Oct 28

We commence today with Chapter 4 of Beauty from Afar, for which I half apologized in advance. I really needn’t have, now that I look at it again. Immodestly, I don’t mind saying that I like the way it starts out, and I have Joseph Cohen, M.D., of the Rosenstock-Lieberman Center for Cosmetic Plastic Surgery in San Jose, Costa Rica, to thank for that.

Chapter 4 Page 1 | You’re Going Abroad for…What !?

Dr. Cohen’s candor made him a terrific person to interview on the subject of what surgical procedures people go overseas for, and why; that he, a prominent cosmetic surgeon in Costa Rica, would consider going to the U.S. (hypothetically) for his own care, under certain circumstances, I think makes for a nice balance in a book that is mostly about people going in the other direction. And it gives him credibility.

We’ve now covered 76 pages of the original text of Beauty from Afar, which has worked out to 37 web pages. That seems about right to me … and it means I’m about a third done, which feels substantial.

I’ve mostly resisted the journalistic urge to step too far outside the boundaries of the book, but anyone interested in the business of medical tourism ought to go read Brendan Borrell’s Reuters story, published today:

Controversial couple dominates U.S. medical tourism

I don’t see how this has any real impact on patients, mind you, or I’d be more concerned. As a nascent “industry,” though, medical tourism has not traveled all that far since I first wrote about it in 2004-2005. The squabbles are a little bigger.

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Oct 26

It was really in 2004 and 2005 when the U.S. media “discovered” Medical Tourism … about the same time I did. (Maybe just a little after I did. 😉 ) And it was discovered because the media noticed that people were going overseas for serious, life-saving procedures, not just cosmetic surgery and dentistry.

Chapter 3 Page 5 | The Media Imprimatur

Medical tourism and travel has been episodically in the news in the U.S. ever since and remains a story in parallel with the dominant narrative about healthcare reform in the U.S. that arose in 2008 — 2009.  I’ve often been asked if real healthcare reform in the United States would be the end of medical tourism, and the answer is no. Medical tourism and international medical care will remain less costly alternatives and U.S. patients and insurers will continue to explore and integrate the travel-for-care options that are available.

We’ve hit the end of Chapter 3. Chapter 4 will look at what surgeries and procedures that patients choose to have done overseas — specifically, it is mostly a list of cosmetic procedures and average prices and savings in 2004 — 2005. As I go through it, I’ll try to put forth any updates of which I am aware. Chapters 4 and 5 (which is a tutorial on doing Internet research) are, to me, the driest parts of the book but I’ve encountered readers who thanked me for them. So … off we go. Tomorrow, probably.

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Oct 23

I don’t know anyone who likes to refer to “Medical Tourism” as “Medical Tourism.” Funny, huh? But someone came up with it in the 1990s, and we are still about half-stuck with it. Increasingly, people in the business prefer the reference “medical travel,” which doesn’t have the the assumed frivolity of “tourism” as baggage.

Chapter 3 Page 4 | Origins of  the term “Medical Tourism” (cont.)

The earliest references I found for the phrase “Medical Tourism” were in 1998, as noted in today’s segment.

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Oct 22

Our little history lesson continues today with a segment about how a plastic surgeon in Costa Rica started marketing to the U.S. market in the early 1980s; and continues with a discussion of a somewhat prescient World Bank report on prospects for health tourism exports in the Caribbean.

Chapter 3 Page 3 | Build It, and They Will Come …

I thought I’d be sailing through Chapter 3 easily but have had a lot of reformatting to do from the version of Beauty from Afar from which I am working … which I have now realized is probably the penultimate digital copy. Aaaaiiieee! An alert reader, Debbie, caught a mistake the other day in which I had named someone other than Alexandre Dumas as author of The Three Musketeers. Fortunately, the error was fixed before the book was printed. I do remember how I felt when I found the mistake initially — after I’d “finished” writing the book and after it had been twice edited. I felt both as though I’d dodged a bullet and as though I was nearly too stupid to live.

There are a couple of minor errors in the paper version of Beauty from Afar. It is nice to have the opportunity to fix them.

I used to be appalled when I found typos or any kind of mistakes in books. How could it happen? Well — now I know the answer. It can happen in all sorts of ways. Human beings are involved. With Beauty from Afar, they mostly happened because I was allowed to fuss with and add things right up until the last second — as though we were producing a newspaper story instead of a book. Overall, I think the additions and last-minute changes made for a better book … but there is a tradeoff. Typos, however minor, are just disheartening.

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Oct 20

In Beauty from Afar, I refer to Dr. Prof.  Ivo Pitanguy of Brazil as perhaps the father of both modern cosmetic surgery and of medical tourism.

Chapter 3 Page 2 | The Pioneers

I had originally hoped the Dr. Pitanguy would write the foreword for my book, but that wasn’t going to happen without my taking a trip to Brazil that I wasn’t able to take on my budget at the time. However, his office, in the person of Pitanguy’s then-assistant, Henrique N. Radwanski, M.D., was generous with time and information.

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Oct 17

Traveling for medical care isn’t new. Looking for historical examples was kind of fun. Starting Chapter 3 with a quote from Alexandre Dumas’ The Three Musketeers is maybe a little pretentious to some people, but I hope others were as mildly amused as I was.

Chapter 3 Page 1A Brief and Selective History of Medical Tourism

I promise, Chapter 3 moves along quickly. It runs from pages 63 to 72 in the bound version of Beauty from Afar … so I’d guess it will all be “live” by the end of the week.

By now, anyone reading along has probably figured out that I had no intention of writing what might have amounted to a directory of international medical services. Others, most notably Josef Woodman with his Patients Beyond Borders series of guides, have ably provided health care consumers with more traditional formats.

I wanted to provide more of a broad overview, a way of thinking about medical travel and tourism. Beauty from Afar, I thought, would take readers to the point where they could make educated decisions about where they might go as medical travelers without telling them where to go. As choices have expanded over the past five years, I am glad that other books have come along. There are now a number of medical travel books; there are magazines; there are newsletters; there are associations.

There were none of those things when I was first researching and writing Beauty from Afar in 2004 — 2005. Things have moved right along.

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Oct 15

Prices for cosmetic surgery vary widely based on a number of factors, as I point out in the concluding segment of Beauty from Afar‘s Chapter 2:

Chapter 2 Page 9 | Prices in the United States and Abroad

Being a surgeon, particularly being a surgeon for uninsured, elective procedures, is a business, wherever one is located.  And the global recession has had an impact on the business of cosmetic surgery. This report is from January 2009, but I rather doubt that cosmetic surgery is less recession-proof than the rest of the economy:

Cosmetic surgeons suffer recession, says new survey

Well-established practices are weathering the storm. Not-so-well established practices are not, and some are not surviving.

Anywhere in between? Whether in the U.S. or abroad, cosmetic surgeons are getting more creative about marketing to patients and that means, often, that patients have some bargaining power when it comes to price.

No sane person chooses a surgeon solely on the basis of price. But discounts can be attractive.

That finishes up Chapter 2, hooray! I have no idea if anyone is following along day by day, but the visitor count has been rising steadily. On to Chapter 3 … which is a brief history of medical tourism.

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Oct 13

Today’s so-called “page” is just three paragraphs. That is the way it worked out with the subheads from the original book.

Chapter 2 Page 8 | If You Can’t Beat Them …

I excerpted this aside from a lengthier interview with Oscar Suarez, M.D. in his office at CIMA Hospital, and I quote him more extensively later in the book. I don’t know if he is still head of the Department of Plastic Surgery at CIMA but it is evident that his practice is thriving. That is one of the problems with including official titles in books — people move on from where they were.

When I first walked into the waiting area of Dr. Suarez’s office, his assistant asked me what procedures I was interested in … and it was the first time anyone ever suggested I might need (or at least want) cosmetic surgery. I’m sure it was SOP for the office and no psychological harm was intended. For the record — at 53, I’m unmodified, other than my teeth.

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Oct 12

Dr. John Corey, an aesthetic plastic surgeon in Scottsdale, Arizona, was kind enough to write the foreword for Beauty from Afar. I found him on the web long before I asked him if he would do that. There are not many cosmetic surgeons in the United States who are openly admiring of the work and advances made in other countries.

Specifically, John has trained at one of the most renowned cosmetic surgery facilities in Brazil He talks about how that has influenced his work in today’s segment:

Chapter 2 Page 7 | The Best of Both Worlds

I’m grateful to have had the benefit of John’s point of view and experience.

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Oct 09

One of the great things about being a writer is that it gives one lots of opportunities to talk to interesting people one would otherwise never have met. For me, over the past 25 or so years, this has meant chatting with people ranging from accused murderers to U.S. Senators, the infamous and the celebrated.

For Beauty from Afar, I got to talk to doctors and surgeons. Lots of them. And they are a fascinating bunch. In today’s segment:

Chapter 2 Page 6 | Point, Counterpoint

… I compared and contrasted statements from two doctors, one from Texas and the other from Brazil, both renowned plastic and cosmetic surgeons.

I remember thinking that Dr. Rod Rohrich of Texas probably wanted to hang up on me while we were chatting on the phone and that I wouldn’t really have blamed him if he did. I was clearly writing something that was going to be at least somewhat at odds with his public pronouncements about going overseas for plastic surgery. I remain grateful that he took time to talk.

The Brazilian surgeon, Dr. Luiz Toledo, is now apparently working in Dubai! Links for both surgeons are provided in the segment.

The web site and staff of the International Society of Aesthetic and Plastic Surgeons (ISAPS) were both very helpful in my research. Sometime after Beauty from Afar came out, ISAPS published its own briefing paper on medical tourism which was rather less negative than the one put forth by the American Society of Plastic Surgeons.

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