Humanities Viewpoint
prove medication adherence and reduce the drug resistance. These children have the same genes now as they will have as adults, but presumably the average drug effect produced in them as children will differ from the average drug effect when they are adults. The effect of environment on genotype was powerfully documented in investigations of the genetically homogeneous North African Berbers; leukocyte markers differed depending on their living in mountainous compared with shoreline regions.5 Nongenetic variations in drug absorption, penetration, distribution, metabolism, and excretion—as well as drug-drug interactions that influence a drug’s potential effects—are a given part of the complexity faced by physicians and patients in drug therapy.6 Recognizing that the same drug will produce variable effects in different individuals highlights the appreciation that so-called meARTICLE INFORMATION Published Online: October 23, 2013. doi:10.1001/jamadermatol.2013.6759. Conflict of Interest Disclosures: None reported. Additional Information: Dr Eaglstein is Emeritus Chairman of the Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida. REFERENCES
too drugs that vary in molecular structure (and especially in the case of topicals with regard to vehicle) are likely to produce effects that differ from those of the pioneer or breakthrough drug. As clearly as we are not biologically me-too people, me-too drugs each have their value. This independent value or differentiation in the clinical setting helps to account for the often lamented failure of me-too drugs to produce a competitive reduction in pricing. The clinical value of having several drugs available in the same category also accounts for the frustrations occasioned by formularies that offer only 1 or 2 drugs in a given therapeutic class. It is important for dermatologists and other physicians to be alert to the value of me-too drugs. This will not only broaden our ability as therapists but also help us to resist at the outset efforts to curtail our patients’ access to all available drug therapies.
2. Angell M. The Truth About the Drug Companies. New York, NY: Random House; 2004.
http://pediatrics.aappublications.org/content/112/3 /e220.long. Accessed September 18, 2013.
3. Gagne JJ, Choudhry NK. How many “me-too” drugs is too many? JAMA. 2011;305(7):711-712.
5. Idaghdour Y, Czika W, Shianna KV, et al. Geographical genomics of human leukocyte gene expression variation in southern Morocco. Nat Genet. 2010;42(1):62-67.
4. Floren LC, Wiznia A, Hayashi S, et al; Pediatric AIDS Clinical Trials Group 377 Protocol Team. Nelfinavir pharmacokinetics in stable human immunodeficiency virus–positive children: Pediatric AIDS Clinical Trials Group Protocol 377. Pediatrics. 2003;112(3, pt 1):e220-e227.
6. Antonia K, Anastasia A, Tesseromatis C. Stress can affect drug pharmacokinetics via serum/tissues protein binding and blood flow rate alterations. Eur J Drug Metab Pharmacokinet. 2012;37(1):1-7.
1. The Free Dictionary by Farlex. Me too drug. 2012. http://medicaldictionary.thefreedictionary.com /Me+Too+Drug. Accessed September 18, 2013.
NOTABLE NOTES
An Unusual Pigmented Lesion: What Is Your Diagnosis? Ronald N. Shore, MD; Allison K. Skae, PA-C
During the course of a full skin examination, a 57-year-old white woman with a history of dysplastic nevus syndrome and basal cell carcinoma was found to have a distinct pigmented lesion on her chest. The lesion, which occurred on a background of sun damage and lentigines, was noted to be asymmetric, possess irregular borders, demonstrate multiple colors, and extend well over 6 mm in greatest diameter (ABCD sign). The lesion was unlike any other on the patient’s skin surface (ugly duckling sign). What is your diagnosis?
Figure. An Unusual Pigmented Lesion on the Patient’s Chest
An Unusual Pigmented Lesion: What Is Your Diagnosis? Answer: Melon-oma (Figure). ARTICLE INFORMATION Author Affiliations: Department of Dermatology, Johns Hopkins Hospital, Baltimore, Maryland. Corresponding Author: Ronald N. Shore, MD, 4701 Randolph Rd, Ste 207, Rockville, MD 20852 ([email protected]). Additional Contributions: We thank Jennifer Nhek, MA, and Stephen Smith for their contributions.
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JAMA Dermatology December 2013 Volume 149, Number 12
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a Georgetown University Medical Center User on 05/23/2015
jamadermatology.com
prove medication adherence and reduce the drug resistance. These children have the same genes now as they will have as adults, but presumably the average drug effect produced in them as children will differ from the average drug effect when they are adults. The effect of environment on genotype was powerfully documented in investigations of the genetically homogeneous North African Berbers; leukocyte markers differed depending on their living in mountainous compared with shoreline regions.5 Nongenetic variations in drug absorption, penetration, distribution, metabolism, and excretion—as well as drug-drug interactions that influence a drug’s potential effects—are a given part of the complexity faced by physicians and patients in drug therapy.6 Recognizing that the same drug will produce variable effects in different individuals highlights the appreciation that so-called meARTICLE INFORMATION Published Online: October 23, 2013. doi:10.1001/jamadermatol.2013.6759. Conflict of Interest Disclosures: None reported. Additional Information: Dr Eaglstein is Emeritus Chairman of the Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida. REFERENCES
too drugs that vary in molecular structure (and especially in the case of topicals with regard to vehicle) are likely to produce effects that differ from those of the pioneer or breakthrough drug. As clearly as we are not biologically me-too people, me-too drugs each have their value. This independent value or differentiation in the clinical setting helps to account for the often lamented failure of me-too drugs to produce a competitive reduction in pricing. The clinical value of having several drugs available in the same category also accounts for the frustrations occasioned by formularies that offer only 1 or 2 drugs in a given therapeutic class. It is important for dermatologists and other physicians to be alert to the value of me-too drugs. This will not only broaden our ability as therapists but also help us to resist at the outset efforts to curtail our patients’ access to all available drug therapies.
2. Angell M. The Truth About the Drug Companies. New York, NY: Random House; 2004.
http://pediatrics.aappublications.org/content/112/3 /e220.long. Accessed September 18, 2013.
3. Gagne JJ, Choudhry NK. How many “me-too” drugs is too many? JAMA. 2011;305(7):711-712.
5. Idaghdour Y, Czika W, Shianna KV, et al. Geographical genomics of human leukocyte gene expression variation in southern Morocco. Nat Genet. 2010;42(1):62-67.
4. Floren LC, Wiznia A, Hayashi S, et al; Pediatric AIDS Clinical Trials Group 377 Protocol Team. Nelfinavir pharmacokinetics in stable human immunodeficiency virus–positive children: Pediatric AIDS Clinical Trials Group Protocol 377. Pediatrics. 2003;112(3, pt 1):e220-e227.
6. Antonia K, Anastasia A, Tesseromatis C. Stress can affect drug pharmacokinetics via serum/tissues protein binding and blood flow rate alterations. Eur J Drug Metab Pharmacokinet. 2012;37(1):1-7.
1. The Free Dictionary by Farlex. Me too drug. 2012. http://medicaldictionary.thefreedictionary.com /Me+Too+Drug. Accessed September 18, 2013.
NOTABLE NOTES
An Unusual Pigmented Lesion: What Is Your Diagnosis? Ronald N. Shore, MD; Allison K. Skae, PA-C
During the course of a full skin examination, a 57-year-old white woman with a history of dysplastic nevus syndrome and basal cell carcinoma was found to have a distinct pigmented lesion on her chest. The lesion, which occurred on a background of sun damage and lentigines, was noted to be asymmetric, possess irregular borders, demonstrate multiple colors, and extend well over 6 mm in greatest diameter (ABCD sign). The lesion was unlike any other on the patient’s skin surface (ugly duckling sign). What is your diagnosis?
Figure. An Unusual Pigmented Lesion on the Patient’s Chest
An Unusual Pigmented Lesion: What Is Your Diagnosis? Answer: Melon-oma (Figure). ARTICLE INFORMATION Author Affiliations: Department of Dermatology, Johns Hopkins Hospital, Baltimore, Maryland. Corresponding Author: Ronald N. Shore, MD, 4701 Randolph Rd, Ste 207, Rockville, MD 20852 ([email protected]). Additional Contributions: We thank Jennifer Nhek, MA, and Stephen Smith for their contributions.
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JAMA Dermatology December 2013 Volume 149, Number 12
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a Georgetown University Medical Center User on 05/23/2015
jamadermatology.com
