PracticalDermatology

“Virginia, your little friends are wrong. They have been affected by the skepticism of a skeptical age. They do not believe except what they see. They think that nothing can be which is not comprehensible by their little minds. All minds, Virginia, whether they be men’s or children’s, are little. Yes, Virginia, there is a Santa Claus. He exists as certainly as love and generosity and devotion exist, and you know that they abound and give to our life its highest beauty and joy. You tear apart the baby’s rattle and see what makes the noise inside, but there is a veil covering the unseen world which not the strongest man, or even the united strength of all the strongest men that ever lived, could tear apart. Only faith, fancy, poetry, love, romance, can push aside that curtain and view and picture the supernatural beauty and glory beyond.” —Written by Francis P. Church in 1897

So we begin another chapter in the annals of our beloved specialty. Yet another year of cursing PBMs and CROs, of playing defense against the daily Google search, and for many of us just staying sane enough to take on the next day that ends in “y.” But we have a lot to be thankful for, including the hard work of Mark and Terry as our presidents, and the excitement of the Seemal show that starts in March. And for those of you who still can’t tell us apart, seeing him upfront should end that mystery.

If there was one topic that has sat with me in 2023, it was the revival of cohesion in dermatology and the hope that the old guard and new guard are starting to mesh, exactly what we need to cultivate new talent and new leaders (and maybe even a few influencers). The cohesion stems from the recognition of the common foes and vandals to the house of medicine, as we navigate our way through the changes in the landscape.

The Oxford dictionary defines a fraternity as “a group of people sharing a common profession or interests,” such as “members of the hunting fraternity,” or “the state or feeling of friendship and mutual support within a group,” which is definitely a pervasive mindset in many of dermatology’s societies. Keep in mind, however, that the spirit of a real fraternity is meant to be inclusive and inviting and not exclusionary or secretive. Many of our industry colleagues know this well especially if they left dermatology for another specialty, or if they joined a company that was not primarily dermatology focused. After all, the cult mentality that we all have manifests in different ways beyond just conferences. So yes Virginia, even Mr. Anderson from the Matrix would agree that the Derm Frat exists.

Common goals and a drive for making dermatology a better place should spark the interest in being a member of the fraternity…but it is inevitable that there will be a few who viscerally take offense of being excluded without even trying to dive deeper into the pool. Fundamentally if the frat is worth being part of, why not aspire to jump on board? Of course, that concept is saddled with the legacy of the “frat boys” who live for the closed doors of the group’s seclusion, similar to the Old Boys Club, the Mean Girls, or any other cliques and elitists we can think of. The recognition of the existence of the Derm Frat is not to identify a secret cabal that runs the show, but to see how we can take the best of “how things were” and adapt similar methods to face today’s challenges.

A legacy of leadership in the specialty or dermatology pharma can easily be mistaken for the image of a closed group, but the opposite is usually true: those who are new to the game and want to be part of the frat might be better served by listening and learning what not to do before delivering infusions of absolutes and opinions (a lesson from the last editorial). The fundamentals of quality over quantity and better instead of bigger have always been part of dermatology, but all of that goes out the window when any voices are cast out and the unattractive truth becomes gospel rather than being questioned. Moreover, the hill gets harder to climb when there is a perception that “pay to play” is funding the machine, and subsequently allows for a louder volume for certain voices and the eventual fading of others on their way out of relevance.

Let’s make sure that the mythical Derm Frat doesn’t just include the dermatology illuminati, but that we all step into the frat house with our knowledge of therapies, our passion for our patients, and even with a few checks for our advocacy platforms. Let’s not forget the days when we were defined by working “outside in,” but also spend more time on patient advocacy and working together to get the right treatments into the right hands, especially since working “inside out” has become just as prevalent. If you ask me the only fraternity I would like to see perpetuate would be the fraternity of “being comfortable” because the more I keep hearing that dermatologists are “not comfortable” using therapies that change lives is scary, and it makes me even more convinced we are giving medical dermatology away. It seems no matter how many conferences we have, how many articles we read, and how much we rinse and repeat the messages, we still have colleagues who are either not taking the time or spending the energy to fight the myths from the almighty internet, or to expose the big bad black box as guidance and not martial law, or,even worse, push back against the most idiotic of step edits written by those who have no clue. By contrast, as many know all too well, the pride that comes with getting involved in advocacy and teaching motivates dermatologists to still feel good about the direction of the specialty, especially with every little victory with each patient.

Most importantly, let’s make 2024 the year that we stop excluding ourselves from the fraternity and leave our differences at the door as much as we can…because there are plenty who would love to close our frat house down, including those who we thought we could count on. Sometimes ignorance is bliss, but now more than ever the Derm Frat needs all hands on deck…so let’s get to work, because just like Virginia needed to hear that there was a Santa Claus, we need some wins in our column and some good news for all of the fraternity brothers and sisters.