Marketing Pharmaceutical Science for Prestige and Profit

Marketing Pharmaceutical Science for Prestige and Profit PREPRINT By David J Elpern, M.D. As a dermatologist, I have observed the profusion of research articles on psoriasis over the past two decades.  A graph of these from PubMed illustrates the five-fold increase in references since the first biologic, infliximab, was approved by the FDA in 1998. (Figure 1) This increase in scientific studies has coincided with a profusion of new therapies for psoriasis and may reflect the pharmaceutical industry’s interest in developing and promoting costly new treatments for this common chronic skin disorder.  With this in mind, a recent article in the New England Journal of Medicine, “Trial of Roflumilast Cream … Continue reading

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Every Specimen is a Person

*Keywords: Dermatopathology, skin specimens, physician burnout, emotional intelligence, detachment, empathy. *The author has no conflicts of interest to report. Preparing Dermatopathology Specimens in Proper Context by Travis Dowdle* As a specimen grosser, I am frequently greeted by samples like this one. Abnormal, soaked in formalin, and disconnected. Without the labeling on the jar there would be no way to ascertain the origin of this tissue. The face and story of this person it was taken from are unknown to me. “Every piece is a person,” Dr. Michelle Tarbox, associate professor of dermatology at Texas Tech University Health Science Center mentioned before going on to explain other important elements of the … Continue reading

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American Mohs: A Critical Review

PREPRINTAmerican Mohs: A Critical ReviewArticle Type: ReviewAuthors: Brett M. Will1, MS; David J. Elpern2, MD; Roy Grekin3, MD; Douglas W. Johnson4, MD Affiliations: 1Medical Student, Georgetown University School of Medicine, Washington, DC; 2Practicing Clinical Dermatologist, Williamstown, Massachusetts; 3Department of Dermatology, Clinical Professor, University of California San Francisco School of Medicine, San Francisco, California; 4Department of Dermatology, The Queen’s Medical Center, Honolulu, HI Keywords: Basal cell carcinoma, Cost effectiveness, Economics, History, Mohs, Squamous cell carcinoma Funding Sources: NoneConflict of Interest Disclosure: None declared Capsule Summary Mohs Micrographic Surgery (MMS) is a valuable tool in the treatment of skin cancer whose indications and implementation have changed significantly since its inception Improved understanding … Continue reading

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Music and Medicine: Bach Partitas on the Covid Ward

by David Elpern For almost a decade, I have used music when performing biopsies and excisions in my office. I got the idea from my friend Tim Lee, an ophthalmologist on Kauai. That led to a study published in 2014.1 Music is a simple, inexpensive aid that we use every day in my office. So, I read the article, Bedside Concerts Comforting Virus Patients by Benjamin Weiser in the May 4th, 2020 New York Times with particular interest. It features Rachel Easterwood, whose idea it was to stage concerts for Covid 19 ICU patients. Easterwood is a professionally trained musician-turned-ER physician from Columbia P&S (the same medical school that my … Continue reading

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Implicit Bias in Medicine: Case Report and Literature Review

by Kory M. Johnson, Emma Fixen, David J. Elpern, Douglas W. Johnson Mount Sinai Health System, New York, NY John A. Burns School of Medicine, PGY1, Honolulu, HI David Elpern MD: The Skin Clinic, Williamstown, MA University of Hawaii School of Medicine, Honolulu, HI Keywords: implicit bias, explicit bias, immigrant, indigent, psoriasis, lymphoma, healthcare A 46-year-old Micronesian woman with history of severe disabling psoriasis and psoriatic arthritis had been our patient for many years (Figures 1 and 2). Her psoriasis started as an adolescent and had been treated with numerous therapies including topical steroids, phototherapy (sunlight exposure in Micronesia), methotrexate, cyclosporine, acitretin, apremilast, etanercept, infliximab, ustekinumab, secukinumab, ixekizumab, IL-23 blocker, … Continue reading

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Anatomy of a Paper: Adalimumab and the Medical-Industrial-Academic Complex

by David J. Elpern, M.D. The Skin Clinic 12 Meadow Street Williamstown, Massachusetts djelpern@gmail.com Something is rotten in the State of Phrma Abstract: Pharmaceutical companies, clinical researchers, key opinion leaders and respected medical journals often work in concert to promote and sell new medications. The biologics are the most profitable and competitive pharmaceutical market today. Herein, I analyze the background of a publication on the biologic, adalimumab in a prominent medical periodical. This cautionary tale may guide readers when they encounter similar ghost-driven PhRMA-sponsored research. Keywords: adalimumab, key opinion leaders, hidradinitis supprativa, medical publications, ghost writing, risankizumab, disclosures, conflict of interest For some years, I had been struggling to treat … Continue reading

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The Melanoma Epidemic: Reflections on a Creature We Have Made

In the end, we are dependent on the creatures we have made. Goethe By David J. Elpern This is a Preprint. Abstract: I believe that the current melanoma epidemic is mostly an artifact of aggressive promotion by dermatologists, dermatopathologists and oncologists. For decades the death rate from melanoma has stayed constant, while the rate of diagnosis has soared. Promoted screenings, diagnostic drift, and the dermatoscope are causing physicians to pick up indolent lesions that are unlikely to kill. These, in turn, cause unwarranted, anxiety in the public and providers. When the dermatological establishment started the war on melanoma in the 1980s it had no idea where it would lead and … Continue reading

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Preprint Opportunities: Dermatology and Medical Humanities

Preprints and Post-Publication Peer Review by David J. Elpern We are creating two Preprint Repositories that will help some authors. dermatolRxiv.com and medhumRxiv are free online archives for finished but unpublished manuscripts (preprints) in dermatology and the medical humanities. Preprints are preliminary reports of works that have not been certified by peer review.1 The so-called major dermatology journals are the domain of academic dermatologists, some of who are bedfellows of pharmaceutical companies (PhRMA).   These major American dermatology journals, in particular, are heavily dependent on lucrative PhRMA ads. We envision dermatolRxiv.com and medhumRxiv as resources for clinical dermatologists and others who are not vassals of PhRMA or academic medicine to publish … Continue reading

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The Preprint Revolution

When we established OJCPCD in 2012, we rejected the concept of peer review.  “Peer review, as it exists today, is an impediment to creativity and keeps many authors away from scientific publication while it serves as a filter to allow Editorial Boards’ gate-keepers to facilitate their academic cronies in getting their work into print.  We, at the Online Journal of Community and Person-Centered Dermatology are embracing a “post-publication ‘peer review’ model that is fair to all and will give voice to a more interesting and varied collection of articles.” (1) “The ultimate goal should be: free, instant scientific publishing Free instant publishing: Once open post-publication peer review provides the critical … Continue reading

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