May 17, 2020

Effect of the recession on plastic surgery practices

Cosmetic surgery
plastic surgery
4 min
13m cosmetic procedures took place in the US in 2010
Written by Sarah Hodge As the world economy teeters between disaster and recovery there are a couple industries that show few signs of impact. The elec...

Written by Sarah Hodge

As the world economy teeters between disaster and recovery there are a couple industries that show few signs of impact. The elective surgeries sector is one of them and earlier this year, media outlets around the world reported on how efficiently the industry performed.

It seems, however, that the economic losses have eventually caught up with the widely accepted practice and now everyone is looking for the right deal to stay afloat and keep customers walking through the doors. The consequences are already affecting doctors and patients and if they are not careful, they could end up changing the way in which the industry operates as a whole.

In the United States alone, more than 13 million cosmetic and plastic surgery procedures were performed last year and according to the American Society of Plastic Surgeons (ASPS), this was a five percent increase from 2009. As a representation of thousands of plastic surgeons across the country, the Society serves as a reference for patients on cosmetic procedures. So what was the reason for an increase in the number of plastic surgery patients? The answer is simple, people wanted jobs.

The state of the economy actually served as a catalyst, encouraging more people to seek out and undergo cosmetic procedures. If beauty is in the eye of the beholder, then employment is the reward for attracting the right employer and plastic surgery has quickly become the new tool to gain a competitive advantage in a stumbling job market.

Men and women found themselves getting tightened, plumped and filled to reduce the signs of aging and avoid getting the axe. Meanwhile, the increasingly popular Botox has gained even more loyal followers and there were reportedly 11.3 million administrations of the FDA approved drug last year.

With the job reports showing declines over the past months, people must resort to their own measures before many job plans will prove to be effective, especially as the economic response in the states and abroad has been less than enthusiastic. In the scramble to keep their appointment books filled, some surgeons have begun to offer their services at discounted rates. For professional organisations such as the ASPS and the British Association of Aesthetic Plastic Surgeons (BAAPS), this is a cause for concern.

According to the BAAPS, discounts and deals could trivialise the importance of the plastic surgery industry, especially after researchers discovered that 26 percent of British and 12 percent of American cosmetic clinics use financial incentives to promote their surgical treatments. These incentives have even gone as far as offering breast enhancement procedures as the main prize in a UK nightclub’s raffle draw. 

However, the growing popularity of Groupon, Living Social and similar daily deals companies is also allowing surgeons to tempt patients with these offers through an exclusive subscriber list. As a result, procedures like liposuction, botox, and nose jobs are available at a fraction of their original cost and the basic format of these incentives is easily replicated and extremely desirable to consumers who want the results without the hefty price tag.

Unfortunately the plastic surgery industry is still a business and if you make cuts in one area other adjustments must be made in order to be profitable. That is where the ASPS raise a red flag, as there are not provisions to regulate what kind of deals surgeons make and such offers create opportunities for unethical practices. 

But it is not just surgeons that are taking advantage of the increased demand for cosmetic surgery treatments. American business celebrity Donald Trump has also found a way to use these avenues to exploit the desires of the masses. His casino, the Taj Mahal, is offering a $25,000 prize to gamblers in their The Nip, Tuck and Lift Sweepstakes.

Advice from the ASPS and the BAAPS to patients is to ensure they always check the fine print of these online deals and the credentials of doctor’s who are offering such heavy discounts. While many potential patients and cosmetic surgery clinics and doctors are feeling the economic pinch, it shouldn’t be at the expense of health and safety.

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Jun 19, 2021

Driving sustainability in medical device production

George I’ons
5 min
George I’ons, Head of Product Strategy and Insights at Owen Mumford Pharmaceutical Services on how technology is driving sustainability 

Environmental protection and stewardship are rapidly rising to the top of the corporate agenda and medical device businesses are no exception. The healthcare sectors of the United States, Australia, Canada, and England combined emit an estimated 748 million metric tons of greenhouse gases each year, an output greater than the carbon emissions of all but six nations worldwide. In order to curb this situation various European standards have been introduced. 

The Waste Electrical and Electronic Equipment (WEEE); Restriction on Hazardous Substances (RoHS); Registration, Evaluation, and Authorisation of Chemicals (REACH) and the Energy Using Products (EuP) regulations have all significantly altered manufacturing processes, specific labelling, compliance with disposal restrictions, and creation of instructions for end-of-life management and recycling.

At the moment many medical devices are currently exempt from these regulations but several directives, including RoHS and WEEE, are in the process of being reviewed and could be applicable in future. This is especially relevant for devices that are ‘connected’ and have a digital monitoring component which then brings them under the regulatory purview of authorities that govern devices with electronic components.

Safety, Usability and Sustainability

While medical device manufacturers have been working to respond to increasing demand for environmental sustainability from the market, they also have to contend with a key element of their mission: to ensure safety and usability to healthcare workers and patients. Parenteral and other invasive devices are strictly regulated to help reduce the risk of Healthcare Acquired Infection which typically runs as high as 5% and 8% in most developed countries, according to the European Centre for Disease Prevention and Control. As a result, they typically contain disposable single-use plastic elements.

At the same time, many hospitals and purchasing organisations have started to recognise that sustainable purchasing practices play a pivotal role in reducing costs over time. Many GPOs have appointed and empowered Senior Directors of Environmentally Preferred Sourcing who are successfully implementing the sustainable purchasing business case. In addition global pharmaceutical companies are increasingly creating senior positions with sustainability objectives as key to the role.

Medical device disposal is a particularly burning issue; generally carried out through incineration in the EU, it typically releases nitrous oxide, as well as known carcinogens including polychlorinated biphenyls, furans and dioxins. Some of the strategies trialled by manufacturers to reduce waste matter destined to incineration include sterilisation and reprocessing.

Sterilisation, however, falls short on the environmental front, and may consume more energy and produce more emissions than incineration itself. In the United States for example, 50% of all sterile medical devices are sterilised with ethylene oxide but since this method releases harmful emissions, the US Food and Drug Administration is now encouraging the development of new methods or technologies. Many other established sterilisation methods use glutaraldehyde that is not only harmful to the environment but also tends to be regulated by strict usage and disposal rules such as COSSH guidelines.

Focus on Recycling

The outlook on recycling is changing significantly thanks to new research and technologies enabling, for example, monomer extraction. Recycled polymers can be broken down to their constituent monomers promoting an almost limitless recyclability of some polymers. In addition to this, Polyvinyl chloride (PVC), renewable polyethylene and polyethylene terephthalate (PET) can be recycled several times without losing critical properties.

Reducing the impact of packaging can also significantly reduce the materials that need to be dealt with through either waste or recycling. Packaging manufacturers are decreasing packaging volume by favouring sealed trays instead of pouches, laser-etching instructions directly on to the tray where regulation permits it, or reducing the number of components required overall. In addition to this, for recycling plans to be successful it important to have a full understanding of the practices surrounding device use and to establish, where possible,  closed loop recycling systems that recover the waste materials from hospitals or patients and bring them back into the recycling process.

Sustainable Manufacturing: Technology and Research

Greater employment of fast degrading plastics or material from other sources is a key strategy to reduce harmful pollutants both at production and disposal stage. Bio-based materials can in fact offset the carbon emitted during processing as the monomer source grows, and a growing range of sources for bio based monomers -such as wood pulp or sugar cane- is available. However, when assessing the most suitable material for a part, the entire lifecycle of the product needs to be considered. For example: bio-degradable polymers can contaminate a recycling stream and emit methane when incinerated.

The use of environmentally friendly materials should also be supported by an increase in clean renewable energy sources. Lower energy consumption means fewer carbon emissions but also financial savings, making this an appealing measure for manufacturers. New technologies are proving a major gamechanger on this front, helping manufacturers marry their environmental stewardship with cost savings and efficiency.  3D printing, for example, can help develop optimum product moulds more quickly, refining production parameters to minimise raw materials volumes and maximising output productivity.

Similarly, ‘digital twin’ production software uses inline sensors to create a virtual, real-time mirror of the production environment to enable inline refinements. The objective is to achieve “zero defect”, waste-free manufacturing. In addition to this, LEAN manufacturing methodologies are already helping to optimise inventory management and reduce overproduction. 

Sustainability by Design

It is increasingly clear that effective environmental sustainability in the medical device sector cannot exist without a full view of the product life cycle from concept development, material selection, design and engineering to manufacturing, packaging, transportation, sales, use, and end-of-life disposal. These evaluations are typically made for factors such as manufacturing efficiency, time to market, or safety and regulatory compliance, packaging and transportation costs, but should be extended to energy efficiency and environmental impact by means such as life cycle analysis.  

In addition to this, with devices rapidly becoming more digitally connected, developers need to be aware that the costs of disposable electronics would simply not be viable, or indeed acceptable in the light of electronics disposal regulations. Design therefore should focus on creating a simple, repeatable interface between the two component sections so as not to impair the functionality or efficacy. As reducing waste and harmful emissions continues to exert businesses and governments globally, the medical devices industry cannot stand by. The environmental but also commercial implications of inaction are too serious and the array of solutions now available is exciting and diverse.

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