Lately, both lectures and publications in dermatology have frequently addressed the future of our specialty and the major paradigm shift that appears to be underway.
Of course, it is not only dermatology. Medicine and healthcare as a whole are undergoing tremendous changes in many respects. The subject is often discussed in the media and on the internet, so perhaps it is hardly a new topic anymore. In any case, I would not claim to understand the entirety of the medical world.
Therefore, I would simply like to comment on those developments within dermatology that have come to my attention and that I can comprehend to some extent.
As I have occasionally mentioned on this blog, biologic agents for the treatment of psoriasis were introduced only in 2010. Yet the number of available drugs has increased with astonishing speed, and there are now as many as nine different biologics. The growing number of options is undoubtedly good news for patients, though I cannot help wondering whether so many choices might actually make treatment selection more difficult.
And it is not only psoriasis. Antibody-based therapies have emerged in a wide range of fields: allergic diseases such as atopic dermatitis and urticaria, autoimmune disorders, and malignant tumors including melanoma and lymphoma. New drugs have appeared in many of the most important areas of dermatology, rendering many traditional concepts and treatment guidelines obsolete.
I once saw a cartoon illustrating this change by comparing it to the battle in which the battle-hardened samurai of the Takeda clan were helplessly defeated by the young Oda army’s musketeers. I thought it was a remarkably apt analogy. The pace of progress is so dizzying that even the common knowledge of ten—or even five—years ago no longer applies. An old-fashioned physician like myself simply cannot keep up.
Even if I tried to stretch beyond my limits, I could not use many of these drugs because my clinic does not meet the institutional requirements for their administration. And how could I possibly prescribe medications that I have never even seen or handled?
These days I keenly feel that I have become an outdated old doctor.
The diagnostic field is changing as well. Genetic diagnosis has reached the point where it can even alter the very classification of diseases. In tumor diagnosis, the advent of dermoscopy completely transformed our methods of diagnosis. Even in pathology, image analysis was once thought incapable of matching the trained eye of an expert. Yet the advances in artificial intelligence have been extraordinary, and it has already been demonstrated that, at least in certain areas, AI can outperform experienced physicians in diagnostic accuracy.
Since it is now common knowledge that AI surpasses humans in games such as Go and shogi, this development should not be surprising in medicine either.
If a computer is fed an enormous amount of data and trained to make diagnoses, it is obvious that it can diagnose diseases and recommend treatments more accurately than an average board-certified dermatologist. In some parts of the world, teledermatology is already becoming a practical reality. And perhaps those who control 5G and 6G technologies capable of processing vast amounts of data will ultimately control these developments.
Depending on how things evolve, a time may come when even non-dermatologists can diagnose and treat skin diseases with the aid of machines. If we are not careful, dermatologists themselves may become obsolete.
Thus, there is every indication that dermatology is on the verge of a major transformation. At the same time, however, alarm bells are being sounded about the financial foundations that support modern healthcare. Expensive biologic agents are covered by health insurance, but the resources that sustain the system ultimately come from taxpayers.
If healthcare expenditures continue to rise indefinitely, will Japan’s universal health insurance system be sustainable in the future? Moreover, most of these drugs are supplied by only a handful of Western pharmaceutical companies. We wish to enjoy the benefits of advanced medicine, yet the costs continue to flow outward. It is a troubling dilemma, and we will need to develop a better system to address it.
I have also heard predictions that, in the future, seventy percent of dermatologists will be women. AI and telemedicine will undoubtedly become increasingly important, but will there be sufficient manpower in university hospitals, teaching institutions, and regional core hospitals?
Perhaps an old physician nearing retirement need not worry so much about these things. The core of dermatology will surely continue to evolve through dramatic changes and progress. Rather than focusing on the negative aspects, perhaps we should look at the positive possibilities instead.
For my part, I can only place my hopes in the younger generation and in their dedication and achievements.
As a private practitioner, I simply wish to continue facing my patients and doing what I can, within my own limitations.