Oy vey! Laser suturing techniques from Israel

An Isralei group is working on a novel technique for laser welding skin incisions. Dr. Abraham Katzir from Tel Aviv is promoting his prototype which advertises itself as the first tissue friendly device for such anapplication. From the description of the technology it sounds like they use some protein-like gel in the wound as "cement" and then use the laser to heat it, essentially spot welding the area. From Technology Review magazine:

Katzir and his colleagues developed a laser-based system with a feedback loop that prevents overheating. First, they had to determine the optimal temperature at which flesh melts but can still heal (about 65 degrees Celsius). Then the group created a pen-sized tool that incorporates optic fibers: one that channels a carbon dioxide-powered infrared laser to the wound with pinpoint precision, and another that leads from the pen to an infrared sensor, which measures the temperature and ensures that the heat remains within the ideal range, between 60 and 70 degrees. All a surgeon has to do is move the pen's tip along the cut, strengthening and sealing the weld with a solder of water-soluble protein.

Below is a picture of two laparoscopic surgery access sites with the top closed with sutures and the lower picture using the laser technique.


Give me a break!
This is a technology that seems a little dodgy on exactly what advantage it offers, which is the lens thru which all medical devices must be examined going forward. In an era where healthcare dollars are rationed, you better show more then bells and whistles. This way of closing a wound is many, many more times expensive then sutures, glue, or staples and will require high maintainence durable medical goods (the laser). I'm not exactly sure what their market is going to be

The world's worst timing in magazine covers - 10 things Obama can learn from Tiger Woods

Fate has a sense of humor apparently. Could you have imagined more ironic timing then the cover of last weeks Golf Digest touting the "10 tips Obama can take from Tiger".

I'm sure Mrs. Obama will be very interested in this article! :)

Rob

"When someone is doing sex to me..." SNL nails Obama on China. Must see TV!

In one of the most brutal political comedy skits ever, Saturday Night Live has found it's voice on President Obama. After bending over backwards to avoid criticism of the President due to their political leanings, SNL is back with it's fangs out. Obama is now forever going to be rightfully caricatured as the milqetoast technocrat rather then some trans formative figure. You wonder if there's any buyer's remorse they cast Hilary Clinton aside?

The new mammogram and self exam guidelines set off a hornet's nest of controversy

The suggestions of the United States Preventive Services Task Force (USPSTF) regarding mammograms and breast self-exam have touched off a hornet's nest (to say the least). The new guidelines recommend that women in their 40s no longer have annual mammograms and that women ages 50 to 74 have them only every other year instead of annually. After having the message drummed into American women that they HAVE to have a mammogram annually starting at age 40, why the change in advice?


The task force report explains that for every 1,000 women in their 40s who receive routine mammograms, only two cases of cancer are detected. Alongside this is the fact that 98 women will also have "false positives" mammograms which will detect something that possibly looks like cancer, but that further testing shows actually is not. The cost and morbidity of routine mammography of the population (and the subsequent workup of such lesions) therefore brings the issue of cost-effectiveness of the program into question.

Last month I wrote a post "The Return of the weregild" discussing how the cost of healthcare gets into the accounting practices of establishing how much a life is worth to society and how much we can afford in support of such a life. Although downplayed by the USPFTF, this actuarial view played some role in the decision. It is my opinion that this is actual the thoughtful way we'll have to address health care spending. Although no one wants the heath care curve "bent" at their expense, you have to look at cost/benefit of practices to the system to control spending and give yourself the biggest bang for the buck for your tax dollars.

If you step back from the hysteria, I don't particularly find the recommendations controversial. It actually reflects the world consensus re. mammograms that mammograms in younger women (<50) are a poor way to affect how many women actually die from breast cancer (the whole point of screening). No other western nation practices routine mammograms under 40 that I'm aware of (and hasn't for some time) looking at this same data. If you're going to screen younger women it needs to be done more selectively to those with strong family history or palpable abnormalities that require further workup. This is exactly what's endorsed by USPFTP and should be a model of thoughtful care for patients going forward.

My first though re. this report was actually that "I wonder how long it's going to be before insurers adopt this" and require certain guidelines be met for women less then 50 perscribed a mammogram. It didn't take long as some HMO's have said they're reviewing their policies in light of this. If you're interested there's a short article on that issue in today's New York Times.

Rob Oliver Jr.

Oh Canada! - excellent NY Times letter response on health reform

I read an extroidinarilary good comment on this article  in the "Prescriptions Blog" NY Times today that I thought was worth reprinting. It was a response to another comment from a Canadian chastising the United States and pointing out what an absurd and misleading benchmark it is to compare the systems and problems of Canada to the United States in many respects:

“Let me tell you about my life. We (Canadians) have health care that is equal to that which an insured American gets for about 1/3 the cost. ”



Let me tell you about Canada. It is 1/10 the size of the US. There is this thing called scaling. Take any program and scale it up 10x and see what happens.


First off it is about 1/2 the cost, not 1/3. US is 2.2x more expensive per capita.

Healthcare is not equal. The infamous study that ranked the US so low overall grugding concluded it was tops in choice and quality. Per capita spending is about double for Canada.
But guess what, the US is top in a number of things that add to that cost. Some examples:
#1 in teen pregnancy (20 times more than Canada)
#1 in obesity (more than twice that of Canada)
#2 in abortions (about 15 times more than Canada)


“We pay about 1/2 the cost for prescription drugs.”
Because the US is in effect subsidizing the Canadian government’s negotiated prices.


“We have about 1/10 the level of gun violence in our country”
Which means healthcare in the US has to be higher to cover those violence related injuries. Which are treated in emergency rooms so they are very expensive.


The US has about, at low estimate, 12M illegals. Canada, by high estimate, has 120K. That is 100x more in the US.

So, once you tried to scale the Canadian system into the US with its differing problems, but trying to keep the same high choice and high quality levels, I would not be surprised to see that medical costs per capita would be very similar to what they are today. Single payer being cheaper per capita in the US than what we have now has NEVER been substantiated. What single payer in the US would do is make it APPEAR cheaper (how many post here have talked about FREE Canadian or English healthcare) to many by placing a higher burnen on higher income earners. The Dems don’t want single payer because it will reduce overall costs, they want it because it can easily be turned into the most progressive payments system around.

Announcing the birth of the Birmingham Breast Blog

Just a note to frequent readers. Due to requests by some of the audience to address some specific topics about breast cancer and cosmetic breast surgery, I started a "companion" blog to Plastic Surgery 101 titled the "Birmingham Breast Blog". Put it on you check in list for some content that will be a little more focused then the stream of consciousness topics I get around to here.

http://birminghambreast.blogspot.com/


FYI, At right is a photo of the statue of Vulcan, symbolizing my hometown.

Lady GaGa - as performed by Christopher Walken

Whimsy post today! No groaning over politics and mediceine (I promise).

Actor, Christopher Walken has such a terrific deadpan that I could listen to him read the phonebook and laugh. He made a classic star turn on the BBC's 'Friday Night with Jonathan Ross' this past weekend, where he killed the audience with a dramatic reading of Lady GaGa's disco ditty, 'Poker Face'

Swimming with the sharks - Democrats once again sell out on malpractice reform

IF anyone doubted the how much the trial lawyers own the Democratic party, please check out this little present to the ambulance chasers tucked away in the 1900+ page healthcare reform bill

In Section 2531, entitled “Medical Liability Alternatives,” establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But]…… a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys’ fees or imposes caps on damages.

So basically it says states are free to experiment with alternative settlement systems, but keep your hands off the big contingency fees of our donor base or we'll withhold federal money. Ironically, this bill would also incentivize states to encourage more frivolous suits by removing existing caps on non-economic damages.


This is absolutely disgusting!

Rob

Welcome to the return of the weregild - your life on the healthcare balance sheet

You may not remember it much, but most of those of us who were forced to endure studying the epic poem, Beowulf were introduced to the concept of the weregild. In the 2007 CGI adaptation of Beowulf, apparently the side plot discussing the weregild was cut to make more time for Angelina Jolie's CGI-enhanced, naked, high heel wearing turn as Grendel's mom. Probably a smart decision by the producers in terms of the box office :)





The weregild was literally a "man price" you paid as compensation for killing someone, and there was a price on everyone from the dregs of society all the way for one prescribed for regicide (killing the king). It's a fascinating social compact that was used to try and temper blood feuds with their cycles of repeat violence and revenge. The Roman Catholic church eventually enacted their own version of "tort reform" on the weregild, condemning it and forcing elimination of the practice near the end of the 1st millennium AD.

From Wikipedia's entry,

The standard weregeld for a freeman appears to have been 200 solidi (shillings) in the Migration period, an amount reflected as the basic amount due for the death of a ceorl both in Anglo-Saxon and continental law codes. This fee could however be multiplied according to the social rank of the victim and the circumstances of the crime. For example, the 8th century Lex Alamannorum sets the weregeld for a duke or archbishop at three times the basic value (600 shillings), while the killing of a low ranking cleric was fined with 300, raised to 400 if the cleric was attacked while he was reading mass.

The size of the weregild was largely conditional upon the social rank of the victim. A regular enslaved man (ceorl) was worth 200 shillings in 9th century Mercian law (twyhyndeman), a nobleman was worth 1200 (twelfhyndeman). The law code even mentions the weregeld for a king, at 30000, composed of 15000 for the man, paid to the royal family, and 15000 for the kingship, paid to the people. An archbishop is likewise valued at 15000. The weregild for a Welshman was 110 if he owned at least one hide of land, and 80 if he was landless.

NOTE: For those interested, there's a fascinating catalog of such fines from the Salian Franks (a German dynasty)here, which covers the price of various offences, ranging from stealing your cow to gang raping your wife


Ok Rob, why are you talking about weregilds on Plastic Surgery 101 anyway?

There were several articles about healthcare I read this week that all kind of intersect at the fringe of the debate on healthcare and got me thinking about the equivalent of the modern weregild.

"A Place Where Cancer is the Norm", which describes Houston's MD Anderson cancer center.

"Cancer Society, in Shift, Has Concerns on Screenings" which describes a pullback from the American Cancer Society on just how effective mammograms and prostate cancer screening (via PSA tests) on affecting death from cancer.











"Can 'bundled' payments help slash health costs?" in USA Today

Sunday Night's 60 Minute's piece (click here to view)on more then $60 billion annual loss to Medicare fraud and how the Feds have been inept at policing it.

An article in Oregon's Statesman Journal, "Government Audits Are Hurting Small Business Owners" describing the federal government's Recovery Audit Contractor(RAC) program for Medicare fraud.

The articles on cancer screening and exotic treatments at MD Anderson hospital to me point towards a more strict cost-benefit analysis coming on cancer treatments. The tertiary chemotherapy drugs and adjuvant radiation treatments described are budget busters with very marginal utility in terms of outcomes. The care described in the article, where chemotherapy treatments were literally thrown against the wall to see what sticks, is not a sustainable model. We're going to asking more and more, "How much are 'x' additional months of this cancer patient's life worth?" in order to balance our health care budget. It is unavoidable that we don't end up with some federal utilization committee who's job it will be to tell us what we cannot do in terms of palliative care for cancer or other chronic diseases. Other countries already do this without much controversy, but President Obama won't touch this with a 10 foot pole.

The USA Today article on bundling payments seems unworkable in situations where physicians are not employees of the hospital or system involved. I would not trust a hospital corporation to distribute that money equitably to independent providers once they have it in their coffer. Would I have access to audit a hospital's books to make sure their accounting is accurate? What's the resolution process for disagreements on the balance sheet? Much like insurers, the temptation for them to slow-pedal payments to collect the interest would be impossible for them to resist. Except in certain "closed system" situations (where all MD's are employees)like the Mayo Clinic, the Cleavland Clinic, or the Kaiser network in California, this bundling would be a unacceptable working situation to most physicians.

The 60 Minutes piece on Medicare shows why no one who is familiar with healthcare believes that the federal government can run a single-payer system. They are unable to investigate or follow up on even the most blatant examples of fraud costing hundreds of billions over dollars a decade.


So what do they do instead? They reauthorize the "RAC" program to aim at providers and hospitals for fraud that may be pennies on the dollar compared to the fraud described in the 60 minutes piece. The feds have outsourced the Recovery Audit Contractor (RAC)program to incentivized companies to autopsy medicare billing going back over 3 years by hospitals and providers where any inaccurate billing (using our byzantine CPT system) is assumed fraudulent and due back with interest and penalties. Analysts expect that inaccurate coding underbills at least as often as it overbills, but do you know what these auditors have produced. What do you get however when you incentivize these companies to claim 8-12% of any recovery (but don't reward refunds)? You get 96%+ of these RAC audits finding overbilling only.

Rob

Fallout from NJ Democrat meddling at the FDA will hold up medical device approval. Thank you very much New Jersey!

Thanks to the intervention of 4 New Jersey Democrats in the FDA approval process for one of their constituents, all medical devices are on the sloooooow track for approval. An editorial in the New York Times summarizes this nicely here.

In short: A New Jersey orthopedic medical device firm, ReGen turned to four Democrats to lobby on their behalf for approval of an orthopedic knee device — Sen Robert Menendez and Sen. Frank Lautenberg, as well as Congressmen Frank Pallone and Steven Rothman. According to the Washington Post, Regen paid Sen Mendez's former chief of staff nearly $300,000 for lobbying services, and Hutton contributed nearly $40,000 to Menendez and the three other Democrats who wrote a letter to the FDA urging the agency to make a decision on the company’s application.

This kind of "pay for play" is par for the course for New Jersey Democrats, but not as appreciated by federal regulators. The blowback from the intervention of theses pols and former FDA head, Andrew von Eschenbach, has reignited scrutiny of the FDA's practices and procedures.

Caught up in this are hundreds of devices in final stages of approval, including the next generations of silicone (and saline) breast implants. I wrote about this last April in a post called "An Exercise in Clock Watching" talking about the bureaucracy of FDA device approval in re. to breast implants. It's amazing and frustrating to think that improved devices used world-wide (US excepted) for 15+ years are still clinically unavailable here.

Rob

Behind the (1 in ) eight ball: More breast cancer patients choosing prophylactic mastectomy

The AP wire is reporting that the number of women opting for surgery to remove the healthy breast after a cancer diagnosis in one breast is rising, despite a lack of evidence that the surgery can improve survival. Sometimes this is presented as controversial, but I think this represents rationale behavior by many women choosing this.

There's the powerful slogan that's penetrated popular culture that women have a "1 in 8" risk of breast cancer. That's kind of correct but oversimplifies things. Biology is destiny with breast cancer and appears to overwhelm anything in your diet or the environment in terms of producing breast cancer. Like most cancers, risk of breast cancer increases as you get older. Taking all comers in the United States, a woman's chance of being diagnosed with breast cancer is about 1 in 233 when she's in her 30s which steadly rises to 1 in 8 by the time she's reached 85. However, there are women in that group who are at substancially more or substancially less risk.

Younger patients in particular would seem to benefit the most from prophylactic removal of the breast due to this increasing bias for later tumor development. The survival benefit for this surgery hasn't really been studied (as far as I can tell) in your breast cancer patients out for decades. It's assumed that you'd likely see a significant difference in that groups risk of breast cancer in the post menopausal group. Widely referenced studies (see here) suggest that after prophylactic mastectomy a woman's risk for later developing breast cancer is reduced by an average of 90% (some even suggest closer to 100%).

It's clear to me which way I'd suggest for all but the most favorable tumors in young women. Is it for you?

Rob

UPDATE on teen breast augmentation death: Florida state medical board finds no fault with doctors action

I just saw an update in the Miami Herald (here) on the events surround the anesthesia related death during breast augmentation of Florida teen Stephanie Kuleba, who underwent a fatal malignant hyperthermia(MH)reaction. This is a case I wrote about in Spring 2008 here & here.

Office based anesthesia is common for many procedures including oral surgery, dentistry, colonoscopies, otolaryngology (ENT), and plastic surgery. There's lots of reviews on this demonstrating outcomes and safety data comparable to hospital operating suites. Most plastic surgery procedures in this setting are on healthier patients, which can make a death more shocking.

Writing back then I said,

"I'm not sure what the take home message from this is. It's such a rare event that it's hard to justify having exotic protocols at all times in low risk procedures. Most office surgery suites maintain a supply of Dantrolene, a medicine to treat MH which is almost $2500 per dose and must be restocked often to stay current. There's plenty of adverse events more common then MH, but we don't have aortic balloon pumps or cardiac bypass machines routinely laying around for that. It already sounds like that the family has hired an attorney who is already assuming an aggressive posture in his comments to the media so I'm sure we'll see some legal proceedings even if perfect care for MH was instituted."

Predictably, the teen's parents in this case are still wanting their pound of flesh and have recently decided to proceed with medical malpractice lawsuits against her surgeon and anesthesiologists despite the Florida Department of Health finding there was no evidence of deviation of standards of care in this tragic event. Does that make any sense to anyone?

Rob

On tort reform, President Obama DOES lie

President Obama has spent the week furiously trying to put lipstick on the pig that is his healthcare reform bill. He gave a fine speech last week which was noticeably short (by design) on specifics, and one which left out any plausible way to pay for the program. Trying to defang critics, he generalized a number of areas where centrist Democrats and Republican ideas would be incorporated. One of these was a brief mention of tort reform.

Color me uinmpressed.

As with his summer speech at the American Medical Society (AMA) meeting that was met with boos, the president has over and over made it clear he is not interested in addressing real medical tort reform. If you took the most disingenuous elements of lawyer-speak mixed equal parts with the opacity of politican-speak you end up with the President's message to his Democratic trial bar donors (alongside organized labor, the most influential group in Democratic politics). ie "Relax boys, THERE WILL BE NO REAL RESTRICTIONS ON YOUR ABILITY TO SUE DOCTORS, Amen!"

Anyway.....

From the 60 Minutes interview tonight(click here for video)

KROFT: If it came down to getting this plan passed would you be willing to do more in the area of tort reform and malpractice insurance? Would you be willing to agree to caps, for example, on malpractice judgments?

OBAMA: You know what I would be willing to do is to consider any ideas out there that would actually work in terms of reducing costs, improving the quality of patient care. So far the evidence I've seen is that caps will not do that. But there are a range of ideas that are out there, offered by doctors' organizations like the AMA, that I think we can explore.....

KROFT: And the conventional wisdom has been that the reason that the House has always voted against any kind of malpractice reform or tort reform was because of the heavy contributions from the trial lawyers.

OBAMA: That is the conventional wisdom. And I think there's also been philosophical issues and differences about whether or not patients who really have been subject to negligence, whether it's fair to just say to them, "You know what? You can only get a certain amount, no matter how egregious it is."

That is nothing but double-speak goblety-gook which avoid any commitment to do anything. At least Democratic leader Howard Dean had the balls to recently come out and say that tort reform is not going to be in the bill because of the relationship of the party to the trial bar.



Rob

Buy one (implant), get one free - Stay classy Wisconsin!

A really, really tacky billboard campaign in rural Wisconsin by a wannabe made me immediately think to quote the Will Ferrel character, Ron Burgundy, from the movie "Anchorman",


"Stay classy, Wisconsin!"








Tasteful advertising! Does it surprise anyone that this Doctor promoting plastic surgery is not actually a Plastic Surgeon? Well at least he's a surgeon which is not the case with all these cases. Of note, this yahoo was recently fined (see here) closed to $20,000 for Medicare billing fraud.


Remember to always look for a board-certified Plastic Surgeon when you're considering cosmetic surgery. You can inquire here on the American Board of Plastic Surgery website.

Rob

Breast Reduction Amazon style - the legend of Amazonian breast mutiliation

According to Greek historian, Herodotus, the Amazons were a race of female warriors living on the Thermodon River in Scythia. There were no men in the community, and any boy born was killed or dispatched to his father beyond the river.

Hippocrates wrote that the girls had their right breast burnt off with hot irons such that they might better draw the bow. In the 3rd century AD, Roman historian Justin asserted that the mythological Amazon is derived from the Greek roots a (without) and mazos (breast). In Anabasis of Alexander, mention of the Amazons, said that their right breasts were smaller and were uncovered in battle. This observation could mean the legend of elective mastectomy was really right breast underdevelopment caused by deliberate binding or pinching.


Does it make sense that a mastectomy would make using a bow easier?

Actually it does. It's been observed that most competitive women archers are smaller breasted, and a chest guard is actually worn by many competitors to avoid inadvertent injury to their breast when shooting. The weight of the breast also changes the center of gravity and requires active extension of your lower back muscles to remain erect, a distinct liability for horseback based or hand to hand combat.




Among these legendary Amazonians were Queens Hippolyta, whose girdle Hercules was assigned to recover (sure sounds like a panty raid to me) as one of his 12 great tasks, Penthesilea for whose death Achilles mourned, and Thalestrias who had an affair with Alexander the Great.


In DC Comics, the famous Wonder Woman is supposed to be Diana, daughter of Hippolyta and Amazonian princess. For whatever reason she apparently did not get the memo about having small breast :)





Factoid to store away next time you're a contestant on Jeopardy: Spanish conqueror, Francisco de Orellana named the Amazon River as such after encountering women warriors among the Indian tribes of South America.

Rob

Pro tennis player Simona Halep's cups no longer runneth over.

While we're on a run of breast reduction posts, I'd like to highlight the related story of Romanian tennis player, Simona Halep. Ms. Halep is a 17 year old tennis prospect who was good enough to win the French Open junior division in 2008 and is working her way up the WTA rankings (currently at #274). Unfortunately for her, she was attracting as much attention for her breast size (reportedly 34DD) as she was for her tennis talent.

Well word got out in the spring that she was considering a breast reduction (reduction mammaplasty), it took things to a whole other level. Photo spreads in British tabloids, fan sites, "Stop Simona from reducing her breasts" Facebook groups (I'm not kidding, click here), and even the infamous Opie & Andy show on satellite radio got in on the act.






Here's a video clip of her practicing where you can see the problems large breasts would cause with movement. WOW, Does she really hit the ball hard or what!





Well it would appear Simona quietly went ahead with the surgery this summer and is recovering to return to her high level athletic career. Resuming the training and competing after this operation could be tricky. There's real reason to be extremely conservative in clearing her to train. At 2 weeks after surgery the breaking strength of her scar would be about 50%, and by six weeks it would be approaching 90% tensile strength. With the kind of torque, tension, and range of motion she will be putting on her incisions there is real reason to believe she may have issues with poor scarring from her reduction.

Discussing her decision in interviews, Ms. Halep

But Simona's set proved too much to handle during matches and she feared they were stopping her from winning titles.

Last month she admitted: "It's the weight that troubles me - my ability to react quickly, my breasts make me uncomfortable when I play as well.

"I don't like them in my everyday life either. I would have gone for surgery too, even if I hadn't been a sportswoman," she added.

The photo below is purportedly after her surgery in late June or early July.



A breast reduction the size of hers is likely not going to be possible with many of the modern "short scar" techniques that I prefer. I would bet she had a traditional "Wise Pattern" or anchor shaped incision.

Rob

Breast reduction surgery and quality of life - Addition by Subtraction!

Breast reduction surgery presents an interesting issue when we're getting into an era where every health care cost is going to be scrutinized. As a society, is this a procedure we're going to be willing to commit major funding to? Currently there is a patchwork of indications that vary between different insurance companies as to what meets medical necessity for this operation.

In general, most insurers make you do extensive documentation of "conservative therapy" before even considering approval. I'm not sure what conservative management of big breast is exactly anyway! There are differing weight requirements for the tissue to be removed as well. Blue Cross of Alabama for instance requires a minimum of 500 grams (~1.1 lbs) per breast to be removed. Others use a sliding scale called the "Schnur Scale" to correlate appropriate weight removal to a calculation of your total body surface area (TBSA). The Schnur scale came from a paper by a plastic surgeon who was trying to quantify symptoms in his breast reduction patients.

The recommendations from that study by Dr. Schnur were perverted by insurers, written into policy guidelines, and are now used to exclude many patients from having breast reduction surgery. There now exists a great deal of literature showing that reductions much less then prescribed by insurance companies is effective in patients suffering from neck, back, and shoulder pain. In fact, a Finnish study suggests breast reduction surgery seems to improve the health-related quality of life indicators as much or more then surgeries for hip or knee joint replacement.These studies are dismissed by insurers as observational,flawed, or biased by greedy doctors, but if they could speak honestly they would explain that they don't want to open eligibility for the procedure to a whole new class of patients and cost themselves a great deal of money.

Apparently we're not the only country that is having issues on whether to cover breast reduction surgery. Hat tip!

A court in the German state of Hessen has ruled that insurance companies do not need to cover the cost of breast reduction surgery as having a large bust is not a medical problem. The decision means that insurers will only have to pay to correct breasts which are deformed.

The case was brought by a 38-year-old woman who suffered orthopaedic and physical problems due to the weight of her boobs. She had been advised by doctors to have breast reduction surgery.

But her insurance company didn’t see it as a necessity and therefore refused to cover the costs of the operation. It claimed she was suffering from back problems because she was overweight and that her physical discomforts would be reduced if she trimmed down weight and built some muscle up.

The court agreed with the insurance company and the big-breasted woman lost her case.

Two and a half years ago, the court in Hessen rejected the case of a woman who thought her breasts were too small. She wanted her medical insurance to cover a breast enlargement operation and claimed that she was physically harassed for her small boobs. The court declared then that small breasts are not an illness

Rob

The World's Worst Plastic Surgery Logos

Choosing your business logo is important, and that holds true for plastic surgery practices as well. When we worked on ours, it took literally dozens of ideas and revisions to get where we wanted. It turned out pretty well if you consider the fact that our trademarked logo for Plastic Surgery Specialists has been "borrowed" by at least half a dozen web sites I've found.

Quick plagiarism trivia: If you'll remember, Richard Ashcroft, lead singer of British pop band The Verve was found guilty of plagiarizing the melody from the Andrew Oldham Orchestra recording of The Rolling Stones' 1965 song "The Last Time" for their 1997 #1 hit "Bittersweet Symphony". Ashcroft was forced to relinquish millions of dollars in songwriting royalties to Mick Jagger & Keith Richards.



Anyway, in doing research for our logo last year, Dr. Jason Jack and myself looked at hundreds of other practices logo choices. There were a few that stood out as really bad.

1. We thought this looked like the "Mud Flap trucker girl".



Versus



2. This one reminded me of all those bad 1970's brown color schemes


Compare it to this 1970's fabric courtesy of the "Tune Up" blog devoted to vintage fabric (talk about your narrow reader demographic!)


It also kind of reminds me of the 1970's San Diego Padres Uniforms.




3. This logo has four different type fonts fighting for supremacy




4. This logo was just too "subtle" :)




Did someone really think a Pitcher Plant emerging from some one's vagina was the right way to go with this ad? Obviously this campaign did not get wife approval factor (WAF) before going to print.

5. I call this ugly logo of various body parts the "Homunculus". A homunculus is any representation of a human being, and is often used to illustrate the functioning of a system.



In medical school neuroanatomy, the concept of this is used to show what areas of the brain control the body.




Not related to plastic surgery per se, but this pediatric clinic logo really could use a redesign :)


FYI, there's a great blog post on the world's worst logo here.
Rob

20/20 segment on the tradeoff's in healthcare reform

Good story on some of what you have to give up to expand healthcare coverage. It's not all win-win when you disincentive 20% of the economy.

Hat tip to my partner, Dr. Jason Jack BTW!


Rob

Democracts backpedal on federal "BOTAX" to plug budget holes

Well, it appears that calmer heads (or at least calmer foreheads) are prevailing.

Yesterday it leaked that the Democratic caucus was considering taxing BOTOX & cosmetic surgery in their desperate search for revenue to provide a fig leaf of budget neutrality in the health care power grab. After much ridicule on the ludicrousness at the feasibility and effectiveness of it, they're backing off.

Presumably, house speaker Nancy Pelosi , she of frozen forehead, killed this :)

Rob

Nip/Tuck gets "nipped" by FX - thank you God!

The insufferable (vaguely) plastic surgery -related drama, Nip/Tuck , has been terminated by the FX network. From the LA Times,

"When "Nip/Tuck" made its debut in 2003, it broke cable-viewing records and instantly distinguished itself with its stylized look, tongue-in-cheek tone, gorgeous stars and fresh take on America's obsession with beauty and youth. Those qualities earned it a Golden Globe for best drama, critical acclaim and water-cooler buzz that lasted for most of its first four seasons.

But when one of FX's signature series quietly wrapped last week on the Paramount lot, it did so without the usual fanfare associated with the end of a noteworthy show. In part, the silent send-off was because TV viewers won't see the "Nip/Tuck" finale, which finished shooting on June 12, for a long time, probably as late as 2011, making it tricky to publicize. Behind the scenes too, during the last week of production, there was an awkward sense that the end had already happened, since much of the crew had already moved to creator Ryan Murphy's new Fox musical, "Glee," last year, and Murphy himself was out of the country location-scouting for an upcoming movie.

....In the five seasons that have aired, the doctors, who are in their 40s, have almost died several times, slept with dozens of women, broken up their partnership a few times and dumped a dead body in the Florida Everglades. In the 19 new episodes, which will probably air over two seasons and may begin in January, the series will become even more operatic and dark, elements that, critics say, have diminished its pleasures over time.
"

Plastic Surgeons, will uniformly celebrate the demise of this tawdry show which did little to accurately portray or advance our field. While less offensive then Dr. 90210, The Swan, Miami Slice, and other "reality" shows, Nip/Tuck was painful to watch. Other then having supermodels throw themselves at me weekly, I just can't can't relate to this show ;)
(just kidding Honey!)

Rob

Doh! Obama's longtime personal physician says the President just doesn't get it on healthcare.

Those pesky septuagenarians just say the darnest things!

It's ironic that President Obama's longtime personal physician in Chicago, 71 year old Dr. David Scheiner, is on the record (see here) saying that the president does not understand the healthcare system or the changes that will be required to fix it.

He spikes the president on a number of issues including

• having close advisers who have no healthcare experience
  
  
• getting in bed with the trial lawyer's on killing malpractice reform



• failing to understand the economic concerns of physicians and fair reimbursement

Rob