Kenneth A. Arndt, M.D., says although opinions may differ regarding the following issues, it's important that laser surgeons discuss them openly and honestly. He is a dermatologist in private practice with Skin Care Physicians in Chestnut Hill, Mass., and recently moderated the American Society for Laser Medicine and Surgery's first stand-alone expert panel on ethics in laser surgery.
He reviews a number of areas prime for discussion of ethics relative to laser use:Conflicts of interest
Potential conflicts can arise whenever a physician publishes or presents research regarding a company with which he or she is economically involved, Dr. Arndt says.
Conflict-of-interest statements are commonplace, he says, "But this still remains an issue. There are certainly investigators who have an interest, stock or other involvement with a company and carry out research on their products."
Such research is useful and not inherently unethical, Dr. Arndt tells Cosmetic Surgery Times. "But it must be fully acknowledged," he says, "and this isn't always the case."
Misleading marketing, advertising
Lasers are perhaps more prone to this problem than other instruments, Dr. Arndt says, "because they have the aura of being magical — and they are, to a degree."
But in many instances, he adds, "The promise of what a procedure or particular wavelength of light can bring about is often so enthusiastic it's unrealistic."
A study Dr. Arndt co-authored involving hundreds of thousands of Internet search engine hits for terms related to laser surgery showed that only a few yielded objective information (Bykowski JL, Alora MB, Dover JS, Arndt KA. J Am Acad Dermatol. 2000; 42 (5 Pt 1): 784-786).
Ultimately, he explains, "Misleading marketing is impossible to control."
Dr. Arndt says that while various societies provide guidelines in this regard, it comes down to individual ethics — which can be influenced (but not controlled) by early training and education.
Advocacy outstripping facts
Dr. Arndt says this problem is especially likely if research is funded by a single manufacturer, which is nearly always the case.
Both practitioners and manufacturers want to know about equipment capabilities and the effectiveness of new and emerging technologies, he notes.
However, he says, "One must be careful in presenting information, listening to speakers and reading journal articles."
Telltale phrases include statements suggesting that a treatment is the obvious "treatment of choice" for a particular problem, or assertions that a company's technology is more effective than accepted standards, Dr. Arndt notes.
Inadequate patient education
Patients must have a full and accurate picture of the potential results — and risks — of any procedure, Dr. Arndt says.
However, he adds that some physicians' excess and, at times, unwarranted enthusiasm about an instrument or technique leads to "a risk of being overly positive. This can result in disappointed and unhappy patients, and that's entirely understandable."
Adverse results, complications
"This goes along with the potential, particularly with new techniques, of using unnecessarily risky or unproven procedures," Dr. Arndt says.
An important corollary is the potential for practitioners to be motivated more by economics than the patient's best interest, he adds.