGP had been planned for release on 1 September even before the recent coverage, is looking at the regulatory role of AHPRA and the national boards, and ways in which to offer greater protection to the public.
 
Last Sunday, a 60 Minutes program aired, while a series of reports and an editorial have also been published in Nine Newspapers over the past week.
 
The newly reported cases include a retired soldier whose surgery for gynecomastia led to his nipple falling off, and who was reportedly sent to a local motel to recover despite complications and blood loss.
 
It also featured the ‘Brazilian butt lift’ operation of a 24-year-old woman who ended up in intensive care with septic shock.
 
GP and cosmetic doctor Dr Imaan Joshi told newsGP the recent coverage prompted ‘so many questions it boggles my mind’.
 
Among the queries is where the patients’ motivation to trust their doctors came from.
 
‘Was it their social media fame and hype or did they check qualifications or was it price?’ she said. 
 
The coverage again drew attention to the ‘largely unregulated’ aesthetic industry, she said – a situation Dr Joshi describes as ‘to the detriment of both the general public and our own safety’. 
 
‘It takes someone with some surgical experience to appreciate all the things that can go wrong, to prepare for them, recognise them and act appropriately – and what was shocking was how clearly these doctors did not recognise any of it,’ she said.

‘It’s not all fun and games when things go wrong and if I didn’t have my extensive surgical background and training as an obstetrics and gynaecology trainee and then skin cancer surgery, I’d not have the courage to do the work I do.
 
‘But Dunning-Kruger seems to be strong in the industry and many operate on the principle that the customer is always right and get what they want as long as they tick the right boxes.’
 
Dr Joshi again reiterated her disappointment at rogue doctors tainting the industry’s reputation, and wants to see stronger regulation, both of the surgical and non-surgical side of cosmetic procedures.
 
However, she believes there are question marks over whether the review conducted by AHPRA will provide the right solution.
 
‘They’re hounding GPs … but have no issues with MBBS or FRACGP doctors with minimal-to-no surgical training and questionable ethics [who] continue to practice,’ she said.
 
Dr Mukesh Haikerwal, a Melbourne GP and former AMA President, made a similar point, and has recently called for a royal commission into AHPRA.
 
While Prime Minister Anthony Albanese would not commit to royal commission into the industry, he did say the issues highlighted recently were ‘of real concern’.
 
The Minister for Health and Aged Care Mark Butler also expects the issue will be placed on the agenda of future meetings between state health ministers and the Federal Government.
 
Professor Allan Fels, the former Chair of the Australian Competition and Consumer Commission, and the National Mental Health Commission, was another to query AHPRA’s role.
 
‘AHPRA is ineffective in protecting the public from very dangerous practices in cosmetic surgery … that’s not good enough for a regulator where public health is at risk,’ he told Nine Newspapers.
 
Associate Professor Gabrielle Caswell, a GP in northern NSW as well as the President of the Australasian College of Aesthetic Medicine (ACAM), believes recent issues may have been exacerbated due to a certain mindset within the medical profession.
 
‘Culturally, we are quite conservative in medicine,’ she told newsGP.
 
‘That’s not a bad thing, but because of that cultural attitude, we haven’t really grasped the demand or the uptake.
 
‘Australia has a real issue melding the concepts of commercial medicine. There has been an issue managing direct-to-market medicine – that’s just something we have not handled well.’
 
She worries that recent coverage may have created ‘unnecessary sensationalism that may impact on people’s choices’.
 
‘As aesthetic medicine practitioners, it’s a very broad spectrum of what we actually treat,’ she said. ‘People always think of the worst examples of the “Kim Kardashian lips”.
 
‘Aesthetic medicine is at the end of our sun damage line – we have the highest rate of melanoma in the world and cosmetic medicine has a wonderful ability to treat sun-damaged skin.’
 
Accreditation is one way the industry can restore greater trust, Associate Professor Caswell believes, as is tighter regulation on the use of social media.
 
‘Without accreditation you can’t mandate standards, education and training,’ she said.

‘Social media has not helped the broader education that all these procedures come with a risk.
 
‘It is an adult choice, but adults do need to understand what they are getting themselves into and be properly consented.’
 
Associate Professor Caswell hopes a review will allow patients to find information more easily.
 
‘From a patient point of view, I would hope there are clear guidelines on how patients can evaluate individual qualifications,’ she said.
 
However, the line between effective regulation and over-reach is likely to be a delicate one.
 
‘I have a rural practice and we have to be extremely careful if we bring in different laws and legislation that they don’t stop valid medical procedures being accessed in rural areas,’ she said.
 
‘We have to be careful we don’t compromise valid services for vanity services.’
 
Associate Professor Caswell would also like to see more oversight when patients opt to have more significant operations to safeguard against misguided interventions for vulnerable patients.
 
She gives the example of someone with obesity and depression who might seek a procedure, such as liposuction, that may be against their best interests.
 
‘Patients should come with a GP or doctor referral,’ she said. ‘I think it’s always good touchstone for the bigger procedures.
 
‘Working as a team for the best outcome for the patient – that’s the model we should move to – as opposed to self-presentation.’
 
Whatever comes from the forthcoming review, the status quo is not an option, according to the ACAM President.
 
‘We need to counter these issues,’ she said. ‘Patients should be assured they can check qualifications, education, experience and understand there are differences between practitioners.

‘The demand is not going to go away.’
 
The RACGP’s submission to the AHPRA and MBA review can be read on the college’s website.

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