W.H. Auden on The Skin Microbiome

A New Year Greeting The poet, W.H. Auden, matriculated at Christ Church, Oxford in 1925 with a scholarship to study Biology. This poem should interest physicians, especially dermatologists. Had Auden become a biologist, think what the world might have lost! Osler quotes Lowell: “We reward the discoverer of an anaesthetic for the body and make him a member of all the societies, but him who finds a nepenthe for the soul we elect into the small Academy of the Immortals.’” (from John Keats: The Apothecary Poet, in The Alabama Student.) This poem was published in Scientific American in 1969 On this day tradition allots         to taking … Continue reading

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Polypharmacy: an Introduction

We recently came across a great video to introduce this subject. Bohemian Polypharmacy on Youtube A good review article on this topic is: How polypharmacy has become a medical burden worldwide. “Taking a multitude of medicines, whether they are prescription drugs, OTC treatments, herbal or dietary supplements — known as polypharmacy — is not only a burden for patients, it can be dangerous. We need a way to mitigate the danger of unwanted drug interactions and improve drug adherence to essential medicines, and this is as true for the United States as it is in Europe. It is imperative that patients are empowered to make informed decisions about the medicines … Continue reading

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Campaigns of Fear

It’s Time to Scare People About Covid — We need a Campaign of Fear Our public messaging about the virus should explain the real costs — in graphic terms — of catching the virus. by Elisabeth RosenthalNY Times  Dec. 7, 2020 Link to Article. (If the link doesn’t work — here is the article.) I still remember exactly where I was sitting decades ago, during the short film shown in class: For a few painful minutes, we watched a woman talking mechanically, raspily through a hole in her throat, pausing occasionally to gasp for air. The public service message: This is what can happen if you smoke. I had nightmares … Continue reading

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COI: Alive & Thriving at NEJM

COI: Alive and Thriving at the NEJM by David J. Elpern, M.D. Abstract: As a reader of the New England Journal of Medicine for more than 50 years, I have observed its growing entanglements with the pharmaceutical industry.  This analysis of a recent NEJM research article highlights authorial and editorial conflicts of interest (COI) and discusses how the Journal benefits financially from pharmaceutical advertisements for the very drug reported on in the Original Article.  What does this say about top tier medical publishing when the world’s most prestigious medical journal is clearly intertwined with the drug industry? The December 3, 2020 issue of the New England Journal of Medicine (NEJM), … Continue reading

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Tomisaku Kawasaki – Obituary

“Not many physicians have a disease named after them. Tomisaku (“Tomi”) Kawasaki, who has died in June 2020 at the age of 95, was one of the few. Kawasaki disease, a rare inflammatory autoimmune disorder found in young children, is his namesake. In recent months, this syndrome has been in the global media spotlight as pediatricians discuss its similarity to the complications of covid-19 in children.” The October 16, 2020 issue of the British Medical Journal has a moving obituary of this humble, but iconic pediatrician. A pdf of the BMJ obituary is attached below.

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All The President’s Doctors

All the President’s Doctors: Walter Read and the Collusion of Anonymityby A.R. Pito Even today, Michael Balint’s seminal book, “The Doctor, His Patient and the Illness” is essential to understanding how patients are managed and treated by physicians and caregivers.  When one considers Team Trump at Walter Read we see this on a granular level. Excerpts from Balint’s book: Chapter 7: The Collusion of AnonymityIn difficult cases, the general practitioner [PCP} does not, as a rule, carry the burden of responsibility alone. The appearance of consultants introduces a number of new factors in the doctor-patient relationship The term the collusion of anonymity refers to who is responsible for the patient … Continue reading

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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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