American Mohs: A Critical Review

Over 80 years ago, Fred Mohs, then a medical student, conceived of a novel approach to remove difficult-to-treat nonmelanoma skin cancers. The procedure, called Mohs Micrographic Surgery (MMS), has been refined over the ensuing years and now large numbers of practitioners provide the service. As the indications have continued to evolve and enlarge, the appropriate use of MMS needs to be addressed. We look at the history of MMS since its inception and present questions that clinical dermatologists are asking. Most importantly, is MMS overused and should precautions be taken to temper its overuse? Full Article Pdf: Full Article Word: Mohs 5.26

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

Ditching the Razor: Armpit Hair is Back!

Tayler D. Parker, BA1; Ashley E. Brown, MD1 McGovern Medical School, UTHealth Science Center at Houston, Houston, TX Corresponding author: Tayler D. Parker, BA, 6431 Fannin St, Houston, TX 77030, email Tayler.D.Parker@uth.tmc.edu, phone: 806-445-4949 Tags: beauty, behavior, shaving, medical sociology, health anxiety “Keep your man faithful and ensure home security- Shave your underarms!”. This slogan may sound comical, but it is an actual message found in underarm shaving advertisements for women as early as 1915.1 Whether shaving was driven by the emergence of sleeveless tops or by a male-driven culture, most women in the United States were shaving their armpits consistently by the 1950s for both social normativity and perceived … Continue reading

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

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

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 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 at present we are … Continue reading

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

Dr. Arrieta’s Lesson: Have We Lost Something in the Gain?

by Ariana Shaari* A global pandemic transformed the way medical care is delivered nearly overnight. Telemedicine, generally defined as healthcare delivery without face to face contact, has crucial applications in the fight against Coronavirus – facilitating social distancing, easing the burden on physicians, and increasing accessibility to care, especially for providers and patients without adequate personal protective equipment (Luz, 2019). Telemedicine had a robust foundation before the pandemic and was quickly adopted to preserve crucial aspects of healthcare delivery. It’s roots are in the 19th century, when a physician first conveyed electrocardiographs over the telephone (Ryu, 2010). In the 1920s, radio consultations were used to provide medical care to patients … Continue reading

Skin, Social Media, and the Psyche of Kids

Emily Burns, BA1* Pauline Berens, BA, BS1 1Baylor College of Medicine, Houston, Texas *Corresponding author: Emily.burns@bcm.edu Keywords: skin harm, pediatrics, social media, psychosocial, adolescence, skin disease, acne Conflict of Interest: None Informed consent: Not applicable Abstract: Most U.S. teenagers use at least one form of social media. Social media usage in children has been associated with both positive and negative psychological effects. One contributor to the negative psychological impact of social media is cyberbullying. Children with skin conditions are more likely to be bullied by their peers. Consequently, children with skin conditions could be disproportionately impacted by increased social media use and the potential psychosocial sequelae. Further research is needed … Continue reading

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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