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H. JOHN ALBERS, MD, London The skin is fascinating. It attracts everybody’s attention. Our own and others’. Numerous professions and industries spend countless efforts and vast resources on it. We may or may not cover it with paint, creams and clothing. Even the healthiest skin is hardly ever left to be itself, but its appearance is often altered at will. Bare skin can both attract as well as repel, but what is more attractive than the face of a smiling infant? What carries more messages of life’s wisdom than the wrinkled face of an octogenarian? Dermatologists are members of this vast army of those who occupy themselves with skin care. They are the ones who are best trained to understand the skin in good and bad times, in health and disease. In their work, they are confronted with an extraordinary range of physical and psychological problems extending over the whole spectrum of human physiology and pathology. This seems to be beneficial to their job satisfaction because, on the whole, they appear to be content with their chosen profession. Does this perhaps explain their wide-ranging interests in nature, environment, history, family, people, geography, travelling and learning? After all, their daily work constantly confronts them with terms from the past and from nature: diseases named after forefathers in the profession and descriptions taken from botany and zoology. Dermatologists not only feel “lumps”, but they see texture and colour which then leads them to a diagnostic picture. In this sense they are akin to visual artists. Dermatologists have dreams and wishes. They would like their fellow-beings to have access to the wealth of dermatological knowledge, especially in times of disease. They would like this wealth to be maintained, disseminated and augmented. These are functions of our universities. However, the current reality in Canada points to the danger that society is beginning to lose such benefits. Waiting times for consultations with a dermatologist can be six months or more. This is not only bad for the patient, but also for the dermatologists who become less and less acquainted with acute and transient diseases. At the same time, many Canadian universities have had to cease meaningful undergraduate instructions in dermatology, not to mention postgraduate training. The reduced number of dermatologists and their overburdening clinical responsibilities make academic involvement a luxury, they can ill afford. Rare or unusual disease may go unreported in the dermatological literature. Research falls by the wayside. It is against this background that the Canadian Dermatology Foundation (CDF) extends all its efforts. Although we cannot create an ideal Canadian landscape with strategically placed, well-equipped and adequately staffed dermatology centres, we can help to maintain some core teams of academic and research-orientated dermatologists who will train and lead future generations. Those we support are ready to carry the flame of knowledge and add to it. Such people have always existed and will always exist. The CDF was founded in 1969. The seventies saw humble beginnings in fund raising and modest grant allocations, most of which for research projects, but some for general purposes, e.g. “dermatology equipment”, “tools for undergraduate teaching” or “sound slide equipment”. In the eighties, a more solid financial structure with higher membership fees and corporate contributions was attained. The selection process of grant applications became more stringent and a formal Medical Advisory Committee was established. Unusually high interest rates produced good income on a still moderate capital fund. The nineties brought extraordinary growth in all respects. The capital fund increased to nearly two million dollars, primarily through endowments. This allowed an increase of CDF grant levels. In 1994, Leo Canada entrusted the CDF to evaluate applications for an annual research grant of $50,000. Since then, other corporate sponsors have also channelled significant research funds through the CDF. Sponsored corporate grants comprise now about 75-80% of all funds distributed through the CDF selection system. CDF research grants are based on merit and go to carefully selected researchers in Dermatology Divisions at the most important Canadian universities. These grants are not large, but they represent recognition of the researchers by their peers and help to support their fund applications to other granting agencies. In addition, they keep dermatology on the academic map in Canada. Research does not always have to be relevant to current clinical practice or be accepted by physicians at large. Here are two poignant examples of many from medical history. “Laennec’s stethoscope was viewed with scorn by some physicians” (quot-ed from Thomas Addison (1793-1860), JMS Pearce MD FRCP, J R Soc Med 2004; 97: 297-300). Paul Langerhans discovered the cell named after him in 1868, but its true significance as part of the immune system in the skin was not recognised until 100 years later. The problems physicians may have in critically assessing new knowledge and research was recounted by Robert Jackson when he described Jonathan Hutchinson’s life-long conviction that leprosy was caused by eating decomposing fish (Jackson, J Cut Med Surg 1998, 3, 54-56). A recent article in the CMAJ will serve to illustrate the importance of dermatology research and writings. Abhay Lodha and Eugene Ng published “A neonate with denuded skin: Hay-Wells syndrome” (CMAJ, July 20, 2004, p. 131). These two neonatologists in Toronto quote five references, all from the dermatology literature. It is a pity, of course, that no dermatologist was involved in this child’s care, but at the same time it may fill us with pride that our profession has helped to provide the knowledge base for it. To continue this tradition of “knowledge increase through research, publications and teaching” in our country is the primary aim of the CDF. Canadian medical publications do receive international attention. In a recent paper on the status and future of German dermatology, Orfanos (JDDG; 2004.2:434-439) compares the number of medical papers of ten countries, incl. Canada, and their citation impact. It would seem important to assure that dermatological themes be part of the total Canadian output so that we are seen as worthy members of the international dermatology community. Closer to home, our academic centres must assure that dermatology continues to rest on sound scientific principles. We simply have to continue teaching and researching along sound and scientific pathways. It would be disastrous for Canadian dermatology if every dermatologist would devote himself/herself exclusively to economically advantageous dermato-cosmetology at the exclusion of classical, disease-orientated dermatology. The legitimate needs of a sick person must always have priority. For this we need well-trained physicians and good teachers. The Canadian Dermatology Foundation has now existed for thirty years. I wish it many more years in the service of Canadian Dermatology. I would like it to continue to grow. I would particularly like it to enjoy increasing and unanimous support from all dermatologists. I hope our colleagues would take personal responsibility for assuring the survival of academic dermatology by giving all the help within their power. May they understand and realize that strong dermatology centres at our universities benefit all of us, the whole population, i.e. patients, physicians and even those who think they will have healthy skin forever; and behave accordingly. I would also pray for farsighted donors who think of the CDF in the form of endowments or planned giving. One does not have to be wealthy to give. May the future show that in the Canadian Dermatology Foundation Wish and Reality have become one. © CDA Bulletin October 2004 - published with permission of the Canadian Dermatology Association |
