Dermatology groups disavow isotretinoin developer

By Michael Woodhead

27 Nov 2020

The dermatologist who developed isotretinoin and the concept of photoageing should have his name removed from scholarships and institutions because of his record of unethical experiments on people in prison, US medical leaders say.

Dr Albert M. Kligman’s research work at the University of Pennsylvania in the 1960s produced a tolerable formulation of tretinoin that led to its licensing for use in acne in the 1970s.

But Dr Kligman, who died in 2010, never showed any regret for testing his research ideas on inmates, most of them black, at Holmesburg Prison in Pennsylvania, according to critics.

Dr Kligman always maintained that prisoners had consented and benefited financially from his work, even though some took legal action that eventually led to a US government ban on human medical research in prisons.

And despite being criticised by medical groups, the American Academy of Dermatology now says the Black Lives Matter movement has highlighted the need to go further and for dermatologists to completely disassociate themselves from Kligman’s work and memory.

“Dermatologists must be honest with ourselves about the profound wrongs done by some of our venerated leaders of the past,” it said.

“We cannot undo this injustice, but we can, and do acknowledge the injustice, acknowledge that disparate impacts on people of colour still exist today [and] commit ourselves to advocating for equal access to care for patients of all races.”

In a statement, the AAD said dermatologists should “promise to work to ensure that our specialty’s diversity better reflects that of the country at large pledge to make it possible for all dermatologists to receive proper training to care for patients with skin of every colour.”

The issue is also raised in JAMA Dermatology editorial which stated that while Kligman was a “giant of dermatology”, honouring his achievements also endorsed unethical human experimentation and direct harm to vulnerable and marginalised people.

The article by Dr Adewole Adamson and Dr Jules Lipoff noted that the Society for Investigative Dermatology (SID) had an award – now discontinued – to honour Dr Kligman accomplishments, which included pioneering fungus studies, developing the periodic acid–Schiff stain and potassium hydroxide preparation, and the original description of the human hair cycle.

However his name remained on professorships, a lectureship, and laboratories at the University of Pennsylvania and scholarship funds at Penn State Mont Alto.

“Some may question the fairness of judging historical figures by today’s standards; however, even with more than 30 years hindsight, Kligman would not acknowledge even any possible harm, and he and others benefited financially and professionally from the misdeeds. Thus, the SID was correct to remove Kligman’s name, and other institutions that still honour his name should do the same,” they wrote.

“Dermatology is already one of the least diverse fields in medicine and continues to work at addressing disparities and inequities in care for African Americans. We urge all to reconsider honorifics, with Kligman as an example, and to make substantive efforts toward equity and addressing health disparities.”

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