April 4, 2002

     Let me start this week's senseless talk with a very, very touchy subject - show-business. I think I got one reader from New Jersey excited already.

     My wife was surfing through cable channels one Sunday afternoon when she called my attention if I'd be interested in a guest of a TV talk show. Being in another room, I asked her which show and she answered, The Buzz. Why not, I thought. A pretty actress in mini-skirt talking enthusiastically in an incoherently and meaninglessly repetitious manner is not a bad idea. The mini-skirt may be more than worth it.

     The Buzz is a showbiz-oriented talk show on ABS-CBN hosted by a balding, bespectacled motor-mouth named Boy Abunda and Kris Aquino, the ex-presidential daughter who once got impregnated by one Phillip Salvador who, incidentally, is a brother-in-law of a College of Medicine alumnus (I don't know what's wrong with me today but I thought I'd mention it). My wife realizes that I puke at the sight of Ms. Aquino so this guest better be good.

     Disappointment was all over me when I saw a 50-something lady with a half-frozen smile seated in-between the two babbling hosts. 'Who on earth is she?', I asked myself, still wondering why I have to be disturbed just to look at her. As I settled down and listened, the guest turned out to be Dr. Vicky Belo. To those who are familiar with (or at least heard about) her and her work, a medical doctor on a showbiz-oriented talk show may not surprise you a bit. To those who are not, you definitely have better things to do in life, but let me keep you up to speed. I may be giving investigative journalism a bad reputation here but it is hard to discuss medical ethics without dragging Dr. Belo's name into the picture. (And you can say that mentioning and discussing Dr. Belo here is in itself unethical, but if you appear on a showbiz-oriented talk-show explaining why your husband left you, denying you're living-in with so-and-so, among other things, that makes you an easy target. Geez, this is so sleazy, I can't believe I just wrote that.)

"If physicians are allowed to advertise, patients run the risk of being lured to the one with the fanciest media coverage rather than to the most competent and experienced."

     Dr. Belo is a medical doctor/dermatologist who first made a name for herself a long time ago by endorsing Ivory soap on television, radio and print. This created quite a ruckus then. Advertising and endorsement of certain products by doctors are considered unethical. To be sure, I checked out the Philippine Dermatological Society (PDS) web site to see if they have something to say about ethics. In a section under Ethics, it says, "The PDS has a Council of Elders composed of the former presidents who are also members of the Ethics Committee. The PDS encourages high standards of professional and ethical conduct from all its members. Self-advertising is not allowed nor endorsements of any specific brands of medicines, equipment or products related to the specialty." This is essentially a vital part of 'Medical Ethics 101' and is not only true to the PDS but to the whole Filipino medical community as well. It is safe to assume that Dr. Belo is not only an outcast of the PDS but also of the Philippine Medical Association (PMA).

     Dr. Belo disappeared from the scene for a while because she supposedly trained in the United States. Upon her return, she shot to the top of 'The Most Popular Doctors' list by using her newly-acquired skill in liposuction on an already voluptuous bold actress named Rosanna Roces. Ms. Roces would mention Dr. Belo's name on every function or awards ceremony she attends. 'I would like to thank Dr. Belo for my beautiful body...', or something along that line. Dr. Belo became very popular among the movie community in the same length as hair-dressers and make-up artists, that she began putting up satellite clinics all over Metro Manila. Pretty soon, it could rival Andok's Lechon in terms of number. There will come a time when getting a liposuction will be as easy as getting hair plucked from your nostrils.

     Legitimate dermatologists or plastic surgeons will tell you that a patient needs to pass certain medical indications to be a candidate for liposuction. You just can't walk into a clinic and ask for a liposuction just because you think you have excess fat in your right thumb. That's why Dr. Belo has long been scorned upon by colleagues (other than she makes a whole lot of money than most of them). But she doesn't budge. She was asked by Ms. Aquino on that The Buzz episode what other doctors and colleagues have to say about her practices. She mentioned that she tried to blend in at first with the medical community but that limited most of what she wants to do. She had no choice, she said, but to break away from the ethical standards that have been embraced by physicians for centuries.

     Should doctors be allowed to advertise? Advertising by medical doctors in the Philippines, in whatever form, is a big no-no. The same is true for endorsing certain products that are medical in nature or related to one's practice. This seems like a non-debate. For me to even discuss the merits of 'no-advertising' versus advertising would lead you to think that I lost my mind or my brain is frozen solid because it's April and here in Crappyville, otherwise known as Chicago, the temperature is still below freezing. (Don't get me wrong. I love the city. I love the people. I love the food. But the weather here simply stinks.)

     I was in class when Medical Ethics was discussed (what are the odds of that?). Although ethics encompasses quite a few subjects, advertising was given much attention (if I'm wrong, blame it on my faulty memory). Ethical medical practice itself is easy to define. It has been defined and discussed through centuries from Hippocrates to the present digital age. It basically rests on the premise that the doctor's primary ethical commitment is to his or her patient. The doctor should see to it that everything is done in the best interest of the patient, his or her well-being and survival. Easy enough. So what's advertising got to do with it?

     Advertising can be a real touchy issue. Some doctors may not realize it but they may already be advertising. Our professor back then mentioned that even putting "US-trained" after your name is considered advertising and is unethical. He even cited a specific example. Many of you who have been passing through Gen. Luna St., just before Diversion Road if you're going south, may remember a certain clinic cum residence with a prominently-displayed billboard that says 'US-trained OB-Gynecologist'. Dr. Belo's tactics, on the other hand, is a blatant display of advertising one's services. Just imagine if a surgeon prominently displayed his face on a billboard with this caption "15-minute appendectomy on a one-inch incision. No surgeon does it better." That's awful. The Philippine College of Surgeons won't have second thoughts and kick you out cold.

     There are very good reasons why most codes on ethics in medicine prohibit advertising by doctors. One literature I chanced upon briefly explains why. "There are good reasons for this prohibition. As professionals, it ill behooves us to publicly sing our own praises or solicit patients. We must await clients by referrals from colleagues or by word of mouth. If physicians are allowed to advertise, patients run the risk of being lured to the one with the fanciest media coverage rather than to the most competent and experienced. This does not deprive the extraordinary physician of renown. Noteworthy contributions to medical theory or practice are legitimately published in medical journals after being subject to review by peers and can command admiration from colleagues." In a country like the Philippines where ignorance and gullibility abound (no offense intended to Dr. Belo's patients), this prohibition makes a lot of sense.

     This 'ban' on advertising, however, is not universal. In the United States, American Medical Association Guidelines for Physicians permit advertising by physicians. In the late 19th and early 20th century, the ban on advertising was imposed as an integral part of professionalism. As the socio-political scene changed, the American Medical Association's ban on advertising by physicians was successfully challenged in the U.S. Supreme Court in 1975. The U.S. Supreme Court held that such a restriction amounted to limiting freedom of (commercial) speech. The AMA subsequently revised its statutes.

     Today, so long as the advertisement does not contain any false or deceptive information, an American physician is free to advertise her or himself through any commercial or other form of public communication. However, certain restrictions still apply. To the extent that testimonials regarding a physician's skill or quality of professional services from patients who do not have a comprehensive access to the physician's practice are often misleading, such endorsements are not permitted. Ethical obligations to share medical knowledge and skills make it improbable that a physician is likely to have unique skills or equipment. An advertisement that makes such a claim would be questioned. However, such a claim may be justifiable in a restricted geographic area. Claims regarding competence and quality of care supported by objective data are permissible.

     The strongest opinion I have come across in support of advertising comes from a doctor who got quite a flak for putting up and promoting herself and her practice though a web site. "There is no doubt that for most doctors, advertising is a dirty word, but I feel this is a hangover from the past. How are doctors who have just started practice going to get patients ? How will patients know of their skills and their expertise ? Many young professionals, who have spent long years to qualify and taken loans to start practice, simply cannot afford to sit back and starve till patients arrive on their doorstep. This is why new doctors have to resort to unethical practices like cuts and kick-backs today - many of which have been institutionalized by their seniors. I think it is far more honest to allow them to inform patients of their skills by allowing them to advertise - at least this is open and transparent."

     "The fact is that the status quo is in favor of senior doctors - those who have an established reputation, with many hospital attachments and lots of patients. These same doctors are the "medical establishment", which sets the rules for all doctors. They will do their best to maintain the status quo and prohibit advertising - not to protect patients, as they claim, but simply to protect their practice, by putting new doctors at a major disadvantage, and protecting their own interests."

     "It is true that advertising has a downside. For one, advertising may cause doctors to start treating their patients as clients or customers, rather than as patients - and this is a shame. For another, some ads will be dishonest, but at least they will be in black and white, where they can be refuted and debated - and a doctor making false claims taken to task. This is far better than making tall claims within the four walls of a clinic and taking the patient for a ride."

     In its landmark 1975 decision, the United States Supreme Court has ruled that professional advertising, as commercial speech, is entitled to First Amendment protection (the guarantee of the right of free speech). The Court held that not allowing doctors to advertise was unfair to them - and also unfair to patients, who need access to information on doctors, so they can select the best for themselves.

     Whatever decision the US Supreme Court promulgates does not necessarily apply to physicians and the practice of Medicine in the Philippines. Given the circumstances, advertisement by Filipino doctors remains unethical and may be more than a downside rather than a benefit to patients.

     Is it really?

From the Inbox:

From Manang Joyce Jaen (1990), Guam,

b4 i 4get i lyk ur txt msg rtcl ;-)

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     The author's e-mail address is at drgarcia@wvsumedaa.com

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