Beauty from Afar

Chapter 3 Page 5 | The Media Imprimatur

The media in the United States did not really discover medical tourism until 2004-05, and it was found in the Far East rather than in central and South America. It was Bumrungrad Hospital in Thailand and the Apollo Hospital Group in India and Penang Adventist Hospital in Malaysia that made 60 Minutes and the front pages of the Wall Street Journal and The New York Times, not the plucky surgeons and dentists of Costa Rica, Mexico, and Brazil — even though far more U.S. citizens were heading South for inexpensive medical and dental care and surgery than were heading to the Far East. There are a few good reasons for that, which I offer not as an apology for the media but as explanation:

1. The story wasn’t about cosmetic surgery, which, despite its popularity and the professionalism of its practitioners, doesn’t get the same treatment in the news as does “real” medicine. Cosmetic surgery news is fluffier, more frivolous, than open-heart surgery news. The international hospitals of the Far East, wisely, didn’t play up cosmetic surgery — though they do a lot of it. They played up cardiothoracic surgery, and their state-of-the-art technology and facilities, and thus were taken more seriously. For the first time, much was made of the fact that there is an estimated 42 million people in the United States who lack adequate medical insurance who could go out of the country to get treatment they could not otherwise afford.

2. The story was delivered in part as a business story with big dollar signs, the kind that gets attention from the media. India put a $2 billion sticker on medical tourism. As previously noted, Bumrungrad sees more than 350,000 patients a year.

3. The story was generated by big multipurpose hospitals, and supported by the tourism and economic development officials of their respective countries. This is the way countries in the Far East go after markets, and there is nothing in Central or South America to compare as yet.

As we move through the first decade of the 21st century, medical tourism is still both newly discovered and in transition. The tip of the iceberg remains elective medical care, mostly cosmetic surgery and dentistry; beneath the surface is the larger consumer health-care market of North America and Europe.

And the media is paying attention. In February 2006 a West Virginia state legislator introduced the first bill in the country providing for the outsourcing of medical care to foreign countries. In Chicago, Blue Cross/Blue Shield investigated and then approved payment for an insured child’s heart surgery in India. And when President Bush visited India for the first time in March 2006, the two countries released a statement pledging American support for Indian efforts to support medical tourism, saying there is “enormous potential for collaboration” in health tourism.

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

The costs for common cosmetic surgery procedures in the Dominican Republic are roughly 40 to 70 percent less than they are in the United States. Dominican surgeons, particularly members of the Society of Plastic Surgery, felt that they were under assault by the U.S. media, by U.S. doctors, and by U.S. politicians because of their success in attracting U.S. patients. They thought that their skill and medical facilities had been unfairly maligned.

Their suspicions were raised by the fact that their statement went unreported in The New York Times or anywhere in the United States and that the initial story lived on in news releases and through references in other stories. As of January 2006, the U.S. State Department was still posting a warning on its travel advisory for the Dominican Republic:

The U.S. Embassy in Santo Domingo and the U.S. Centers for Disease Control and Prevention are aware of several cases in which U.S. citizens experienced serious complications or died following elective (cosmetic) surgery in the Dominican Republic. The CDC’s Web site contains further information for all patients seeking elective surgery overseas at http://www.cdc.gov/travel/other/elective_surgery_2004.htm.

Patients considering travel to the Dominican Republic for cosmetic surgery may also wish to contact the Dominican Society of Plastic Surgery (tel. 809-688-8451) to verify the training, qualifications, and reputation of specific doctors.

A similar report posted on the CDC’s Web site had been taken down months before, but the scare lived on. I assumed that business for plastic surgeons in the Dominican Republic had to have gone down the tubes. Negative publicity is bad enough when it involves a single doctor but the Times’ story was directed at the cosmetic surgeons and doctors of an entire country! What damage did it do to the country’s cosmetic tourism business? Surely, I thought, it had slowed to a trickle.

Not so.

If anything, business is better, Roberto Guerrero, M.D., of Santo Domingo told me a year after the story was published. Dr. Guerrero is a plastic surgeon who trained under Brazil’s Ivo Pitanguy, M.D.; it is a credential most U.S. plastic surgeons would love to have. “People heard more about us, about what we do. If anything, the story helped us.”

Dr. Guerrero, in a lengthy phone interview, defended the quality of surgery and the facilities available in the Dominican Republic. There are roughly 60 board-certified surgeons, and the requirements for certification are every bit as stringent as in the United States.

“The infections — they can happen anywhere. They happen in the U.S.,” he said. “We have doctors here who are not board-certified, who do cosmetic procedures … and you have that in the U.S. as well.”

But by then, Dr. Guerrero was telling me what I already knew — that there are supremely talented cosmetic and aesthetic surgeons working in the Dominican Republic in modern facilities, just as there are in Brazil, Costa Rica, Argentina, Mexico, and, of course, in the United States, and around the rest of the world. Like one woman told the Times: “There are good and bad doctors everywhere.”

(Author’s note: The CDC Internet page cited  above no longer exists in 2009. However, the State Department warning about cosmetic surgery is still up, here; and the dated CDC report lives on, here — five years later.  My guess is that it is a bureaucratic nightmare to get the State Department to remove such information.)

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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.

Chapter 2 Page 1 | Comparing Quality, Comparing Costs

Why care abroad is just as good as in the United States, and
why it is so much less expensive than in the United States and Europe

If ever there was a day that America was going to be persuaded that traveling abroad for inexpensive plastic surgery is foolhardy and dangerous, it was July 2, 2004. On that day a story about cosmetic surgery overseas that came out of a news conference called by the city of New York made the front page of The New York Times; it subsequently made every major newscast, in fact. “A Warning on Cut-Rate Surgery Abroad”, was The Times’ headline.

At least nine women in New York and seven more elsewhere had been diagnosed with serious infections, all traced to their having had cosmetic surgery in the Dominican Republic. The Times attributed the problem to “what has apparently become a phenomenon among New York City’s Latinas: cosmetic surgery conducted in the Dominican Republic after being arranged through beauty salons in Washington Heights and other city neighborhoods.”

The city’s health commissioner, Thomas Friedman, M.D., and other officials called the bilingual news conference in the city’s Washington Heights section for the express purpose of warning New Yorkers (and anyone else who would listen): Don’t even think about going out of the country to have plastic surgery — especially to the Dominican Republic.

“It is so important to get the message that something that is cheap can be very costly,” said New York City Councilman Miguel Martinez. “It can cost you your life.”

Officials vowed to shut down what they said was a loosely coordinated network for recruiting patients, which they referred to as a “big business.” They called in the national Centers for Disease Control and Prevention to investigate.

Notably absent from the story, however, was any comment from doctors, surgeons, or officials in the Dominican Republic, though The Times quoted several women from the Washington Heights area, who shrugged off the warning. One woman said she had had a $3,000 tummy tuck done in Santo Domingo a few years earlier without a problem. She told The Times she knew of hundreds of women from Washington Heights who had cosmetic surgery procedures done in the Dominican Republic and that only a few had complications. In fact, she said she was planning to go back again for more cosmetic surgery the next month.

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Introduction Page 3 | Seeking Beauty from Afar: How I Got My Smile Back

A Nose Job in Iran?

I first focused on the bigger picture, which was plastic and cosmetic surgery in Costa Rica and elsewhere, and soon found myself swimming in a sea of Internet message boards. Mexico — was it safe? Had anyone been to Malaysia? Did South Africa make any sense at all? Why Spain for weight-loss surgery? Nose jobs in Iran, tummy tucks in Colombia, sexual reassignments in Thailand, new boobs in Brazil … it seemed that in every corner of the globe, plastic surgery was being performed for fees dramatically less than those charged by doctors in the United States and Europe, and it was even being done in places prospective patients could consider going to for a vacation.

Still, it was something one had to know about to find. It was a phenomenon, perhaps even a trend, but small — in fact tiny — when measured against the number of people who don’t leave the country to want cosmetic surgery. It didn’t even really have a name yet, though the mainstream media made periodic attempts to label it. “Lipotourism” was tried on for size (notably by The New York Times), but it didn’t really stick, describing, as it did, mostly a quick trip for fat suctioning and not much else. I’d run across “medical tourism” and used it once in an article, but it wasn’t in common usage. “Health tourism” was another borderline misnomer. As time passed, the term “medical tourism,” as uncomfortable as it is to some people, caught on.

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