At the annual AAD (American Academy of Dermatology) meeting in Miami Beach, Fla, one of the more interesting panel discussions was titled, "Ethical Economics in Dermatology and Dermatologic Surgery." Audience members used keypads to respond to questions from the podium. The event took place Saturday, March 6, 2010.

A panel of physicians, together with the audience, explored the ethical ramifications of the vignettes and the tallied audience responses. Ethics forum uses audience response keypads to elicit votes, generate discussion:

Clifford Warren Lober, M.D., who is also an attorney, defines the term "ethics" and pointed out that most ethics textbooks -- even those for medical and law schools -- don't actually define the term. When a definition of the word is found, it typically uses general words, such as "correct," "good" and "moral," he said, but that doesn't leave people with a measurable standard.

"Ethics are behavioral ideals defined by fundamental beliefs," he says. "These beliefs are either arbitrarily accepted as true in and of themselves or are derived inductively or deductively from other fundamental beliefs."

Ethics, he adds, are inherently subjective.

"If we change our fundamental beliefs, our ethics will change," he says. "Ethics will certainly differ in different societies. Human sacrifice is either an ideal to please the gods or absolutely abhorrent."

And just because something may be legal, such as abortion or the death penalty, doesn't mean it's ethical.

"Never conclude that something is ethical because it is legal or unethical because it is illegal," Dr. Lober says.

Scenarios shared by presenters and voted on by attendees ran the gamut, from funny to contentious. All, however, were applicable in some way.

Read it all.

 

The growing media attention paid to the married between cosmetic surgery and stem cells has been very upbeat and almost blissfully "forward thinking." PSP is no stranger to this interpretation of where we are headed -- adding stem cells into the aesthetic medicine mix sounds very promising. Therefore, it satisfies my journalistic senses when a physician offers a common-sense view of where we stand with this "marriage." From WFAA-TV: Dallas doctor uses stem cell injections in cosmetic surgery:

Dr. Jeffrey Caruth, an OBGYN practicing cosmetic surgery, started the procedure by removing fat from several parts of her body to create volume in her face and chest.
 
Under local anesthetic, she was awake during the entire surgery. Her hands were strapped down to keep her from touching the sterile area. It was a procedure Jones called painless.
 
“You know when you're hungry and your tummy is grumbling before it's time to eat, it kind of felt like that,” she said.

Caruth said stem cells help solve a problem that has plagued prior procedures.
 
“The problem has been with traditional fat grafting that you put a volume of fat into the face, the buttocks and then in a month or two or three there is significant volume loss due to death of the fat cells you put in,” he said.
 
To help the fat survive, it was injected with Jones' stem cells for regenerative purposes. Caruth used an enzyme to pull the stem cells out of her fat. A machine then created a concentrated solution of stem cells, which are injected into a fresh batch of fat for double the power.
 
“You're going to get twice the graft survival versus other methods,” Caruth said.

Jumping down the page, I appreciate the comments from Jeffrey Kenkel, MD, a well-known aesthetic practitioner who puts the whole stem cell slash plastic surgery debate into perspective:

...While he has great hope for stem cells, he said they aren't predictable enough yet to guarantee results.
 
“There is a tremendous amount of excitement about stem cells," he said. "We just don't have a lot of information about them, about how they work and how we control them to do what we want them to do."
 
Kenkel agrees stem cells will change medicine in the near future, but said more scientific and objective research is needed.
 
“Are the stem cells going to stick around and actually control how that person heals and what kind of results they have?" he said. "We just don’t' have the answer to those questions yet."

Read it all.

 

 

Haideh Hirmand, M., FACS. a plastic surgeon who has been in private practice in New York City since 1999, has come out swinging against laser and other aesthetic device makers that have "gone the way of Big Pharma" with direct-to-consumer marketing rather than direct-to-physician. Is Non-Invasive Liposuction a Fat Lie?

None of the technologies presently have FDA approval for specific body contouring/fat reduction applications. Some are approved for dermatologic purposes for example. As a plastic surgeon who is familiar with these latest technologies, I have been excited about their arrival for a while, but I am also skeptical about how some of these machines are being marketed directly to the consumer ahead of their FDA approval and scientific data. In the old times, you had to first convince doctors that a machine worked by showing results and clinical data and then doctors offered it to their patients.

Read it all.