Ask the Doctors

A review of an “Ask the Doctors” Website and its psoriasis information.

Grade D

From the “You Can Have Lots of Letters After Your Name and Still Not Know What You’re Talking About” department, I present the “Ask the Doctors” section of the Community WEB. This is a place where people can ask medical questions, and hope to receive an informative reply. Unfortunately for psoriasis sufferers, the “answers” available tend to be at odds with what medical science has to say about the disease and its treatment.

Overall, there are twelve psoriasis-related questions, answered by seven “doctors.” Ten of the twelve answers are simply awful, in my opinion. One is “tolerable,” and one is very, very, good. None of the people answering questions is a trained expert in dermatology (or, if Ask the Doctors had such an expert, he/she didn’t answer any of the psoriasis questions). “Dermatologist” doesn’t always equal “psoriasis expert,” but, in general, it’s a lot more likely to than “optometrist” is.

Five of the seven “doctors” give every appearance of being experts, however, simply by offering answers that appear to be definite and unquestionable. But their answers don’t very much agree with each others’, or with modern medical science, and one of them doesn’t appear to be able to agree with herself as time goes by.

In short, if you want to ask a doctor a question about psoriasis, do it somewhere other than at’s “Ask the Doctor” site.

In alphabetical order by last name, I list the “doctors” and what they had to say in response to the questions asked.

Steven Angel, M.D.

In Q & A 3360, a patient asks about long-term nail psoriasis, which hadn’t responded to previous treatment. Dr. Angel’s response is very short, and only mentions calcipotriol. I’d categorize Dr. Angel’s answer in the “tolerable” category simply because he admitted to being fuzzy on the whole subject, not knowing what he was talking about, and suggesting that a “clinical dermatologist” would be a better person to answer the question.

Nancy Appleton, Ph.D.

Between november of 1996, and July of 1999, Dr. Appleton answered five questions for Ask the Doctors, and in all five, she tries to sell her own books, and little else. Twice she mentions The Secrets of Natural Healing with Food, but in all five she tells people to read Lick the Sugar Habit (“for specific information and medical documentation on allergies and psoriasis”). She never, in these five answers, mentions that she wrote those books.

Only in her very first response does she even come close to actually answering the questions posed. In Q & A 800, someone asks “How is psoriasis caused, what is it, and what is the treatment?” To this, Dr. Appleton answers “I believe that psoriasis is a food allergy,” and goes on to say that by eliminating “abusive foods,” psoriasis will vanish.

That is, obviously, only half an answer. It plainly ignores all of the general medical ideas about what psoriasis is, what causes it, and what the usual treatments are. But, since Dr. Appleton’s doctorate is in “Health Services,” and she is not an M.D. or, it appears, even close to being one, should anyone expect a good, comprehensive answer?

Next, in Q & A 1873, someone asks about the relationship between psoriasis and stress. Dr. Appleton answers by saying “My research shows that psoriasis causes a toxic liver,” and then she talks about how stress can induce food allergies.

I think we can assume that “causes a” is a typo, and should read “is caused by,” because in her very next answer, Q & A 2059, she says, “My research shows that psoriasis is a toxic liver due to past indiscrections.” What the last two words mean is unclear.

In Q & A 3239, a person with psoriasis and another dermatitis on his/her hands and feet asks for information about cracks and splits which develop in the skin (perhaps from overuse of steroid medications). Dr. Appleton fails to suggest anything practical. Instead, she says, “I think that you should look to see what you are doing to cause your psoriasis,” as if it were the patient’s fault. She goes on to say, “My research shows that food allergies can cause it,” in which case it wouldn’t be the patient’s fault, anyway. And she doesn’t mention her previous “toxic liver” theory at all.

Finally (for Dr. Appleton), a person asks, in Q & A 5010, whether or not a tanning bed can replace sunlight for the treatment of psoriasis. Dr. Appleton fails to answer this question, as well, deciding instead to go back to the old “toxic liver” theory, calling it “the main problem in psoriasis.”

Bill Chan, D.C.

In Q & A 1882 (a duplicate question to Q & A 1873, see above, in the section on Nancy Appleton), a patient asks about the relationship of stress and psoriasis. Dr. Chan (a chiropractor) “answers” by offering some relaxation activities, and then describing that he’d heard from some patients that flax seed oil might help, but to check with a health-food store first (as if the clerks there will tend to be experts in either flax seed oil or psoriasis). To finish up this non-answer, Dr. Chan offers a Globe & Mail article about flax seed oil’s effects on cancer.

Myron B. Lezak, M.D.

In Q & A 513, Dr. Lezak answers a question about psoriasis, psoriatic arthritis, and the side effects of some medications by describing a treatment program of “colon detoxification,” essential fatty acids, Vitamins A, C, and E, selenium, zinc, and an herb, milk thistle. In my opinion, Dr. Lezak, a gastroenterologist (and not a dermatologist or immunologist), should probably have left the “words of encouragement” to others more knowledgable in the field.

George Schmidt, O.D.

In Q & A 3277 (a duplicate question to Q & A 3239, see above, in the section on Nancy Appleton), a person asks for short-term help in getting a little relief for cracks in his/her hands and feet. Dr. Schmidt, who’s in the field of clinical optometry, not dermatology, sugests dietary changes (“definitely in order” — sure, doc!) and advises olive leaf extract for two to three months because he heard an interview with Dr. Morton Walker, a nutritionist and author.

“May be worth a try and certainly can’t hurt” are Dr. Schmidt’s thoughts on the above. Sure, but that’s not going to make a person with cracks in his/her hands more comfortable now, while waiting for another appointment with a dermatologist.

Dr. Schmidt finished up this terrible answer with a note on our old pal, the “toxic liver,” and suggests that milk thistle as part of a “liver cleansing formula” might help.

A. Van Beveren, Ph.D.

Dr. Van Beveren holds a doctorate in clinical physiology, but his work at the Health Integration Center (in New Jersey) on “Nutrition, Homeopathy, Color Therapy, Bodywork, Sensory Reduction, Anti-Aging Techniques” seems to drive his answers about psoriasis (two of them).

In Q & A 2266, a patient asks about nail psoriasis, and describes a bunch of things he/she is doing. Dr. Van Beveren offers up an “exhausted liver” (not “toxic”?), distrubances in fat metabolism, pork and food allergies as causative factors, but he’s not done yet.

According to Dr. Van Beveren, there is “no doubt” that cholesterol is involved (and since it’s “involved” in so many different processes in the body, why not? But that’s not helpful). But he then calls psoriasis a “liver enzyme deficiency disease” due to an “outpouring” of proteins and lipids in “various stages of digestion.” “Outpouring” to where? From where? He doesn’t say.

He then says that psoriasis (or nail psoriasis, can’t be sure) is “often seen in those with a history of heavy antibiotic use,” and then blames the disease on some sort of systemic “yeasty-ness!” Dr. Van Beveran’s rambling “answer” is all over the place, and probably does nothing but cause confusion. Finally, once the “yeasty-ness” is dealt with, he claims that the nails can be cleared up with a “2000 yr old Chinese formula” called “WO oil,” and gives a phone number for a company from which it can be purchased.

Dr. Van Beveren’s second answer, to Q & A 6284, is largely a subtle evisceration of doctors who, in his estimation, overlook the possibilities of toxic or nutritionally deficient diagnoses. The patient asking the question simply wanted to know what the differences are between psoriasis and eczema, and instead got a long rant, followed by the non-answer that telling the difference is “easy” (without actually describing any differences), along with a suggestion to see a holistic physician.

Aase Marit Waage

Aase Marit was once a fairly regular participant in the psoriasis newsgroup, which is where I ‘met’ her. That familiarity aside, it is painfully obvious that Aase Marit, who is the only “doctor” without a degree (she’s a certified social worker) to answer a quesiton about psoriasis, was the only one who got things right.

Q & A 1870, another duplicate of question 1873 (see above, in the sections on Nancy Appleton and Bill Chan), was about the relationship of stress and psoriasis. Aase Marit provides the longest and most detailed answer of all of the ones discussed here, an answer which actually answers the question which was asked.

The biggest flaw in Aase Marit’s answer is that she said that the gene(s) responsible for psoriasis had been found. It’s now five years later, and they still haven’t been, although researchers are closer. But, when you consider that her answer in regards to stress is not based on knowing what the psoriasis genes are, then even pointing out this flaw seems like nit-picking.