Trend toward cosmetic practice raises questions

The dermatology field's increasing shift toward cosmetic services requires practitioners to examine the relationship among patients, their dermatologists and other participants in the cosmeceutical market, say William P. Coleman III, M.D., and Zoe D. Draelos, M.D., a Dermatology Times editorial adviser, who answered a series of questions on the topic for staff correspondent John Jesitus.

DT: How is it possible to avoid a conflict of interest when selling products in the office?

DT: Is it realistic to assume that patients will not be intimidated into purchasing cosmeceuticals directly from the physician?

Dr. Coleman: The patient certainly may feel some pressure if the physician decides to apply that pressure. The way I avoid this in my office is by having only a very few unique products available to patients. I believe there is a potential for alienating the patient by appearing to be a pharmacy instead of the patient's advocate. We specifically see patients all the time who come to us because they were frustrated with an office where the doctor was pushing this and that product.

Dr. Draelos: It depends on how it's handled. Patients don't need to be intimidated. However, it's easy to think that in order for the doctor to take care of them, they need to purchase something. I don't sell products out of my office for that reason. I don't believe it's possible to walk that fine line for all patients and all perceptions.

DT: How can dermatologists complain about pharmacists acting as physicians when giving advice about drugs, while physicians who dispense drugs in their offices appear to be doing the pharmacist's job?

Dr. Draelos: That's an issue. It's hard to be unbiased. Obviously, what one sells may not be the best. But in the patient's perception, because their doctor is selling it, it must be. The way around all that is to sell it for cost, or cost plus a handling fee - not to mark it up the traditional 50 to 100 percent.

Dr. Coleman: Dermatologists who make prescription drugs available in their offices would probably say that selling these products allows the patient more convenience. One of the problems patients have nowadays is that their dermatologist will prescribe something, the patient will go to their drugstore, and the medication is not there, because pharmacists don't want to stock a broad range of items. The ethical approach is to be sure that the markups (in a doctor's office) are no more than what a patient would find in a pharmacy.