Refuting Negative Online Reviews

Protecting your medical spa, personal, and professional reputation online can be damn near impossible.

With internet marketing opportunities on the rise, today's aesthetic clinicians are faced with a "double edge sword". One side, if you don't advertise yourself on the internet you have less of a chance to gain presence and new business over your competitors. The other side of the blade is that you are opening yourself and your practice up to negative comments and reviews.

While patients do have a right to exercise The First Amendment, what we really find in our industry is that positive reviews don't come freely. Seldom does a "customer" of a business post how wonderful a place is or what a great experience they had. Typically, rave reviews are solicited by the business encouraging their customers to post reviews if they are "happy". Whereas, someone who is disgruntled in some sort of way has no apprehension whatsoever in posting their views on the internet.

With many sites not requiring the identity of the poster to be verified, this opens up the "Wild West", so-to-speak, for anyone to post anything he or she desires. This also includes your competitors who can acquire an email address with any vendor, then post anonymous false reviews of you and your practice.

How can you combat this? First, you have to be diligent in canvassing your reputation on the web. You have a choice to let the comments go, or research them to see if you can determine who they are so you can have the opportunity to correct the review (if it is a legitimate complaint). You can also report the review to the posting internet site with a clear description of why you believe the post should be removed. However, there is no guarantee you will even receive a response.

Many social media marketing gurus state that all positive reviews on a business tends to make the consumer think something is a little fishy with the business, so one bad review can add to the business's authenticity. Take book reviews on Amazon for example. I know I read through them all, good and bad, then make my decision. After reading a few, you get a general idea of what reviews are just "out there" (i.e., insults, poor language, obscenities, etc.) and which ones are more reliable and genuine.

David Goldberg, M.D., J.D. has written an excellent article for Dermatology Times entitled "Physicians have limited recourse against online defamation". This is a must read article for any clinician!

From the post:

There are known instances of dentists being accused online by their competitors of being child molesters. Similarly, laudatory online comments can be written by the physician himself.

One way to try to work around such frivolous online statements is to have patients sign a waiver that has them promise, in case they are not happy with their care, that they will not post online comments to that effect. The way such contracts are enforceable is as follows.

In general, websites acting as platforms for outside commentary are not liable for defamation suits. They are, according to North Carolina neurosurgeon/attorney Jeffrey Segal, M.D., J.D., subject to copyright laws. Waivers can be written to assign copyright to the treating physician. If the treating physician asks the patient to sign such a "copyright" waiver, the physician can claim ownership of any anonymous review of the practice and demand that such an online review then be removed. There are now examples of website posts removing such deleterious copyrighted comments.

Needless to say, not all patients will agree to sign such a waiver. Some may feel such waivers are simply "gag orders." The reality is that disgruntled patients are free to speak with family, friends, other physicians, lawyers, hospital peer review committees or credentialing committees. There are many appropriate places where patients can express their views.

This guest post is written by Paula D. Young RN, author of Advanced IPL & Laser Training For Non-Physicians and co-owner of Young Medical Spa in Center Valley PA.

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Medical Spa Advertising: Keeping it Legal - PART 2

State and federal regulations centering on medical spa advertising can often be daunting to navigate through.  How can you make sure your ads are within the “legal” realm?   Read on through Part 2 of Medical Spa Advertising - Keeping it Legal. 

Read: Medical Spa Advertising: Keeping it legal Part 1

The ever increasing number of State and Federal laws that can pertain to the use of photographs of patients has triggered a lot of questions from the medical community.  Below are some frequently asked questions and answers from Michael Sacopulos, General Counsel for Medical Justice Services.  Note these are general answers and are not State specific.  You should consult local licensed counsel to address laws, regulations and prohibitions specific to the State in which you practice.

Question #5: What concerns should I have if I want to implement an e-campaign to my database?

Answer: You will not be surprised to learn that there are specific Federal laws related to the use of e-mail campaigns for commercial purposes.  Specifically, the CAN-Spam Act sets forth the Federal requirements for those wishing to promote goods and services by e-mail.   Before you start to send those e-mails, check out the Federal Trade Commission’s website on this act:  http://www.ftc.gov/bcp/edu/tubs/business/ecommerce/bus61.shtm  

Question #6: What should I know before I start a Facebook account?

Answer: From the legal perspective, information that you place on Facebook is treated exactly the same as information that you would place on your practice’s website.  However, some have found Facebook to have a more intimate feel.  People tend to make statements and do things on Facebook that they might not otherwise do on a typical web page.  We have all read the accounts of individuals losing a job because of some posting on Facebook.  I recommend that you keep two separate Facebook accounts.  You may have one for your practice and one for personal use.  I believe it to be a mistake to mix your personal and professional activities in one Facebook account. 

Question #7: Can I give a referral patient a gift card to use towards services?

Answer: Yes.  Few problems arise from giving a gift card or a discount to a patient that has been referred to your practice.  It is more difficult to compensate patients for the promotion of your practice.  As we discussed above, should you wish to compensate a patient for the use of his or her before and after photographs on your website, this fact must be disclosed. 

Question #8: If all these are legal requirements, why don’t more doctors get prosecuted?

Answer: This sounds like a practical question from a risk taker.  The answer to this question rests in the limited resources for enforcement.  Most people driving above the speed limit don’t receive a ticket, but it is clearly a possibility every time someone exceeds the speed limit.  One more word of caution: The penalties for violating some of the rules and regulations described above can be quite harsh.  Your smartest move is to try to comply with all rules and regulations regarding online advertising.                 

One final word of caution about online advertising and the use of patient images…Many professional societies have ethical guidelines that members are to follow when advertising.  These guidelines may be stricter than State or Federal laws.  The AAFPRS has some well reasoned guidelines that should be known by members prior to initiating an advertising campaign.  Members of the ACS should consult that society’s Code of Professional Conduct which can be found at http://www.facs.org/fellows_info/statements/stoprin.html. The AMA has an extensive document entitled “Principles Governing Advertising in Publications of the American Medical Association” which provides guidance.  This document can be found at http:/pubs.ama-assn.org/misc/adprinciples.pdf .

Mr. Sacopulos is a practicing attorney in Indiana.  This article reflects his opinions and perspectives on advertising and legal issues set forth in this article. 

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Medical Spa Photographs & Testimonials: Keeping it Legal

Medical Spa ads are often peppered with photos (highlighting “real” patients and models) and glowing testimonials.   

Images of more than ideal treatment results from Botox, laser hair removal, fillers, chemical peels, photofacials grace local rags to targeted online ad placements…okay, you get the picture. 

A recent article stated that there are now more medical spas in the US than Starbucks!  Now, that makes for a very competitive market. 

As you strategically, aggressively advertise your Medical Spa – are you aware of the legal guidelines & do you know how to keep your advertising legal? 

The ever increasing number of State and Federal laws that can pertain to the use of photographs of patients has triggered a lot of questions from the medical community.  Below are some frequently asked questions and answers from Michael Sacopulos, General Counsel for Medical Justice Services.  Note these are general answers and are not State specific.  You should consult local licensed counsel to address laws, regulations and prohibitions specific to the State in which you practice.

Question #1:

When do I need to use the label “MODEL” on a photograph?

Answer:

The term “model” should be used when the photograph is displaying the results of a procedure or procedures not performed by the physician or practice (displaying the photograph).  Here the term “model” is being used in a general representative fashion and is not being used to display a specific practice or physician’s professional services/results. 

Physicians should secure a written release from any individual, patient, or model before using a photograph of that individual, patient, or model in any way.  The release should be specific to the photographs being used.   The release should also specify the way or ways that the photographs may be used.  For example, a release “for educational purposes”, will not cover internet marketing.  Do not attempt to get a release signed that covers “any and all future images, photographs or depictions…”  Courts have ruled that releases can go stale.  Finally, it is best for the release to specify the conditions and manner by which an individual may revoke the release at a later date.  

Question #2:

I hear the use of testimonials has regulations. Please explain.

Answer:

There are several sources of regulations over the use of patient testimonials.  Some state licensing boards greatly restrict or prohibit testimonials.  Each state has different standards; some flexible, some very restrictive.  The Federal Trade Commission also has rules that apply to the posting of testimonials.  In general, a physician should make sure that the testimonial is accurate (what the patient really said and not paraphrased).

Question #3:

What does HIPAA have to say in its marketing regulations about the use of “before and after” photographs and testimonials?

Answer:

HIPAA in general protects patient privacy.  Although the act does many things, it would prohibit the use of before/after photographs without a patient’s permission.  However there is nothing in the act that would prevent the use of accurate before and after photographs with a patient’s prior approval.  As always, this approval should be documented.  Finally, it should be made clear that a patient can withdraw his or her approval to use the photographs at a later date and that the physician must comply with this subsequent withdrawal of approval.

Question #4:

What is this I am hearing about The Federal Trade Commission in regards to “results not typical” and endorsements?

Answer:

Earlier this year, The Federal Trade Commission set forth new guidelines for the use of testimonials and advertising that apply to many areas including healthcare.  In the past, The Federal Trade Commission has taken action against certain weight loss products when these products were advertised by an individual claiming extreme weight loss.  The FTC’s position was that it is a deceptive trade practice to show an individual has lost 100 lbs. when this result is not at all representative of a typical patient’s outcome.  In this situation, the term “results not typical,” would need to be used.  Under the new regulations, we should expect that the FTC will take a similar approach.  My discussions with FTC officials have led me to believe that the Commission acknowledges that health care results vary.  The Commission’s goal is to see that potential consumers are not misled by advertising.  It is not advisable to select a statistical outlier to be representative and then try to protect it by adding the term” results may vary.”  Under the new FTC rules, you must also disclose the fact if an individual has received compensation (of any amount) or discounted services in exchange for providing a testimonial or endorsement. 

Mr. Sacopulos is a practicing attorney in Indiana.  This article reflects his opinions and perspectives on advertising and legal issues set forth in this article. 

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Is Suing Your Medical Spas Patients Ever A Good Business Strategy?

Your medical spa or laser clinic is going to be the target of negative reviews at some point. How are you going to deal with unhappy patients who have a forum?

In the aesthetic medicine business, reputation management is a big deal. First, of course, you want to do good work for your patients. You want them to be happy with the results, and then you want them to tell all of their friends how happy they are. Good reputations take time to build, but bad ones can be made very quickly. A California plastic surgeon is now dealing with the fallout of some bad online reviews by taking legal action against the people who posted them.

Unhappy patients aren't anything new, but the Internet, with it's assortment of social media and consumer review sites give grudge-holding patients a significant amount of power. A few of those patients recently vented their opinions of Greenbrae, CA, plastic surgeon Kimberly Henry, MD, on consumer rating sites Yelp.com and DoctorScorecard.com. The doctor, in return, sued the patients.

What may have begun as a consumer rant--the sort that goes on every day about restaurants, car dealerships and plumbers-just got serious. According to an article in the Contra Costa Times, Dr. Henry is currently seeking injunctions against 12 reviewers, allegedly former patients, for libel, defamation, invasion of privacy and interference with prospective economic advantage. The doctor is seeking $2 million in damages plus other unspecified costs.

Earl Thurston, the proprietor of DoctorScorecard, confirmed that he provided Nordskog e-mail and IP addresses of Henry critics in January, but has not done so since. Nordskog's subpoena was the first he had ever received.

"I was inexperienced with the law and the way the court system works," Thurston said. "I assumed that if a judge ordered that I provide the information, that I was required to do so by law."

Since then, another lawyer sent him a subpoena for user information for a similar lawsuit in Texas. Thurston said he is fighting the subpoena with the help of Public Citizen, a nonprofit consumer advocacy organization in Washington D.C.

"I spent many hours reading online about the legal process and came to the conclusion that I could fight to keep our users anonymous, even if a judge orders us to reveal their identities," Thurston said.

Stephanie Ichinose, a spokeswoman for www.Yelp.com, a site that posts user reviews on numerous subjects, noted that a similar case played out last year in San Francisco. In that case, dentist Gelareh Rahbar filed a defamation suit against Jennifer Batoon, a patient who wrote a negative review about the dentist on Yelp.com.

"The judge threw out the defamation counts and ordered Rahbar to pay $43,000 for Batoon's legal fees," Ichinose said.

The claim was dismissed because of California's law against so-called SLAPPs - strategic lawsuits against public participation - which are lawsuits aimed to squelch free speech. Batoon was represented by the California Anti-SLAPP Project, a public interest law firm in Berkeley.

John Diamond, a professor at University of California, Hastings College of the Law, in San Francisco, said forum providers such as Yelp.com are immune from defamation suits, and that anti-SLAPP laws provide some protection for online commentators.

But Diamond, who has no knowledge of Henry's case, said reviewers can be held liable if they assert "false facts, not just opinions."

"They actually have to commit defamations, and that is something that is false and damaging to reputation," said Diamond, a Tiburon resident. "I think what's happened is many more people have a forum now to make comments and have a impact. Previously there haven't been that many opportunities."

This guest post is written by Grant Clauser, Editor of Healthy Aging Magazine. Read Grant's post: Plastic Surgeon Strikes Back At Online Reviews on the Healthy Aging blog.

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Is The Recession A Boon For Laser Tatoo Removal?

The recession may actually be a benefit for medical spas and laser clinics that offer laser tatoo removal.

Playing it safe is not usually associated with great success. It’s that whole, nothing ventured, nothing gained, and the risk is worth the reward sort of thing. And in this business, you’re surrounded by risk-takers. Of course by the time they get to us, the risk resulted in regret.

In the midst of a recession, we launched a laser tattoo removal business in Houston, Texas. There were already over 100,000 people unemployed in our little part of the world, so needless to say entrepreneurial ventures were looking particularly intimidating.

In spite of the clear obstacles to starting a business, we had a strong sense that there would be a market for our services. And while some people feel it’s better to cast a wide net, we kind of took the opposite approach. We decided to bypass several other popular kinds of laser treatments and to focus specifically on laser tattoo removal. We knew that it was a risk, but it felt right to stick to one service that we were passionate about, and good at. I feel like a lot of people fail because they spread themselves too thin and lose sight of their true passion.

Dominos Falling

It wasn’t long before we realized that, our gut feeling was dead on. Despite providing a scary backdrop for our new company, the recession also provided the perfect landscape for our services. Remember that astronomical unemployment rate? It turned out, oddly enough, that it actually worked in our favor.

See, it was a matter of dominos falling in a way. The recession impacts businesses of all sizes and kinds, forcing them to lay people off. We saw first hand that when business downsize, it creates a massive pool of job seekers all vying for the same limited number of positions. The competition for work had people doing everything in their power to even the job-search playing field. And that’s where we came in

The Waning Job Market

In the increasingly competitive job environment, with larger pools of candidates to choose from, employers could be as selective as they wanted to be. Suddenly, little things like visible tattoos became deal breakers. W began to see the impact of that reality on our phones and in our lobby. While women have commonly gotten tattoos removed after becoming moms, the main reason a man comes to us, is because his tattoo is limiting his job prospects. In fact, we found that almost a quarter of our new appointments listed employment opportunities as their reason for wanting a tattoo removed. At that point our hunch, felt a lot more like ESP.

Sure, in some industries tats have always been an issue, but it’s actually amazing how many jobs have a “no visible tattoo policy”, it’s really not just bankers anymore. Companies from Toys R Us to Calvin Klein have prohibited visible tattoos. Even the local police forces in Houston and Dallas have a “no ink showing” rule. I mean, these are cops. These are tough guys, guys who are supposed to be able to brave the needle and use bad ass tattoos to strike fear in the hearts of criminals.  Now even they need to wear long sleeves, patches or makeup. Speaking of weapon-yielding folks that have to “cover it”; tattoos are also an issue in the military. And for many people in the throes of unemployment, military ink policies pose an issue.  We’ve heard plenty of stories from people whose slim prospects for work, have them looking to the military as a “Plan B”. Of course by the time they come to us, Plan A is often a distant memory.

When someone has to come in to remove a tattoo, whether it’s to improve their chances of finding work, or to meet military enlistment standards it is always bittersweet. Sure, the focus is on the future, but it’s hard to say good bye to something meaningful. So while the laser treatment may be painless, the parting is not. In some cases parting with payment is difficult too. In a tough economic climate, having to spend over $1000 for several sessions is a brutal investment in the future. I guess the old saying, you have to spend money to make money, applies here.  Especially if you have neck tattoos from your teen years.

Learning Our Place

All of those combining social and economic forces happened to be a sort of perfect storm for a little laser tattoo removal venture. It would be nice to say we predicted how all this would play out from the very beginning. But I don’t think we could have. We only knew that this technology would become more important to society, and that it was already important to us. It was early on though that we recognized how our country’s circumstances would impact our future. When we identified that niche of people who needed our services, not simply out of regret but out of necessity; it helped us feel like we were really changing lives for the better.

If there were 2 pieces of advice anyone should take from our story it would be; focus on doing one thing to the best of your ability and always try to look past the surface of your deliverables. Find what you are really giving people. In our case, it made all the difference in the world when we began to think ourselves as a piece of a much larger puzzle, and we considered the role we really wanted to play.  I mean, on the surface, yeah, we remove tattoos. But when we looked deeper, we discovered that what we’re really doing is giving people a new beginning.

This guest post is written by Janet Peterson, a writer for “New Look” a Houston laser tattoo removal business. Janet has extensive experience writing about tattoos and tattoo culture.

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Liposuction Patient Selection

Selecting Liposuction Patients

Cosmetic practices spend large amounts of time planning their clinic, what services they are going to offer, and advertising to get patients interested enough to come in and purchase services. Unfortunately, practices do not spend enough time identifying good liposuction candidates after they walk in the door. As a consequence, patient safety, outcomes, and patient satisfaction can greatly be affected. To be a successful surgery center or medical spa, and eliminate possible liability, you must be able to identify which type of patients you want signing up for surgical procedures.  

Cosmetic patients are for the most part kind, caring and wonderful people. When you are conducting services and they feel comfortable with you, they will tell you all about their marriage, divorce, kids, job, etc. There are simply a plethora of good patients. Unfortunately, there are a few cosmetic patients who may be at the wrong point in their lives for undergoing cosmetic surgery. When patients come in for services such as Liposuction, you are entering a relationship with these patients that will extend through the surgery and through follow ups and aftercare. The ideal relationship you want to create is one of harmony, happiness, peace, instead of dysfunction and high-stress.  So how do you identify what patents might be best for liposuction?  

It all starts even before the consult. If a patient comes in to your office and is rude to the receptionist or other staff, be cautious and understand that this is a person your office will have to interact with many times over the course of their treatment(s).  If they are not happy with minor everyday events, they probably will be very unhappy recovering from surgery and in a binder for one month. During the consult, a patient can sometimes be harboring some unrealistic expectations due to media, false advertising, and their own ideas. This is where the patient care coordinator or Surgeon needs to educate the patient on what he/she can expect as an outcome.  Sometimes it’s a joke when a patient says, “I want to look like J. Lo in the butt and Dolly Parton in the breasts.”  Other times a patient is serious and you need to explain what is and is not possible with their body type.  Showing your before and after pictures during this time of previous cosmetic patients who have the same body shape is important so patients can form their own picture of what they can expect with their results.  

Another red flag is if the patient has had multiple plastic surgeries and is still not happy with their body or the patient believes their abdominal fat is sticking out over their jeans t and you cannot visually see that for yourself. Such a patient may be suffering from body dismorphic disorder (BDD).  BDD is observed in as many as 10% of all cosmetic patients. Signs and symptoms of BDD include a strong belief that a patient has an abnormality or defect in their appearance that makes them ugly, feeling extremely self-conscious, avoiding social situations, refusing to appear in pictures. Patients with body dismorphic disorder may focus on a body feature they want to change and then focus on another part in the future (picture Heidi Pratt). Please realize you can never make possible BDD types of patients happy and refer suspected BDD patients to a mental health provider for treatment. If you are in doubt, it might be a good idea to refer your patient to a mental health professional for clearance before moving forward with cosmetic surgery.

Sometimes patients come in with an urgency to get surgery performed “right away.” The sense of hurry needs to be explored as this could be related to a divorce or other catastrophic event that may not be in the patient’s best interest nor lend the patient’s full dedication to a surgical procedure. It’s always a good idea to wait until a patient is in a “good place” in their lives.  Further, patients, who are excessively obese, have psychological or emotional problems, history of drug abuse and unrealistic treatment goals are also not good candidates. It is mandatory to perform a comprehensive preoperative consultation including a screening questionnaire to identify patients who are appropriate candidates. A liposuction consultation should cover the risks, goals, anticipated results, and expected postoperative care. All patients’ questions should be answered and an assessment should be made as to whether or not the patient is the right candidate for surgery.

The ideal patient for cosmetic procedures is content, with a pleasant disposition and not dealing with any life changing problems when they come into your office. They are realistic about their expectations and basically feel good about themselves but have an area or two that is troublesome. Patients need to be made aware that liposuction is strictly a body-contouring procedure and should never be viewed as a method of weight loss or an alternative to diet and exercise. Patients should be selected with localized adipose deposits that will not go away despite diet and exercise. As in all cosmetic procedures, proper patient selection is vitally important in ensuring satisfactory results after liposuction.

Wendy Hovorka B.S.  M.L.A.  Valley Laser Surgical Solutions Vein Center,  McAllen, Texas

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Your Medical Spa Patient Care Coordinator

What is a Patient Care Coordinator?

As Jeff mentioned in his post entitled Your Medical Spas Front Desk, it is very important in the cosmetic industry to find a competent and friendly front desk person.  It is equally important to find a dynamic and motivated Patient Care Coordinator.

In most Plastic and Cosmetic Surgery Centers, Patient Care Coordinators are few and far between. This is unfortunate because a motivated Patient Care Coordinator can exponentially increase your profits.

A first-rate Patient Care Coordinator usually possesses a business/marketing degree and can not only handle your website marketing, blogs, and Facebook, but can also field inquiry calls in a professional and effective manner.

Oftentimes Patient Care Coordinators will even start the initial consultation if they are “complimentary” in your office. Then when a patient is interested proceeding forward with a surgery, they are ushered in to meet with the Surgeon. This way, the Surgeon is not wasting his/her valuable time speaking to someone who is simply gathering information or price shopping. Also, if your Surgeon is not a “warm and fuzzy” type, the Patient Care Coordinator is a good go-between, and is able to relate to the patient on a more personal and friendly level. Patient Care Coordinator’s usually handle all aspects of patient financing and have the ability to help the patient choose which financing plan works best for them, sometimes calling in for the patient to seek approval.

In addition, if any areas are lacking in your practice, such as your employees taking lousy before and after pictures, A good Patient Care Coordinator does not mind stepping in to take over the picture taking or train the right person to handle this task because high-quality before and after pictures are crucial for marketing during a consultation and your photo gallery on the internet.

If you have an employee that you feel is up for the position of Patient Care Coordinator  but is unpolished, don’t worry because there is help out there. The best course I have attended is offered once every few months by Michele Tyler from Dr. Todd Malan’s office in Scottsdale, Arizona.  I myself was literally thrown into this course by my husband, who was taking a fat grafting course from Dr. Malan and wanted to make sure I had something to do while in Scottsdale (although I tried explaining to him there is much to do there!).

As I have been a Patient Care Coordinator for 5 years, I came to Michelle’s course with an overconfident attitude that I most likely knew all there was to know about this position and there was nothing I could be taught. Although I knew from both my own training and trial-and-error on the job training, much of the material being presented,  there were many excellent tricks and pointers that I learned that were worth their weight in gold and paid off many times over the relatively small price we had to pay for the course. One such topic was “What to do when a potential patient is calling and is asking how much a procedure costs?.” I’m not going to give away any of Michelle’s secrets but, if your Patient Care Coordinator or Receptionist does not know the answer to this question and consistently does not get patients into your office who ask questions such as these,  your employee probably needs to take the class!

If you are uncertain if your office employees are answering patient inquiry calls adequately and successfully, drop me an email and be sure to include your office phone number. I will “mystery shop” for you and give you a free of charge brief assessment of whether or not you need a Patient Care Coordinator in your practice.

Wendy Hovorka B.S.  M.L.A.  Valley Laser Surgical Solutions Vein Center,  McAllen, Texas

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The Price Of Fake Botox

Are price increases in Botox motivating some physicians as well as non-physicians to sell fake Botox to their patients?

A Houston physician, Gayle Rothenberg was sentenced to 5 ½ months in Federal prison last Friday for injecting patients with a fake Botox product not approved by the Food and Drug Administration for human use. Apparently Dr. Rothenberg injected at least 170 patients with an unapproved botulism chemical. According to testimony, Rothenberg stopped using Botox after a price increase in January 2004 and began ordering the unapproved drug, which was half the price, despite knowing it was not for human use and labeled only for research purposes. In 2004, when fpur people became paralyzed from the counterfeit Botox, the FDA’s involvement has led to 31 arrests and 29 convictions of individuals selling the fake Botox. In addition to a jail sentence, Dr. Rothenberg must pay more than $98,000 in restitution to her patients and cannot reinstate her suspended Texas medical license.

The case of Dr.Rothenberg is no different than the case of Laurie D’Alleva, another fine citizen of my home state of Texas charged with selling counterfeit Botox. So far D’Alleva’s case has yet to be prosecuted as evidence is still being gathered. The common similarities between the two are that both individuals were motivated by greed to jeopardize patient safety ahead of financial gain.  Laurie’s case is especially intriguing to me based on public opinion. Here is someone who seems to be viewed by her customers as a “business woman” who was doing a “good service” for those individuals who felt that Botox cosmetic was too expensive because the “greedy” doctors were charging too much for the filler. While Laurie seems to be viewed by many as a caring individual, making Botulism more affordable to the masses, public commentary on Dr. Rothenberg is quite the opposite. Comments such as “5-1/2 months? Justice is not only blind, it's stupid. (and maybe corrupt) “ and “That sentence is not even one day of confinement for every defrauded patient!.” I feel the same way as the above two comments, but why is the public sentiment different with these two con-artists? Is it because one is a doctor and one is not?

Personally, I find it very frustrating that the price of Botox has doubled in since its introduction. I remember being excited when Dysport came out because I thought this product would be half the price and would drive the price of Botox down so more patients could afford the price. Sadly, this was not the case. As physicians have to pay more money for Botox, so do their patients. These increasing prices enable individuals such as Ms. D’alleva and Dr. Rothenberg to find counterfeit Botox they can buy at a cheaper price to make a greater profit, while sacrificing patient safety. Laurie d’Alleva’s “Botox” price was probably pennies on the dollar, whereas a physician’s cost for Botox is now at $600 per bottle. Hopefully another pharmaceutical company peddling botulism toxin will come along, get FDA approval and drive the price of Botox down to a more reasonable price for physicians to purchase for their patients. Until then, brace yourself for more Laurie d’Allevas and Dr. Rothenberg’s to come along. Thank heavens for the invention of ventilators!

Guest post by Wendy Hovorka, Valley Laser Surgical Solutions Vein Center,  McAllen, Texas

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