There has been some back and forth on one of the threads about who gets to decide what medicine is and who can perform it.

Bill Sappenfield, who is part of a medical spa franchise called Mona Spa & Laser (He's Mona's husband I think) has taken the positon that... well, I'll let his comments speak form him.

Bill Sappenfield of Mona Spa & Laser Centers:

"So right you are. We have been running lasers for over 5 years with only estheticians. The medical boards seem to think that only nurse practitioners, physician assistants, and nurses are the only people qualified to run lasers.

Oh Contraire! Estheticians have more knowledge about skin care than 95% of the nursing community. Now don't get me wrong. Any qualified individual can learn and be trained in this business.

I am a firm supporter of the medical community in this business. However; this is the BEAUTY business no matter what the state medical boards say.

Most medical people don't even know what CIDESCO is! (We are 1 of 8 certified CIDESCO day spas in the U.S.) They don't realize that even some dermatologists have failed the CIDESCO exam.

As to your last comment, this is why so many physicians fail in this business. They just can't comprehend why their standard medical protocols and practices aren't working in this industry..."

And then there's this from Bill:

"Medical Board Regulations are regulations for the Medical Board. That does not make it law and even if a state board comes after someone for the "practice of medicine", that individual has the right to defend himself in a court of law. My point is that in most states, no one has questioned these regulations with a few exceptions. You don't have to believe me, but take a look at what is going on Texas and what has happened in Michigan.

It is the courts and the legislature that are the ultimate judges of what is and is not the practice of medicine..."

Of course LH (who is well know to medspaMD members) has a differing point of view:

"...From your previous posts you are a business person. Also,I am not sold that individuals with 600 hours of "training" know skin that well.

I would disagree with you on the idea that there is a significant dividing line between ablative and non-ablative lasers. The non-ablative lasers can cause severe scarring. IPL can cause significant problems as well.

I do think we agree on one thing though. You feel that the physicians can have all of the fillers, botox and ablative lasers and I feel you can have all of the body wraps and facials. I only offer facials, microderms and light chemical peels to my patients. I offer these because I do not want some cosmetologist telling them that they have some topical which is better than botox..."

Of course the problem is that the IPL's and lasers are where the money is. Hair salons and day spas are the second most common business in the U.S. (after restaurants). It's only the medical license that provides any barrier to entry in the practice of medicine and, of course, that's where the money is.. the practice of medicine.

So who gets to decide what constitutes the practice of medicine? Is it the courts or the medical boards?