Canadian doctors urged to understand Indigenous health benefits program
Physicians treating Indigenous patients can access resources to support better outcomes (1,500 words, 7 minutes)
To enhance care for Indigenous dermatology patients, Canadian physicians are being encouraged to familiarize themselves with the Non-Insured Health Benefits (NIHB) program, a federal initiative providing healthcare benefits to Indigenous peoples in Canada.
Speaking at the fourth annual Indigenous Skin Spectrum Summit, Dr. Megan MacGillivray emphasized the importance of understanding the NIHB program's coverage and accessibility. The NIHB offers supplementary benefits not covered by provincial, territorial, or private insurance plans.
Dr. MacGillivray founded the FullCircleDerm Virtual Acne Clinic based in Barrie, Ont., and runs the skin cancer biopsy clinic and an Indigenous health-focused clinic at the Royal Victoria Regional Hospital in Barrie.
The NIHB covers medications, medical transportation, dental care, medical equipment and supplies, vision care, and mental health counselling.
Dr. MacGillivray said the list of agents for covered skin conditions is fairly comprehensive. It includes a range of moisturizers, topical antifungals, anti-inflammatory agents, acne medications, antineoplastics, disease-modifying anti-rheumatics, biologics, and small-molecule immune inhibitors.
She said physicians can search the NIHB drug benefit list online (accessible here) to see if a patient's medication is covered.
Notably, in Ontario, patients on the NIHB have easier access to dupilumab as they do not have to fail one of the disease-modifying anti-rheumatic drugs—they only have to fail a topical steroid and topical calcineurin inhibitor and not have access to phototherapy, said Dr. MacGillivray.
Dr. MacGillivray said she would like to see NIHB cover products such as ivermectin, clascoterone, trifarotene, roflumilast, and clobetasol propionate shampoo (Clobex.)
Bottom line: Canadian dermatologists should familiarize themselves with the NIHB to support their Indigenous patients more effectively. There is a searchable database of medications covered by the program that facilitates prescribing agents that these patients will have access to.
From the literature on dermatology in skin of colour
Infection patterns of scabies and tinea between inland and resettled Indigenous Negrito communities in Peninsular Malaysia
This study aimed to update the data on infection patterns of scabies and tinea among the Negrito communities. The Negrito is the smallest and most isolated Indigenous tribe in Peninsular Malaysia, with approximately 6,500 individuals remaining.
Researchers recruited 361 participants from eight villages representing all six Negrito subtribes.
The results revealed an overall skin infection prevalence of 35.6%, with scabies (11.7%), tinea versicolor (11.3%), and tinea imbricata (7.5%) as significant infections, with no co-infection. Researchers note that infection rates were significantly higher in resettled villages (55.2%) than inland villages (24.8%). Scabies and tinea versicolor were more prevalent in resettled villages (21.2% and 23.6%, respectively) than inland villages (6.4% and 4.7%, respectively), while tinea imbricata was more common in inland villages (9.4% vs 3.9%).
Furthermore, there exists a predisposition of scabies among the Kensiu subtribe. A high prevalence of tinea imbricata was observed among the inland Bateq subtribe, while the prevalence of tinea versicolor was high among the resettled Bateq. Risk analysis revealed specific associations: scabies with Kensiu subtribe (p=0.002), high income (p=0.001) and underweight individuals (p=0.009); tinea versicolor with Bateq subtribe (p=0.003), resettled villagers (p<0.001), males (p=0.040), and overweight/obese individuals (p=0.015); and tinea imbricata with Bateq (p=0.011) and smokers (p=0.004).
Disentangling race from skin colour in modern biology and medicine
In this review, researchers examine the taxonomies used to classify people, which have influenced the development of the contemporary disciplines of biology and medicine, including dermatology, worldwide.
They noted that early European scientists and physicians were intertwined with the social environment. That social environment created classifications and hierarchies of skin-colour-based races, which were then reinforced by political systems that supported colonial economic structures and, in many cases, chattel slavery.
The authors note that these classification systems persist even though genetic research has revealed that systems of skin colour-based racial and ethnic classification lack biological meaning and are socially constructed. The bodies of knowledge and practices built on these classifications did not reflect the observable biological diversity of people but the dominant cultural institutions and economic systems of their times.
In the paper, the researchers recommend actions to reduce the underpinnings and ramifications of racial and ethnic classifications, ultimately improving biomedical research and medical care for all patients.
Some of these recommendations are: Research journals and funding agencies should require mandatory reporting of the use and rationale for population descriptors beyond race for human-subjects research, including environmental factors. Educational institutions, professional societies, funding agencies, and regulatory organizations should educate researchers and medical providers on the history of science and medicine, the biological/societal meaning of race, and how racism occurs in relevant institutions. They should also provide education on typological thinking and population descriptors for human-subjects research.
Determining the mean Dermatology Life Quality Index of skin of colour (SOC) patients with vitiligo: A South Asian perspective
This descriptive, cross-sectional study was performed in the dermatology outpatient department of a tertiary healthcare setup in Rawalpindi, Pakistan. A total of 113 patients with vitiligo, both male and female, aged 15 to 65, were included in the study (mean age 34.96±9.59 years). In all cases, researchers recorded Dermatology Life Quality Index scores.
Investigators found the mean DLQI score of the vitiligo patients in their cohort was 9.39±6.35. The mean DLQI score was higher in female patients and those with vitiligo universalis than in other skin condition forms.
In their conclusion, the authors note that the SOC population affected by vitiligo is at a higher risk of decreased QOL and may need special attention regarding quality health delivery services.
VIDEO: Primary care dermatology in skin of colour
Winfred Frazier, MD, Associate Professor and Vice-Chair for Education in the Department of Family Medicine at the University of Pittsburgh, presents information on the factors contributing to skin health disparities in skin of colour. He also discusses common skin conditions in these populations and identifies educational resources beneficial to primary care physicians on dermatology in skin of colour.
The deadline for submissions to the 2024 Dermatology Resident Essay Competition is Nov. 15, 2024.
The competition is organized by the Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE), a committee consisting of Canadian life sciences managers and executives, physicians, and allied parties who are committed to improving the patient experience and outcomes of underrepresented skin types in Canadian dermatology, through physician education, resources, and industry support.
Canadian medical residents are invited to submit an original short (350 to 500 words) essay on a topic of choice relating to skin of colour and Inclusivity, Diversity and Equity in Dermatology. The essay could be about observations made during medical training, personal experience, or be aspirational regarding improved dermatologic care for these members of Canadian society. Entries may be submitted in French or English. Six finalists will be selected, with each finalist receiving a dermatology textbook prize (digital or print), publication of the winning entries on the Derm.city website, and in the journal The Chronicle of Skin & Allergy. All submissions to the competition must include: Your name, university, telephone number, and email address and be submitted via email to admin@derm.city
Full details about the 2024 contest can be found at derm.city/for-residents
At the intersection of skin and society
A committee of Alberta chiefs is questioning Canada's commitment to upholding First Nations' water rights following the government's defence in a $1.1-billion national class-action lawsuit, reports CBC News.
According to the news outlet, the chiefs say the case only adds to their concerns that Canada is trying to absolve itself of treaty rights and legal responsibilities through a federal clean water bill, C-61, which they call "dump and run legislation."
The group is speaking out after federal lawyers argued in court earlier this month that Canada has no legal duty to ensure First Nations access to clean water, even if ministers publicly suggest otherwise.
CBC quotes Rupert Meneen, chief of Tallcree Tribal Government on Treaty 8 land in northern Alberta, who wonders how to reconcile the seemingly contradictory messages from the federal lawyers and the ministers.
“If they're saying it's not your treaty right to own or drink water, have water in your community, who do you believe?” he said.
“That kind of puts a little bit of the damper on what we're trying to do. Because where do we go from here?”
Indigenous Services Minister Patty Hajdu denied the government's desire to avoid its legal obligations, telling reporters on Oct. 10 in Ottawa that the law would impose “a very high legal bar” on Canada.
However, Hajdu declined to comment directly to the news outlet on the legal defence, saying, “This legislation would not give those kinds of arguments to government lawyers.”
This week
The second full week of November is National Nurse Practitioner Week in the U.S.
Nov. 14 is World Diabetes Day
Nov. 16 is International Day for Tolerance
Something to think about in the week ahead . . .
—John Desmond Bernal, Irish scientist and pioneer of X-ray crystallography in molecular biology (1901 to 1971)
Next week
In a presentation at the 2024 Indigenous Skin Spectrum Summit, Dr. Rachel Asiniwasis provides an overview of many of the current dermatologic challenges facing Indigenous communities in Canada.
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Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Jennifer Beecker (Ottawa) discusses the treatment of alopecia areata, including a range of therapies recently approved in Canada.
Dr. Cathryn Sibbald (Toronto) reviews the treatment of atopic dermatitis in children, with particular attention to the biologics and other systemic agents approved in Canada for use in young patients.
Drs. Jenn Tran (Toronto), Jennifer Lipson (Ottawa), Jessica Asgarpour (Toronto), and Maxwell Sauder (Toronto) provide an overview of essential news in acne therapy, including a new topical hormonal therapy and new combination treatments.
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Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
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