Category: …and everything else

The internet is one of those fun things that can be used for good, or for serious procrastination (which some might argue is still good). Since I’m obviously not getting anything done that I need to, seeing as I’m buried under several blankets on the couch, watching Whose Line and trying not to form iciles on myself, I figured I’d use the procrastinating power of the internet to catch up on various email alerts and at least use my brain for something more strenuous than trying to figure out what animal Ryan Stiles is miming at the moment.

I’m still trying to figure out just how the paper affiliation is working, but this article in some Texas-area paper is talking about the growth of medical spas in our country. These are places doctors open to do mostly cosmetic surgeries in an aromatherapy-filled spa. It goes rather without saying that these places are not covered by insurance, but are out-of-pocket fixes for people with disposable money and the inclination towards cosmetic surgery. One of the more interesting things about them is that the doctors are not what you’d think: ob/gyn’s, neurosurgeons,… in other words, not people with cosmetic surgery backgrounds, and sometimes not even outside/extended training. That is, of course, if you manage to get a doctor at all – many people are simply technicians with little to no training, applying chemical peels and botox treatments.

In the article, David Magnus of Stanford’s Center for Biomedical Ethics says that this flocking of doctors to spa services “says something about medicine that we should be concerned about” and that it’s not necessarily about the traditional role of a doctor promoting patient well-being. As much as I admire Magnus, I’m more inclined to agree with Jonathan Moreno, who’s also quoted in this article. Dr. Moreno points out that society does have this notion of doctor’s acting for social good, a romanticized notion of the Time Life doctor walking down the dirt road, taking payment in the form of apple pie and gratitude as much as financially (well, Moreno starts that thought out, with my own embellishments for illustrative purpose). But that romanticized notion hasn’t caught up with the realities of managed care and the slim margins of profit now available for doctors. (Whenever I get depressed over the amount of debt I’m going to eventually graduate with, I just remind myself what my sister is going to end up with, once she’d got her M.D., and I stop grousing so much.)

In conjunction with our romanticized notion of the good doctor, we have the Porsche-driving, McMansion owning doctor who brings in fabulous amounts of money from their practice. What does it matter, we think, that insurance companies are in a position to negotiate lower payments while malpractice costs soar? They still have money! Our idea of who and what a doctor is has not caught up to the present, so we see articles about doctors opening spas for cosmetic purposes and roll our eyes; those greedy doctors, just wanting more money.

I just don’t think it’s that easy. Were it any other business, we’d be applauding the entrepreneurial spirit, finding a new way of making money! But since it’s attached to a medical degree, we become suspicious.

I do agree that we should look for some sort of guidelines for these spas, to guarantee some basic level of knowledge and care. But in some ways, this is also the responsibility of the client, to make certain the background of the person they’re seeing is up to parr. And given how many people who do have money opt to travel to other countries to have medical treatment, it’s obvious that credentialing services aren’t necessarily the most important thing for clients. Often, I think access, environment, and cost end up playing more to the greed and desires of the client.

It’s an issue that can’t simply be boiled down to “bad doctor, greedy”. I think these medical spas are symptomatic of several much larger social issues. Putting the emphasis on the doctor as greedy shifts the focus away from those larger social issues and lets them go unaddressed, while simply patching that which is immediately in front of us.

This is a really interesting article that suggests people with debilitating dementias still exist, on some level, in their mind, and can communicate through alternative means. My maternal grandmother had a long battle with Alzheimers, and the one time I saw her after her descent, she thought I was my mother, and didn’t recognize Mom at all. I wonder if it would have been easier for the family if she had had an alternative form of therapy like this, available for communicating with everyone? Perhaps she would have had her own directions to her daughter’s house.

How do you prevent abortions? You prevent pregnancies. And how do you prevent pregnancies? You teach comprehensive sex education to kids, and you make sure birth control is accessible. This seems rather self-evident, and it’s something those of us who’ve taught sex ed or otherwise been deeply involved in the sex education wars are well aware of. And now, Will Saletan over at Slate has written a cleverly titled piece, Where Rubber Meets Roe, about the pro-life brigade finally jumping aboard the bandwagon. While it’s interesting to see the logic of pro-life Democrat Tim Ryan, of Ohio, and how his bill ended up splitting into two over the debate over contraception, what’s really important about the article is the data that swayed Ryan.

Ryan’s bill is targeting families with incomes 200 percent below the poverty level, a number that is hard to wrap your mind around. (Consider that the poverty level for parents with two children under 18 is $19,000.) It looks like that in this group of women, access to contraception fell, and sexual activity also fell. But rates of unintended pregnancy increased; the fall in sexual activity did not match the fall in contraception use, so abortion rates increased. What the Saletan piece doesn’t mention, though, is the composition of the women in that 200 percent below poverty level group. We can infer, from the government census website, that the majority of the women in this group are going to be Hispanic or African American. Non-Hispanic white’s only make up 8.3% of the 37 million people in poverty in this country, a number that is slowly falling. Hispanic and African American’s make up 21.8 and 24.9%, respectively.

Access to abortion and contraception is an important women’s health issue that is intensified by class issues and money. And for better or worse, there is a racial disperity between the people fighting these legislative bills and the people who have to live in the reality of the changes the bills bring.

(And a hat tip to AJOB’s bioethics newsfeed, which put this article across my desk this morning.)