Does a woman have the right to know what is surgically placed into her body? According to a recent decision in Idaho involving non-FDA-approved silicone breast implants, the answer is a resounding yes.

It seems the twin American obsessions of cosmetic procedures (almost 16 million served last year) and bargain hunting have merged lately in a variety of odd ways.

First was the advent of medical tourism, ranging from abdominal sculpturing (to get the killer six-pack) in Poland to facial restructuring in China—altogether a thoroughly modern 21st-century innovation. Advertisements and inducements stress the combination of seeing the bright lights of a new big city with becoming a better you—never mind that you might spend the tour taking pain medications and trying to avoid popping your stitches. Of course there are a few mishaps given the thinly regulated doctors, centers, equipment, and medications, but hey, if you look marvelous, you feel marvelous.

Also somewhat new to the scene is the apparent situation in Idaho—real live U.S. doctors in real live U.S. facilities who cut some corners to pass the savings on to you, the consumer. Usually this takes the form of buying unregulated supplies, such as botox, that are cheaper even if they might be, oh, 10 or 100 times stronger than the label suggests.

The doctors’ fees might be about the same—after all, some actually are trained to do the procedure, some licensed for somewhat similar work, while still others generously might be said to be reclaiming the turf of the old country do-it-all-doctor of yore, the one who would deliver your baby, lance your boil, and take out your appendix, all before lunch.

It is not certain which category the recent kerfuffle in Idaho fits. There, 16 women filed suit against a surgeon demanding that he notify patients in advance just what he was using for his breast implants. Not surprisingly, the women were appalled that the product now in their body was not patient-grade, at least by American standards. According to the story, at least one is planning to have the implants removed.

And it gets worse, a little. The surgeon in question, the one doing the breast implants, is a specialist in ear, nose, and throat surgery. From a Google vantage, he appears to have been the lead player in a clinic situation called Magic Valley Laser Cosmetics, a local concern that did all sorts of cosmetic work.

He surely was not a breast surgeon or a person trained to deal with any anatomy below the collarbone. And for whatever reason, the website for Magic Valley notes that because of his busy ear, nose, and throat practice, he no longer was able perform cosmetic surgery but could refer an interested patient to someone who does. The last sign of life on the website was a blog entry from July 2015, suggesting a recent exit.

A quick word about the surgeon, Dr. Temp Patterson, courtesy of the internet. He graduated from medical school in Utah in 1991 and trained at the University of Oklahoma (my alma mater) for the requisite five years to become an ear, nose, and throat specialist. He is currently licensed to practice in Idaho, has no disciplinary actions noted against him from the state, and is certified in his specialty.

As an aside, it should be noted that some ear, nose, and throat doctors migrate toward plastic and cosmetic surgery, first with botox and nose jobs, then a little eyelid work, and some of this and some of that until breast augmentation seems the logical next procedure. So Dr Patterson’s path, though perhaps eccentric at first glance, is familiar.

As a medical student in a rural town, I once assisted on a breast augmentation procedure. The surgery was performed under local anesthesia on a cot stretched across the cement-floored garage of the general practitioner’s home. A small airplane was in the garage as well. Then and now, a licensed doctor is allowed to perform the surgery—OK, no more cement-floored-garages, but from the is-the-doctor-capable perspective, caveat emptor still is the rule of the land.

But caveat non-emptor must be the rule regarding what a patient is told. You are free to pick an unqualified doctor and free to have the practitioner perform a heart transplant on you, but you must be told the risks and be told truthfully what is what. Of course, doctors are not exactly forthcoming all of the time, which is why the clumsy and exasperating system of checks and balances, aka regulation, exists.

The always-vilified FDA clomps along but does indeed keep easy-to-break silicone implants off the market. And hospitals extract endless amounts of paper and records to make certain a doctor can do what he says he can do—though the hospital has no sway if the doctor opens a “private clinic” across the street in a regulation-free zone. Because as the 16 women in Idaho have demonstrated yet again, the only thing worse than regulation is the lack of regulation.