Human Nature: Science, Technology, and Life.

Bubble Jobs

Two months ago, I celebrated what seemed to be an emerging recession in cosmetic surgery. That assessment was based on anecdotes and sketchy data from Reuters and the Los Angeles Times. The good news, I argued, was that the rough economy was reminding people which medical procedures were necessary and which weren't. It was also forcing doctors to shift from cosmetic profit back to the real work of promoting health.

Last week, a follow-up Reuters story cast doubt on the trend. Britain's biggest cosmetic surgery company reported a 35 percent increase in procedures in less than a year, led by a 59 percent increase in tummy tucks and a 40 percent increase in breast augmentations. A company spokeswoman opined:

It's interesting to see what people cut back on during a credit crunch. Research among our patients has shown that despite cutting back across all other areas ... people aren't cutting back on money they spend on themselves. For many who are undertaking an abdomnoplasty this is something they've planned for years. For this reason, they're unlikely to want to now put this off and instead they consider their procedure to be an investment.

How depressing. I know it's now standard practice to peddle every product or service as an investment. But cosmetic surgery? It's not health. It's not even disposable property.

Now further data are backing up the original trend reports. Natasha Singer of the New York Times says the two-year waiting lists of a few years ago have dried up:

Earlier this month, this reporter, using a script, made identical anonymous calls to the offices of 48 prominent plastic surgeons in makeover meccas like Orange County, Calif., and the Upper East Side of Manhattan, asking staff members about the earliest possible appointment dates for consultations and cosmetic surgery. I selected plastic surgeons who have appeared regularly on television, or in glossy magazines, or who are listed in the 2007 edition of "America's Top Doctors" ... [A]bout 90 percent of the doctors' offices offered consultations in three weeks or sooner; and about 94 percent offered surgery dates in June or July.

More broadly, total cosmetic surgeries are still 3 percent below the levels of eight years ago.

Why the shrinkage? Because money is tight. "A survey in April and May of more than 600 plastic surgeons, by the American Society for Aesthetic Plastic Surgery, reported that almost 53 percent said the downturn in the economy has had an adverse impact on plastic surgery practices," Singer reports. Data show that the recession hasn't driven clients out of the cosmetic market altogether. But it has downshifted their spending from expensive surgeries to Botox and other cheaper nonsurgical procedures.

One plastic surgeon tells Singer that in previous years he had clients "refinancing their homes and using them as A.T.M.s" to pay for breast augmentations and liposuction. Ponder the insanity of that: risking the most expensive of life's three traditional needs—food, clothing, and shelter—for pure vanity. And then, when you can't pay the mortgage, we're supposed to bail you out? And your surgeon calls what you did an "investment"?

Fortunately, not every doctor has lost perspective. When asked to explain the drop in clientele, another plastic surgeon tells the Times: "We are a luxury item. People want us, but they don't actually need us."

Exactly. Skip the boob job. Keep the house.

Boob-Job Conservatism

New piece this morning on the recession in cosmetic surgery. As I was writing it, I realized how completely it dovetails with the previous post about nipple rings. Both argue for a distinction between elective and necessary procedures. That's an old theme of bioethics, and it suits my conservative streak. Or maybe it's not conservative; maybe it's just hard-nosed. I do think some things in life are way more important than others, and both abundance and indulgence can make you forget the difference.

On the other hand, I don't want to become cranky. When I think of cranky, I think of Bob Dole, or at least Dan Aykroyd's caricature of Bob Dole, muttering bitterly about how easy some people now have it. In general, there's nothing inherently wrong, and there's usually a lot that's wonderful, about making things easy that used to be hard. That's certainly true of medicine. It's just important to keep in mind the relative value of the things achieved and the relative importance of effort in making a particular result worthwhile.

I remember going to a transhumanist conference a couple of years ago. For those of you who don't know them, transhumanists are people who believe in the technological transformation of humanity into something greater. When I first left politics to cover this beat, I took a pretty conservative line on bioethics generally, and the transhumanists sounded pretty fruity to me. Well, they're still kind of fruity. But they certainly are interesting, if you treat them as a voice in the public dialogue rather than as a threat to dictate future policy and destroy human nature (whatever that is). And the more you listen to their assault on conservative assumptions, the more you find yourself asking questions about the way things are and whether they have to be that way. Those are good questions to ask.

I'm still trying to find my own blend of progressive and conservative, liberalism and discipline. Nipple rings? Just not that big a deal, either way. Face lifts? Ditto. But sex-reassignment surgery? That's pretty fundamental to who you are, and I'm inclined to listen to people who have lived in what they profoundly experience as the wrong body. I'll keep thinking about these things, and I'll try to keep my mind open to all ideas, including the idea of limits.