Are we consultants or peddlers?

Ethics in cosmetic dermatology

The dispensing of nonprescription skin products by dermatologists and the performance of ineffective cosmetic procedures are the most controversial subjects associated with the practice of cosmetic dermatology. These topics have been hotly debated within the profession for several decades, with each side presenting cogent arguments. The debate is also characterized by strong passion and emotions on both sides that are not easily reconciled. Dermatologists and their patients are best served by an objective, organized approach to clearly delineating the various aspects of these issues and providing guidelines for practitioners that can be shared with patients.

Ethics of selling skin care

One of the most controversial topics surrounding the practice of dermatology is in-office dispensing of nonprescription skin care products by dermatologists. The controversy is not new, with legitimate arguments debated for and against it. The ongoing debate will continue, emotionally charged and with sharply demarcated battle lines, but without the promise of ever reaching a consensus. Regardless of one's position, the objective is to develop strategies to improve the practice of dermatology and the welfare of patients.

Chiropractic in the United States: trends and issues

Chiropractic is the best established of the alternative health care professions. Although marginalized for much of the 20th century, it has entered the mainstream of health care, gaining both legitimacy and access to third-party payers. However, the profession's efforts to validate the effectiveness of spinal manipulative therapy, its principal modality, have yielded only modest and often contrary results. At the same time, reimbursement is shrinking, the number of practitioners is growing, and competition from other healing professions is increasing. The profession's efforts to establish a role in primary care are meeting resistance, and its attempts to broaden its activities in alternative medicine have inherent limitations. Although patients express a high level of satisfaction with chiropractic treatment and politicians are sympathetic to it, this may not be enough as our nation grapples to define the health care system that it can afford.