Beauty from Afar

The American Society of  Plastic Surgeons (ASPS) released in April 2005 what amounted to an acknowledgment that medical tourism exists, in the form of a briefing paper that got some media attention. This was when I was in the middle of researching Beauty from Afar and was pure gold, as far as I was concerned. In the end, I quoted and commented on the entire document — which makes today’s “page” pretty long. But I thought it best to keep all the material together.

Chapter 2 Page 5 | American Doctors Speak Out

By that time, I’d spoken with enough doctors and surgeons with varying opinions on the subject of medical tourism that I was pretty sure I had a more complete and nuanced view of the subject than the ASPS could possibly put out, given that they had to present a united view … and given their constituency. I felt qualified to comment despite my lack of medical credentials.

To the credit of the ASPS, they have updated their information and resources on medical tourism over the past few years. A new link for them is in the “author’s note” for the page … and also here.

I still don’t know the source of the infections that caused the Center for Disease Control and the U.S. State Department to warn against cosmetic surgery in the Dominican Republic in 2004. I don’t know the names of the patients; I think it would be very hard to find those out. Their privacy would be protected by both the CDC and their doctors.

But there has been no such outbreak since that time, or I almost certainly would have heard about it. In:

Chapter 2 Page 4 | Sticks and Stones

… I kind of closed the circle on that story, as much as I could. Good doctors and surgeons everywhere agree on fundamental practices that impact patient safety. Surgery, almost by definition, is not 100 percent safe. Even good surgeons can have poor or even disastrous results on occasion, despite every effort to reduce the likelihood to zero.

Patients take risks. They sign a lot of papers before undergoing surgery in which they acknowledge risk. They do their own part to minimize risk by informing themselves about what to expect; by preparing their minds and bodies for surgery; and by choosing a good doctor and surgeon. That is a lot of what Beauty from Afar was (and is) about: patient choices, and how to make good ones. I included the lengthy segments about the Dominican Republic because the story illustrates so many aspects of medical travel. In the end, I draw a different conclusion than did New York City officials, or the U.S. news media. I would not tell anyone not to go to a particular country for surgery. Tens, even hundreds of thousands of patients have gone to the Dominican Republic … or to Mexico, Costa Rica, Brazil, Columbia, Thailand, Malaysia, etc.  for cosmetic surgery in the last five years and have been happy with the results and the price.

And a few have gone and have been unhappy, or worse.

Today, we continue the short saga of the U.S. and its media vs. cosmetic surgery in the Dominican Republic in 2004.

Chapter 2 Page 3 | A warning lives on, mostly unheeded

When I was writing Beauty from Afar, I remember being somewhat concerned about the fact that I was saying that the U.S. State Department was still warning in 2006 against having cosmetic surgery in the Dominican Republic based on a 2004 CDC report … surely, I thought, that warning will be taken down at some point in time.I was careful to note the time element.

I needn’t have been concerned on that count, anyway. The warning is still up in 2009.

In this passage, I quote Dr. Roberto Guerrero. I remember the conversation well and regret that I never have gotten to meet him in person. His web site isn’t in the book. I see he can now be found at PlastiCenter: New Concepts in Plastic Surgery.

News coverage can make — or break — the medical travel business of a doctor, a hospital or even a country. Reports of poor health care abroad — or reports of bad results in otherwise good health care — can have a significant impact on medical travel decisions.

One can imagine that the news media coverage in 2004 of illnesses allegedly connected to cosmetic surgery done in the Dominican Republic might have led to a significant decline in the number of people going to that country for procedures.

Chapter 2 Page 2 | News Gets Around

As I  have noted, however, the story was short-lived and in this particular case, may have done more to publicize the availability of inexpensive cosmetic surgery in the Dominican Republic than it did to convince prospective patients of danger! More on that in the next post …

There are occasions in Beauty from Afar when I use contemporaneous news reporting about medical travel and tourism as kind of a foil: “This is what was reported,” vs. “This is what actually happened,” or “This is what they didn’t say.”

As someone who has spent a lot of years in a newsroom, I didn’t take any fiendish glee in pointing out the shortcomings of reporting. I am only too aware of how difficult the job can be and how hard it is to do well. The anecdote with which I lead in Chapter 2, about a brief panic in New York City over mysterious illnesses attributed to botched cosmetic surgery done in the Dominican Republic, is a case in point.

Chapter 2 Page 1 | Comparing Quality, Comparing Costs

You’ll have to stop back to get the rest of the story, since I’m taking this a day at a time. But I recall that I managed to track down the reporter who did the original story — which was fine, as far as it went. But as I pointed out, the story cried out for a follow-up that never came. (Until Beauty from Afar.) The reporter was an intern, gone by the end of the summer. No one else followed up. That kind of thing happens a lot in journalism. Even at The New York Times.

I have always attributed the phrase in the headline to Mark Twain, among my favorite authors … but I see by Wikipedia that it is of mixed or uncertain parentage. No matter. Please consider the link as a footnote to this post … my sixth footnote of the day. Earlier, I added what had been the five end notes to Chapter 1 of Beauty from Afar to the online pages where they belong, turning them into footnotes.

I see that I felt rightfully obligated to be fastidious about attributing statistics and numbers to their original source; and careful and fair readers should note that I chose sources that are known for doing good research and that I couch  prose that surrounds any  statistics rather carefully. There is almost nothing worse in journalism or argument than using bad statistics, or using good statistics badly, and it is done all the time.

To the extent that I am not guilty, I credit a professor of mine, Edward Tufte, whom I knew originally in the 1970s when he taught undergraduates at Yale. He has gone on to much bigger things.

Here, again, is the link to the last bit of Chapter 1:

Chapter 1 Page 9 | Medical Tourism: A Moving Target

We’ll begin Chapter 2 … oh, well. Before Monday, certainly.

There was a time when I thought that perhaps I ought to put myself forward as a reasonable candidate to be the caretaker and editor of Wikipedia’s entry for medical tourism.

Upon careful consideration, I realized that I would rather stick my hand in a bee’s nest. This is nothing against Wikipedia, which I think is a wonderful project; and I conclude Chapter 1 of Beauty from Afar with some direct quotes from Wikipedia. It was remarkable how the entry for “Medical Tourism” evolved in a short time:

Chapter 1 Page 9 | Medical Tourism: A Moving Target

… And the reasons which I am glad I did not become, or try to become, the Wikipedia editor of the page, are not yet apparent, in the above-linked passage from Beauty from Afar.

If you look at the current entry, you’ll see that it has evolved through a contentious few years. Many people have added and deleted and bitterly disputed sentences, paragraphs and sections of the entry, over time. It has been a bone over which dogs of the medical tourism industry fought. I make no apologies for the analogy. Medical tourism “experts” in every country with any claim to being a medical travel destination have vied to define the reality of medical travel. Bias was inevitable.

The entry is not so bad now as it was at a few stages in its evolution. For a partial discussion of the issue of bias, take a look at the Wikipedia “Talk” page on the Medical tourism definition/entry.

Bees sting.

Anyway — Chapter 1 of Beauty from Afar is now posted completely. It is in 9 online pages, rather than the 18 in the printed version of the book. I do have to add the end notes to the chapter but have decided to go back and insert them as footnotes to the appropriate pages in this online edition; so I’ll probably do that tomorrow, before commencing with Chapter 2.

Also, a technical note: I have made BeautyfromAfar.com a dofollow blog, which means that links on this blog have relevance to search engines. Many blogs use a “nofollow” default, meant to discourage comment spam. I don’t see the point, since I delete comment spam and blatant marketing attempts with extreme prejudice. If you have something to add to the discussion here, I want you to get credit for doing so, with a link from your name to your site, at least. (And if you don’t understand this paragraph, it probably doesn’t apply to you.)