Daniel Leach

Hello to all, this is Dr. Reese. I was asked to respond to a comment that was made from one of my patients concerning the use of Proscar as opposed to Propecia as an aid to stop ongoing hair loss. Yes, both of these trade names, (Proscar and Propecia) represent the generic medication finasteride. Proscar, (finasteride 5mg) is indicated for the treatment of bladder outlet obstruction, commonly known as BPH. Proscar is covered by insurance companies for the above mentioned medical indication. Proscar does not have an accepted indication for the treatment of androgenetic hair loss. Nonetheless some patients attempt to obtain a prescription for Proscar, (and therefore decrease the cost of the medication) so they can quarter the tablets and use it in a dose that is close to the dose of Propecia, at a cost that is lower than purchasing Propecia directly. Propecia, (finasteride 1mg) is indicated for the treatment of androgenetic hair loss. The cost of Propecia is rarely covered by an insurance company. In my geographic area Propecia will cost $65. or more to use for a month of therapy. I do inform my prospective patients at the time of their initial consultation that stopping ongoing hair loss is an important issue in the patient ultimately obtaining their "density and coverage" goals. I inform them that since Propecia is not yet available as a generic, (it will be in mid to late 2013) that if they choose to use the medication, that they will have to pay more for a few years until the generic is available at which point the cost will come down. I inform them that as a hair transplant surgeon I will not be performing a prostate examination on them, and as such do not have a medical indication to prescribe Proscar. In my opinion, to do would raise ethical concerns that I am not willing to expose myself to. If a prospective patient has a medical indication to utilize Proscar, that is a condition that is diagnosed and treated by their primary physician and/or a urologist, but not a hair transplant surgeon. While I empathize with this group of patients, I do not create the rules that I am governed by. I simply follow them. And as such I have not been exposed to questions about ethical conduct in the past. What this patient did not expose on this site is that he met with his primary care physician and requested that he provide him with a prescription for Proscar but was turned down by this physician because there was not a medically necessary indication for the use of Proscar in his case. What this patient did not state in his e-mail is that he informed me that if I wrote him a prescription for Proscar he would not have it filled through his insurance company, but assured me that he would pay for the prescription himself. Obviously, once the prescription is provided to the patient, it is out of my control, and whether or not he did as he told me would be unknown to me, unless I was notified by the State Medical Board that I was providing patients with unauthorized prescriptions. Again, this is not a practice that I choose to participate in. Not in the past, not now, not in the future. Once finasteride is available as a generic, I will be happy to provide it to my patients in this form. Until then, I will not. It is also unfortunate that there are some individuals who choose to anonymously disparage quality physicians because they do not "get what they want", irrespective of the guidelines that physicians must practice under. I enjoy a very good reputation for my work. My staff and I have worked very hard to provide our patients with an excellent experience when in our care, as well as give them an excellent result with their procedure. For the past ten years I have very successfully competed with some of the most outstanding hair restoration surgeons in the world who are located in my own geographic area. If my work was not as least as good, I would not have survived let alone thrived in this environment. My work stands on it's own merits. My ethics stand on their own merits. As such I have been rewarded by my contemporaries by being asked to become a member of the Board of Directors for the American Board of Hair Restoration Surgery. I have also been appointed Chair of the Written Examination for the ABHRS. I have been accepted as a Member of the International Alliance of Hair Restoration Surgery, (several of my video posts are located there for review). I am Certified in General Surgery, as well as Hair Restoration Surgery. I am a member of the Department of Surgery of two hospitals in the Twin Cities. My credentials are second to none. Certainly I am not perfect, but I do work hard for my patients, and they benefit from my efforts on their behalf. In my opinion, if an issue/concern arises it is best dealt with directly, man to man, face to face, as opposed to anonymously on a web site. Thank you for the opportunity to respond. Dr. Robert J. Reese.

I want to make sure that I understand your logic. Merck is a giant corporation that makes millions, maybe even billions of dollars each year. So what you are saying is that it is ok and ethical for physicians to write prescriptions that infringe upon Mercks patent protection and may joepardize that physicians livelyhood if patients fraudulently use their insurance benefits. It's ok because Merck makes enough money? Right? Let's turn that around however, and say Dan Leach (who is not rich by any means) has a patent on a product and a big company arbitrarily decides to use my patented product without paying me for it. We would all be up in arms. Right? It has as much to do with ethics as it does with protecting himself. I don't like the cost of Propecia either....but your argument is with Merck not Dr. Reese.

I have had the pleasure of working with Dr. Reese now for nearly a decade and have heard him explain thousands of times why he will not write a prescription for finasteride. As the creater of this thread points out finasteride and Propecia are the same thing. While this is true, the issue here is that propecia is prescribed for the treatment of hair loss which is generally considered cosmetic and not covered by insurance plans. Additionally, Propecia is still under patent protection. For years finasteride has been prescribed in the 5mg dosage for the treatment of the prostate(aka Proscar). Proscar is typically covered by insurance since treating the prostate is medically necessary. Dr. Reese does not perform a prostate exam and does not treat these types of problems in his clinic. He performs hair transplant surgery. I want be absolutely clear about the reasons Dr. Reese will not prescribe finasteride. The risk is too great that patients will end up using their insurance benefits to purchase finasteride or Proscar thus leaving Dr. Reese vulnerable to insurance fraud. I which watch this thread and if I can provide any additional information, just ask. Thanks, Dan Leach

My name is Dan Leach, I work for Dr. Reese at Reese Hair Restoration. I have a very young patient who was recieved some severe scarring to the scalp from a burn many years ago. This has become very tragic to her as she moves into adolesence. Has anyone ever heard of insurance companies helping out in this situation and how to go about enlisting thier help. If you have any experience with this please email me. Thanks, (promotional email removed)

Dr. Reese operates a clinic out of Edina, Minnesota. Dr. Reese is a Board Certified Surgeon and also certified by the American Board of Hair Restoration Surgeons. Dr. Reese has presented original research in the field of hair restoration surgery at the International Society of Hair Restoration Surgery. In our Edina office Dr. Reese performs only one procedure per day ensuring your comfort and confidentiality.