From the editor
From the Editor
Dr. Van Voorhees is the physician editor of Dermatology World. She interviews the author of a recent study each month.
By Abby S. Van Voorhees, MD, January 1, 2018
My term as medical editor is winding down. I’ve been thinking about what I might like to say to you, in this, my penultimate column. The answer came to me as I thought about the articles in this month’s Derm World. It is a bit like the opening line of Dickens’s Tale of Two Cities — these are the best of times and the worst of times. To me, the future of dermatology is both exhilarating and frightening.
The best of times: Who could have imagined that it would be possible for scientists to be able to target the causes of some of our most horrific diseases with laser precision? Read our Acta column, and revel in how Drs. Payne and Ellerbrecht describe their work on chimeric antigen receptor T cells that potentially can cause a surgical strike against pemphigus. I’ve been using rituximab for the past few years in my pemphigus patients, and it can truly be a game-changer. However, the accompanying potential risks are always a worry. Seems like it won’t be long before rituximab is going to look primitive; one can only guess that more sophisticated and safer treatments are just around the corner. The science of this is breathtaking. Decades ago people died from pemphigus. My career began when the only therapies were systemic steroids. Those with pemphigus were destined to a life of steroid side effects and complications, but it was better than dying of infections. The future is much brighter now for those with pemphigus, and it looks like it will be getting even better in the years to come.
The worst of times: There is an ever-widening gap between those who can afford health care and those who can’t, and I fear that we’ve gotten hardened to the realities of this class effect. This crisis goes beyond the appointments in our offices; it also includes the medications that we each prescribe. I remember a time when a patient’s copay was two dollars and medications were cheap. We didn’t spend time appealing denials, and we cared for those who had lost their insurance. Not today. Many of us have gotten so beaten down that we don’t fight for the medicines our patients need. Already some of us push these patients off on to others or provide substandard care driven by costs. No one knows where health care reform is going. However, if the ACA is dismantled, then many more will fall into the abyss. The crisis is so severe that in this month’s DW Robert Portman, JD, and Cristina Krysinski, JD, write about our ethical and legal obligations to patients who have lost their insurance.
Where is our outrage? How is it possible that getting health care is at the mercy of partisan politics in Washington? We’re facing a national emergency. Our country has decided that education is a critical part of a civilized society, and so we educate our children. Our country is the better for it. To me, the day has come when health care must be handled in the same way. Our treatments now have an effectiveness that was never before possible. All deserve access, so that we all can be productive members of this society. It’s time for us to fight back against the bureaucracies that are strangling medicine. Ensuring that we all get health care when we need it might be the first step in truly making America great again.
Enjoy your reading.
