Sunday, February 6, 2011

Yosipovitch on itch clinics

Last Thursday I spoke to Gil Yosipovitch, an eminent dermatologist and itch expert at Wake Forest University. I called him because Martin Steinhoff said Yosipovitch ran the only itch clinic in the United States, and I wanted to learn how such a clinic operates.

The only problem: Yosipovitch does not run an itch clinic. There are NO itch clinics in the United States. "I very much believe it's the future and there should be many of them," he says. He's happy that Steinhoff is establishing one. The centers in Germany are the model; apparently a colleague is also starting one in Singapore.

Y believes there are a couple barriers to itch clinics getting started in the US. The major one is insurance companies and the current system for reimbursement; doctors have much more incentive to do basic treatment like wart removal than they do to care for patients with chronic conditions who require regular monitoring. Also, he says, to establish a clinic, a department chair (at a hospital or university) has to put money into it. That means leadership, and no-one except for Steinhoff has shown that leadership.

Y says that he likes Steinhoff's plan of directing a clinic with a number of resident doctors and a nurse practitioner who keeps in touch with patients through an online forum. In fact, Y himself once ran such a forum, called "Living with Itch" (if I understand correctly, it got folded into the International Forum for the Study of Itch website, but I can't find a link to old postings). The problem was that the site, on which patients shared their "anguish, frustration, and practical ideas," was quickly "hacked," in Y's words--possibly not hacked, but overwhelmed with spam from quacks advertising miracle cures like some garlic diet. So the forum became useless and was abandoned. Y thinks an online patient forum could work if someone was dedicated to the web technology side, and ensuring that only authorized patients could use it. (Also, there are "HIPAA," or medical privacy, issues, he says; presumably his former site managed to solve them.)

A point Y insisted on making was that itch should be treated as a disease, not a symptom. It's a major issue. He sees many parallels between itch and pain; itch is now where chronic pain was thirty years ago.

Y also thinks that eczema patients should look to psoriasis as a disease whose patients have been successful in setting up support groups and activism for funding. "But [itch clinics] needsencouragement from the upper levels," he says, meaning the NIH and legislators who have the power to make insurance companies change the incentive model.

Y is a fan of the National Eczema Association. "They're providing a lot of support to atopics," he says. He was able to leverage a small NEA grant into a large NIH one (that's how science funding works--a granting agency will only give you money if someone else has already given you money). I suppose I should be happy that he likes the NEA. He said he only decided to talk to me because I was raising money for them.

In my next post I'll talk about Y's position on alternative medicine. My next post, by the way, may be my last for some time. I need to resolve this trouble I've been having with my neck, and the less time I spend at a computer the better, for the moment.


  1. I probably should wait to see what your stance is on alternative medicine, but couldn't resist after the neck comment- and because I found your blog off another blog that is pro- alternative medicine (specifically NAET). Why don't you find an NAET practitioner who is an acupuncturist or chiro and see if they could help you with both the eczema and the neck pain. Worth a shot. I really enjoy your blog- lots of great information- so thank you!

  2. I am very sorry to hear about your neck problems! That can be quite painful. I had/have problems with my shoulder and neck from sitting long hours in front of a computer, too, but I found a very good massage therapist that really helps me. Of course, I will miss your regular blog entries, but I will enjoy reading your blog no matter how often - or seldom - you will post. It is really great that you had a chance to talk to Steinhoff and Yosipovitch about the itch centers and thanks for sharing what you learned! I hope you will be better soon!

  3. Thank you both!

    While I try to be open-minded about all kinds of medicine, I'm a scientifically trained skeptic, so consider me pro-Western medicine. But if something works, it works. Not up for NAET yet, but I've had a good experience with a chiropractor, and right now I'm starting yoga (Iyengar), because a friend strongly recommended it. Namaste to all.

  4. Dear Spanish Key,
    how is your neck? Are you feeling better? I was just checking your blog to see if you posted already about Yosipovitch's position on alternative medicine. I am in a bit of a crisis about alternative medicine right now and would love to learn what Yosipovitch has to say. I see that you haven't posted for a while and was just wondering how you are.
    All the best,

  5. Hi Caroline--thanks for writing!

    I know, I promised to write that post, and never have. In short, Yosipovitch is all for alternative medicine, whatever variety, as long as it works. He was not critical of it at all, to my surprise. I'd have to dig up my notes to find the details.

    It's unbelievable but I still have back trouble that makes me very cautious about using a computer more than I have to. And the half-hour I used to spend blogging each night is now taken up with doing physiotherapy exercises. Fortunately the ORIGINAL neck problem I had is gone; but it has been replaced by a new one! If it ever goes away, I hope to get back to the blog.



  6. I am sorry to hear that you are still struggling with your neck and back - these things can take forever. I hope that will go away soon.

    Interesting that Yosipovitch supports alternative medicine "as long as it works". And this is exactly my problem. I feel like looking for the needle in the haystacks. How do I find the one thing that works? I guess we just have to keep looking.....

    All the best to you!

  7. Yes, I do think that one has to keep looking, unfortunately. Y didn't claim that any particular therapy was better than the rest.

    I've just had a very enthusiastic comment on my first vitamin D post from someone who says that 4000 UI/day is working for him. Of course, he's only 3 days into the regimen.

    Re: the back thing, my physiotherapist suggested acupuncture, which I will likely try at some point. There was a time when I would have pooh-poohed acupuncture, but I can imagine that a well-placed needle might cause some strategic inflammation, or turn on or off some crucial pain or itch nerve. Does it work for my problem? That is the key question for any therapy.

  8. I have never know about these clinics...but I think there is good medication and good help for eczema.