Sunday, January 31, 2010

Medical Tourism is On The Rise

Angioplasty in Argentina ? A mastectomy in Malaysia ? Plastic surgery in Paraguay? Or a cosmetic cut-n-paste in Costa Rica ? You've probably already heard about it, but what you may not know is that in recent years, medical tourism has grown into a multi-billion dollar business. And more growth is expected.

According to an article published in 2005 from the University of Delaware publication, UDaily:

"A heart-valve replacement that would cost $200,000 or more in the US, for example, goes for $10,000 in India--and that includes round-trip airfare and a brief vacation package.

Similarly, a metal-free dental bridge worth $5,500 in the US costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about one-fifth of what it would in the States

Lasik eye surgery worth $3,700 in the US is available in many other countries for only $730."

An estimated 750,000 Americans went abroad for health care in 2007 and consulting firm Deloitte published a report in 2008 that projected a tenfold increase in medical tourism over the next decade. The growth in medical tourism results in billions of dollars in savings to patients, and in even more in lost revenue to U.S. health providers.

Overseas surgery costs less, but why ? For one, there is a more favorable malpractice system in many countries, plus a lower cost of building, staffing, and maintaining facilities. Overseas hospitals and surgeons are also not burdened by insurance paperwork and billing because their patients typically pay cash up-front. Follow-up care, which consumes a large amount of a doctor's time, is also virtually non-existent.

Medical tourism is not without it's risks and pitfalls, however.

Patients travelling are often recruited or channelled trough a "booking agency" that receives payment for the referrals. This bypasses the usual doctor's referral and recommendation process, and patient's are largely left to word-of-mouth recommendations or the internet. Both of these processes can be influenced at various levels, and are generally a poor substitute for physician-to-physician referral.

Checking credentials on doctors and facilities in various countries is often difficult, as there is no standard that is uniformly accepted. Board-certification, for example, requires continuing medical education in the U.S. and in fact is a law to maintain licensure in all states. This varies widely in other countries.

Patients also do not enjoy the same degree of consumer protection due to the lack of an aggressive malpractice system in most other countries.

In the U.S., the Joint Commission is an independent, not-for-profit organization that develops nationally recognized standards to improve patient care and safety. They work with hospitals to help them meet standards for patient care, and then accredit those hospitals who achieve those standards.

Joint Commission Internationalis a relative of the Joint Commission in the United States that has been accrediting hospitals since 1999. Overseas institutions, mindful that American consumers value accreditation, are increasingly looking towards this international accreditation. Competition between overseas hospitals for American medical tourists will likely result in a move towards accreditation.

Unfortunately, in the plastic surgery arena, where most surgery is done in clinics, there are no international regulatory agencies in place. The highly publicized deaths of celebrities such as Donda West and Argentinian beauty queen Solange Magnano have heightened public awareness about the safety of plastic surgery procedures being done in clinics without adequate personnel and equipment for aftercare.

Likewise, the media is replete with patients who have returned from plastic surgery overseas with complications or unfavorable results. Finding care domestically is difficult or impossible for these individuals. Plastic surgery complications, usually minor, are a simple fact of life. But their treatment and outcome vary significantly, depending on whether they occur at home or abroad. Dr Jospeh Capella, a pioneer in post-weight loss plastic surgery, reported a complication rate of 50% after large procedures such as body lift, whereas Dr. Dennis Hurwitz, founder of the total body lift procedure, reposted a complication rate of 76%.

Medical devices used overseas also vary in terms of their quality warranty support. Breast implants placed outside of the U.S. by either of the 2
major manufacturers are not warrantied in the U.S. Replacement surgery, if needed due to rupture or leak, must be done in the country of origin.

Capella JF. Body Lift Clin Plast Surg. 2008 Jan;35(1):27-51.

Hurwitz DJ, Agha-Mohammadi S, Ota K, Unadkat J. A clinical review of total body lift surgery. Aesthet Surg J.2008 May-Jun;28(3):294-303; discussion 304-5.

Saturday, January 30, 2010

Obesity is Unhealthy : For Reasons You Might Not Think

A recent report on revealed an unpleasant truth in medicine, but one I've known about for years. It's shocking, but it's true: Being a woman who's more than 20pounds overweight may actually hike your risk of getting poor medical treatment. In fact, weighing too much can have surprising -- and devastating -- health repercussions beyond the usual diabetes and heart-health concerns you've heard about for years.

According ther the article, studies have found that if you are an overweight woman you:

• May have a harder time getting health insurance or have to pay higher premiums

• Are at higher risk of being misdiagnosed
• Are less likely to find a fertility doctor who will help you get pregnant

• Are less likely to have cancer detected early

Fat discrimination or obesity bias is part of the problem. A recent Yale study suggested that this bias can start when a woman is as little as 13 pounds over her highest healthy weight.

Our culture has enormous negativity toward overweight people, and doctors aren't immune. Dr. Jerome Groopman, a Harvard Medical School professor and author states "Our culture has enormous negativity toward overweight people, and doctors aren't immune," He is author of a book called "How Doctors Think." "If doctors have negative feelings toward patients, they're more dismissive, they're less patient, and it can cloud their judgment, making them prone to diagnostic errors."

With nearly 70 million American women who are considered overweight, the implications of this new information is disturbing.

When Jen Seelaus, from Danbury, Connecticut, went to her doc's office because she was wheezing, she expected to get her asthma medication tweaked. Instead, she was told she'd feel better if she'd just lose some weight. "I didn't go to be lectured about my weight. I was there because I couldn't breathe," says the 5-foot-3, 195-pound woman. "Asthma can be dangerous if it gets out of control, and the nurse practitioner totally ignored that because of my weight."

Seelaus's nurse made a classic diagnostic error, according to Groopman. "It's called attribution, because your thinking is colored by a stereotype and you attribute the entire clinical picture to that stereo­type. Because obesity can cause so many health problems, it's very easy to blame a variety of complaints, from knee pain to breathing troubles, on a patient's weight. That's why doctors -- and patients -- need to constantly ask, 'What else could this be?' "

There aren't statistics on how many diagnostic errors are due to weight, but the data for the general population is disturbing enough. Researchers at Rice University and the University of Texas School of Public Health in Houston found that as patient BMI increased, doctors reported liking their jobs less and having less patience and desire to help the patient.

Whether they know it or not, doctors' attitudes may actually encourage unhealthy behavior.

Feeling dissed about their weight can make some women turn to food for comfort. "Stigma is a form of stress, and many obese women cope by eating or refusing to diet," Puhl says. "So weight bias could actually fuel obesity."

Studies have also found that overweight women are more likely to delay doctors' appointments and preventive care, including screenings for cancer, because they don't want to face criticism. "It can be frustrating to treat obese patients," admits Dr. Lee Green, M.D., M.P.H., a professor of family medicine at the University of Michigan in Ann Arbor. "I spend most of my time treating the consequences of unhealthy lifestyles instead of actual illnesses.

Tuesday, January 26, 2010

Stem Cells Will Benefit All Aspects of Plastic Surgery

Grow your own breast implants ? Replace a broken bone or a clouded cornea ?Having your very own custom-grown tissues available "off the shelf" in case of damage or disease will happen to some degree in our liftetimes.

Researchers have already shown how cosmetic surgery might be improved with natural implants that keep their original size and shape better than synthetics.

Natural tissues, instead of synthetic implants, would also allow easier breast reconstruction after breast cancer, or soft tissue replacement following cancer or trauma surgeries.

Cells needed for the implant can be obtained by a simple needle stick, compard to the dramatic transfers of tissues from other parts of the body, which are currently the norm. The other option is tissue from cadavers, such as the recent and much-publicized face and hand transplants.

These procedures, however, require that patients take a lifetime of powerful drugs to suppress the immune system.

Interestingly, the best source of stem cells is plain old fat. As in the stuff I remove during liposuction. Maybe we shouldn't be so quick to throw it all away !

New York Wants To Take My Drug Rep Sandwich

According to a recent issue WSJ blog, Governor David Paterson of New York wants to join Massachusetts and Vermont in limiting the ties between drug companies and doctors.

Paterson’s proposal is less restrictive than some. It would still allow drug reps to bring lunch to doctors’ offices, for example, though it would ban taking docs or their staff out to a restaurant. Gifts “such as floral arrangements, artwork, compact discs or tickets to a sporting event” would also be prohibited.

The proposal also regulates consulting relationships between doctors and drug companies, and more importantly, industry funding of continuing medical education.

Health-care professionals could be fined $5,000 to $10,000 for violations !

I am certainly against the influence wielded by big pharma and the medical device companies, but I don't think a drug rep bringing pens and lunch to a doctor's office is the root of the problem. Patterson's misdirected priorities, by the way, are also leading New York to consider tax sodas. Because they cause obesity. Right.

Has anybody considered the $38 million spent by the insurance lobby to influence lawmakers as part of the problem ? Or an equal amount of time and money spent by big pharma to buy face time with lawmakers on Capitol Hill ? These are the real problem when it comes to industry influence. Always has been.

To be sure, I think that doctors who are on the payroll of the companies (usually to the tune of $100,000/year) for their cheerleading tours to promote drugs need to decide whose team they are on. Those arrangements need to be targeted for reform.

So before they vote to ban my staff from getting a few notepads and Subway sandwiches, maybe lawmakers should look at where the real problem lies.'s not in my turkey and's that lobbyist waiting outside your door.