Tag Archives: American Academy of Dermatology

NBA Legend Bill Walton Grateful, ‘Feelin’ Fine’

Five years ago NBA Hall of Famer Bill Walton returned home to San Diego from a road trip when “my spine collapsed,” he told attendees at the annual meeting of the American Academy of Dermatology.

Bill Walton holds court in San Diego. Doug Brunk/IMNG Medical Media

Years of debilitating back problems had finally caught up with him. He had spent more than 4 decades on the road as a basketball player then as a television broadcaster, navigating his 6-foot, 11-inch frame through “horrendous hotels I couldn’t stand up in, sitting in chairs built for children” and being cramped in the cabins during “mind-numbing airplane flights, [logging] 800,000-plus miles a year.”

He spent 2 years mainly lying in a horizontal position on the floor, he said, “in excruciating, unrelenting pain. If I had had a gun, I would have used it. I was standing on a bridge knowing full well that it was better to jump than to go back to what was left.”

But then he was saved, he said, “by doctors like you, by innovating companies like the ones changing the world of dermatology.” More than 3 year ago Mr. Walton underwent an 8-hour experimental surgery on his spine – his 36th orthopedic operation.

“They straightened everything up, bolted it back together,” he said, noting that the foundations of the procedure involved placement of two titanium rods and an Erector-Set-like cage. This was followed by a week in a medically induced coma, 73 postoperative days on morphine, “and the long hard climb back to trying to figure out how to play the game of life and how to get on that mountain one more time.”

During his recovery, Mr. Walton, now 59, said that he was reminded of how lucky he’d been in life, of the support of his parents, friends, and “heroes and role models who stood for principle, who lived their lives with passion and purpose. And they believed in more than material accumulation.”

To borrow a phrase from the Grateful Dead gem “Touch of Grey,” well-known Deadhead Mr. Walton appears to be “feelin’ fine” these days. His views on sports are as colorful as ever. He described basketball as “the perfect game of all, unlike football, which is basically a halfway house between the Army and prison. And baseball, which is a bunch of guys out of shape scratching themselves, standing around, taking steroids, and waiting for the game of life to come to them.”

Welcome back, Bill.

— Doug Brunk

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Going to AAD? Places to Get Your Groove On

The twin foundations of New Orleans life are music and food.  If you’ve ever been to the city, you already know that, and it’s likely what draws you back — that and the plethora of medical meetings held there each year.

Just as an aside, is there anyone who doesn’t think it’s ironic that cardiologists would choose to gather in a city that has enshrined butter, pork fat, and salt?

If you are headed to the American Academy of Dermatology’s annual meeting Feb. 4-8, we’ve got guides to both food and music for you. Food was ably covered by my colleague Michele Sullivan, here.  Now on to music.

First, know that it is New Orleans; being a laissez-faire kind of town, nothing ever is written in stone. So it is wise to check the listings before heading out anywhere.  Good places to look are in the New Orleans Times-Picayune’s daily events page, WWOZ’s live wire (on-air at 90.7 FM on the hour and on the Web), and Offbeat magazine’s club listings.

Many bands or musicians have weekly gigs, and some play nightly, so there is more than one opportunity to catch some of them.

Geno Delafose via Flickr user Bruce Tuten

Thursday is one of the most popular nights to go out and always offers an embarrassment of riches. On Thursday, Feb. 3, you can choose from the smooth jazz sounds of Jeremy Davenport at the Ritz-Carlton, to the funkier trumpet of Shamarr Allen at Irvin Mayfield’s Jazz Playhouse at the Royal Sonesta, to the pounding zydeco beat of Dwayne Dopsie at the Krazy Korner on Bourbon St.  Zydeco, with its deep bass and drums, is actually not a New Orleans music form. It originated in southwest Louisiana, just as Cajun music did.  If you want to see a real zydeco cowboy from that area and some serious dancing, head to Rock ‘N’ Bowl to see Geno Delafose. Rock ‘N’ Bowl is a New Orleans icon: part bar, part bowling alley, and a testament to post-Katrina survival.

For a divey experience, try Le Bon Temps in Uptown on Magazine St. for the Soul Rebels brass band’s regular gig in the cramped collegiate space.  At the opposite end of the spectrum is the music/interview at the Ogden Museum of Southern Art’s Odgen After Hours program. You can sip wine, tour the museum, listen to music, and be in bed by 10pm.

On Friday, try walking up and down Frenchmen St., where many of the clubs lining both sides of the street for several blocks have no cover, and you can check out the music from the street. There’s almost always a party around  trumpeter Kermit Ruffins — a one-man New Orleans- and self-promoting machine who will be at the Blue Nile, but not until 11 pm.  Kermit also holds court Tuesday nights at a bar in Treme, Bullets, and Thursday nights at Vaughan’s in the Bywater.  He will be recognizable to anyone who has seen the HBO miniseries Treme, as will Vaughan’s.

Something more low-key? Try local singer-songwriter Paul Sanchez at the off-the-beaten path and no-smoking bar, Chickie Wah Wah.  Or the Ellis Marsalis Quartet at Snug Harbor, a premier jazz club on Frenchmen St. The Marsalis family is one of the pre-eminent New Orleans music families, along with the Nevilles.

Saturday night, check into d.b.a. (which also recently went nonsmoking) on Frenchmen for the superbly soulful vocals of John Boutte.  John lent his song Treme to HBO for the series’ theme song.  Only a $5 cover and the show starts at 8pm.

Kermit Ruffins via Flickr user dsb nola

Monday night is a good time to see David Doucet of Beausoleil play his acoustic guitar and spin tales from his Cajun upbringing at the stately Columns Hotel on St. Charles Ave. No cover. Funk and jam band devotees go to the Maple Leaf Bar for Papa Grows Funk.  Tuesday night belongs to the quintessential horn-based sounds of Rebirth Brass Band at the Maple Leaf.  Expect a mostly college-age crowd and a very late start.

Wednesday night, you’d be remiss if you did not at least stop in at d.b.a. for some of Walter Wolfman Washington’s seriously bluesy funk.

Almost any night is a good time to stop into Preservation Hall, which opened in 1961 with the aim of protecting the heritage of New Orleans jazz. If Clint Maedgen is singing with them, you’re in for a treat. The powerful vocalist is usually tied up with his side project, the quirky New Orleans Bingo Show.  For a taste of him and the band, consider purchasing the excellent benefit CD,  Preservation, which features vocalists from Merle Haggard to Tom Waits.

The best place to pick that up, aside from the Hall itself, is one of America’s best independent music stores, the Louisiana Music Factory, across from the House of Blues on Decatur St. in the French Quarter. The Factory also has free music on Saturday Feb. 5.  But I’d recommend stopping here right before you go home — to stock up on CDs from all those great musicians you heard.

— Alicia Ault (on Twitter @aliciaault)

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Dermatologists Doing Good

If you’re a dermatologist planning to attend the next American Academy of Dermatology annual meeting in New Orleans, you can make a difference in a neighborhood still recovering from Hurricane Katrina.

The AAD new’s “Dermatologists in Action” program is organizing volunteers to refurbish a local school on February 3, 2011 from noon to 5 PM.  (The annual meeting will run from February 4 – 8). December 15, 2010 is the deadline to register.

Dr. Susan Olbricht (photo by D. McNamara)

“There are still a lot of schools struggling after Hurricane Katrina,” Dr. Susan Olbricht said at the annual meeting of the Florida Society of Dermatologic Surgeons. She is Assistant Secretary and Treasurer for the AAD.

The hands-on volunteer opportunity, planned in conjunction with HandsOn New Orleans, is open to AAD members and spouses, said Dr. Olbricht, who is also Chair of Dermatology at the Lahey Clinic and on the dermatology faculty at Harvard Medical School in Boston.

You can also donate money to the academy’s Sustaining Fund and/or donate requested medical supplies to the Tulane Community Health Center, which serves populations with limited access to primary care.

Remember to pack clothes appropriate for painting and cleaning.

–Damian McNamara, @MedReporter on twitter

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Isotretinoin – Caught Between Help and Hype

The James Marshall Accutane trial has been highly anticipated – at least by some, including:

  • Rabid fans of the actor who at one time was dubbed “The next James Dean.”
  • Lawyers hungry to cast more chum upon the churning Accutane waters.
  • And dermatologists, who must balance yet another risk/benefit ratio: the risk of being named in a multimillion dollar lawsuit vs. the benefit of isotretinoin to young people with disfiguring acne.

Marshall – who goes by his legal name James Greenblatt in the case filed in New Jersey Superior Court – was the free-wheeling biker in “Twin Peaks,” and Pfc. Louden Downey in the Academy Award-winning film “A Few Good Men.” He used isotretinoin and developed an inflammatory bowel disease that required a colectomy. Mr. Greenblatt claimed this resulted in incontinence, derailing his acting career. The suit, scheduled to go to trial today, had an all-star cast of witnesses: Brian Denehy, Martin Sheen, and Rob Reiner.

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We might be able to handle the truth about isotretinoin -- if we could only decide just what it is. Photo by Flickr Creative Commons user rot ist die farbe der hoffnung

When I called the court this morning to confirm the case, court administrator Rob Helsabeck told me it had been indefinitely adjourned. “No continuance date has been set,” he said. “I don’t know the details, but I heard that there is ongoing discussion between Roche and Mr. Greenblatt’s attorneys.”

Will Roche settle, sacrificing a few million to keep a high-profile case low-profile?

Or, perhaps science will prevail?

And that leads us to the science…

Flckr Creative Commons user cemre - before and after isotretinoin

Accutane was practically birthed with a bad reputation. In 1982, it went to market with fewer than 100 cases under its clinical belt, Dr. Hilary Baldwin said at the summer meeting of the American Academy of Dermatology.

Its teratogenic dangers were already well-established, and the prescribing information made it abundantly clear that it could cause thalidomide-like birth defects. But it wasn’t long before — like an eighth-grade girl caught kissing in the bathroom —  Accutane began to acquire a long list of horror stories.

Alopecia. Aggression. Violence. Depression. Suicide.

And, beginning in 1986, ulcerative colitis and Crohn’s disease. Subsequent reports led to a 1988 modification of the package insert, warning of a possible association with inflammatory bowel disorders, and urging patients to be on the lookout for GI pain, rectal bleeding, and diarrhea.

“In 2007, the lawyers got hold of this by the neck,” said Dr. Baldwin, a dermatologist in Brooklyn, N.Y. “Since then, more than 5,000 suits have been filed.

Seven of those have gone to trial, and Roche lost every one of them, with a total settlement amount of $45 million. Three, however, have been overturned on appeal – one just last week, with  Roche recovering more than $10 million.

It’s a victory for the company to be sure, but 45 more cases are lined up in the New Jersey Superior Court case docket. One of Roche’s biggest legal handicaps, Dr. Baldwin said, is that it has been unable to fully tell its side of the story.  “You certainly don’t want to make light of the poor young person who has developed this terrible disorder, and yes, it’s sad that someone would get IBD after treating their acne. But the jury only hears the numerator – they were never able to hear the denominator, that 18 million people have taken isotretinoin” and only a tiny minority developed IBD.

“The picture gets even cloudier when you consider that a time of peak onset for IBDs is 15-30 years – also the prime time for isotretinoin treatment.”

Two clinical reviews, one conducted in 2006 and one in 2009, found no statistically significant association between the drug and either ulcerative colitis or inflammatory bowel disease. The 2006 case-control study found 85 cases of IBD concurrent with isotretinoin use – a rate of 14 per year. “Interestingly, the expected results from this age population would have been about 59 new cases per year, so you could look at it that isotretinoin was actually protective of developing IBD,” Dr. Baldwin said.

According to a probability scale used in the study, four cases (5%) scored in the “highly probable” range for isotretinoin as the cause of IBD, 58 cases (68%) were “probable,” 23 cases (27%) were “possible,” and no cases were “doubtful,” – a conclusion that would leave most doctors unconvinced of a direct causality.

Lawyers have a different interpretation. “Study confirms 100% of IBD cases may have been caused by Accutane,”
trumpets the website of The Orlando firm, P.C., of Athens, Ga.

So who’s right?

The answer is still fuzzy, Dr. Baldwin said. Things looked pretty good for isotretinin through 2009, when a Canadian study looked at 12 years of data on 1 million Manitoba residents. There were no significant associations between the drug and the disease in the case-control analysis.

But earlier this year, an American team came up with a slightly different conclusion. Looking at about 15 million people in 12 health care claims databases, the authors concluded that 24 cases and 36 controls had been exposed to isotretinoin. Cases were 4.5 times more likely than controls to develop ulcerative colitis, but there was no link between the drug and Crohn’s disease.

“With our two most vigorous studies showing conflicting data, we are left not knowing what to do,” Dr. Baldwin said.

In the meantime, she said, the best physicians can do is strongly warn patients (and their parents) to be on the lookout for GI symptoms, and to report them immediately. The warning must be repeated at every follow-up visit and the medication discontinued if anything untoward develops.

The reality? As Oscar Wilde said,  “The truth is rarely pure – and never simple.”

— Michele Sullivan (@MGSullivan on Twitter)

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Filed under Dermatology, Family Medicine, Gastroenterology, IMNG, Internal Medicine, Pediatrics, Primary care, Psychiatry, The Mole

A Poster Girl for Poster Sessions

I gotta say it – poster sessions are one of my favorite meeting venues.

Thronged with excited doctors who can hardly restrain themselves during the delicate balancing act of pointing out statistics and conclusions, all the while balancing plates of food and glasses of wine like the Cat in the Hat and his famous multitasking adventure with Meg and the goldfish.

Here are scientists just being themselves – taking pictures of friends proudly displaying their “babies,” unconcerned about microphones or accents, uninhibited by the formality of speaking before a crowd, congratulating the sharp conclusion, questioning the flawed method, pushing for the truth.

A typical poster mash-up at a medical meeting. Photo for Flickr Creative Commons user euthman

The sessions are deservedly popular- a glorious mash-up of crowd focused on having fun through the whirlwind of group mind. One question leads to another and another — with both investigators and listeners saying, “Wow, I hadn’t thought of that angle.”

And then there’s the ritual exchange of cards – the face-to-face interchange that forges new relationships. I hear it all the time: “I’m going to email you some data I think you can really use.” “I’m working on something similar – let’s get together later and see how we can work together.”

They might not be broad enough or profound enough to make it to a big session, but they’re often specific enough to solve a riddle that has plagued a doctor in his or her own practice. Nothing beats it when you see a proverbial light bulb switch on over someone’s head and then that person says “Wow, I have a patient with EXACTLY this issue! I’m going to go home and give this a try!”

In a nutshell, it’s what medicine is all about – standing on someone else’s shoulder to grab the formerly ungrabbable.

From a purely selfish perspective, these sessions often make for great stories. The pros ask questions that might never cross my mind, and whether relaxed by the convivial atmosphere or the free goodies, everyone is in a generous “information-sharing” mood that journalists don’t always encounter.

Contrast that to the digital poster sessions here at the summer meeting of the American Academy of Dermatology.

There’s the requisite  big, cavernous room.

Subtract the papers on the wall, quadruple the number of empty computers, and you have some idea of the AAD's poster session at the summer meeting in Chicago. Photo by Flickr Creative Commons user Art as a weapon.

There’s a central podium with a TV screen made for displaying the poster.

There are rows and rows of computers, each with a chair in front.

And 90% of them are empty.

I visited twice yesterday, both times when an author I wanted to meet was scheduled to present data.

Once I was alone in the room.

Once there was one doctor, who told me this was the second “session” he’d attended – neither of which was graced by the author of the scheduled poster.

“I asked about it at the registration desk,” he said. “I was told it’s not mandatory for the presenter to attend. People can come in here any time and view all of the posters on screen.” The proctor in charge of the room told me only one presenter had shown up all day – and no one was there to hear her speak.

I checked it out. The program is easy to navigate. It brings up the poster in a series of PDF images. There’s even a link to email the presenter – although after you input all the data you get a message saying “Thank you. Your email will be delivered after the meeting concludes.”

In almost 10 years of medical reporting, this is the first 100% digital poster session I’ve attended, and I have to say it was a sad sight. I realize “green” is the new byword of our society – and computer presentations do save on printing costs for the giant poster and hundreds of handouts. But nothing can replace the human element of group mind – the electric conflagration that happens when the 10 trillion neurons in one brain start firing in tandem with 100 trillion  more – and that’s just when 10 people are discussing the same work. Multiply it by the hundreds that typically attend these sessions and you can get some idea of the intellectual energy that fires up a room.

Not to go all metaphysical on you – but let’s just say that the law of the universe employs a different math than humans do. In the poster session, 1+1 does not just equal 2. It equals an infinity of thought.

Don’t we all spend too much time hunched over our computers in solitary pursuit of knowledge? Aren’t we all beginning to miss the human interaction that really forms the basis of society, or scientific advancement, or religious theory, or the creation of community?

A digital poster session robs us of one more little piece of our essential human birthright – the right to build a collective mind – and have fun doing it.

–Michele G. Sullivan (on Twitter @MGsullivan)

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