Professor Anand Deva, a leading Australian clinician, academic, translational researcher and healthcare innovator writes in response to the recent tragic events in Sydney about the death of a medi-spa owner who perished during a cosmetic surgery procedure.
The circumstances of her death are now under investigation and it has been alleged that a visiting Chinese tourist administered a toxic dose of medication intravenously while preparing her for a breast enhancement procedure in the back room of the victim’s own beauty salon.
She suffered a cardiac arrest, was taken in an ambulance under the gaze of news cameras and died 24 hours later in a Sydney hospital.
This tragedy highlights the dark side of a burgeoning cosmetic medical industry. Unacceptable and tragic as this is, it should prompt us to really look into the various factors that led to this event and how these factors are impacting on the day to day delivery of treatments to patients who seek them.
On Friday last week, a class action was filed at the Supreme Court of NSW against Australia’s largest cosmetic surgery provider — the Cosmetic Institute. The statement of claim alleges that the company’s staff lacked the capacity to access urgent medical assistance and the clinics did not have adequate infection control.
This is not the first time, nor it will be the last time, that patients are allegedly put at risk from treatments that are outside acceptable practice or more importantly right on the line between what is best for the patient and what is best for the practice.
The stories that grab headlines, however, are really the tip of the iceberg when you look critically at outcomes following treatment. The problem is that substandard results take time to manifest. If you look, for example, at breast implant surgery, the commonest reason for failure and/or re-operation takes three to four years to come to light. This delayed and often hidden burden will surface and then place pressure on public health resources and ultimately on to taxpayers.
It is interesting to reflect that cosmetic surgery and subsequent cosmetic medical treatments were first born out of the treatment of severe facial injuries and disfigurement after the world wars. The same techniques used to reconstruct noses, faces and eyelids and move deformity toward normality were quickly adapted to treat ageing and have now moved into essentially treating healthy and normal patients who wish to “improve” their appearance. For a long while, this surgery was performed surreptitiously and was only accessible to the wealthy or famous. Our own Dame Nellie Melba was said to have suffered infection following a facelift procedure, which in the days prior to antibiotics, proved lethal.
In recent years, the accessibility of these treatments has increased due to falling prices fuelled by intense competition. Now, anyone over 18 can openly seek treatment and find a practitioner to suit their budget quickly and easily. In parallel, the demand for these treatments has grown exponentially fuelled by media, social media and the cult of celebrity.
The top three treatments are anti-wrinkle injections, soft tissue fillers and breast enhancement — which alone generate an estimated $1.5 billion in sales per year, double what it was estimated just two years ago.
Our own (vague) statistics have shown a 10-fold increase in breast augmentation in Australia over the last decade — this industry is one of fastest growing in medicine. And therein lies the problem. The demand is fuelling desperation in patients who are willing to seek out “bargains” both here and overseas and it is also giving rise to entrepreneurs who see a huge commercial opportunity. This mixture of insatiable blind demand and unchecked medical entrepreneurship is literally, at times, a toxic and lethal combination.
At the heart of this mix is the quest for profit over and above the delivery of medical care. While one may argue that some of these treatments are “low risk” and just make us “feel better about ourselves”, they do not go to the heart of society’s desire to match appearance with well-being.
We are not here to argue against the merits of seeking to improve appearance — our focus within the industry should be to ensure that quality, safety and standards of care are never subordinate to the need to capture patients for profit. Any voice that calls for a more objective and evidence based approach to these treatments is often drowned out by claims of “vested interest” and “conflicts”. More likely the call for transparency and the truth may well challenge existing business models built around trying to capture vulnerable patients pushed by insatiable demand.
What if our motivations were a little purer? Perhaps it is time for a few of us to abandon the pressure sales tactics and high exposure marketing to pursue a more traditional approach to both informing patients and reporting true outcomes of treatment.
The “smoke and mirrors” perhaps will then be pared back to reveal the true benefit of cosmetic procedures and their capacity to improve quality of life and self-esteem. Scientific and objective outcome analysis and data registries will also push this industry towards mainstream medicine and patients will hopefully be able to be served by an ethical, evidence and outcome driven industry.
In the meantime, as we struggle to come to terms with this terrible tragedy — let us not let this opportunity for introspection, reflection and commitment to improve pass us by.