January 27, 2020

Dear Friends:

Every year I write a letter to my patients for several reasons.  The first is which to announce our annual Patient Appreciation Party but also I would like to let you know what is going on in the practice and in my life.

As the population on the Treasure Coast is changing quite a bit I would like to mention the patient party.

Many of my patients know about it and have been to it for many years but I would like to explain a little bit about it again and how it got started.

When I first opened my practice, I had a party for the local physicians.  Only one physician came.  I spoke to a patient about it and he said, “The other doctors don’t support your practice, your patients do.  You should have a party for us instead!”  

I threw a party that year in the parking lot of the office and we grilled hot dogs and had a DJ playing music.  About 200 people came, and since then I have always tried to affirm our practice philosophy to be about the patient and their medical needs. This year the letter is going to be a little shorter than usual because we had to change the location of our party. 

It is our 20th party, and we usually have it by the stadium in St. Lucie West.

Construction at the stadium has prevented us from doing this again and the party location has changed.

I also like to talk a little bit about my family.  I have two children (George and CC, she is named after her mother Cammy, but her nickname is CC).  George is autistic and has several of the issues associated with this syndrome. He has a lot of difficulty talking and at this point last year was not talking much.  He is saying many more words, and is enrolled in a Montessori school that seems to be a good fit for him.  Though he is not talking much, he likes to sing, and when he does, his mother and I, well, our hearts dance with him.

His teachers and counselors have helped him go a long way and many people ask about him.  I appreciate their concern and support.  Despite his difficulties, he is an incredibly happy child, and he is getting better every week.

CC, my daughter, is now 8 years old and is in second grade.  She likes art and is creative like her mother.  And, she is also good at reading and math.  I am so proud of her. Like her brother, she seems happy and as well-adjusted as any of us can be in these crazy times.

My wife Cammy, my rock and the owner of my heart, is doing great. After being together about 15 years I still can’t wait to see her when I get home and I am grateful that she is my partner in love, family and life.

The practice has not changed much, I am considering taking on another doctor, and that may happen in the next year or two. 

Our practice is different than a lot of practices and because of that, finding the proper fit is not only difficult, but it is essential for me, the staff, and especially our patients.

Our practice is different in a couple of ways and one way is that we don’t do cosmetics.  Botox, collagen and other things like this seem to form a large part of other practices but we have chosen to be a medical practice at Treasure Coast Dermatology.  I am not taking away from any other physician who does these procedures.  Cosmetic procedures pay in cash, and it is harder and harder to run a physician’s office these days.  After all, we are a small business.

I have been lucky that I have been able to avoid this in order to better focus on my patients’ medical problems. One issue with this is that new graduates often want to do these cosmetic procedures.  It is perceived as glamorous and certainly the money, not being through an insurance company, can be attractive especially to those with a lot of debt.

I am doing my best to keep our core philosophy here at Treasure Coast Dermatology by finding the right fit.

Another issue that I spoke about on my last letter was the vaccine that I was working on for skin cancer.  Progress has been slow.  There are a couple of problems with any new treatment, especially one as potentially effective as this vaccine.

First of all there is an inertia in medicine.   People, especially doctors, do not like to change the way they think about things.

We have several upcoming publications, including chapters in books, articles in prestigious medical journals, but until publication I am not supposed to talk about them.

One of the problems with this issue is that medical journals do not like people talking about the articles that they publish, so when they publish them they can make a bigger splash.  Medical journalists depend on advertising and internet clicks just like Google does.

So, please understand, the information is getting out there and several things have happened to reinforce the importance of our observation.

I do want to mention a couple of things that I can talk about.  The first of which is a paper that came out from Harvard that showed the immunologic basis of skin cancer based on an infection, not ultraviolet radiation from the sun.  This is the same infection that is targeted by the vaccine we are using. 

One researcher told me “The science has finally caught up with our observation.”

So, I am pleased that our colleagues in the Ivy League have helped confirm our observation.

This Harvard study though, was conducted in a lab, but because of our publications we have more and more clinicians using this on patients who are otherwise difficult to treat.

The chairman of Mount Sinai, Dr. Mark Lebwohl, gave a talk at University of Miami and spoke about his own experiences with our vaccine.  He himself is using this in his clinic, and is writing a paper on it.  Dr. Lebwohl is one of the most famous dermatologists in the world, and his acceptance and use of our vaccine will help get it approved and out there for more and more patients. 

If I do sound a little frustrated by the pace of this, I am.   But I have come to realize that rather than fighting or spending energy railing against this inertia, it would be better if I put that energy to more productive uses.

I said I would keep the letter short this year because I wanted to include a map of the party location but I have to mention one more thing as it is especially timely.

At Treasure Coast Dermatology we have never taken any meals or gifts from drug representatives.  You have never been kept waiting in my office while I sat in the back chatting up a drug rep, because I simply do not see them.

I think that a physician taking gifts and things from drug reps is a form of “payola” and I am going to tell a story that I have mentioned several times in my previous letters.  When I first opened a practice in Fort Pierce more than 20 years ago, many drug reps would come by.  I politely turned them all away.  One was especially forceful, and one day I walked in my office and she was setting up a lunch.

I told her to pick up the food and take it away and she said “Dr. Ioannides you are a doctor, you can afford lunch, maybe your employees would like a free one every now and then.”  I told her I would buy lunch for my employees that day, and she said “yeah sure today, what about tomorrow?”  Well, I have bought lunch for my employees every day since then for the past 20 years. 

If she can be obstinate and stubborn, so can I.  I am not going to compromise my ethics.

I am bringing this up for a specific reason and not to place some type of badge of honor on myself or anything like that but I do believe that doctors should not be taking these gifts, honorariums, etc. from drug reps. 

Ultimately this is your money.

I have many patients on fixed incomes who struggle to pay not only their basic bills for food and electricity but go without medication because of their skyrocketing costs.

Just this past week in the headlines there was some legislation that would allow patients to more easily bring in medication from Canada.

This is an idea that could only be thought of as a solution by our politicians.

While it is nice that they might make it easier for us to get the medication there, why not just apply the same prices to our local drug stores.

You and I know why.

They are on the take. I do not care which side you are, a republican, democrat, libertarian or whatever, no one has solved these issues.

Unfortunately this issue disproportionately hits the elderly population, especially those on fixed incomes.

Please write your congressman about this.  I do not want to get on a high horse and I certainly do not like discussing politics but instead of allowing us easier access to Canadian drugs, why don’t they just legislate that pharmacies have to sell those drugs in the U.S. at the same price as they are selling them in Canada.  They wouldn’t sell them for a loss in Canada, so they are still making a profit, but how about not bankrupting many of us in the process.

The government legislates what physicians can charge in Medicare, but not what pharmaceutical companies can charge in pharmacies.  Like I said, we all know why.  They are all complicit.

But this is taking hard earned money from my patients and making the “golden years” a lot less golden. If that doesn’t make you angry, I don’t know what will.

I think this frustration ties in with the frustration with the slow progress of the vaccine. Inertia on both of these is related to patient care, but no one in Washington seems to care.

We do care about this issue at Treasure Coast Dermatology. So, if there is a prescription that is too expensive, please call our office and we will do our best to find an alternative.  

They won’t stop us from doing the best that we can for you. 

We don’t know if we can beat the system, but we will go down fighting for you and your health.

I wish all of you my prayers for your health, happiness and prosperity, and thanks for continuing to be a part of the Treasure Coast Dermatology family.

Warmest Regards,

TIM IOANNIDES, MD