WASHINGTON - Atousa Yazdanfar wanted bigger breasts, but wasn't happy with the prices quoted by seven or eight plastic surgeons - about $6,000 for the implants.
So, as an enterprising person in the cyber-age, the Long Beach, Calif., woman went to a Web site, posted a request for breast implants and held an online auction. Plastic surgeons bid on the procedure, and she eventually chose the lowest bidder at $3,500. The surgery last month was a success, she said.
"I just wanted to go bigger," said Yazdanfar, 26, who now has size 34-DD breasts. "I couldn't be happier with the results. It's amazing."
Yazdanfar isn't alone in having doctors bid online for business. In a strange twist on the burgeoning use of cyberspace to hawk goods - ranging from cars to baseball cards - people are holding online auctions to find cheaper elective surgery.
So far, the practice involves only a handful of Web sites and is hardly a trend. Yazdanfar used Medicine Online, a California site that began offering cyber auctions in March. Early next year, a Wisconsin firm plans to hold auctions for more serious operations, including open-heart surgery and orthopedic procedures.
The collision of the Internet and surgery was inevitable, say ethicists and those who run the auction sites. The Internet has become a popular tool to find deals, and medicine has evolved into a high-stakes business concerned about the bottom line, they said.
"I wish I could say I was surprised," said Arthur Caplan, who heads the Center for Bioethics at the University of Pennsylvania. "We've decided that medicine is a marketplace."
Some warn that the Internet auctions could lead to problems.
"You can't price your bodies like a commodity," said Dr. Roger Greenberg, former president of the California Society of Plastic Surgeons. "Who is likely to quote the lowest bid, the busy surgeon or the not-so-busy surgeon? Buyer beware."
Medicine Online - www.medicineonline.com - specialized in providing information to physicians and hospitals before it launched its auction site. The company's officers decided they needed to do something different to save their business from folding like so many other content-based Web sites.
"We really couldn't make money the way we were doing business," said David Puffer, a Medicine Online vice president. "When a physician pitched [auctions] to us, we thought it was crazy. Now, we're kicking ourselves for underestimating consumers."
In its first three months, Puffer said, Medicine Online linked more than 1,000 patients with physicians through the bidding process, but has not kept track of statistics since.
More than 350 doctors participate in the Medicine Online bidding process nationwide, Puffer said, though not every state is represented and some patients have been unable to find a doctor through the site.
Medicine Online doesn't charge any fees right now, Puffer said, because it is hoping to build a name and capture the market. Eventually, the company plans to charge patients a 2 percent fee for each surgery.
The company is surviving on money supplied by its original investors, Puffer said.
The site works much like other popular online auction houses, only in reverse. Prospective patients log on, fill out an online questionnaire describing their desired surgery, and doctors respond by posting their fees. Some doctors have even opted for an automated response that posts their fees anytime a specific surgery comes up, Puffer said.
Potential patients then view a Web page that shows the fees, and they can decide whether to click on links to read more about the doctors offering the surgery.
Those online resumes contain such information as how many procedures the doctors have performed, where they obtained their medical degree and whether they have been sued.
Patients get free consultations with the surgeons before deciding to go forward, Puffer said, and the lowest bidder doesn't always get the work.
"You better have peerless credentials if you are the lowest or highest bidder," Puffer said. "If you're the lowest, the patient is asking what is wrong with you. If you are the highest, you better be pretty darn good."
Medicine Online checks to make sure that its doctors are certified and have hospital privileges, but Puffer said patients should double-check the other items on the doctor's resume.
The auctions are supposedly blind. Doctors are not told what other physicians are bidding, though they can easily log onto the site to discover the prices other doctors are quoting, Puffer said.
A Wisconsin company also has decided to enter the online surgery world by early next year. PatientWise - www.patientwise.net - will offer a similar service, but focus on more extensive procedures such as cancer and brain surgeries in addition to open-heart and orthopedic operations, said Brad Engel, chairman of the company's board.
'Surgery is risky'
Medical ethicists, surgeons and regulators are wary of the online world intruding on medicine.
The American Medical Association has taken no stance on medical auctions, but Dr. Donald Palmisano, a member of its board, said the practice was troubling.
"The AMA doesn't believe that patients should select physicians based on price alone," he said. "Going online, getting the lowest bid and then going to that individual, we don't think that is good medicine."
"We're saying that medicine is a profession, not a routine business," he added. "Every surgery is risky. We're not dealing with widgets here."
Some regulators also worry that the Internet might trivialize cosmetic surgery, making it seem easy and safe.
"Using the Internet is a really stupid way for someone to choose a surgeon," said Janie Cordray, a researcher with the California Board of Medicine. "There are a lot of deaths and unhappy patients from even the most qualified surgeons. ... Qualified surgeons do not have to advertise in this aggressive way."
Even doctors who use Medicine Online say they are concerned about the effect the auctions might have on their profession. Dr. Seth Goldberg of Rockville began using the site in March and has gotten three referrals through the process. But none of those patients has decided to go forward with the surgery yet.
Goldberg decided to use the site, he said, because it seemed like good marketing in the increasingly competitive world of cosmetic surgery. "It was an interesting and fascinating idea," he said.
But Goldberg now has "mixed feelings," he said, because he doesn't feel the site does enough checking of credentials.
"Anyone can claim they can do something," he said. "The patient wouldn't know. I can claim to do breast implants and have never done one."[Goldberg and Yazdanfar gave Medicine Online permission to provide their phone numbers to The Sun. The names of Medicine Online's patients and doctors ordinarily are confidential, the company said.)
The California Board of Medicine and Medicine Online say they have not received any complaints about surgeries related to the auctions.
Yazdanfar heard about Medicine Online through a news report on television, went through the bidding process and selected a California surgeon to perform the surgery.
It was her second breast enlargement in five years. In 1996, she went from a 34-A to 34-D, and that wasn't her only procedure. She's had four nose jobs, and some of that surgery was necessary, she said, to correct shoddy work.
"I've had some bad experiences with other surgeries," she said. "I had to learn the hard way. Every surgery is a risk."
Venturing into cyberspace proved to be a risk worth taking, Yazdanfar said. She was so pleased that she sent a testimonial e-mail to Medicine Online, extolling the success of her surgery.