MEDICAL SPAS REVIEW OCTOBER 2014

12

MEDI CAL SPAS • September 2014

www.medicalspasreview.com

OCTOBER ISSUE 2014

ANNE BOLDUC Group Publisher & President EDITOR IN CHIEF Guy J. Jonkman

the aesthetics business review

18

SENIOR EDITOR Bernard Burt

the medicine environment of the future –TODAY

SELECTING A NAME AND BRANDING – Take advantage ofthe extra protection that registering your name as a trademark can give you. While it’s not required, registering your name as a trademark at the state and/or federal level can prevent other businesses from using a name that’s likely to be confused with your business name.Be as specific as possible.

20 • MIRAVAL WELLNESS RESORT FACING MANHATTAN • EASTMAN MEDSPA • CELEBRITY CRUISES WITH CANYON RANCH • MARILYN MONROE BECOMES SPA ICON

24 KEEP THE INSURANCE PROFIT,REDUCE TAXES,PROTECT ASSETS: OWN YOUR OWN INSURANCE COMPANY – As medical reimbursements continue to shrink and the impact of healthcare reform looms,a very popular question we receive at conferences and in consults with high income practices is, “Would owning part of a Small Insurance Company help me and my practice become more financially efficient?” If your practice currently generates over $3,000,000 of revenues and you would like to take advantage of opportunities to improve the financial success you realize from your hard work without having to see any more patients,then this article may prove to be very valuable information for you.

28 MED SPA LAW 101:

Regulatory and Compliance Training Desperately Needed in the Med Spa Industry – I became a self-proclaimed “med spa lawyer” over five years ago. I say “self-proclaimed” because when I first started representing med spas and aesthetic practitioners there literally were no other lawyers in my state that practiced med spa law. The lawyers that represented med spas were corporate lawyers or health care lawyers, but none of them seemed to understand the nuanced issues that med spas faced on a daily basis.

Monica T. Brown Bernard Burt Jon Canas Dr. Ronald Klatz Raoul Andrews Janet McCormick

EDITORIAL Hannelore R. Leavy Jonathan Paul de Vierville Shirley Meerson Douglas Preston Dr. Robert Goldman Melinda Minton

SEND EDITORIAL INFORMATION info@MedicalSpasReview.com or P.O. Box 2699 Champlain NY 12919-2699 Fax (450) 833-2444 Please forward all advertising material, insertion orders to: Northeast Group / MEDICAL SPAS REVIEW 12 Nepco Way, Plattsburg, NY 12903-3961 (450) 833-2400 • Fax: (450) 833-2444

the aesthetics business review the medicine environment of the future –TODAY

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Send payment to: P.O. Box 2699, Champlain, NY, 12919-2699 6-12 WEEKS FOR FIRST ISSUE MEDICAL SPAS REVIEW Chief Operating Officer, ANNE BOLDUC Systems Manager, DANIEL DOREY Director Human Resources, ESTHER AMAR Treasurer, STARR WYLKIE Group Publisher, ANNE BOLDUC Chief Editor, GUY J. JONKMAN MEMBER International Spa Association American Academy of Anti-Aging Medicine American Med Spa Association

Copyrights © 2014 by MEDICAL SPAS REVIEW All Rights Reserved

e-mail: info@MedicalSpasReview.com

33 BREAKING BARRIERS IN HEART CARE – Everyone knows that smoking is bad for health. It can cause heart disease, peripheral arterial disease (PAD), cancer, Alzheimer’s and a whole host of other problems. For years,scientists assumed that the damage was done either by the smoke or the nicotine. A new study on a group of smokers found something very surprising.The researchers discovered high levels of lead and cadmium in blood of those with artery damage. Those with the highest blood levels of these metals were three times more likely to develop PAD.The scientists concluded that not the smoke,but the heavy metals in cigarette smoke damage the lining of arteries,leading to more pronounced disease.

38 ARRIVAL OF THE TRIPLE-DIGIT LIFESPAN VIA ANTI-AGING BIOMEDICAL TECHNOLOGIES Anti-aging medicine is a clinical specialty founded on the application of advanced scientific and medical technologies for the early detection, prevention, treatment, and reversal of age-related dysfunction, disorders, and diseases. It is a healthcare model promoting innovative science and research to prolong the healthy lifespan in humans.As such, anti-aging medicine is based on principles of sound and responsible medical care that are consistent with those applied in other preventive health specialties. The phrase "anti-aging," as such, relates to the application of advanced biomedical technologies focused on the early detection, prevention, and treatment of aging-related disease.

This issue is published by Publicom Inc. CP 399 Place d’Armes, Montreal, QC H2Y 3H1 (450) 833-2400. Postage paid in Montreal, QC and Plattsburgh, NY. POSTMASTER: PLEASE SEND ADDRESS CHANGES TO MEDICAL SPAS REVIEW, P.O. BOX 2699, CHAMPLAIN NY 12919. Nothing contained in this publication shall constitute an endorsement by Medical Spas Review of any information contained in this publication. The publication and/or ownershareholders directors, disclaim any liability with respect to the use of reliance of any such information. The information contained in this publication is in no way to be construed as a recommendation or approval by Medical Spas Review of any industry standard, or as a recommendation of any kind to be adopted by or binding upon any spa owner. Reproduction of any portion of this issue by any means (facsimile or electronically, for example) is strictly forbidden. Editorial supplied must be accompanied by return postage. The publisher assumes no responsibility for return of unsolicited photographs or manuscripts. Subscriber: Send subscription inquiries and address changes to: Circulation Department, Medical Spas Review, P.O. Box 2699, Champlain NY 12919. Give old and new address, including postal code and the address label from most recent issue.

Allow six weeks for change. Printed in Canada. Legal deposit number 500073-D. US POSTAGE PERIODICALS PAID AT PLATTSBURGH NY 12903.

ISSN #1199-0600. MEDICAL SPAS REVIEW reserves the right to accept or reject advertisers and/or advertising material. Medical Spas Review is not responsible for the advertising contents in this magazine.

Printed in Canada on recycled paper Printed on 100% recyclable paper with an aqueous coating, this is an “environmentally friendly” magazine

PUBLISHED SIMULTANEOUSLY in United States and Canada www.MedicalSpasReview.com The Worldwide Guide to Spa on the Internet

MEDI CAL SPAS

Medspa Branding

MEDI CAL SPAS

REGISTER YOUR NAME AS A TRADEMARK

PREVENT OTHER MEDSPAS TO USE YOUR NAME

Medspa Branding

same group of legal protections. Owners of name isn’t the same as that of an existing corporation, trademarks have rights under both federal and state LLC, or limited partnership in your state. Contact your

SELECTING A NAME AND BRANDING

law that gives them the power in many cases to state filing office to find out how to search their name prevent others from using the same or confusingly database. If your proposed name (or a very similar similar trademarks.

one) shows up in your state’s database, you will have to choose another.

CONDUCTING A NAME SEARCH

Unfortunately, there is no one place to look when REGISTERED TRADEMARKS

If you have a business opportunity that you would like to share with us, contact us at: info@ medicalspaconsultant.com

searching for conflicting business names. In large Finally, no matter what type of structure you have part, this is because a business can establish a

chosen for your business, you should search the

trademark simply by using it -- and millions do just federal trademark database to determine whether the

Cheryl Whitman, founder and CEO of Beautiful Forever

that. Use the following search tactics to search for name you want to use has already been registered

By CHERYL WHITMAN, Founder and CEO Beautiful Forever

both registered and unregistered trademarks.

www. medicalspasuccess.com

with the U.S. Patent and Trademark Offi ce (USPTO).

If you don’t, and you use a trademark that’s on the

FICTITIOUS NAME DATABASES

T

First check with your county clerk’s office to see you, you can be liable for what’s called willful

ake advantage of the extra protection that registering your name as a trademark can

Trademark Protection

give you. While it’s not required,

registering your name as a trademark at the state and/or federal level can prevent other businesses from using a name that’s likely to be confused with your business name. Be as specific as possible.

What is a trademark?

To make sure your proposed business to an existing trademark, perform a

that you won’t fi nd in any other database -- usually

trademark search.

unregistered trademarks of very small companies. If

Go to the USPTO’s Trademark Electronic http://www.uspto.gov/web/menu/tmeb

for both types of marks because they refer to the

name database. If that is the case in your state, your types of trademark violations. county clerk will tell you.) This list will contain names

word, phrase, design, or symbol used to market a

mark, though the term trademark is commonly used

ctitious or assumed business names in your county. trademark, even though it wasn’t intentional. Willful

name won’t infringe on someone’s rights

Business Center at

a service, rather than a product, is called a service

whether your desired name is already on the list of fi infringement, or knowingly violating someone else’s (In a few states, there is just one statewide fictitious infringement carries more costly penalties than other

A trademark, sometimes called simply a mark, is any

product or service. Technically, a mark used to market

federal register and the trademark owner sues

c/index.html and choose “Search.”

Then follow the instructions on your screen.

you find that your chosen name (or a very similar

It’s easy to search for federally registered trademarks.

name) is listed on a local fictitious or assumed name register, you should not use it.

Go to the USPTO’s Trademark Electronic Business Center at:

CORPORATION, LLC, AND LIMITED PARTNERSHIP NAME DATABASES If you are organizing your business as a corporation,

www.uspto.gov/web/menu/tmebc/index.html and choose “Search.”

Then follow the instructions on your screen.

LLC, or limited partnership, ensure your business 20

MEDI CAL SPAS • October 2014

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www.medicalspasreview.com

MEDI CAL SPAS • October 2014

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MEDI CAL SPAS

MEDI CAL SPAS

People & Places

MIRAVAL WELLNESS RESORT FACING MANHATTAN MIRAVAL

TO COME EAST, TRANSFORM

HISTORIC

NEW JERSEY

EASTMAN DOCTOR PRESCRIBES A DETOX REGIMEN QUEBEC'S SPA EASTMAN

ESTATE

By BERNARD BURT

Author/historian Bernard Burt documented the new wave of spas in the 1980s with his book Fodor's Healthy Escapes. Founding Director of ISPA, he launched PULSE magazine in 1991, coauthored 100 Best Spas of the World, and

ARIZONA-BASED MIRAVAL

WILL

FEATURES NATURAL HEALING

Naturopath Ilona Dowgiallo consults with spa guests on complementary medicine at Quebec's premier health resort, Spa Eastman.

An east coast version of Miraval Resort & Spa is planned in a nature preserve close to Manhattan.

ABOUT THE AUTHOR

People & Places

OFFER

SIGNATURE SPA SERVICES AND WELLNESS an array of group scheduled programs and activities, and a LIFESTYLE PROGRAMS AT AN HISTORIC ESTATE nightly resort credit per person per night based on your package choice to apply to select spa services, sessions with WITHIN THE 500-ACRE NATIRAR STATE PARK Miraval specialists, and activities.

IN SOMERSET COUNTY, NJ. Tucked away in lush hills, the property features a 1912 Opened in 1996. the Miraval 135-acre spread near Tuscon mansion and award-winning culinary arts center, was acquired in 2004 by Steve Case’s Washington-based Revolution LLC, a hospitality and travel company that owns currently open for dinner, meetings, and events.

ZipCar, LivingSocial, and Exclusive Resorts club.

When complete in 2015, Miraval at Natirar will boast a wellness pavilion, yoga center, and 16,000-square-foot Contact: www.miravalresorts.com; 800-232-3969 spa, as well as a restaurant featuring Miraval spa cuisine.

Renovation of the mansion as a luxury hotel will blend historic character with contemporary flair, according to reports in local media.

BOTH A DOCTOR IN PHYSICS AND HERBALIST, ILONA PRESCRIBES A DETOX REGIMEN OF BACH FLOWER TINCTURE THERAPY, PLUS BODYWORK BY HER HUSBAND MICHEL, WHO HAS BEEN AT EASTMAN FOR 20 YEARS. Now a fixture at international spa conferences, Ilona lectures on “The Art of Fighting Fatigue” for Eastman guests.

Detox also shows up in hair treatments at Spa du Cheveu, Eastman’s exclusive salon devoted to the scalp. And a sustainable development program that includes the use of naturally filtered salt water in pools; refillable bottles of biodegradable soap in all rooms; tissue products made from 100 % recycled fibres; compact fluorescent light bulbs; natural eco-friendly certified cosmetics, and their private label Spa Eastman Experience line

tracked trends for Spa Management Journal.

Currently his reviews are on Examiner.com and Insider's Guide to Spas.com

The daily schedule includes guided walks, hikes, and exercise. Aqua Aerobics in the swimming pool, or relaxing at the big pond. The choice is yours.All activites, meals, and lodging are included in the daily rate. Groups take over a building, or come for special weeks devoted to raw food, naturopathy, and total immersion in health and wellness

The Natirar resort occupies 90 acres within the 500-acre park.

Development was orchestrated by preservationist/founder Robert Wojtowicz.

Sir Richard Branson previously partnered with Wojtowicz to acquire the estate from the Royal Family of Morocco with the intention of creating the first Virgin Limited Edition <http://www.virginlimitededition.com/> resort in the United States. Ultimately it was decided to structure a public / private partnership with the Somerset County government to preserve the estate and open it to the public.

Living Food weeks are a recent addition. Lasting 8 days/7 nights, they offer raw food menus based on sprouts, shoots, fruits, and vegetables, plus green smoothies and wheat grass juice. In addition, workshops with experts from Montreal’s Crudessence Culinary Academy build sustainable habits. The all-inclusive package is priced from $1,746 per person, double occupancy, plus tax.

Miraval at Natirar will be the first outpost for the famed Arizona resort.

Staying focused on confirmed therapeutic approaches is basic to Spa Eastman's success spanning 36 years. And there are still no telephones or TV in the rooms.

Ranked among America’s top destination spas and health resorts, Miraval’s daily guest rate starts at $375, plus 20% resort fee, taxes (approx. 15%). The all-inclusive rate is per person, per night and includes accommodations (single or double occupancy), transportation to & from Tucson Airport, all meals & snacks, your choice to participate in 22

MEDI CAL SPAS • October 2014

Contact: www.spa-eastman.com; 1-800-665-5272, 450-297-3009 www.medicalspasreview.com

www.medicalspasreview.com

MEDI CAL SPAS • October 2014

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People & Places

MEDI CAL SPAS

MARILYN MONROE SPAS MAKES GETTING THAT CLASSIC MARILYN LOOK ACCESSIBLE AND FUN

CELEBRITY PASSENGERS CAN PRE-BOOK TREATMENTS MIRAVAL CELEBRITY CRUISES AND CANYON RANCH PLAN TO LAUNCH CANYON RANCH SPACLUB® AT SEA ONBOARD 10 STATE-OF-THE-ART CELEBRITY SHIPS, ELEVATING THE CRUISE EXPERIENCE WITH NEW SERVICES AND TREATMENTS. Scheduled to debut in April, the luxurious Canyon Ranch SpaClub on Celebrity Cruises will include spa lounges, beauty salon, and a range of wellness and fitness offerings.

THE

INDUSTRY-LEADING

INTRODUCE EXCLUSIVE

BRANDS

SPACLUB

INTEND

TO

TREATMENTS AND

SERVICES TAILORED TO THE PERSONAL PREFERENCES

CELEBRITY GUESTS, INCLUDING NEW FACIAL AND BODY TREATMENTS, AND SEA-INSPIRED YOGA AND MEDITATION CLASSES.

OF

“We are passionate about providing our guests with unforgettable experiences, and this collaboration with Canyon Ranch is an important milestone in our drive to elevating guests’ modern luxury vacations,” said Michael Bayley, President and CEO, Celebrity Cruises.

The expansion of shipboard operations will create 300 additional jobs, according to a Canyon Ranch spokesperson.

Based in Manchester, England, the Canyon Ranch SpaClub at Sea division of Canyon Ranch has been recognized as a “Best Spa at Sea” by Condé Nast Traveler and SpaFinder Wellness.

Celebrity’s modern luxury vacations bring guests to inspiring destinations on all seven continents. In addition to its newly enhanced spa and wellness programming, the premium brand “AquaClass” accommodations infuse staterooms with spa-like amenities as well as a host of other extras. AquaClass guests can exclusively dine in the chic specialty restaurant, Blu, and enjoy unlimited access to the Persian Garden, a relaxing oasis with heated mosaic lounge chairs and grottos releasing a variety of dry heat, aromatherapy-infused steam and mists into the air.

Celebrity is one of six cruise brands operated by global cruise vacation company Royal Caribbean Cruises Ltd. (NYSE, OSE: RCL).

For more information, dial 1-800-437-3111, visit www.celebritycruises.com, or call your travel agent.

About Canyon Ranch

Canyon Ranch pioneered the evolution of the wellness lifestyle and has been an industry leader for close to 35 years. Operating celebrated destination health resorts in Tucson,Ariz., and Lenox Mass., the Canyon Ranch Passengers can pre-book spa treatments through a Hotel & Spa in Miami Beach, and a full-service SpaClub® at dedicated cruise concierge at Canyon Ranch prior to The Venetian® & The Palazzo® in Las Vegas, Nev., they sail sailing. the world onboard nine luxury ships, including Cunard QE2, Regent, and Oceania Cruises’ entire fleet, to be joined by 10 Celebrity Cruises liners.

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MEDI CAL SPAS • October 2014

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People & Places

MOVE OVER ELIZABETH ARDEN AND BETTY WHITE, MARILYN MONROE IS THE NEW SPA ICON. Monroe’s classic look has been copied by legions of A-list stars following in her footsteps, but the opening of Marilyn Monroe Spas introduced her to a new generation.

FROM

HER CHEEKY BEAUTY MARK TO HER CLASSIC

RED LIPS,

MARILYN’S LOOK INSPIRED SPA NIKI BRYAN TO CREATE A NEW

INDUSTRY

definition of Resort Spas and Health Clubs in the 1980s with companies such as Ritz-Carlton, Walt Disney World, GLAMOUR FOR THE BRAND WHICH DEBUTED IN Marriott, and Hilton.

VETERAN

LEVEL OF

FLORIDA AND CALIFORNIA. Now, Marilyn Monroe Spas makes getting that classic Marilyn look accessible and fun.

Guests will be swept away by the high quality and cleanliness of the spa as well as with the atmosphere of timeless glamour. Not a franchise, each company-owned and operated location will provide exceptional service in an atmosphere that is decidedly Marilyn -- fun, flirty and glamorous.

In the words of Niki, “Consumers have told us our industry needs to change. The spa experience has stagnated while prices have steadily risen; standards of service, hygiene, and quality in the nail boutique business are highly variable and generally not nearly what they should be. Marilyn Monroe™ Spas, Glamour Rooms and Nail Boutiques are replacing the experience that consumers have too long settled for with one that that is vibrant and social, and will leave them looking and feeling wonderful after every visit.”

Trademarked Marilyn Monroe Spas offer an array of As defined by Marilyn Monroe, who famously said services including hair and makeup in posh settings "I just want to be wonderful!" reminscent of Hollywood sets. Facials, massages, body treatments, manicure/ pedicure, waxing and polish Contact: www.MarilynMonroeSpas.com treatments come with an added touch of glamour.

Located in some of the world’s most sought-after locations, Marilyn Monroe Spas™ will provide an unexpected vacation or simply an abbreviated trip to another world, according to company founder Bryan.

Opening at the Hyatt Regency Monterey Hotel and Spa in California, the Marilyn Monroe Nail Boutique in Miami, and the Marilyn Monroe Nail Boutique in Orlando, the company plans to create Marilyn Monroe Spas, Nail Boutiques, or retail Glamour Rooms in New York City, St. Petersburg, Maui, Atlanta, Phoenix, and San Diego in 2014.

Niki Bryan, Founder and CEO of Marilyn Monroe™ Spas, has spent over 30 years as an active leader in the spa, beauty, and fitness industries, consistently driving higher standards and innovations in spa facility design and services Through Niki Bryan Spas, she elevated the www.medicalspasreview.com

MEDI CAL SPAS • October 2014

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MEDI CAL SPAS

MEDI CAL SPAS

Practice Tools

WOULD OWNING PART OF A SMALL INSURANCE COMPANY HELP ME?

KEEP THE INSURANCE PROFIT, REDUCE TAXES, PROTECT ASSETS: OWN YOUR OWN INSURANCE COMPANY B y DAVID B. MANDELL, JD, MBA CAROLE C. FOOS, CPA David B. Mandell, JD, MBA, is an attorney

As medical reimbursements continue to shrink and the impact of healthcare reform looms, a very popular question we receive at conferences and in consults with high income practices is,

books for doctors, including

“Would owning part of a Small Insurance Company help me and

FOR DOCTORS Only:

my practice become more financially efficient?”

Building More, as well a

financial consulting firm OJM Group (www.ojmgroup.com), where

If your practice currently generates over $3,000,000 of

WHAT IS A SMALL INSURANCE COMPANY (SMIC)?

revenues and you would like to take advantage of

The SMIC we will discuss here is a properly-licensed, U.S.-

opportunities to improve the financial success you realize

based insurance company – domiciled in one of the states

from your hard work without having to see any more

that have special legislation for small insurance

patients, then this article may prove to be very valuable

companies. While some advisors promote insurance

information for you.

arrangements in small international jurisdictions to take

Carole C. Foos, CPA works as a tax consultant.

advantage of lower creation and maintenance costs, we Small Insurance Companies (or “SMICs”) are often

think it is advisable to domicile SMICs in the U.S. As a

They can be reached at

referred to as captives, closely-held insurance companies,

number of states’ recent captive insurance statutes allow

877-656-4362

or a number of other names. Like any corporate structure,

formation for reasonable costs, we find domestic options to

or mandell@ojmgroup.com

SMICs can be ideal tools if they are created for the right

be financially feasible like never before.

type of practice and the corporate formalities are maintained properly in a legitimate jurisdiction. The

SMIC AS A RISK MANAGEMENT TOOL

purpose of this article is to briefly describe appropriate

The SMIC must always be established with a real insurance

uses, potential benefits, and approximate costs of SMICs.

purpose. Insurance companies have been well defined in

To better illustrate potential benefits, we offer a case study

the vast array of tax laws, revenue rulings, private letter

where the use of an SMIC significantly enhanced many

rulings, and case law. There are requirements for an

areas of the client’s comprehensive financial planning.

insurance company to be a facility for transferring risk and protecting assets. Practitioners who specialize in this area have found ways to manage risk to maximize long term

26

MEDI CAL SPAS • October 2014

policy that would pay your legal fees (and allow full choice

insurance statutes. How risk is managed and how much

of attorney) but would not provide any benefit to creditors

risk can be insured in a captive will be answered based on

or claimants (what we call “Shallow Pockets” policies).

your particular situation. The nice thing is that there is a

This prevents the client from appearing as a “Deep Pocket”

great deal of flexibility in how the SMIC can benefit a

(a prime lawsuit target). Avoiding this appearance is a

client.

valuable asset protection strategy that is stressed in our

One specific way clients can use the SMIC is to supplement

www.medicalspasreview.com

Building More.

their existing insurance policies. The SMIC can insure deductibles, copayments, and excluded risks.

A Guide to Working Less &

He is a principal of the

profit while reducing unnecessary risk within the

Practice Tools

book, For Doctors Only: A Guide to Working Less and

and author of five national

number of state books.

SMALL INSURANCE COMPANY ARE CREATED FOR THE RIGHT TYPE OF PRACTICE

Such

The SMIC has the flexibility to add coverage for liabilities

“excess” protection gives the client the security of knowing

excluded by traditional general liability policies, such as

that the company and its owners will not be wiped out by

wrongful termination, harassment, or even ADA

a lawsuit award in excess of traditional coverage limits. In

violations. Given that the awards in these areas can be over

this case, you could think of the SMIC as a tax-efficient,

$1 million per case, the SMIC can provide valuable

asset protected war chest to cover potential future losses.

protection here. To illustrate how the SMIC can be used, let’s examine the case study of Justin and Harry.

Most doctors are acutely aware of medical malpractice, but there are many other risks to doctors as employers and recipients of insurance (and Medicare). The SMIC can be

CASE STUDY: JUSTIN AND HARRY USE SMICS

used to protect the doctor and practice from employment liability, insurance audits, HIPAA defense and a variety of

Justin and Harry are Doctors who each own successful

other risks that will vary based on your practice size,

practices and surgery centers. Justin feels like he is

revenue, number of employees, and other risks. This

paying too much for his group’s medical malpractice

protection can be of significant value and potentially very

and commercial liability insurance policies. After our

profitable to the SMIC if you manage risk well. In some

firm introduced Justin to an attorney and actuary who

instances, the SMIC may even allow the client to reduce

specialize in SMICs, he created one to issue policies that

existing insurance, as the SMIC policy will provide

cover the least significant, most common medical

additional coverage.

malpractice and commercial liability claims (under $100,000 per occurrence). This significantly reduced his

Some doctors choose to use an SMIC to provide flexibility

existing insurance premiums because he then had much

in using customized policies not easily found in the

higher deductibles for his 3rd party insurance policies.

commercial space. For example, you may desire a liability www.medicalspasreview.com

MEDI CAL SPAS • October 2014

27

MEDI CAL SPAS

Practice Tools

MEDI CAL SPAS

MEDICAL REIMBURSEMENTS CONTINUE TO SHRINK

IMPACT OF HEALTHCARE REFORM LOOMS

Justin believed he could reduce his insurance premiums

SMIC:

WHO CAN AFFORD

to commercial insurance companies, implement

COMPARED TO SELF-INSURING – THE “RAINY DAY FUND”:

requires particular expertise, as explained above. Thus, as

OJM Group, LLC. (“OJM”) is an SEC registered investment

successful risk management programs, reduce the

Because our society has become so litigious, many Doctors

might be expected, the law firms most experienced in these

adviser with its principal place of business in the State of

claims of the center, and reduce his overall payments

have been “self-insuring” against potential losses like the

matters charge significant fees for both the creation and

Ohio. OJM and its representatives are in compliance with

and costs. Ultimately, he hoped that the SMIC would

ones named above. These clients have simply saved funds

maintenance of SMICs. Set-up costs are typically $75,000+

the current notice filing and registration requirements

help him increase the profits of the center. He was right.

on an after tax basis to pay any expenses that may arise if

and annual maintenance costs can be around $5,000 per

imposed upon registered investment advisers by those

While a significant portion of the $1.5 million in total

a risk comes to fruition. This is the proverbial “rainy day

month. While these fees are significant (and often fully

states in which OJM maintains clients. OJM may only

payments was paid out to cover claims, there was still

fund.” While a rainy day fund may prove wise, the client

tax-deductible), they can be shared among a number of

transact business in those states in which it is registered, or

over $1 million in his SMIC reserves after five years.

would be better off using an SMIC to insure against any

SMIC owners. The SMIC’s potential risk management, tax,

qualifies for an exemption or exclusion from registration

Justin also had the SMIC owned by a Trust for his family,

risks. That is because the formal payment of premiums to

practice, estate planning, and asset protection benefits

requirements.

so he was able to build the wealth created by the SMIC

the SMIC may be tax-deductible to the practice. Those

often combine to make it a very attractive option for very

registration status of OJM, please contact OJM or refer to

out of his taxable estate.

funds in reserve of the insurance company enjoy the

successful doctors. There is no better way for successful

the Investment Adviser Public Disclosure web site

highest levels of asset protection (+4/+5), can be

practice owners to leverage their advisors than to work

(www.adviserinfo.sec.gov).

Harry had a different approach. He established an SMIC

structured to grow outside the taxable estate, can be

with them to create such a flexible and efficient planning

to insure lesser risks that were not covered under

structured to layer into a practice exit strategy, and can

tool as a small insurance company.

commercial insurance.

These policies included

generate very significant long term tax advantages as well.

Medicare fraud defense, HIPAA litigation expense and

None of these benefits are found with the traditional “rainy

Conclusion:

Form ADV using the contact information herein. Please

malpractice defense policies (which is available only to

day fund.”

SMICS CAN BE GREAT TOOLS FOR CERTAIN PHYSICIANS

read the disclosure statement carefully before you invest or

Because successful doctors have significant risks, are

send money.

pay for the company’s legal fees, but not to pay

AN

Practice Tools

SMIC? Setting up an SMIC Disclosure:

For information pertaining to the

For additional information about OJM, including fees and services, send for our disclosure brochure as set forth on

claimants). After five years, Harry’s SMIC paid limited

AVOIDING LAND MINES: It cannot be overstated – the

interested in better management of these risks, desire asset

claims. At this point, most of the premiums are still

SMIC structure must be properly created and maintained

protection, want to build tax-favored wealth over the long-

This article contains general information that is not

growing as asset-protected reserves of the SMIC to be

by insurance experts. If not, all risk management, asset

term, and might enjoy learning new ways to fund practice

suitable for everyone. The information contained herein

used to pay future claims. If there are very few future

protection, estate, practice and tax benefits may be lost. For

buy-out and estate planning opportunities, there is a good

should not be construed as personalized legal or tax

claims, the SMIC may become a profitable investment

these reasons, using professionals who have expertise in

reason to spend a little time reviewing the benefits of the

advice. There is no guarantee that the views and opinions

for Harry and his family.

establishing SMICs for clients is critical – especially the

SMIC as an important planning tool.

expressed in this article will be appropriate for your particular circumstances. Tax law changes frequently,

attorneys, actuaries and insurance managers who need to Harry was also considering bringing on younger

be involved. While using such experts and a real SMIC

SPECIAL OFFERS:

accordingly information presented herein is subject to

partners in to his practice. He plans on using the SMIC

structure may be more expensive than some of the cheaper

For a free hardcopy of For Doctors Only: A Guide to Working

change without notice. You should seek professional tax

as part of an exit strategy for his practice as well, with

alternatives being touted on the internet or at fly-by-night

Less & Building More, please call (877) 656-4362. If you

and legal advice before implementing any strategy

each new partner responsible for paying some of his

seminars, this is one area where “doing it right” is the only

would like a free, shorter eBook version of For Doctors Only,

discussed herein. ■

buyout –from both the practice and the SMIC.

way to enjoy the SMIC’s benefits and be 100% compliant.

please

download

our

“highlights”

edition

at

www.fordoctorsonlyhighlights.com 28

MEDI CAL SPAS • October 2014

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MEDI CAL SPAS • October 2014

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State regulations

MEDI CAL SPAS

NOT TOO MANY LAWYERS PRACTICE MED SPA LAW

THERE ARE NUANCED ISSUES THAT MED SPAS FACE ON A DAILY BASIS

MED SPA LAW 101:

conservatively estimate that 60-70% of the med spas situation can give you legal advice. (By the way, if you

practice. In Illinois where I practice, I would different, and only an attorney familiar with your

in business are operating illegally.

in the Med Spa Industry

They

either

corporate

law firm, and founder of the

have

improper

structure,

improper

supervision, or are engaging in fee

By ALEX R. THIERSCH, JD

American Med Spa

splitting or the unauthorized

Association (AmSpa), an

industry on the rules and

smart and sophisticated professionals at that – who (I think I start every sentence that way). Be

Desperately Needed Associates, a Chicago based

educating the medical spa

the vast number of aesthetic professionals – extremely is NOT legal advice, and should not be taken as such

still don’t know the basic rules that govern their forewarned: every situation is different, every state is

is a partner at Thiersch &

association dedicated to

What continues to amaze me even today, however, is know that as a lawyer I am obligated to state that this americanmedspa.org

Regulatory and Compliance Training Alex R. Thiersch

I became a self-proclaimed “med spa lawyer” over five years ago.

I say “self-proclaimed” because when I first started representing med spas and aesthetic practitioners there literally were no other lawyers

regulations affecting it.

in my state that practiced med spa law.

He can be reached at

practice of medicine.

What this industry needs is some basic legal training. “Med Spa Law

before a med spa is opened. But

The lawyers that represented med spas were corporate lawyers or health care lawyers, but none of them seemed to understand the nuanced issues that med spas faced on a daily basis.

since every state is different – oftentimes vastly different – it is extraordinarily

difficult

to

synthesize all this information,

W

hat I soon realized was that the Unfortunately, state regulators have never been practitioners themselves – plastic impressed with the “I didn’t know” argument. surgeons, med spa owners, nurses, Ignorance of the law, as they say, is not an excuse. And

don’t have an attorney, please visit What this industry needs is some basic legal training.

“Med Spa Law 101” should be a required course before a med spa is opened.

101” should be a required course

alex@americanmedspa.org

basic as it is, into one place (which is why – shameless plug! – I started the American Med Spa Association).

But since every state is different – oftentimes vastly different – it is extraordinarily difficult to synthesize all this information, basic as it is, into one place (which is why – shameless plug! – I started the American Med Spa Association).

obvious in retrospect – if the lawyers representing the spa-related questions was difficult, if not impossible, clients don’t know the law, how in the heck could we that fact never stopped the state from slapping down expect the clients themselves to know it?

hefty fines or suspensions for those who broke the law,

americanmedspa.org and you’ll find one).

FEE SPLITTING I’m often surprised at how many practitioners are unaware of the prohibition against fee splitting. It’s been around forever, and the laws in many jurisdictions haven’t changed for some time. The rule is simple: physicians may not split medical fees with anyone other than physicians. This means that when a fee is paid for an aesthetic treatment – Botox for instance – that fee must be paid directly to the physician or physician-owned corporation only, and no part of

estheticians – knew even less about the rules and even though the state regulators themselves readily regulations than I had ever imagined. This seems admitted that finding answers to basic med

State regulations

Since Med Spa Law 101 is currently not offered in that fee can be split with a non-physician. medical school, nursing school, or in aesthetician training, what follows is a brief overview of some of In the med spa setting, this problem often manifests the laws that affect you. Before you read further, please itself in one of two ways: first, a nurse, laser technician

even unwittingly.

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State regulations

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IF LAWYERS DON’T KNOW THE LAW COULD WE EXPECT DOCTORS TO KNOW IT?

PRACTITIONERS KNOW VERY LITTLE ABOUT RULES & REGULATIONS or other professional is paid a commission on the treatments. As such, these treatments must be

this is allowed in some jurisdictions (the state of the unauthorized practice of medicine. Remember,

amount of revenue he or she generates (i.e. 10% of all supervised by medical professionals. Thus, at a

Florida being one), in most states this is a HUGE no- medical treatment is the domain of physicians. While

revenue generated from Botox or laser hair removal); minimum, medical supervision is required, on site, for

no. In Illinois where I practice, for instance, the state treatment can be delegated to nurses or other

or second, non-physicians (including patients) are the practice to be compliant. If a physician is not on

boards have prosecuted many med spas because the professionals, such delegation must originate from

paid referral fees for bringing in new patients. Both of site, a nurse, nurse practitioner or other medical

ownership structure is improper. In order to run a the physician, and that can happen only after a

these practices, depending on the

professional should be, and the

medical facility in Illinois, the

physician-patient relationship is

jurisdiction, may constitute fee

physician should be available by

business must be owned solely by

established. In many states, this

phone.

physicians.

Although it is difficult to

splitting.

Remember,

make generalities regarding SUPERVISION/DELEGATION

supervision, the fact remains

CORPORATE

PRACTICE

the physician.

This becomes problematic when

domain of physicians.

physicians and non-physicians wish

While treatment can be

of

to partner in a med spa. In many

delegated to nurses or other

problematic in the med spa

OF

that the treatments we are

different from most other medical

discussing here – Botox,

practices because many of the

fillers, and laser treatments

medicine” is a sticky concept that

jurisdictions this is not allowed due

professionals,

industry as physicians are not

treatments are not performed by

– are generally considered

often comes up in my practice. In

to the corporate practice of

such delegation must

always present and the medical

physicians. Botox and fillers are

medical treatments.

essence, this doctrine states that

medicine

originate from the

procedures are not, medically

often performed by nurses. Laser

As such, these treatments

only physicians may practice

jurisdictions the medical company

physician, and that can

speaking, overly complicated. But

treatments are performed by laser

must be supervised by

medicine. Non-physicians (1) may

must be owned only by physicians,

happen only after a

med spas are still medical facilities

technicians. As a consequence,

medical professionals.

not practice medicine, and (2) may

with no lay people allowed in the

physician-patient

Thus, at a minimum,

not own a business or corporation

ownership structure at all.

perform these treatments without proper supervision.And physicians

medical supervision is

MEDICINE The

“corporate

practice

doctrine.

In

these

that practices medicine. In other

In many states, this means

words, the practice of medicine is

UNAUTHORIZED PRACTICE OF

the sole domain of physicians and

MEDICINE

without

physician-owned corporations. The

Many states require that a physician

procedures in place to ensure

policy behind this rule is that

(or mid-level practitioner like a

often leave their practices in the hands

of

others

required, on site, for the practice to be compliant.

proper supervision.

relationship is established.

a face-to-face consult with the physician.

This

issue

is

particularly

and, as such, all rules applicable to medical facilities apply. This means that an exam from a physician or nurse practitioner is necessary (note that in some jurisdictions physician’s assistants may perform initial consults as well).

physicians, and only physicians, should practice

physician assistant or nurse practitioner) examine

medicine and be in charge of medical care.

every patient prior to any medical treatment being SOCIAL MEDIA AND ADVERTISING

Although it is difficult to make generalities regarding

performed. When a patient is treated without first Technology and social media has driven businesses,

supervision, the fact remains that the treatments we This has become an issue as the industry has grown.

being seen by a physician or mid-level, the big and small, to use the internet as a tool to provide

are discussing here – Botox, fillers, and laser Non-physicians, seeing the potential for large returns,

professional treating the patient may have engaged in information to their clients. Med spas are no

treatments – are generally considered medical have begun opening laser centers and med spas.While

exception. Many of my med spa clients use social

MEDI CAL SPAS • October 2014

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www.medicalspasreview.com

americanmedspa.org

means a face-to-face consult with

The medical aesthetic industry is

non-physicians are often left to

32

medical treatment is the

State regulations

MEDI CAL SPAS • October 2014

33

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Medical Spa Networking

IGNORANCE OF THE LAW IS NOT AN EXCUSE media - websites, Facebook, LinkedIn and even clients often inadvertently violate HIPAA through

American Med Spa Association americanmedspa.org

Twitter - to market their services and attract new seemingly innocuous posts or tweets. patients.And with the recent uptick in the number of med spas, competition is forcing them to stand apart So remember- although it is important to keep current to get noticed by prospective clients. Several med spa with technology trends to stay competitive in the clients have asked for my opinion on advertising their marketplace, you have to be extra careful that your med spa services using daily deal sites like Groupon med spa marketing and advertising practices are to get ahead of competitors by offering their services compliant with your state’s laws. at a discount.

Although in Illinois, where I practice, Groupon has been deemed legal by the state regulatory authorities, not every state agrees. Since Groupon receives a percentage of the total revenue, instead of a flat fee, from the med spa’s patient treatments, some states consider this a form of fee-splitting. And while this form of advertising may be lucrative at first, many of my med spa clients have later regretted the decision to offer a Groupon because of disgruntled clients, negative reviews, and loss of profits.

Further, never forget that medical spas are medical facilities, and they are therefore governed by the same rules as physicians. There are strict prohibitions on certain statements that can be made in advertisements and on websites, and patient confidentiality must be strictly guarded. Patient testimonials, for instance, are inherently risky as many state boards deem them to be unreliable and misleading. And with the explosion of social media, 34

MEDI CAL SPAS • October 2014

IN CONCLUSION… Medical spas and laser centers are becoming bigger and bigger targets of law enforcement.

Lawsuits and prosecutions are on the rise.

As the industry grows, scrutiny and oversight will grow with it.

I have only scratched the surface of the many rules and regulations that apply to medical aesthetic practices, and it is crucial that practitioners get the guidance they need from a qualified health care attorney.

And I would be remiss if I didn’t refer back to the super-important caveat that different jurisdictions have different laws, and some jurisdictions are stricter than others.

Please check with your local attorney and proceed with care. ■

www.medicalspasreview.com

Everyone knows that smoking is bad for health. It can cause heart disease, peripheral arterial disease (PAD), cancer, Alzheimerâ&#x20AC;&#x2122;s and a whole host of other problems. For years, scientists assumed that the damage was done either by the smoke or the nicotine. A new study on a group of smokers found something very surprising. The researchers discovered high levels of lead and cadmium in blood of those with artery damage.

Sibia Medical Centre, Ludhiana, India

those without PAD. The toxins in cigarette smoke affect even non smokers and as the heavy metals are everywhere they are easily absorbed from the environment and many edibles.A little lead enter our body every time we sip coffee from a ceramic mug or smudges the fingers with lead containing ink when reading the daily newspaper. Even the computer monitor and television set contain lead and many candles contain lead in their wicks that raise the concentration of lead in the air when they burn.

The good news is that toxic heavy metals can be removed with a process known as chelation therapy. Medical practitioners have treated atherosclerotic disease that causes heart attack with chelation therapy for over 50 years. Till now lack of strong evidence relegated chelation therapy to complementary medicine practitioners, who reported good results.

BREAKING BARRIERS IN HEART CARE

Dr.S.S.Sibia, MD in Internal Medicine Director and Senior Consultant at Sibia Medical Centre, India

Those with the highest blood levels of these metals were three times more likely to develop PAD. The scientists concluded that not the smoke, but the heavy metals in cigarette smoke damage the lining of arteries, leading to more pronounced disease.

These metals donâ&#x20AC;&#x2122;t have to be very high to cause problems and the arterial disease can be was associated with lead concentrations only 13% higher than

Over time evidence linking metals with cardiovascular disease and mortality gradually accumulated, suggesting a possible role for chelation therapy.

Based on this concept the Trial to Assess Chelation Therapy (TACT) was conducted. In the study intravenous EDTA based chelation with multivitamins and multi-minerals was given.

He said “The study validates what we are doing. Worldwide millions of patients with heart disease and poor circulation have chosen this treatment.

We have personally seen benefit from chelation so we recommend it to our patients who want an alternative to surgery or stents.

Chelation is safe and we have done over

Total 1708 patients aged 50 years or above, who had already had a heart attack were studied. The treatment proved to be safe and reduced overall cardiovascular events by 18%.

2300 chelations in the year 2013 and most of our patients are satisfied. As we provide ACAM (USA) protocol and international treatments at Indian cost popularity of our centre among overseas patients is increasing and patients from over 30 countries have availed various treatments at Sibia Medical Centre.

The Trial to Assess Chelation Therapy (TACT) conducted to verify the effects of Chelation Therapy proved it to be safe and reduced overall cardiovascular events by 18%. Benefit diabetes mellitus was even better with a 41% reduction in need for treatment.

Dr Sibia recommends Chelation Therapy for patients unfit for surgery, with failed bypass or stent and those who want to avoid surgery or stents.

Chelation Therapy can be life saving for patients who are unfit for surgery, where bypass or stent has failed and those who want to avoid surgery.

The benefit in patients with diabetes mellitus was even better with a 41% reduction in need for treatment.

An educational website www.chelation.in provides more details of this treatment.”

Dr Sibia, Director of Sibia Medical Centre, Ludhiana introduced this service in India in the early 1990’s and hence is fondly referred to as Father of Chelation Therapy in India.

Breaking Barriers in Heart Care: Increased heavy metals in blood damages the arteries and can cause heart disease, peripheral arterial disease (PAD), etc.

Doctors have been treating heart attack causing atherosclerosis with chelation therapy to remove heavy metals and thus breaking the link between metals and cardiovascular disease.

Dr.S.S.Sibia, MD in Internal Medicine is Director and Senior Consultant at Sibia Medical Centre, India. He maintains an educational website www.chelation.in and can be contacted at Mb: +91-9814034818 or Email: drsibia@sssibia.com

Sibia Medical Centre, Ludhiana, India Contact: Mb: +91-9814034818 Office: +91-161-2444818 Email: drsibia@sssibia.com Websites: www.SibiaMedicalCentre.com www.Chelation.in www.CytotronTreatment.com

MEDI CAL SPAS

Anti-Aging

MEDI CAL SPAS

FOR THE EARLY DETECTION, PREVENTION, TREATMENT, AND REVERSAL OF AGE-RELATED DYSFUNCTION, DISORDERS, AND DISEASES

ANTI-AGING MEDICINE IS A CLINICAL SPECIALTY

Anti-Aging

ANTI-AGING MEDICINE IS THE FOLLOWING:

ARRIVAL OF THE TRIPLE-DIGIT LIFESPAN VIA ANTI-AGING BIOMEDICAL TECHNOLOGIES

• It is scientific. Anti-aging diagnostic and treatment practices are supported by scientific evidence and therefore cannot be branded as anecdotal.

• It is evidence-based. Anti-aging medicine is based on an orderly process for acquiring data in order to formulate a scientific and objective assessment upon which effective treatment is assigned.

By DR. RONALD KLATZ, MD, DO, President American Academy of Anti-Aging Medicine (A4M; www.worldhealth.net & www.a4m.com)

ABOUT THE AUTHOR Dr. Ronald Klatz, M.D., D.O. is a physician, medical scientist, futurist, and innovator. He coined the term "anti-aging medicine" and is recognized as a leading authority in the new clinical science of anti-aging medicine. Dr. Klatz is the physician founder and President of the American Academy of Anti-Aging Medicine. In 1984, Dr. Klatz was a pioneer in the clinical specialty of preventative medicine: as a principal founder of the National Academy of Sports Medicine and researcher into elite human performance and physiology.

Dr. Klatz is a best-selling author, and is columnist or Senior Medical Editor to several international medical journals.

Since 1981, Dr. Klatz has been integral in the pioneering exploration of new therapies for the treatment and prevention of age-related degenerative diseases. He is the inventor, developer, or administrator of 100-plus scientific patents, including those for technologies for brain resuscitation, trauma and emergency medicine, organ transplant and blood preservation. Today, Dr. Klatz helps to support aging-related biotech research and supervises postgraduate medical training programs for physicians from 120 countries.

SCIENTIFIC BASIS OF ANTI-AGING MEDICINE Anti-aging medicine is a clinical specialty founded on the application of advanced scientific and medical technologies for the early detection, prevention, treatment, and reversal of age-related dysfunction, disorders, and diseases. It is a healthcare model promoting innovative science and research to prolong the healthy lifespan in humans. As such, anti-aging medicine is based on principles of sound and responsible medical care that are consistent with those applied in other preventive health specialties. The phrase "anti-aging," as such, relates to the application of advanced

• Is well-documented by peer-reviewed journals. As of this writing, the National Library of Medicine hosts more than 3,000 peer-reviewed articles on the subject of anti-aging medicine.

Scientific and academic journals that routinely publishing studies relating to life enhancement and/or life extension include: Annals of Internal Medicine BMJ (British Medical Journal) Cancer Prevention Research European Heart Journal FASEB Journal (Federation of American Societies for Experimental Biology) JAMA (Journal of the American Medical Association) Lancet Neurology PLOS One It is a seminal position of the anti-aging medical science, that aging is not inevitable, in that longevity is not finite. In a study conducted by demographer J. R. Wilmoth and colleagues, the researchers found that in Sweden, the maximum age at death has risen from 100 years during the 1860s to about 108 years during the 1990s. They also make note that the increase *in longevity has become expedited: before 1969, the increase in maximum age at death increased at 0.44 yr/decade; and since 1969, it has risen at the pace of 1.11 yr/decade. The team cites "an intensification of efforts … to prevent or even cure ailments such as coronary heart disease, stroke, and cancer" has profoundly contributed to "the more rapid rise in the maximum age since 1969."

[Wilmoth JR, Deegan LJ, Lundstrom H, Horiuchi S, "Increase in Maximum Life-Span in Sweden, 1861-1999," Science Sep 29 2000; 2366-2368.]

biomedical technologies focused on the early detection, prevention, and treatment of aging-related The goal of anti-aging medicine is no to merely prolong the total years of an individual's life, but to ensure that those years are enjoyed in a productive and vital fashion. When I co-founded the

disease.

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Anti-Aging

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ANTI-AGING IS A HEALTHCARE MODEL PROMOTING INNOVATIVE SCIENCE AND RESEARCH

TO PROLONG THE HEALTHY LIFESPAN IN HUMANS

American Academy of Anti-Aging Medicine (A4M; www.worldhealth.net & www.a4m.com) in 1991, we established the field of anti-aging medicine as a direct extension of sports medicine. Just as sports medicine aims to keep the athlete’s body functioning at its optimum level, anti-aging medicine seeks to keep the body functioning at its peak. In other words, the similar principle, of extending and maximizing the healthy human lifespan, is at the core of both anti-aging medicine and sports medicine.

The anti-aging lifestyle can add 25.3 more years of productive lifespan. Researchers from the Harvard School of Public Health found that the longest-living Americans are Asian-American women residing in Bergen County, New Jersey USA. They live longer than any other ethnic group in the United States – to an average lifespan of 91.8 years. In contrast, the Harvard team found that the shortest-living Americans are Native American populations in South Dakota, despite receiving free or low-cost government provided medical care - living an average lifespan of 66.5 years.

Around the world, people are seeking medical guidance for ways to stay healthy, active, and vital well into their older years. The exponential growth in the popularity of anti-aging medicine is largely a result of the global demographics shift towards a swelling aging population. The United Nations observes that: “The world is in the midst of a unique and irreversible process of demographic transition that will result in older populations everywhere. As fertility rates decline, the proportion of persons aged 60 and over is expected to double between 2007 and 2050, and their actual number will more than triple, reaching 2 billion by 2050. In most countries, the number of those over 80 is likely to quadruple to nearly 400 million by then.” [http://www.un.org/en/globalissues/ageing/index.shtml.]

As a group, the Bergen County women have ready access to preventative health services, consume a healthy diet, received higher education, are/were professionally employed, and enjoy a network of family and friends. These are proven life-extending factors that – when combined, exert a synergistic effect on longevity. These factors are also the cornerstones of the anti-aging medical model. [“Bergen County, NJ is long in longevity,” New York Times, September 12, 2006; “Asian women in Bergen have nation’s top life expectancy,” Free Republic, September 12, 2006; “Asian-Americans live well in Garden State,” Wall Street Journal, Nov. 15, 2010.]

As a patient-centric, wellness-oriented model of advanced clinical preventive medicine, the principles of the anti-aging medical model are gaining rapid and widespread acceptance as a framework for lifelong habits for healthy living. This innovative medical specialty is achieving demonstrable and objective results that beneficially impact the degenerative diseases of aging.

CLINICAL OBJECTIVES OF ANTI-AGING MEDICINE The clinical specialty of anti-aging medicine is concerned with extending lifespan – the maximum number of years a person lives, as well as healthspan – how well, absent of infirmity and disability, a person lives. Currently, clinical approaches to enhance the healthspan while extending the lifespan are conducted in twelve major focus areas, as listed in Table 1.

Table 1. Major Focuses of Clinical Anti-Aging Medicine Anti-Aging Endocrinology & Hormone Replacement Therapy Antioxidant Analysis & Optimized Supplementation Maximized Immune Function

Metabolic & DNA Repair

MEDI CAL SPAS • October 2014

A ten-year long study of 2,432 elder Canadians demonstrated that the most important predictors of excellent health were: • Absence of chronic illness • Annual income over US $30,000 • Having never smoked • Drinking alcohol in moderation • Maintaining a positive outlook, managing stress levels The study authors conclude that: “Many of these factors can be modified when you are young or middle-aged. While these findings may seem like common sense, now we have evidence of which factors contribute to exceptional health [as we age].”

[Kaplan MS, Huguet N, Orpana H, Feeny D, McFarland BH, Ross N.“Prevalence and factors associated with thriving in older adulthood: a 10-year population-based study.” J Gerontology Series A, October 2008.]

Skin De-Aging & Repair

Lifestyle Modification Musculoskeletal Rehabilitation-Sports Detoxification Medicine-Conditioning Cardiovascular Protection Biomarkers of Aging Assessment Cognitive Function Assessment & Repair Prospective Advanced Diagnostics

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Anti-Aging

www.medicalspasreview.com

The precepts of the anti-aging lifestyle are validated as key approaches that help people to maintain physical and cognitive capacities as they age. Severine Sabia, from University College London (United Kingdom), and colleagues studied a group of 5100 men and women, ages 42 to 63 years, who were enrolled in the Whitehall II study. The team defined a set of four healthy behaviors: namely, never smoking, moderate alcohol consumption, physical activity (2.5 h/wk or more of moderate physical www.medicalspasreview.com

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THAT ARE CONSISTENT WITH THOSE APPLIED IN OTHER PREVENTIVE HEALTH SPECIALTIES

ANTI-AGING MEDICINE IS BASED ON PRINCIPLES OF SOUND AND RESPONSIBLE MEDICAL CARE activity or1 h/wk or more of vigorous physical activity), and eating fruits and vegetables daily. We defined successful aging, measured over a median 16.3-year follow-up, as good cognitive, physical, respiratory and cardiovascular functioning, in addition to the absence of disability, mental health problems and chronic disease (coronary artery disease, stroke, cancer and diabetes). The researchers revealed that people in the successfully aging group were younger than the normally aging group (mean age 49.7 versus 51.3 yr), and 81% were married compared with 78% in the second group and 71% in the deceased group. Successful agers were more likely to have higher education than the normally aging group (32% v. 24%) and 18% in the deceased group. In the study population, Observing that: “participants engaging in all 4 healthy behaviours had 3.3 times greater odds of successful aging,” the study authors conclude that: “Although individual healthy behaviours are moderately associated with successful aging, their combined impact is substantial.”

[Severine Sabia, Archana Singh-Manoux, Gareth Hagger-Johnson, Emmanuelle Cambois, Eric J. Brunner, Mika Kivimaki.“Influence of individual and combined healthy behaviours on successful aging.” CMAJ, October 22, 2012]

Anti-Aging

TOP FIVE ANTI-AGING BIOTECHNOLOGIES FOR PRACTICAL IMMORTALITY We are experiencing the dawning of an exciting new era in medicine, one which will result with longevity intervention orders of magnitude greater than any other advancements made in medicine to-date. The A4M submits that there are five key biotechnologies that will impart a vast wealth of knowledge about the most basic cellular mechanisms of aging and sickness. As such, taken collectively, these five biotechnologies compose are the singlemost important contribution which will enable mankind to overcome its oldest, most debilitating, and most elusive disease -- old age. As a result of the quantum leaps in biotechnology, it is within reason to expect that Practical Immortality -- human lifespans of 120 years -- may well be achieved by the year 2029.

THE ROLE OF BIOMEDICAL TECHNOLOGIES We are currently witnessing unprecedented leaps in medicine and healthcare that have resulted from discoveries in biotechnology. According to the Biotechnology Industry Organization: • Currently, there are more than 250 biotechnology health care products available, many for previously untreatable diseases.

• Today, there are more than 200 biologic medicines that benefit millions of patients worldwide.

• There are more than 1,200 biotech diagnostic tests being used in clinics around the world.

• More than 600 new biologic medicines are in development, including treatments for cancer, HIV/AIDS, Alzheimer's disease, and numerous rare conditions. [“What is Biotechnology?; and “”Healing the World,” Biotechnology Industry Organization. www.bio.org ; accessed 3 Feb. 2014.]

In short, modern biotechnology provides breakthrough products and technologies to combat debilitating and rare diseases. Biotech is improving the odds for millions of patients around the world with life-threatening conditions and helping to combat everyday threats confronting the developing world.

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Today, over 800 drugs are in the Pharma pipeline to “combat the diseases of aging”; these may extend the human lifespan to 80 years. Near-term regenerative biomedical technologies – namely stem cells, DNA repair, telomerase modulation – may be available by 2029, potentially resulting in a human lifespan of 120 years. Advanced regenerative biomedical technologies - from artificial organs to machine-based human enhancements – perhaps available 2050 to 2095, may achieve a human lifespan of 150 to 200 years.

TOP BIOTECH #1. Stem Cells Generally speaking, stem cells are self-renewing primitive cells that can develop into functional, differentiated cells. They have the unique ability to be manipulated by genetic engineering to give rise to specific cell types. The culmination of stem cell research is to achieve a plentiful source of human cells for transplantation. www.medicalspasreview.com

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Anti-Aging

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"ANTI-AGING" RELATES TO THE APPLICATION OF ADVANCED BIOMEDICAL TECHNOLOGIES

FOCUSED ON THE EARLY DETECTION, PREVENTION, AND TREATMENT OF AGING-RELATED DISEASE

University of Pittsburgh (Pennsylvania, USA) scientists improve the lifespan of mice with an aging disease (progeria) by injecting them with normal stem cells, prolonging their lifespan by two to three times: • The stem cells, which were derived from the muscle of young, healthy rodents, did not migrate to other tissue in the body, and appear to have secreted a growth factor that delayed the aging process..

• Instead of losing muscle mass and moving slowly, the animals grew as large as normal ones.

The study authors write that: “These results establish that adult stem/progenitor cell dysfunction contributes to ageing-related degeneration and suggests a therapeutic potential of post-natal stem cells to extend health.”

[Mitra Lavasani, Andria R. Robinson, Aiping Lu, Minjung Song, Laura J. Niedernhofer, Johnny Huard, et al. “Muscle-derived stem/progenitor cell dysfunction limits healthspan and lifespan in a murine progeria model.” Nature Communications 3, 3 January 2012.]

46

naturally occurring dietary agents like luteolin has many advantages and may have potential application in chemoprevention in clinical settings.”

[Debatosh Majumdar, Kyung-Ho Jung, Hongzheng Zhang, Sreenivas Nannapaneni, Xu Wang, Dong M. Shin, et al.“Luteolin Nanoparticle in Chemoprevention: In Vitro and In Vivo Anticancer Activity.”

Cancer Prev Res, January 2014; 7:65-73.]

TOP BIOTECH #3. Genomics Personalized medicine is a field of medicine that involves the determination of each individual’s unique molecular characteristics and to use those genetic distinctions to diagnose more finely an individual's disease, select treatments that increase the chances of a successful outcome and reduce possible adverse reactions. Personalized medicine also is the ability to predict an individual's susceptibility to diseases and thus to try to shape steps that may help avoid or reduce the extent to which an individual will experience a disease.

Nanommedicine may be our best armament in treating -- and even curing -- stubborn diseases such as cancer and diabetes. Nano-based approaches deploying micro- and molecular-sized tools to manipulate human tissue biology for microsurgical repair on a gross level, as well as microscopic repair techniques for the most basic cellular level.

To effect personalized medicine, it is essential that reliable personalized genomic data be available for clinical use. To that end, affordable genome testing is a primary goal. A DNA Sequencer costing ~ $149,000 is now able to generate a complete Human Genome Map at $1000 per Map. Utilizing an integrated circuit directly performs non-optical DNA sequencing of genomes and an ion chip with 1.2 million wells to permit parallel, simultaneous analysis, the machine completes a map in 24 hours.

The Study authors submit that: “Development of semiconductor sequencing will have as profound an effect on sequencing as the introduction of [image sensors for] digital photography … it will make sequencing ubiquitous, fast and low cost.”

[Rothberg JM, Hinz W, Rearick TM, Schultz J, Mileski W, Davey M, et al. "An integrated semiconductor device enabling non-optical genome sequencing." Nature. 2011 Jul 20;475(7356):34852. ]

Researchers at the Winship Cancer Institute of Emory University (Georgia, USA), have discovered a more effective drug delivery system using nanotechnology that could one day significantly affect cancer prevention. Dong Moon Shin and colleagues encapsulated microscopic amounts of luteolin, a naturally occurring antioxidant compound found abundantly in green vegetables, in a water-soluble polymer. When injected into mice, the nano-luteolin inhibited growth of lung cancer and head and neck cancer cells. Whereas large quantities of luteolin would need to be consumed to be effective, by concentrating the compound into a nanoparticle and making it easy to dissolve in water, researchers conclude nano-luteolin has immense potential for future human studies of chemoprevention – a technique currently in-use to help stop the recurrence of cancer in patients and reduce the risk of cancer in others. The study authors submit that: “Our results suggest that nanoparticle delivery of

TOP BIOTECH #4. Gene Therapy Gene therapy aims to identify and alter human genetics to ameliorate dysfunctions, disorders, disabilities, and diseases.

A team at University of Pennsylvania (USA) has devised a precision technique to attack the specific targets that are responsible for a patient's disease. The approach is known as chimeric antigen receptor (CAR) cell engineering. The CAR process starts when T cells (naturally occurring immune cells) are extracted from the blood of an individual and outfitted with two powerful features: a receptor on the outer cell surface that recognizes a protein called CD19 present on most leukemic cells and a powerful mechanism inside the cell that triggers it to expand and proliferate once attached to the targeted protein. With these new engineered features, the T cells are injected back into

TOP BIOTECH #2. Nanomedicine Employing nanodevices -- high-tech, miniaturized devices on the scale of billionths of a meter, nanomedicine manipulates human biology at its most basic levels. These tiny tools enable scientists to play on the size scale of biology itself, just as a mechanic works on a car's engine using tools that are on the same scale as the engine.

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Anti-Aging

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the patient, now primed to seek and destroy cancer cells. Studies on the CAR approach provide data on both adult and pediatric patients with leukemia who have responded well to this treatment strategy. Preliminary studies have found that this process may generate responses in as many as twothirds of cases in which all other treatment options have failed. Further, because the cells are derived from the patient, there is an inherently lower risk of toxicity because the cells are less likely to attack the host tissue than cells introduced from a foreign body.

[Barrett DM, Singh N, Porter DL, Grupp SA, June CH. Chimeric Antigen Receptor Therapy for Cancer. Annu Rev Med. 2013 Nov 20.]

Anti-Aging

CONCLUDING REMARKS The future prospects for the quality and quantity of the human lifespan are bright. Advanced biomedical technologies provide a cascade of potential benefits to improve the human condition. The A4M envisions a future in which the worldwide population is free of the diseases that presently ravage old age. This may be achieved as scientists continue to innovate biomedical technologies and apply them to preventive healthcare.

Anti-aging medicine is now practiced by thousands of physicians in private medical offices, as well as at some of the most prestigious teaching hospitals around the world. Universally, those involved in healthcare, or those whose fields of expertise intersect with healthcare issues, support anti-aging medicine as a healthcare model

TOP BIOTECH #5. Nerve-Impulse Continuity Today, both the young and old can succumb to serious medical conditions that are caused by the brain failing to communicate properly with the rest of the body. The majority of these cases are due to spinal cord injury (SCI), which occurs when a traumatic event results in damage to cells within the spinal cord or severs the nerve tracts that relay signals up and down the spinal cord, usually leaving the patient with limited, if any, movement of the body and limbs. In addition, some individuals suffer from damaged brain circuitry, causing them to have cognitive problems, most notably memory difficulties.Repair of damaged brain circuitry is also a key research focus that aims to restore the signals responsible for memory in humans.

promoting innovative science and research to prolong the healthy human lifespan. Public policy organizations and government agencies are now embracing anti-aging medicine as a viable solution to alleviate the mounting social, economic, and medical woes otherwise anticipated to arrive with the aging of nearly every nation on the planet.

A prolonged healthy lifespan – and the practice of the anti-aging medical specialty – beneficially impacts the economic framework of nations around the world. Until we've eradicated the age-related decline in health that leads to many of us becoming dependent and disabled in our older years, society will bear increasing financial costs to sustain the older population. In the absence of scientific solutions that halt the onset of the degenerative diseases of aging, the elderly support burden may swell and compromise the economic and social

University of Washington (Washington, USA) researchers have performed what they believe is the first noninvasive human-to-human brain interface, with one researcher able to send a brain signal via the Internet to control the hand motions of a fellow researcher. Using electrical brain recordings and a form of magnetic stimulation, Professor Rajesh Rao sent a brain signal to researcher Andrea Stocco who was on the other side of the university campus, causing Stocco’s finger to move on a keyboard. The technologies used by the researchers for recording and stimulating the brain are both well-known. Electroencephalography, or EEG, is routinely used by clinicians and researchers to record brain activity noninvasively from the scalp. Transcranial magnetic stimulation is a noninvasive way of delivering stimulation to the brain to elicit a response. Its effect depends on where the coil is placed; in this case, it was placed directly over the brain region that controls a person’s right hand. By activating these neurons, the stimulation convinced the brain that it needed to move the right hand. While researchers at Duke University have demonstrated brain-to-brain communication between two rats, and Harvard researchers have demonstrated it between a human and a rat, this is considered to be the first successful demonstration of human-to-human brain interfacing. [“Direct Brain-to-Brain Communication in Humans: A Pilot Study,” Univ. of Washington, August 12, 2013.]

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frameworks of many industrial nations. In that anti-aging medicine is a healthcare model promoting innovative science and research to prolong the healthy lifespan in humans, In many respects, the most important contribution of the A4M is to provide the tools by which nations will effectively reduce disabilities, diseases, and dependencies otherwise associated with aging and greying populations.

The American Academy of Anti-Aging Medicine (A4M; www.worldhealth.net & www.a4m.com) is the leading resource for physicians and health practitioners pursuing education and training in the fast-growing medical specialty, as well as the trusted informational reference for consumers seeking to learn ways to promote an extended, healthy, productive, fit, and vital lifespan.

Internet’s #1 Ranked Anti-Aging educational website and official educational outreach portal of the A4M, and sign up for the FREE Longevity Magazine™ e-Journal, your weekly health e-newsletter featuring wellness, prevention, and biotech advancements in longevity.

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