LAST September, Michelle Wilder left Dr. Emil W. Chynn of Park Avenue Laser armed with the usual postoperative fare: eyedrops, sunglasses and a pair of prescription-free contact lenses. And oh, yes: a DVD of her Lasek surgery, so she could experience from the confines of her own home the joy of watching the doctor scrape her eyeballs.
Her viewing pleasure was not Dr. Chynn’s only concern. He hoped Ms. Wilder would be so thrilled with her results that she would post the 10-minute video on YouTube, along with his credentials, a link to his Web site, and a rave review.
As an incentive, Dr. Chynn offered either a free Botox injection worth $400 or a $100 discount on the $5,000 Lasek operation, which, unlike Lasik, doesn’t entail cutting a flap in the cornea.
“I thought it was a little odd, because I was wondering ‘Who wants to see my surgery?’ ” said Ms. Wilder, 25, a Manhattan accountant. “But then I thought, ‘Well, it’s just my eye, you can’t see anything else about me, so of course I’ll post it.’ ” Why not take a discount, she reasoned.
Doctors have long recruited patients to help advertise — witness the doctor-patient tag teams on talk shows and infomercials. It has remained an open question as to whether doctors pay or remunerate those smiling patients in violation of the rules of many physician associations. But it’s now clear that doctors openly offer “thank you” rebates and discounts to patients who post videos of their breast augmentations, bright white teeth or nose jobs — or are willing to be taped extolling the virtues of their physician.
Most payments or freebies to post on video-sharing sites like Revver, Yahoo and YouTube are modest. A few hundred dollars off. Or an $800 squirt of Juvéderm. Nevertheless, they have raised concerns among medical ethicists and consumer advocates.
Doctors — and patients — have taken to online video postings with gusto. Type in the word “Botox” on YouTube and around 2,400 videos pop up. “Breast augmentation” garners over 2,000; “Lasik” around 2,000 videos.
Some have been produced by marketing companies like Spore Medical or SalemGlobal Internet both of which began offering video packages in the last year, while others have been videotaped and edited by a staff member. (In Dr. Chynn’s case, the camera is attached directly to the laser for a you-are-there effect.)
The videos featuring full-on views of needles piercing furrowed brows, scalpels slicing and “Clockwork Orange”-like eye surgeries are both disturbing and fascinating.
Not all show gore. Some aspire to be mini-documentaries with narrative arcs: A Day in the Life of Dr. X and His Formerly Big-Nosed Small-Breasted Ecstatic Client.
All 15 doctors interviewed for this article didn’t see anything ethically unsound about remunerating patients for posting glowing endorsements. “It’s really not a conflict of interest,” because the rebates are so tiny, Dr. Chynn said. “I’m charging $5,000 for the surgery. If we gave $1,000, that would be a problem.”
Besides, he said, only about 10 percent of the patients he asks actually post online. “If it were truly a conflict of interest, then 90 percent of the patients would do it because it would be so worth their time,” Dr. Chynn said. “New Yorkers are so busy. They’re not in Kansas. We’re not talking about Dorothy and Toto.”
Some medical ethicists are not so sure. “It’s disappointing to see commercialism creeping into what should be a very altruistic profession,” said Ruth Fischbach, a bioethics professor and the director of the Center for Bioethics at Columbia University. “If you agree to give your testimonial on YouTube, will that doctor treat you better when you come back than someone else who has refused to do this? It puts a lot of pressure on patients. If someone’s a multimillionaire, they would probably just laugh at the idea, but if someone needed money to fill up their gas tanks — $100 is $100.”
A Benjamin was enough to silence one dissatisfied patient, who asked to remain anonymous because he is still undergoing treatment for an operation he had done about six months ago. Never mind that the video went up almost immediately, before he had time to heal, he said. “Regardless of whether I’m happy — that’s not going to stop me from posting,” he said. “It’s money in my pocket.”
As it turns out, he isn’t satisfied with his results, but he hasn’t taken down his glowing endorsement.
Rebates, no matter how tiny, may squelch candid reviews of medical care, consumer advocates warn. “With paid testimonials you’re running the risk that the consumer’s opinion was skewed by dollar signs, and isn’t necessarily telling the truth,” said Alison Preszler, a spokeswoman for the Better Business Bureau. “When we’re talking about a plumber, the worst that can happen is that you’ll end up with a basement full of water. But when it’s about a plastic surgeon, you could spend the rest of your life as the Elephant Man.”
Thanking patients for endorsements with financial discounts or free Botox is legal. But groups like the American Society of Plastic Surgeons, an organization of 5,800 board certified plastic surgeons, are debating the ethics of doing so — especially without disclosing to the public that some kind of remuneration is involved.
“Our ethics policy says with advertising that members shall not compensate or give anything of value directly or indirectly to members of the media,” said Dr. Richard D’Amico, the president of the society of plastic surgeons. “The question is: Is the Web another form of the media? In my opinion, it is.”
The American Academy of Ophthalmology, an organization of eye doctors, also admonishes financial compensation for patient testimonials and requires that payments are disclosed.
Not every ethicist thinks it is a problem, as long as the rebate is made known. “If a patient voluntarily surrendered their privacy by having their procedure filmed and posted in trade for a financial cut on a service, what’s wrong with that?” asked Dr. Kathy Faber-Langendoen, a professor or bioethics and medicine at SUNY Upstate Medical University in Syracuse.
Trouble is, most marketing videos don’t announce that patients are compensated. Take Jiffy Reed, who posed for a video tribute on YouTube about Dr. Daniel Noor, a New York-based cosmetic dentist who straightened her smile with invisible braces. “I was so happy, I would have done anything,” Ms. Reed said. What the video doesn’t mention is that her physician whitened her teeth at no charge; it usually costs about $700.
Dr. Noor doesn’t consider exchanges like this problematic. “I just wanted to thank them for their time,” he said.
But what about rebates for posting online that amount to three-quarters of the cost? Or when a financially strapped patient does publicity because otherwise elective surgery would be unaffordable?
Last year, Cynthia Goodstein was struggling to figure out how to pay for a face-lift. During a consultation with Dr. Payman Simoni, a Beverly Hills facial plastic surgeon, the doctor asked if she would be willing to be a before-and-after on a promotional video made for YouTube. “I probably said, ‘Do I get any discount?’ and he gave me a good deal,” Ms. Goodstein said, who paid just $3,800 instead of the $12,000 he usually charges.
Dr. Joseph T. Cruise, a plastic surgeon in Newport Beach, Calif., has posted 23 client videos on YouTube since 2005. While he said he did not have difficulty getting patients to talk in front of a camera (it is, after all, Southern California), the cash incentives of 10 percent or so didn’t hurt. (He stressed that all surgeries were already scheduled when he offered patients a publicity rebate.) “The money kind of gets them in the door,” he said, “but once they go through the process, they’re happy to talk.”
Doctors stress that their videos educate, not only promote, their trade. That distinction allows them to meet the bar of sites like YouTube, where the policy states that people can “upload health-related, educational, scientific and documentary footage — even when it involves graphic content.”
The especially grisly videos are dubbed “age restricted,” said a YouTube spokeswoman, and a warning appears before they play.
Dr. Stuart A. Linder, a board certified Beverly Hills plastic surgeon who has wielded his scalpel on the BBC and MTV, argues that his patients have altruistic motives for participating in his marketing ventures. “A lot of them find it interesting for the world to see, so others can know there’s help for them,” he said. Dr. Linder, who has 11 patient videos on YouTube, stressed he would “never do free surgery in lieu of media exposure,” but he refused to say how he shows his appreciation. (“I can’t even state that,” he said.)
For Dave Gibson, 53, a New York actor, who had his Lasek surgery with Dr. Chynn in May, posting a video on Facebook and YouTube was a no-brainer. He even added his own blow-by-blow narration. (“The first thing Dr. Chynn does is place a round apparatus in the center of my eye… .”) At the doctor’s request, he also sent an e-mail message to 100 of his closets pals, racking up a $1 credit for each. As soon as Dr. Chynn mentioned the rebate, Mr. Gibson thought to himself, “I’ll do anything to save money.”
