DermHelpCentral

When is Cancer NOT Cancer?

Gina Kolata, in the 11/23/2011 NY Times, has an  important article which addresses the overdiagnosis of cancer and highlights the dangers of screening. She postulates that "the word 'cancer' is out of date, and all too often it can be unnecessarily frightening." This article needs to be read by physicians, patients and their families.  Although it highlights breast and prostate cancer, it is applicable to skin cancer as well.  Squamous cell carcinoma-in situ, melanoma in-situ, actinic keratoses should not be labeled as "cancer" (or pre-cancer) but as cutaneous dysplasias.  Treatment need not be aggressive.  In my opinion, the whole idea of "screening" needs to be reconsidered. See:  Download ‘Cancer’ or ‘Weird Cells’

Chronic Itching

Here are three excellent reviews which will help with the diagnosis and management of patients with chronic itching.

1. Somatic and Psychiatric considerations:  Download Chronic Pruritus

2. Guidelines on Chronic Pruritus from the European Dermatology Forum: Download Guideline-on-Chronic-Pruritus

3. Clinical Classification of Itch: a Position Paper  Download Clinical Classification of Itch

These are very helpful articles for physicians and lay persons with itch-related disorders.

Gabapentin for Neuropathic Pain

"Gabapentin (Neurontin) is now widely used for neuropathic pain. Controlled clinical trials in diabetic neuropathy and postherpetic neuralgia show that gabapentin at 2400-3600 mg/day has an efficacy similar to the tricyclic antidepressants. Consistent, though less compelling clinical evidence supports its use for a variety of other neuropathic pain syndromes, including cancer pain syndromes, pain associated with HIV infection, chronic back pain and others. The exact mechanism and site of action of gabapentin is unknown. Its use for neuropathic pain has become widespread because it is generally well-tolerated, easily titrated, has few drug interactions, and does not require laboratory monitoring. However, cost may be a limiting factor for some patients.

Patients suitable for Neurontin should ideally have a clear neuropathic pain syndrome, characterized by sharp, shooting, lancinating and/or burning pain, in a nerve root (radicular) or stocking/glove distribution."

This as a good reference for Gabapentin and Neuropathic Pain.

Drug Company Scams

The biggest introduction of a generic drug in pharmaceutical history is being met with tough business strategies by Pfizer and pharmacy benefit companies, according to recent letters to pharmacists.  A pharmacy group and an independent expert say the tactic will benefit Pfizer and benefit managers at the expense of employers and taxpayers, who may end up paying more than they should for the drug.  Lipitor is the best-selling drug ever, accounting for $106 billion sales over the last decade, or almost one-quarter of Pfizer’s total. Pfizer has told analysts it is preparing for the loss of Lipitor’s patent with a variety of business moves to preserve market share.

Big drug companies will go to extraordinary ends to protect their market share.  Who suffers?  The public, of course.  See: Plan Would Delay Sales of Generic Lipitor.

This article is important because it discusses and exposes a common PhRMA ploy to maximize their profits at the expense of patients and the government.

Prayer of the Orphan Patient

by Walter B. Shelley & E. Dorinda Shelley

Listen to me

Don't be cynical, indifferent, or in a hurry.
Ask me what makes my problem better or worse.
Ask me what I think the cause is.
Ask me to look for clues and teach me what they are.

Think about me

Think of my problem when you read those books, journals, and atlases.
Think of my problem when you attend meetings.
Think of asking your colleagues about me.

Test me

Order specific tests to help you decide on my diagnosis and treatment.
Could I have AIDS, cancer, or lupus?
Do I need a biopsy?
A challenge with a medication?
Do I need hospital help?
Do I need to see a consultant?

Don't give up on me

There is always one more treatment you can try.
Just imagine I have a different disease and treat me for that.
See me during an attack to get new ideas and new tests.
Ask me lots of questions during every visit.

I won't give up on you, for I am an orphan