What Can We Do About the Practice of Dermatology?
Thanks to everyone who took the time to read my last message and
especially to those who responded.
I’m sorry if I sounded too gloomy. Having skin problems is more
than
discouraging enough, and I didn’t mean to discourage anyone even
more.
But I do think we have to be realistic. In my opinion the best that
dermatologists will do for us is offer temporary relief from some of
the symptoms until we can find something that can resolve our skin
conditions. At best, the approach that dermatologists take is a stop
gap approach. As we know, their treatments lose effectiveness over
time and long term use of what they prescribe can cause harm. (For
instance, long term use of steroids and antibiotics.) And who knows
what the side effects of long term use of immunomodulator drugs like
Elidel or Protopic are? These drugs have not been around very long.
What I find unconscionable, even bordering on immoral, is that
dermatologists aren’t up front about this and that their
treatments
don’t address what causes these skin problems. Their treatments
are
too parochial and are not at all holistic. Because of this they
don’t get at the root of the problem so of course they have no
cures
to offer us. Obviously the field of dermatology needs to take a
broader approach to how it treats disease, but unfortunately all the
dermatologists I’ve met are very myopic.
If they aren’t going to change how they deal with disease then
they
should at least be up front and honest with us. The first things out
of their mouths should be, "Look, the best I can do is offer you
temporary relief of some of your symptoms. I have no idea what
causes these skin problems and I certainly cannot offer you any kind
of cure. The treatments I prescribe lose effectiveness over time and
do have side effects, especially if used over a long period of time.
We don’t know what the long term side effects are for the newer
treatments."
They should be willing to work with us. They should say something
like, "You need to look at what is going on in your life to
determine
what may be causing these skin problems and I’ll try to help you
with
that. I urge you to find out if you have allergy problems,
here’s a
referral to an allergist. Watch your stress and take a stress
management class. Try adjusting your diet. Here’s a referral to
a
dietician. And there are other things we can pursue later if these
things don’t pan out."
You’ll never hear anything like that from a dermatologist. In my
opinion that’s a disgrace. And in my opinion the entire field of
research is headed in the wrong direction and that’s another
disgrace. They are focusing on new drugs that will treat the
symptoms, not finding out and curing what is causing the problem. As
long as dermatology is headed in this direction I bet we won’t
see a
cure to any of these diseases.
How can we change this?
I wonder how dermatologists can justify the sorry state of their
profession. I wonder if any dermatologists are reading this.
Dave
March 6th, 2004 at 12:16 am
ok i have to start disagreeing now. the dermatologist i saw (the first and
only) was completely up front with me about what he could achieve for me. he
never pushed anything my way as a cure. the word ‘cure’ was never used, i was
told that i could expect ’some help’ in controlling the condition. thankfully
mine is a mild case.
also the issues you raise with regard to dermatologists ‘focusing on new drugs’.
this is probably the best use of their time to be fair, or at least its the best
use of time from their perspective. they are western doctors and i’m, afraid
the issues you raise with regard to their focus is also a general problem with
western medical philosophy. the shift to a holistic approach is starting,
slowly admittedly, but it is starting. once that is true then the referrals you
mention will become commonplace (i for one can’t wait for this).
sorry to seem down on what you say, by and large i do agree with you, but there
are things that ultimately we ourselves are responsible for and in all honesty
we ourselves are our best hopes for finding what truly works for us in a control
and manage sense. every face a dermatologist (scuse the pun) is faced with is
completely individual and has an entire drug response topology all of its
own…its a hard job, from what i can tell. i’m still trying this and that
cream after nearly 9 months of experimentation, what can a derm really achieve
in 1 half hour consultation?
peace and regards,
jammer
www.jammer.biz
March 7th, 2004 at 1:42 am
I wasn’t trying to say that dermatologists are telling people
they
can cure skin diseases. I’ve been to many dermatologists over
the
years, and I can’t recall any of them telling me they can cure
anything.
The point I was trying to make is that in my opinion most
dermatologists are not up front about the long term prognosis that
their treatments offer people with skin diseases. They certainly
don’t tell their patients that they only treat the symptoms and
they
don’t focus on what causes the disease. And most of them are not
interested in what causes the disease. They show virtually no
interest in exploring the relationship that your diet, stress, the
environment or other factors may have in causing your disease. The
next time you talk with your dermatologist try getting past talking
about treating symptoms and see where the conversation goes. It will
go nowhere.
You’ll never hear a dermatologist say, "I only treat the
symptoms of
your disease, not the cause, so unless your body heals itself nothing
I prescribe for you will offer you a long term resolution of your
skin problem." But that’s exactly the way it is. This is
the way
dermatology was fifty years ago, and I bet you money it will be the
way dermatology will be in the year 2053. The chemical goop and the
pills they prescribe only treat symptoms (and often with some nasty
side effects for some people.) As long as this is the case these
skin conditions will always be with us.
And why is all the research money going in to developing drugs that
treat symptoms instead of getting to the bottom of what causes these
diseases? I think the drug companies and dermatologists have found
an economic model they are comfortable with. They know that treating
symptoms offers both short term and long term profits. My guess is
that they don’t feel that anything else offers anything better
than
what they have now. Where would the drug companies and
dermatologists be if we found that many of these skin diseases could
be resolved with changes to the patient’s environment and/or diet?
In my opinion this entire situation is absurd. Patients should
demand better.
Dave
March 7th, 2004 at 10:19 am
i agree 100%
tony the baloney the one and only
March 7th, 2004 at 4:15 pm
I think maybe that the Biogen product called Amevive may be a step in the
right direction however–Amevive targets the T-cells that are directly
resposible for skin inflammation
The main controversy of Amevive is whether or not it has undesirable side
effects on other T-cell functions–so far, it seems like the side effects
are minimal but then again you can never trust a drug company when they talk
about side effects
IMHO, I think this product will be the closest thing to a cure we can hope
for in the foreseeable future–best thing about this drug also is that it is
an injection and not a topical so we won’t have to worry about increased
local sensitivity/irritation/etc etc.
This product should be receiving final FDA approval any day now and should
be covered by most health plans (like Enbrel is). Now I just need to
convince my derm that my mild psoriasis on my knees and elbows is enough for
him to give me the RX as I am sure derms won’t be prescribing this for seb
derm. To that end, I have purposefully NOT been treating my psoriasis and
it has gotten slightly worse over the past few months.
My plan the day I go to see him about Amevive is to scrath the hell out of
it so that is bleeding and very inflamed and just tell "Nothing is working,
please give me Amevive to end this madness"–
RJ
March 8th, 2004 at 3:01 am
firstly i wanna say that i agree with you dave.
western medicine practises, ironically, suffers from chronic shortsightedness…
it was this paragraph from your initial mail that caused me to think you were
expecting a cure.
<dave>
If they aren’t going to change how they deal with disease then
they
should at least be up front and honest with us. The first things out
of their mouths should be, "Look, the best I can do is offer you
temporary relief of some of your symptoms. I have no idea what
causes these skin problems and I certainly cannot offer you any kind
of cure. The treatments I prescribe lose effectiveness over time and
do have side effects, especially if used over a long period of time.
We don’t know what the long term side effects are for the newer
treatments."
</dave>
sorry for the misunderstanding.
however i do go back to my point in that its our responsibility to find what
works for us best anyway (with some help from a derm). i’ve just taken two days
off any sort of treatment and my face is much less red than its been for ages!!
go figure! :O) i don’t get it yet…