This page will highlight several issues of importance with regard to consumer medical/health issues.

When being "licensed" or "certified doesn't mean much...

Many advertisements for laser clinics mention that the laser operator is a certified or licensed laser technician. This would lead you to assume that this person passed some sort of a test and had extensive training to get this certification. You would be completely wrong in this assumption. There isn't a state board of licensure or certification for lasers in Iowa. This isn't a function of the Medical Board or the Aesthetician board either. There is no agency or board that oversees laser training and there isn't one which issue certificates or licenses. Hmmm...

Here's the deal. You buy an expensive laser for hair removal, or whatever. The company sends a training technician to your facility to teach you about how to turn on and operate the laser. This training may last 2-4 hours, sometimes a little longer. They teach you how to operate the laser, they *don't* necessarily teach you anything about alternative options for the treatment, how to handle complications, or how to select the best candidate. At the end of your training, you get a certificate from the training technician which was printed on a laser printer. No testing, no actual certification, no "board" overseeing the training to make sure that it was adequate, and *poof*, you are a certified laser technician.

If you are being evaluated for treatment with a laser by someone who has essentially no training or expertise in dermatology, you are putting yourself at a disadvantage. I'll give you an example...suppose you wanted leg veins treated. You go to a laser shop and they tell you how wonderful their laser is. Do they have the expertise to tell you that most people still consider sclerotherapy the gold standard treatment for lasers and that it is usually less expensive and quicker to produce results? Doubtful. Remember the old adage: "when the only tool you have is a hammer, everything starts to look like a nail." They won't tell you about other options, because all they have is the laser, and that is what you will be "sold." You should demand better service than that.

Dermatologists are your skin experts.

Is There a Doctor in the House?

If you are having any procedures done (laser, Botox®, Restylane injection), it would be highly recommended that your evaluation for this treatment be done by a physician. Iowa has very lax regulations when it comes to lasers, and unfortunately, that does not mean that they are safe for anyone to use on you. Lasers can hurt you. There have been many incidents of permanent scarring caused by lasers wielded by poorly trained individuals. Remember -- Dermatologists are your skin experts. Who is better qualified to tell you whether you would even benefit from the treatment you are interested in -- a dermatologist or a "laser tech" who had two hours of training on how to turn on the laser and set the buttons?

If you are considering Botox® or injection of a filler substance such as Restylane®, you should again resist the urge to look for the "lowest price." When I was in the Army and something broke, we always used to joke about the manufacturer being the "lowest bidder." You don't want to seek out the lowest bidder when it comes to cosmetic procedures such as these. Experience and expertise are important. Using Botox® seems pretty straightforward, but believe me, it just *seems* that way. To get the best results, you should see someone who has an intimate knowledge of facial anatomy and who works with it daily. Most of the skin cancer surgery I do is on the face and I think about facial anatomy daily. We can give you the results you want with Botox® cosmetic, and we have years of experience with it and numerous satisfied customers.

IMPORTANT QUESTIONS YOU SHOULD ASK:

1) Is there a physician in the clinic? So called "medical spas" with an absentee medical director may be staffed by less qualified personnel. You should have a physician in the clinic to answer your questions. And should there be a problem with the administration of a treatment, is the doctor immediately available to help you? There is always a physician available to you in our clinic and we specialize *only* in skin. We're not off delivering babies on the side. ; )

2) Is there a physician evaluating you? If not, what are the qualifications of the person who is telling you about the treatment and determining whether you are a candidate or whether there might be something that works better for your problem?

3) Who will be doing my laser treatment? As busy as medical practices can be, most offices will use ancillary personnel to administer laser treatments. However, you have the option of scheduling your treatment with me (Dr. Angeloni) should you desire.

4) Some clinics offer a low price on Botox®, and have a doctor come into their clinic periodically to administer the treatment. This is really poor practice, IMHO. If there isn't a physician evaluating you for your Botox® injection, why is that? Will that person have the same expertise as the doctor who does the treatment? Who is the physician who will do the injection? What is the specialty of the doctor who will be doing the injection? (And I'd advise you not to take anyone's "word" on this -- get the name and go to the Iowa Medical Board site and *look up* their listed specialty. See the link below under the section "Non Dermatologists Practicing in Iowa) Will you get to meet the doctor before the treatment? Will they be available to you after the treatment? What if you have questions after the treatment or a complication? Who will take care of these things if your "doctor" just gives you an injection and disappears? What if your Botox® injection requires an adjustment injection the next week -- can you have it done by a doctor who only comes to that spa once a month?

The recent episode in Florida where 4 people got botulism was not from a standard Botox® treatment. In fact, the botulinum toxin that was used was a "research" grade product not intended for human use! At Heartland Dermatology we always use Botox® cosmetic. Invoices available at your request.

Fooled by the Media

There appears to be an increasing trend for the media to "test" cosmetic/beauty products by having a person use them and report on the results. In some cases the media even conducts "studies" comparing one product to another. While these might seem convincing on the surface, they are a total farce. This type of evidence is called "anecdotal", and in the eyes of science, these studies are meaningless. Why? Because they are poorly controlled and usually biased. A good example would be a celebrity endorsing a product and saying it worked great for them. Well, it might work great for me too if the company was also giving me $10,000 to say that. Just because something works for one person, doesn't mean it will work for the majority. So if wearing an "ionic bracelet" cures arthritis for one person, will it do so for 99 people out of 100, or is it just 1 person in 100 who feels it helps? The trouble with these claims is that you don't know how many people it works for, so trying such a product is a huge gamble, especially if your chance of it working is only 1%!

The other major problem with this approach is bias. A popular magazine "tests" various cosmetic products and beauty enhancers by giving them to employees to try for a while. I have yet to see a truly negative report from one of these people. Is it because the products they are given are from companies that advertise in that magazine? Hmmm...makes you wonder. If someone from the local media interviews a cosmetic sales person at Dr. Bob's Tooth Cleaning and Day Spa International, are they going to give you an honest assessment of the product or are they only likely to say very positive things about the product to encourage sales? Any salesperson who likes their job would say just about anything to keep themselves busy, don't you think? They don't have to be outrightly deceitful, but they can put an unwarranted positive spin on it. If the cream they are talking about could eat the paint off your car if left on too long, they might say "a short application is highly invigorating and leaves your skin feeling totally refreshed." Then you might take it home and find out it is so uncomfortable it even makes your teeth hurt! Buyer beware.

So what if the media does a "controlled study?" Say they test one product against another, have one person use product A and one person use product B for a few weeks and take before/after pictures and report what the users thought. This is still a poorly designed study which has too few test subjects to provide meaningful data. "But the after pictures for product B looked great on TV!" Well, I can take two pictures of you 1 minute apart with my digital camera and can guarantee that I can make you look 10-15 years younger, just by changing the lighting a little bit (and this can be easily done, without using Photoshop software). Before and after pictures, even if professionally done, are difficult to judge.

And the fact of the matter is, after you have purchased such a product, deep down inside you really want it to work. And if it is a product that takes several weeks have an effect, you are likely to "see" changes in your wrinkles, even when they aren't there. That is why many scientifically done studies employ "blinded" observers who don't know which product was used on the patient. In addition, many scientifically done studies let you know up front whether there are any conflicts of interest, so you can then decide whether the study was designed in a way to get favorable results for the company which sponsored it. Doctors and scientists are held to a high standard when it comes to determining which products really work...should the media be held to a lower standard when they are encouraging you to buy products that are over hyped and overpriced? I think not.

Mesotherapy - Emerging Technology Report

The American Society for Dermatologic Surgery recently released an emerging technologies report which I scanned in and posted here. If you don't want to read the whole thing the important points to remember would be:

- this is a non FDA approved procedure with little data to support its effectiveness or safety.

- the active ingredient used (phosphatidylcholine) was prohibited by the Brazilian National Agency of Health in 2003 due to a lack of scientific data supporting its use for reduction of local fat deposits

Non Dermatologists Practicing in Iowa

There are several medical practitioners in Iowa and the Des Moines area who bill themselves as "dermatologists" when they are not. If you are not seeing a board certified Dermatologist, who knows what kind of care you will receive. When you schedule your appointment, make sure you ask whether the doctor is board certified in Dermatology. Do not just ask if the doctor is "board certified" because if the answer is yes, they could be certified in Family Practice or Pathology. You must specifically inquire whether they are board certified in Dermatology. Just because someone puts an advertisement in the paper offering "advanced dermatologic" care, doesn't mean they are qualified. You can check to see what specialty a doctor listed when he/she applied for their Iowa Medical License by using this link to the Iowa Board of Medical Examiners:

http://www.docboard.org/ia/ia_home.htm

Click on the DocFinder button and you can get search a database of physicians with Iowa medical licenses.This will show you the specialty they listed for their medical license.

Dermatologists - your skin experts

Several medical spas and laser "clinics" have been set up in this area and are advertised prominently in the Register.All of these advertise that they specialize in skin care but the doctors who oversee these clinics are not dermatologists. Remember, Dermatologists are your skin experts. Our training is totally concentrated on skin and skin alone, and we are especially qualified to meet all of your skin health needs. When it comes to skin care, board certification in Dermatology IS important. Make sure you ask whether the doctor is a Board Certified Dermatologist.

V. Angeloni MD