FLORIDA: Risks Increase As Vanity Medicine Grows
Vanity and anti-aging medicine practitioners are flooding Florida, currently exceeding the total number of specialists in heart disease and cancer combined and accounting for about one in 17 doctors in private practice, the Ft. Lauderdale Sun-Sentinel reports. A study conducted by the newspaper found more than 1,700 doctors offering services such as cosmetic surgery, face peels, weight-loss programs, removal of varicose veins, hair transplants, chelation therapy and human growth hormone injections. Many of these doctors have little training in the procedures they offer, according to the study, and some so-called doctors have no licensing at all. The increase of these practitioners is "changing the face of medicine in Florida," and some worry that the change is not a positive one -- especially in light of the number of patient deaths and injuries following some of these procedures.
Forty-one of 44 patient deaths since 1986 followed cosmetic surgery. Three were associated with chelation therapy or anti-aging treatments. More than 1,200 injuries were confirmed as a result of these procedures, ranging in severity from serious burns to permanent, disfiguring injuries. Most of these treatments and surgeries take place in doctors' private offices, where "regulatory oversight is minimal." The doctors in these fields face sanctions for misconduct far more often than other doctors, and roughly 200 of these doctors have no medical malpractice insurance or no agreement with a hospital that would allow them to send patients there in case of an emergency. The investigation also discovered at least a dozen unlicensed practitioners who have provided services ranging from liposuction to the injection of human growth hormones. Regulation is lax in these fields, primarily because state health officials have not yet recognized the speedy growth of the fields and have not set quality controls to protect the public from the dangers of these treatments. No one is even certain how many complications or fatalities arise from such treatments, as there is no state agency that tracks the cases, and there is no requirement for doctors to report the kinds of procedures they offer.
The fields of vanity and anti-aging medicine have exploded in recent years, as the population ages and HMOs have reduced doctors' incomes. The Baby Boomers are a "ready market" that are willing to spend money on staying youthful or improving their quality of life as they age. The growing consumer demand provides doctors with an incentive to offer such services in times of falling profits. Industry observers and physicians say that the rise of these practices are a result of doctors' "hung[er] for cash" and control, as many feel HMOs have "robbed them" of authority over their practices and imposed guidelines and cost-reductions that have lowered their incomes. Dr. Richard Feinstein, professor of dermatology at the University of Miami School of Medicine said, "The managed care companies will only pay $25 a visit. With a staff of five, with huge rent, people are saying 'I don't want that.' They can do a hair transplant and make $3,000 cash." The lack of government or peer regulations is another factor contributing to vanity medicine's sudden growth. Managed care is partially responsible for the move of procedures from hospitals to private offices, where nearly all of vanity medicine operates.
OR to Office
Patients save money by having procedures done at a doctor's office. Surgeons keep a higher percentage of their fees, and avoid competing for hospital operating room space. But some say the shift removes doctors from the oversight of their peers and the strict quality standards the state imposes on hospitals and health plans. Dr. David Mackey, an anesthesiologist at the Mayo Clinic in Jacksonville is pushing for tighter controls over office cosmetic surgery. He said, "You can't do this in a hospital because you have to have credentials. This is one of the biggest issues facing medicine in the U.S. today." Many of the doctors offering these services attend two-day seminars teaching the new techniques, after which the doctors can begin offering the procedure. Many doctors, such as podiatrists or even dentists, are offering liposuction or breast enlargement or hair transplants. Dr. Conrad Goulet, president of Guylaine Lanctot Cliniques, a chain of vein clinics, said that doctors learn the techniques and jump into vanity medicine just for the fast money. Dr. Stephan Baker, past president of the Greater Miami Society of Plastic Surgeons, is concerned that the desire for quick money could obscure doctors' professional judgment: "Just because you're a doctor, doesn't mean you're an upstanding citizen" (Schulte, 12/12). To read more of the Sun-Sentinel's investigative reports about the risks of cosmetic surgery, click here.