For folks who study race-based health disparities and genetics. How can it be that Black people are so singularly evolutionarily cursed that their genes can explain disparities in just about every common disease that afflicts man/woman? HOW?
So many people surprised to see me walking around the hospital today. Yes, dermatologist work on Thanksgiving too!!! Stay moisturized my friends.
#HappyThanksgiving2022
The idea that medical students in 2020 discovered the issue of skin color representation in medical textbooks is laughable. Black dermatologists have been at this for DECADES. This erasure is deeply problematic.
Medical Student- Malone Mukwende, creates a medical handbook for Black and Brown people.
The Second year student identified racial gaps during his studies. He explains that many resources refer to symptoms on white skin.
The handbook displays signs and symptoms on darker skin.
Effect of Sunscreen Application on Plasma Concentration of Active Ingredients This provocative study in JAMA about sunscreen deserves a
#tweetorial
. Bear with me as I take you through the controversy and discuss sunscreen in general. 👇🏾👇🏾👇🏾
Just a few short years ago I was told that shedding light on this issue was career damaging and I should just keep quiet. Now because of the efforts of so many the the City of Philadelphia is apologizing for abuses by Penn dermatologist Albert Kligman and others at Holmesburg.
Today, on behalf of the City of Philadelphia, we formally extended an apology to those who were subjected to inhumane and horrific abuse from the experiments conducted at Holmesburg Prison from the 1950s to 1970s.
This tweet got a bit derailed by the attempted coup yesterday...but Gil Welch,
@BenMazer
and me in this week's
@NEJM
where we explain how UV exposure CAN'T explain the rapid rise in melanoma which is likely an epidemic of diagnosis and NOT disease THREAD👇🏾
I look at how badly the comments on this tweet have aged and reflect. Its been 75 days and still no peak in Texas, just steady declines in COVID-19. Making predictions under uncertainty is HARD. Should doctors, public health officials, and pundits admit when they get it wrong?
BREAKING: Texas is lifting its mask mandate, making it the largest state to end an order intended to prevent the spread of the coronavirus. Gov. Greg Abbott has faced sharp criticism from his party over the mandate, imposed eight months ago.
There are a lot of misconceptions about sunscreen and whether or not dark-skinned people need to wear it to prevent skin cancer. This NPR piece does a POOR job presenting the actual evidence. I think a TWEETORIAL is in order.
If you are black, wear sunscreen to prevent uncomfortable sunburns, signs of aging, freckling, but it’s not going to reduce your already low chance of melanoma lower.
Yet ANOTHER example of Dr. Albert Kligman, on the wrong side of history. This time teaming up with two other white men to describe a hair disorder in Black women and blame it on their hair care practices. Let’s take a look at the original paper from 1968. THREAD.
“Drs. Lopresti, Papa, and Kligman coined the term ‘hot comb alopecia,’ asserting: “The cause is unmistakable, namely the practice of straightening the hair with a hot comb...” Now known as CCCA, the etiology is considered far more complex.”
Sunscreen is USELESS in melanoma prevention in dark skinned (e.g. black) people. Let me explain why in this
#tweetorial
👇🏾👇🏾👇🏾
Also see my latest opinion piece, published here:
Our article about Dr. Kligman who notoriously experimented on Black prisoners is now in the Philadelphia Inquirer. If Black Lives really Matter, Penn should do something about this. See here:
NEW 🚨research🚨 where we show that patients diagnosed with melanoma in situ (MIS) live LONGER overall than age/sex/race matched individuals (112% relative survival) without MIS. this suggests MIS may mostly be a marker of health seeking behavior.
If it was about getting people into primary care then why not use the $600 million on the back end as debt forgiveness once they've graduated and decided on primary care?
On the 110th anniversary of the Flexner Report which modernized medical education, I'm reminded of how deeply racist the document was and helped destroy black medical education in the South.
This is an extremely disingenuous tweet. I’ve dedicated my professional life to the skin and this article exploring the effect of adequate moisturizing on dementia is ridiculous.
Google launches AI health tool for skin conditions in Europe The algorithm was developed based on training data with less than 4% dark skin types. It should come with a warning BEWARE OF RESULTS IF BLACK!!!
My dad calls me up yesterday: Ade, I saw you wrote an article in JAMA Derm about copay policy and skin cancer in Illinois. Since when did you write about policy?
Me: Dad, I literally have a degree in public policy.
Dad: Oh, that’s right!
Me: 😐
Dad: Well, congrats!
On the TODAY show yesterday a black dermatologist came on to discuss the NYTimes article I was featured in about sunscreen and black people. She rejected my arguments while providing no evidence to the contrary.
#thread
1/
The
@washingtonpost
with more melanoma health disparities pornography replete with misleading statistics and false statements. I’m not sure who dropped the bag here, the journalist or the researchers/dermatologists. Probably both. THREAD 🧵👇🏾
Melanoma is far more deadly in Black men, who may get skin cancer in unexpected places such as fingernails and the bottoms of their feet, according to a study of more than 205,000 cases.
For those of you that made it all the way to the end, here are some gratuitous pics of our new 9 week old puppy, Ruby Dee. We got her last week. Potty training is wearing us out, but she is too cute for us to be upset about it!
I think folks with darker skin types deserve to have research done and subsequent messaging tailored to them and not just lazily extrapolated from lighter skin types.
I came across this article in my inbox and appreciate that
@NEJM
decided to highlight the issue of representation of skin images in medical education material. However, I would be remiss if I didn’t add further important context missing from this article.
Bob Marley, who famously died from melanoma, is often invoked as the reason to wear sunscreen. He’s BLACK, y’all! However, Bob Marley died of a melanoma on his foot under his toenail, one of the most frequent places black people get melanoma.
With all due respect Dr. Olbricht as a former American Academy of Dermatology president you have much more influence than I do as junior faculty. Those in power need to make this a priority. I’m trying to do my part.
Will one of you tackle this problem? Not enough images of skin disease in POC. Please figure out and teach how to take good photographs of rashes and lesions in dark skin.
#dermtwitter
can amplify your tips.
@SkinOfColor
@RoxanaDaneshjou
@AdeAdamson
I bet MOST 4th year medical students could not correctly define all of the following terms: 1) health care premium
2) health plan deductible
3) out-of-pocket maximum
4) co-insurance
They could probably tell you the genetic mutation in Marfan Syndrome though.
#meded
#priorities
Effect of Sunscreen Application on Plasma Concentration of Sunscreen Active Ingredients: PART-2 of a study on chemical sunscreen absorbing into the blood. This is surely going to stir up more controversy. Let me break it down in this thread
#tweetorial
👇🏾
Another article promoting sunscreen for skin cancer prevention in skin of color. This time in the
@washingtonpost
. I'm literally the only person interviewed presenting data. Some of what is reported is tantamount to misinformation.
Skin-Lightening Cream Put A Woman Into A Coma. It Could Happen Again. 40% of women in Taiwan, Hong Kong, Malaysia, Philippines, Korea said they used skin lighteners and 77% of women in Nigeria and 25% in Mali said they did, according to the W.H.O. WOW!
Effect of Topical Brimonidine on Alcohol-Induced Flushing in Asian Individuals interesting study from a team at UCSF. Look at the photos! I wonder if people will start using this before they hit the bar? 🤔
Came to UCSF for match day and it was celebrated outdoors in the cold because of COVID. In 2024 this is absurd!!! COVID shafted them 1st year in 2020 (understandable ) and now it’s COVID policy robbing them of a normal experience on the way out. A damn shame.
Yes, you still need to wear sunscreen indoors — here's why via
@CNN
This is one of the more absurd articles I've seen on sunscreen. Nothing is safe, not even light emitted from your phone!!! We should all live in caves with the lights off!!!
Bottom line is black and brown dermatologists have been making a big deal about this, curated and published content, and I hope they and their efforts do not get erased in calls to infuse medical education with images that reflects that of society.
This move is all about school ranking. It has nothing to do with increasing primary care doctors. I’ll wait to see if specialty choice or school diversity changes at NYU. Doubt it.
Last year the
@TODAYshow
said I was wrong about sunscreen and skin cancer in Black people. Here is our latest publication in
@JAMADerm
showing why I was right.
Let me explain....
On the TODAY show yesterday a black dermatologist came on to discuss the NYTimes article I was featured in about sunscreen and black people. She rejected my arguments while providing no evidence to the contrary.
#thread
1/
Machine Learning and the Cancer-Diagnosis Problem — No Gold Standard:
My latest work in
@NEJM
with Dr. Gil Welch in which we discuss how machine learning cannot overcome a central problem in cancer diagnosis and we suggest a way forward.
#tweetorial
👇🏾👇🏾👇🏾
Black and brown dermatologists have published NUMEROUS texts including separate textbooks such as – Dermatology for Skin of Color by A. Paul Kelly and Susan Taylor – in order to fully highlight rashes in darker skin types.
This tweet makes it seem like sunscreen is unsafe. The "safety threshold" isn't about safety per se. Its a threshold for the requirement of further safety testing. Its a nuanced but important difference. This study does NOT show that sunscreen is unsafe.
New studies show that after a single application, a total of seven chemicals commonly found in sunscreens can be absorbed into the bloodstream at levels that exceed safety thresholds
Melanoma and Racial Health Disparities in Black Individuals—Facts, Fallacies, and Fixes NEW Viewpoint in
@JAMADerm
from Drs. Marchetti, Halpern, and me, setting the record straight about melanoma and racial disparities in Black Americans.
#Thread
👇🏿👇🏿👇🏿
This simple but powerful figure is what animates so much of my work. The relationship between melanoma incidence and mortality across time. I really want to fully understand this epidemiologic phenomenon! Long way since my start funded by
@ARCS_Atlanta
What is more strongly related to melanoma incidence across US counties: UV exposure or diagnostic scrutiny? We show melanoma incidence is WEAKLY correlated with UV-related variables and more strongly related with diagnostic scrutiny-related variables:
This was blasted out to the entire American Academy of Dermatology listserv this morning. The only myth being served here is by the quoted dermatologist. This is a zombie idea that needs to either be proven true or eliminated.
This has all the spin that I talked about in my article from last month. Notice the lack of actual data about the association of UV exposure and melanoma in dark skin. On cue, they even slide in the Bob Marley reference. 🙄
Damaging UV rays can penetrate all types of skin, regardless of your ethnicity, so even people with dark skin need sunscreen. Pro-tip: If you have skin, you need to use sunscreen.
So I wrote a piece in JAMA Derm suggesting that eliminating Copayments for Skin Cancer (melanoma) Screening had limited evidence and now I have been called a "Naïve, literature-bounded evidence-based medicine aficionado" LMAO.
I just read a recent JAAD CME about racial and ethnic disparities in dermatology. "Racism", "discrimination", or "social determinants of health" are NOT mentioned even ONCE and there are nearly 6,000 words in the review. This is concerning. THREAD 🧵
The wildest thing about this paper is we wrote it in 2017, then shelved it because of the initial push back in peer review. This experience taught me A LOT about when colleagues are ready to accept ideas that challenge their thinking. 🧵
1/9
Over HALF of new melanoma diagnoses among white Americans in the United States likely represent overdiagnosis. New research out in
@JAMADerm
. THREAD! 🧵
One positive of the pandemic is getting the chance to hear my spouse give lectures, conference talks, and teach from the other room. I have such a better appreciation of just how good she is at what she does.
Other important texts include – Ethnic Dermatology: Principles and Practice by Drs Dadzie, Petit, and Alexis. And if you are looking for an atlas of pure images check out Dermatology Atlas for Skin of Color by Dr. Amit Pandya. This is an abbreviated list.
This sums up a lot of what I've been working on the past 2-3 years. I've been called everything from "dumb" to a "naïve, literature-bounded evidence-based medicine aficionado." (in a peer-reviewed dermatology journal no less!) Its been quite a ride so far.
Another provocative study by
@JoannElmoreMD
et al showing that dermatopathologists are influenced by the diagnosis of a previous dermatopathologist. This can even influence them to make an INCORRECT melanoma diagnosis.
Is there large-scale object evidence that visual diagnostic accuracy is lower for disease in darker skin?
@JamesADiao
and I attempt to answer this by exploiting the
@NEJM
image challenge. Short answer: Perhaps. THREAD 🧵 below 👇🏾👇🏾👇🏾
NYU officials worry that rising medical-school tuition and soaring loan balances are pushing new doctors into high-paying fields and contributing to a shortage of researchers and primary-care physicians
Nice to see a spread in Harvard Medicine magazine about all things skin! Pumped to be featured along with others on
#DermTwitter
such as
@DrEstherFreeman
'Tsundoku' is the Japanese word for all the books you buy but never read Do they have a word for papers I’ve downloaded off of pubmed but never read? 🤔
This is an 🚨important🚨 new study in the field of dermatology. So important that it required TWO OPPOSING Editorials! A MUST read for dermatologists. The issue of melanoma screening is a critical debate to have in our field and it needs to be had in the open.
Harvard & MIT-trained Visionary
@AdeAdamson
has become a leading voice in flagging critical yet overlooked issues. “I go where the data take me. Sometimes that means I’m challenging some deeply held assumptions about the world." Learn more:
Over HALF of new melanoma diagnoses among white Americans in the United States likely represent overdiagnosis. New research out in
@JAMADerm
. THREAD! 🧵
Black male disparities in prostate cancer are because of *gulp* the transatlantic slave trade?! Its both embarrassing and harmful this kind of nonsense was published in a peer reviewed journal in 2020. Yet another race=biology article to include in my class on race and medicine🤦🏿♂️
This move is all about school ranking. It has nothing to do with increasing primary care doctors. I’ll wait to see if specialty choice or school diversity changes at NYU. Doubt it.
Today, attending medical school takes more than just ambition, it takes a willingness to take on a crushing amount of debt. Can NYU School of Medicine’s radical solution solve the problem?
Resources have existed for at least 40 years. It’s just that they were not widely disseminated or used. We need to be honest about this and not erase the work of folks, particularly black and brown docs.
When stuff like this arises, Drs have resources that they can look at pictures and compare them with their patients’ symptoms.
Except if the patient is Black
There IS a resource to show these symptoms in Black patients.
When was it created?
In 2020
Last year I was told writing about the problematic legacy of dermatologist Albert Kligman would damage my career…looks like Penn Medicine has now decided to apologize.
While this is a welcome step forward, questions and concerns still remain…THREAD 🧵
TL;DR melanoma in people with dark skin (e.g. black people) is uncommon and unrelated to sun exposure. Wearing sunscreen will do NOTHING to reduce melanoma risk in these populations. Its only benefit is cosmetic and/or preventing sun burns.
This is an irresponsible tweet spreading missinformation. The STRONGEST risk factor for skin cancer is blistering sunburn. This is disgusting and they use
@AADskin
as a source! The
@AADskin
would never advocate this position.
People keep saying "this is the first American vaccinated for COVID" as if there wasn't an entire clinical trial of the vaccine that happened already. 🤔
Lack of diverse skin types in textbooks has been an important issue for DECADES. It has been continuously brought up by dermatologists of color (black ones in particular) who have called on major textbooks and education materials to diversify images.
Also, when was the last time you heard of a melanoma epidemic in sub-Saharan Africa, which has a lot of sun and black people, but limited sunscreen? Didn’t think so!
Syllabus: A History of Anti-Black Racism in Medicine To my medicine colleagues that want to learn more about how we got here. I recommend checking out this syllabus by
@AJohnsonHist
,
@byeliseam
,
@AyahNerd
via
@AAIHS
India’s skin lightening industry is estimated to be worth nearly half a billion dollars. Around 60% of women and 10% of men say they use fairness products.
See our
#VICEonHBO
report tonight at 7:30 PM and 11 PM EDT on
@HBO
I had a great time teaching this class with
@drashleyfarmer
. The best feeling as a teacher is when the ideas and discussions stick with students well after class is done.
In 2020 I took a Race & Medicine course. We had two brilliant professors. One was a Black historian. The other a Black medical doctor. Each week we explored primary and secondary literature that documented historic and contemporary antiblack racism within the medical field.
TL; DR – certain chemical sunscreens are absorbed after application; we don’t know what this means for human health. This does not mean you should abandon sunscreen use nor does it mean sunscreens are unsafe.
This is ABSURD!!! Even on its surface the utility of liquid biopsies for melanoma early detection is ridiculous. Let me explain…
If interested, see thread below 👇🏾👇🏾👇🏾
This
#BlackMenInMedicine
movement fills my heart with joy. Its rare for me to interact and see folks like me in medicine. Seeing amazing brothers across the country/world is truly inspiring! This is Twitter at its best.
This study is yet another one in a growing list demonstrating that dysplastic nevi are NOT obligate precursor lesions for melanoma. Let me give you a brief history/discussion of the 40 year old controversy.
A thread/
#Tweetorial
👇🏾👇🏾👇🏾
Study examines the outcomes and risk for the development of subsequent cutaneous
#melanoma
in moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins, observed for 3 years or more.