The VIP syndrome has spread beyond celebrities via direct-to-consumer treatments.


Last spring, inspired by (what else?) a TikTok, I got interested in CoolSculpting, a non-surgical procedure that freezes fat cells. Although cryolipolysis can be applied just about anywhere on the body, including upper arms, bra area, stomach, and thighs, I was interested in twisting its icy grip on my jawline. . In the micro video, I saw a girl like me go from having an average mandible to proudly sporting an anime character’s diamond-cut chin, all for $750.

A quick Google search turned up a “medspa” two metro stops away that offered the 35-minute treatment. I booked a consultation. But in obsessively trying to figure out how, exactly, this procedure worked, a seemingly rare side effect caught my eye: paradoxical adipose hyperplasia. In less than 0.5% of cases, researchers report, the body rebels and eventually produces Continued fat in the area targeted by cryolipolysis. Such a low incidence rate might have been reassuring for a life-saving medical procedure, but given that CoolSculpting is the definition of “optional,” I was scared enough. I canceled my consultation, and in the months that followed, I only occasionally felt a sense of nostalgia about the chin that might have been.

So when ’90s catwalk icon Linda Evangelista recently opened up about her “fat freezing trauma” in a People magazine exclusive, I was surprised but justified. Evangelista said her own CoolSculpting treatments left her with painful, hard protrusions on her jawline, thighs and bra line, which two rounds of corrective liposuction have so far failed to repair. Along with announcing a $50 million lawsuit against Zeltiq Aesthetics Inc., CoolSculpting’s parent company, Evangelista said she was going public to “help other people who are in the same situation as me.” But how, I wondered, did so many other ordinary people (potentially including me!) end up in the same absurd situation as a world-famous model?

The answer lies in “VIP syndrome,” a term coined in 1964 by psychiatrist Walter Weintraub to describe an intriguing paradox: Throughout history, the rich and famous, with all their resources and fancy doctors, have often received worse medical treatment and suffered worse health outcomes than the average person. When doctors grant “special privileges” to their powerful patients, from “Mad King” George III to Michael Jackson, they seem to get sicker and even die. While Weintraub, a psychoanalyst, blamed the problem in part on doctors unknowingly resenting their influential patients, it seems doctors are simply smitten with celebrities and high-profile figures. Despite their medical expertise, these doctors find themselves foregoing basic tests for “privacy” or prescribing dangerous drugs for “comfort.”

The VIP syndrome was once a problem limited to members of the British royal family and internationally known pop stars, but it has recently become more widespread. Thanks to an endless parade of healthcare startups that have turned medical treatments into direct consumer goods, more people than ever before have access to nurses, doctors, and more, available to act on their medical whims. . Unfortunately, we are often worse off.

CoolSculpting is just the tip of the iceberg. The United States today has about 4,200 medspas that offer clinic veneer with few regulations. In those malls and stores around the corner, anyone can pay out of pocket for Botox, laser vein removal, dermal fillers, and other procedures designed to soak us in markers. superficial health: tense foreheads, smooth legs, chubby cheeks. Online, the options for prescription drugs designed to optimize both work and life are seemingly limitless: stimulants, beta-blockers, hair loss medications and erectile dysfunction drugs can all be delivered. straight to your doorstep, often with minimal human interaction required. Add to that a frenzy for over-the-counter skincare products with harsh active ingredients and dietary supplements available in bulk at pharmacies and you have millions of people with individualized, unsupervised routines based on the idea that there is an intervention for everything.

Traditionally, health care is provided by a primary care physician who knows your story. When you arrive for your annual checkup, medical professionals take your vital signs, ask you a few questions about your health behaviors, and send you for blood tests. If you need specialists, they can refer you to someone in-network and, in theory, monitor all of your treatments. Or at least that’s how it should be. But health care in the United States has become increasingly fragmented, if you can access it. As the COVID-19 pandemic revealed, there is no health care “system” and few people have a doctor they can constantly turn to. Direct-to-consumer startups took advantage of this landscape and began to exacerbate it. They can provide ad-hoc services accessible to people who would otherwise feel like they slipped through the cracks, giving startups a sliver of social good. At the same time, they make the idea that everyone is a VIP an implicit part of their self-promotion: his is “tailor-made for you”. Roman does all the work “without the waiting rooms”. Nurx is “on your terms”.

Of course, cosmetic procedures have been popular for decades, and overprescribing has been a concern for just as long. But recent developments have changed the way these services are provided and to whom they are intended. Invasive plastic surgery, which requires a physician with years of specialized training, has been partially replaced over the past decade by no-recovery or low-recovery procedures such as injectables. Although they can still dramatically change a person’s appearance, treatments like dermal fillers typically only last a few months, lowering the barrier to entry for people who might be reluctant to make a permanent physical change. .

Meanwhile, online stores like Hims, Roman, and Cerebral have essentially hybridized telemedicine (connecting patients and doctors) and pharmaceutical companies (selling prescription drugs) — two entities that struggle to mix in such a way responsible. In the case of Hims, for example, if a patient decides they want a drug for erectile dysfunction, they can visit the site, fill out a questionnaire, and then chat with a clinician employed by the company to get a prescription for Cialis. , Viagra , Tadalafil or Stendra. Yes, a doctor can always deny a patient medication, but in 2020 people employed by Hims said they felt pressured by the company to maintain their numbers. It seems to be an industry-wide trend: Employees at Cerebral, a fast-growing mental health care startup, recently told Bloomberg that senior management wants 95% of all customers seeking a prescription get one (100%, they were warned, might sound like a “pill mill”).

The result is that the entire treatment cycle is driven by a consumer’s wishes, not a patient’s needs, contrary to the prevailing principle of shared decision-making in which physicians and patients are expected to work together to decide on a treatment. “We shouldn’t equate medical care with a good mattress,” says Henry Curtis, Ph.D. candidate in philosophy at SUNY Albany and author of a paper on Roman and Hims’ ethics. This is exactly what the DTC healthcare companies seem to want. Yet the fact remains: people may not always know what kind of health care they really need. Erectile dysfunction, for example, can be caused by cardiovascular issues, depression, and even musculoskeletal issues like cauda equina syndrome, three things that cannot be treated with erectile dysfunction medication. But this is how the “Very Important Patient” industrial complex perpetuates itself, driving people away from sensible solutions towards new purchases focused on resolving symptoms, which inevitably come with side effects.

I get it: when it’s so hard to find a doctor or therapist in real life, laser and foam for a healthier, happier life has immense appeal. But democratizing VIP services (and their risks) is not the solution, especially at a time when self-diagnosis is rampant. In an ideal world, direct-to-consumer marketing of prescription drugs would be illegal in the United States, as it is almost everywhere else on Earth. Patient autonomy would be respected, but physician due diligence would remain essential. And everyone would really have access to a primary care physician who could coordinate all of the care. If the fragmentation of health care continues, “there’s a risk that the left hand and the right hand won’t talk to each other,” says Caleb Alexander, an epidemiologist at Johns Hopkins University who studies prescription drugs. That’s when things go wrong.

Although CoolSculpting may seem unique in that it can go very wrong, each “solution” has the potential to become a problem in its own right. When done incorrectly, laser hair removal can lead to burns, blisters and scars. The abuse of stimulants can lead to addiction and excruciating withdrawal. And new trends seem to erupt across the vast chasm between personal care and health care every few months. But no matter what appears on my TikTok “For You” page, I don’t think I’m going to schedule any more medspa consultations or fill out any more online prescription questionnaires. Because I’m not a VIP, I’m just an ordinary person. And regular, reliable health care is what we all deserve.


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