Medical paper: Beauty vs. medicine

Below is an interesting article by Brody (2003) on the increase of non-physicians performing procedures like laser hair removal.

Dermatol Surg 2003 Apr;29(4):319-24
PMID: 12656807
Beauty versus medicine: the nonphysician practice of dermatologic surgery.
Brody HJ, Geronemus RG, Farris PK.
Department of Dermatology, Emory University Medical School, Atlanta, Georgia, USA.
</font><blockquote><font size=“1” face=“Verdana, Helvetica, sans-serif”>quote:</font><hr /><font size=“2” face=“Verdana, Helvetica, sans-serif”>
BACKGROUND: This investigation was initiated because of a growing concern by the American Society for Dermatologic Surgery about the proliferation of nonphysicians practicing medicine and its impact on public health, safety, and welfare. OBJECTIVE: Prompted by an alarming rise in anecdotal reports among dermatologic surgeons, the study sought to determine whether there was a significant increase in the number of patients seeking corrective treatment due to complications from laser and light-based hair removal, subsurface laser/light rejuvenation techniques, chemical peels, microdermabrasion, injectables, and other cosmetic medical/surgical procedures performed by nonphysicians without adequate training or supervision. METHODS: A survey of 2,400 American Society for Dermatologic Surgery members in July 2001 and in-depth phone interviews with eight patients who experienced complications from nonphysicians performing cosmetic dermatologic surgery procedures were conducted. RESULTS: Survey data and qualitative research results attributed patient complications primarily to “nonphysician operators” such as cosmetic technicians, estheticians, and employees of medical/dental professionals who performed various invasive medical procedures outside of their scope of training or with inadequate or no physician supervision. CONCLUSION: The results underscore the need for improved awareness, legislation, and enforcement regarding the nonphysician practice of medicine, along with further study of this issue.
</font><hr /></blockquote><font size=“2” face=“Verdana, Helvetica, sans-serif”>Some notable comments in the article:

They outline the following reasons for increases in side effects:

  1. Increased use and acceptance of nonphysician clinicians (NPCs) in the healthcare arena
  2. the variability of uniform state laws defining the practice of medicine
  3. the blur between medical procedures and beauty treatments
  4. the emergence of hybrid “medical spas” and “retail clinics.”

They call these practitioners nonphysician operators (NPOs).

They state that the highest risk comes from NPOs who perform cosmetic surgery procedures without physician supervision.

They cite media portrayals of new technologies without focusing on the risks (until later, of course, when they can run “horror story” pieces about the very technologies they promoted as magic bullets).

They discuss the “rent-a-medical-director” ads found in spa and salon trade publications

Five of their 8 examples of patient complications are laser hair removal and include first- and second-degree burns as large as a quarter, blisters, hypertrophic scars, infection, discoloration, and hypopigmentation.

When one patient complained to the spa manager about her complications, “the patient was reminded that she had signed a consent form regarding risks such as scarring and was sent on her way without any wound care.

Physicians cannot allow entrepreneurial interests to supplant good medicine.