Balancing Medical Dermatology and Clinical Trials

March 2014
Balancing Medical Dermatology and Clinical Trials
Rod Kunynetz, MD, FRCPC
One of the great advantages of dermatology is that it is a multifaceted specialty. It includes
medicine, surgery, cosmetics, immunology, dermatopathology and infectious diseases.
Fortunately, most if not all, of these paths include the opportunity for research. Probably the
most common in Canada is that of clinical research, ranging from phase one to phase four
trials. Being involved in clinical trials has its great rewards, but also has its disadvantages. It is
a fine balance between the usual dermatological patients requiring medical or surgical care
and those that have been enrolled in trials.
Those involved in clinical trials quickly learn that scheduling becomes a nightmare; trying to
balance both sides of the equation. The clinical trials themselves and the investigator
meetings are very time consuming. They are unpredictable as to how many, how often and
the ebb and flow of new trials are very erratic. Often investigator meetings are scheduled
several months ahead only to be cancelled and/or rescheduled for a later date. Difficulties
often arise in trying to attend these meetings, usually held in the southern United States,
rarely in Europe or western US or Canada. Scheduling routine medical patients and even the
clinical trial patients (who are to see you by a certain date) around them is difficult because it
means cancellations in order to travel. Fortunately most of the pharma community has
realized that such travel infringes not only on routine medical income for a dermatologist, but
also presents headaches with clinical trial patients being seen within their proper follow-up
scheduling windows. The community has thus responded in scheduling investigator
meetings, for the most part, on weekends. This certainly does lead to a very long week for the
investigator with the weekends being spent from morning to evening at the meeting hall and
then travel back home. There are thus many hidden costs to being involved with clinical trials
which the novice quickly learns.
Among the advantages is that one becomes a much more complete physician; again
rediscovering the stethoscope and the otoscope and “dusting off” the black medical bag which
many of us have stored over the last several decades. Having access to novel therapeutic
modalities, usually pharmaceutical, is a great advantage as we become very familiar and
comfortable with them before their approval and introduction to the general medical
population. One can also give patients hope for better outcomes given the prior
familiarization with these modalities. In general I believe you become a better physician.
Scheduling can be approached in a number of ways. The most common is intertwining
patients for clinical trials with those of your general medical dermatological practice. Some
dermatologists will segregate, for instance, seeing their dermatological patients in the
morning and the clinical trial patients in the afternoon. The former is usually a steady stream;
however the afternoon clinical trial patients may give you an overfull schedule at some times
of the year and at others, a sparser pace. The use of staff also can be varied if one does
segregate the morning and the afternoon patients. The same staff can be used in the morning
and afternoon. However the intertwining of patients does certainly require a dedicated
clinical trial staff. Just as with any medical procedure one does need to rely heavily on the
dedication and the efficiency of this staff; ultimately any misadventures will end up in the lap
of the dermatologist.
Despite all the above potential headaches, I feel that clinical trials are very rewarding for all
involved: the physician, the staff, the patient, and the pharma industry.
Editorial Board /
Conseil de rédaction
National editor/
Rédacteur en chef
Regional editors /
Rédacteurs régionaux
Robert Jackson, MD
Ottawa, ON
Paul Kuzel, MD
Edmonton, AB
Charles W. Lynde, MD
Markham, ON
Benjamin Barankin, MD
Toronto, ON
Ian Landells, MD
St. John’s, NL
G. Daniel Schachter, MD
Toronto, MD
Executive director /
Directeure générale
Marc Bourcier, MD
Moncton, NB
Catherine McCuaig, MD
Montréal, QC
Victoria Taraska, MD
Winnipeg, MB
Chantal Courchesne
Ottawa, ON
Peter R. Hull, MD
Saskatoon, SK
Kathleen Moses, MD
Ottawa, ON
Catherine Zip, MD
Calgary, AB
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