Lecture by Dirk Brandl, speaker of NETWORK-Lipolysis
Welcome to the subject of networks. Most of you will already know me. My name is Dirk Brandl, and I am responsible at this event for outlining the ways in which our network can be expanded. So I wish to start by giving a brief overview of the themes I would like to discuss with you.
Theme 1: What is a network?
Theme 2: NETWORK-Weightdoctors/Network Alizonne
Theme 3: NETWORK-Aesthetics
Theme 4: NETWORK-Globalhealth
Just what is a network and in what way does it differ e.g. from a medical society?
The term “network” has become increasingly used recently as a consequence of cybernetic and system-theory thinking. The central outcome of research in these two fields of science calls for a paradigm change in the sciences in general. It has, namely, shown that a research topic cannot be viewed in isolation without running the risk of producing incomplete or distorted scientific results, since the context in which a subject of investigation exists (its milieu, its multifarious relationships to other subjects) also plays a constitutive role. All of these connections and relationships can be embraced in one term: a network.
Networks develop spontaneously and in accordance with principles that were first explored mathematically in connection with the chaos theory. Accordingly, our NETWORK Lipolysis developed as a spontaneous response to a dynamic situation. Networks have no hierarchical structure, and each node of a network is of equal importance. Networks are linked with other networks that exist beside, above and below them. Networks always develop outside of a state of equilibrium, through feedback loops and through the constant interaction of the objects linked to each other within the network.
Thus, out of the currently developing Lipolysis and Weightdoctors Networks, a further superordinated structure is now starting to grow, which we have called NETWORK-Aesthetics. I will say more about this later. This superordinated structure is not something we planned and constituted on the drawing board. We simply concerned ourselves with the development of the sub-networks that may be able to offer our members new developments in the field of aesthetic medicine, and in which you can be involved right from the start. The logical conclusion from this is that the individual networks need a joint superstructure that is in the position to foster an intensive exchange of experience – i.e. the NETWORK-Aesthetics, which you are now becoming part of.
Treatment of overweight in networks
I would like to illustrate the network idea more closely taking 3 examples that have to do with your activity. With the first example, I will focus on the subject of the treatment of weight problems, which also has marginally to do with our lipolysis therapy, but more particularly relates to the NETWORK-Weightdoctors. You will no doubt be frequently visited by overweight patients who expect to be treated by you. Overweight and obesity are a phenomenon that has increasingly concerned us in the last few years. But unless we view overweight as a multisymptomatic phenomenon, the therapies we offer will only have limited success. So it is worth knowing more about the complex of symptoms behind this phenomenon, of which I will list just a few: Eating disorders always have a psychosomatic component that expresses itself in addictive behaviour. Sensual needs are substituted by oral needs, or are reduced to them, and can hence affect the entire metabolism. The reason for the progressive growth in the problem of overweight can, to put it generally, be found in the change in the way people live. But no one cause can be defined in isolation as the main reason for these changes; rather, there are a whole complex of different factors in a dynamically developing situation: Greater flexibility leads to changes in eating habits, changes in family structures generate changes in the consumption of food, the increased volume of media offerings result in lack of movement and exercise, and changes in the working world, away from hard physical work, mean reduced calorie needs. All these causes, together with insecurity arising from the increased pace of our societies, with stress as a symptom of how we deal with this, have changed our attitude towards our own bodies and to our intake of nutrition. Attractive appearance is becoming ever more important as an indicator for success in the career and other areas, whatever our own feelings may be. Also the genetically conditioned form of obesity cannot be viewed in isolation, since it is also a form of network, passed on from generation to generation, but whose causes can nevertheless be of a social nature, for social problems can also be inherited.
So as you can see, in these complexes we already have to do with psychological causes, and even with social problems. The increasing individualisation of our commercialised society creates an illusion of independence. Sensual inter-human contact, one of the phylogenetic preconditions for the development of mankind, can no longer always be satisfied as a matter of course. Individuals therefore resort to substitutes. In the past, when overweight was only an occasional problem, people needed one another; today, they use one another. This is a fact that every doctor should be aware of, and unconsciously, most doctors are. In psychotherapy, it has long been realised that there is no point treating the individual in isolation; the environment in which he or she lives also plays a major role, if changes are to have any long-term effect.
Network work therefore means thinking and acting within a context. Overweight is a phenomenon that extends across many interlinked network levels – social networks, economic networks, family networks, psychosomatic networks, networks within the body, as well as medical networks – and can therefore only be properly treated if due regard is had to this. A meaningful response to this situation is, for example, our NETWORK-Weightdoctors/Network Alizonne with the Alizonne therapy of Dr. van der Lugt.
The second example concerns not only doctors, but everyone else, too. Recently, the subject of globalisation is one that is talked about everywhere, with the implication that it is a new phenomenon that did not exist before. To my knowledge, however, we have always lived on this planet and, as chaos theory and system theory have shown, everything has always been connected to everything else. Consider, for instance, that peoples have developed historically in the same way, without any communication or linguistic contact between them. We are all of us tied into networks at all times in our lives. All doctors are part of the worldwide network of medicine with its many sub-networks, without which they would not be able to practise.
We are frequently not aware that we exist within networks, and indeed that the whole pattern of life is one of networks. We are only just starting to realise that we have always been linked to one another and that everything is dependent on everything else, and we describe this with the term globalisation. However, this is in fact only a correction of our awareness. Why is it that previously we did not consciously have this knowledge, but it is only now thrusting itself on our awareness? The market, our historical agent, implacably shows us what globalisation is, and we have to make our decisions dependent on global factors. Whether we want to or not, we cannot change these market laws. They are as they are. What we can do, however, is live up to them better, so as to be better able to generate synergies out of these complex relationships, which have always existed but which were unknown to us. This will lead us to overcome our self-centredness and provinciality. That, for me, is the new meaning of globalisation, and with this new awareness, we are better equipped to meet the great crises of our time. So a network is a pool against competition and is at the same time a good balance against the everyday, competitive isolation in our careers.
The bacterial network
A third, and final, example of a highly lively network – and one which has strongly influenced the living conditions of bigger networks and indeed of our planet as a whole – is the highly interesting network of bacterial organisms. It is the oldest network known to us, and at the same time has entered into symbiotic relationships with other networks, for instance the human organism, while the permanent exchange of genes between bacteria of one kind is the defining structural characteristic of this particular network.
Because of the specific conditions under which they have developed, social networks may be more or less effective.
Networks function effectively and can generate synergies for their members if they are moderated by network specialists. This is the case with NETWORK Lipolysis. It should, however, be remembered that the development conditions in each network are different and depend to a large extent on where and how they started. As lipolysis is a therapy which is still only in its infancy, the work of the moderators in NETWORK Lipolysis is aimed at enabling all the members to contribute to the development and standardisation of the therapy. You have all done this in an outstanding manner thanks to your many and varied activities. For this, we as moderators can only express our highest praise.
Involvement in a network calls for a fundamental paradigm change on the part of the members, whereby our job as moderators is to facilitate this. The new paradigm is: The members are the NETZWERK. The living interaction between the members is what generates the quality of the network. The members are not served; they must serve themselves, and each other.
Under this new paradigm, the doctors are the NETWORK, and are themselves individually and creatively responsible for the state of the NETWORK. As a result, causes for confrontation and dissatisfaction become tasks for which solutions must be found through everyone working jointly. The assumption of responsibility also includes drawing attention to as yet insufficiently developed aspects of the NETWORK, but always on the premise that all the members together are responsible, and not external forces or an ominous leadership. It must thereby be remembered that especially social networks have never yet proved susceptible to complete planning and are not subject to simple implementation mechanisms. There is hitherto simply too little knowledge about their constitutional conditions, and there are therefore limitations on the extent to which they can be moulded. Therefore, you must definitely not view us as the architects of such social networks – and this also includes NETWORK Lipolysis. If I do see us as possessing one positive characteristic that can go some way towards offsetting this weakness, it is that we have our own consciousness of the wrong tracks, weakness and development needs, and are well aware of our limitations. One of the results of this is that we do not respond negatively to criticism but have developed a positive attitude towards argument.
As doctors, dealing with matters of life and health of your patients, you know in any case that you always have to bear the full and sole responsibility for your actions. The same also applies to your participation in the network. This paradigm shift, i.e. away from placing responsibility in the hands of a static hierarchy of the kind that exists in other organisations, to the assumption of responsibility for the nature and state of the NETWORK by the individual members, frees up possibilities for cooperation and synergies that are not prevented in other constellations. The greatest synergy effects always arise where no-one expects anything of others, but where everyone contributes to the best of their abilities and so enriches the whole system, for the system development lies in their own hands and has the character of a process which is never static and therefore also uncovers gaps and aspects where further development is necessary.
Feeding each other
A very good metaphor for the new paradigm can be found in a Jewish story that tells of a rabbi having a conversation with God about heaven and hell. “I’ll show you hell”, says God, and leads the rabbi into a room with a big table in the middle. The people sitting round the table look starved and in desperate. In the middle of the table, however, stands an enormous pot with stew that smells so delicious as to make the rabbi’s mouth water. Everyone round the table is holding a spoon with a very long handle. Although the spoons are just long enough to reach the pot, the handles are longer than the arms of the potential eaters. As they can therefore not put the food in their mouths, no one can eat. The rabbi sees that their suffering is indeed terrible.
“And now I’ll show you heaven”, says the Lord, and they go into another room that looks exactly like the first. In the middle of the room stands the same big round table, and in the middle of the table the same pot with stew. The people are holding the same long-handled spoons as next door – but this time, they are all rotund and well-nourished, and are laughing and talking. The rabbi is completely at a loss. “It’s easy, but it calls for a certain skill”, says the Lord. “In this room, you see, they have learned to feed each other.”
To give an example of this kind of synergy effect: The development of our therapy standards in NETWORK Lipolysis has proceeded at tremendous speed. If you compare the introduction of botox – without moderation – with the introduction of lipolysis, you will find that we have saved a time of about 10 years. This has only been possible thanks to the activity and cooperation of all our members.
Which brings me to the end of our first theme, namely the question of “Just what is a network?”
I would now like to indicate how we have worked in the last few years, taking the example of the NETWORK-Weightdoctors/Network Alizonne. At our members congress in 2004, in addition to her main topic of ultrasonolipolysis, Dr. van der Lugt also gave some information on her Alizonne therapy against overweight and adiposity which she has now been developing for over 8 years. I believe that all those who were present at the time will confirm that her results, and especially the pictures she showed, were breathtaking. Following the congress, both we ourselves and Dr. van der Lugt received numerous inquiries about this therapy. At that time, we had no thought of setting up a further network. In the course of the last year, however, we met with Dr. van der Lugt and her husband, Peter Beckers, altogether 15 times in order to discuss the possibilities for multiplying her therapy. And during that time, a relationship of trust developed between us, with the result that we jointly decided to set about the task of establishing a corresponding network. You have already received detailed information on Dr. Claudia’s Alizonne therapy, and therefore know what I am talking about. It soon became obvious to us that Dr. Claudia is treating overweight patients with great success. What we had to find out was whether the therapy owed its success to Dr. Claudia’s personality, or whether it could also be applied equally successfully by other doctors working with the Alizonne protocols.
Once we had seen that the therapy was capable of multiplication, it was necessary to develop a concept which, as in NETWORK Lipolysis, would enable the treating doctors to develop in line with the development of the therapy. However, there was one major difference between the Alizonne therapy and injection lipolysis: the Alizonne therapy is already fully developed, and a ready-to-use treatment concept already exists. This is not the case with injection lipolysis. In the latter, you are all developing the therapy standards together, and there is still a lack of serious research.
What they do have in common, on the other hand, is that support through medical marketing is both meaningful and beneficial for the members.
For us, the creation of this new network gave rise to the question of what Alizonne has to do with injection lipolysis. While lipolysis is also used by Dr. Claudia as a complementary aesthetic treatment, it is not a central element of the Alizonne therapy.
Therefore, the two networks either had to exist independently of one another, or there should be a link between them on a higher level: We have found this by developing – jointly with Dr. Claudia and Dr. Franz – the idea of the NETWORK-Aesthetics. The NETWORK-Aesthetics is a superordinated network, which can be followed by further sub-networks. While we took account of the members’ views by taking close note of the responses to Dr. Claudia’s presentation, the decision was ultimately taken by ourselves. This was understandable, given the dynamic and sometimes whirlwind development, but in terms of our network philosophy, this must change. We have already received further requests for other networks. However, we no longer wish in future to be the ones who decide on whether a therapy should be adopted or not. This has been one of our clear insights from the development of the past year: All Network members should vote on the adoption of a new therapy and the establishment of a new sub-network, and hence decide on whether a particular therapy should be part of the Network-Aesthetics in future or not.
Collaboration and assistance
Additionally, we would call on you all to contribute your own ideas to this new network. Have you developed a new therapy yourself? Are you a specialist in a certain therapy which you believe should have a firm place in the network? Or do you know or know of a colleague who has developed a new therapy or has outstanding knowledge in an existing therapy which you regard as important for the incipient network? If so, please contact us directly about these and similar questions, or raise them with us.
A further question which arises from this practice-based conception for the structuring of new networks is how new networks should be integrated in future. We have our own ideas on this, which we would now like to discuss with you:
Before we accept a therapy as a network therapy, we believe that all members should vote on it individually. This vote would empower us to conduct further research and initially test the therapy: Is it successful? Is it a better alternative than or at least as good as existing therapies? Can it be of interest for a large number of network members? What benefits does this alternative therapy offer the patients? What investment costs would be incurred by the members before they can offer the therapy? These are just some of the questions that would need to be answered. If this initial research produces a positive vote, the new therapy should then be tested by selected members. Only when this test has also proved positive, would we accept the therapy and build a new sub-network around it. Let us stay for a moment with NETWORK-Weightdoctors: Here, there is the theoretical possibility that other, equally successful weight reduction therapies may be offered to us. If we accept them, this then means that we can offer and recommend a range of additional possibilities. These should, however, meaningfully complement the Alizonne therapy; the individual therapies must not be mutually contradictory.
For every therapy, we need to know its specific capabilities and limitations, and we need to be able to offer the members absolutely first-rate training in use of the therapy. We should also – and I view this as a particularly important point – investigate the market and calculate the cost-effectiveness in relation to the investments. To refer once more to the Alizonne therapy. The training is excellent. The market is huge, and still growing. The investment costs are relatively high, but because of the average price that can be charged, can be recovered in a relatively short time – on a cautious estimate, we reckon within a period of one year. There are other advantages and disadvantages with this therapy that also have to be taken into account: Most of the work for the therapy can be done by appropriately trained assistants. Assuming an 80% capacity utilisation of his/her unit, the doctor will need to invest about 12 hours a week. To name one of the disadvantages: We can only provide the training in Düsseldorf, as 4 complete treatment units have to be transported, which gives rise to enormous costs.
To move on now to our 3rd theme, namely the NETWORK-Aesthetics, which is located higher up in the network hierarchy. And here, I need to emphasise one point straight away: If the networks located on the base level, i.e. Network-Lipolyse or Network-Weightdoctors, are not alive and working productively and synergetically, a superordinated level will not help us at all. A superordinated level only makes sense if the other individual networks are functioning fully and properly. The purpose of Network-Aesthetics is to synchronise all the medical activities of the individual networks, to represent them externally as a brand, and to generate a continuous inflow of new ideas for the field of aesthetic medicine.
I would characterise the outstanding function of Network-Aesthetics as that of quality assurance. You might also say that it constitutes a virtual academy for minimal-invasive aesthetic medicine. Its goal is to establish worldwide quality standards. A certificate issued by this academy should therefore enjoy worldwide validity as a seal of quality. As you all know, there are as yet no generally accepted therapy standards in this field. Our goal is to establish especially qualified trainers and to have the therapy conducted in networks in order to ensure compliance with these standards. We are thereby not focussing exclusively on new therapies, but are also looking for new combinations, networked therapy models, and applications that are gentler and therefore more patient-friendly. To give you an example: Many of you will already have taken a training course in the provision of treatment with botox or fillers. For the treatment of wrinkles, however, a whole arsenal of therapies are available, of which the following are just a few: peeling, botox, fillers, dermabrasion, injection lipolysis, mesotherapy, and also lifting. A contextual approach therefore means identifying what results it is aimed to achieve, what needs of the patient it is aimed to fulfil, and therefore what combination of therapies must be employed in order to achieve an optimum result.
This network is currently being built solely from the bottom up. However, we will pay attention to ensuring that as it becomes established, movement can also take place from the top down, so that all levels can mutually fertilise each other. Therefore, starting from now, we will begin looking round for new therapies. I would therefore ask all members who offer and are particularly qualified in a therapy to inform us of their ideas, for the suggestions of our members naturally have priority over those coming from outside.
Also the NETWORK-Aesthetics will not stand alone and in isolation, and there are several reasons for this which I would now like to illustrate. One of our members is specialised in a highly successful therapy against arthritis, gout, rheumatism and other illnesses, which involves treatment with leeches and is therefore classified in the field of alternative medicine. After someone of my nearer acquaintance contracted gout and underwent very successful treatment with this method, I undertook a little research and found that this therapy is in request by many patients. After all, diseases of this kind are very common, and the market, as for the treatment of obesity, is very great. This therapy would doubtless not be of interest to all members, for instance those specialised in the field of aesthetic medicine. But also an aesthetic surgeon will presumably have no objections to an application of this kind being included in our range of network offerings. Consequently, we should broaden out into the whole field of medicine. We also have a highly interesting therapy for the gentle treatment of periodontosis and periodontal prevention in the field of dental medicine. We have therefore done some thinking, and from this born the vision that networking at a higher level still would make sense for all members. Our vision for this is a NETWORK-Globalhealth, encompassing all areas of medicine and providing support for individual theme-networks.
Networks nesting within networks
This would, like the then subordinated NETWORK-Aesthetics, no longer be responsible for the support and marketing of an individual therapy, but for the marketing of the network idea itself. I personally believe that what at present is only a vision for a worldwide cooperation between doctors of many different disciplines could be built on the principles of network creation I outlined above, and would constitute such a such a novel form and such an innovative response that it would generate worldwide interest in all our networks – i.e. an extended form of the creation of higher synergies.
This now brings me to the end of my brief introduction to our discussion of the possibilities for enlargement as outlined above, and would ask you all to contribute to the discussion of these possibilities. And because critical objections can be very helpful in creating a realisable alternative, we also expressly welcome your critical remarks.