TheBakersfieldCalifornian.com

For years, consumer groups and patient advocates have warned about the difference between cosmetic procedures done by plastic surgeons, who complete several years of training in specialized surgery, and those done by other doctors who may have little training in such procedures but heavily market their services at discount prices. But sometimes it takes hearing a personal story of horror to really get the message.

K. Marie Espinoza bravely shared that story with Californian readers in reporter Kellie Schmitt's two-part series, "Buyer Beware," detailing her unhappy experience with a liposuction procedure performed by a local doctor, the aftereffects she suffered and her effort to do something about it. Espinoza is not alone in experiencing a bad outcome. But what was especially concerning about her story is that she claims the procedures were suggested and performed by her own gynecologist. Espinoza said her doctor mentioned to her that he performed cosmetic procedures. She was "self-conscious" about some areas of her body, trusted her doctor and decided to let him perform the recommended procedures.

This is the ethical minefield created when a doctor who is charged with managing a patient's health is also allowed to market his cosmetic services to her. Unlike health services billable to insurance companies, cosmetic services bring thousands of dollars in additional profit to doctors in the form of upfront cash. And a doctor of gynecology, in particular, has a ready-made client base for such services. Patients could interpret their doctor's marketing of cosmetic services as their physician endorsing those services. Some might even take it to mean cosmetic procedures are foolproof.

The ethical implications of a gynecologist marketing cosmetic services like breast enhancement to patients is just one example of the lax regulation of the industry that has gone on for too long. It's shameful that policymakers, the Medical Board of California and the California Medical Association, have been so apathetic in addressing the safety risks and exploitation of patient trust created by the lucrative cottage industry of cosmetic surgery. To be clear, there is nothing wrong with cosmetic procedures. But such surgeries should be strictly separated from the practice of preventive medicine.

For now, the job of exposing this gray area of medicine is left to people like Espinoza. If only the people with the power to make needed changes in this area had such guts.