It is in this time following approval where we can realize that we have at first made two steps forward in the treatment of a condition, but then have to take one step back as we see side effects become apparent as the drug is used by a wider population.

There was one example in the New York Times today as some older men are having complications from cataract surgery if they’ve been taking the drug Flomax for urinary flow problems. I hate to poke fun, but that means those virile men in the television commercials where they are river rafting without a care in the world may, some of time at least, need glasses because while their urinary problems were better their vision may have become worse. The drug company says it has always advised patients to talk to their eye surgeon about their use of Flomax and have the surgeon consider a different technique to reduce the risk of a complication. Now experts are saying this may not be enough attention to a real problem.

I just heard about another example of a side effect: severe acne in some cancer patients who take one of the new epidermal growth factor inhibitor medicines. It seems epidermal growth factor is important in healthy skin cells and not just cancer cells. The concern is, while the new medicines can really help fight cancer, the skin problems that go with them have to be treated too, and treated early to prevent infection or such severe side effects that cancer fighting treatment has to be suspended and the cancer patient’s prognosis suffers because of it.

So, as I like to say, there is no “free lunch” with powerful medicines, and sometime we don’t know the full picture until they are approved, and out there for thousands of patients and doctors to use. That doesn’t mean it is not medical progress. It is medical progress tempered.

I know from an interview conducted this week with a dermatologist who specializes in helping cancer patients that the skin problems from the new cancer drugs can be managed. And I am betting millions of men who take Flomax can still get the eye care they need when they need it. This comes with more refined treatment plans based on experience. Two steps forward, one step back. It is to be expected.

My advice to patients is to read the fine print as you take a new medicine. There is always a “package insert.” Were eye issues observed with Flomax in the trials, yes, I believe so? How about skin problems with the EGF inhibitors? Yes, there too. So we patients should prepare and force a discussion with our doctors as we take new medicines to probe how vigilant we should be about side effects and how to limit them. It’s one more time when, like it or not, we have to be a strong advocate.

I welcome your comments at questions@patientpower.info and, as always, I remind you that knowledge can be the best medicine of all!

Wishing you and your family the best of health!

Andrew

Now consider that psoriasis is an autoimmune condition where skin plaques are merely one of the more evident symptoms and that many dermatologists rarely delve that far below the surface. With this in mind, it’s pretty evident that you owe it to yourself to consult with a psoriasis specialist – someone who is well-versed in the latest treatment options that attack the problem where it lives – if you want to get the best care.

Even if you keep your dermatologist, you should have an expert physician be the co-architect of your treatment plan (with you, of course!). That’s what I did for my cancer, and it makes just as much sense for a serious chronic condition like psoriasis.

While there are not that many “super specialists” for psoriasis, there is sure to be one within your reach. Check with the National Psoriasis Foundation or our own Psoriasis Community message boards if you need a recommendation. And be sure to ask about clinical trials. There might even be a better medication coming down the pike that you could try now.

I’ve heard many people with psoriasis are somewhat blase about taking proactive steps to “get the best.” I know if you are reading this, that’s not you. But no matter what, I urge you to review whether the smartest psoriasis expert in your area has weighed in on your case.

With our medical understanding of psoriasis growing and the treatment landscape shifting as much as they have in recent years, it can’t hurt, right?

–Andrew