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Doctoring the Web 

A plastic surgeon has positive online reviews. But not from that patient who died.

Wednesday, Sep 15 2010

Page 2 of 4

On Aug. 14, 2008, trosecra posted the following on "Perfect Breasts!!!...Usha [Dr. Rajagopal] is an incredibly nurturing, warm person that loves what she does (and it shows!)...I always wanted to have breast augmentation surgery ever since I was 14, and it was the best decision!"

On Oct. 24, 2008, a posting appeared on in which "trosecra" encouraged those with so-called man boobs to see Rajagopal. "I had gynecomastia procedure performed by Dr. Usha Rajagopal, and just wanted to let everyone know what a great surgeon she is," trosecra wrote. "I was also recommended by a friend that was really happy with what a kind, experienced doctor she was. He gushed so much, I had to check her out." The post also included before and after photographs of a man's chest: "I ... felt so happy with the results, I thought I'd share them with everyone else." Later, trosecra engaged with another user who was asking questions about the procedure. "Best decision I ever made!!" trosecra wrote. "Usha's a great doctor. I highly recommend her."

Reached by phone for an interview, Rosecrans explained how she was able to raise Rajagopal's profile. "A lot of it is based on natural reputation and contacting websites and people who have worked with her," she said. Rosecrans claimed she guides a process in which Rajagopal's office manager contacts patients after their surgeries and asks them to help promote the doctor.

When asked whether she ever contacted the patients or posted reviews herself, Rosecrans said no. "I don't post any reviews directly," she said.

When asked why her screen name was attached to positive reviews of Rajagopal, Rosecrans changed her answer. "I did write one review for the doctor," she said quietly. "That was because I actually went through a procedure with her."

Rosecrans denied that she had ever posted as a man. "If you could forward that to me, it would be interesting to look at," she said. The reporter did so, and asked follow-up questions about whether there was any explanation for Rosecrans' distinct screen name popping up with positive reviews for Rajagopal. She did not respond. Numerous calls and e-mails to Rajagopal and her lawyer also went unreturned.

One medical corporation has been formally caught astroturfing: plastic surgery franchise Lifestyle Lift. The medical corporation has about 40 locations across the United States, and was prosecuted last year by the New York state attorney general's office for instructing employees to pretend to be patients and spam the Internet with positive reviews.

The attorney general's office discovered the fraudulent reviews and fabricated websites purportedly started by patients of Lifestyle Lift, but was unable to prove the franchise was behind the effort until it subpoenaed corporate e-mails. They revealed how employees had been instructed by their superiors to pose as patients and send out fake reviews with the purpose of improving the reputation of the center. One e-mail told an employee to "put your wig and skirt on and tell them about the great experience you had."

The employees started websites such as the now-defunct, pretending to be satisfied customers who had nothing but wonderful things to say about their surgeries. "Ann" created a plausible-sounding journal about how she initially read horror stories about Lifestyle Lift online. "People were trashing Lifestyle Lift, their employees, their doctors, etc. I got scared and seriously thought about canceling my procedure," she wrote.

Instead, Ann apparently did her own research in the waiting room, and found that the other patients were "pretty happy." "Those negative stories did not add up at all," she wrote. "Lifestyle Lift had done thousands of procedures, their doctors are board certified, and they have doctors from Harvard, Stanford, and all the top universities in the county." She concluded that the negative stories were "made up" and had come from jealous doctors.

Of course, it turned out that Ann was the one who was made up.

"This company's attempt to generate business by duping consumers was cynical, manipulative, and illegal," New York state Attorney General Andrew Cuomo announced in July 2009.

Lifestyle Lift received a $300,000 fine, and the franchise also agreed to take down the misleading web posts. "The case is believed to be the first in the nation aimed at combating astroturfing, a growing problem on the Internet," Cuomo's office stated in a press release. The release also touched on the franchise president's excuses for engaging in the practice. Apparently he believed that negative Internet postings had hurt his company's reputation, and its success hinged on controlling what was communicated online.

In this case and others, though, it seems that the phony, glowing reviews are also used to cover an ugly reality.

According to the New York state Office of Professional Medical Conduct, one of Lifestyle Lift's doctors, Douglas Halliday, was charged last year with 10 counts of professional misconduct. One charge involved him injecting patients with what he told them was Botox but was in fact an unapproved drug. Halliday was put on probation and fined $20,000.

Here in the Bay Area, RateMDs' Swapceinski has seen hundreds of cases of obviously fraudulent reviews on his site, which can often be caught by an automated process meant to catch fakers. It "looks at things like IP addresses, cookies, the kind of browser the person uses, and how often the doctor was rated," he says. "It goes through, and anything suspicious is deleted." Readers of the site can also click on a red flag next to a posting and then explain why they believe the review should be deleted: "Sometimes they're able to prove to us that it's false, in which case we will delete."

A search for Rajagopal at RateMDs brings up three anonymous reviews, all of which have given her perfect scores (five out of five) in each of four categories: staff, punctual, helpful, and knowledge.

About The Author

Ashley Harrell


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