LONDON - A special edition of the journal, Clinical Risk, published by the Royal Society of Medicine, looks at how the combination of an under-regulated market, “professional greed”, increased marketing and overwhelming media hype have created a “perfect storm” that threatens patients and practitioners alike. The journal’s editor argues that cosmetic surgery patients in the UK are at more risk than ever before.

Dr Harvey Marcovitch, who commissioned leading experts in the field to write for this special issue said, “Patient safety is this journal’s main aim and there can be no area of medicine where patients in the UK are more in need of protection. We need tight control of advertising of cosmetic surgery - including internet advertising. We need proper regulation of the industry and we need both surgeons and GPs to manage patient expectation.”

In one paper, entitled ‘Clinical Risk in Aesthetic Surgery’, Nigel Mercer, consultant plastic surgeon and President of the British Association of Aesthetic Plastic Surgeons (BAAPS) argues: “We have reached a stage where public expectation, driven by media hype and, dare one say, professional greed, has brought us to a ‘perfect storm’ in the cosmetic surgical market.”

He adds, “There has been a massive increase in ‘marketing’, including discount vouchers, 2-for-1 offers and holidays with surgery! In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a ‘2-for-1′ advert for general surgery? That way lies madness!”

Highlights:

Clinical Risk in Aesthetic Surgery: Nigel Mercer discusses the role of the media and advertising and calls for tighter regulations in the UK, comparing this country’s lack of regulation with the Food and Drug Administration’s role in the US.

Key quotes:

- “Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic ’surgical’ procedures, including on search engines…”.

- “If we have to sell anything, we should sell our advice, not procedures. If we cannot self-regulate, then, like the financial institutions, regulation will eventually be imposed…”

- “All cosmetic treatments are medical interventions, and every medical intervention has a complication and failure rate. Consequently, there are no ‘consumers’ or ‘clients’ but only ‘patients’…”

- “Perhaps the single most important factor in reducing clinical risk in cosmetic surgery is the motive for performing any procedure must never be financial gain, so I suggest we get our act together as an industry as we are in grave danger of biting the hand that feeds us.”

France Sets Standards for Practice of Aesthetic Surgery: French consultant plastic surgeon, Alain Fogli describes the strictly defined guidelines for cosmetic surgery in France which include:

- Surgical procedures can only be undertaken by surgeons who are registered specialists and deemed competent. Possession of a general medical degree, and the fact that the practitioner is ‘experienced’ are not deemed to be sufficient qualifications

- A ban on all forms and methods of publicity and advertising, direct or indirect, in whatever form, including the Internet

Minimizing Risk in Aesthetic Surgery: Foad Nahai, President of the International Society of Aesthetic Plastic Surgeons (ISAPS) and former president of the American Society of Aesthetic Plastic Surgeons (ASAPS) describes how to minimise risk in each facet of ‘the safety diamond’: patient, facility, procedure and surgeon.

He tells readers:

“Regulations governing the training of all cosmetic surgeons are sorely needed. Governments are reluctant to become involved, as they see this issue as a ‘turf battle’ between various physician groups and not a public safety or patient safety issue. However, there is no question that this is a patient safety issue of paramount importance and I take our governments to task for not addressing it.”

- Since by law any physician is allowed to practise cosmetic surgery, attempts by individual physicians or plastic surgery organisations to restrict those who are not qualified is viewed as a restraint of trade.

Improving the Safety of Aesthetic Surgery: Recommendations Following a 14-Year Review of Cases to the Medical Defence Union (1990-2004): Consultant plastic surgeon and BAAPS Secretary, Rajiv Grover, reveals a 14-year audit of claims to the MDU which shows why patients sue. He provides recommendations to avoid these situations such as careful pre-operative counselling, thorough documentation and exploring with the patient what degree of correction and scarring is realistic - and not being falsely optimistic about the likely outcome.

Managing Risk to Reputation: Magnus Boyd, Partner at leading UK solicitors, Carter-Ruck suggests how doctors can protect their reputation and how the media can influence the outcome of a professional investigation or the expression of anger from a disgruntled patient.

Both Dr Harvey Marcovitch and Mr Nigel Mercer are available for comment.

Clinical Risk

The journal Clinical Risk aims to give both medical and legal professionals an enhanced understanding of key medico-legal issues relating to risk management and patient safety, through authoritative articles, reviews and news on the management of clinical risk. The AvMA Medical and Legal Journal and the Healthcare & Law Digest, both included within Clinical Risk, contain articles on current medico-legal issues and reports on a wide range of recently settled clinical negligence cases.

BUDAPEST — It was a night for unnatural beauties. Contestants showed off breast implants, nose jobs and face lifts as Miss Plastic Hungary 2009 strove to promote the benefits of plastic surgery in a country where artificial enhancements are viewed mostly with a wary eye.

“I think this competition is long overdue,” said photographer Marton Szipal, one of the pageant judges. “Hungarians used to laugh about plastic surgery but it’s time for Hungarian women to care more about their appearance. They are the most beautiful in Europe.”

Plastic surgeon Dr. Tamas Rozsos said the pageant also meant to show that cosmetic corrections did not necessarily have to be about oversized breasts, bulbous lips and skin stretched to near tearing point.

“This about restoring harmony … eliminating asymmetries and giving women the opportunity to have normal features,” Rozsos said. “Plastic surgery has a bad reputation in Hungary but its mostly due to the exaggerations.”

Despite Hungary having been hit hard by the global economic crisis with the government forced to scale back spending on health services, Rozsos said that the number of surgeries had been rising year by year.

“People for whom this is important always find the money,” Rozsos said.

To qualify for the pageant, the 18 Hungarian residents had to prove they’d gone fully under the knife — mere Botox or collagen injections did not count. Nearly all the contestants showed off augmented breasts, with reshaped noses also popular. One finalist had surgically adjusted toes.

Organizers claimed contestants were expected to show “a perfect harmony of body and soul,” but the three-part pageant concentrated almost exclusively on the women’s physical attributes and the usually conspicuous wishes for world peace went missing.

Miss Plastic candidates were at least 18 years old and included a former rhythmic gymnast, a firefighter married to a police officer, a mother of three and several strippers. There was a special category for women over 30.

Pageant queen Reka Urban, a 22-year-old hostess, won an apartment in Budapest, first runner-up Edina Kulcsar was given a new car and second runner-up Alexandra Horvath took home diamond jewelry worth 2 million forints ($10,800). The winners’ plastic surgeons also received awards.

HELSINKI- Scientists from University of Helsinki Institute of Biotechnology have identified a novel therapeutic target for Parkinson’s disease.

Lead researcher Professor Raimo K. Tuominen and colleagues have identified a growth factor that can be used to halt the progress of damage brought on by a nerve poison, and possibly restore the function of damaged cells.

The team is investigating two new nerve growth factors. MANF (mesencephalic astrocyte-derived neurotrophic factor) and CDNF.

MANF is released from glial cells in the midbrain and is a member of the same growth factor family as CDNF.

The team found that in the experimental PD model, MANF and CDNF injections into the brain prevented dopamine nerve destruction caused by nerve poison and to some extent even restored the function of damaged cells in rats.

This suggests that MANF spreads more readily in brain tissue than other known growth factors.

This may be a highly significant finding in respect to the development of growth factor therapy for PD.

What is aromatherapy?

Aromatherapy is the use of essential oils from plants for healing purposes. The word aroma in aromatherapy is misleading because essential oils are not solely used as inhalants. They can also be massaged into the skin or even taken by mouth (although this is less common). Whether inhaled, absorbed, or ingested, essential oils are gaining new attention as an alternative treatment for infections, stress, and other health problems. (Note: essential oils should never be taken by mouth without specific instruction from a trained and qualified specialist)

What are essential oils?

Essential oils are concentrated extracts taken from the roots, leaves, or blossoms of plants. Each essential oil contains its own mix of active ingredients, and this mix determines the healing properties of the oil. Some oils promote physical healing — for example, some are able to relieve swelling or fight fungal infections. Others are used for their emotional value — they may enhance relaxation or make a room smell pleasant. The essential oil derived from orange blossom, for example, contains a large amount of ester, an active ingredient thought to induce a calming effect. This may explain the tradition of a bride carrying an orange blossom bouquet on her wedding day.

What is the history of aromatherapy?

Essential oils have been used for therapeutic purposes for nearly 6,000 years. The ancient Chinese, Indians, Egyptians, Greeks, and Romans used essential oils in cosmetics, perfumes, and drugs. Essential oils were also commonly used for spiritual, therapeutic, hygienic, and ritualistic purposes.

More recently, René-Maurice Gattefossé, a French chemist, discovered the healing properties of lavender oil when he applied it to a burn on his hand after an explosion in his laboratory. Following this unexpected finding, he devoted his time to analyzing the chemical properties of essential oils and to recording their value in treating burns, skin infections, gangrene, and wounds in soldiers during World War I. In 1928, Gattefossé founded the science of aromatherapy. By the 1950s massage therapists, beauticians, nurses, physiotherapists, doctors, and other health care providers began using aromatherapy. In France, more than 1,500 trained doctors use essential oils as an alternative to antibiotics.

Aromatherapy did not become popular in the United States until the 1980s, when essential oils gained the attention of massage therapists, alternative practitioners, and the commercial industry. Today, many lotions, candles, and beauty products are sold under the name “aromatherapy.” Unfortunately, however, many of these products contain synthetic fragrances which do not have the therapeutic substances found in essential oils.

How does aromatherapy work?

Researchers are not entirely clear how aromatherapy works, but many experts speculate that our sense of smell plays a very important role. This sense is incredibly powerful — according to some estimates, about 10,000 times stronger than any other sense. The “smell” receptors in your nose communicate with two structures that are embedded deep in your brain and serve as storehouses for emotions and memories. These structures are called the amygdala and hippocampus. When essential oil molecules are inhaled, they affect these parts of the brain directly. Researchers believe that stimulation of these structures influences our physical, emotional, and mental health. For example, lavender is believed to stimulate the activity of brain cells in the amygdala in the same way that certain sedative medications work.

In addition to stimulating certain brain structures through your sense of smell, essential oils can also influence mood through several other methods. Aromatherapy massage is a popular way of using essential oils because it works in several ways at the same time. It produces benefits from absorbing the oils into the skin, from inhaling the oil’s vapors, and from the physical therapy of the massage process itself.

What happens during an aromatherapy session?

Professional aromatherapists, nurses, physical therapists, pharmacists, and massage therapists can provide topical or inhaled aromatherapy treatment. Only specially trained professionals can provide treatment that involves taking essential oils by mouth.

At a typical aromatherapy session, the practitioner will ask about your medical history and symptoms, as well as any preferences you may have for certain scents. Depending upon the condition of your health, the practitioner will instruct you to inhale essential oils either directly from a piece of cloth or indirectly through steam inhalations, vaporizers, or sprays. The practitioner may also apply diluted essential oils to your skin during a massage. In most cases, the practitioner will instruct you on how to continue using aromatherapy at home. For example, many essential oils can be mixed with milk or cream and added to a bath.

What is aromatherapy good for?

Aromatherapy is used in a wide range of settings — from health spas to hospitals — to treat a variety of conditions. In general, aromatherapy appears to ease pain, enhance mood, and promote a sense of relaxation.

Several clinical studies suggest that essential oils (particularly rose, lavender, and frankincense)administered to pregnant women by qualified midwives lowered feelings of anxiety and fear, promoted a sense of well-being, and reduced the need for pain medications during delivery. Many women also report that peppermint oil relieves nausea and vomiting during labor.

Massage therapy with essential oils may also be of value (together with medications or therapy) for people with depression. The smells of the oils are believed to stimulate positive emotions through the limbic system (the area of the brain responsible for memories and emotions). However, the benefits of aromatherapy with massage appear to be related to the relaxation effects of the treatment as well as to an individual’s belief that the treatment will be helpful.

Clinical studies have found that chemical compounds in certain essential oils have antibacterial and anti-fungal properties. Some evidence also suggests that citrus oils may enhance immune function and that peppermint oil may promote proper digestion. Fennel, aniseed, sage, and clary-sage have estrogen-like compounds, which may make them effective in relieving symptoms associated with premenstrual syndrome, menopause, and the menstrual cycle.

Other conditions for which aromatherapy may be helpful include:

    * Alopecia areata (hair loss)

    * Agitation, including, possibly, agitation related to dementia

    * Anxiety

    * Constipation (namely, abdominal massage using aromatherapy)

    * Insomnia

    * Pain: Studies have found that people with rheumatoid arthritis, cancer (specifically, topical chamomile), and headaches (specifically, topical peppermint) require fewer pain medications when they use aromatherapy

    * Pruritis (itching), a common side effect for those receiving hemodialysis

    * Psoriasis