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80% Club
by Ed Dewke

posted <January 1998

I've been seeing an unusual amount of advertising lately, on TV and in print, about over-the-counter (OTC) psoriasis products. My thinking about these products "at large" (which I know is not entirely fair to the products) has been expressed time and time again. In a nutshell, I think OTC psoriasis remedies are a crapshoot. They work for some people for some period of time.

Most of the product commercials are laced with testimonials from satisfied customers and statistics about the success of the product. I find one thing disconcerting about both the testimonials and the statistics: that is, they're one dimensional in a three-dimensional world. Exorex™, for example, in its TV ads, shows a picture of someone's naked back that is nearly covered with plaque lesions, then they cut to a man and a woman who claim the product cleared them up and keeps them clear. Aside from the man saying his knee had a lesion and now it's gone (video cut to close-up, knee), we have no information about the severity of their psoriasis. Exorex™ concludes its TV commercial with a claim that 80% of its users experience good results. What defines good? For how long? How long did it take? How severely were they affected?

Have you noticed that "80%" seems to be a magic number in the statistical claims of almost all psoriasis-remedy manufacturers? I throw the whole lot of them, and their devotees, into a group I call the "80% Club." Admission is granted if you manufacture a product for, or are one of the 8 out of 10 people who experience some improvement under some unknown regimen of product use, over some unknown period of time, involving some unknown range of severities, with unknown previous treatment histories, suspected trigger factors, or other variables. Of course, we can't expect full disclosure of research in a 30-second commercial; nonetheless, what is disclosed is what drives thousands of psoriasis sufferers to buy the product. And it's probably unimportant to the manufacturer that there might be a high turnover rate of his customers because the product worked for a few months then stopped working. (There's always a new batch of psoriatics to respond to the commercial as it's rerun.)

While all the commercials and ads I've seen lately appropriately decline from blatantly saying they "cure" the disease, there persists the implication in virtually all of them that they will clear lesions indefinitely. Let me ask you. If you tried an OTC product and it worked, and six months into your "relief" the manufacturer asked you for a testimonial—which you are delighted to provide, especially since he's willing to pay for your time to record it—and then six months after you've signed the release, recorded your statement, received your payment, the product stops working ... are you going to call the manufacturer and say, "Stop using my testimonial in your ads. Your product stopped working for me"? Probably not. For one, the release you signed had a "right to use in perpetuity" clause. Furthermore, you're disinclined to return the money you received. So, to assuage your sense of moral indignation, you resolve yourself to the caveat emptor principle that governs free enterprise and go about searching for your next source of relief from psoriasis.

Some may say, "Hey Dewke! What are you complaining about? So the product only worked for a year? That's a year of living lesion free! I'm not complaining!" That's a valid argument. In fact, chances are if an OTC product works for you for a prolonged period then loses efficacy, if you lay off it for awhile—handle your psoriasis some other way for a period of time—the same OTC product may work for you again at some point in the future. Hey! This is true for me even with prescription products. I believe completely that any product or regimen that focuses on the symptoms of psoriasis—i.e., lesions—is a temporary fix at best. The proclivity to be psoriatic inevitably outlives strategies to palliate the symptoms. When my lesions clear under certain regimens (usually topical potions), over time I'll start to get new lesions on previously unaffected skin. But typically the lesions, over time, just stop responding to the current regimen. Palliating symptoms, friends, is merely a preoccupation.

My derm has instructed me to "try anything you're inclined to try." He's got this attitude because he knows his limits. All psoriasis remedies available to us today are, for at least 2 out of 10 of us, unlikely to work, and even more unlikely to work for prolonged periods of time. This is just as true for most prescription drugs and treatment regimens as it is for OTC products.

I believe it's important for psoriatics—especially severe psoriatics—to understand nothing they're apt to take or do today is likely to cure the disease. I grieve to think about the money spent on palliative measures that might have advanced research towards a real cure. While I don't fault anybody the measures they take to make tomorrow a better day, I do fault the greed that makes snake-oil manufacturers divert attention away from research. I would try any OTC product on the market if their ads would say, "For every bottle of our product you try, we will donate one dollar to the National Psoriasis Foundation to support research towards a cure." I would think more highly of derms in general if their practices promised: "For every hour of PUVA you pay for, we'll send five dollars to the National Psoriasis Foundation to support research...." And my faith in insurance companies would be resurrected if even a handful of them said, "We'll donate 50% of your deductible to the NPF for psoriasis research."

Of course all of this is high-spirited fancifulness, because we all know the price of drugs and treatments would just go up if the manufacturers and treatment providers were made to donate towards cures. The real solution might be behind something Dr. Stephen Covey said. I don't know if Dr. Covey thought this up or was just passing it along. Paraphrased, it went like this: If we really want to reform health care in this country we should establish the practice of paying doctors only when we are well. What a paradigm shift! If you get sick, obviously your doctor isn't doing his job! How fast do you think we'd find a cure for psoriasis if the derms had to pay for the research as a "cost of doing business?" Oh my ... I've got to stop until I get over this belly laugh.

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