Conflicts of Interest for Doctors?

New York Times Article Points To Rampant Conflicts of Interest for Cosmetic Doctors

Where Can Women Get Unbiased Medical Information on Skin Care Treatments and Products?

In early February, the New York Times reported that the F.D.A. had warned a prominent cosmetic dermatologist, citing her for expressing positive comments about the anti-wrinkle drug, Dysport, before it had been approved. F.D.A. regulations prohibit investigators or researchers from promoting a drug before it is approved.

The truth is, almost every prominent cosmetic dermatologist quoted by fashion or beauty journalists, has relationships with cosmetic companies that raise potential conflicts of interest. Virtually every one of those dermatologists receives consulting fees, stock options, speaking fees or honoraria, investigating or research stipends or grants, board fees, or the use of free or loaned devices such as lasers.

Here are Two Examples

Dr. Fredric Brandt is a well-known dermatologist and author. He is often quoted in the beauty and fashion press. Does he have any ties to the cosmetic industry? Ms. Singer of the New York Times reports that he is an investigator and consultant for:

• Medicis, the distributor of Restylane and Dysport
• Allergan, the maker of Botox
• Ortho-Neutrogena
• Dozens of other makers of dermatology products

Here's another example. In August 2008, one of the best-known conferences on laser medicine listed 29 M.D.s giving presentations. Each presenter is required to identify potential conflicts of interest by disclosing relationships with companies from whom they receive something of "value."

Guess how many doctors had potential conflicts of interest because they were receiving something of "value" from a company?

• 28 out of the 29 doctors have relationships with companies who give them something of "value"
• 17 of the doctors take something of "value" from 4 or more companies
• 6 of the doctors have potential conflicts with over 10 companies
• One of the doctors began her oral presentation by saying, in a joking fashion, "Oh, we have to disclose our relationships with companies now, but I pretty much take money from everyone."

These Conflicts Deprive Consumers of Valuable Information

Big deal, you say. So these doctors work part of the time for cosmetic companies or device makers. Everybody is working some angle. Even some bloggers get in the game to get free products.

The problem is that consumers are spending billions of dollars to get effective anti-aging and cosmetic treatments. And because of the potential conflicts by the dermatologists, sometimes consumers are not getting good science. Or they're getting biased information.

Here are two types of information that consumers are not getting, both of which would be very helpful in guiding consumer decision-making:

1.  Negative reviews or reports. Have you ever wondered why you never read about a skin care product or cosmetic treatment that doesn't work? Because doctors get paid to say good things, not bad things. So they either promote a product or treatment, or say nothing at all. Consumers have a right to learn about treatments or products that don't work.

2.  No head-to-head studies of devices or products. Why don't we ever read about studies that pit different devices, or different skin care products, head to head in clinical studies? Wouldn't it be very useful to know which laser worked best? Or which over-the-counter retinol was most effective? No company will fund those studies, and no doctors will do a study unless they get the easy money from the cosmetic company. So these kinds of studies never get done. 

Where Can Women (and Men) Get Unbiased, Reliable Medical Information on Cosmetic Skin Issues?

So what are the options for getting unbiased and accurate consumer information on cosmetic medicine?

• From SkinTour.com's top skin care products article. That may sound self-serving, but truly, I don't know of another website from a dermatologist who has maintained independence from cosmetic companies and still provides detailed consumer information. About four months ago I added a blog to SkinTour, so users can ask questions and get my information and opinions directly.
• From Paula Begoun, on skin care products. You may know of her as the author of the book series Don't Go To the Cosmetic Counter Without Me. She has become the expert on skin care products. Her Beautypedia.com is a subscription service that has information on thousands of skin care products. And her email newsletters are well-researched and excellent. She is not a doctor, so her focus is more on skin care and beauty.
• From sites like WebMD.com or RealSelf.com. These sites are okay, but the content is a patchwork quilt of articles and opinions from users of the sites and a diverse array of "experts." Consumers don't get a coherent approach and the doctors are promoting their own practices, rather than providing comprehensive consumer information.
• From Bloggers. Blogs can be great - if you know where to find the good ones. They don't give medical information, but some give good, honest opinions on skin care and cosmetic issues. Here are two good ones: Bionic-Beauty.com and MythBusterBeauty.com.
• User-generated content sites. You can have some fun on sites that aggregate user opinions, like MakeupAlley.com. And lots of people surf those sites. But I personally don't expect great, high-quality information on sites that aggregate content and opinions from lots of sources.

Next, learn about Skin Imaging: Is it a useful tool or a gimmick?

From www.SkinTour.com and Dr. Brandith Irwin. Copyright 2008-2012 SkinTour LLC. All rights reserved. Journalists, bloggers, and media may reprint this without permission so long as they include this credit box with the article.