Saturday, August 27, 2016

Private equity firms are suddenly buying dermatology practices — here's why

Justin Thomas sprays himself with sunscreen during the first round of the 2016 The Masters golf tournament.

Private equity firms are snapping up dermatology practices across America.

In the past two years, there have been over 200 deals involving physician practices, with about 30 of those transactions in dermatology.

Investors are attracted by profitable new cosmetic procedures offered by many dermatologists, and are placing premium values on high-performing, well-positioned practices.

Some of the recent deals have been huge.

New York-based private equity firm Harvest Partners  recently purchased Maitland, Fla.-based Advanced Dermatology & Cosmetic Surgery, the largest U.S. dermatology practice, in a deal reportedly worth more than $600 million.

Varsity Healthcare Partners sold dermatology practice Forefront Management Holdings to the private investment arm of pension fund giant Ontario Municipal Employees Retirement System in a deal worth more than $450 million.

The Wall Street Journal reported that the transaction valued Forefront, with more than $30 million in earnings before interest, taxes, depreciation and amortization (EBITDA) last year, at about 13-times EBITDA.

We can expect more deals.

That’s especially true because dermatology is a fast-growing specialization. The market is expected to increase to $13.1 billion by next year, according to a 2013 Harris Williams & Co. study.

There is a dermatologist shortage that will likely persist for years even as a growing number of medical students pick the specialization.

To private equity firms, there are several factors that make dermatology practices more attractive than other medical practices.

Demographics. By 2019, there will be 54 million Americans over the age of 65, up from 46 million-plus today, according to a report by the U.S. Department of Health and Human Services’ Administration on Aging. Skin cancer, particularly melanoma, is on the rise too, striking about 3.5 million people annually, according to the American Cancer Society.

Healthcare access. More and more Americans have access to healthcare thanks to the Affordable Care Act. About 20 million people have gained insurance coverage between the passage of the law in 2010 and early 2016, boosting demand for dermatology.

Financials. Common medical and surgical dermatology procedures are typically well reimbursed.  Additionally,  high-margin cosmetic procedures tend to be paid out of pocket by consumers and are not as reliant on discounts made to insurance providers as many other types of medical care. Notably, most dermatology work is conducted outside of hospitals and as such is not subject to the push for cost-savings underway at hospital systems.

The upsell. Many dermatology practices have a cosmetic component, offering everything from Botox, Restylane, micro-dermabrasion and laser correction, CoolSculpting (a non-surgical fat removal process), high-end skin creams and other services. Investors like the idea of training doctors to do a better job of upselling such offerings so that patients who might come to have a mole removed are likelier to sign up for more lucrative services.

Historically, physicians may have viewed the full or partial sale of their practice as the loss of independence or control.

Today, many doctors embrace the idea of being able to spend 100 percent of their time providing patient care.

The consolidation of back office functions — like billing, scheduling, and insurance contract negotiation — is a huge motivation to sell.

Some physicians with thriving practices are teaming up with investors to become consolidators, acquiring other dermatology practices and getting an equity stake in the larger entity.

Some have joined or formed multi-physician dermatology practices with several locations and additional specializations.

In the end, consolidation should be good for patients. Ultimately, it ensures that doctors spend more time with them.

Patrick Krause

Kaolin and eyelid surgery

Using kaolin-impregnated gauze offers limited benefit for blepharoplasty patients. The mineral, which has been shown to help control hemorrhage when combined with gauze and applied to wounds, showed no quantifiable change in intraoperative hemostasis among cosmetic eyelid surgery patients.

Postoperatively, the limited positive effects on lid edema and ecchymosis were noted in the later healing stages by surgeons but not by patients, according to a new study.

Investigators reported on a prospective, randomized, double-blind study of 46 eyelid surgery patients. After making skin incisions, they placed kaolin-impregnated gauze in one eyelid wound bed and cotton gauze in the other.

They removed the gauze and took postoperative pictures on days one, four and seven. Blinded observers graded the photos for edema and ecchymosis, and patients completed a survey at each visit, asking them which side had more bruising, swelling and pain.

Researchers noted no notable difference in the number of intraoperative bleeding sites for kaolin compared to plain gauze. The blinded observers didn’t see differences in postoperative edema between lids photographed.

But while they didn’t see immediate effects from the treated gauze, there appeared to be limited postoperative benefit — a statistically significant difference in ecchymosis at days four and seven. Patients, however, didn’t note this or any differences in perceived edema, ecchymosis or pain between the lids.

While this study doesn’t show a clear benefit associated with using kaolin-impregnated gauze for blepharoplasty patients, considering the time and cost, other research suggests the gauze might be of more benefit with repeated applications, according to the authors.

Cherry Hill, N.J., plastic surgeon Steven L. Davis, M.D., does not use kaolin-impregnated gauze for eyelid surgery patients.

“…the additional cost does not seem beneficial,” he says. “I use 1% lidocaine with epinephrine on a gauze topically after incision.”

Examining low-level laser therapy

A new study suggests that once weekly treatment of low-level laser therapy (LLLT) for six weeks might be more effective than three treatments weekly for two weeks, for noninvasive body contouring of the waist, hips and thighs.

The six-week protocol offers a more convenient treatment plan, which, could increase patient satisfaction, according to the authors.

Researchers at two dermatology practices studied 54 healthy adults with body mass indexes of 25 to 40 kg/m2, who had one weekly LLLT procedure for six consecutive weeks. In the study, which was sponsored by Erchonia Corporation, the researchers used Erchonia’s Zerona 6-Headed Scanner (EZ6) device with six 17 mW, 635 nm red diodes, to contour patients’ waists, hips, thighs and upper abdomens.

They treated patients’ backs and fronts for 30 minutes each, or a total 60 minutes, and repeated that approach weekly for six weeks.

Measuring the treated body area circumference weekly, the researchers defined study success as a 4.5-inch average decrease in combined body circumference. They used the minimum mean decrease of 4.5-inches because the FDA had determined that to be statistically significant and clinically meaningful, based on prior LLLT studies.

In this study, they found a mean decrease at six weeks of 5.4 inches; 81% of patients said they were satisfied or very satisfied with their results.

The new study confirms and demonstrates LLLT’s effectiveness for reducing circumference of the bilateral thighs, hips and waist. It also shows significant reductions in upper abdomen circumference, which decreased a mean 5.4 inches, according to the study.

Among the limitations of the study is its small size and open-label design, according to the authors.

Cosmetic surgery: A close encounter with injectables of the face-plumping kind

Unless she is telling a most unusual lie, cosmetic nurse Susi Garrett is a walking testimony to her art.

Unusual, because most people lying about their age would shave off a few years. But Garrett has just told me she's nine years older than me when, honestly, she looks a decade and a half younger.

Under the bright light bouncing off the white walls of the injectables room here at Face Plus Medispa in Sydney's Bondi Beach, her skin is dewy perfection, not a wrinkle or age spot to be seen under her barely there make-up. Nor does she look like someone who's had cosmetic work. She looks fabulous – calm, relaxed and glowing, as if time's wearying strains have simply passed her by.

She hands me a mirror to look at my own face. "Tell me what you don't like," she says. Where do I start? With the bags under my eyes, exacerbated by a head cold? My frown line? The sun damage caused by years of blithely baking myself under an African sun?

It's a confronting business looking at yourself in the bright light of a place staffed by beautiful women whose promise is that you could be more beautiful too should you be prepared to spend the money. Certainly there's no shortage of treatments to splash out on at Face Plus and other clinics of its ilk, from smoothing facials and soothing massages to enzyme peels, laser treatments and LED light therapy.

Holistic clinic

Here in the injectables room are "anti-wrinkle relaxants" (starting at $150) and "dermal fillers" to replace lost skin volume ($390-$790 for a 1ml syringe of hyaluronic acid gel). On the wall in front of me is a before-and-after chart of faces and lips in various stages of ravagement and rescue.

Women's lips lose volume and colour as they age, Garrett tells me, but she also sees a lot of "virgin lips". "Girls as young as 18 come to me twice a year because there's pressure to look like Kylie Jenner." Lots of men come, "particularly gay men in their 20s and 30s", but older men too.

Garrett started out as a nurse assisting in plastic and facial reconstruction surgery. She moved on to injectables because "I'm quite artistic", she says. "I love design, drawing and architecture, and to sculpt someone's face with filler is very rewarding."

Her first recommendation for me, however, has nothing to do with needles. She advises me never to go outdoors without SPF50 sunscreen, even to hang up the washing, and to drink more fluids.

Because this is a holistic clinic, she recommends I see the naturopath. I can have laser treatments or chemical peels to remove pigment, and a dermal therapist can advise me on a serum to brighten my skin.

As for her, she would draw me up a 12- to 24-month plan. I'll need Botox for that frown line, and a couple of fillers here and there. She touches my temples and below my cheek bones. My jawline, thank goodness, is fine.

As I leave she gives my arm a kindly pat. "Come back and I'll look after you," she promises.

Charis Perkins

UK - At long last - government to start cracking down on dodgy cosmetic surgeons

In a long overdue but very welcome development for patients of cosmetic surgery, the government is finally taking steps to tighten regulation surrounding cosmetic surgeons.

The cosmetic surgery industry has been woefully under-regulated for many years; due in part to the fact that cosmetic surgery is not a defined speciality and the majority of it is carried out privately. Despite this, more and more people are undergoing cosmetic procedures, with 51,000 people opting for cosmetic surgery in 2015, a 13% increase on 2014.

But it looks like the tide may finally be starting to turn, with new initiatives being introduced with the aim of tightening up the industry and establishing much needed protection for consumers and patients.

CQC’s scope to extend to cosmetic surgery providers

A new Department of Health paper published on 22 August 2016 will hopefully go some way to addressing problems with the industry, by providing safeguards for people considering undergoing cosmetic surgery.

The paper proposes expanding the public rating system currently operated by the Care Quality Commission (CQC) to providers of cosmetic surgery. This means that clinics will now be subjected to a rating system whereby the CQC will rate them as “outstanding”, “good”, “requires improvement” or “inadequate”. The results will be published online, allowing individuals planning to have cosmetic surgery to make a more informed choice about the clinic they have chosen before going under the knife.

Accreditation system for cosmetic surgeons in the pipeline

In addition to the CQC rating system, the Royal College of Surgeons has also announced plans to launch a new system of accreditation for cosmetic surgeons later this year, designed to go hand in hand with the rating system. This will hopefully help patients to find a certified surgeon with the appropriate level of experience, training and insurance to carry out a procedure.

General Medical Council guidelines already in force

The new proposals complement new GMC guidance which came into force in June 2016 requiring cosmetic surgery providers to market and advertise their services responsibly and give patients time to change their mind without feeling rushed or pressured. The guidance also bans doctors from offering two for one promotions on cosmetic surgery or offering surgery as a prize.

Criticisms of the cosmetic industry

The government’s decision to take steps to clamp down on rogue cosmetic surgeons stems from a growing concern about the industry following the publication of the critical 2012 report into cosmetic surgery providers by Sir Bruce Keogh in the wake of the PIP breast implant scandal.

Although the changes signal a move in the right direction, concerns still remain about the way that the industry is regulated, and further steps will be needed if patients are truly to be protected.

Douglas McGeorge, former president of the British Association of Aesthetic Plastic Surgeons (BAAPS), which has long criticised the cosmetic industry, said that the changes were welcome but that patients still needed to be wary: “This is an arena where regulation has historically been lax and many practitioners can engage in procedures they are not trained or even qualified to perform. However, it is important to stress that the Care Quality Commission (CQC) regulates facilities - that is, clinics rather than clinicians. Their remit entails a facility or practice's aspects such as equipment, record-keeping and administrative areas, so we still call for the public to remain extremely vigilant of; and query; their surgeon's experience and accreditations.”

Considering cosmetic surgery?

The risks associated with cosmetic surgery can be serious. If you are considering undergoing a cosmetic procedure, the best way to protect yourself is to properly inform yourself about the procedure you are planning to undergo, and thoroughly research the surgeon or doctor you are thinking of using.

Vietnam - Public hospital fees hiked by 18% in August

Public hospital services and products in 16 provinces and cities have become 18 per cent more expensive since the middle of August, as patients pay for health staff’s basic salaries. — Photo

HÀ NỘI — Public hospital services and products in 16 provinces and cities have become 18 per cent more expensive since the middle of August, as patients pay for health staff’s basic salaries.

Labour-intensive services such as check-ups, bed charges and surgeries, particularly those requiring up to eight medical workers for three or four hours, cost more now.

Deputy Minister of Health Phạm Lê Tuấn said the new tariff regime was for health insurance card-holders only and was being implemented in 16 localities where 85 per cent of the population have bought medical insurance.

However, special medical insurance card-holders such as poor people, children under six years of age, social welfare beneficiaries and national revolutionary contributors such as Vietnamese heroic mothers and soldiers would not be affected by the increased rates as they were subsidised wholly or mostly by the government, he said.

The localities are Lào Cai, Thái Nguyên, Điện Biên and Hà Giang, besides Bắc Kạn, Sơn La, Tuyên Quang and Cao Bằng, as well as Lai Châu, Yên Bái, Lạng Sơn and Hòa Bình, as also Đà Nẵng, Sóc Trăng, Thừa Thiên-Huế and Quảng Nam.

In March this year, public hospital fees were hiked by 30 per cent, with patients now having to pay for nearly 1,900 services and products that were earlier subsidised by the government, such as power and water, maintenance of equipment and waste treatment facilities and training and research.

When the first round of hikes took effect in March, the cost of a health check-up in first-class hospitals (national hospitals or major hospitals in cities/provinces/regions), for example, doubled to touch VNĐ40,000 (US$1.8).

Bed charges per day went up from VNĐ80,000 ($3.6) to VNĐ215,000 ($9.6).

The cost of stomach flushing rose to VNĐ106,000 ($4.7) from VNĐ30,000 ($1.3).

According to finance and health ministries, this year would see three more hospital fee hikes in other localities in the country.

The fee revision is aimed at ending government subsidies in hospitals and at gradual improvement of the quality of health services.

Phạm Lương Sơn, head of the Việt Nam Social Insurance Agency’s Health Insurance Policy Implementation Department, said the new prices would not apply to uninsured patients to give them time to buy insurance, but it would apply in the near future.

Uninsured patients would suffer the most with the rising prices, he said.

Around 71.1 million people, accounting for 77 per cent of Việt Nam’s population, had been covered by medical insurance as of the end of May. The country aims for 78.8 per cent coverage by the end of this year and 90 per cent by 2020.

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.

Vietnam - Vietnam to use bacteria-infected mosquitoes to prevent Zika

Nha Trang leaders on Friday said they support a plan to release mosquitoes infected with a strain of bacteria in the resort beach town next year to control dengue and Zika.

The plan was introduced by a Health Ministry working group at a meeting with local leaders, following a successful pilot project carried out in Nha Trang between 2013 and 2015.

Health officials said the infected mosquitoes would be released in four wards of Nha Trang.

The method takes advantage of the naturally occurring strain of bacteria known as Wolbachia, which live in insect cells and are found in 60 percent of common insects.

Infecting mosquitoes with Wolbachia significantly reduced their ability to transmit dengue and the Zika virus, studies have shown.

The bacteria has been released in several countries including Australia, Brazil, and Indonesia as part of strategies to control dengue.

In the pilot project in Vietnam, it helped almost eradicate dengue cases in Tri Nguyen, an island 2 km off Nha Trang coast.

In the meeting Friday, Nguyen Dac Tai, vice chairman of Nha Trang's People's Committee, said local leaders support the plan.

However, he insisted that it be carried out discreetly.

Vietnam has so far reported three Zika patients, including one in Nha Trang.

Hien Luong

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.

Vietnam - Public Sector Graft An Issue In Vietnam, But There Could Be One Simple Solution

This picture taken on December 14, 2013 shows Duong Chi Dung, former Vinalines chairman, standing trial at Hanoi’s People’s Court. Vietnam on December 16, 2013 sentenced two former top executives at scandal-hit national shipping company Vinalines to death for embezzlement, a court official said, as authorities move to allay rising public anger over corruption. AFP PHOTO/Vietnam News Agency.

Like just about every developing country, Vietnam struggles with the issue of corruption. It has been officially acknowledged at the highest levels as one of the key factors holding back the country’s progress.

It is an issue that seems intractable at times. And, at least in terms of the perception of corruption and the willingness to weed it out, recent incremental progress seems to have taken a step back, according to a study from the United Nations Development Program.

The Provincial Governance and Public Administration and Performance Index is an annual survey that has been carried out nation-wide since 2011, and reflects people’s experiences with government and public service delivery. It looks at six areas of governance, including participation at local levels, transparency, vertical accountability, control of corruption, public administrative procedures and public service delivery. Almost 14,000 randomly selected citizens were interviewed for the 2015 report, the result of which were released earlier this year.

The “Control of Corruption” dimension looks at limits on public sector corruption, limits on corruption in public service delivery, equity in state employment and willingness to fight corruption. All four of these areas scored lower than in previous years. The survey also found fewer people believed authorities were serious about fighting corruption.

Fewer of those surveyed agreed that public officials did not divert public funds for private use, ask for bribes when handling land use rights certificates or ask for kickbacks when handling construction permits than in 2014. In terms of corruption in public service delivery, the study looked specifically at the health care and primary education systems.

There is still a common practice of paying café tien, or coffee money, to your child’s teacher to ensure they get proper attention, or to move up the waiting list to see a doctor at a public hospital. Public sector wages are absurdly low, a new doctor in the public system will make around $250 a month.

In a paper for the journal Vietnam Law and Legal Forum, researchers from the National Economics University who analyzed data from the 2014 PAPI report, laid the reason for this custom on the remuneration doctors and teachers receive.

“Corruption in these two sectors is widely recognized in Vietnam, and low wages for healthcare workers and teachers and decreasing public investment in the sectors are to blame,” the authors wrote. They further added, “It is commonly perceived that, without additional informal incomes and under-the-table incentives, healthcare staff and teachers would not feel motivated to be attentive to patients and students.”

The same paper offers several broad recommendations for countering the problem of corruption in the country, such as encouraging more people to report corruption, increasing transparency and participation in the political process. These are all fine, but rather amorphous and uncertain in making some kind of tangible and immediate impact. In the meantime, finding the money to bump public sector pay packets might be worth a try.

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.

Vietnam - Vietnam Says It's Now Safe to Swim at Most Central Beaches

A Vietnamese government minister says it's now safe to swim at most beaches in four central provinces where massive fish deaths occurred more than four months ago because of toxic chemicals released by a Taiwanese steel company.

The online newspaper VnExpress quoted Environment Minister Tran Hong Ha as telling a conference Monday that aquaculture is now also safe in most areas, but that research by the Ministry of Health is needed to determine whether it's safe to eat fish caught within 20 nautical miles (23 miles, 37 kilometers) off the coast of the four affected provinces.

Professor Mai Trong Nhuan, who headed a team of Vietnamese and foreign scientists commissioned by the government to study the impact of the disaster, told the conference that the chemicals, including cyanide and carbolic acids, are becoming more dilute, according to VnExpress.

Nhuan said the marine ecosystem, including coral reefs, sea grasses and other marine resources that were seriously damaged, has begun to recover.

The factory, owned by the Formosa Plastics Group, acknowledged in June that it was responsible for the pollution that killed large numbers of fish off the central Vietnamese coast, and pledged to pay $500 million to clean it up and compensate affected people.

The country's worst environmental disaster has devastated the fishing and tourism industries in the region.

The government said in a report to the National Assembly in July that the disaster harmed the livelihoods of more than 200,000 people, including 41,000 fishermen.

An estimated 115 tons of fish washed ashore along more than 200 kilometers (125 miles) of the central coast in April, the report said. The pollution sparked rare protests across the country.

Formosa Plastics's $10.6 billion steel complex in Ha Tinh province includes a steel plant, a power plant and a deep sea port, and is one of the largest foreign investments in Vietnam.

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.

Vietnam - Insurance funds misused: official

People pay hospital fees with health insurance at the National Hospital of Otorhinolaryngology. Health insurance funds have been misused. – VNA/VNS Photo Dương Ngọc

HÀ NỘI — Health insurance funds for medical check-ups and treatment have been misused, becoming a “nightmare” with spending that exceeds State limits, a health official has told local media.

In the first half of this year, more than VNĐ30 trillion (US$1.3 billion) was spent, a 40 per cent increase over the same period last year and greatly exceeding this year’s budget of about VNĐ2.1 trillion ($93.3million). This amount has climbed to nearly VNĐ3trillion ($133.3million) as of July 18, Phạm Lương Sơn, deputy general director of Việt Nam’s Social Insurance said.

Sơn attributed the overspending to the number of health insurance cardholders increasing 12 per cent in the period. However, the main problem was health insurance cardholders and health facilities trying to make money from the fund, he said.

“The abuse of health insurance funds is happening in many places, at different levels and becoming more sophisticated,” Sơn said.

Some medical facilities take advantage of loopholes in policies or shortages of human resources, supervising measures to abuse the fund, he added.

New regulations state that patients can freely choose medical facilities at district level to have medical examinations while enjoying similar benefits at any facility. This change has led to the fact that many cardholders go to different facilities for health check-ups several times in one day.

Statistics from Việt Nam’s Social Insurance showed that in July, some cardholders had medical check-ups 27 times per month.

These fraudsters can get prescriptions worth VNĐ200,000 ($9) at each facility they have the check-ups and then sell them to pharmacies for profit.

Commercialised health services

Sơn also pointed out that the unnecessary use of CT Scanners, MRIs or expensive medicine prescribed by doctors contributed to the problem.

The total spending on testing, ultrasound, and endoscopic exams can reach VNĐ4 billion ($178,000) each month on average, Việt Nam’s Social Insurance revealed.

Việt Nam’s Social Insurance will figure out the tests were for diagnosis or only for regular health-check-ups, Sơn said.

Representatives from private hospitals also contact local women’s associations and veterans’ associations to get residents to go for health-check-ups or offer discount programmes for second time check-ups as promotional measures to increase health check-ups demand and multiple spending from the fund.

Another surprising figure is the surge of expense of distilled water test-tubes in 2014-2015. Many hospitals have switched from using glass distilled water test-tubes to plastic ones, increasing the spending on the tubes by VNĐ15 billion ($667,000).

This money could be used for health insurance for the poor, patients with cancer, cardiac diseases, tuberculosis or HIV and save thousands of sick people, Sơn said.

If the spending exceeds 30 per cent of allocated funds, health insurance funds are unable to fill the deficiency, Sơn said.

He said that tightening the fund in the final months of the year is the key task of Việt Nam’s Social Insurance. Social insurance agencies of localities must analyse fee increases in health check-ups and treatment and co-operate with local departments and sectors to take better control of the fund.

Sơn said that consistent denial of payment must be applied for medical facilities misusing health insurance funds. For example, this year, Phương Nam Clinic in southern Cà Mau Province was denied health insurance check-ups and treatment payment of VNĐ71 billion ($3.1million) due to alleged abuse of spending.

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.

Vietnam - Inconsistency the only consistency in reports on fish quality in central Vietnam

A lack of consistency in seafood samples taken from central Vietnam seawater since mass fish deaths hit the region earlier this year has left many concerned about seafood safety there.

A report submitted by the National Institute for Food Control (NIFC) to the Ministry of Health shows that six out of nine seafood samples collected from the central coastline were discovered containing excessive amounts of phenol, cyannual, and cadmium, a heavy metal substance.

According to the NIFC, out of the nine fish samples retrieved on August 5 from the coastal area around Ha Tinh Province’s Ky Anh and Cam Xuyen Districts, one contained high cadmium levels, about 0.079 milligrams per one kilogram of fish, and six others were found with excessive phenol and cyannual.

Meanwhile, the Agency of Food Safety under the Ministry of Health told Tuoi Tre (Youth) newspaper on Tuesday that testing throughout August confirmed that only one out of every 18 samples contained high levels of cadmium.

Responding to the inconsistent results, a representative from the Agency of Food Safety stated that the new findings by the NIFC were only recently updated.

Similar inconsistencies have also been recorded on various testing done since the beginning of the mass fish deaths in April.

Accordingly, the Ministry of Health announced in late May that 97 out 140 fish, salt, and water samples taken from the impacted coast areas did not include excessive toxins.

In more recent reports, the ministry stated that over 430 seafood samples collected in April and May were discovered with high amounts of heavy metals including iron, lead, and chromium.

Seafood contamination in central Vietnam is believed to have started after massive numbers of dead fish washed ashore in Ha Tinh, Quang Binh, Quang Tri, and Thua Thien-Hue in April 2016.

By late June, local and international scientists had concluded that wastewater from the Vietnamese steel-making subsidiary of Taiwan’s Formosa Plastics Group was responsible for the environmental disaster.

The Ministry of Natural Resources and Environment asserted at a conference on Monday that most, but not all of the central waters, are now safe for swimming and fishing activities.

However, the overall edibility of seafood from the region remains unclear, with local fishermen concerned for their livelihoods.

The lack of consistent test results has left a hung jury on fish safety in the region and local authorities are uncertain of what to do with local seafood.

Nguyen Huu Hoai, chairman of the Quang Binh People’s Committee, said hundreds of metric tons of frozen fish have been put in storage with unclear plans for their fate.

Meanwhile, the Quang Tri administration has announced that it will dispose of 60 frozen seafood bought from local fishermen between late April and May due to low salability.

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.

Vietnam - Vietnamese government fails to get a grip on food safety

Consumers have no idea if what they're putting in their mouths could give them cancer.

Demand for safe food is rising in Vietnam, and many consumers have become suspicious of goods touted as safe on the local market. This was the focus of a business–consumer connection forum held by the Ministry of Agriculture and Rural Development (MARD) on Wednesday.

Vietnam seems to be stuck in a circle of trust and moral deterioration between consumers and companies at the moment, and the consequences appear to be a slow erosion in its citizens’ health and a bleak outlook for Vietnamese food industry.

Experts said that lack of trust in food processors and sellers, who have far too often been proved reckless in their pursuit of profits, has left food on the shelves which in turn has made it difficult for them to remain “straight”.

In recent years, it’s become increasingly common to hear about cases of unscrupulous food sellers in Vietnam using banned chemical in meat or excessive concentrations of pesticide in vegetables to increase or maintain the food’s appeal to consumers. 

Cong An Nhan Dan (People's Police) newspaper said in a report Wednesday that in 2015, the country recorded 171 food poisoning cases with nearly 5,000 people affected. Each day, people in Hanoi consume about 1,000 tons of meat, 600 tons of fish and 3,200 tons of vegetables, but only a handful is clean or has been proven place of origin, said experts at the forum.

For some, the situation is even grimmer than it looks. “I don’t believe there are clean vegetables (in the market) anymore, because Vietnam imports 4,100 types of pesticides and 1,643 different chemical ingredients, 90 percent of which come from China," the report quoted Nguyen Lan Dung, chairman of the Vietnam Biotechnology Association, as saying ."It’s impossible to control how our farmers use them,” .

According to the report, in a recent inspection conducted by the National Institute for Food Control (NIFC), 40/120 vegetable samples were found to have excessive levels of chemical pesticides, and 455/735 samples of meat products were unsafe for consumption. The unethical practice of mixing “dirty” food with safe produce to sell at a higher price is common in the market, even in supermarkets and other places that naturally enjoy higher consumer confidence.

While these cases are not common, the government's ineffective response to tighten food safety control has further eroded consumer trust.

The terrifying fact about these unethical practices is that the damage caused by unsafe products does not usually come to light immediately. According to Prof. Hoang Dinh Chau, director of the Hung Viet Cancer Hospital, each year Vietnam has 150,000 new cancer patients, and 75,000 people die from cancer annually. It is estimated that about 35 percent get cancer from consuming “dirty” food, topping the 30 percent of lung cancer patients who contract the disease from smoking.

Chau said chemicals used in livestock feed and plant protection products such as preservatives and pesticides are the main causes of cancer and other illnesses in the country.

Remaining issues that gain attention

With pressure mounting to strengthen food safety measures, the Vietnamese government has been urged to put food safety higher on national agenda and to issue policies that are strong enough to encourage the production and supply of safe food.

Tran Quan, director of a chain of seafood stores called Soi Bien (Sea Wolf), said that the MARD has yet to issue standards for organic agricultural products, forcing him and other businesses to search elsewhere overseas for applicable standards.

Quan also added that overlaps in food safety management have frustrated many in the industry. “There are inspection teams from the health and agricultural sectors. Then there are teams from the ward, district and even inter-agency teams from a municipal level. Why can't these teams share their test results to save costs and cut the onerous red tape?” said the director.

Blaming Vietnam’s poor market discipline and questioning the government's protection of consumers, Chairman of the Hanoi Supermarkets Association Vu Vinh Phu’s opinion has received from other experts. “We aren't able to distinguish between an honest business and an unscrupulous one… And don’t ask the consumers to wise up; the authorities must actively protect them,” Phu said.

On the other hand, Le Tu, director of Hong Thanh Viet – a catering business in the southern city of Vung Tau – revealed that even food safety certificates such as VietGap – the Vietnamese good agricultural practice standard – have a price tag, adding a challenge that the government and consumers have to confront .

“Someone even offered to sell me a VietGap certification,” Tu told Cong An Nhan Dan. "If it's that easy to buy, then what can the consumers believe in nowadays?”

Vietnam has seen numerous problems related to food safety in recent years, mostly resulting from imports of food preservatives from China.

Taiwan's Formosa Plastics Group, which owns Formosa Plastics, was ordered to pay a $500 million fine for discharging toxic waste from its steel plant in the central province of Ha Tinh in April, killing large numbers of fish. The incident could have resulted in a serious health hazard.

Under new food safety laws revised in July, the maximum punishment for food poisoning and other violations in Vietnam was raised from five to 20 years' imprisonment. Fines were also increased tenfold to VND500 million ($22,425).

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Vietnam - Salbutamol imports resume after 9-month ban

Vietnam’s health officials have allowed a resumption of salbutamol import into the country after the drug, which is often used to treat asthma and breathing problems, was banned from import for nine months.

The Drug Administration of Vietnam under the Ministry of Health officially approved salbutamol imports after reviewing the trade and use of the substance, which had reportedly been abused by many livestock farmers to make pigs grow fast and lean.

In its document sent to the General Department of Customs, the administration also allowed a resumption of clenbutarol import, its deputy head Do Van Dong said on August 24. The drug is also used to increase muscle mass for livestock.

Salbutamol is vital in treating respiratory diseases but in early March, the Environment Police Department, also known as C49, revealed the abuse of the substance in pig farming.

According to the police, over 20 firms imported 9,140 kilograms of salbutamol into Vietnam last year. Of the volume, six tons were sold on the market but only ten kilograms were bought and used in accordance with regulations. A big amount of the substance ended up being used by livestock farmers.

The drug administration issued a document on November 20 last year halting import of both salbutamol and clenbutarol.

During the nine-month ban, the administration tightened its management on the trade and use of salbutamol. So far local enterprises have generally adhered to regulations. To meet the domestic demand for salbutamol in medical treatment, the administration has decided to reopen the door for the drug.

However, the removal of the ban applies to drug producers that have registered to use the substance for making medicine and still hold valid certificates to import salbutamol. Other businesses whose contracts to import the drug were approved before November 20 last year are not allowed to do so.

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