Is Phototherapy Destined to the Fate of Slide Rules?

T hough I’m not much of a serious collector of anything, somewhere in my basement is a collection of slide rules amassed during the high school years. At one time, my pride possession was a very high-quality Pickett slide rule. Ah, the Pickett, the Cadillac of slide rules. For a long time it was beyond my means, but when the first calculator arrived, these Pickett’s slide rules went on sale. A short time later, they were gone for good. The Future of Phototherapy Thinking about the fate of slide rules made me ponder whether phototherapy may suffer the same fate. Psoriasis specialty care has revolved around the phototherapy unit. We have to remember, though, that this “business” isn’t the phototherapy business, it’s the psoriasis treatment business. We need to be ready to change. Biologics are a huge advance for patients who need them. It’s awesome to see psoriasis and psoriatic arthritis melt away with biologic treatment. But will biologics replace phototherapy the way calculators replaced slide rules? Phototherapy has been around for thousands of years, and biologics aren’t the first challenge. Managed care nearly took phototherapy out in the last decade. As if phototherapy wasn’t inherently inconvenient enough, the combined effects of constrained reimbursement and immodest co-pays had phototherapy on the ropes. Yet the effectiveness and well-established safety profile of phototherapy kept it going. A Resurgence Will the biologics be the knock-out blow to phototherapy? I don’t think so. In fact, because of the higher price of genetically engineered biologic medications, managed care may suddenly look on phototherapy with open eyes and see a highly effective, very safe alternative treatment. Medical directors of managed care organizations may recognize that encouraging phototherapy is an important component of managing care for severe psoriasis patients. While limited reimbursement and high co-pays reduced phototherapy use in the last decade, higher reimbursement and elimination of disincentives to try phototherapy could lead to a resurgence in the next. Maybe I’m out of the times, but it seems to me that, unlike slide rules, phototherapy still has a place. Steven R. Feldman, M.D., Ph.D. Chief Medical Editor

T hough I’m not much of a serious collector of anything, somewhere in my basement is a collection of slide rules amassed during the high school years. At one time, my pride possession was a very high-quality Pickett slide rule. Ah, the Pickett, the Cadillac of slide rules. For a long time it was beyond my means, but when the first calculator arrived, these Pickett’s slide rules went on sale. A short time later, they were gone for good. The Future of Phototherapy Thinking about the fate of slide rules made me ponder whether phototherapy may suffer the same fate. Psoriasis specialty care has revolved around the phototherapy unit. We have to remember, though, that this “business” isn’t the phototherapy business, it’s the psoriasis treatment business. We need to be ready to change. Biologics are a huge advance for patients who need them. It’s awesome to see psoriasis and psoriatic arthritis melt away with biologic treatment. But will biologics replace phototherapy the way calculators replaced slide rules? Phototherapy has been around for thousands of years, and biologics aren’t the first challenge. Managed care nearly took phototherapy out in the last decade. As if phototherapy wasn’t inherently inconvenient enough, the combined effects of constrained reimbursement and immodest co-pays had phototherapy on the ropes. Yet the effectiveness and well-established safety profile of phototherapy kept it going. A Resurgence Will the biologics be the knock-out blow to phototherapy? I don’t think so. In fact, because of the higher price of genetically engineered biologic medications, managed care may suddenly look on phototherapy with open eyes and see a highly effective, very safe alternative treatment. Medical directors of managed care organizations may recognize that encouraging phototherapy is an important component of managing care for severe psoriasis patients. While limited reimbursement and high co-pays reduced phototherapy use in the last decade, higher reimbursement and elimination of disincentives to try phototherapy could lead to a resurgence in the next. Maybe I’m out of the times, but it seems to me that, unlike slide rules, phototherapy still has a place. Steven R. Feldman, M.D., Ph.D. Chief Medical Editor