Derma

Derma

My dermatologist was pale with a round face and, while she didn’t have whiskers, in a lab coat she looked like a mouse.  She busied herself with my examination as if she needed to get to the vegetable market quickly.  Her fingers quickly tapped up the side of my face and through my hair checking for signs of cancerous or pre-cancerous moles or lesions or blotches. Her fingers scurried up and down my back like that she was playing Going-On-A-Treasure-Hunt.  She checked my legs and chest.  I was wearing boxers and she didn’t ask me to remove them so she could check my more private parts. I didn’t offer either, even though she was a doctor.  She seemed so prim that I felt she’d be embarrassed, though I vaguely wondered whether she would be liable if it turned out that I had a cancerous mole on my butt that she missed in her inspection.

She finished the examination and was starting to burn away a couple of imperfections with dry ice when I asked her a question.

“Say, Dr.Wainscott,  I hope you won’t mind if I ask you a question.”

“Oh sure, how can I help?”

“Well I have always wondered what would happen if you take a number 8 sunscreen and a number 15 sunscreen and you rub them on the same spot of skin.  I mean do you get a 23 or do you get a 15 or do you get an 8, or maybe something else?  I asked you last time I was here but I didn’t understand what you said.”

She gave me a quick smile as if accustomed to that complaint.  “The answer is: we don’t know.  If the FDA would require sunscreen manufacturers to list the elements that they put in the sunscreen then we could evaluate.  The problem is that they just require them to give the SPF.  That means you can’t tell whether the sunscreen it has phenylbenzimidazole sulfonic acid or titanium dioxide or zinc oxide.”

“Yes, I think that’s what you said last time. I just don’t understand it.  Why don’t we know the answer to my question?  It feels like that’s a question that has an answer.”

She said, “Oh yes, there is an answer to the question, we just can’t know what the answer is.”

“That seems unsatisfactory to me.  Why don’t we know what the answer is?”

“You see you can’t tell the answer unless you know what the materials are in the sunscreen.” She darted a glance at me over her glasses.

“Why does that matter?  I mean it seems like if you add two things together they would either bigger, because you are putting more of them in one place – like putting one blanket on top of another – or they would get smaller, because they are diluting each other – like if you put chocolate milk and regular milk together you get something in the middle.”

“Oh you definitely get something in the middle.  We just can’t tell you where it is in the middle.”

“So you mean one does dilute the other?”

“Oh yes.  That’s what would happen.”

“So, if you put eight and fifteen together you’re gonna get something somewhere north of eight and south of fifteen?”

“Yes, that’s how it would work.”

“Oh I am so glad I asked you the question.  I didn’t understand that before.”

“You see what they don’t talk about – it’s a big secret – but people don’t all need the same amount of SPF..  Everybody’s skin is different and everybody’s got a different capacity to produce melanin.  Some people are very efficient and they don’t need a lot of sun screen.  Others shouldn’t outdoors.  But unless you’ve got vitiligo or you’re an albino you probably don’t need an SPF 70.”

“What’s vitiligo?”

“Oh that’s what…” she lowered her voice and whispered the name of a famous singer, “… had.  That’s where part of your skin doesn’t have any pigmentation.  Of course he later went and did this treatment.  They don’t allow it in the United States you know but he did it in England where he basically destroyed the pigmentation in all of every cell of his body that produced pigment.”

“He did?

“Yes. He destroyed all the pigment in his body.  It is not a safe thing to do,” she said.

“Why did he do that? Just to look the same all over?”

“Well I don’t know if I should say, but dermatologists have a theory.”

“Really, what’s the dermatologists’ theory?”

She slightly lowered her voice and continued furtively.

“Well you see he was on his tour and there was an allegation that came to light that there was a teenager and you know he had… you know . . .” She looked as if it were a struggle to name the deed.

I wanted to jump in and help.  I said, “Inappropriate . . .

She didn’t need the help, it turned out. She said,  “Sexual intercourse . . . with a teenager.”

“Oh.”

“And you see he broke right off from the tour and he flew to England overnight and he had this surgery to get rid of his pigments.”

“I had no idea..”

“Yes and dermatologists think it’s because vitiligo is particularly likely to effect the genitals.”

“Really?”

“Yes. Dermatologists think that he was afraid that he could be identified by the coloration on his penis and so he decided to get all of his pigment producing cells destroyed.”

“So he couldn’t be identified?”

“Well that’s what dermatologists think.”

“Wow, that’s wild.”

“It’s the dermatologist theory.”

She smiled at me, quite pleased with the turn the conversation had taken.  I put my t-shirt on.

“I just wish the FDA would make them tell us what’s in sunscreen.  I have some patients that are very allergic to UVA.  But you can’t get any sunscreen without UVA now because it is the latest must-have sunscreen component.  But they don’t tell you.”

“Why don’t you make your own sunscreen?  You must have a lot of patients that would appreciate that.”

Her eyes lit right up.  “Oh why that’s a good idea.”

“Yeah you could start a business. Dr. Wainscott’s Sunscreen.  You could sell it on the internet.”

“It would be very valuable.”

“I could hook you up with a business guy to help you market the product.  It would be good that you are a doctor.  You could endorse it.”

“Well, I have always been concerned about the ethics.  You know James Dingler?”

“No, who is James Dingler?”

“Well good for you that you don’t know him.  I am happy to hear that.”

“Well who is he?”

“Oh he just was a doctor who sold his snake oil by using his Harvard medical degree.  You know we like to think that you should do the research and then develop a product after the research has been done.  But he didn’t do it that way.  He thought that would slow him down, so he developed the product first and then after he had the product came the research.”

“I bet the research said that the product was effective.”

She laughed quite loudly. I had never seen her laugh before.   “Oh you are so very smart.  Yes it did.”

“And I bet he paid somebody else to do it.”

“Oh right you are, and I am sure that he promised that there would be big checks in the future if it did turn out that the research showed that the product was effective.  He had books and he had . . .  Oh dear, you must think that I am complaining about having to be ethical…”

“Oh no.”

. . . but it does really bother one to see somebody making millions like that. With no ethics.”

“You better start your own business.”

“Well that’s really quite a good idea.  Thank you for suggesting it.”

“My pleasure.”

– Jay Duret

jayduret@yahoo.com

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