Patient advocates and patient mentors

Hair Transplant
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I heard a radio broadcast tonight by a patient advocate. I remember speaking with him in 2005. I remember precisely where I was during this conversation. In 2005, he stated that FUE was not equal to strip surgery (FUT). Apparently, he has not kept up with the literature because we have shown over and over that FUE produces better yields without the negatives of strips. The negatives of strips include the potential for wide scars, changes in hair growth angles, the marriage of fine hair with coarse hair, the inability to trim your hair short, persistent tightness in your scalp, persistent loss of sensation in your donor area along with the number one negative, which is strips kill hair in your donor area. Strips create traction alopecia in the donor area. I presented this data in 2014, but no strip surgeon nor any patient advocate has acknowledged this compelling data. Strips kill hair. FUE does not kill hair. Of course, these same advocates and mentors have always failed to recognize all the other problems that strips cause dating back to 2003.

Thus, the question remains, why don’t these advocates recognize the truth. The fact is that they all promote strip surgeons for a fee. I found this radio broadcast so ridiculous because it was the exact opposite of what I’ve preached since 2003. In the radio show the host states that if the surgeon believes that you are a candidate for a strip, but the surgeon still promotes FUE, you should walk out the door. I’ve reiterated since 2003 that if the patient is a candidate for FUE and your surgeon does not offer or suggest FUE by a doctor skilled in FUE (all the time), you should walk out the door. The host goes on to state that tool makers are only interested in making money, so they promote them. However, he fails to mention that he makes money off of helping his strip surgeons and his FUE surgeons and making money is his objective. What this radio host failed to mention was that tools for FUE did not exist in 2003 so I had to create them and other manufacturers followed. Does this host even bother to give us credit for inventing tools to carry out advancements in medicine? No! This host is interested solely in advancing his message, which is to scare patients into accepting his advice and supporting the doctors, who financially compensate him for this embrace.

Most of the individuals claiming to be advisors or consumer advocates are making money in their promotions. Thus, all of their advice should recognize that money is involved.

I can recall when these patient advisors and patient advocates promoted strips over FUE. Then the tide turned, and they had not recourse other than to accept FUE as if they invented it. Now they still claim strips are still beneficial in some instances. There is never a case in which FUT are useful. Strips cause harm in every case.

I would not take the advice of these individuals. They offer poor judgment for financial reasons. They remind me of Cramer on CNBC. Sometimes Cramer makes good recommendations and sometimes he does not. I’ve never seen him come on TV to apologize for his bad advice, and Cramer does not cover your losses. Cramer appears to still sell advice for a fee. That’s all these patient advocates, and patient mentors do. When advocates and mentors give you bad advice, only the patient has negative consequences. Remember, the best doctors do not need anyone to recommend them. Only bad doctors need an advocate or mentor to obtain surgeries. Sure, these advocates and mentors suggest some good doctors, but they also support some atrocious ones and losers just as Cramer does. No advocate nor mentor recommends all top doctors because the many top doctors don’t need advocates nor mentors to push their practices.

It is time for advocates and mentors to find a new avenue to make money because the internet has leveled the playing field. We don’t need these advocates and mentors any longer. There was a time when these scoundrels served a purpose, so we had to put up with these fear mongers. Now we don’t need them, and they have become a nuisance.

I’d suggest that if your advocate recommends ARTAS in any way, you should run away from his advice. Some of the worst results and greatest damage to the donor area are ARTAS results. Advocates don’t publish these negatives because they have financial incentive to suppress these bad results.

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Aren’t these so called advocates or mentors required to disclose where they get their revenues from?

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Anyone considering ARTAS fue should take note, apparently H&W had tried ARTAS and later on abandoned it in favor of manual FUE because they are not happy with the results produced by ARTAS, So think twice when someone is trying to sell you an ARTAS fue.

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There are many physicians, who have tried ARTAS, and stopped. Many own an Artas for marketing reasons, but don’t use the machine. A Japanese physician published a poster at the 2013 ISHRS meeting in San Francisco showing that 26% of the graft attempts became what we now call “missing grafts.” Imagine that for every 100 wounds in your donor area, 26 wounds result in no graft. In my opinion, Restoration Robotics had an ethical responsibility to warn patients about the potential for a very high number of missing grafts. Instead, Restoration Robotic neither warned the public nor did they inform doctors. The majority of physicians, who used Artas, did not inform the public either. I believe this was morally improper, as well. In a more recent study out of Korea involving 22 patients, as I recall, the missing graft rate was only 5%. However, based on the earlier Japanese study, how do we know this paper did not choose only the 22 best results. Wound size has been a huge issue for the Artas, as well. In one example, you could fit more than five 0.8 mm punch wounds into a single Artas wound. Some of the patients I’ve seen from Artas had very poor growth. All patients had unacceptable scarring in the donor area. In one case, the Artas took almost all the follicular units in isolated areas and depleted the donor area in one pass, while producing a very thin, unacceptable result. If these negative outcomes are not disclosed to patients in advance, there is are serious ethical problems.

I believe that Hasson and Wong use a nurse to harvest their FUE grafts. I was glad to see them begin to offer FUE.

As far as paid consultants, consumer advocates, and mentors, some of these advisors make it clear that promotion is for a fee. It is unclear whether all make this clear. The fee typically is $12,000 a year and higher. There was a time when these individuals served a purpose, but today, I believe these advocates are unnecessary and harmful. Not only do these advocates recommend some doctors, who consistently get poor outcomes, these advocates steer patients away from some of the best doctors and away from the best advice. Some paid advocates still consider strip surgery as the gold standard and recommend this disfiguring procedure to many patients, who are poor candidates for strip surgery. Frankly, I do not believe there are any suitable candidates for strip surgery. Other times, paid consultants recommend a novice physician and begin to market this novice doctors for a fee. The original concept behind paid advocates was to steer patients to the best doctors. Today, this philosophy has changed entirely. Today, the paid advocate wants to have as many doctors as possible paying them an annual fee of $12,000 or more. These paid consultants do not recommend physicians, who do not pay this fee. Some of the very best surgeons in the world do not use these paid advocates. Instead, it is usually the less desirable physician, who believes they require paid advisors to steer patients to their practice.

If we consider ultilitarianism or outcome-based ethics, paid advocates today no longer produce the greatest positive benefits for the greatest number of individuals. More often, paid consultants, advisors, patient advocates, and mentors give advice that produces a negative benefit. It is time for these profiteers to go and it is time for patients to cease listening to these individuals. I don’t know of a good one in the bunch.

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Tried to edit post earlier but accidentally pressed trash icon. I agree, i think ARTAS is being pushed by some consultants. Especially, if the consultant Is known. It is supposed to be precise from the start, but now another upgrade makes it more precise? You cant get precise over precise, that’s deception. Machine was described as having perfect extractions earlier now the upgrade makes it more precise? That means there are people that did not get results under precision. Unfortunately, there are some online venues that do not let you speak of failures. It is best to get feedback from real patients and see them face to face. Especially those that do not have financial or reward or refund relationships with physicians they had work with. I get tons of messages from a lot of guys from all ages, but i work for no one. I offer to help some guys cope with repair and the failure of some physicians as someone that knows how painful the process is. The best repair doc is the one that can successfully repair another docs sub par work.

I know surgeons that dropped ARTAS too where it is “collecting dust”. Lets get something straight, A doctor needs to do the dagone surgical aspects of surgery which includes scoring into skin/flesh. This machine can be used as a loophole for docs to leave it to others to extract (nurses, techs) in multiple patients in a day. I can see the profit aspect for the physician, but i think it is detrimental to patient safety.

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Artas has done their best to improve the results both by collecting data from real life surgeries and through ongoing meetings with physicians, who use the Artas. In these meetings, Artas collects information and does their best to make improvements. Intuitive response is something positive. Unfortunately, Artas built on unacceptable results from the beginning. The major negative, of course, is that Artas released the first machines way before they should have. Thus, you can consider all the first patients were part of an ongoing training experiment. On the job training is no way to enter the medical field especially when we already had great success with FUE in 2011 when Artas began selling their device. Artas did not consult the physicians with the most FUE experience. Instead, Artas consulted with doctors, who did a limited number of FUE cases each month/year. Artas is still not aligned with the most successful FUE surgeons. I’m sure the product is better than it was originally, but how much better is the question. Artas has not released any data that I am aware. They just keep on selling machines. Their business model seems to have changed from experienced hair transplant doctors to plastic surgeons with no hair transplant experience. Perhaps if the physician doesn’t know what good is, the physician will use the machine more often. The whole process has been a travesty. I feel sorry for the first Artas patients, who trusted technology over reason. Is the machine ready for today’s patients? I don’t know. The company is not releasing data as far as i am aware. All I know for sure is that I’ve not seen a good nor great Artas result yet.

You are correct about online pay to play communities. I supported one right up until they banned negative comments regarding the Artas. That’s when I couldn’t stomach paying the fee any longer. I have no idea for sure, but I would suspect that this community is being paid hush money to suppress negative commentary on the Artas.

Patients benefit from a resource, and the repair patients definitely need someone to talk with. Unfortunately, once you start taking money, your information starts to become biased toward the paying players. I would support a guy, who makes unbiased recommendations. Talking to patients, especially patients with previous bad work, is gut wrenching. I feel so sad for these individuals. Also, these communications are time-consuming. These people need someone to listen to their pain. It’s a critical role. I’d love to see a way to change the system. However, once you start making money, the vision gets lost, and you begin to take on hundreds of recommended doctors globally. Even one hundred customers at $12,000 per year are $1.2 million, and all you have to do is run a website and recommend a limited number of doctors in specific geographical locations. Then these consultants steer patients away from the excellent doctors and toward mediocre doctors and along with, novices. We talk about unethical practices and physicians, yet today some of the most unscrupulous individuals are the ones promoting doctors with limited skills for a fee. These people are making millions of dollars a year doing little more than pointing patients in the wrong direction day after day.

Regarding repair, this is an artform and an exceptional talent. There just are not many excellent repair surgeons in the world. Even the best sometimes fail. The average doctor will fail more times than not. Once we get into the realm of repair, there simply is not margin for error. The problem is that sometimes we can’t get crops to grow in a bad soil. This is when the excellent repair surgeon fails.

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Dr Cole, you make some good points. It is great you are researching things that may help folks in need of repair. Or those who need to repair a repair etc. I really hope you get some more positive outcomes with your prp. I will see how things go in a few months and if a good job was done on me by my doc. It is a waiting game but it is getting stressful.

If a doctor helps the right patient, more doors may open. I hope most docs do the best and finish the job the right way and don’t leave patients hanging.

I am hoping to be able to move forward peacefully soon. Struggling with loss of time and family due to this. It is not fair. So, I hope you succeed with sonicated prp big time as it may help tons of patients.

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I hope with my heart that you move forward too. Not all PRP is equal. I think some produce results faster based on my experience. Acell does seem to improve results in PRP that is not subjected to sonication. I think the Acell further activates platelets and increases growth factors. Good luck. I hope all goes well for you. Don’t throw in the towel if things do not go well. There are some PRP protocols that produce nothing. Others are just slower to produce. Some are faster.

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@Dr_Cole @forhair did you ever come onto this forum to apologize to your patients for unsatisfactory work and cover their losses?