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Andrew Burd on 21st century catches

15 Jun, 11 | by BMJ

Andrew BurdA few weeks ago I received a parcel in the post. I unwrapped it with care and found it was a book. A very interesting book actually, entitled Oculoplasty – Innovative Simpler Techniques. This book can be found on Amazon. It was written by an internet friend, Hemant Mehta. I have never actually met Hemant in the flesh, so to speak, but we first met, online, when he submitted a paper to a journal I was editing. It was immediately obvious to me as an editor that the submitted paper was not really quite appropriate, but a revised form, more a personal review, would be highly educational and most informative. And so it was. So I opened the book and was highly touched and flattered to see a hand written “dedication” in the front page, basically acknowledging my impetus for the book and appreciating my “visionary editing of JPRAS.” Now, those who know me, will confirm that I am a very modest man, but I was quietly pleased, nay delighted, with these comments. Thus I reviewed the book in a very positive way. By “review” I mean I read it!

It is indeed a wonderful book and has, for me, a beautiful blend of humility, philosophy, surgical honesty and exquisite surgical technique. As a reconstructive plastic surgeon I was ‘blown away’, what a jargoned expression, but true nevertheless, by Hemant’s description of regeneration of the lower eyelid after the creation of excisional defects. The whole basis of the book was simplicity, safety and surgery based on serendipity, common sense and observation. This is the man who introduced the quilting suture to maintain the approximation of a graft to its bed pending the ingrowth of new blood vessels. So simple but so radical in concept when the “giants” of plastic surgery were advocating the “tie-over” dressing. Hemant’s book covers the spectrum of repair and reconstruction of both upper and lower eyelids together with more esoteric subjects as orbital fractures tumours, and exenterations. Clinically magnificent, but I have yet to see another single author book with a chapter dedicated to innovation. Hemant Mehta is a remarkable author who has produced a remarkable book, and I felt compelled to write a review of the book on the Amazon website. I duly logged in and found the appropriate page but then … unless I have bought a book from Amazon I cannot write a review. Is this real? Is this fair?

But then I philosophically realized that this is the 21st century way. I am calling it the 21st century catch. This evening I visited Toys-R-Us to buy a Nintendo DS for my son. He has done very well at school and also socially, and it was a reward. It was quite expensive, and somehow the purchase triggered some release of chemicals in my brain, such that I found myself being drawn into one of the local computer stores to see how much the iPad2 costs. I was acting as a victim of retail therapy and, leaving all caution aside, I entered and boldly approached the first salesperson I saw and enquired about the iPad2 status. I was directed to a sign behind the sales counter. There is the Wifi-only iPad2 and the 3G iPad2, with different configuration of memory.

Each configuration had black or white models. Plastered adjacent to each configuration was a sign “Sold Out.” Apart from the black 64GB Wifi only model. In a moment of impulse I said, “okay, I will buy it.” But there was a problem, and the salesperson had a limitation in English, or possibly embarrassment, and asked a senior person to come over to explain; explain what? If I bought the iPad2 64GB Wifi only black model I also had to buy an accessory. There was a choice, a case or a screen protector. I was totally thrown. I cannot review a book for Amazon unless I have bought a book; I cannot buy an iPad2 unless I buy an accessory. What is this? I feel it is some sort of retail blackmail and it just does not seem right. But perhaps it is the way of the 21st century. Mrs Jones, I cannot remove this prominent mole from your chin unless I give Botox treatment for those glabellar wrinkles. Does that sound ethical? Or is that the way to go?

Andrew Burd is professor of plastic, reconstructive and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.

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