With the ongoing battle between Allergan and Valeant, it is evident that no practicing dermatologist can avoid concerns with the painful and tactical machinations. Long-term representatives have likely already changed their nametags from one company to another and are now pitching the same drugs under a new owner. Other representatives are exhorting their dermatologists to take an active role in the defense of Allergan against Valeant's offer.

Who would have thought this could have been possible even a few years ago? With the only constant being change, dermatologists and cosmetic surgeons must recognize the new reality and consider how our practices can adapt to the new arrangements. Additionally, we have to try to understand how the uninvolved (Merz and Strathspey Crown/Alphaeon) fit into the equation. Will they become part of the picture or will this all crumble and leave them the only unscathed parties?

Sadly, this all continues to involve not just numbers and dollars/cost savings, but people and their families, as well as relationships with dermatology that have spanned decades in some cases. In my case, I have seen the loss of over 150 man-years of relationships and the transfer of nearly 50 man-years of relationships within just two companies recently. Luckily, most of my affected friends have found jobs or were nearing the end of their careers, but it still is a painful reminder of the humanity behind this corporate chess game.

As to the ultimate question of whether this will be good or bad for dermatology, my initial reaction has to be a knee-jerk ‘bad,' but in reality it was probably bound to happen one way or another over time. Dermatology was one of the few insulated specialties that lived in a collegial, nearly ‘Leave it to Beaver' world, with pharmaceutical relationships that could only be referred to as familial in many ways. Perhaps we are now encountering the millennial generation of pharmaceutical companies.

As with any situation, wherever there is a void there is an opportunity. Merz and Strathspey Crown/Alphaeon can possibly provide a different model of relationship that fits the world we live in, and Galderma has a tremendous opportunity to leverage the years of relationships they have acquired lock, stock, and barrel. Will Allergen fend off Valeant or will their force be working for the people they decried as unsustainable for so long? How will their sales force perform in this situation? And finally, possibly the most concerning question regards innovation and its chances for the future. Will innovation suffer as profits are extracted at any cost? I personally don't think so, as innovation happens in the most unlikely of places. Forced innovation rarely succeeds and even if it does, it is inauthentic and usually shallow. Latisse, Botox and Rogaine were all examples of accidental innovation that resulted in huge opportunity. While pharmaceutical companies clearly funded the process (with two out of three of these examples having been Allergan-funded), these innovations likely could have happened outside of Big Pharma, but that remains unclear.

We all wait and wonder as this unfolds and, as always, our hearts go out to our friends, colleagues, and supporters who are now in a state of suspense. Let's hope that the best scenario unfolds, whatever that may be.

—Joel Schlessinger, MD, FAAD, Chief Cosmetic Surgery Editor

This editorial will appear in the August edition of Practical Dermatology. Visit www.practicaldermatology.com for more insights on the latest trends and news in the specialty.