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Research in dermatology comprises only a small portion of the total amount of money spent yearly on research in fields such as internal medicine, neurology and cancer. The need for interested and talented individuals to tackle the big challenges in dermatology is greater than ever before, and practitioners are looking at ways to make the most of limitations in funding, compensation and opportunities that stand in the way of recruiting more qualified individuals to the research ranks.
The skin is the largest organ in the human body, and that's not all. It's exposed to sunlight and countless other hazards from bacteria to bug bites, and when things go wrong the consequences can be fatal.
Despite these facts, the world of medical research devotes fairly little attention to dermatology. And dermatologists themselves tend to avoid careers in research.
Dr. Gilchrest"A very small proportion of the entire population of dermatologists are doing laboratory research. Below 10%, maybe 5%," says Barbara A. Gilchrest, M.D., of the department of dermatology at Massachusetts General Hospital. "That's a small fraction compared to other fields like neurology or internal medicine in general."
Now, the dermatology research gap is getting more attention.
"Unfortunately, today’s financially austere research climate presents unprecedented regulatory and funding threats to both junior and senior researchers," the authors wrote. "To continue to conduct high-quality research that advances patient care, the field of dermatology must identify the dermatologic researchers of tomorrow and prepare them to tackle the challenges that lay ahead."
To shed light on the problem, Dermatology Times reached out to Dr. Hartman, Dr. Gilchrest and commentary co-author Alexa B. Kimball, M.D., MPH, president and chief executive officer (CEO) of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center and professor of dermatology at Harvard Medical School. They all provided perspective about the challenges and solutions on the dermatologic research front.
Dermatologic research lacks the sexiness of other kinds of research. But why?
A commentary in The Journal of Investigative Dermatology1 notes that "there has historically been a tendency to trivialize dermatologic diseases because of their nonfatal nature, and as a result, less research funding has been devoted to them."
Indeed, a 2014 study2 found that the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases devoted only 18% of its $424 million fiscal 2013 budget to skin conditions. Researchers discovered that several conditions -- including acne vulgaris, viral skin diseases, fungal skin diseases, scabies and melanoma -- were funded at lower levels than their disability burden suggests they deserve.
There is some good news, however.
"Despite the shortage of funding, dermatology research is growing, with increasing publications and new treatments for a number of diseases including hidradenitis suppurativa, eczema, and alopecia areata," Dr. Hartman says.
And Dr. Gilchrest says there's "exciting new therapy" in the melanoma field, much of it based on basic work by dermatologists.
"Cancer therapies are often more lucrative for pharmaceutical companies," says Dr. Gilchrest, who added that there's also extensive research into psoriasis.
Dr. KimballStill, the three dermatologists interviewed for this story find plenty of reason for concern. "The areas that remain vulnerable are basic science, where funding is scarcer than ever, and clinical trials, which require large dollars in order to complete investigations," Dr. Kimball says.
Even when funding is available, young dermatologists often reject a career in research. Pay is one issue.
"The private practice of dermatology can be quite lucrative, and that's a temptation dangling out in front of people," Dr. Gilchrest says.
Even when academics manage to woo dermatologists from careers in private practice, many end up on the clinical side instead of working on research.
"Graduating residents are finding academia quite appealing currently, with academic jobs are becoming increasingly popular and more competitive. That’s a change from previous years," Dr. Kimball says. "But the research career trajectory is more complicated and uncertain than it used to be. The clinical needs of academic centers have changed, and there are more types of career tracks today in academia than ever before, some of which aren’t dedicated to research."
There's yet another complication that affects dermatologic research. Unlike some other specialists, dermatologists often don't practice in a hospital setting "where it's relatively easy to do research," Dr. Gilchrest says.
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In the commentary, the dermatologist authors call for "a critical mass of interested and qualified investigators," supervisors and mentors to provide guidance, and research funding to support researchers in various stages of their careers.
"Finally," they write, "young investigators need models of successful career pathways to either emulate or modify."
The three dermatologists say dermatology organizations are crucial to the future because their meetings allow young researchers to mold their futures. "Many trainees over the years have talked about how formative these kinds of experience are for them," Dr. Kimball says. "It’s a combination of meeting people who have been there and creating a network and an opportunity to model one’s own career path."
Dr. Hartman agrees, saying "mentorship is crucial."
Dr. Hartman"The Society of Investigative Dermatology resident retreat, as well as mentorship programs from other societies such as the American Academy of Dermatology, Women's Dermatologic Society, and American Society for Dermatologic Surgery, are providing fantastic opportunities for young mentees to connect with mentors," she says.
Dr. Gilchrest points to Advances in Dermatology, which will hold its 37th annual gathering later this year in New York City. She says its meetings bring together dermatology residents and junior faculty, "a dialogue that wasn't happening before. The message that they have is very appealing, and I think it will result in more effective translation of research to physicians as a community."
Where will money for dermatologic research come from?
"The National Institutes of Health (NIH) is a well-known funding source," Dr. Hartman says, "but there are many other phenomenal funding opportunities including the Dermatology Foundation, American Skin Association, other governmental organizations such as the Agency for Healthcare Research and Quality (AHRQ), and the military, patient advocacy groups, and industry."
According to her, younger researchers may seek funding from these alternative groups given that the average age of an NIH-funded researcher is increasing.
Meanwhile, Dr. Gilchrest sees the growing links between universities and the drugmakers’ world as a positive trend. "For a long time, the academic institutions really didn't want to have anything to do with the pharmaceutical industry. It was considered to be dirty to be interested in making drugs," she says. Now, she says, connections are being made and changing these relationships for the better.
The dermatologists are hopeful about the next generation of skin doctors and their commitment to developing new treatments.
"In general, the millennial generation likes to be a part of larger organizations and communities that have a meaningful mission," Dr. Kimball says. "That bodes well for academia and research."
For her part, Dr. Gilchrest sees a future in which some younger dermatologists seek an alternative to the modern frustrations of private practice. "Being in a laboratory or clinical setting is a very welcome contrast for many people," she says. "Hopefully, those who come into the field will see a path that includes a long-term element of research as both a way to be creative and very important to their mental health.
Dr. Kimball reports that she investigates and consults for industry in the design and conduct of clinical trials.
Dr. Gilchrest reports no relevant financial interests.
1Dermatology’s Researchers of the Future: Our Workforce Pipeline and Richest Opportunities Hartman. Rebecca Ivy et al. Journal of Investigative Dermatology, Volume 136, Issue 2, 345 - 348
2Karimkhani C, Boyers LN, Margolis DJ, Naghavi M, Hay RJ, Williams HC, et al. (2014) Comparing Cutaneous Research Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases with 2010 Global Burden of Disease Results. PLoS ONE 9(7): e102122. doi:10.1371/journal.pone.0102122