The XX Factor: What women really think.

Peddling Botox

Ah, yes, the unsolicited-Botox pitch. My experience wasn't nearly so harrowing or prolonged as Melinda's, but a couple of years ago I went to a dermatologist for a small, straightforward medical matter. It was hard not to notice the large photo on his examining room wall, showing him on vacation, trekking someplace exotic. At the end of our appointment, he took my file and looked at my birth date. "You're over 40," he pointed out, gratuitously. "Want to try some Botox?"

This was a mainstream medical doctor, seeing a patient for a medical matter, and here he was, peddling a pricey cosmetic sideline, doubtless as a way of paying his next sherpa. I declined his offer. He shrugged and assumed I was just offended. And in a way, I was; it's hard not to feel self-concious about your forehead when your doctor offers to correct some aspect of it. But mostly, I was shocked. I'd never had a doctor try to sell me something. It was no big deal to him. Some women resent the suggestion, he confided, but others don't. For that reason, he said, it's hard to know the best way to make the pitch. Next patient!

Cosmetic surgeons may be hurting in the current economy, but the pressures of managed care are also inspiring some some regular practioners to seek ways to augment their own income by performing—and proferring—cosmetic procedures. I was chatting about this recently with Kathryn Hinsch, founder of the Women's Bioethics Project, who has lots of concerns about physicians dabbling in lucrative cosmetic enhancements. The problems are manifold: It's cheesy, it commercializes medicine, and most of all, it corrupts doctor-patient trust. Hinsch pointed out in our conversation that general practitioners, family practitioners, and ob-gyns are all cashing in on the trend. And who are their primary targets? Well, women contribute by far the majority of cosmetic-procedure revenue.

And how are we paying for these procedures? On another topic, Melinda, just to tie up one loose end: That data set I mentioned last week, showing that one-third of all wives earn more than their husband? This may be a violation of the blogging ethos, but after your entry, I felt curious and made a call, to the Labor Department, to see if there were any caveats or backstory. It turns out that this statistic does not include families where the wife does not work. (The WSJ article was a little misleading that way.) But in families where the wife earns a paycheck, one third of the time she makes more than her husband. So she has even more $$$ with which to pay her GP for that liposuction!