This is also the flip side of the various challenges that cosmetic medicine currently faces, and at the meeting, there were a series of harsh remarks from members, including those involved in cosmetic medicine, such as, "We must not allow bad money to drive out good money" (Miyagawa Masaaki, standing director of the Japan Medical Association), and "The problem is the morals of doctors. Unless we do something about this, we probably won't move forward. I think the number of doctors who are straying from morals is increasing more than you would imagine" (Kujime Akito, president of Kyoritsu Plastic Surgery Clinic).

　The background to the launch of the study group is that while the number of doctors and medical institutions providing cosmetic medical treatments and the ease of access to services, such as online consultations, are on the rise, the number of consultations and cases of harm from users is also on the rise. The number of doctors working primarily in "cosmetic surgery" at clinics is steadily increasing, and many of them are in their 20s and 30s. Among consultations regarding cosmetic medical treatments, the number of cases that fall under "harm," such as skin disorders, burns, and digestive disorders, is on the rise.

　Cosmetic medical treatment covers a wide range of topics. This committee will focus on "medical procedures" for "beauty purposes" and will discuss the issue from two perspectives: solicitation, explanations, and contracts, and the implementation of medical treatment. From the next meeting onwards, they will hear case studies related to these issues, discuss the causes and issues by type, and continue to discuss the direction of responses, aiming to reach a conclusion by the end of 2. Professor Ono Taichi of the National Graduate Institute for Policy Studies has been appointed as the chairperson (materials are available on the Ministry of Health, Labour and Welfare's website).

(Documents from the Study Group on the Appropriate Implementation of Cosmetic Medical Treatment, June 2024, 6)

　In health insurance treatment, guidance, audits and timely investigations are carried out, but cosmetic medical treatment, which is an elective medical treatment, is not subject to these. Opinion-based medical treatment is also subject to guidance and supervision by the public health center, but the public health center has expressed opinions such as "it is not clear how medical-related laws and regulations should be applied to various medical procedures, and there is little evidence to judge compliance with laws and regulations."

　The report is expected to categorize problematic cases to a certain extent and take measures for each type, but one point to watch is whether it will go as far as to introduce some kind of legal regulation. "If there is not a thorough discussion on how the government, including the Ministry of Health, Labor and Welfare, will crack down on those who deviate from the rules, there will be no appropriate development of cosmetic medicine," said Miyagawa of the Japan Medical Association.

　The members of the conference include Tatsuro Kamakura, president of the Japanese Society of Aesthetic Plastic Surgery (JSAS), Kei Takeda, president of the Japanese Society of Aesthetic Plastic Surgery (JSAPS), and Ritsu Aoki (director of Greenwood Skin Clinic Tachikawa), former president of the Japanese Association of Aesthetic Medicine. As other members unanimously pointed out, a major challenge is how to publicize and raise awareness of the proposed measures to those outside the society, so that bad money does not drive out good money. The Consumer Affairs Agency, which attended as an observer, advised, "The challenge is how we can all work together to increase coverage and counter-force against outsiders."

　The current situation in which many young doctors are moving into cosmetic medicine, and the problem of uneven distribution of doctors in various medical specialties, are outside the scope of this study group. In addition, medical institutions that provide cosmetic medicine are managed by individuals, medical corporations, and general incorporated associations, but the committee does not plan to delve into the issue of governance.

The number of clinic "cosmetic surgeons" has more than tripled in about 15 years

　At the first meeting, the Ministry of Health, Labour and Welfare presented materials on the current state of cosmetic medical treatment, and the Japan Association of Aesthetic Medical Treatment introduced "Inquiries received through the public online consultation room." The meeting then took the form of a discussion on cosmetic medical treatment, including the scope of this study group.

　Between 2008 and 2022, the number of doctors primarily engaged in "cosmetic surgery" at clinics more than tripled, while the number of doctors working in "plastic surgery" roughly doubled. In particular, the proportion of doctors in their 20s and 30s is increasing. The number of clinics that advertise themselves as cosmetic surgery also increased 2008-fold, from 983 in 2020 to 1404 in 1.4.

(Documents from the Study Group on the Appropriate Implementation of Cosmetic Medical Treatment, June 2024, 6)

　The most common cosmetic medical procedure is blepharoplasty, which is a surgical procedure, followed by hair removal, botulinum toxin injections, and cellulite treatment, which are non-surgical procedures.

　As cosmetic medical treatments become more common, the number of inquiries sent to PIO-NET (Pioneer Network: National Consumer Affairs Information Network System) is also on the rise. In addition to inquiries about contracts and fees, there have been reports of skin disorders such as "Anti-aging drips caused itching and a rash all over the body" and "Botox injections caused swelling in the eyes and a headache, and another doctor told me it would take three months for a full recovery," as well as "harm" such as burns and digestive disorders.

(Documents from the Study Group on the Appropriate Implementation of Cosmetic Medical Treatment, June 2024, 6)

The scope of the discussion also includes what constitutes "medical practice"

　The discussion began with a discussion on "medical acts." Aoki pointed out that if "medical acts," which are the scope of this study group, are discussed, the discussion will turn to whether unlicensed people should perform "medical acts" at beauty salons and other facilities. "It would be good to have a basic discussion to some extent about what the scope of medical acts is," said Aoki. Miyagawa also said that if the first step of determining whether something constitutes "medical acts" is not determined, "it will be a meaningless discussion."

　Miyazawa Hiroaki, chief inspector at Shinjuku Ward Public Health Center, said, "Some doctors believe that nurses are allowed to do whatever they want as long as the doctor gives instructions, as long as it is within the scope of 'assisting medical treatment.' I have heard of cases where this is interpreted even more broadly, and as long as a doctor is present, nurses will perform medical procedures as they see fit, even if there is no specific instruction given."

　The Ministry of Health, Labour and Welfare's secretariat responded, "The rules that apply will vary depending on whether it is a medical procedure or not. If it is a medical procedure, it will naturally be subject to the Medical Practitioners Act and other laws, but if this is unclear or, in a sense, interpreted arbitrarily, it could lead to illegal acts, so this point will be discussed at the study group."

Will the "GLP-1 diet" become popular through online medical consultations?

　One of the individual issues that came up was the "GLP-1 diet." "Recently, we've seen an increase in inquiries about using online medical consultations for cosmetic medical treatment. They're probably thinking about prescribing GLP-1. If this type of treatment increases in the future, there will be less GLP-1 on the market, and it will no longer be possible for it to reach those who really need it (through insurance treatment)," said Miyazawa.

　Concerns that elective medical treatment would put a strain on insured medical treatment were also raised from another perspective: "If a problem occurs during cosmetic medical treatment and the treatment is covered under insured medical care, it will eat into the insurance finances. Ideally, this should be dealt with as part of elective medical care, but this is something that is not being done," said Miyagawa.

Social media has diversified the sources of information available to citizens, but it can also be difficult

　Furthermore, it was also pointed out that it is necessary to raise literacy among the general public, not just those providing medical care, so that they do not resort to cosmetic medical treatments without careful consideration. "High-quality cosmetic medical treatments exist. I would never resort to anything else. It is very important to raise literacy so that people only undergo cosmetic medical treatments after receiving a proper explanation. I would like to see high-quality information provided to the general public," said Miyagawa.

　Yuriko Umino, a beauty and medical journalist, said that the spread of social media has enabled clinics that had not previously been featured in the media to simultaneously publicize themselves, and that "doctors with no skills or experience are attracting young patients, and all sorts of things are happening." She pointed out that it is difficult to deliver appropriate information because there are so many different sources of information.