Interview with AAD president Prof. George J. Hruza

Dermatology in the future: Access to the right drug will be a global challenge

 

Conducted by Dr Susanne Kammerer

President of the American Academy of Dermatology, Adjunct Professor at St Louis University, and Director of the Laser & Dermatologic Surgery Center in St Louis, USA.

Prof. Hruza, what are your highlights of this AAD meeting?

This is a though question. About 18,000-20,000 people came to the meeting, including 9,500 medical professionals and a huge international presence. Talks are all about the new stuff, like the biologic drugs enabling us to treat inflammatory diseases such as psoriasis and atopic dermatitis better than ever before. There are also exiting new developments in skin cancer treatment, as drugs for advanced squamous cell carcinoma of the skin have come out for the first time. There are also new technologies. I just saw an ad for a device that induces rapid whole-body muscle contractions, so people could get tight muscles without even going to the gym. In the procedural area, I learned about an investigational drug for cellulite that breaks up the collagen bands after being injected into the bands so that dimpling is reduced. And there are of course advocacy matters, especially in the US where we have big issues with cost of medications.

How can you insure access to the right drugs?

It’s not easy. We have these revolutionary medicines to treat psoriasis or atopic dermatitis. Yet, the costs can be quite prohibitive. The insurers oblige us to follow the so-called “step therapy”, but it really is “fail first therapy”. We have to put patients through all the older medications and their inherent potential side effects, just to prove that they fail and the patients have to go on suffering until then. I think this is just not the right way to go. We also have to deal with pre-authorisations. In the US, we have hundreds of medications that must be approved by the insurers, even generic ones, before treatment. This is totally ridiculous and a waste of time, staff, and resources, as in 90+% of cases they finally approve it. We are fighting these restrictions in all the states and at the federal level.

With all the online possibilities, do you think it is still worth to attend an AAD meeting?

If you want to learn about, for example, some specific drug, this is to some extent possible online. However, there are important other aspects. One is the possibility of a live connection to an expert speaker whom one can ask questions in real time. It is so much more effective than online watching; even if online questions are possible. The actual exchange is important; be it during the session or afterwards as the speakers often stick around for questions. The other part is the interaction with other dermatologists on a personal level: it is so important and valuable. I think most people feel the same, as our meeting gets bigger and better every year.

What is your most important goal as president of the AAD?

My mission is to help my fellow dermatologists to maintain and, if necessary, recapture their “joy of dermatology”. I have been doing my work for over 30 years and I still love it every day: interacting with the patient, keep on learning, trying new things. However, in the US, we are having a lot of regulatory and electronic health record hassles resulting in the fastest rate of burnout among medical specialists. For me, the Academy’s role is to be a bit of a cheerleader that also tries to reduce some of these burdens such as providing templates for automated prior authorisation or helping with electronic health record issues.

What is the major future challenge in dermatology?

In the US, very few dermatologists are now going into private practice; they are mostly employed by hospitals, universities, private equity-backed groups, and even insurance companies. So, there is a loss of independence. Those dermatologists may be thinking that their employer will take care of all the regulatory burden and advocate for them, which is not true but could reduce their bond to the Academy. In the long term, our big challenges with augmented intelligence have just started. Dermatology is a visual field and computers can be used to analyse images. A software programme has already shown that it could determine if something is benign or malignant; in some cases even better than a dermatologist. But while many of our members see this as a threat, I think we need to embrace it as a tool that we integrate into our work. It is never going to replace our experience, our judgement, and most importantly the connection to the patient. I think that patients want, even crave, the human connection, and we have to make sure they have access to it. At the moment, however, we do not have enough dermatologists in the US. The average wait time to see a dermatologist is 77 days.

Posted on 23 April 201916 March 2021