Tuesday, November 9, 2010

Many are never diagnosed with eczema

Dr. Sib mentions something interesting in her first post. Although she is now a doctor, when she first developed eczema around the age of 19 she waited a long time to consult a doctor. (Who then confirmed her doubts about the medical profession by prescribing an antifungal cream.)

She isn't alone in this. Many people suffer from eczema without ever having it diagnosed by a doctor. In Jon Hanifin and colleagues' 2007 survey of eczema prevalence in the U.S., the authors estimate that there are 31.6 million people in the United States with some form of eczema. How did they know these people had eczema? They surveyed 116,202 people and extrapolated to the entire population; they asked, first, whether each subject had experienced symptoms that would add up to eczema; and then, whether the subject had been diagnosed with eczema by a doctor. Of the group designated as "symptomatic," i.e. suffering from eczema, only 37.1% had been officially diagnosed.

So there could be as many as 20 million people in the U.S. who have eczema and don't even know they could try to relieve it with steroids, emollients, restricted diet, or whatever therapy you might choose. Instead, they're doing nothing, or treating it as ringworm.

Let me take this opportunity to applaud, first, the NIH's PubMed catalog of medical papers, and second, open-access scientific publishing. In the U.S., the vast majority of science research is paid for by taxpayers via the NIH. And yet, the best papers end up in Science or Nature or Cell, or other journals that you have to pay to read. (Actually, Science makes papers open-access after one year.) In my day job, I have access to a lot of journals, but as soon as I come home, I'm locked out of almost the entire scientific literature. At least PubMed is free, so I can search for papers and see what has been published (you can often write to authors and they'll send you copies, as Jon Hanifin did for me); and there is a family of quite highly ranked open-access journals called Public Library of Science (PLoS). Check 'em out. It's all free! The problem is that I haven't yet found any interesting eczema research in PLoS Medicine. We should ask prominent researchers to publish their work in the PLoS family of journals. If we funded them, they're morally obliged to try!

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