Canadian doctors are embracing cosmetic surgery and abandoning less lucrative fields, says the magazine Macleans. "In 15 minutes I can inject Botox and make three, four, five hundred dollars," says a Toronto dermatologist. "In the same 15 minutes I can excise a malignant melanoma and make $50." And as doctors abandon family medicine, dermatology and other specialities to provide firm, unlined, hairless skin for ageing baby-boomers, the availability of care for people who are actually sick is diminishing -- although perverse incentives created by the Canadian health care system certainly play a role in this, as well.

Whatever the reason, cosmetic medicine is becoming more and more popular with Canadian doctors. Morale is another factor. Cosmetic patients are normally happy and appreciative, while patients in a family medicine practice are cranky and sick. Cosmetic surgery is also more adventurous in terms of medical technology.

But doctors acknowledge that cosmetic medicine can be quite different from traditional medicine: patients become customers. And in a consumer marketplace which tries to maximise self-esteem rather than health, customers make their own diagnoses. A bioethicist at the University of Victoria, Eike Fuller-Kluge, comments that any kind of cosmetic surgery, apart from repairing deformities, is ethically suspect. "As soon as you start moving into beautification, the patient becomes an object, an easel on which the doctor can create. That constitutes a fundamental shift to medicine as a commodity."