Thermage coming to Medical Spa MD?

thermage-sigmacon.jpgIt looks as though Thermage may be adding some content to Medical Spa MD for members who may be interested.

I've had a number of phone calls with Thermage it looks as though they're going to get together some materials that will only be available to Medical Spa MD members. (If you're not already a member you can join Medical Spa MD in 30 seconds.) 

I've been waiting to distribute these reports until I have a medium that can handle the content which should be available shortly.

You can read more about Thermage through these links:

3.
Today I had lunch with Clint Carnell, Vice President of Domestic Sales for Thermage. I  met Clint over at a local pub in Park City and we sat down to chat about Thermage and Surface. (Clint didn't know about this blog.) Clint is a fairly recent addition to Thermage's management team as the Vi...
4.
Thermage's response to physicians purchasing reactivated tips from abroad.   Clint Carnell, VP of Thermage, asked me to post Thermages position on reactivating tips. I have posted it in it's entirety and have added an addendum to the previous post on the supposed study in question. You'll not...
5.
It's surprising to me how polarizing Thermage as a treatment seems to be. There are 5 threads on Thermage going on in the Physician to Physician discussion area. While the 'pro' Thermage docs seem to be relatively calm, the 'con' side is much more strident in their views. ( It appears that the docs ...
6.
As business models: Thermage is commission, Titan & Fraxel are hourly. (Thermage + Fraxel discussion threads) I had lunch with Clint Carnell, Vice President of Domestic Sales for Thermage today. While we were talking about the current state of the medical spa market he referred to the Thermage ...

 

Houston, we had a problem...

Well... Medical Spa MD is back online.

I recieved a number of emails asking if Dermacare or American Laser Clinics had managed to shut down the site.

Nope. 

It was a simple oversight on my part. The domain had expired and I had to get it renewed which took  a day or so. (Workday of course since you can never get anyone over the weekend.) So all of your links should be working again. I'm sorry for those of you who got the blank screen.

Dermacare Medspas Lawsuit: Franchise Reaction

authority.jpgSince Dermacare (it's  CEO Carl Mudd) has decided to sue the Dermacare Franchisees who have commented or communicated on Medical Spa MD, there have been a number of comments asking about what the status is.

There have been a number of comments describing this lawsuit and the demand to find out who everyone is as an act of complete desperation. I myself can not see it as being in any way positive for Dermacare. I'm assuming that most if not all of the individuals that Carl Mudd is looking to identify are working for Dermacare or a Dermacare Franchise. I can't see that Dermacare suing all of it's franchises is something that it could possibly recover from since, if the commenters are correct, Dermacare hasn't sold a new franchise in more than a year. (Dermacare's UFOC will have to reflect any clinic closings and it's financials.) If there are any happy franchiesses they're more than welcome to comment as well.

It seems likely that this is the beginning of the end for Dermacare.

Take a very best case for Carl Mudd: He sues the Dermacare franchises and wins some sort of settlement or they settle. How will he possibly sell another franchise ever. He can't. Who would want to take the same chance.

Of course I'm just thinking out loud. It seems that Mr. Mudd is caught on the horns of a dilemma. Dermacare can suffer the death of 10,000 cuts, with franchisees speaking out and warning away potential new sales, or... Mr. Mudd's best be personally (since he eveidently owns 100% of Dermacare) is to sue the current franchisees and see what he can get before walking away.

If Mr. Mudd has chosen to sue everyone, there's really nothing you can do about that except defend yourself. I'm guessing that if franchisees are actually served, there will be a counter-suite tuite suite. Mr. Mudd may find out that simmering anger turns the horns of the bull from a quandry into a real battle. It would seem that there are plenty of former Dermacare corporate employees who have no love lost for Carl Mudd.

Carl Mudd and Dermacare may have bitten off more than it can chew.

Dermacare sues everyone on Medical Spa MD?

It appears that Dermacare has thrown in the towell regarding it reputation.

I received this email from Dermacare and it's CEO Carl Mudd regarding a suit that Dermacare has filed. Since this is the first contact I've ever had with Dermacare, I'm a little surprised. It makes me wonder what's been going on on that Dermacare thread that has 700 comments. 

Rather than engage in a back and forth or aim for clarity, which is what I would have recommended, or complaining to me that some of the remarks have crossed a line, (I have actually taken down many comments if they contain profanity directed at any specific individual.), Dermacare and it's CEO Carl Mudd have actually gone and filed suit. (I also received a PDF of the suit naming multiple John and Jane Does.)

Here's the email: 

VIA E-MAIL AND U.S. MAIL

Jeff Barson
(I've removed my address here)

                Re:         DLC Dermacare, LLC v. John and Jane Does – CV2008-090071

Dear Mr. Barson:

My office represents DLC Dermacare, LLC (“Dermacare”) and its CEO Carl Mudd.  I am writing in regards to the blog that you host located at www.medicalspamd.com .  As you know, you have allowed numerous persons to post information related Dermacare and about Mr. Mudd personally on your site.  The information posted is overwhelming incorrect and has served as a discussion board for Dermacare franchisees to not only discourage potential franchisees from partnering with Dermacare but to also promote the breaching of current franchisee agreements held by many of the bloggers on your site.

The comments that you have allowed to be posted on your site have evolved from mere discussions/complaints into actionable claims against the bloggers and possibly even you personally.  Pursuant to our filing the above referenced complaint we are now seeking the Internet Protocol (IP) address and the Internet Service Provider (ISP) for each of the following bloggers on your site:

  • Dermadoc
  • Mr. Bob
  • Just Another Ex
  • Passive Conduit
  • Pm
  • Jennifer D
  • Pengy
  • Mr. Freeze
  • Bastard Son of Dermadoc
  • GH
  • Maxwell Smart
  • The Clinician
  • The Real M. Smart
  • John Galt
  • George
  • Max
  • XYZAL
  • Christmas
  • Maxwell’s Silver Hammer
  • The Passive Conduit
  • The Riddler & The Joker
  • DoubleDermadare You
  • Mad Max
  • Manic Max
  • Mad as Hell in Dermacare Hell
  • A current Franchisee
  • FreeTheDerm@ yahoo.com
  • WPS
  • Insider
  • Thomas Jefferson, Jr
  • TF
  • T. Jefferson, Jr.
  • The Joker
  • Curious
  • Mr. X

Please provide the IP address and ISP for each of the above names no later than Friday, January 18th, 2008.  Should you not provide the requested IP addresses and ISP by this date I will be forced to have you served with a subpoena to obtain this information.  I have included a copy of the lawsuit that was filed in this matter for your files.  If you have comments or questions please direct them to my office.

                  Sincerely,

John N. Skiba

One North Macdonald Road, Suite 201
Mesa, Arizona 85201
Tel. 480.361.5643
Fax 480.704.3071
www.skibalaw.com

 

You can download the actual PDF of the Suit here.

I wasn't asked to keep any of this confidential so here it is. 

 

So what's Dermacare and Carl Mudd doing?

This is what is know as a CyberSLAPP suite. Basically it's a way of intimidating critics by threatening to find out their identity and hit them with some kind of suit. (read below)

You'll notice that Dermacare and Carl Mudd are demanding that I turn over everyones ISP. For those of you who are not that technically savvy, ISP = Internet Service Provider, which I have absolutely no way of knowing anyway as far as I can tell. The IP address is different. That's a unique identifier and could be used to find out who someone is.

These kinds of suits have become increasingly common as a way of combating free speech on the internet. It used to be that if someone said something unkind, it didn't matter that much since only a few people would hear about it. The net changed all of that and now someone who's unhappy with you or your business can be found by everyone so those whe illicit a lot of negative comments tend to have a rougher go of it.

My guess is that this is intended to intimidate those who may comment in a negative way about Dermacare or Mr. Mudd, and to find out who everyone is. While anonymous speech is protected by the constitution, its still unnerving to have someone you've been talking about know exactly who you are, especially if you're in some kind of business relationship. By filing a real suit against 'everyone' in the form of John and Jane Does, it allows him to issue a legal subpoena to get information. (It's basically a cynical way of using the courts which is why some states like California have laws specifically against this.)

Here are some links about these kinds of CyberSlapp suits and where the law comes down on free speech and other issues around this:

Chilling Effects Clearinghouse: A joint project of the Electronic Frontier Foundation and Harvard, Stanford, Berkeley, University of San Francisco, University of Maine, George Washington School of Law, and Santa Clara University School of Law clinics.

Do you know your online rights? Have you received a letter asking you to remove information from a Web site or to stop engaging in an activity? Are you concerned about liability for information that someone else posted to your online forum? If so, this site is for you.

Defamation
The law of defamation balances two important, and sometimes competing, rights: the right to engage in free speech and the right to be free from untrue attacks on reputation. In practice, the filing or even the threat to file a lawsuit for defamation has sometimes been used as a tool to shut down legitimate comments on the Internet.

John Doe Anonymity
Do you post to a public message boards or discussion areas on websites such as Yahoo, AOL or Raging Bull? Do you use a pseudonym, fake name or a "handle"? Has someone asked the host of the discussion or your ISP to turn over information about you or your identity? If so, then the John Doe/Anonymity section may answer some of your questions.
Topic maintained by Stanford Center for Internet & Society

Protest, Parody and Criticism Sites
The Internet, which offers inexpensive access to a worldwide audience, provides an unparalleled opportunity for individuals to criticize, protest and parody.

The following is long but you'll come away with a much better understanding of what this all means: 

About Defamation:

Question: What are the elements of a defamation claim?

Answer: The party making a defamation claim (plaintiff) must ordinarily prove four elements:

  1. a publication to one other than the person defamed;
  2. a false statement of fact;
  3. that is understood as
  4. a. being of and concerning the plaintiff; and
    b. tending to harm the reputation of plaintiff.
  5. If the plaintiff is a public figure, he or she must also prove actual malice.

Question: What defenses may be available to someone who is sued for defamation?

Answer: There are ordinarily 6 possible defenses available to a defendant who is sued for libel (published defamatory communication.)
1. Truth. This is a complete defense, but may be difficult to prove.
2. Fair comment on a matter of public interest. This defense applies to "opinion" only, as compared to a statement of fact. The defendant usually needs to prove that the opinion is honestly held and the comments were not motivated by actual "malice." ( Malice means knowledge of falsity or reckless disregard for the truth of falsity of the defamatory statement.)
3. Privilege. The privilege may be absolute or qualified. Privilege generally exists where the speaker or writer has a duty to communicate to a specific person or persons on a given occasion. In some cases the privilege is qualified and may be lost if the publication is unnecessarily wide or made with malice.
4. Consent. This is rarely available, as plaintiffs will not ordinarily agree to the publication of statements that they find offensive.
5. Innocent dissemination. In some cases a party who has no knowledge of the content of a defamatory statement may use this defense. For example, a mailman who delivers a sealed envelope containing a defamatory statement, is not legally liable for any damages that come about from the statement.
6. Plaintiff's poor reputation. Defendant can mitigate (lessen) damages for a defamatory statement by proving that the plaintiff did not have a good reputation to begin with. Defendant ordinarily can prove plaintiff's poor reputation by calling witnesses with knowledge of the plaintiff's prior reputation relating to the defamatory content.


Question: Can an opinion be defamatory?

Answer: No — but merely labeling a statement as your "opinion" does not make it so. Courts look at whether a reasonable reader or listener could understand the statement as asserting a statement of verifiable fact. (A verifiable fact is one capable of being proven true or false.) This is determined in light of the context of the statement. A few courts have said that statements made in the context of an Internet bulletin board or chat room are highly likely to be opinions or hyperbole, but they do look at the remark in context to see if it's likely to be seen as a true, even if controversial, opinion ("I really hate George Lucas' new movie") rather than an assertion of fact dressed up as an opinion ("It's my opinion that Trinity is the hacker who broke into the IRS database").


Question: Is there a difference between reporting on public and private figures?

Answer: Yes. A private figure claiming defamation — your neighbor, your roommate, the guy who walks his dog by your favorite coffee shop — only has to prove you acted negligently, which is to say that a "reasonable person" would not have published the defamatory statement.

A public figure must show "actual malice" — that you published with either knowledge of falsity or in reckless disregard for the truth. This is a difficult standard for a plaintiff to meet.


Question: Who is a public figure?

Answer: A public figure is someone who has actively sought, in a given matter of public interest, to influence the resolution of the matter. In addition to the obvious public figures — a government employee, a senator, a presidential candidate — someone may be a limited-purpose public figure. A limited-purpose public figure is one who (a) voluntarily participates in a discussion about a public controversy, and (b) has access to the media to get his or her own view across. One can also be an involuntary limited-purpose public figure — for example, an air traffic controller on duty at time of fatal crash was held to be an involuntary, limited-purpose public figure, due to his role in a major public occurrence.

Examples of public figures:

  • A former city attorney and an attorney for a corporation organized to recall members of city counsel
  • A psychologist who conducted "nude marathon" group therapy
  • A land developer seeking public approval for housing near a toxic chemical plant
  • Members of an activist group who spoke with reporters at public events

Corporations are not always public figures. They are judged by the same standards as individuals.

Question: May someone other than the person who originally made the defamatory statement be legally liable in defamation?

Answer: One who "publishes" a defamatory statement may be liable. However, 47 U.S.C. sec. 230 says that online service providers are not publishers of content posted by their users. Section 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law.

Question: Can an ISP or the host of the message board or chat room be held liable for
defamatory of libelous statements made by others on the message board?

Answer: Not in the United States. Under 47 U.S.C. sec. 230(c)(1) (CDA Sec. 230): "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This provision has been uniformly interpreted by the Courts to provide complete protection against defamation or libel claims made against an ISP, message board or chat room where the statements are made by third parties. Note that this immunity does not extend to claims made under intellectual property laws.

Question: Must an ISP or message board host delete postings that someone tells him/her are defamatory? Can the ISP or message board delete postings in response to a request from a third party?

Answer: 47 U.S.C. sec. 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law.

 

About John Doe Anonymity

 

Question: How is Internet anonymity affected by John Doe lawsuits?

Answer: Often called "CyberSLAPP" suits, these lawsuits typically involve a person who has posted anonymous criticisms of a corporation or public figure on the Internet. The target of the criticism then files a lawsuit so they can issue a subpoena to the Web site or Internet Service Provider (ISP) involved and thereby discover the identity of their anonymous critic. The concern is that this discovery of their identity will intimidate or silence online speakers even though they were engaging in protected expression under the First Amendment.

Question: Why is anonymous speech important?

Answer: There are a wide variety of reasons why people choose to speak anonymously. Many use anonymity to make criticisms that are difficult to state openly - to their boss, for example, or the principal of their children's school. The Internet has become a place where persons who might otherwise be stigmatized or embarrassed can gather and share information and support - victims of violence, cancer patients, AIDS sufferers, child abuse and spousal abuse survivors, for example. They use newsgroups, Web sites, chat rooms, message boards, and other services to share sensitive and personal information anonymously without fear of embarrassment or harm. Some police departments run phone services that allow anonymous reporting of crimes; it is only a matter of time before such services are available on the Internet. Anonymity also allows "whistleblowers" reporting on government or company abuses to bring important safety issues to light without fear of stigma or retaliation. And human rights workers and citizens of repressive regimes around the world who want to share information or just tell their stories frequently depend on staying anonymous – sometimes for their very lives.

Question: Is anonymous speech a right?

Answer: Yes. Anonymous speech is presumptively protected by the First Amendment to the Constitution. Anonymous pamphleteering played an important role for the Founding Fathers, including James Madison, Alexander Hamilton, and John Jay, whose Federalist Papers were first published anonymously.

And the Supreme Court has consistently backed up that tradition. The key U.S. Supreme Court case is McIntyre v. Ohio Elections Commission. http://www.eff.org/Legal/Cases/mcintyre_v_ohio.decision

Question: How do CyberSLAPP plaintiffs discover the identity of anonymous Internet critics?

Answer: CyberSLAPP plaintiffs usually get the personal information you gave an ISP or online message board when you signed up (name, address, telephone number, etc.). Some web sites that host discussion boards might only have your e-mail address, in which case a second subpoeana to the ISP that hosts that address will reveal your identity. In many cases, even more detailed information about your use of the Internet can be obtained; it's important to realize that when you go online, you leave electronic footprints almost everywhere you go. (With advanced knowledge of the Internet, however, there are ways to cover your tracks.)

Question: Don't judges review subpoenas before they are sent to ISPs?

Answer: No. The issuing of civil subpoenas is not monitored by the court handling the case. Under the normal rules of discovery in civil lawsuits, parties to a suit can simply send a subpoena to anyone they believe has information that could be useful. That information doesn't even have to be relevant to the lawsuit, as long as it could possibly lead to the discovery of relevant information. The only way that a court will evaluate an identity-seeking subpena is if either the ISP or the target of the subpoena files a motion asking the judge to block the subpoena. Unfortunately, in practice that rarely happens. That is because these subpoenas usually have a short, roughly 7-day deadline, and because many people never even find out that their Internet data has been subpoenaed.

Question: Isn't my ISP required by law to tell me if someone asks for my Internet-usage records and identity?

Answer: Unfortunately, in practice CyberSLAPP subpenas are rarely challenged becaue ISPs often fail to notify the individual who's personal information is sought. Even when they do, the short deadline (often as little as 7 days) does not provide enough time for the speaker to find and hire an attorney and the attorney to prepare the Constitutional arguments necessary to defend against the subpena.

Question: What is a "motion to quash" a subpoena?

Answer: This is a formal request for a court to rule that your information should not be given to the requesting party. This normally includes the request, plus a legal brief (sometimes called a memorandum of points and authorities) explaining why, by law, your information should not be turned over. Samples of briefs filed in John Doe cases are available at:

EFF Archive, Cullens v. Doe, http://www.eff.org/Privacy/Anonymity/Cullens_v_Doe/
http://www.citizen.org/litigation/briefs/IntFreeSpch/articles.cfm?ID=5801

Question: What should I do if I receive notice that my ISP has received a subpoena for my data?

Answer: First you should decide whether you wish to fight to protect your identity, Internet usage records, or whatever else is being sought. You might want to ask your ISP for a copy of the subpoena if they haven't already provided one. If you decide to fight it, you should inform the ISP immediately, and you may want to request that they delay compliance to give you time to find a lawyer. Then find a lawyer, who will file a motion to have the subpoena thrown out. (If your lawyer can later prove that the lawsuit was frivolous, you may be able to recover legal fees if your state has passed an anti-SLAPP statute.)

Question: What are the typical claims behind a CyberSLAPP suit?

Answer: The most common complaints by CyberSLAPP plaintiffs are defamation, trademark or copyright infringement, and breach of contract. Speech that involves a public figure - such as a corporation - is only defamatory if it is false and said with "actual malice." It also must be factual rather than an expression of opinion. In the US, because of our strong free speech protections, it is almost impossible to prove defamation against a public figure. Trademark and copyright complaints typically claim that defendants have violated intellectual property rights by using the name of a corporation or its products, or by quoting from some of their copyrighted materials such as an annual report. In reality, the First Amendment includes a clear right to criticize and discuss corporations and their products, and the law includes clear exceptions for the "fair use" of protected material for those purposes. Breach of contract suits often involve a claim that anonymous speakers might be employees who have violated a contract by releasing confidential information. Of course, the right to anonymous speech is meaningless if a corporation can unmask your identity at will because you might be an employee breaking a promise of confidentiality.


Question: How do judges decide whether to let a subpoena go forward?

Answer: This is a very new area of the law, and there are few well-established principles. The courts do have a duty to balance the right of anonymity against the need to prevent true defamation. So far there have been both good and bad rulings from judges; fortunately several have ruled that the plaintiff must prove that his case has at least a theoretical chance of prevailing before anonymity can be stripped away. Other cases have established a set of key factors to be used in judging anonymity-stripping subpoenas. In most of these the key factors are 1) that the party seeking the subpoena provide evidence that the identity is needed; 2) that the identity is directly needed for a key element in the case; 3) and that the identity information is not otherwise available to the party seeking it. While not yet firmly entranched in the law, these common-sense principles are clearly the right way to ensure that First Amendment rights are protected while still allowing identity to be revealed when there is a genuine need to do so.

Question: What are some of the important cases in this area of law?

Answer: Important CyberSLAPP cases include Dendrite v. Does, http://www.citizen.org/documents/dendriteappeal.pdf,
Melvin v. Doe, http://legal.web.aol.com/decisions/dlpriv/melvinop.html,
Doe v 2TheMart.com, http://www.eff.org/Cases/2TheMart_case/20010427_2themart_order.html,
Global Telemedia International v. Doe, http://www.casp.net/busted.html. Additional information about these and other cases can be found by searching the Internet or looking on the Web sites listed below.

Question: Can I do anything to help change this situation?

Answer: You can do several things. Be educated about your rights. Find out your ISP's policy on the handling of subpoenas, and encourage them - and any Web sites you frequent - to adopt good policies, especially a pledge to notify you of any subpoena before any private information is disclosed. Encourage your state legislators to pass legislation requiring such notice, and press them to amend state anti-SLAPP statutes to explicitly include Internet anonymity cases.

Question: What other resources are available?

Answer: Web sites dealing with this issue include:

www.aclu.org,
www.citizen.org,
www.eff.org,
www.epic.org,
www.johndoes.org,
www.casp.net,
www.cybersecuritieslaw.com,
cyber.findlaw.com/expression/censorship.html


Question: Can someone ask for my identity even if I am not the Defendant in the case?

Answer: Yes. The rules of civil discovery allow a party to a lawsuit (the plaintiff or defendant) to ask anyone for any information that may lead to the discovery of relevant evidence to their case. However, your ability to quash such a request if you are not named as a party to the lawsuit is the same as if you are named. You can still file a motion to quash. Below is a link to the case files for such a case:

http://www.eff.org/Cases/2TheMart_case/

Question: I am in California. Do I have a right to both resist such a subpena and to ask a court to throw out the case, right away, and award me attorneys fees?

Answer: Yes. California has a specific statute, called the anti-SLAPP statute, that allows an early motion to be brought to have a case dismissed if it is aimed at silencing protected expression and participation in matters of public concern.

Code of Civil Procedure § 425.16(b)(1) provides:

A cause of action against a person arising from any act of that person in furtherance of the person’s right of petition or free speech under the United States or California Constitution in connection with a public issue shall be subject to a special motion to strike, unless the court determines that the plaintiff has established that there is a probability that the plaintiff will prevail on the claim.

A legal brief explaining the California statute further in a case involving claims of online defamation is available at:

http://www.eff.org/Legal/Cases/Kesler_v_Doe/

Question: What are the key federal decisions involving anonymous speech?

Answer: 1. Buckley v. American Constitutional Law Foundation (1999) 525 U.S. 182, 197-200;

2. McIntyre v. Ohio Elections Commission (1995) 514 U.S. 334. In that case, on page 357, the Supreme Court said:

"[A]n author is generally free to decide whether or not to disclose his or her true identity. The decision in favor of anonymity may be motivated by fear of economic or official retaliation, by concern about social ostracism, or merely by a desire to preserve as much of one’s privacy as possible. Whatever the motivation may be, . . . the interest in having anonymous works enter the marketplace of ideas unquestionably outweighs any public interest in requiring disclosure as a condition of entry. Accordingly, an author’s decision to remain anonymous, like other decisions concerning omissions or additions to the content Amendment.
* * *
Under our Constitution, anonymous pamphleteering is not a pernicious, fraudulent practice, but an honorable tradition of advocacy and dissent.

3. Talley v. California (1960) 362 U.S. 60. (holding unconstitutional a state ordinance prohibiting the distribution of anonymous handbills)

4. Lamont v. Postmaster General (1965) 381 U.S. 301, 307 (finding unconstitutional a requirement that recipients of Communist literature notify the post office that they wish to receive it, thereby losing their anonymity);

5. ACLU of Georgia v. Miller (N.D. Ga. 1997) 977 F. Supp. 1228 (striking down a Georgia statute that would have made it a crime for Internet users to “falsely identify” themselves online).

Question: Aren’t people required to explain why they’re subpoenaing my identity and other information?

Answer: Not with the initial request. The reasons for the subpena are only provided if the subpena is challenged, through a motion to quash. In opposing the motion to quash, the person seeking the information must demonstrate, at a minimum, that it is likely to lead to the discovery of information that would be useful in a lawsuit.

Question: I signed a confidentiality/privacy agreement with my ISP that provides that they will not release my information. Doesn’t that protect me?

Answer: No. Most privacy agreements state that information will be turned over in response to legal requests, and a subpena is such a request. Even if the agreement does not say so, a legally issued subpoena overrides such agreements as a matter of public policy. Each ISP has a different policy about notifying users when their information has been subpoenaed, but they cannot simply ignore a subpoena under the law without risking legal santion themselves.

Question: What does "respond" to the subpena mean?

Answer: Usually, it means that the ISP will give the requested information to the requesting person. In some cases, ISPs have resisted requests for information on behalf of their customers, but this is not the norm. Unless specifically told differently by your ISP, you should assume that your ISP will turn over your information as part of its response.

Question: Can an ISP or the host of the message board or chat room be held liable for defamatory of libelous statements made by others on the message board?

Answer: No. Under 47 U.S.C. sec. 230(c)(1): "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This provision has been uniformly interpreted by the Courts to provide complete protection
against defamation or libel claims made against an ISP, message board or chat room where the statements are made by third parties. Note that this immunity does not extend to claims made under intellectual property laws.

Question: Can my ISP or the host of a message board be held liable for defamatory statements I make on the grounds that they are a "publisher" or "republisher" of the information?

Answer: No. Federal law provides: "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This has been interpreted to protect hosts of discussions between other people against defamation and libel claims as a "republisher" of the information. Note that this protection does not extend to claims under intellectual property laws.

Question: Must an ISP or message board host delete postings that someone tells him/her are defamatory? Can the ISP or message board delete postings in response to a request from a third party?

Answer: 47 U.S.C. sec. 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law.

Question: My ISP tells me it's been asked to turn over my name as part of a lawsuit against hundreds of "John Does" in a faraway state. What can I do?

Answer: You should probably contact a lawyer, and suggest that the lawyer take a look at arguments raised by the EFF, ACLU, and Public Citizen in one of these suits (e.g., http://www.eff.org/IP/P2P/RIAA_v_ThePeople/JohnDoe/20040202_UMG_Amicus_Memo.pdf)

Top ways to get yourself banned from Medical Spa MD

Jeez. Is it just me or did the hidden agenda crowd just arrive in force?

It seems that Medspa MD here has just shown up on some radar screens once we hit 50,000 unique visitors a month. So, in the interest of clarity for those who are new and havent read the fine print about how to behave, here are the top three ways to get yourself banned from this site.

  1. Spamming: There are a couple of reasons that people spam and ways it's manifested. Whenever a site becomes popular, more people visit, more sites linke to it, and the search engines rank it higher in their listings. Since this site's most popular with doctors and there are a lot of them here, people who are looking to get in front of docs or have a link from this site to theirs find Medspa MD a great place too. if you see comments that are totally nondescript, offer no info, but still have a link in the signature, that's generally what's happening. Of course there's the hidden agenda spam too. Most if not all of the major laser and IPL companies have a rep or two who read this site. There are also a lot of medspa franchisees and franchisors. While everyones welcome to comment and post, I take a jaundiced eye at entirely blatant self promotion like 'Check out this opportunity!' comments.

  2. Flaming: There are plenty of places to engage in personal attacks on the web. This is not one of them. If you end up resorting to vulgarities and name-calling you'll get yourself ousted faster than.... well... really fast. Feel free to argue or criticize, just don't go overboard. 

There are some comments that are very critical of certain medical spa businesses, physicians, franchises, or those running them. These are peoples opinions. Those criticized are always welcome to respond as long as they follow the above two rules as well.

This is America after all and everyone is welcome to have an opinion. If you disagree with mine, start your own blog and you can run it any way you want.

Medspa MD: Housekeeping

It's been a while since the look and feel of the sites been updated and there were a number things that weren't working or displaying correctly. So, I took two hours and made a few changes that should make the site a little cleaner and easier to navigate. I'll thank Medspa Guy for the last few posts. I know there are more coming from him but you should all take a few minutes and read the beginning of his series on Medspa Success.

I've tried to keep up with removing the spam and keeping all of the conversations civil. I'll thank all of the regulars for their efforts in this regard as well. Dermadoc, Dermacareless, LH, Medspa Guy and all of the others. I'll have to build a regulars list at some point.

For those of you who've accepted my invitation to write for Medical Spa MD and haven't yet put fingers to keyboard.... 

The Third Key to Med Spa Success

locationAs the medicalspamd.com blog continues to tell us the ongoing saga of med spa woes and the struggling and/or controversial med spa franchises and colossi (or colossuses) such as American Laser Clinics, DermaCare, et al, I would like to try to continue an examination of the various fundamentals necessary for establishing and maintaining a financially viable med spa business model. As I read about the various blogs detailing the colorful exploits of the enigmatic medical spa founders including Mr. Mudd, Mr. Jones, Mr. Engelmann, Mr. Buckingham, et al-- I also cannot help but wonder if it is not really the same person flying from city to city stirring up all this anger and frustration?

Key to Success No. 3: Location, Location, Location.

The three most famous words in real estate are also very important for the location of your med spa. Selecting a poor location can make everything else you do a chore. If your location is hard to find, or is in an area with unsuitable demographics, you will find it very hard to build the patient base you need for success. Some of us have turned down higher priced retail facilities with excellent walk-in or drive by traffic potential in favor of hard to find industrial or "medical" spaces for budgetary or other reasons. Don't forget that if you try to save money by setting up a "destination location" you will have to spend significantly more on marketing and advertising to generate adequate traffic. Choosing a highly visible and desirable location with convenient parking is one of the most efficient ways to insure an adequate flow of patients right from the day you open your doors. In most cases paying higher rent for good foot traffic and the right demographics saves money in the long run. Keep in mind the fact that many med spas spend between $10,000 and $20,000 per month on advertising-- even more in some cases-- when you are haggling over rent for various locations. Don’t be “penny wise and pound foolish”. The exorbitant rent necessary to secure a first class location may prove to be insignificant when compared with the cost of driving patients to a “destination location”.

Since medical spas offer purely discretionary services that are in most cases moderately expensive, in most cases you will want to establish your clinic in the most upscale neighborhood you can afford. As a general rule, most patients like to visit a clinic that is within five miles of their homes. Before you decide on a particular location, you need to evaluate the demographics. This is a make or break research project that many med spa owners have omitted and paid the price down the road with business failure. By conducting primary research such as focus groups and surveys you can learn a great deal about the community. You can identify the socio-economic make up of your proposed location by obtaining information from the U.S. Census Bureau (www.census.gov) as well as contacting city offices, local real estate firms and the local chamber of commerce for demographic information. You can also obtain this information from professional consultants as well as through Internet research.

It is also usually a good idea to try to find a location where you will not be right next door to a number of competitors. If you find an area where no other med spa is located within a five mile radius you have the opportunity to be the only game in town for your nearby residents.

Dermadoc's Ode to Dermacare

While not exactly in the holiday spirit, Dermadoc's ditty about Dermacare is certainly funny.

iStock_snowflake1.jpg"T'was the night before Christmas and all through the franchise,
Not a creature was profitable because of the damn lies.
The booby traps were hung by the chimney with care,
in hopes Saint Carl soon would be there.

The children were nestled all snug in their beds,
While visions of foreclosure danced in their heads.
My bank in a tizzy,
And Carl full of crap,
Had just settled in for a lawsuit. Oh Snap!

When out on the lawn there arose such a clatter,
I dropped my wife's Botox to see what was the matter.
Away to the windows I flew like a flash,
Threw open the blinds and saw a huge A%$.

The moon on the breast of his newest Bimbo
Gave the lustre of hormones to the object, a 'ho.
When, what to my wondering eyes should appear,
But an neophyte lawyer and 8 interns, in fear.

With a maniacal client, so lethargic and drunk,
I knew right then it was Carl, the skunk.
More rapid than eagles, his lawsuits they came,
And he whistled and shouted, and sued them by name!

"Now Denver, Now Jersy, Now Schulzes with Tatum,"
(On TV, On Radio, In print they will Hate 'im.)
"To the top of the docket, to the Court that's Supreme,
I'll sue everyone who doesn;t fall prey to my scheme!"

And then in a twinkling, I heard on my roof,
The repo guys taking my satellite dish 'Poof!'
As I drew in my head plans to rebuild my life,
Down the chimney Uncle Carl came with a knife.

He was dressed in the finest our money could buy,
But they were stained with more than a few drops of Rye.
A bundle of Lasers he had filling his sack.
"Buy these damn things so I can get my kickback!"

His telangectasias how they twinkled,
His comb-over how scary!
His breath was like fire,
His presence made us wary!
His droll little mouth was drawn in like a sneer,
For the intent of the visit was to instill us with fear.

The stump of a franchisee's leg in his teeth,
And the arm that went with it, dangling beneath.
He had a stone face and cirrhotic liver,
Not many of us would call him a 'giver'.

He was languid and dour, a right nasty old pr*&k,
I fumed when I saw him, and looked for a brick.
A twitch of his eye and a twist of his head,
Made me hope he was having a stroke in his head.

He spoke not a truth and went straight to his work,
Stole all my kids presents and laughed. What a jerk!
And showing one middle finger he said,'try and stop me!'
And giving a nod, piled another lawsuit atop me!

He sprang to my car, and to his team gave a holler,
"Don't stop suing until you get their last dollar!"
And I heard him exclaim as he rode out of sight,
"I screwed you all and didn't even kiss you good night!"


I have no idea what inspired me to write this, but enjoy it every one!

Happy Christ-Hannu-Kwanza-madon!"

Via Dermadoc 

 

Medispa Classifieds

The classified section of this site which was free to both sellers and buyers is going to be down for a time as I try to find another resource. Edigo, the resource I have been using has closed it's doors.

We'll see what we can do about getting another vendor. I am aware that during it's current iteration, approximately $500k or so of equipment was moved. 

Medical spa classified listings >

Med Spa Success Key No. Two: It Takes Money!

100dollarsIn an attempt to perhaps encourage a shift of the current focus of this blog to helpful suggestions for business success (rather than focus entirely on problems with one particular franchise and equipment and clinical issues) I am continuing my post with a discussion of a number of the myriad factors that will make the difference between your success or failure in this enterprise....

Key No. Two: It Takes Money to Make Money.

 
Everyone knows that it takes a fairly substantial capital investment to start any business. We have all heard stories about businesses being started with an initial investment of only about $200.00 years ago (the Curt Carlson (Radisson Hotels, TGI Fridays, etc.) legend), but that doesn't happen very often in today's world. If you don't adequately capitalize your business from the outset, you will not be able to properly take care of any of the 15 keys to success and you will fail. Start up expenses are important, but equally important is your ability to provide an adequate cash flow for the business during the first several years to keep the boat afloat as you make the mistakes along the way that we all make-- no matter how well prepared or well funded we are.

Many of us think nothing of spending $500,000 or more on our education, but then try to start a business on a shoe string. For your med spa, even a single room with adequate equipment and supplies may set you back from $100,000 to $300.000 depending on whether you lease or buy your equipment and how many devices you decide to purchase. Oftentimes you will be able to negotiate a substantial portion of your build out expenses with your landlord, and even roll a certain percentage of these costs into your lease. For a larger med spa, many physicians have financed over a million dollars for the proper set up (my build out of 2800 sq. feet -- for example-- was $250,000 and my equipment retailed for over $500,000). Once you are established you will face difficult decisions each day about how many employees to hire, how much to spend for equipment and product, and how much to allocate to advertising and promotion. As a general rule, the more you spend on advertising and promotion the higher your gross revenues will be-- provided you have adequate staffing and your personnel are well trained, motivated and suited for the task. Since sales of aesthetic services and products are 100% discretionary-- as opposed to traditional medical services which are largely paid by insurance and are generally more of a necessity-- the difference in sales results with an excellent and properly trained staff as compared to a mediocre and poorly trained staff can be astonishing.

A big mistake that many med spa owners have made is that as expenses rise and profits shrink they often panic, throttle way back on advertising, and try to "get by" with a smaller staff. The end result of this scenario is that the clinic gets into a "death spiral" which oftentimes leads to insolvency or bankruptcy.  Don't allow this to happen to you. Start with a sound business plan and adequate financing for at least twelve months. If you sell treatment "packages", don't succumb

Med Spa Guy

590769_syringe.jpgMED SPA WARS

A LONG TIME AGO... IN A GALAXY FAR, FAR AWAY...

 
It is a period of med spa wars throughout the nation. Rebel franchisees, striking from all corners of the United States and in particular from a weblog known as www.medicalspamd.com .... have caused the collapse--or near collapse -- of several of the leading med spa franchises. Many other med spa owners and physicians attempting to cash in on "med spa mania" are also struggling financially. How do you make a profit at this???

No doubt, as anyone who has been reading this weblog lately has discovered, the operation of a "medical spa" is by no means an easy proposition. Certainly-- as many of us have discovered-- it is not a get rich quick scheme. For some of us it has been a "go broke quick" reality. What can we do to increase our likelihood of succeeding in this challenging enterprise? I have come up with "15 keys to success" in an attempt to share some of the things I have learned getting arrows in my back over the past five years. This exercise will hopefully stimulate some dialogue from others who may be able to provide additional insights and suggestions. Rather than just "slinging mudd" at various nefarious individuals out there (who shall remain nameless) I hope we can move into some helpful debate about the most essential fundamentals of the business. I will start with the first  "key to success" and deliver several more a few days down the road.

Key No. One: Recognition that a Med Spa is a Business.

Even though there are a number of viable ways to add aesthetics to a "traditional" medical practice, many physicians who decide to expand to aesthetics seem to forget that med spas are similar to any other retail business. This means that all the basic principles applicable to other businesses-- from fast food to night clubs-- apply to medical spas as well. Let's start by mentioning a few things that medical spas are not:

1. "A Sure Thing": A successful med spa is certainly not a "sure thing". Just because you are doctor, or because you spend a great deal of money on equipment and/or a beautiful build out, does not mean that your venture will succeed. You will need to do all the "right things" that any business owner has to do to succeed with this venture. You will need a solid business model and business plan, and you will need to execute on this plan. You will need to hire the right people, train them properly, implement cost effective marketing programs, purchase the right equipment for your needs, and work hard. And you will find out quickly that-- without an emphasis on "sales"-- no business can thrive.

2. "A Profession": During the "golden age of medicine" it was possible to earn a decent income in medicine without the need for advertising, marketing and "selling". Advertising was traditionally frowned upon by the medical community. The golden age has been replaced by managed care.

3. "A Calling": Among the options that exist for doctors wishing to move in an aesthetics direction are the "100% med spa" option, the "50%/50%" option, and the "single room" option. Starting your med spa as a "sideline" -- whether it is a single room dedicated to aesthetics or a side-by-side med spa operated alongside your existing clinic-- can be the most conservative approach and is probably much less risky that a separate, stand alone facility. However, even the single room approach has its challenges. No matter what scale of operation you implement, it will still require compliance with every single one of these 15 keys to success.

Recognition that a med spa is a business requires you to embrace the fact that sales is the cornerstone of any successful business. Sales is a requirement-- not an option. The fact is that most people simply do not like sales. Many of us are afraid to sell because we think that a successful salesman has to be pushy nd obnoxious. Medical professionals have lived for decades in a world in which sales was considered either unethical or beneath their dignity. If you are not able to embrace the critical importance of sales to your business you will be doomed to fail. Marketing and advertising are also important factors, as these activities will cause your telephone to ring and prospects to walk through your doors. But the necessary "internal sales" activities that take place inside your facility are even more important. Salesmanship is a skill and an art that needs to be learned and fostered, and it is the lifeblood of any successful medical spa.

In addition to embracing and fostering sales and marketing, you will need to have a focused commitment to maintaining up to date profit/loss statements and striving for a satisfactory return on your investment. You will need to do your homework and make sure you understand the myths and realities of the economics or "metrics" of a successful med spa. You need to commit adequate financial resources to your venture so you do not set yourself up for failure. You will need to cover all of the bases discussed in these 15 keys to success, from your location to your hiring practices and your ongoing staff development. In the initial stages of your venture, you will want to enlist the help of legal and financial consultants to review your business plan with regard to local and state regulations, zoning issues and privacy laws. You will need to arrange for the necessary insurance policies to cover all of your operations and property. The issues you encounter in your preliminary investigation may have an impact on the location or set up of your medical spa and the services you decide to offer, as well as the staff you decide to hire and the procedures you establish for providing treatments, charting and storing records. You may also wish to enlist the assistance of marketing, public relations and web site experts to assist you in these areas as well. All of these programs should be in place before you open your doors.

Facial Yoga & You?

facial_yoga_tout2.jpgSometimes you just can't believe that this stuff makes it in to the mainstream press.

Facial yoga? 

Surprise Me!
Widen your eyes, as though surprised, but try not to wrinkle the brow. Focus on a point in front of you for about five to ten seconds. Then repeat, four times.

In New York City, Annelise Hagen, a devoted yogi, former actress and author of The Yoga Face: Eliminate Wrinkles with the Ultimate Natural Facelift, runs a weekly facial yoga class. Hagen says she started to develop her face-based technique when she realized that her students, mostly well-to-do, well-educated professionals, were practicing yoga but getting Botox injections during their lunch breaks. "It didn't seem to be in the spirit of yoga to me," she says.

Doctor Debt: Student loans article

Er... is there any doubt why physicians are flocking to cosmetic medicine?

Young doctors in debt

Chris and Meg Reis are on their way to long medical careers. Now it's time to deal with $500,000 in student loans.

It's all supposed to pay off, of course. Once they become full-fledged doctors (attending physicians, in the trade), they'll have six-figure incomes, more reasonable hours, a respected occupation and work that they love.

But for this generation of doctors, and for Meg and Chris in particular, financial security won't come guaranteed with their medical licenses. As health-care economics squeeze physician salaries, rising college and med school tuitions are putting young doctors ever deeper in the hole.

Chris and Meg live frugally, work hard and are making the kind of investments in their future that would make any parent proud. But they're also on track to finish their medical training in the next few years with a staggering $700,000 in debt.

And in the near term, their austere, stressful and sleep-deprived lives are about to grow even more so. Meg, 28, is due to have their first child in November. Although they've lined up day care, they still aren't sure about babysitting help for the early mornings and late nights that they'll both be working.

 

Medical Spa MD is asking for some help.

1963.jpg

I started writing Medical Spa MD a few years ago.

Medspa MD currently has around 600 pages, 4000 comments, and 550 or so members and is read by more than 20,000 unique readers and has 100,000+ page views every month. I've tried to be generally unbiased but express my point of view. I've kept the spammers and hidden agenda crowd at bay and have made a few friends. In general it's been an even trade.

But I've run into a little bit of a conflict. Time. There's not enough of it and blogging on Medspa MD has been somewhat sparse of late. I realize that and I'm aware that regular readers do as well.

Why? Well, I'm working on launching Sendside.com, a replacement technology for email in addition to my other blogs, Wild Blue Creative, Simple Curiosity, Surface, and the medical marketing print portal I've been on about for months. I'm swamped.

So I'm faced with a number of options. I can close Medical Spa MD down. I can just leave it up and hope. Or, option number three and the one I'm going with, I can solicit help from some of the regular contributors.

I'm making a groveling solicitation for some of the regular contributors to Medspa MD to step forward and help just a little.

Medspa Guy, DermaDoc, Dermgal, LH, Dermacareless and any of the other regular crew of physicians who have been so free with information, I'm hoping to tap you for some additional help and make you contributors to the regular blog in addition to the forums.

For those of you who whish to remain anonymous, that can be arranged. In fact, I don't even need to know who you are. (This is not really an open call but a narrow one to those who have already earned their spurs.)

So, please contact me. I'll work out all of the techie stuff. There's no need to make a real commitment. Post when you can.

If we can get three of the above to write a post or two a month, I can fill in the rest and we can keep Medspa MD up and thriving as the only place on the web where these discussions take place. 

Lipodisolve is popular despite obsticles

 Via USA Today: Lipodissolve proves popular despite lack of FDA nod

The American Society of Non-surgical Aesthetics, a trade group, estimates that 50,000 to 100,000 lipodissolve treatments have been performed in the USA and Europe. That's nothing compared with the 300,000 liposuction procedures performed last year in the USA, but the lipodissolve group predicts its U.S. market will grow to 500,000 a year.

Lipodissolve practitioners inject small amounts of a chemical found in lecithin — better known as a food ingredient derived from soybeans — into pesky protrusions of pudge, aka love handles, muffin tops and bra