Binge-drinking, boob-jobs and the black art of spin

Shawn Burns says:

09:59am | 07/07/09

Lead with Paul Harragon, transition to plastic surgery regulation and end with boob jobs - quite an achievement, David.

RT says:

01:02pm | 07/07/09

I agree with Shawn Burns, the wandering path of this article lost me less than halfway through. On the comment about NRL boozers cleaning up their act to minimise bad publicity, David, the problem is that you work in an industry that thrives on bad publicity. Bad publicity is the core business of the media. So the media industry seems to be constantly at war with the spin doctors of those the media is interested in. Just when the spin doctors escalate things by finding a way to negate negativism, the media will find a way to break through the barriers to discover the hidden naughty behaviour.

Dave says:

01:58pm | 07/07/09

lol, what a load of crap. 60% of professional rugby league players are ashamed to be professional rugby league players.

Since bloody when?

I’d be far more ashamed being known as a journalist.

MR says:

02:10pm | 07/07/09

This is a barely disguised press release, advocating the specific commercial interests of a client who is currently paying the author to promote their interests. 

This isn’t news or opinion - it’s advertising.

The Punch has yet again allowed a ‘commentator’ with a massive conflict of interest to publish content promoting their private agenda without disclosing that conflict anywhere within the article.

When are you guys going to start adhering to basic editorial integrity?

David Gazard says:

05:15pm | 07/07/09

Dave,

You ought to be reading Rugby League week. They did the poll on 100 players. This is what happens when you don’t get on the front foot; no-one wins.

There was widespread coverage of the players’ poll.
http://www.news.com.au/couriermail/story/0,20797,25717607-10389,00.html

http://www.smh.com.au/news/lhqnews/players-ashamed-of-their-profession/2009/07/01/1246127559401.html

At very least the poll damaged the code with headlines like this: Sex scandals make top players ashamed to play NRL

Don’t blame me for writing it on The Punch. You ought to take it up with the players.

DG

Mondo Rock says:

05:54pm | 07/07/09

Paul - putting aside the disclosure issue (which I really don’t believe you have sufficiently addressed) - why would you allow David Gazard to write an opinion piece that quite explicitly promotes the interests of a paying client?  Surely I’m not the only one who thinks this is a gross breach of journalistic ethics?

In what way does this article contribute anything to the public domain, other than encouraging readers to be sympathetic to the interests of David’s client?

AJ says:

05:57pm | 07/07/09

MR: The author’s business relationship HAS been disclosed in the body of the article. What’s more interesting is the public interest in having the powerful entrenched interests of plastic surgeons exposed and challenged by mere transparency. Cosmetic surgeons are doing the right thing; it’s time others followed their example. It’s about time the ACCC and other government bodies started holding them to account for their protectionist practices which have created unnecessary shortages of surgeons throughout the health care system.

Carbondogg says:

06:03pm | 07/07/09

I think the negative commenters here are missing the key point to this—what happens when you allow bad behaviours to go unchanged with no policy framework without acknowledging that the world has changed. You can be flying a plane and bitch about the fact that there’s a mountain out there somewhere you might hit, and how unfair it is, but if you don’t look at the instruments it is no one’s fault but your own if you crash.

David Gazard says:

06:34pm | 07/07/09

Carbondogg, that IS the point. I was trying to find examples from personal experience to clearly demonstrate exactly what you are saying. That is explicity disclosed.

But the point was a broader one than just what the cosmetics are doing.

You’ve nailed it. The world changes and good administrators and policy makers read the wind move ahead of the times.

DG

Sparkles says:

07:29pm | 07/07/09

I would just like to say that having worked in financial services and having had a cosmetic procedure, which left me scarred, plastic surgeons could use a dose of the same kind od disclosre rules I have to contend with. Until recently, I had no idea plastic surgeons were not necessarily trained to perform many cosmetic procedures. But you wouldn’t know it from all the misinformation I had to wade through. All industries should have to have beter information standards!

Chris R says:

07:59pm | 07/07/09

David Gazard, I see you have at some point been a journalist. I see now that you are a ‘specialist communicator’, a ‘relations consultant’. Pardon me if that doesn’t sound like you might be a ‘spin doctor’!

Ok. Full disclosure. I am a medically qualified doctor. That is, I have an MBBS degree. I am a specialist anaesthetist.

I don’t do any plastic surgery, nor do I anaesthetise for any plastic surgeons. I do know however that plastic surgeons are doctors who have gained their qualifications as specialist surgeons from the Royal Australasian College of Surgeons, and then gone on to further training in plastic and reconstructive surgery with the College-authorised Australian Society of Plastic Surgeons.

The point being…there is already a way to “ensure anyone who practices cosmetic surgery meets the highest possible training standards”. It is to ensure that doctors performing this surgery are fully qualified by the existing Australian Medical Council-approved Royal Australasian College of Surgeons.

Cosmetic “surgeons” are really just doctors performing cosmetic surgery without AMC approved surgical training. Far from “trying to get ahead of the curve and cleaning up their act before others (clean) it up for them” they are instead involved in a process of “spin” to try and convince authorities that a wastefully duplicative second training pathway is required. Far from having the best interests of patients in mind, they are attempting to have legitimised a fast-track, back-door entry into this kind of practice for the sole purpose of lining their pockets. Far from “tut tutting”, plastic surgeons are rightly defending the fact that they are the doctors who are properly qualified to perform this surgery.

So please, spare me the “campaign from moral strength” diatribe and tell it like it is. We already have excellent plastic and cosmetic surgery standards in this country. The sure way to a “shocking boob job” is to dilute these standards by legitimising an inferior and unnecessary alternative training pathway.

Daniel says:

09:17pm | 07/07/09

Chris R.—It is wrong to say that cosmetic surgeons are just doctors with no AMC approved training. And plastic surgeons are not trained in the basic procedures of cosmetic surgery such as liposuction and breast augmentation as a part of their plastic and reconstructive surgical fellowship. Cosmetic surgery is not yet recognised by the AMC and plastic surgeons can not have received AMC approved training in cosmetic surgery. Though many good cosmetic surgeons have begun their training as plastic surgeons, that is not the only pathway towards cosmetic training. The Australasian College of Cosmetic Surgery provides cosmetic surgery training to doctors who must have completed their MBBS plus a 3 year surgical experience before they can apply to the ACCS’s training program.

To suggest that plastic surgeons are fully and properly trained in cosmetic surgery because they have completed plastic and reconstructive training is dangerous spin. By way of disclosure, I am a cosmetic surgeon. I have on more than one occasion had to revise the cosmetic surgical work of untrained plastic surgeons that have badly injured unknowing patients. It is time to put an end to the misinformation propagated by RACS and plastic surgeons who wish to protect their part time earning stream against highly qualified, full time practitioners who are properly trained and are willing to have that training tested by the AMC.

If a new specialty of Cosmetic Medical Practice is recognised, then any organisation of doctors or training facility in the country will be able to apply to have their training scheme, qualifications and accreditation processes assessed against the requirements of the specialty as set out by the AMC in order to be an accrediting organisation in the specialty.

Australian consumers would be better protected and more able to make informed decisions if they were able to choose practitioners who have undergone relevant specialist training, assessment and accreditation specifically in cosmetic surgery and medicine. Recognition of Cosmetic Medical Practice as a distinct specialty will provide clarity for consumers so that they can make informed choices.

Daniel

JR says:

11:10am | 08/07/09

The article here is about spin and the plastic surgery connection is that they are the masters of spin. How else can you explain their complete rejection of the push to regulate cosmetic surgery. Just because they are trained in plastic surgery does not make them good at cosmetic surgery which is different. Chris R says he is a trained anaesthetist and so I would expect that he would be good at his job. But that would make me worried if he tried to convince people he was a specialist in another field and use his anaesthetic qualifications as evidence.
journalists need to look a bit deeper at the urban myth that plastic surgeons are so good at everything. There is the big lie out there waiting to be uncovered but journalists are too lazy to look deep enough and ask the hard questions. So therein lies the rub. Journalists are guilty of perpetuating the spin because ommision is just as much a lie.

Allie says:

11:54am | 08/07/09

Two boob jobs later. The first was not good. Imagine the surprise when the Plastic Surgeon said sorry but it was only his SECOND boob job!! This is the group who oppose regulation. now I know why.
Fortunately fixed properly by a cosmetic surgeon who had done hundreds!!!

Chris R says:

12:04pm | 08/07/09

Daniel says “It is wrong to say that cosmetic surgeons are just doctors with no AMC approved training.”

Then one sentence later he says…

“Cosmetic surgery is not yet recognised by the AMC…”  Sorry….? So cosmetic “surgeons” ARE just doctors with no AMC approved training.

Further on he says “...plastic surgeons can not have received AMC approved training in cosmetic surgery.” That’s obvious! There is no AMC approved training in cosmetic surgery (as Daniel says himself).

My point remains…If you want to be a “surgeon”, which generally involves using a scalpel and cutting people, you should be trained by THE body accredited by the AMC for training in surgery (namely the Royal Australasian College of Surgeons). Yes perhaps further training needs to occur for specific “cosmetic” (as opposed to “necessary”) procedures. This should also occur under the auspices of the Royal Australasian College of Surgeons.

If you want to have a separate training pathway for cosmetic “medicine” that might involve simple things like injections etc, then I agree this should also be highly regulated perhaps by the AMC. But you should not be unleashed upon the public wielding a scalpel unless you are a surgeon (as trained by the Royal Australasian College of Surgeons).

Daniel please don’t pretend that I am making an argument for less regulation and training in cosmetic surgery. Clearly I am not and you know that. My argument is that training in cosmetic SURGERY should occur via the organisiation already approved to provide training in surgery. When you cloud the issue like you have you encourage people to post the nonsense that JR just did.

Daniel says:

12:46pm | 08/07/09

First, RACS does not provide plastic training; it sub-contracts this to the the plastics’ association, and both organisations refuse to answer any basic questions about the training provided. That’s why codes such as authorised by the ACCC and AMC recognition will provide the information patients need. Second, several other specialties “using a scalpel and cutting people” that are not part of RACS’ “training” program such as Gynecology & Obstetrics, ophthalmology and trauma medicine. And indeed many rural GPs also recieve surgical training though they are not “surgeons”.

RACS and ASPS repeatedly claim that plastic surgeons are not only all fully trained in cosmetic procedures but also that they are the only doctors who are properly trained in cosmetic procedures. Despite the revelations of one former ASPS’s member and professor that Professor the RACS/ASPS curriculum in cosmetic surgery has been no more than a reading list, these organisations continue to refuse to answer the basic questions which would clarify their claims about their cosmetic training and would provide transparency for patients and cut out the spin. The most recent refusal was in May 2009 in response to the list of questions below submitted during the public submissions process for authorisation of the ACCS’ Code of Conduct by the ACCC. The questions are:

1. How long does a trainee in plastic and reconstructive surgery spend in cosmetic surgery specific attachments?
2. What percentage of the trainee’s overall program does this represent?
3. Is this mandatory and applicable to all trainees or only some of them?
4. Does this take place in the private or public hospital system?
5. When were the most recent standards for cosmetic surgery put in place?
6. How do these differ from 5 years ago?
7. Would you be willing to indicate the average number of the commonly performed cosmetic surgical procedures which trainees, at the time of qualification as an FRACS in plastic and reconstructive surgery, have performed or at which they have acted as assistant surgeons? This information should be readily available from the log books all RACS trainees are required to submit?
8. What evidence can you provide concerning the training and experience in liposuction provided by RACS and the ASPS to the plastic surgeon who qualified as a plastic and reconstructive surgeon in 2004 whose patient died 3 days after he operated on her?
9. What training does RACS provide for its non plastic surgeon Fellows who perform cosmetic surgery?

Until these questions are answered—and as JR says, journalists start asking the questions—the dubious claims of the plastic surgeons’ representative bodies should be considered no more than marketing propaganda – ie spin.

KT says:

03:21pm | 08/07/09

Take one look at Michael Jackson’s face and does any one believe plastic surgeons have some special talent or ethics? Lets have more competition. But more importantly, more information. I can’t understand why plastic surgeons would be against better standards and more information for consumers. What have they got to hide? As for footie stars… you couldn’t write a code of conduct to control players like Nate Myles.

Chris R says:

08:59pm | 08/07/09

I think it’s time you admit Daniel that the Australasian College of Cosmetic Surgery’s campaign for legitimacy has nothing to do with “provid(ing) the information patients need” or refuting the “dubious claims” of plastic surgeons, and it has nothing to do at all with faux concerns about patient safety. Instead it has everything to do with the protection of a little patch of practice that has been allowed to flourish without AMC regulation. There’s nothing wrong in principle with protecting one’s turf but it’s time to be honest about these motivations. The ACCS is involved exactly in the kind of “spin” that you audaciously accuse the plastic surgeons of. Indeed you have hired a spin doctor to “get ahead of the curve”. He wants to get involved in a “PR war”. Doesn’t sound much like patient safety is the real concern!

It’s interesting that you are introducing your code of practice via the ACCC. This is a consumer and competition watchdog. These are not people interested in patient safety. When the ACCC get involved in deciding who can practice what in clinical medicine, we know that the quality of training is not the primary concern. It’s all about who’s allowed to bite the cherry!

Now I’m not an apologist for the College of Surgeons. If there are quality of training issues within that organisation they should be addressed. The answer is not to invent another “College” to do what this College can and should already do.

And please spare us the anecdotal case reports! Until you can assure us that not one patient undergoing a procedure with an ACCS-ticketed doctor has suffered any complications then you’re practicing the art of spin at the highest level.

Daniel says:

06:06pm | 09/07/09

Chris, like RACS and ASPS you too ignore the questions. And with respect, the ACCS was not “invented” any more than the College that you belong to, i.e. The Australian and New Zealand College of Anaesthetists (ANZCA), which was formed after Australian anaesthetists broke away from the College of Surgeons in 1992. Our College was formed in 1999.

As Allie’s post noted and as has been my experience the issue about botched surgery is not simply about normal complications; it is about plastic surgeons performing surgery for which they are not trained, while their patients are misled to believe they are qualified due to RACS and ASPS propaganda. Patients deserve better.

As for PR and spin, I can only say that since its inception, the ACCS has sought to work cooperatively with governmental and industry stakeholders in order to raise standards and improve patient safety – the aim of the College.

In many instances the College’s cooperation has been reciprocated. As a result, innovations and improvements have been introduced in a variety of areas related to Cosmetic Medical Practice in Australia. Examples of these efforts have been presented in the College’s application to the AMC, which can be read online via the AMC.

Unfortunately, over the same period of time the ACCS and its members have expended a great deal of effort correcting what is in the opinion of the ACCS orchestrated attempts to attack the College, its members, the proposed specialty, myth-making (only RACS/ASPS members are trained to perform cosmetic surgery), misleading and manifestly inaccurate statements in the media by the very well resourced and wealthy RACS, ASPS and some of its membership. We all have crosses to bear, so you will understand why we also use the best communication professionals available. What’s the expression? ‘Never bring a knife to a gunfight.’

The College has also been subject to a number of illegal boycott activities that’s attracted the attention of the ACCC which despite your view has a very important role to play in medical practice. Why should doctors, who engage in for-profit activity, be immune from consumer and competition laws? Indeed, two RACS surgeons were recently prosecuted for boycotting their own junior members! Although RACS has in the past tried this line of attack on, it has been rejected.

The fact is, Chris, the College is prepared to have its training and accreditation program tested against a standard recognised by the Australian Medical Council and does not seek exclusivity so your allegations about protecting a patch outside of AMC regulation are incorrect (though I’m glad you now recognise the specialty lacks recognition and plastics cannot claim they are recognised by the AMC in it. Indeed, RACS admitted before the ACCC that the specialty may well be recognised.) Properly trained and accredited cosmetic surgeons are happy to leave the spinning to the plastics and let facts speak for themselves, and that’s why an application for recognition is before the AMC.

Despite what RACS and ASPS may infer they do not have a monopoly on surgical training. You’ve fallen into the trap that all monopolists in the past have fallen into. There is no secret knowledge or one organisation that is by dint of its historical association better qualified than any others in the present or future to be responsible for training and accreditation. The ACCS currently has two RACS general specialist surgeons enrolled in its training program precisely because they cannot obtain the additional training they seek from RACS.

Other specialty colleges already provide surgical training. Some are in medicine, some in surgery. Some, such as Obstetrics and Gynaecology or Ophthalmology include practitioners who have training and competencies in both. In the case of the ACCS, the College’s surgical qualification includes training and examination in cosmetic medicine. In the future it is likely that training may evolve in some cases to be run entirely by teaching hospitals and universities. But to suggest it must remain as it is because it has always been so is hubris.

John H says:

11:20am | 10/07/09

I have become aware of this interesting debate and I must declare at the outset that I am a member of the Australasian College of Cosmetic Surgery.

On the one hand we have ACCS which is seeking regulations from authorities to help govern cosmetic surgery ( that will include all practitioners, not just us) and is seeking to work with these regulatory authorities and educational institutions to achieve this. The College has an egalitarian view of the access to training and does not stipulate from which part of medical practice a doctor may seek entry. We do expect that each doctor will undergo specific training in this particular discipline and reach benchmark standards of expertise and knowledge.
How can this possibly be anyting oher than a committment to patient safety and standards within the discipline. How can this possibly not be a benefit to patients. Get real Chris R.

On the other hand we have RACS and Plastic surgeons who are fighting tooth and nail to keep their own monopoly and resist every attempt to introduce training. They prefer to protect their own turf, keep everyone else out, and rely on the fact that they have a different specialty qualification albeit not in cosmetic surgery, and more particularly they have NEVER BEEEN ASSESSED by AMC for training in cosmetic surgery. How dishonest is that!!

Take Chris R’s last entry, in the first paragraph, substitute RACS or ASPS ( the Society of Plastic Surgeons) for ACCS and there you have the real situation. But hey Chris, good spin.

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