Archive for July, 2010

Yahoo Released Its Best Hospital List: Do You Care?

Sunday, July 25th, 2010

Yahoo just released its current report: Best Hospitals (in the U.S.) 2010-11: the Honor Roll. There were no surprises although I believe I could find another 14 hospitals equally good. The list includes John Hopkins, Mayo Clinic- Rochester, Mass General, Cleveland Clinic and others; and much as I see the logic in this list I also see the perverse irrationality in its construction.
For instance: why does Yahoo publish this? Is it an interesting item that sells advertising? Is it a public service? Since there are only 3 hospitals in the West (2 in Calfornia and 1 in seattle) and 2 in the Midwest, and the rest are on the east coast, am I to believe that people are going to travel coast to coast to go to a best hospital?
More important, who takes these evaluations seriously? The reality is these hospitals are the site of origin of many of the clinical studies in the United States and cultivate much of the innovative brain power in medical care. Yet only 1 in 4 Americans with cancer will consent to enter a clinical study and less than 20% of women with breast cancer do so. The reality is these university health systems have partnerships with community hospitals that are laced with financial incentives and the university systems would not impugn the reputation of any clinical hospital for fear of economic reprisal. And another reality is that there is economic competition between community based physicians and university based physicians and it is not in the economic interest of community based physicians to promote the services of the university health system.
Then there is the issue of unaffordable health care and a health care bill passed by the Obama administration that ignores the main causes of runaway health care costs and rewards the beneficiaries of the system. I am referring to the health insurance companies and the trial lawyers who lobby through the trial lawyer associations and its many euphemistic marketing organizations. It cannot go unnoticed that both Barack Obama and Hillary Clinton are attorneys and have supported the heavy contributors to their election campaigns (I bring in Clinton since she was Obama’s main competitor for the Democratic nomination).
Ultimately it is my judgment that the awarding of kudos to what are in fact excellent centers of medical care are just so many marketing ploys to promote the interests of marketing companies (i.e. Yahoo) and political interests. I sense that it is unlikely that we will either address the real issues of disparity in the availability of superior health care or address the issues of educating a poorly informed public as to their more rational choices in times of serious illness.

Liposuction is Safe and Effective

Thursday, July 15th, 2010

Sometimes it’s good to reflect on where we have been and where are we now. Sometimes it even leads to where are we going, but for this blog that will have to wait another day. I have practiced liposculpture since 1992 so I have seen the fads and the promises and the disappointments and mostly I have seen an incredible evolution in body contouring.
For what must be first and foremost, the procedure is safe when performed by well trained surgeons in certified surgical centers. Blood loss has been all but eliminated and pain has been minimized. Most cases can be done using local anesthesia and recovery time has been minimized. Virtually all patients can walk 4-8 miles per day the morning after surgery if they could walk 4-8 miles per day before surgery.
A decade ago total body liposculpture meant one procedure to sculpt the abdomen, waist, back, and hips and another procedure to sculpt the circumference of the thighs. Today liposculpture can be performed on the face, neck, breasts, abdomen, waist, back, thighs, legs, and ankles. Fat can be transferred from one part of the body and used to make the face more youthful or enhance the fullness of the buttocks.
A decade ago our notions of what constituted an ideal body appearance was grandiose and existed only in the mind of the beholder because there were no criteria for what a normal body looked like or how people with different body types could achieve their ideal form. Today we know that it is the musculoskeletal appearance which dictates body shape and the purpose of body sculpting is to show that as best as possible.
A decade ago we understood that removing fat would cause skin to retract but we didn’t know how to enhance it. One of the banes of the procedure was loose or hanging skin after a procedure and while we haven’t completely solved the problem laser lipolysis has greatly improved results in addition to shortening healing time.
So now we have liposculpting for women and liposculpting for men. We have laser lipolysis known as smartlipo and coollipo, and slimlipo among others to enhance skin appearance. We have circumferential liposculpting for thighs and torsos, and liposuction for breast reduction for men and women. Stove-pipe legs and ankles can be shaped and sagging arms tightened.
Perhaps my one concern is that so much liposculpting is performed in non-accredited surgical centers and so many by doctors who are board certified but not cosmetic surgeons who are appropriately trained dermatologic surgeons, plastic surgeons, facial plastic surgeons, oculoplastic surgeons, general surgeons, oral-maxillofacial surgeons, and gynecologic surgeons. While price certainly matters the disillusionment in patients I see who have had surgery done at some of these locations is disturbing. Most puzzling are how many patients go to medi-spas as a result of internet advertising despite the fact that they don’t know who their doctor is much less have a relationship with him. I guess for a fogey like myself it is a product of the IT age and I will have to keep my concerns to share with patients who already agree with me. In the meantime, the technology is here for safe, reproducible, and efficient body sculpting and for that I am grateful.