A few years ago, when my fiancé had surgery on his shoulder to stop it from dislocating, he came back from the operating room with something I'd never seen before: a DVD of the surgery, shot from inside his shoulder. (It was the footage from the laparoscopic camera used during the operation.) We watched it that night, and I have to say that it was a much better souvenir than the stickers I used to get from my pediatric dentist: gross and fascinating at the same time, narrated by a surgeon himself. It's like a poorly produced, low-budget version of "Planet Earth: Laparoscopic Edition."
I bring this up because of an article in today's New York Times Style section about people who are posting videos of and about their surgeries on YouTube. But the videos provide more than just a voyeuristic thrill -- the posters use the clips to endorse their doctors' work, and the doctors, in turn, often give the patients a little kickback (a free teeth whitening, a discount off the procedure) as thanks. The article's question: Is this unethical?
Take, for example, a young woman mentioned in the article who went in for Lasek surgery and came out with a DVD so that she "could experience from the confines of her own home the joy of watching the doctor scrape her eyeballs." Her doctor encouraged her to post the video on YouTube along with "his credentials, a link to his website, and a rave review." In return, he offered either a free Botox treatment (thanks for the self-esteem boost!) or $100 off the $5,000 cost of the surgery. Do a quick search for "breast augmentation" on YouTube and you'll see that there's a wide variety of surgery videos available (though many of them -- Botox, teeth whitening, nose jobs, etc. -- have to do with appearances).
It turns out that thanking patients for endorsements with discounts or free services is legal. But the question remains, is it ethical? None of the 15 doctors interviewed by the Times found the practice objectionable. The doctor who performed the aforementioned Lasek procedure pointed out that he was only offering $100 on a $5,000 surgery. "If we gave $1,000, that would be a problem," he said, pointing out that only 10 percent of his patients take him up on the offer. "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," he said. But some medical ethicists disagree. (And some doctors offer much heavier discounts.) "It's disappointing to see commercialism creeping into what should be a very altruistic profession," said 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?"
And the American Society of Plastic Surgeons itself has its reservations. "Our ethics policy says with advertising that members shall not compensate or give anything of value directly or indirectly to members of the media," the society's president is quoted as saying. "The question is: Is the Web another form of the media? In my opinion, it is."
It's a tricky question: Since doctors often get business by word of mouth, why shouldn't they be allowed to encourage patients to use the Web to spread the word? But at the same time, does this practice risk cheapening the power of personal endorsements? (After all, you don't know if the people are speaking from their hearts, or from a desire for a free Botox treatment.) There may be a middle ground: The American Academy of Ophthalmology, which disapproves of doctors' offering financial incentives, requires that payments be disclosed. Personally, I think this last option might be the best -- that way, if patients truly feel motivated to spread the good word about their doctors without any special treatment, their testimonials will carry more weight. Thoughts?