Worse than the cure?
A Health Department proposal about product labelling and advertising has supporters of alternative medicine up in arms, writes Karen Angel
The aisles of the second annual Natural Products Expo Asia at the Hong Kong Convention and Exhibition Centre were bustling last week with thousands of buyers from more than 50 countries hunting for natural products that hawked their ability to detoxify the body and boost immunity, among other claims.
But local exhibitors were distracted from the business at hand by a new Department of Health proposal, which many believed would prevent them from marketing their products in Hong Kong - and would threaten the future of events such as the expo.
The proposal, an amendment to the Undesirable Medical Advertisements Ordinance (UMAO), stated that 'so-called health food products' couldn't make any claim, written or spoken, about nine areas of health, including breast lumps, genito-urinary function, and regulation of the endocrine system, blood pressure and blood sugar.
The government said the amendment was needed because more products making claims not covered under the original UMAO had entered the market, and complaints about them from the public were on the rise. A committee formed last year to study the claims came up with the nine areas. 'Misleading or exaggerated' claims in these areas could cause consumers to delay seeking proper medical treatment, exposing them to health risks, according to the government.
'We often encounter people who are harmed by these false claims,' said Dr Lo Wing-lok, president of the Hong Kong Medical Association and deputy chairman of the government's Health Services Panel.
'Instead of receiving conventional treatment for their illnesses, they just use these so-called health products, and as a result, their treatment might be delayed and the consequences might be making a less serious illness more serious or a curable illness incurable.'
But some didn't buy that. In letters sent to the government, alternative-medicine doctors, supplements manufacturers and retailers, among others, argued the proposal would restrict the flow of information to consumers and stifle the natural products trade.
They demanded to see proof of injury caused by natural products. And they said that requiring products to meet scientific standards before they hit the market would make more sense.
The public consultation period took place between September 26 - when the Department of Health announced the new initiative with a press conference - and November 15. By November 30, the department had received 1,637 letters about the proposal. 'Consumers won't be able to make an informed choice,' said Peter W.K. Chan, director of business development for CK Life Sciences, a Hong Kong company that makes 'nutraceutical' products, as he stood outside the company's booth at the show. 'A lot of companies will be affected.'
If the proposal were to pass, many of the 200 exhibitors from more than 20 countries at the show would have to change their product labelling and advertising. But last Monday, revisions presented by the Department of Health at a Legco meeting gave Mr Chan and the other natural-products vendors reason to rest somewhat easier.
The proposed amendments would permit certain general or pre-approved claims for six of the nine disorders ('improves immunity,' for instance), along with a disclaimer stating that the product 'is not a registered pharmaceutical product or a registered proprietary Chinese medicine'. The three areas for which claims still would not be permitted - breast lumps, and regulation of the genito-urinary and endocrine systems - were defined as high-risk areas. Also, while the original proposal applied to all 'orally consumed products', the revised version excluded food and beverages.
At the meeting, objections were raised by several Legco members, including Selina Chow Liang Shuk-yee, who said: 'We are not talking about drugs, but you are using an ordinance that governs drugs. Suppose shark-bone tablets have an effect on breast lumps - that can't be claimed anymore if this is passed?'
Vetting products before they hit the market was 'the next step ... to consider,' said Deputy Director of Health Leung Ting-hung. But he said the high cost of such a procedure made legislation on claims more realistic, at least initially.
At the session's end, Health Services Panel chairman Michael Mak said the proposal 'still has a lot of loopholes' that need to be addressed before going forward. He urged the Health Department not to 'submit the legislation to us hastily' and said the planned submission date of February 2004 was probably too early.
However, a spokeswoman for the Health, Welfare and Food Bureau, which oversees the Health Department, said the Bureau still planned to introduce its health-claims amendment in February, after considering and responding to Legco members' critiques. Some in the industry believe that is a mistake.
'They sell it as protecting the public, but the public doesn't want it,' said Graeme Stuart-Bradshaw, managing director of the Integrated Medicine Institute in Central and vice-president of the Hong Kong Association of Naturopathic Medicine.
According to the Health Department, about 793 members of the public opposed the proposal while more than 30 organisations, most of which are professional bodies, including medical and pharmaceutical groups, supported the proposal.
'This doesn't fix the issue because it still doesn't address unsafe products in the marketplace,' Mr Chan said. 'The Department of Health's whole premise is to protect the public. To think you can control consumer safety by controlling advertising is a little on the far end of stretching it.'
The industry would rather have to submit clinical data to get products approved than be limited in its ability to promote those products, Mr Chan added. The revised ordinance would also cover spoken claims relating to the nine health areas.
Dr Lo also said the revised proposal shouldn't go ahead as planned - but for different reasons. 'I believe the proposal in its original form, not subject to changes proposed recently, should be implemented as soon as possible, but with all those modifications made, I don't think we should put it into effect,' he said. I believe the changes proposed will cause more confusion than they intend to.'
The government should look to other countries for guidance, according to Anne Loseff, owner of the New Age Shop in Central. 'Rather than using the original legislation with disclaimers attached, it makes far more sense to go back to the drawing board and create a proposal that follows the regulatory behaviour of respected countries such as Britain, New Zealand and Australia,' she said. Hong Kong had fewer natural-products stores than other Asian cities because of its already-stringent regulations, she added.
Other countries have handled this issue in various ways. Many allow supplements to make health claims, based either on pre-marketing approval or the use of a disclaimer saying the product is untested by the government.
On the mainland, companies get health claims pre-approved based on scientific evidence. Most countries don't subject supplements to the same level of scrutiny as medical drugs. The supplements market in Hong Kong grew 13 per cent from 1997 to 2002, to $935.4 million from $826.6 million, according to the international market-research group Euromonitor.
By comparison, throughout Asia from 1997 to 2001 (the last year for which figures were available), the market grew 20 per cent, to US$13.4 billion from $11.2 billion, according to Nutrition Business Journal. Globally, it grew 17 per cent, to US$50.7 billion from $43.3 billion, during the same period.
'The supplements market here is still quite limited, but it's growing worldwide - that's why it's becoming a real threat to the pharmaceutical cartel,' said Alexander Yuan, director of the Optimum Health Centre, a Causeway Bay clinic that has natural-product shops. 'This law has nothing to do with protecting the public from unsubstantiated claims. The ultimate goal is to restrict access to these products - this is a pharmaceutical-company lobby. I don't think we should add to the old law,' Mr Yuan said.
With Google at everyone's fingertips, trying to stop the flow of information is futile, Mr Stuart-Bradshaw said.
'I believe they're creating a toothless tiger. They're trying to control something you can't control because there's such demand for it.'
On the no-no list
Claims the Health Department would like to ban (quoted from product advertising and packaging) include:
Improved function of the pancreas
Stimulate the secretion of insulin
Excrete cholesterol in the blood vessel [sic] outside the body
Improve the metabolism of breast tissue, effectively disintegrates and eliminates abnormal cell tissues
Prevent urination at night
For uncontrollable urinary discharge/incontinence
Stimulate hypothalamus, increase secretion of estrogen
Improve imbalance of male hormone secretion
Help maintain balance of hormonal secretions in men and women
Eliminate fat in the body
Help excrete excess fat
Can promote firm muscle and beautiful body curve
Prevent excess sugar from converting into fat
Enhance ability of white blood cells to engulf microscopic invaders
Remove toxins in the blood