By Abby S. Van Voorhees, MD,
February 01, 2012Memorabilia of the founding fathers of this country is omnipresent in Philadelphia.
Signs abound attesting to where George Washington slept and ate. Somehow they are most apparent in February as we head into Presidents’ weekend and George Washington’s birthday. Since George (as we in Philly say) and my mother shared a birthday I have always been most intrigued by him. I often find myself wondering about the founding fathers — what made them so visionary? They were able to think beyond the accepted norms of their day and create a new type of government. We in the U.S. were lucky to have had leaders who could think outside of the box and challenge the status quo back then. Not sure which side of the political aisle you sit on, but I wish there was more of this kind of thinking on both sides today.
We have a few articles this month which are also challenging the medical assumptions of our day. Our Acta column highlights concerns that dermatologists have with the CDC guidelines on botulinum toxin. These rules were created by the CDC based on poor practice standards where multiple patients were injected with the same needle, so-called “double dipping.” Hard to imagine that 30 years after the arrival of the HIV/AIDS epidemic that would even be part of any discussion. However, in talking with David Ozog, MD, it is clear that we are left with rules that enforce unnecessary waste for practitioners and patients alike. His paper on the reconstitution and storage of botulinum toxin type A in the JAAD directly challenges the CDC view. He highlights the lack of infections noted in the dermatologic community when vials are used for multiple patients rather than single use, the durability of the toxin once mixed over weeks rather than days, and the advantages of reconstituting botulinum toxin with saline rather than the recommended diluent. Hopefully this will get the CDC thinking a little differently given the uniform success of these approaches by dermatologists across the nation.
Another assumption that dermatologists are questioning concerns the implementation of cosmetic taxes by some of our individual state houses. The assumption in many cash-strapped states has been that this would create a financial windfall. Connecticut has just recently implemented this type of tax, while other states tried to do the same but were not successful. One of this month’s features reviews the outcomes of New Jersey’s cosmetic tax — and this couldn’t be more timely, as a bill repealing the law was signed into law just as we went to press. We discuss many of the assumptions about this tax — ranging from the amount of monies that could be generated to the characterization of this tax as a rich person’s tax. Read it for yourself…maybe forward it to your local governor’s office.
I truly hope that you like our debuting column called “Technically Speaking.” For most of us in 2012 not much could be worse than our computer systems crashing. But we all need to accept this reality and in fact be willing to plan for this crash. We have fire drills where our patients question whether they are truly supposed to go outside without their clothes on — guess the next step will be computer crash drills where we will return to the days of handwritten scripts that patients take to the pharmacies themselves…how 1790s.
Enjoy your reading.