Jeffrey J. Meffert

Key opinion leaders: where they come from and how that affects the drugs you prescribe

Key opinion leaders (KOLs), also known as thought leaders, are the experts in their field upon whom we depend for original research leading to disease understanding and new therapies. We rely on them to write the articles, author the textbooks, and give the presentations that we absorb to become better dermatologists. KOLs have become intimately entwined with the marketing of pharmaceuticals and medical devices, used not only to lend credibility to claims of efficacy and safety but also to promote anecdotal and off‐label use of these medications to increase industry profits. Identification and marketing of the KOLs themselves is being done more and more often by KOL management companies who are hired by industry to turn those involved in medical education and research into efficient and productive members of the sales force.

I swear! Physician oaths and their current relevance.

Most graduating medical students will take some sort of oath that is to inspire them to take their proper place in the comradeship of physicians and remind them of their obligations to their patients, society, and their profession. The nature of these oaths has changed over the years as society itself has changed. What may be considered moral, ethical, or legal at one time can appear quaint or outrageous in another time and place. Several classic and newer oaths can be compared and contrasted in what they are tasking the newly minted physician to do.

Boutiques, Botox ® , and Basal Cells: Can Dermatology Set Its Priorities?

The public perception, now confirmed in the scientific literature, that it is easier and faster to get an appointment for cosmetic botulinum toxin injection than one to evaluate a possible melanoma poses a challenge to the specialty of dermatology. Addressing this disparity will require significant changes in the attitudes and priorities of many dermatologists; additionally, changes in the financing of graduate medical education may also be required. The demand for dermatological advice and treatment far outstrips specialist availability and will do so indefinitely. Primary care physicians and physician extenders will continue to deliver dermatologic care. Dermatologists are duty-bound to ensure that those providing this care are as well trained as possible.

Cutaneous sarcoidosis masquerading as chronic cutaneous lupus erythematosus - case report.

BackgroundSarcoidosis is a multisystemic granulomatous disease of unknown origin. Chronic cutaneous lupus erythematosus (CCLE) is an autoimmune disease that is associated with autoantibody production and T-cell dysfunction. Cutaneous manifestations of sarcoidosis may mimic CCLE and vice versa making it difficult to reach a diagnosis clinically.Case presentationWe present a case of a 57-year-old woman with long-standing sarcoidosis who presented to clinic with diffuse painful plaques that were very distinct and suggestive of CCLE. She had a family history of both sarcoidosis and CCLE. The patient was immediately started on topical corticosteroids and oral hydroxychloroquine. Skin biopsy and the absence of direct immunofluorescence confirmed a skin manifestation of her previously diagnosed sarcoidosis, despite the clinical morphology favoring classic CCLE.ConclusionSarcoidosis may have diverse manifestations and may mimic other disease processes. A detailed history along with a low threshold for biopsy is important for determining a diagnosis.

Marketing the Physician: From Antitrust to Distrust

A pediatric dermatologist, who specializes in the treatment of vascular anomalies, takes a position as an employee of a large hospital-based group practice. One evening, he views a television advertisement, sponsored by the hospital, that describes the group practice as having the best and most experienced doctors in the state.

No more pens: what the 2009 Pharmaceutical Research and Manufacturer's Association code changes really mean.

In 2002, new guidelines for interactions with the pharmaceutical industry and physicians were published as an official code of conduct. Adherence to the guidelines was voluntary, and there were no provisions for discipline to companies who did not subscribe to the code or who subscribed but did not comply. Many of the code standards are routinely violated, sometimes egregiously, with many violations on easy display at national professional meetings. In response to further problems and complaints, tougher code standards-now famous for the specific ban on logo pens and coffee cups-were adopted in 2009. Subscription to the new code is voluntary, and there are no provisions for discipline or punishment for those companies who chose not to subscribe or who may violate its standards.

Sexually transmitted infections and HIV control efforts

Dermatology has had a long and close relationship with sexually transmitted infections with the majority having dermatological manifestations. This article reviews the epidemiology of common and significant sexually transmitted infections and is then followed by a weighing up of the many pros and cons of syndromic disease therapy, widely used in developing countries. Sexually transmitted infection control and sex education efforts, in both the USA and worldwide, highlight the continuing significance of these diseases on our lives and society, with the failures as meaningful as the successes.