Beauty from Afar

We commence today with Chapter 4 of Beauty from Afar, for which I half apologized in advance. I really needn’t have, now that I look at it again. Immodestly, I don’t mind saying that I like the way it starts out, and I have Joseph Cohen, M.D., of the Rosenstock-Lieberman Center for Cosmetic Plastic Surgery in San Jose, Costa Rica, to thank for that.

Chapter 4 Page 1 | You’re Going Abroad for…What !?

Dr. Cohen’s candor made him a terrific person to interview on the subject of what surgical procedures people go overseas for, and why; that he, a prominent cosmetic surgeon in Costa Rica, would consider going to the U.S. (hypothetically) for his own care, under certain circumstances, I think makes for a nice balance in a book that is mostly about people going in the other direction. And it gives him credibility.

We’ve now covered 76 pages of the original text of Beauty from Afar, which has worked out to 37 web pages. That seems about right to me … and it means I’m about a third done, which feels substantial.

I’ve mostly resisted the journalistic urge to step too far outside the boundaries of the book, but anyone interested in the business of medical tourism ought to go read Brendan Borrell’s Reuters story, published today:

Controversial couple dominates U.S. medical tourism

I don’t see how this has any real impact on patients, mind you, or I’d be more concerned. As a nascent “industry,” though, medical tourism has not traveled all that far since I first wrote about it in 2004-2005. The squabbles are a little bigger.

It was really in 2004 and 2005 when the U.S. media “discovered” Medical Tourism … about the same time I did. (Maybe just a little after I did. ) And it was discovered because the media noticed that people were going overseas for serious, life-saving procedures, not just cosmetic surgery and dentistry.

Chapter 3 Page 5 | The Media Imprimatur

Medical tourism and travel has been episodically in the news in the U.S. ever since and remains a story in parallel with the dominant narrative about healthcare reform in the U.S. that arose in 2008 — 2009.  I’ve often been asked if real healthcare reform in the United States would be the end of medical tourism, and the answer is no. Medical tourism and international medical care will remain less costly alternatives and U.S. patients and insurers will continue to explore and integrate the travel-for-care options that are available.

We’ve hit the end of Chapter 3. Chapter 4 will look at what surgeries and procedures that patients choose to have done overseas — specifically, it is mostly a list of cosmetic procedures and average prices and savings in 2004 — 2005. As I go through it, I’ll try to put forth any updates of which I am aware. Chapters 4 and 5 (which is a tutorial on doing Internet research) are, to me, the driest parts of the book but I’ve encountered readers who thanked me for them. So … off we go. Tomorrow, probably.

I don’t know anyone who likes to refer to “Medical Tourism” as “Medical Tourism.” Funny, huh? But someone came up with it in the 1990s, and we are still about half-stuck with it. Increasingly, people in the business prefer the reference “medical travel,” which doesn’t have the the assumed frivolity of “tourism” as baggage.

Chapter 3 Page 4 | Origins of  the term “Medical Tourism” (cont.)

The earliest references I found for the phrase “Medical Tourism” were in 1998, as noted in today’s segment.

Our little history lesson continues today with a segment about how a plastic surgeon in Costa Rica started marketing to the U.S. market in the early 1980s; and continues with a discussion of a somewhat prescient World Bank report on prospects for health tourism exports in the Caribbean.

Chapter 3 Page 3 | Build It, and They Will Come …

I thought I’d be sailing through Chapter 3 easily but have had a lot of reformatting to do from the version of Beauty from Afar from which I am working … which I have now realized is probably the penultimate digital copy. Aaaaiiieee! An alert reader, Debbie, caught a mistake the other day in which I had named someone other than Alexandre Dumas as author of The Three Musketeers. Fortunately, the error was fixed before the book was printed. I do remember how I felt when I found the mistake initially — after I’d “finished” writing the book and after it had been twice edited. I felt both as though I’d dodged a bullet and as though I was nearly too stupid to live.

There are a couple of minor errors in the paper version of Beauty from Afar. It is nice to have the opportunity to fix them.

I used to be appalled when I found typos or any kind of mistakes in books. How could it happen? Well — now I know the answer. It can happen in all sorts of ways. Human beings are involved. With Beauty from Afar, they mostly happened because I was allowed to fuss with and add things right up until the last second — as though we were producing a newspaper story instead of a book. Overall, I think the additions and last-minute changes made for a better book … but there is a tradeoff. Typos, however minor, are just disheartening.

In Beauty from Afar, I refer to Dr. Prof.  Ivo Pitanguy of Brazil as perhaps the father of both modern cosmetic surgery and of medical tourism.

Chapter 3 Page 2 | The Pioneers

I had originally hoped the Dr. Pitanguy would write the foreword for my book, but that wasn’t going to happen without my taking a trip to Brazil that I wasn’t able to take on my budget at the time. However, his office, in the person of Pitanguy’s then-assistant, Henrique N. Radwanski, M.D., was generous with time and information.

Traveling for medical care isn’t new. Looking for historical examples was kind of fun. Starting Chapter 3 with a quote from Alexandre Dumas’ The Three Musketeers is maybe a little pretentious to some people, but I hope others were as mildly amused as I was.

Chapter 3 Page 1 |  A Brief and Selective History of Medical Tourism

I promise, Chapter 3 moves along quickly. It runs from pages 63 to 72 in the bound version of Beauty from Afar … so I’d guess it will all be “live” by the end of the week.

By now, anyone reading along has probably figured out that I had no intention of writing what might have amounted to a directory of international medical services. Others, most notably Josef Woodman with his Patients Beyond Borders series of guides, have ably provided health care consumers with more traditional formats.

I wanted to provide more of a broad overview, a way of thinking about medical travel and tourism. Beauty from Afar, I thought, would take readers to the point where they could make educated decisions about where they might go as medical travelers without telling them where to go. As choices have expanded over the past five years, I am glad that other books have come along. There are now a number of medical travel books; there are magazines; there are newsletters; there are associations.

There were none of those things when I was first researching and writing Beauty from Afar in 2004 — 2005. Things have moved right along.