(11b) Immediacy is both a liability and an asset of the Internet


Immediacy is an important attribute of the Internet. It allows for the exchange of letters with a small enough lapse of time that real conversation is facilitated. It also allows for less delay in reviewing and publishing scientific articles. These are important attributes that allow on-line journals to bring pertinent information to the reader with more dispatch. Unfortunately immediacy has a downside.

This Spring the Journal published a case report by C.E. Crutchfield et.al. on the use of zinc pyrithione (Skin CapTM) for the treatment of psoriasis. We were enthusiastic because, at the time, we thought we were publishing the first photographic documentation of what had been a remarkable tale on the RxDerm-L (Internet) discussion list. Had it not been for the immediacy of the Internet, however, this report might not have been published. A controversy has subsequently developed over ingredients and this product is now being withheld from the American market by the U.S. Food and Drug Administration. Several independent laboratories have reported the presence of the potent corticosteroid clobetasol propionate in this product.

From the comments received, and from the conversation on the RxDerm Archives one gets the sense that the compound may, in fact, be efficacious for the treatment of psoriasis. However the ingredients and therefore the side-effect profile are unknown. It would be unfortunate if patients were persuaded to use this product on the basis of a Journal report now under question.

WARNING!

This product has been withdrawn from the American market by the U.S. Food and Drug Administration because of questions over ingredients and safety. (see the next issue).
In the face of unknown risks to patients from the use of Skin CapTM, we felt an obligation to append a note on the already published article warning readers to view the subsequent comments. Safety of the patient is clearly the most important issue. The appended warning is time stamped and crafted to stand out as not part of the original report. We are also writing to Cheminova America Corp. and Cheminova International requesting them not to use copies of that article without the attached warning. Skin capTM may eventually prove to be both efficacious and safe in the treatment of psoriasis, and the warning should be removed when the Food and Drug Administration is satisfied.

While the immediacy of the Internet may have facilitated premature publication of a psoriasis treatment option, the flexibility of the medium allowed for a warning to appear on the same article. Had this process taken place in a conventional paper-based journal, there would be no opportunity to provide additional information appended to the same article. Immediacy is then part of the problem and of the solution.

Arthur C. Huntley, M.D.