 Editorials
from David Williams (Editor)
Editorials from BL#1 and BL#2
Editorials from BL#4 and BL#6
Editorials from BL#7 and BL#9
Editorials from BL#11 and BL#12
Editorials from BL#13 and BL#17
Editorials from BL#18 and BL#20
Editorials from BL#21 and BL#22
Editorials from BL#23 and BL#24
Editorials from BL#25 and BL#26
 Even though I’ve been a journalist for more than 25 years—I was somewhere between a zygote and an embryo when I scribbled my first column—I still have my fair share of professional surprises. The latest one began life as two paragraphs buried in a press release mentioning a study on Botox addiction. To put this into context, the “addiction” was psychological and was addressing the theme of a patient’s self-image and the hazards of treating those who have unrealistic expectations.
On opening the email and reading the release, I didn’t even bat an eyelid. Frankly, body dysmorphic disorder is hardly a new topic (we published an article by a psychologist on BDD over six years ago). Second, citing a patient’s psychology as a common reason for frequent Botox injections is grounded more in supposition than in science.
But there are more than a few publications that don’t let the facts get in the way of a good story. Media from around the world were on the phones, trying to flesh out the bones of a Botox addiction exclusive. Most of the journalists seemed to have ignored “psychological” and instead fastened onto the notion of physical addiction. Now, had there been any truth in it, this would run and run in the world’s press—what journalists call “a story with legs”. It would also be catastrophic, bearing in mind the millions of users and the impact it would have on the public’s perception of cosmetic surgery.
Could the addiction be analagous to an opiate? Would the medical profesion have to formulate an alternative—like methadone is for heroin—in order to wean wrinklies away from regular injections?
The truth is Botox is chosen by many to help them look younger. It has no physical addiction—although, there may be a few zealots who make it appear so. However, it’s all in the mind.
 The migration of medical specialists and GPs to cosmetic medicine raises questions about certification and competencies to practise in what, historically, has been the domain of cosmetic surgeons and dermatologists.
Plastic surgeons and dermatologists refer to their new colleagues as “out of scope” or “noncore” physicians, and they strongly object to the intrusion into their specialisations, insisting that cosmetic medicine requires lengthy training.
Doctors from other fields contend that cosmetic procedures, like facial injections and vein removal, are far less complicated and risky than procedures within their own specialisation and that the fundamentals can be learned in continuing education classes. As one doctor said: “We are all doctors with the same primary training whose education continues after medical school.”
As well, manufacturers of medical devices have utilised new technology and made their products fairly easy to use. Generally, the knowledge for their application does not need to be that extensive.
But the crux of the matter is that certification in a specialisation confirms a doctor’s ability to deliver quality care in a particular discipline for which he or she has studied for years. The system has taken years to develop. When you use a generic medical license to practise other forms of medicine, there is an inherent danger to patient safety.
One dermatologist, commenting on referrals to his own practice from other specialists, said he gets a few. “Cosmetic doctors may think a certain skin procedure is not ‘brain surgery’ until a patient presents a problem. Then, what do they do? Send the patient to me or to another dermatologist, of course.”
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