An Astute Observer

Priscilla Ly, BS Keywords:William Osler, smallpox, tuberculosis verrucosa cutis, hereditary telangiectasia, Osler nodes, Osler-Weber-Rendu William Osler was the best known physician of his time with an insatiable interest in all fields of medicine. He was not only a pathologist and an internist, but he was also a multispecialist who contributed greatly to the field of dermatology. As an astute observer, William Osler naturally reported many of his cutaneous observations. He was meticulous in his attention to detail and authored nearly 100 publications describing cutaneous conditions. He brought clinical teaching to the bedside of patients and taught his students the power of observation. If the light were not good, he was … Continue reading

Medical Nemesis: The Expropriation of Health (1975)

From the Introduction: full notes at:Medical Nemesis Illich Ivan Illich, 1926-2002 ( Introduction: The medical establishment has become a major threat to health.  The disabling impact of professional control over medicine has reached the proportions of an epidemic. Thoughtful public discussion of the iatrogenic [“physician caused”, iatros=physician & genus=birth] pandemic, beginning with an insistence upon demystification of all medical matters, will not be dangerous to the commonweal.  Indeed, what is dangerous is a passive public that has come to rely on superficial medical housecleaning. My argument is that the layman, not the physician, has the potential perspective and effective power to stop the current iatrogenic pandemic. During the last generations … Continue reading

Why so serious?

Tyler Marion, B.S., M.B.A., Kevin Cao, B.S., Jorge Roman, M.D. Keywords: Chlorotrichosis; Pseudochromhidrosis; Copper toxicity; Green hair; Mercury, Contact dermatitis; Perioral erythema; Erethism; Joker. Notoriously known as Batman’s ultimate adversary, the Joker is considered as one of the most iconic villains in comic book history. He is easily recognized by his trademark green hair, bleached white skin, and cherry red lips; as well as his cynical smile. These traits have remained consistent through the many adaptations and portrayals of the character. Appearing in several films including the Batman (1989), The Dark Knight (2008), and Suicide Squad (2016), the villain’s famous features have a fascinating origin ripe for speculation. The most … Continue reading

Notes on Pathographies

Notes on Pathographies: An Arabian Nights’ Experience David J. Elpern* * The Skin Clinic, Williamstown, Massachusetts Email          A few years ago, a group of us gathered in the Osler Library at McGill. Osler guided us with his words: The practice of medicine is an art, not a trade: a calling not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with powders or potions, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, the wise upon the foolish… Courage and cheerfulness … Continue reading

The Soul in the Machine

Keith Wagner, MS – University of Texas Medical Branch at Galveston PDF of Article: Humanism Essay Final-1 Medicine has many facets, but at its heart there is only the patient to be found. The word “patient” is derived from the Latin “patiens,” meaning “I am suffering.” Patients’ collective will to feel well or relieve their burden has spawned every branch on the tree of the health professions. Regardless of their physical or psychosocial ills, they are all souls seeking relief. Patients are not just some complicated machinery to be repaired. They are the spirit hidden inside that machine. You will not find a patient’s love of fishing on UpToDate. … Continue reading

Sentinel Lymph Node (SLN) Decision Aid

The question of whether to undergo a SLN biopsy for melanoma is a difficult one.  It is clear that some experts recommend it while others don’t.  If you live in Boston you will be told one thing.  If you live in Montreal you’ll be told another. Where does that leave a patient? In England the National Institute for Clinical Excellence (NICE) provides decision aids for many conditions. Here is their SLN Decision Aid for melanoma.  Please give it thought and discuss it with your dermatologist or surgeon.  The decision is really up to you.  It boils down to “What Matters To You.” Option-Grid-Sentinel-Node-Biopsy-yes-or-no

To JR – whoever you are

by Jon Karnes, M.D. I stumbled across a negative review of myself by a patient scheduled to see me on a day I had a family emergency.  It got under my skin and, for whatever reason, in response I started writing.  The following poem is what came out of it.  It has been therapeutic and I’m happy to share it with you. JR–Whoever you are We actually have a lot in common When you gave me that one star and lumped me together with Starbucks, Sam’s Club, and the United States Post Office — “it is only Doctors that get away with making an appointment with clients and then routinely … Continue reading

Cry the Beloved Specialty

by David J. Elpern, M.D. presented in shorter form at the Lown Institute Conference, Washington, D.C. April 9. 2018 Every peddler praises his needles. Portuguese proverb In November 2017, the NY Times published an expose about the current state of dermatology.1 It documented bizarre instances of over-diagnosis and over-treatment that are driven by ignorance and greed. Over the past 40 years, I have witnessed these changes in my specialty and am dismayed by the reluctance of my colleagues to address them. This trend began in the early 1980s when the Academy of Dermatology (AAD) assessed its members over 2 million dollars to hire a prominent New York advertising agency to … Continue reading

Fake Skin Diseases Online: a Review of Dermatological Hoaxes

Warning: The following article may induce nausea and nightmares! Fake Skin Diseases Online: a Review of Dermatological Hoaxes Keith D. Wagner, M.S. Department of Dermatology University of Texas Medical Branch Julie A. Croley, M.D Department of Dermatology University of Texas Medical Branch Corresponding Author: Keith D. Wagner Department of Dermatology 301 University Bvld Galveston, TX 77555-0783> Abstract The internet has become a fixture of modern times. However, not all the information it holds is accurate. For more than a decade, users have shared images intended to shock. Some have even gone so far as to create fake skin conditions using photo-editing programs or other means.  We present six “skin conditions” … Continue reading

Thoughts about “Countering Creeping Confusion”

by Richard Ratzan, M.D. Dr. Ratzan was a Classics major at Trinity College whose early publication as a medical student was on the Greek word for herpes (see reference # 8 in his attached letter). THE EDITOR kindly asked me to comment on an unusual paper suggesting we rename Herpes virus “Habita virus”, a paper imaginatively conceived, adroitly executed and very well written.[^1] In it, the authors evince four reasons to support their suggestion: lack of congruence between the etymological history of “herpes” and its dermatological appearance; sociological and psychological stigma; potential confusion concerning first the different herpetic diseases and second an unrelated virus, Hepeviridae, a virus associated with diseases … Continue reading

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