Beauty from Afar

I have mostly watched medical tourism from afar for several years, not participating in the so-called industry other than to continue to recommend my own dentists and to advise family, friends, acquaintances and strangers about how and when to access medical and dental care outside of the country.

I do know what I’m talking about — but I choose not to say much, very often. I have concerns about the Americanization of health care overseas, and also about general quality of care as more and more providers seek patients/clients/customers. A decade ago, when I first wrote about medical travel, I think it was actually easier for me to figure out an individualized approach if only because the doctors and dentists who were experienced were directly accessible. Now — that seems to be less prevalent.

I don’t know when or if I will update Beauty from Afar, the book, which is now eight years old, beyond the chapters on this site. It is available from online sellers for just a few dollars, at this point. I make nothing from it, which is fine. But I have moved on to other projects.

Back in the day — it was very exciting for me to be on NPR Talk of the Nation (Medical Tourism, and the Costs of Traveling for Care) and on ABC News (Money Matters, Special Report on Medical Tourism). If you’re interested in the topic — I think my book is still worth reading and those links are worth visiting. I’m leaving this site up — anywhere from 20-100 people a day still seem to want to take a look — but I’ll only be poking my head in episodically.

If you want to know what I’m up to, visit me at jeffschult.com … I am resolved to be there.

You probably found this blog post by searching the Internet, which might mean that you can skim or even skip Chapter 5 of Beauty from Afar, which starts today:

Chapter 5 Page 1 | Research, Research … and More Research

But then again, you might learn something even if you’re a whiz at Internet research. This is probably the most blatant “How-To” self-help-style chapter in the book and if you dislike self-help books generally, which I do, maybe you want to take a look through and see how I managed to make the material palatable … which I’m guessing I did. It starts off OK, anyway.

I really did have the notion that I *might* get enough of a book advance for Beauty from Afar to take a budget tour of the world’s best hospitals. As it turned out, I didn’t get quite that much and the advance payment mostly went for things like food and shelter.

I found the silver lining in having to do most of my research online and by phone, as you’ll see.

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.

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.

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.

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 1 |  A 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.

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.

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.)

… and I am quite sure I am the only one who noticed.

Here is what should have been yesterday’s update:

60 Minutes and Medical Tourism Part 2

And yesterday’s update, of course, should have come today:

Vignettes … Didi, Fabio … Part 3

I fixed the internal navigation of the site. And if I haven’t mentioned it before — I will be wildly grateful to anyone who points out any technical or factual errors I might make in the course of publishing the text of Beauty from Afar.

The 60 Minutes show in 2005 that featured Bumrungrad International hospital in Thailand did much to legitimize medical tourism in the United States.  It spurred more serious journalistic coverage of the subject and, thereafter, people who went abroad for medical care were treated with a little more respect.

It also got the attention of my publisher, which asked me if I could write Beauty from Afar faster than I had agreed. By contract, I owed them the book in January 2006. After some hemming and hawing and looking at the calendar, I said I could turn it in by October 2005.

It was April 2005 at this point. I was saying, “Sure, I can write this in six months.” And I did.

When it come to writing about places to which I have traveled, I have almost always chosen to write about the people I encounter and what it is like to be *me* when I travel. This is perhaps remarkably egocentric, yet I don’t see an honest way out of it. People can have wildly different experiences from a trip that is supposed to be more or less the same for anyone. I imagine that most people have very similar trips to DisneyWorld, for example. Yet my first visit there was on a belated honeymoon, nearly a quarter of a century ago; and my strongest recollection of the trip is a fabulously nonsensical fight I had with my then-wife over a game of miniature golf. This is not Disney’s fault; for all that they try to homogenize the American Vacation Experience, not everyone leaves with the intended memories.

Anyway —  I tried to make Beauty from Afar as much a book about compelling personal stories as it is a general guide to traveling overseas for cosmetic surgery, dentistry and medical care. So Chapter 1 starts out at a breakfast table at Las Cumbres Inn in Costa Rica, with patients sharing experiences, before I head in to Prisma Dental for a long second day with my mouth open.

Chapter 1 | Medical Tourism: Here, There and Everywhere

We’re up to Page 23 of the actual book, out of 220.