HOLD ON - IT WILL BE A "WILD RIDE"

Insurance sold on marketplaces may limit access to doctors, hospitals.

In a front-page story titled “Insurers Restricting Choice Of Doctors And Hospitals To Keep Costs Down,” the Washington Post (11/21, A1, Somashekhar, Cha, 4.28M) reports that “Americans...are discovering that insurers” selling plans on the Affordable Care Act’s marketplaces, “are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.” According to the Post, there is now “a two-tier system” as “many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.” The Post says this situation has been exacerbated by some “providers” that “have balked at being in exchange networks because they are unhappy with the reimbursement rates or are concerned that the exchanges could be dominated by sick people who won’t be able to pay their portion of the bills.”

        As the AP (11/21, Alonso-Zaldivar, Ramer) notes, President Obama “promised people could keep their doctors,” which could make this “the next health overhaul issue.” American Medical Association president Dr. Ardis Dee Hoven is quoted as saying, “Although it may be too early to reach any definitive conclusions, we are monitoring the adequacy of the exchange networks and will be analyzing the impact of these restrictive strategies on patient access to care.”

        Moreover, the Washington Examiner (11/21, Pollock, 319K) reports that consumers visiting healthcare.gov are not able “to learn whether their doctors participate in an Obamacare-approved health care plan because the website doesn’t include such information.” Jessica Waltman, senior vice president of government affairs for the National Association of Health Underwriters, explained to the Examiner: “Under the exchanges, the government did not require health plans to submit detailed network information. That’s why the networks aren’t listed on healthcare.gov. When you go to look in at the plan choices, you can’t see the provider networks.”

ANOTHER INVESTIGATIONAL DRUG THAT MAY BE BENEFICIAL - THE BODY'S IMMUNE SYSTEM IS THE KEY

Merck says cancer drug boosts survival of advanced melanoma patients.

The Wall Street Journal (11/18, Subscription Publication, 5.91M) reports Merck & Co. provided an update Monday to its early-stage study of a melanoma treatment, showing that it has an 81 percent survival rate at the one-year mark. The pharmaceutical giant provided data on its investigational MK-3475 against advanced melanoma at the International Congress of the Society for Melanoma Research, reports the Journal.

        Bloomberg News (11/19, Cortez, 1.91M) provides more details, noting the drug being “evaluated in nine different malignancies kept more than four of five melanoma patients alive for a year in a study,” including patients who had “exhausted all other treatment options.” The study found 41 percent “responded to treatment and 9 percent showed evidence of the tumor disappearing.” The drug belongs to a new group of medicines called PD-1 inhibitors “that harness the body’s immune system to attack cancer.” Merck is evaluating the drug in more than 3,000 patients suffering from cancers such as lung, bladder, breast and colorectal tumors, the article notes.

ANOTHER SURGICAL PROCEDURE THAT IS USUALLY NOT NECESSARY

Sharp rise in number of women getting genital plastic surgery: researchers 

Experts blame porn for confusing teen girls and women about what a vagina is supposed to look like. In Britain, there’s been a fivefold increase in the number of female cosmetic genital surgeries, which aren’t medically necessary and could cause health problems.

 

 

There’s been a scary rise in the number of women and teen girls getting unnecessary labiaplasties, researchers said.

 

A shocking number of teen girls and women are undergoing plastic surgery on their vaginas to replicate what they see in pornography, British researchers said.
The Royal College of Obstetricians and Gynecologists reported a fivefold increase in labiaplasties, which are considered cosmetic surgeries, over ten years.Experts attribute the sharp uptick, in part, to porn. “The misapprehension arises from the prominence of just one type of ‘neat’ genital appearance, the type to be found prominently depicted in pornography,” Thomas Baldwin of RCOG’s ethics committee, told Agence France-Presse.

The paper examines the dangers associated with these surgeries, which aren’t medically necessary.
“The younger a girl begins her labiaplasty trajectory, the higher the number of operations over her lifetime and the greater the risk of scarring and sensitivity loss,” researchers wrote.

The operations aren’t recommended for women under age 18, whose vaginas aren’t fully developed.
In Britain, 2,000 of these operations were performed in 2010, according to the report. But experts say the true number is much higher, as that figure doesn’t take into account surgeries done in the private sector. The trend is also growing in the United States, despite a 2007 warning to physicians from the American College of Obstetricians and Gynecologists, to consider the “medical validity and safety” of female genital cosmetic surgery, Reuters reported.

GOOD NEWS AND BAD NEWS

CDC: Teen smoking down but use of cigars, e-cigarettes up.

The Wall Street Journal (11/14, Esterl, Subscription Publication, 5.91M) is part of the group of US national media outlets reporting on new findings from the US Centers for Disease Control and Prevention that were published yesterday. Though the CDC revealed that cigarette use among minors in the US is dropping over last year, the use of alternative tobacco products, such as miniature cigars, electronic cigarettes, and hookah, has risen. The Wall Street Journal focuses on the first of that group, cigarillos and little cigars, as being the second most used tobacco product among teenagers.

WE STAND ON THE SHOULDERS OF GREAT MEN - DR. TOM REES WAS AN INSPIRATION

November 15, 2013

Plastic surgery mourns loss of one of its giants: Thomas Rees, MD, passes at 86

Plastic surgery pioneer and ASPS Life Member Thomas Rees, MD, Santa Fe, N.M., passed away Nov. 14. Dr. Rees was world-renowned for facial aesthetics, particularly rhinoplasty. He was also a prolific author who literally wrote the book – actually, six textbooks - on cosmetic plastic surgery and other procedures.

Along with his mentor Sir Archibald McIndoe, MD, and fellow plastic surgeon Sir Michael Wood, MD, Dr. Rees in 1957 co-founded the African Medical and Research Foundation, more commonly known as the Flying Doctors Service of Africa. The organization was dedicated to providing those living in the most remote areas of Eastern Africa with access to hospital care via air transport.

“During my years of active practice in New York City for 40-45 years, I was spending every winter in East Africa,” Dr. Rees told PSN in 2006. "I had this side avocation going on.”

“Dr. Rees’s contributions to aesthetic techniques – both in the United States and throughout the international aesthetic community of plastic surgeons – are extraordinary,” says ASPS President Robert X. Murphy Jr., MD. “His dedication to sharing his knowledge with residents and other plastic surgeons is overshadowed only by his tremendous humanitarian work with the Flying Doctors of Africa. He was truly a giant in our specialty and beyond.”

Dr. Rees stopped practicing plastic surgery in 1994, and penned a memoir chronicling his experiences in Africa titled Daktari: A Surgeon’s Adventures with the Flying Doctors of East Africa. He also continued to make annual trips to Africa with his wife of 63 years, Nan, who passed away in May 2012.

“Dr. Rees is a shining example of plastic surgery at its best,” says Kevin Chung, MD, president of The PSF. “His significant contributions extended well beyond the clinic, and he left a blueprint for international service that is inspiring and enduring.”

Dr. Rees, who came from a family of physicians, says he developed an interest in plastic surgery during a rotation in the specialty as part of his general surgery training.

“I liked it very much because it left a lot of room for innovation,” he said. “If you’ve done 50 gallbladders, you’ve done them all, [but] plastic surgery was different. It appealed to my artistic sensibilities. I liked the idea that you were constructing things instead of destroying things.”

As a dedicated teacher and humanitarian, Dr. Rees leaves a rich legacy that impacted generations of plastic surgeons and thousands of patients’ lives a world away.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 10

10. “Those who need surgery the most will benefit from it the least.”

Most people turn to plastic surgery when they feel age has finally caught up with them and nothing else will rid them of that troublesome bulge or crease. But the dirty little secret of plastic surgery is that with many procedures, the more you need it, the less of an impact you can expect.

Those who have damaged skin, more common as we age, can expect some serious complications. Skin stretched by weight gain, for example, loses its elasticity; following liposuction, skin may not snap back into place but instead will hang like an apron over the area that was suctioned. Because smokers have poor circulation to the epidermis, their skin can die after surgery, meaning months of unsightly scars and possible additional surgery. And procedures such as a face-lift done on sun-damaged skin won’t last as long and may result in more-prominent scarring. Likewise, those hoping for dramatic weight loss from liposuction are looking in the wrong place; surgeons say it’s meant only to shape a certain part of the body in conjunction with diet and exercise.

Ironically, those who need cosmetic treatments the least — generally, those who are younger (say, in their late 30s or 40s) and opt for a little tweaking here and there — are going to fare the best. What’s more, while plastic surgeons sometimes downplay the role that lifestyle can play in one’s looks, a growing body of evidence suggests that overall health and appearance are indeed related, Sarwer said.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 9

9. “Of course I’m board certified, for what it’s worth.”

A board-certified plastic surgeon should be the best, right? Not always. Because any medical doctor can legally perform any cosmetic procedure, without obtaining any specific certification, and because certification boards are self-regulating, many certifications aren’t so telling. The American Board of Laser Surgery, for example, certifies nurses, veterinarians and oral surgeons in laser surgery — through a take-home written exam and video Web conference. “This being the U.S. and the land of entrepreneurship, just saying you’re board certified is not enough,” says Nahai. “Ask them which board.”

There are some certifications that matter. The American Board of Plastic Surgery’s is one of the most rigorous for this specialty and the only certification for whole-body plastic surgery recognized by the American Board of Medical Specialties that provides training and assessment for entire body cosmetic, plastic surgery, and reconstructive treatments. The American Board of Medical Specialties is a nonprofit organization that’s widely recognized as a leader in physician certification. Members of the ABPS have completed residences in both general surgery and plastic surgery and are trained to do all procedures from liposuction to nose jobs. Other ABMS Member Boards may have some specific plastic surgery procedures for which their certified physicians are also qualified (for example, physician members of the American Board of Otolaryngology may be very well qualified to perform nose jobs). The American Board of Medical Specialties runs a website, CertificationMatters.org, where patients can see if their doctor is certified by a rigorous board.