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 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

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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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Strategies for Hope Conference

Strategies for Hope: Addressing the opioid crisis in rural communities. May 17, 2019 Berkshire Community College, Pittsfield, Massachusetts Random notes from a compulsive note taker I attended this important conference and am a compulsive note taker. Most people, when the lecturer says, “Good morning,” will mumble back “Good Morning.” But, if one is a pre-med, when the professor says, “Good morning,” you write it down as it may appear as a question on an exam. I never unlearned that habit. These note may be of some value to others.Erik Garcia, M.D.: Homeless Outreach and Advocacy Program, Worc3ester, Massachusetts. Stigma and shame play a big role in epidemics. HIV, opioid. It … Continue reading

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Evolus Launches Jeuveau at Cancun!

NY Times article: Botox Rival Invites Doctors to Party in Cancun, With Fireworks, Confetti and Social Media Posts Link. Top plastic surgeons and cosmetic dermatologists gathered at the Ritz-Carlton in Cancun one weekend this month to learn about a wrinkle-smoothing injection, Jeuveau, that goes on sale this week. It was billed as an “Advisory Board” meeting! All expenses were paid. More than a dozen top doctors gushed about the event on social media — using the company’s preferred hashtag, #newtox — without disclosing that Evolus had paid for their trips. Some of who attended this “working weekend at Cancun” were: Dr. Melanie Petro from Alabama Dr. Lara Devgan, New York … Continue reading

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Dear Skin,

dear skin, you have been the cup of my life embracing the everything mystery called me during those years i never thanked you— employed as you are to bear both the scars and joys of my existence someday you will be dust returning me to the inscrutable All of love, laughter and stars when that day comes you will know a new breath and oh the touch that you have always longed for Sr. Lou Ella Hickman Author Bio: Sister Lou Ella Hickman is a former teacher and librarian. She is a certified spiritual director as well as a poet and writer.  Her poems have appeared in numerous magazines and … Continue reading

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