By CLARK HOYT
Published: January 16, 2010
WHEN The Times interviewed Michael Chertoff about airport security after the underwear bomber tried to blow up a passenger jet on Christmas Day, he said full-body scanners should be deployed at airports. Chertoff, the former secretary of homeland security, did not volunteer that he is a consultant to a company that makes such equipment, and though they spoke to him twice, reporters never asked if he had a financial stake in the matter.
Peter Galbraith, a former diplomat, wrote several Op-Ed columns a few years ago supporting a strong and independent Kurdistan. The editors who published his pieces learned only in November — from a front-page article — that Galbraith’s business ties to a Norwegian oil company operating in Kurdistan positioned him to earn millions.
Jonathan Gruber, a prominent M.I.T. health economist, wrote an Op-Ed column and was quoted frequently in other Times columns, news articles and blogs on health care reform before it came to light that he had a contract worth nearly $400,000 to analyze health proposals for the Obama administration.
Neil Sadick, a famed Manhattan dermatologist, was quoted in a Skin Deep column discussing electronic devices for the home treatment of acne, but the article did not say that Sadick has a business relationship with a company that makes one of the devices.
These examples have resulted in five embarrassing editors’ notes in the last two months — two of them last week — each of them saying readers should have been informed of the undisclosed interest. And on Thursday, the standards editor sent Times journalists a memo urging them to be “constantly alert” to the outside interests of expert sources. The cases raised timeless issues for journalists and sources about what readers have a right to know and whose responsibility it is to find it out or disclose it.
The ideal expert source is entirely independent, with no stake in an outcome. But in reality, the most informed sources often have involvements, which is why they know what they know. Readers are entitled to disclosure so they can decide if there is a conflict that would affect the credibility of the information.
But each recent Times case showed how tricky it can be to navigate the ethics of disclosure.
Chertoff, who championed full-body scanners as head of the Department of Homeland Security, long before he went into private business, said it was no secret that he had become a consultant to corporate clients through the Chertoff Group, a risk-management firm he formed in March. He said that when two Times reporters, Eric Liptonand John Schwartz, called and the subject turned to scanners, it was up to them to ask whether he had ties to that industry. “I always answer when I’m asked,” he said. “But I don’t think it is my obligation to put myself in the head of a reporter” to decide what the reporter needs to know.
Chertoff did tell NPR and CNN interviewers when they asked.
Lipton and Schwartz agreed that they should have asked Chertoff, but both expressed disappointment that he did not volunteer obviously germane information. Bob Steele, a professor at DePauw University and a journalism values scholar at the Poynter Institute, said, “I believe a source does have an affirmative obligation to reveal any competing loyalties, even if the source isn’t sure they create a direct conflict of interest.”
Interestingly, Chertoff wrote an Op-Ed article for The Washington Post, published New Year’s Day, that carried a one-sentence biography divulging that his clients included a scanner manufacturer — a note he said he volunteered.
“If I’m affirmatively getting out there,” he said, as opposed to being called by a reporter, “I make it my business to disclose.” That’s a distinction I don’t buy. What difference does it make whether a source seeks a forum or a reporter happens to call? Knowing Washington’s culture of revolving doors and news spin, the Times reporters should have asked the obvious question. But if Chertoff had a connection he thought the public needed to know in one instance, he should have made it clear in the others.
Galbraith said he regretted not telling Times editors that he had business interests in Kurdistan when he wrote Op-Ed columns published in 2005 and 2006. He did provide a vague disclosure for one in 2007. But he disputed the November editors’ note that said he could have benefited from an independent Kurdistan because he had a stake in an oil field there.
He said his support of an independent Kurdistan was against the interests of DNO International, the oil company with which he had a relationship, because it had invested $300 million in Iraq, expecting it to remain unified. “I did not promote or discuss matters of specific interest to my clients and, indeed, my generally pessimistic view of Iraq’s future was not consistent with the interests of companies trying to attract investors for projects in the country,” he said.
Galbraith asked where the line was if an Op-Ed contributor was writing about political issues in a country where he also had economic interests. Because politics and economics so often go hand in hand, I would say someone in his shoes should disclose all interests to editors and discuss whether any pose a conflict that needs to be disclosed to readers. That is what The Times requires of all Op-Ed columnists, in plain, written language.
Gruber, the health care economist, wrote an Op-Ed column in July supporting an excise tax on so-called Cadillac health plans. Not long before, he had signed a contract with the Department of Health and Human Services to analyze the economic impact of various health care proposals in Congress. He did not tell Op-Ed editors, nor was the contract mentioned on at least 12 other occasions when he was quoted in The Times after he was consulting for the administration. After a blogger reported on Gruber’s government contract on the Daily Kos Web site, Gruber did volunteer it to Steven Greenhouse, a Times reporter interviewing him for an article on the excise tax. Greenhouse said he included the fact in a draft but struck it because the article was too long. Greenhouse said that Gruber’s views on the tax were so well-known that he did not think they would be influenced by a consulting contract. But had he realized how large the contract was, Greenhouse said, “I would have stood up and paid lots more attention.”
Gruber said, “I guess it never occurred to me that the fact that I was doing technical modeling would matter.” He said he has long supported the tax and that the administration opposed it when he wrote his column, so he was hardly bending his views to a government paymaster.
Sometimes, there can be misunderstandings even when a reporter asks. Camille Sweeney, the freelancer who interviewed Sadick about acne treatments, said she asked the dermatologist a specific question: Had he been paid by any manufacturer for tests he performed on the products? He said he had not. But after the article was published, a Times editor recalled seeing an endorsement by Sadick for a hair removal product by one of the manufacturers.
What is the lesson from all this? Lipton said, “I do need to ask whenever I call a person for comment as an expert if they have any financial relationship with the topic.” He said he has posted a reminder on his computer: “Ask if hired gun.”
Tuesday, January 19, 2010
Thursday, November 19, 2009
Thursday, November 12, 2009
Surgery at a Spa? Buyer Beware.
Béatrice de Géa
New York Times
Published: November 4, 2009
THERE is little to suggest that the TriBeCa MedSpa in Manhattan is a medical facility, at least in the traditional sense. In the waiting area, called the Tranquillity Room, a waterfall cascades down one wall. A client may have a pedicure or facial before entering a softly lighted space where a plastic surgeon performs laser Fraxel treatment or some other minimally invasive procedure that would cost twice as much in a harried doctor’s office.
TriBeCa MedSpa is one of 1,800 medical spas in the United States, hybrid facilities that offer treatments like laser hair removal and liposuction alongside massages and other traditional spa fare. In recent years, the business has become a growth industry: from July 2007 to December 2008, the number of medical spas increased 85 percent, according to the International Spa Association, far outpacing the growth of day, destination and resort spas.
The kinds of procedures performed in medical spas has also increased. At the Park Avenue Medical Spa in Armonk, N.Y., for instance, clients who have undergone chemosurgery for skin cancer, which may leave the skin pitted, can receive reconstructive surgery, a treatment that falls outside the strictly aesthetic category and may point in the direction the industry is evolving.
“It certainly seems like the wave of the future,” said Dr. Gerald Ginsberg, a cosmetic surgeon and medical director of the TriBeCa MedSpa, who noted that, increasingly, patients are becoming “customers” searching for the best deal in what he calls “today’s medical emporia.” All the more reason, in his mind, that it is important to enforce regulations “to ensure we’re offering the best care for the best price.”
In fact, despite the many well-regarded facilities like TriBeCa MedSpa, the rapidly growing industry is coming under increased scrutiny. Proposed legislation to tighten controls over the credentials of those who can own a medical spa; what procedures can be performed in such places; and how much training someone must have to perform particular procedures is making its way through several state medical boards, including those in Massachusetts, New York, Utah and Florida, where the death last month of a patient, Rohie Kah-Orukotan, is generating renewed concern.
On Sept. 25, Mrs. Kah-Orukotan, a 37-year-old nurse, entered the Weston MedSpa in Weston, Fla., for a minimally invasive liposuction procedure to remove fat from her abdomen and thighs. During the treatment, she suffered seizures and never regained consciousness.
Michael Freedland, the family’s lawyer, said she was given Lidocaine and propofol, a drug that induces sedation and is believed to have contributed to the death of Michael Jackson.
The case, which is still under investigation, raises several issues that concern experts around the country. First, should the treatment — which may actually have been, by the state’s classification, a more advanced, or Level II, liposuction procedure — have been performed at Weston MedSpa, which is licensed as an electrolysis facility, not a medical facility?
“We believe Mrs. Kah-Orukotan received more than a minimally invasive Level I liposuction procedure in a setting that was inappropriate,” Mr. Freedland said. In fact, a new rule before the state’s board of medicine would not allow any surgical procedure that requires sedation to occur outside of a registered Level II surgery facility.
And then there is the question of the experience of the doctor who performed the procedure on Mrs. Kah-Orukotan. Dr. Omar Brito Marin, a medical doctor with a specialty in occupational medicine, learned liposuction in a three-day intensive course, according to his lawyer, Brian Bieber, who said he believes no malpractice was committed in the case.
For some industry observers, the issue of training and experience is the cause for perhaps the greatest concern. Dr. Darrick Antell, a plastic surgeon in Manhattan, noted that all too frequently someone who starts out performing one procedure migrates to another with only minimal experience. “Someone may start out doing laser hair removal, and next thing you know they’re doing treatments for cellulite,” said Dr. Antell, who said that personnel in medical spas are pushing the boundaries of what is allowed.
Wendy Lewis, an aesthetic surgery consultant and author of “Plastic Makes Perfect,” said: “The incident in Florida is nothing short of tragic, and I feel for that woman’s children and family. But I say, buyer beware.”
Such sentiment applies to another popular medical spa procedure: laser hair removal. For years, complaints of second- and even third-degree burns from laser hair removal procedures have been reported. Yet in places like New York State, it is still not considered a medical procedure, despite vigorous protests from many in the medical community.
“In New York, legally, even a barber could do it, not that he would,” said Dr. David Goldberg, a cosmetic dermatologist in New Jersey, New York and Florida, as well as a law professor at Fordham University and a legal counsel to the Medical Spa Society.
In Massachusetts a medical spa task force has been set up to advise the state legislature on how best to regulate the facilities. “We are trying to set some standards here, yet make it flexible enough to accommodate rapid changes in the industry,” said Russell Aims, chief of staff of the Massachusetts Board of Registration in Medicine.
“We don’t want to say to the consumer, ‘Don’t go get these procedures done,’ or to a physician that he or she can’t profit from this potentially lucrative business, but I think it’s around the time I saw a place offering walk-in Botox shots at a mall that I became concerned,” Mr. Aims said.
“To me it’s a lot like the mortgage industry,” said Dr. Ranella Hirsch, a dermatologist in Cambridge, Mass., and an advocate for more stringent regulations of medical spas. “While it may allow more accessibility to treatments and procedures, it’s also brought a much higher level of permanent injury,” she said. Dr. Hirsch added that she thinks a system of federal regulations of medical spas would be more cohesive than the current state-by-state model but believes that is unlikely to happen, since medical and other professional boards, like nursing, electrology and aestheticians boards, are regulated and licensed by individual states.
“What is likelier to happen (and currently under way) is that national organizations like the American Society for Dermatologic Surgery, which represents member dermatologists nationwide, provide guidelines for legislative guidance state by state,” she said in an e-mail message.
Despite all the safety and regulatory controversies concerning medical spas, there are thousands of satisfied medical spa customers. Among them is Gail Fox of Palm Beach Gardens, Fla., who went to the Anushka Cosmedical Center Spa and Salon in West Palm Beach, for facial fillers that were administered by a nurse practitioner and found the experience “a pleasure.” “The service was on sale so the price was right. That’s what drew me in. The pace was slower than at my dermatologist’s office. All my questions were answered, and I didn’t feel pressured,” Ms. Fox said.
“These places can offer a wonderful opportunity for a consumer to reduce stress and get treatment for the whole body,” said Lynne McNees, president of the International Spa Association. But, she added, “just because someone is in a white coat, it doesn’t mean he or she is a qualified to perform a procedure on you.”
Both Ms. McNees and Hannelore Leavy, executive director of the International Medical Spa Association, emphasized the efforts their associations are making to educate the medical spa consumer. For instance, Ms. Leavy’s organization has a section on its Web site that pertains to current legislation affecting medical spas.
“If someone is cutting you open or injecting something into you it’s not a spa service, it’s a medical one,” Ms. McNees said. “You’re going to need to know who is performing that procedure, know their credentials and accreditations and really do your homework,” she said. “I tell everyone, ‘If you don’t know, don’t go.’ ”
New York Times
Published: November 4, 2009
THERE is little to suggest that the TriBeCa MedSpa in Manhattan is a medical facility, at least in the traditional sense. In the waiting area, called the Tranquillity Room, a waterfall cascades down one wall. A client may have a pedicure or facial before entering a softly lighted space where a plastic surgeon performs laser Fraxel treatment or some other minimally invasive procedure that would cost twice as much in a harried doctor’s office.
TriBeCa MedSpa is one of 1,800 medical spas in the United States, hybrid facilities that offer treatments like laser hair removal and liposuction alongside massages and other traditional spa fare. In recent years, the business has become a growth industry: from July 2007 to December 2008, the number of medical spas increased 85 percent, according to the International Spa Association, far outpacing the growth of day, destination and resort spas.
The kinds of procedures performed in medical spas has also increased. At the Park Avenue Medical Spa in Armonk, N.Y., for instance, clients who have undergone chemosurgery for skin cancer, which may leave the skin pitted, can receive reconstructive surgery, a treatment that falls outside the strictly aesthetic category and may point in the direction the industry is evolving.
“It certainly seems like the wave of the future,” said Dr. Gerald Ginsberg, a cosmetic surgeon and medical director of the TriBeCa MedSpa, who noted that, increasingly, patients are becoming “customers” searching for the best deal in what he calls “today’s medical emporia.” All the more reason, in his mind, that it is important to enforce regulations “to ensure we’re offering the best care for the best price.”
In fact, despite the many well-regarded facilities like TriBeCa MedSpa, the rapidly growing industry is coming under increased scrutiny. Proposed legislation to tighten controls over the credentials of those who can own a medical spa; what procedures can be performed in such places; and how much training someone must have to perform particular procedures is making its way through several state medical boards, including those in Massachusetts, New York, Utah and Florida, where the death last month of a patient, Rohie Kah-Orukotan, is generating renewed concern.
On Sept. 25, Mrs. Kah-Orukotan, a 37-year-old nurse, entered the Weston MedSpa in Weston, Fla., for a minimally invasive liposuction procedure to remove fat from her abdomen and thighs. During the treatment, she suffered seizures and never regained consciousness.
Michael Freedland, the family’s lawyer, said she was given Lidocaine and propofol, a drug that induces sedation and is believed to have contributed to the death of Michael Jackson.
The case, which is still under investigation, raises several issues that concern experts around the country. First, should the treatment — which may actually have been, by the state’s classification, a more advanced, or Level II, liposuction procedure — have been performed at Weston MedSpa, which is licensed as an electrolysis facility, not a medical facility?
“We believe Mrs. Kah-Orukotan received more than a minimally invasive Level I liposuction procedure in a setting that was inappropriate,” Mr. Freedland said. In fact, a new rule before the state’s board of medicine would not allow any surgical procedure that requires sedation to occur outside of a registered Level II surgery facility.
And then there is the question of the experience of the doctor who performed the procedure on Mrs. Kah-Orukotan. Dr. Omar Brito Marin, a medical doctor with a specialty in occupational medicine, learned liposuction in a three-day intensive course, according to his lawyer, Brian Bieber, who said he believes no malpractice was committed in the case.
For some industry observers, the issue of training and experience is the cause for perhaps the greatest concern. Dr. Darrick Antell, a plastic surgeon in Manhattan, noted that all too frequently someone who starts out performing one procedure migrates to another with only minimal experience. “Someone may start out doing laser hair removal, and next thing you know they’re doing treatments for cellulite,” said Dr. Antell, who said that personnel in medical spas are pushing the boundaries of what is allowed.
Wendy Lewis, an aesthetic surgery consultant and author of “Plastic Makes Perfect,” said: “The incident in Florida is nothing short of tragic, and I feel for that woman’s children and family. But I say, buyer beware.”
Such sentiment applies to another popular medical spa procedure: laser hair removal. For years, complaints of second- and even third-degree burns from laser hair removal procedures have been reported. Yet in places like New York State, it is still not considered a medical procedure, despite vigorous protests from many in the medical community.
“In New York, legally, even a barber could do it, not that he would,” said Dr. David Goldberg, a cosmetic dermatologist in New Jersey, New York and Florida, as well as a law professor at Fordham University and a legal counsel to the Medical Spa Society.
In Massachusetts a medical spa task force has been set up to advise the state legislature on how best to regulate the facilities. “We are trying to set some standards here, yet make it flexible enough to accommodate rapid changes in the industry,” said Russell Aims, chief of staff of the Massachusetts Board of Registration in Medicine.
“We don’t want to say to the consumer, ‘Don’t go get these procedures done,’ or to a physician that he or she can’t profit from this potentially lucrative business, but I think it’s around the time I saw a place offering walk-in Botox shots at a mall that I became concerned,” Mr. Aims said.
“To me it’s a lot like the mortgage industry,” said Dr. Ranella Hirsch, a dermatologist in Cambridge, Mass., and an advocate for more stringent regulations of medical spas. “While it may allow more accessibility to treatments and procedures, it’s also brought a much higher level of permanent injury,” she said. Dr. Hirsch added that she thinks a system of federal regulations of medical spas would be more cohesive than the current state-by-state model but believes that is unlikely to happen, since medical and other professional boards, like nursing, electrology and aestheticians boards, are regulated and licensed by individual states.
“What is likelier to happen (and currently under way) is that national organizations like the American Society for Dermatologic Surgery, which represents member dermatologists nationwide, provide guidelines for legislative guidance state by state,” she said in an e-mail message.
Despite all the safety and regulatory controversies concerning medical spas, there are thousands of satisfied medical spa customers. Among them is Gail Fox of Palm Beach Gardens, Fla., who went to the Anushka Cosmedical Center Spa and Salon in West Palm Beach, for facial fillers that were administered by a nurse practitioner and found the experience “a pleasure.” “The service was on sale so the price was right. That’s what drew me in. The pace was slower than at my dermatologist’s office. All my questions were answered, and I didn’t feel pressured,” Ms. Fox said.
“These places can offer a wonderful opportunity for a consumer to reduce stress and get treatment for the whole body,” said Lynne McNees, president of the International Spa Association. But, she added, “just because someone is in a white coat, it doesn’t mean he or she is a qualified to perform a procedure on you.”
Both Ms. McNees and Hannelore Leavy, executive director of the International Medical Spa Association, emphasized the efforts their associations are making to educate the medical spa consumer. For instance, Ms. Leavy’s organization has a section on its Web site that pertains to current legislation affecting medical spas.
“If someone is cutting you open or injecting something into you it’s not a spa service, it’s a medical one,” Ms. McNees said. “You’re going to need to know who is performing that procedure, know their credentials and accreditations and really do your homework,” she said. “I tell everyone, ‘If you don’t know, don’t go.’ ”
Thursday, September 17, 2009
The Alternative Medicine Cabinet: Arnica for Pain Relief By Anahad O'Connor
What alternative remedies belong in your home medicine cabinet?
More than a third of American adults use some form of complementary or alternative medicine, according to a recent government report. Natural remedies have an obvious appeal, but how do you know which ones to choose and whether the claims are backed by science? Today, New York Times “Really?” columnist Anahad O’Connor begins a weekly series exploring the claims and the science behind alternative remedies that you may want to consider for your family medicine cabinet.
The Remedy: Arnica
The Claim: It relieves pain.
The Science: Arnica Montana, a plant native to mountainous areas of Europe and North America, has been used for centuries to treat a variety of pain. Athletes rub it on muscles to soothe soreness and strains, and arthritis sufferers rub it on joints to reduce pain and swelling. It’s believed that the plant contains derivatives of thymol, which seems to have anti-inflammatory effects.
Either way, scientists have found good evidence that it works. One randomized study published in 2007 looked at 204 people with osteoarthritis in their hands and found that an arnica gel preparation worked just as well as daily ibuprofen, and with minimal side effects. Another study of 79 people with arthritis of the knee found that when patients used arnica gel twice daily for three to six weeks, they experienced significant reductions in pain and stiffness and had improved function. Only one person experienced an allergic reaction.
The Risks: Arnica gels or creams can cause allergic reactions in some people, but it is generally safe when used topically. However, it should never be rubbed on broken or damaged skin, and it should only be ingested when in a heavily diluted, homeopathic form
More than a third of American adults use some form of complementary or alternative medicine, according to a recent government report. Natural remedies have an obvious appeal, but how do you know which ones to choose and whether the claims are backed by science? Today, New York Times “Really?” columnist Anahad O’Connor begins a weekly series exploring the claims and the science behind alternative remedies that you may want to consider for your family medicine cabinet.
The Remedy: Arnica
The Claim: It relieves pain.
The Science: Arnica Montana, a plant native to mountainous areas of Europe and North America, has been used for centuries to treat a variety of pain. Athletes rub it on muscles to soothe soreness and strains, and arthritis sufferers rub it on joints to reduce pain and swelling. It’s believed that the plant contains derivatives of thymol, which seems to have anti-inflammatory effects.
Either way, scientists have found good evidence that it works. One randomized study published in 2007 looked at 204 people with osteoarthritis in their hands and found that an arnica gel preparation worked just as well as daily ibuprofen, and with minimal side effects. Another study of 79 people with arthritis of the knee found that when patients used arnica gel twice daily for three to six weeks, they experienced significant reductions in pain and stiffness and had improved function. Only one person experienced an allergic reaction.
The Risks: Arnica gels or creams can cause allergic reactions in some people, but it is generally safe when used topically. However, it should never be rubbed on broken or damaged skin, and it should only be ingested when in a heavily diluted, homeopathic form
Monday, July 20, 2009
New York nips facelift firm for astroturfing
But they're still grinning...
Posted in Music and Media, 15th July 2009 18:35 GMT
A facelift firm is being slapped with a $300,000 fine by New York state for flooding the internet with fake positive reviews about itself.
State Attorney General Andrew Cuomo said the case is believed to be the first in the US to punish so-called "astroturf" marketing.
Under a settlement deal announced Tuesday, the cosmetic surgery outfit Lifestyle Lift agreed to cut out publishing anonymous positive reviews about the company on internet message boards and websites and pay the state $300,000 in penalties.
Lifestyle Lift, which mostly targets consumers though infomercials as a "minor one-hour" facial firming procedure, has a history of aggressively guarding its reputation online. The company has filed several lawsuits alleging trademark violations against websites that publish negative reviews or comments about the company.
Cuomo's office alleges Lifestyle Lift's president decided negative internet postings were causing a significant loss of face and ordered his employees to pose as satisfied customers on various internet message boards and websites. Internal emails discovered in the investigation show specific marching orders to engage in the illegal activity:
"Friday is going to be a slow day - I need you to devote the day to doing more postings on the web as a satisfied client," one email to employees read.
"Put your wig and skirt on and tell them about the great experience you had," stated another.
Lifestyle Lift also created stand-alone websites and blogs made to appear as if they were created by independent, satisfied customers.
"I decided to create this website because I wanted to share my story with others," one such website stated. "After my first consultation, I went online and read horror stories about Lifestyle Lift. People were trashing Lifestyle Lift, their employees, their doctors, etc...I got scared and seriously thought about canceling my procedure. I was getting cold feet. What was with all the negative posts online? Those negative stories did not ad up at at...
"I realized quickly that most of that stuff was probably made up: the reviews were using long medical terms that only a doctor would use..." it continued. "I also talked to my doctor about it.... He told me that many of the negative stories I was reading online were probably from envious doctors and just made up because he never heard any of this from his patients."
According to the settlement, Lifestyle Lift employees will no longer pose as customers on the internet. The company also agreed not to promote its services without disclosing they are responsible for the contentThursday, June 4, 2009
A Face From an Infomercial
IT used to be that a cosmetic surgery patient who was tired of sagging jowls would discreetly ask for names of reputable doctors who did face-lifts. A surgeon, building a practice as word of mouth about his skills spread, became, in effect, his own brand.
But now face-lifts themselves are being branded. Certain minimally invasive procedures are marketed directly to patients in a one-size-fits-most approach. Patients pick an operation — usually after seeing it touted online, on TV or in magazines — and are referred by a national organization to a doctor.
Two procedures sold this way are the Lifestyle Lift, which an ad in Family Circle describes as “revolutionary” and a way to “remove wrinkles, frown lines and sagging skin” in about an hour; and the QuickLift, which also benefits from nationwide marketing that promotes a short recovery and only local anesthesia.
Because these procedures, priced at $4,000 and $5,900, contrast with more extensive face-lifts requiring general anesthesia and usually costing more, they have become popular: More than 100,000 patients have received the Lifestyle Lift alone since 2001, according to the company.
But some surgeons think branded face-lifts are problematic. It is not the procedures themselves that disturb critics — many plastic surgeons and otolaryngologists (head and neck surgeons) offer their own quick-recovery face-lifts. But some doctors are concerned that patients may be so persuaded by advertising that they don’t seek a second opinion or investigate the full range of options. Consumers may pick a minimally invasive procedure when the results they seek may require more complex — and expensive — intervention.
“What’s new is this is plastic surgery being marketed to the public as a widget,” said Dr. Brian Reagan, a plastic surgeon in San Diego. “People are buying, so buyer beware.”
In this new landscape, patients are encouraged to seek an advertised procedure rather than work with a surgeon to select from a menu of options. What’s more, some patients are now “looking not for the best doctor, but the one who has the magic wand,” said Dr. Reagan, who has given a lecture titled “Invasion of the Mini-Lifts ... Coming to a Clinic Near You.”
Dr. David M. Kent, an osteopath and facial plastic surgeon who founded Lifestyle Lift, said he employs nearly 100 doctors in 31 offices who are trained to do Lifestyle Lifts. (The company also has 10 doctors in private practice who license its brand.) “Every single patient gets the same basic face-lift,” he said, explaining that it consists of lifting underlying layers of muscle and connective tissue, and trimming skin. Patients also receive custom nips and tucks as needed.
The QuickLift, which roughly 10,000 patients have had since 2003, is sold differently. Doctors who offer it maintain their own practices and might also offer traditional face-lifts. A company, MDCommunications, helps those physicians market the QuickLift by placing television spots and optimizing how fast a doctor is found online.
Dr. Dominic A. Brandy, the developer of the QuickLift, coined the term to describe his adaptation of an S-lift, an operation that uses teardrop-shaped sutures to suspend sagging features. Dr. Brandy said he improved on the S-lift by pulling the face vertically instead of toward the ears.
Currently, 25 to 30 doctors receive patients through QuickLiftMd.com. The doctors attended a one-day workshop priced at $1,950 (and sometimes a few other days of training) taught by Dr. Brandy, a cosmetic surgeon with a background in emergency medicine.
Teresa Bradley, 47, found her QuickLift surgeon on the company’s site. Even before meeting him, she had decided QuickLift was for her. “I researched the procedure,” she said. “It was excellent.” But she has agonized over the results. “He lifted one side very high and left the other side hanging,” she said.
Now Ms. Bradley said she realizes the QuickLift is only as good as the surgeon doing it.
In response, Dr. Brandy said, “When you teach somebody a procedure, even if they use the basic same procedure, skill levels are so different.”
The American Society of Plastic Surgeons hasn’t taken a stand on branded procedures. But its president, Dr. John W. Canady, advised, “Go get a second opinion from someone who doesn’t have a big ad.”
Patients should be presented with a range of options, said Dr. David S. Kung, a board-certified plastic surgeon in the Washington, D.C., area. He considers deeper-plane face-lifts “the gold standard,” because they “last the longest and they can effect the maximal change,” he said. But he sees a place for middle-of-the-spectrum face-lifts, which in his opinion, include the QuickLift, Lifestyle Lift and another (nonbranded) lift, the minimal access cranial suspension.Dr. Kent said that before patients meet a Lifestyle Lift surgeon, they see a consultant and watch a video in which the company’s medical director explains its philosophy. Then they meet with a surgeon before deciding whether to proceed.
But three Lifestyle Lift patients and Dr. Mario S. Yco, a board-certified otolaryngologist who was an employee of the company for about a year, said that patients were urged to put down a deposit before they met with a surgeon.
“The consultant sold the surgery,” said Dr. Yco, who practices in Encinitas, Calif. Often by the time he saw patients, the surgery was booked. “There were many patients I had to cancel,” he said, explaining that he didn’t deem them appropriate candidates.
In response, Dr. Kent said, “It’s never a consultant that decides whether or not a patient should have surgery.” He described the company’s consultants as “people-friendly people.” They make sure patients “understand what they are getting into, explain the things we offer, talk about the doctor,” he said.
Dr. Yco said he was amazed at the power that advertising had over Lifestyle Lift patients. “They are sold by the concept, they are not sold by the surgeon’s credentials,” he said. “Unfortunately if they are not satisfied, it’s a big drop for them.” He added, “It’s like lemmings going down a cliff.”
In May, on the job site Monster.com, the Manhattan branch of Lifestyle Lift ran an ad seeking applicants to be plastic surgery consultants. “No medical experience needed,” it said, adding that the right candidate would have an “ability to match the offerings of Lifestyle Lift with the desires of Clients.”
Sharron Bryant, a manager for Lindt Chocolates in Dallas, who got a Lifestyle Lift in 2007, said she had a “high pressure” consultation and put down a deposit before meeting a surgeon. Ms. Bryant, then 59, paid $6,100 for a Lifestyle Lift and chin liposuction. She never needed pain medication during her weeklong recovery, she said.
But she disliked the loose skin that remained on her jowls and neck. “I got nothing for the money,” she said. She later paid $8,200 for a traditional face-lift from a different surgeon.
With “every plastic surgery procedure, there’s a certain number of people afterwards that are unhappy,” Dr. Kent said. “There’s nothing wrong with them medically. They are just dissatisfied.”
On Realself.com, a Web site where patients discuss cosmetic surgery, 37 percent of the 170 people who reviewed the Lifestyle Lift said the procedure was “worth it,” while 63 percent didn’t think so.
Leigh Floyd, 46, a technical writer in Houston, is an “extremely satisfied” customer of Lifestyle Lift, which she partly attributed to her realistic expectations. “You won’t look 20” afterward, she said, “because it’s still your 40-year-old skin.”
But she was most impressed by the skill of her surgeon, Dr. Kevin R. Smith, a Houston otolaryngologist. “His sutures were so tiny,” she said. “I just know I picked the right doctor.”
Here’s some advice for those considering face-lifts.
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Check whether your surgeon is certified by one of the boards of the American Board of Medical Specialties at abms.org. They require physicians to complete residency training in a specialty and to pass rigorous oral and written exams.
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Before you schedule an operation, meet the surgeon to make sure you’re on the same page. “The best surgeons will give you their honest opinion whether they can achieve what you’re looking for,” said Dr. John W. Canady, the president of the American Society of Plastic Surgeons.
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Don’t settle for a hasty consultation. The downside as well as the upside of an operation should be covered, said Dr. Robert Singer, a plastic surgeon in La Jolla, Calif.
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You should never feel as if you’re being sold a procedure. “If you’re getting a high-pressure sales pitch for a procedure, personally that would worry me,” Dr. Canady said.
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It never hurts to get a second opinion.Thursday, May 7, 2009
What to Know Before Going Under the Liposuction Knife
From a swank office on Beverly Hills' Rodeo Drive, Craig Alan Bittner built a busy cosmetic-surgery practice that specialized in a procedure he called liposculpture.
He spread the word through magazine ads in which he referred to himself as Dr. Lipo 90210. He sent out mailings showing before-and-after pictures of women's love handles, thighs and abdomens. Though he touted liposculpture as "an advanced technique," the procedure is essentially a marketing term for common liposuction surgery, medical experts say.
Body Sculpting
What to do before going for liposuction:
- Learn about liposuction and find surgeons at asds.net and plasticsurgery.org.
- Check if a doctor is certified in plastic surgery or dermatology at abms.org.
- Ask how a doctor would handle a medical emergency.
Then, in December, Dr. Bittner, who is in his early 40s, shuttered his Beverly Hills Liposculpture practice. The California Medical Board is looking into patient claims that Dr. Bittner allegedly allowed unlicensed office staff to perform cosmetic surgery. Investigators from the board's enforcement arm executed a criminal search warrant of his offices in Beverly Hills and Irvine, Calif., and his Santa Monica residence in November. The warrant, signed by a state superior court judge, sought information concerning at least 15 of Dr. Bittner's patients, whose names were listed on the warrant; employment records for office staff; and "evidence tending to show the unlicensed practice of medicine."
No charges have been filed against Dr. Bittner, and it remains unclear whether he engaged in any wrongdoing pending the outcome of the California board's inquiry. "Investigations are not public record," said Candis Cohen, a board spokeswoman.
Dr. Bittner's current whereabouts couldn't be confirmed. In a farewell letter to patients left on his Web site, he wrote that he was relocating to South America to do volunteer work with a small clinic "where I can help those most in need." In a telephone interview last month, Dr. Bittner denied any wrongdoing and said he "retired" because he wasn't enjoying his work anymore. He didn't say where he was calling from, and the line went dead midconversation.
Dr. Bittner claimed that what prompted the board's scrutiny of him was an unusual element of his practice -- using his patients' harvested fat to fuel his car. Dr. Bittner publicized this unorthodox use of body fat on a now-defunct Web site, lipodiesel.org.
The field of cosmetic surgery is rife with inflated promotional claims and malpractice suits. Still, the controversy over this high-profile practitioner of liposuction, the most common form of cosmetic surgery, spotlights some lessons for patients in how to pick a doctor in this popular field.
![[dr. lipo]](https://lh3.googleusercontent.com/blogger_img_proxy/AEn0k_uoM1Ms7HoRibpFvgPkkxZ7gAfmp0nWuvqrFiKkyN8a9rm5rVvc_mM6EohlHm06PxUpXXQcLod0kxk2LkwFOVPuqAKN7anmuCl9PDueyBrGTZCJCQTDS8tfr4TdB-qH2CWq2yGuFJ9daJz8Tausnp3q=s0-d)
Dr. Craig Alan Bittner promoted "liposculpture" in ads until closing his practice.
Plastic surgery has for years attracted doctors from unrelated specialties who are able to acquire a minimum level of training in cosmetic medicine by attending courses for brief periods, medical experts say. Liposuction surgeons may end up competing for patients mainly on the basis of aggressive marketing and advertising claims that tell consumers little about their medical qualifications. Fully trained plastic surgeons and dermatologists frequently complain about having to compete with newcomers who have little experience in the field.
State records show that Dr. Bittner graduated from the Johns Hopkins University School of Medicine in 1993. He is a licensed doctor with board certification in interventional radiology, a field unrelated to cosmetic medicine. In the telephone interview, he said his liposuction training came from a two-month apprenticeship with a dermatologist in South Florida, who he said is now deceased. He also said he trained with surgeons in Europe and attended programs at meetings of the American Academy of Dermatology.
Consumers seeking cosmetic surgery are able to check a doctor's credentials by going online. Details about a physician's board certification can be found at the American Board of Medical Specialties Web site (abms.org). Medical experts generally recommend choosing someone who is board certified either in plastic surgery or dermatology and has performed large numbers of liposuction surgeries. Patients also should check with a state medical agency Web site to see if any action has been taken against a physician's license.
John Canady, professor of plastic surgery at the University of Iowa and president of the American Society of Plastic Surgeons, said patients should question a surgeon about plans for handling a medical emergency. He says prospective patients should ask what the doctor's procedure is for handling events such as a heart attack during surgery, or an infection which could develop later. If doctors seem to be "dancing around" answering questions about their credentials, training or emergency procedures, "I would start to feel very uncomfortable," Dr. Canady said.
There were 456,828 liposuction procedures performed in 2007, the latest data available, an increase of 13% from a year earlier, according to the American Society for Aesthetic Plastic Surgery. To perform liposuction, a practitioner must be a doctor, but isn't required to have any special licensing or certification. In many states, a licensed physician assistant can participate in the surgery, but only under a doctor's supervision.
Cosmetic surgeons say they are seeing fewer patients because of the recession. Still, magazines, newspapers and the Internet continue to be full of ads for liposuction, many offering steep discounts.
One liposuction patient drawn by Dr. Bittner's marketing was Kelli Michael, a 35-year-old nutritional-products salesperson in Southern California. Ms. Michael said she contacted Dr. Bittner two years ago after doing an online search. "Every time I put in anything that had to do with liposuction, his name was the first to pop up," she said. "He was on Rodeo Drive, so you would think he would be good," she added.
Ms. Michael said she complained to Dr. Bittner repeatedly about the results of her surgery, which she claims left her with uneven scar tissue "as hard as a rock" above her belly button. She said Dr. Bittner dismissed her complaints. Ms. Michael said she told a medical board investigator late last year that Dr. Bittner appeared only at the end of her surgery and that most of it was performed by "a man and a woman, taking turns." She didn't recall their full names.
Ms. Michael was among the patients whose names were listed on the search warrant seeking records from Dr. Bittner's practice.
Other patients have filed malpractice suits against Dr. Bittner, claiming that he allowed unlicensed staff in his office to perform parts of their operations.
Benjamin Gluck, a Los Angeles criminal attorney representing Dr. Bittner and his practice, denied any wrongdoing by anyone in Dr. Bittner's office. "No criminal charges have been filed against him," Mr. Gluck said, adding, "We are litigating the search warrant and the manner in which it was executed." He said the investigators improperly took legal files and correspondence with attorneys.
"We believe the evidence supports our actions," said Ms. Cohen, the medical board spokeswoman, in response to Mr. Gluck's challenge of the search warrant.
Dr. Bittner said he faces four malpractice suits. "It's not surprising that after 7,000 cases, there are four lawsuits, especially in a bad economy," he said in the telephone interview. As for the criminal probe, he said that certain parts of the surgeries done at his Beverly Hills practice were lawfully performed by licensed physician assistants under his supervision. "On every single patient, I did the final work, the sculpting," Dr. Bittner said.
This isn't Dr. Bittner's first run-in with the California Medical Board. Before turning to liposuction, he operated a chain of radiology-imaging shops in California and other states. He offered magnetic resonance imaging, or MRI, that he claimed was better than mammography for detecting breast cancer. In 2003, the California board claimed this was false advertising in a civil suit it filed against him and the company he founded, HealthScan America Inc. The shops closed at about the same time. In 2004, a California state court ruled against the business and ordered it to pay $1 million in penalties. The court dismissed Dr. Bittner from the suit.
Dr. Bittner said in the telephone interview that his approach to preventive medicine using MRI to screen for breast cancer was "ahead of its time."
Annual mammograms are still the staple prescription for women at average risk of breast cancer. But the American Cancer Society in 2007 issued new guidelines recommending annual MRIs, in addition to mammograms, for women with certain genetic mutations tied to breast cancer and those whose family history signaled a significantly elevated lifetime danger of the disease, among other high-risk categories.
In promotional materials for his liposuction practice, Dr. Bittner identified himself as Alan Bittner, using his middle name. Earlier, in promotional materials for his radiology shops, he identified himself as Craig Bittner, using his first name.
Dr. Bittner defended his use of discarded body fat from his patients to fuel his car and said he received signed consents from patients who were told of the intended use. Still, "the medical board went ballistic" about this practice, he said.
Using medical waste obtained from liposuction as a biofuel "is not currently an approved alternative treatment technology," according to the California Department of Public Health. To seek approval, an individual would have to submit an application to the department for this alternative use. There is no record of Dr. Bittner filing such an application, a department spokesman said.
The practice spurred "death threats against me and my staff," Dr. Bittner said. "I thought it was a great thing to demonstrate to the world how many ways there are to solve the energy crisis."
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