Douglas D. Koch, MD: "Do we practice medicine in the spirit of Hippocrates, or do we sell used cars?"
LASIK advertising has become an embarassment to the field of ophthalmology. Patients are enticed into a risky, unnecessary surgery by aggressive and deceptive advertising. LASIK advertising portrays the surgery as virtually perfect and risk-free. When patients call LASIK providers for information or to schedule a consultation, they are subjected to high-pressure sales tactics. Some LASIK surgeons violate AMA ethics rules by offering financial incentives for referrals. And then there are the LASIK advertising gimmicks which trivialize the surgery: "Kiss a Pig and Win Free LASIK!"
LASIK surgeon, Brian Boxer Wachler, MD rapping for LASIK
Editoral comment: This rap video which was produced by and stars Dr. Brian Boxer Wachler is unethical, unprofessional and in very poor taste, in our opinion. LASIK patients who suffer permanent, life-altering complications with diminished quality of life feel that marketing tactics such as this music video contest should be prohibited by the AMA, AAO, and regulatory bodies. LASIK is serious surgery which carries significant risk to the organ through which we get 80% of our information. Eyesight is our most precious asset. The decision to have elective surgery on your eyes should never be taken lightly, and LASIK should not be promoted in a manner that trivializes the surgery. Shame on you, Dr. Brian Boxer Wachler.
Open questions for Dr. Brian Boxer Wachler: Who was the last physician to perform surgery on a young man from Nevada who committed suicide in 2008 due to LASIK complications? Did your patient, Olympian Steve Holcomb, have post-LASIK corneal ectasia (after LASIK by another eye surgeon), which led to his 2007 suicide attempt? Isn't it true that your peers and associates have repeatedly denied any link between a bad outcome from LASIK and suicide or depression?
FDA warns LASIK providers to stop misleading ads - December 18, 2012
From the press release: The U.S. Food and Drug Administration today warned five eye care providers to stop the misleading advertising and promotion of refractive lasers used in eye surgery procedures such as LASIK. The FDA found that the providers' advertisements and promotional materials did not offer consumers adequate information about associated risks, as well as warnings and possible adverse events.
The five providers that received FDA Warning Letters are:
FDA letter to ASCRS: LASIK ads which fail to disclose risks are illegal - 3/20/2012
From the letter: Whether a particular advertisement or promotion is false or misleading is determined on a case-by-case basis and, in making this determination, FDA considers many factors, including how risk information is described, displayed, and located. However, the FDA‑approved labeling for every laser approved for LASIK includes the risks of dry eye syndrome, which can be severe; the possible need for glasses or contact lenses after surgery; visual symptoms including halos, glare, starbursts, and double vision, which can be debilitating; and the loss of vision. FDA recommends the inclusion of this risk information in all advertising and promotional materials for FDA‑approved lasers used for LASIK. In addition to this common risk information, advertisements and promotional materials should include the contraindications for the particular laser that the eye care professional uses. The contraindications for each laser can be found in the approved labeling for the laser. Moreover, eye care professionals should consider other risk information, such as warnings and precautions, in the approved labeling for the laser used by the professional to determine whether that risk information should be included in their advertisements and promotional materials.
FDA Letter to LASIK Surgeons, 90 Day Warning on False Ads - 9/23/2011
From the letter: The FDA expects that this notice and the additional information that the agency is providing will permit eye care professionals to correct within 90 days of the date of this notice any advertisements or promotional materials that do not comply with the Federal Food, Drug, and Cosmetic Act (FD&C Act). After that time, the FDA may take regulatory action against eye care professionals whose advertisements or promotional materials violate the FD&C Act. Agency actions may include warning letters, product seizures, injunctions and civil money penalty proceedings.
The Economics of Lasik Surgery
FDA writes to eyecare professionals, LASIK ads must warn consumers of risks - May 22, 2009
From the letter: The FDA has received complaints that eye care professionals’ advertisements for LASIK procedures and FDA-approved lasers used for the LASIK procedures failed to inform consumers of the indications, limitations, and risks associated with LASIK procedures and the approved lasers used for the LASIK procedures. The FDA believes that eliminating deceptive or misleading health-related advertising claims is an important part of protecting the public health.
Undercover investigators expose LASIK clinic doctors and employees lying about risks - GlobalTV 5/28/2011
LASIK surgeons imply that it's cheaper to have LASIK than to continue wearing glasses or contact lenses
Stephen Updegraff, MD, Brian Davis, MD, Jayne Weiss, MD and other LASIK surgeons imply that it's cheaper in the long run to have LASIK than to continue to wear glasses or contacts. What Dr. Updegraff, Dr. Davis, Dr. Weiss and their colleagues may not tell you is that LASIK can result in such devastating complications that patients may spend many times the cost of their LASIK surgery in just the first few months or years after surgery, and that LASIK complications can add up to be the most costly medical expenses of a patient's lifetime.
File a complaint with the FDA and FTC for false advertising of LASIK
LASIK advertising is a source of contention between LASIK patient advocates and the LASIK industry. Many injured LASIK patients feel they are victims of deceptive LASIK ads that promise a lifetime of perfect, glasses-free vision with no mention of risks.
LASIK advertising is subject to federal laws. The responsibility for enforcement of these laws as they apply to lasers used for LASIK is shared by the Federal Trade Commission (FTC) and the Food and Drug Administration (FDA). We have designed a template that you may use to file your complaint with the FDA. False ad template.
Read the FTC guidance for LASIK advertising: Link
Deceptive Bait and Switch LASIK Ads, a Common Practice of LASIK Providers
Doctors speak out against deceptive LASIK advertising
Terrence P. O'Brien, MD: "Other trends we will see are discount open heart surgery or budget brain surgery," O'Brien said. O'Brien gave examples of extremely bad advertising that has given laser vision correction an unfavorable public perception of procedures. In several cases, competitors offering "blade-free" refractive surgery have depicted razor blades as visuals that O'Brien said add to the fear factor. EyeWorld May 2003
Steve Arshinoff, MD: "I read the editorial on advertising in ophthalmology with great interest and wholehearted agreement. The seemingly progressive tendency to irresponsible advertising, particularly of laser in situ keratomileusis (LASIK), is becoming an embarrassment to all of us who wish to practice ethical medicine and do no harm to our patients." J Cataract Refract Surg. September 2004.
H. Dunbar Hoskins Jr., MD, American Academy of Ophthalmology Executive Vice President: "In medicine our role as professionals is to put the patient's interest ahead of our own. Professional societies have had ethical standards that underscore the importance of that principle. Historically this went unquestioned. It was a medical need that caused the patient to seek out the physician... Now this principle is being tested as we see increasing efforts to attract or even entice patients into practices. This is a continuation of an activity that began with cataract surgery some 10 years or so ago. It is the nature of a competitive marketplace. It also sends a strong message to the consumer: 'Let the buyer beware'." EyeNet Magazine, June 2000 Link to source
Francis W. Price, MD: "It's a shame. I'll lay it all on the government and the lawyers. They gave doctors the right to advertise". EyeWorld, March 2001 Link to source
Douglas D. Koch, MD: "Ads imply that the result will be perfect, permanent, and/or complication free. Examples include "20/20 for $2995" or "20/20 promise" or "quick and pain-free way to eliminate your need for corrective lenses."... "In my view, an even more repugnant approach is the "money back guarantee." This implies that the procedure is somehow reversible and that there are no potential risks of sight-threatening or sight-disturbing complications. Getting one's money back does not make up for a lifetime of unhappiness about one's vision; it is not like returning a broken television... Primum no nocere: First do no harm. Do we practice medicine in the spirit of Hippocrates, or do we sell used cars?" Source: Journal of Cataract & Refractive Surgery, August 2003
Barry N. Wasserman, MD: "However, we have to remember that we are not used-car salesmen. We have to maintain a different standard or we lose the trust of those for whom we care. For example, one laser center offers “two-for-one LASIK.” Of course, there is so much fine print in the offer that it is akin to the bait-and-switch tactics of discount electronics stores. Is that how we garner trust when we are asking patients to put their most valued sense in our hands?" Source: EyeNet Magazine, March 2008. Link to source
Doctors offering discounts to patients for posting testimonials on YouTube
The New York Times: [Dr. Emil W. Chynn] 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... “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. Source
What does the American Medical Association say about doctors offering financial incentives to patients for referrals?...
"Physicians should not offer financial incentives or other valuable consideration to patients in exchange for recruitment of other patients. Such incentives can distort the information that patients provide to potential patients, thus distorting the expectations of potential patients and compromising the trust that is the foundation of the patient physician relationship." Source
From Dr. Emil Chynn's website, "In fact, the primary reason that Dr. Chynn switched from performing (thousands) of LASIKs to SafeSight is that he himself, has some minor (but bothersome) dry eyes and night glare after his own LASIK." (9/28/2011) http://www.parkavenuelasek.com/why-safesight/
Editor's note: LASEK is not FDA-approved.
LASIK undercover investigation: CBS 2 New York
Dr. George Waring III: "I would not be willing to take even a 1 in 500,000 risk on my eyes," Dr. Waring said. Source: Demand High for RK Eye Surgery – Critics Say Glasses, Contacts Work Best, Doctors Just Trying to Enrich Themselves by Jeffrey Weiss. Seattle Times, p.A4 7/12/93
Stephen G. Slade, MD: "I do not believe an ophthalmologist must undergo eye surgery to avoid being hypocritical or to be able to consult properly with his own patients. I myself have not had eye surgery; I am a little myopic in one eye and am old enough to like the natural monovision." Source: Cataract & Refractive Surgery Today, October 2008
"Dr. Lindstrom believes that it is also helpful for the surgeon to have undergone LASIK. “I think it’s an advantage for the physician to have undergone LASIK. I personally haven’t had LASIK, but every one of my partners who is myopic has had it done. I tell patients that I’ve performed LASIK on several of my partners and my family members, and I think it helps a lot,” he says..." Source: Review of Ophthalmology 2/21/2008
"While it may be ideal for a LASIK coordinator to have undergone LASIK, Drs. Lindstrom and McDonald agree that it is not imperative. It is crucial, however, for the LASIK coordinator to never wear glasses while at work. “They can wear contacts, but they can’t wear glasses. If they wear glasses, all the explaining in the world about why they are not candidates for LASIK is not going to make a difference,” Dr. McDonald says." Source: Review of Ophthalmology 2/21/2008
"The FDA advisers — a group of mostly glasses-wearing eye doctors — recommended that the agency make more clear the warnings it already provides for would-be Lasik patients... That's a big reason why Weiss, the glasses-wearing ophthalmologist, won't get Lasik even though she offers it to her patients. "I can read without my glasses and ... operate without my glasses, and I love that," she said. "The second aspect is I would not tolerate any risk for myself." Source: USAToday 4/24/2008
Rachel K. Sobel: "Would I ever get LASIK?... Being an ophthalmologist with blurry vision would handicap me. Finally, I do have dry eyes, which could get worse. I'll stick to my glasses and contacts for now." Source: philly.com 3/30/2009, previously posted at Link to Article
Shameful scare tactics
Doctors imply LASIK is safer than contact lenses...
From the article: “Many people who wear contact lenses have complications and infections,” said ophthalmologist Joseph Feder, M.D., of Aurora Health Care. “There are many options for people with these problems. This event will focus on LASIK, one of the treatment options.” Source
From the article: "If they're not adhering to the normal contact lens wearing time schedule, we will often explain to them that it's in their best interest for the health of their eyes to consider LASIK." Source
From FDA MedWatch report: "I had lasik surgery in 2000... I wore contacts prior to the surgery but my Dr. said that because of eye infections, I would go blind if I continued wearing contacts. I decided to get the lasik procedure... [Now] my night vision is the pits..." Link
'Money Over Medicine' Mentality
Marguerite McDonald, MD: "Sometimes, listeners then ask me if they should wait for the next procedure. My favorite response involves an analogy to a car. I explain that they are hardly likely to wait 10 years to buy an automobile, because the currently available models function beautifully." Cataract & Refractive Surgery Today, May 2007
Editor's note: Perhaps Dr. McDonald doesn't understand that you can't 'trade-in' your LASIK-damaged eyes for a new pair in a couple of years.
Michael W. Malley, LASIK Marketing Consultant: "Discussing long-term post-LASIK visual needs with a patient is probably not a good idea BEFORE they have the procedure." Ophthalmology Management, February 2007
Kay Coulson, LASIK Marketing Consultant: "Recommend what the patient should do. If a refractive counselor cannot commit to a patient that they are a candidate without having the surgeon review the chart, you have not set LASIK criteria appropriately for your staff. If you present patients with a full-distance vision vs. monovision LASIK option and send them home to think about it, you have lost the patient. The same for advanced surface ablation vs. phakic. Reason through the options silently while examining the patient and reviewing test results, but make sure that patient is very clear about what you recommend and aim to schedule the surgery at the time of consultation". Ophthalmology Management, November 2007
Shareef Mahdavi, LASIK Marketing Consultant: "What is interesting about the Baby Boomers is that they are now between the ages of 42 and 60. They are going to develop presbyopia and they are going to develop cataracts for the most part, and that is good news." OCULAR SURGERY NEWS U.S. EDITION September 15, 2006
FDA warns about 'slick' LASIK ads: If it sounds too good to be true...
From the FDA website: Be cautious about "slick" advertising and/or deals that sound "too good to be true." Remember, they usually are. There is a lot of competition resulting in a great deal of advertising and bidding for your business. Do your homework.
Refractive surgery advertising raising red flags in Washington
EyeWorld, August 2001
From the article: "With competition heating up in refractive surgery, more physicians and surgery centers are promoting themselves through advertising and marketing techniques that probably would have been anathema to the profession just a few years ago.
Physicians and other professionals have the legal right to advertise under U.S. law, but when they do, their advertising is just as subject to federal consumer protections as any other advertiser. What you don't know about the laws designed to protect consumers could hurt you if your ads are questioned.
Federal laws prohibit unfair or deceptive acts or practices in advertising, and false advertising of food, drugs, and services. The responsibility for enforcement of these laws as they apply to drugs and medical devices is shared by the Federal Trade Commission and the Food and Drug Administration.
According to FTC official Matthew Daynard, advertising is considered "deceptive" if it is likely to mislead "reasonable" consumers and if it is likely to affect consumers' conduct or decisions. A practice is "unfair" if it causes or is likely to cause injury to consumers that they could not reasonably avoid and that is not outweighed by the benefits."