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.

Medical travel for major dental work, plastic surgery and other medical care continues to be in the news in the United States. On Friday evening, I was interviewed about the subject on the Your Time with Kim syndicated talk radio program.

You can listen to it here:

Kim Iverson — Jeff Schult interview on medical tourism

(Link fixed, Feb. 2015)

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

Before I wrote a word of this book, I:

• Read or at least skimmed and saved more than 6,000 posts about medical tourism and cosmetic surgery in Internet forums. I have no idea how many I read and did not save.

• Accumulated more than 200 Internet bookmarks — and this is despite pruning my files regularly to try to only keep the ones I thought I absolutely needed.

• Read or at least glanced through more than 1,500 news stories and press releases about medical tourism and cosmetic surgery. I read seven or eight books, only three of which I had to buy. I found the others in the library.

My e-mail folders for book material alone number more than 40, on two separate Internet accounts. Mercifully, I have unlimited long-distance at a flat rate in North America and very inexpensive overseas rates with an Internet phone service. The time I spent on the phone with surgeons and patients and other sources was extensive, but the cost was nearly inconsequential.

I say this not to boast, but to explain that doing the research for this book did not work out at all the way I had originally hoped. It was a grind, a day-in and day-out sifting and weighing of information that went on for a year. I had wanted to travel from country to country — around the world, in fact. In between plane flights, I had wanted to live in strange and new places, perhaps, on-and-off, for months. Everyone I e-mailed, everyone I talked to on the phone, I wanted to meet in person; and I still do.

Maybe someday. It was as unaffordable for me in 2005 as the dental work I needed was in 2003. I did go to some places. In the end, I realized, more traveling would not have made for a better or more useful book, though it would have been more fun for me and better for me and my sources to meet in person. But I might have skimped on the basic research. A reader might enjoy my around-the-world tour but find it the superficial account of a jet-setter. If you are going to consider the option of going abroad for medical care or cosmetic surgery or dental work, you probably won’t tour facilities in person around the globe, either. You’ll sit at home and research and read, as I did. Then you’ll either plan and go, or you won’t.

A lot of people are very good, even great, at doing research on the Internet. They may skim through this chapter, as skilled Internet researchers, familiar with the tricks and tips I am about to unveil. But I know from years of experience working for Internet companies that most people are less than expert in their use of computers and the Internet, even to the point of feeling helpless. But you, or a friend willing to help you, will need at least rudimentary computer skills — typing, mouse clicking, Web browsing — to get what you need from this chapter.

The Bare Minimum: General Resources

Recommending Web sites in a book is somewhat perilous. Books are immutable. Web sites come and go, change, move, break; they can go stale; they can even be stolen. However, there are a few — just a few — in which I have a high degree of confidence, enough to recommend them in print and discuss. They are enough to get anyone well-started who is interested in traveling abroad for cosmetic surgery or any other kind of medical care.

It is certainly possible, using the following dozen or so sites to:

• Consider the cosmetic procedures in which you have an interest.

• Decide whether traveling overseas for surgery is an option you want to consider.

• Evaluate options as to which country to go to, which surgeon to consult, and where to stay.

You’d still have a whole lot of e-mails, phone calls, planning, and worrying ahead of you, but between this book and the Web sites provided, you should be able to glean enough to make informed decisions. You might make a few new virtual friends, as well. In most countries — the United States included — any licensed medical doctor can legally perform many cosmetic procedures and surgeries.

Checking credentials and references is critical, whether your prospective surgeon is in the United States or abroad. When asked about a “south-of- the-border” cosmetic surgery disaster story one Mexican surgeon simply told me: “There are charlatans everywhere. The United States has them. We have them. People have to be careful.”

I have known people to make a decision to travel abroad for cosmetic surgery and/or dental care on as little as the advice of one good friend. I’ve known others who agonized over the decision for months, researching perhaps as much as I did to write this book before making up their minds. Most people fall somewhere in between.

The big Internet search sites are a paramount tool, of course. I prefer Google (www.google.com), more out of habit than any firm conviction that it is the best, and will cite examples of using Google for searching and other services. I have no relationship of any sort with Google that compels me to mention it or cite its usefulness; I am simply used to working with it. However, if you are more comfortable with other search engines, or prefer using multiple search engines, I can not say that you will have any less success. Use what works for you. I will have occasion to mention Yahoo (www.yahoo.com) and MSN (www.msn.com) as well.

You will be able to find updated links and information at the support site for this book, www.beautyfromafar.com. (Author’s Note: That’s clearly a little superfluous if you are reading this online, eh?)

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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.

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.

Chapter 3 Page 2 | The Pioneers

Brazil, in particular, gradually became known internationally for the expertise of its aesthetic and plastic surgeons, but it was not a fame that extended to the mass consumer markets of the more economically developed world. Prof. Dr. Ivo Pitanguy is not a household name outside of his home country, where he is revered. Dr. Pitanguy has performed or guided thousands of surgeries in a storied, five-decade career and has trained more than 500 plastic surgeons from more than 40 countries who practice internationally, making cosmetic surgery expertise and technique one of Brazil’s best-known exports.

Among his peers, Dr. Pitanguy is regarded as the father of modern cosmetic surgery. He also has become the father of modern medical tourism, for those he has trained are among the most sought after surgeons in the world. Yet his name and his work, outside Brazil and South America, are familiar primarily only to other plastic surgeons, Brazilians living abroad, and the families and friends of his patients — not to the millions of potential plastic surgery patients in the United States who are far more likely to know the names of surgeons on Dr. 90210 or The Swan.

In the United States, if one had to name a doctor who was famous in international medicine during the 1960s, perhaps the only household name was Christiaan Barnard, M.D., the South African who performed the world’s first heart transplant in 1967. Notably, Dr. Barnard trained in the United States, as did Dr. Pitanguy, before heading home to eventual renown.

I cite Dr. Pitanguy and Dr. Barnard as pioneers not so much for their unquestioned skill as surgeons but because they achieved the kind of international fame that, for most of the 20th century, was reserved for doctors and scientists only in the West (North America and Western Europe) and, to a lesser degree, the East (mostly the former Soviet Union). Patients in Eastern bloc countries frequently traveled to the then-USSR and its allied nations for advanced medical care. For all of the 20th century, and even into the beginning of the 21st century, the vast majority of medical tourists were not jetting to South America or Africa, let alone the Far or Middle East. They were coming to the world’s great doctors and hospitals in the United States and in Europe.

From the perspective of the United States, in particular, this state of affairs served, and still serves, to reinforce the generally held belief that the United States has the finest medical care in the world. In the last 50 years, only Dr. Barnard’s achievement challenged this notion in the popular imagination. People were oddly comforted when Drs.  and Michael DeBakey started transplanting hearts in Houston, Texas, almost in the same way they were when the United States finally answered the Soviet space challenge of Sputnik.

Meanwhile, Dr. Pitanguy just kept doing what he was doing. Patients spread the word. Brazil was and is the mecca of plastic and cosmetic surgery, challenged only recently by Southern California. The surgeons Dr. Pitanguy trained spread out through South and Central America and around the world. Over time, a second essential precondition for medical tourism to emerge as big business was met — medical talent spread out, belonging less exclusively to the developed world. In economically emerging nations, improving health care was a priority — which meant building more modern medical facilities.

The quality of care in the less-developed world rose steadily, at least in metropolitan areas, but prices for medical services remained low, relative to the United States and Europe.

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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.

When I was writing Beauty from Afar, my publisher really, really, really wanted me to say how many people traveled abroad for medical care, surgery, cosmetic surgery and dentistry.

I probably should have accommodated my publisher’s wishes, and thrown a number out there and backed it up as best as I could. That is pretty much what McKinsey and other researchers have done since. What I chose to do has invited a lot less ridicule and a lot less controversy. I could have stood up to the former and the latter probably would have been good for book sales.

What I did, instead, is mostly in the segment/page I put online today:

Chapter 1 Page 7 | 100,000 Fellow Travelers — or More

I came up with a very reasonable estimate on the number of U.S. residents who were having cosmetic surgery abroad in 2004-2005.  I didn’t have any basis, I thought, for guesstimating how many Americans were going abroad for anything other than cosmetic surgery or dentistry. Four or five years later, I think I am still on the non-ridiculous side of the argument.

But that doesn’t keep journalists from asking the question. How many people go abroad for medical care? And the answer is — who do you want to count? I have no trouble saying “a million” — if you want to count dentistry, and cosmetic surgery, and every person who drives to Mexico for any kind of medical care at all. Throw in some millions of Americans living abroad who already get medical care overseas … you want to count them, as well? I can make the number quite large.

But the number of people who get on an airplane and fly overseas for life-saving or extending surgery, non-cosmetic surgery, is a relatively small number, no matter what you’ve read elsewhere. It is perhaps in the tens of thousands annually. It’s not trivial. But it’s not huge, either.

Most medical travel is regional. Americans are not lined up to go to the Far East for new hips or heart valves. Numbers that suggest otherwise should be looked at very carefully.

I added Curtis J. Schroeder’s Afterword for Beauty from Afar today, along with fussing with links on the table of contents page and updating the “About” page to reflect the fact that I am available for work and that I am open to the partnership and advertising possibilities inherent in this site.

Curt, as far as I know, is still group CEO at Bumrungrad International in Bangkok, Thailand; and I am still grateful for his kind words, written in 2006.

Yes, putting up the Afterword now is out of order. I thought about putting it up last. But I decided that anything that was really about the book and gives people the reasons why they might want to read it, ought to go up before I started posting actual chapters.

Besides, I love the Afterword and it makes me feel good to read it again.

So … next, I’ll put the jacket copy up, somehow; and then the Introduction … and then, I’ll probably start letting people know about the site and, little by little, post the 12 chapters. I’ll make pretty ebooks, in various formats, once I have pulled all the text out of the Quark file and massaged it sufficiently.

This is another place where links to Chapters 1-12 and the Introduction reside. I am finding it best to provide both the reader and myself with some alternatives as I move along with this project. As it has developed, this page seems to be useful for listing each of the “pages” as I add them.

Introduction | Seeking Beauty from Afar

Introduction (Part 1) Stumbling upon an open secret

Introduction (Part 2) Jurassic Park, it’s not …

Introduction (Part 3) A Nose Job in Iran?

Introduction (Part 4) It’s so … Foreign

Introduction (Part 5) Competition for the United States

Chapter 1 | Medical Tourism: Here, There and Everywhere Part 1

60 Minutes and Medical Tourism … Part 2

Vignettes … Didi, Fabio … Part 3

Patients Going Abroad: A Burgeoning Industry … Part 4

U.S. Healthcare and Spiraling Costs … Part 5

Dear Dr. Rubinstein … Part 6

100,000 Fellow Travelers — or More … Part 7

Tip of the Iceberg — and a Trend … Part 8

Medical Tourism: A Moving Target … Part 9 (End of Chapter 1)

Chapter 2 | Comparing Quality, Comparing Costs … Part 1

News Gets Around … Part 2

A Warning Lives on,  Mostly Unheeded … Part 3

Sticks and Stones … Part 4

American Doctors Speak Out … Part 5

Point, Counterpoint … Part 6

The Best of Both Worlds … Part 7

If You Can’t Beat Them … Part 8

Prices in the United States vs. Abroad … Part 9

Chapter 3 | A Brief and Selective History of Medical Tourism Part 1

The Pioneers of Medical Travel … Part 2

Build It and They Will Come … Part 3

Origins of Term Medical Tourism (cont.) … Part 4

The Media Imprimatur … Part 5

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

Cosmetic Surgeries and Procedures … Part 2

Eyelids, Foreheads, Noses and Peels … Part 3

Breasts, Arms and Tummies … Part 4

Body Lifts and Butts … Part 5

Hair Implants, Otoplasty, Bariatric, Dental Work … Part 6

What Else is Out There? Non-Cosmetic Procedures; Conclusion … Part 7

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

Medical Travel and Cosmetic Surgery: Top Resources … Part 2

Patient Support Sites for Medical Tourism … Part 3