This issue of the Newsletter mainly reports on the progress of work of the Chinese Medicine Practitioners Board (PB) in the past few months, including the preparation for the 2014 Chinese Medicine Practitioners Licensing Examination, renewal of practising certificates of registered Chinese medicine practitioners (CMPs) and matters relating to Continuing Education in Chinese Medicine (CME), summary of disciplinary inquiries conducted by the PB and matters requiring the attention of CMPs.
The PB appeals to all CMPs to undertake continuing education so as to enhance their professional knowledge and skills and to ensure that they will be able to meet both the requirements laid down in the Chinese Medicine Ordinance (CMO) and those formulated by the PB on continuing education when applying for renewal of their practising certificates.
Regarding disciplinary inquiries, the PB specifically reminds all CMPs to note and observe the regulations on professional responsibility and ethics, issue of prescriptions and standards on prescribing medicines as stipulated in the CMO and the Codes of Conduct (the Codes)1 in their practice; and be sure not to dispense medicines containing western drugs lest they should violate the law, pose public safety hazards and bring negative impacts on the Chinese medicine profession.
The PB would like to draw the attention of all CMPs to some special topics published in this issue of the Newsletter, including information on the banning of all forms of asbestos as provided in the Air Pollution Control (Amendment) Ordinance 2014, and the attached letter issued by the Environmental Protection Department, which elaborates on the banning of the use of Chinese herbal medicines containing asbestos as stipulated in the Amendment Ordinance and the precautions to be taken when disposing Chinese medicine products containing asbestos materials.
Last but not least, the answers of the 2013 CME Quiz for awarding CME points through reading the Newsletter are attached to this issue for CMPs' reference.
May I wish you all good health and happiness.
Mr WONG Kit
Chairman of the Chinese Medicine Practitioners Board
1The Codes refer to the Code of Professional Conduct for Registered Chinese Medicine Practitioners in Hong Kong and the Code of Conduct for Listed Chinese Medicine Practitioners.
The application for sitting the 2014 CMPs Licensing Examination for non-listed CMP persons was closed in late October 2013 and that for listed CMPs and repeaters was closed on 28 March 2014.
The Paper 1 and Paper 2 of the Written Examination of the 2014 CMPs Licensing Examination will be conducted on 10 June and 12 June 2014 respectively. In the event of bad weather, the examination on 10 June and 12 June 2014 will be postponed to 14 June and 16 June 2014 respectively. The clinical examination is scheduled to be held between 1 August and mid-August 2014.
Candidates should receive the admission form and the Guidelines for Candidates one week prior to the examination. They may contact the Secretariat of the Chinese Medicine Council of Hong Kong at 2121 1888 if they do not receive the above-mentioned documents on time.
As at the end of March 2014, there were 6,740 registered CMPs, 65 CMPs with limited registration and 2,710 listed CMPs.
Pursuant to section 76 of the CMO, registered CMPs must obtain valid practising certificates before they are allowed to practise Chinese medicine in Hong Kong. The usual validity period of a practising certificate is three years. Registered CMPs should fulfill the CME requirements prescribed by the PB before they can renew their practising certificates. From December 2013 to February 2014, 29 registered CMPs renewed their practising certificates. All registered CMPs who have their practising certificates renewed should report promptly to their CME Administrators their new CME cycles, required CME points, and the validity period of their practising certificates.
The CMO also stipulates that if registered CMPs practise Chinese medicine without obtaining valid practising certificates for a period exceeding six months since the expiry of their practising certificates, the PB may order removal from the Register the name of those registered CMPs in accordance with section 56(1)(d) of the CMO.
Apart from the CMO, the Codes also stipulate that registered CMPs should be holders of valid practising certificate to practise Chinese medicine. The PB will process violation case seriously in accordance with the procedures stipulated under the CMO.
To encourage the CMPs in reading the Newsletter, the PB endorsed in 2011 the introduction of the CME Quiz. Ten questions, based on the content of the three issues of the Newsletter of the year, will be published in the December issue every year. Two CME points would be awarded for successful attempt of six or more questions.
The correct answers of the 2013 CME Quiz are attached to this issue of Newsletter at Appendix I for CMPs' reference. The 2014 CME Quiz will be published in the December issue of the Newsletter this year.
The PB held disciplinary inquiries from December 2013 to March 2014 on six registered CMPs and one listed CMP who were convicted of an offence punishable with imprisonment and/or alleged breaching the Codes. The CMPs concerned were found guilty after the inquiries. The PB ordered to remove the name of one registered CMP for 18 months; the name of one registered CMP was ordered to remove for three months with a suspension of 24 months; the name of one registered CMP was ordered to remove for three months with a suspension of 12 months; the name of one registered CMP was ordered to remove for one month with a suspension of six months and to issue a warning; the name of one registered CMP was ordered to remove for one month with a suspension of three months; reprimand one registered CMP and put the decision for one listed CMP on record for future reference.
Summing up the above cases, the PB reminds all CMPs to take note of the following issues.
Chinese Medicine Practitioner Must Not Use Western Medicine
The PB would like to remind all CMPs that a CMP should not prescribe any Chinese herbal medicines or proprietary Chinese medicines which contain Western medicine to his patient when practising Chinese medicine. The PB is of the view that CMPs should have a thorough understanding of the regulations of practising Chinese medicine as stated in the Codes and understand the medicines which can be prescribed by CMPs under the CMO.
In addition, in order to provide safe and good medicines to patients, CMPs should buy medicines from licensed Chinese medicine traders with good reputation and should not buy medical products with unclear and unreliable source.
As CMPs prescribing herbal medicine which contains Western medicine to patient has an adverse effect on the image of the Chinese medicine profession, the PB would like to remind all CMPs to observe relevant regulations stated in the Codes at all time, i.e. CMP should adopt treatment methods on the basis of principles of the Traditional Chinese Medicine in prescribing Chinese herbal medicines or proprietary Chinese medicines and shall not use other professional treatment methods (e.g. medical practitioners). If any CMP is convicted for similar case, the PB will process the case seriously in accordance with the disciplinary procedures stipulated under the CMO.
Standards on Prescribing Medicines
It is stipulated in the Codes that a CMP shall issue prescriptions which conform with professional standards and shall not prescribe excessive or inappropriate medicines. If a CMP prescribes inappropriately with excessive dosages or excessive number of medicines without referring to any therapeutic principles, treatment methods, treatment priorities, or against the principle by which medicines are combined, the treatment of patients would be adversely affected.
In addition, the PB reminds all listed CMPs that, according to section 109 of the CMO, only registered CMPs are permitted to prescribe Chinese herbal medicines specified in Schedule 1. For details of the provision and the schedule, please visit this website (http://www.legislation.gov.hk/blis/eng/index.html). If any listed CMP prescribes Chinese herbal medicines specified in Schedule 1 of the CMO, the PB will process the case seriously in accordance with the disciplinary procedures stipulated under the CMO.
Issuance of Prescriptions
The PB also noticed that there were CMPs failing to issue prescriptions to their patients and would like to remind all CMPs that patient has the rights to know clearly the details of the Chinese herbal medicines being prescribed. In case of any medical incident, medical professionals whom the patient is referred to can make use of the prescription to take immediate follow up actions so as to maintain the benefits of the patient. The Codes also state that the contents written on the prescription issued by CMP must be clear and easily legible. In addition, prescription must include the names of all Chinese herbal medicines; their dosages; number of times for re-dispensing; method of use of the medicines; name, address, contact telephone number and signature of the CMP and the issue date of the prescription.
The Codes also state that the names of Chinese herbal medicines should be based on the names in Schedules 1 and 2 of the CMO. Names of Chinese herbal medicines not listed in the Schedules should be based on the names in the "Pharmacopoeia of the People's Republic of China"(《中華人民共和國藥典》), the "Chinese Materia Medica", (written by XU Guojun etc.)(《中醫藥材學》(徐國鈞等著)), the "Dictionary of Chinese Herbal Medicines"(《中藥大辭典》) or the "Chinese Herbal Medicines"(《中華本草》).
Practising Certificate of Registered Chinese Medicine Practitioners
According to Section 76 of the CMO, registered CMPs shall not practise Chinese medicine unless they are the holders of valid practising certificate. In addition, according to the Codes, registered CMPs must display their practising certificates at a conspicuous place in the clinic.
As one of the providers of professional healthcare services, CMPs also play a significant role in promoting public health education. The PB has noticed that CMPs may, from time to time, publish articles on health information in newspapers, magazines or publications. The PB would like to remind CMPs that they must abide by the regulations stipulated in the Codes that the information given by them should be on the basis of principles and theories of traditional Chinese medicine, and they must ensure that the contents are accurate, true and based on objective facts. Such information must not be exaggerated or misleading, arouse public concern or anxiety or cause to generate unrealistic expectations. Should there be any breach of the Codes, a CMP may be charged with misconduct in a professional respect and be subject to disciplinary inquiries by the PB.
The provision on pCms to be registered under the CMO has come into effect since 3 December 2010. All products meeting the definition of pCm are required to be registered by the Chinese Medicines Board under the Chinese Medicine Council of Hong Kong (CMCHK) before they can be imported, sold and possessed in Hong Kong. Any person who manufactures, sells or possesses any unregistered pCm in Hong Kong commits an offence and is liable to a maximum fine at level 6 (currently HK$100,000) and to imprisonment for two years.
To facilitate business and the development of Chinese medicines, the CMO has laid down the conditions and provisions for exemption of pCms from registration. The following are for reference only and provisions in the law should prevail (www.legislation.gov.hk). A pCm will be exempted from registration if –
it is of a reasonable quantity that is manufactured by a manufacturer, or imported by a wholesaler of pCm, for the purposes of providing samples and seeking registration (section 119(3) of the CMO);
it is required for the purposes of education or scientific research; and the Chinese Medicines Board may exempt, with or without conditions or restrictions, a person or institution concerned with education or scientific research from the requirements for registration for the pCms in question (section 158(1) of the CMO);
it is imported by a wholesaler of pCms for the purpose of re-exporting by the same wholesale dealer (section 158(5)(a) of the CMO);
it is imported by a holder of a valid certificate for clinical trial and medicinal test and is to be used for the purposes of the clinical trial or medicinal test to which the certificate relates (section 158(5)(b) of the CMO);
it is compounded by or under the supervision of a registered or listed CMP at the premises where he practises if such pCm is being used for the purpose of administering or supplying to a patient under his direct care (section 158(6)(a) of the CMO);
it is individually prepared or compounded for a patient-
by a person nominated under section 114(2)(b)(i) or (ii) of the CMO; or
under the supervision of such person,
at the premises in respect of which a retailer licence is in force and in accordance with a prescription given by a registered or listed CMP (section 158(6)(b) of the CMO);
it is manufactured in the premises in respect of which a manufacturer licence is in force, and by or under the supervision of a responsible person in accordance with a prescription given by a registered or listed CMP; and
it is for internal application or both internal and external application, and the medicine is to be administered or supplied to the patient to whom the prescription is given and who is under the direct care of the Chinese medicine practitioner; or for external application only, and the medicine is to be administered or supplied to a patient or patients under the direct care of the CMP; and
the Chinese Medicines Board has received from the manufacturer, at least one working day before the day on which the manufacturing process of the medicine begins, a written notification including the particulars set out in section 37(2) of the Chinese Medicines Regulation and being accompanied by an undertaking referred to in section 37(3) of the Chinese Medicines Regulation (section 37(1) of the Chinese Medicines Regulation).
Currently, it is quite common for CMPs to prescribe Chinese medicine granules for patients. For single Chinese medicine granules, they are for use by CMPs in herbal formulation as a substitute for processed herbal medicines in general. These products are not subject to registration as they do not fall within the definition of pCm. However, since compound Chinese medicine granules and other single Chinese medicine granules which are openly sold meet the definition of pCm, these products are required to be registered in accordance with the stipulations of the CMO except under and in accordance with the provisions on exemption of pCms from registration in the CMO.
For information on registration of pCms and details of the registered pCms, please visit the website of the CMCHK (http://www.cmchk.org.hk).
The Air Pollution Control (Amendment) Ordinance 2014 (the Amendment Ordinance) enforced by the Environmental Protection Department (EPD) has been passed by the Legislative Council and will come into operation on April 4 this year. The views of the Chinese Medicines Board under the CMCHK on this subject, which were submitted to the EPD earlier, have been incorporated in the Amendment Ordinance. Details are summarised in the ensuing paragraphs.
To further safeguard public health, the Amendment Ordinance bans the import, transhipment, supply and use of all forms of asbestos and asbestos containing materials, including all Chinese herbal medicines and pCms which contain asbestos or those with asbestos containing materials. The affected Chinese herbal medicines include tremolitum and actinolitum, the former being a Chinese herbal medicine included in Schedule 2 of the CMO. Exemption will be given to a pCm that fulfils the following conditions:
it is a pCm registered under section 121(2) of the CMO;
it is a pCm deemed under section 128(2) of the CMO to be registered; and
it is a pCm exempted from registration under section 158(5) of the CMO.
Besides, the above exemption is also applicable to a person or an institution exempted from registration under section 158(1) of the CMO.
Regarding the relevance of the Amendment Ordinance to the Chinese medicines trade, CMPs should take note that tremolitum and actinolitum, which are Chinese medicines, have been prohibited from supply and use. While registered pCms are exempted, to safeguard public health and avoid inhalation of asbestos fibres when pCms containing tremolitum are misused, the Chinese Medicines Board has decided that the following contents must be added under the "precautions to be taken regarding its use" in the package insert of the oral dosage form of pCms containing tremolitum2:
Capsule: "This product contains Tremolitum. Take the capsule by swallowing it whole. Don't open the capsule."
Pill: "This product contains Tremolitum. Take the pill by swallowing it whole. Don't crush the pill."
Accordingly, the Chinese Medicines Board has resolved that the "Guidelines on package inserts of proprietary Chinese medicines (Reference for Industry)" (guidelines on package inserts) has to be revised and that holders of pCm registration are required to replace the package inserts by 30 September 2014 in order to meet the requirements of the revised guidelines on package inserts. The revised guidelines can be downloaded from the website of the CMCHK (http://www.cmchk.org.hk/pcm/pdf/gp_pcm_e.pdf).
In view of the impacts of the implementation of the Amendment Ordinance on Chinese medicines dealers and the wide variety of ingredients of Chinese medicine products containing asbestos materials that Chinese medicines dealers might have enquiries on how to dispose these products, the EPD has issued a letter, via the CMCHK, to all Chinese medicines dealers and CMPs before the Amendment Ordinance comes into operation, to state and explain the provisions relating to the Chinese medicines trade in the Amendment Ordinance and to provide guidelines on how to dispose Chinese medicine products containing asbestos materials, so that the trade may have ample time to adapt themselves for the implementation of the legislation.
The letter issued by the EPD and a flow chart on the regulation of Chinese medicine products as stipulated in the Amendment Ordinance are set out at Appendix 2 (Chinese Version Only) for CMPs' reference. Should there be any enquiries on the Amendment Ordinance or the Waste Disposal Ordinance, please contact Miss Doris LEUNG (tel. no.: 2835 1235) or Mr Dennis LEUNG (tel. no.: 2835 1027) of the EPD direct.
2Records show that currently there are tremolitum (as an active ingredient)-containing registered pCms; there are no registered pCms which contain actinolitum as their active ingredients.
April 7 of each year is designated the World Health Day. The World Health Organisation will select a theme for the day to highlight a priority area of public health concern in the world. The theme for this year is vector-borne diseases.
In response to the World Health Day, the Department of Health launched a territory-wide publicity and public education campaign in April this year. The slogan of the Campaign is "Beware of stings - protect ourselves from vector-borne diseases". Through this Campaign and active support from all, the Department of Health aims to raise the awareness of the general public on the threat posed by vectors and vector-borne diseases.
The letter issued to CMPs by the Department of Health is at Appendix 3 (Chinese Version Only) for reference of all CMPs. To obtain more information or educational resources on vector-borne diseases, please visit the thematic miniweb of the Centre for Health Protection at http://www.chp.gov.hk/whd.
All CMPs are requested to notify the Secretariat as soon as possible if there are changes in their registered address, correspondence address, practising address, telephone number, fax number and other personal data which have been previously reported to the PB. The form of Change of Personal Particulars of CMPs can be obtained from the Secretariat or downloaded from the CMCHK homepage (http://www.cmchk.org.hk).
Should you have any opinions regarding the content of the Newsletter, please write to the Secretariat by post, fax or email, indicating "Newsletter of the Chinese Medicine Practitioners Board". Every issue of the Newsletter is uploaded to the CMCHK homepage (http://www.cmchk.org.hk) after publication and those CMPs who are interested may visit the above website.
Chinese Medicine Council of Hong Kong
Room 2201, 22/F, Wu Chung House, 213 Queen's Road East,
Wanchai, Hong Kong
Enquiry telephone: (852) 2121 1888
24-hour enquiry system: (852) 2574 9999
Fax Number: (852) 2121 1898
E-mail Address: email@example.com
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