I received in the mail, the following anonymous letter today:
“Dr Steinsapir:
“I must say that I was quite surprised at your comments on the website Realself re: dermaroller treatments. The public has the Internet and are much more educated than you might believe. You may want to look through the hundreds of “official” clinical trials and articles on PubMed.gov for the “evidence” you are lacking.
“Simply type in key word such as: dermaroller, percutaneous collagen induction, microneedling, needle dermabrasion, etc. You will find hundreds of clinical trials and articles from professional journals such as “Journal of Cosmetic Surgery, Journal Of Cutaneous and Aesthetic Surgery, etc. which PROVE via not only patient satisfaction but histological examination that Dermaroller treatments are EFFECTIVE for treating scars as well as wrinkles and skin laxity by increasing collagen and elastic deposits; a 40% thickening of the stratum spinosum and rete ridges. On average patients report improvement between 60-80% better than before Dermaroller treatment.
“By doing a PubMed.gov search you will find your “shred of evidence” that it does more than cause pain, as well as the before and after photos which you claim to not exist, and a whole lot of other EVIDENCE that Dermaroller treatments do in fact work…who knows, maybe with an increase in your knowledge base, you too may decide to utilize Dermaroller treatments in your practice and even decide to revise your comments on Realself.com. You can thank an informed consumer.
“Sincerely
“Signature illegible.”
Dear Signature Illegible,
First, thank you for taking the time to send me a letter regarding my Realself opinions on the Dermaroller. In a very nice way, you suggest that I do not know what I am talking about because I feel there is very little evidence that supports the use of this device. You state that there are “ hundreds of “official” clinical trials and articles on PubMed.gov and basically if I were just to read them “you may decide to utilize Dermaroller treatments in your practice and even decide to revise your comments on Realself.com.”
Well fair enough. In my comments, I did not cite the medical literature on this subject, which, honestly, is not commonly done on Realself. Rest assured that in addition to being a board certified Ophthalmologist, I completed three years of fellowship training in cosmetic surgery and oculoplastic surgery. Additionally, I did a two-year basic science post-doctoral research fellowship at the Jules Stein Eye Institute so I actually know how to read and understand a scientific paper. In fact, I serve as a peer-reviewer for 8 Index Medicus listed journals. That means I read unpublished papers for these journals, make criticisms, and recommend if these scientific papers should be published, corrected, or rejected.
You state that there are hundreds of “official” clinical trials and articles. Pubmed is the official website for the Library of Medicine supported by the National Institutes of Health. Not all journals are listed in this index because not all journals meet the rigorous standards required by the Library of Medicine.
A search under Dermaroller and micro needling reveals not “hundreds of “official” clinical trials and articles but rather 10 articles, percutaneous collagen induction 8 articles, needle dermabrasion 3 articles. That is approximately 21 articles so not hundreds of articles. Many of these articles are descriptive methods papers that really to not present objective results and do not qualify as clinical trial. Perhaps the strongest of these papers is the 2008 paper: Aust MC, Fernandes D, Kaplan HM, and Vogt PM. Percutaneous collagen induction therapy: An alternative treatment for scars, wrinkles, and skin laxity. Plast Reconstr Surg. 121: 1421, 2008. However, this study is not a clinical trial. The University of Michigan defines a clinical trial as “a prospective, biomedical or behavioral research study of human subjects that is designed to answer specific questions about biomedical or behavioral interventions (drugs, biologics, treatments, devices, or new ways of using known drugs, biologics, treatments, or devices).” The paper by Aust and co-workers was a retrospective study, not a prospective study and therefore not a clinical trial. They looked at the effect of treating 480 patients with a Medical Roll-CIT, a microneedle skin rolling device. Unfortunately, these authors had financial conflicts of interest. Dr. Des Fernandes worked for the company whose products were used in the study and owned stock in the company that made the skin roller. Dr Aust was a paid consultant for the company that made products used in the study. Dr. Kaplan was also a paid advisor to the United States company that distributed the skin products used in the study. There were a number of other confounding factors in the study design that affect the strength of this study. Even the before and after pictures in this paper demonstrated profound lighting differences between the before and after images. Due to these biases, it is not reasonable to conclude that this treatment is even beneficial, let alone able to improve the skin 60-80% as claimed by the authors. Obviously, if you are in the business of providing these services or selling the equipment, you want to embrace these results.
Not all medical journals are considered to be equally reliable. For example, Journal of Cosmetic Surgery, that you mention, is not listed as part of the Index Medicus for this reason.
I take you at your word that you are in fact an “informed consumer.” Unfortunately without the knowledge of how to interpret these papers, it is easy to be mislead that a service is something more than it really is. This manipulation of the public is unfortunately all too common. The monetary value of these services makes the financial incentives to present data in the most positive light very strong. It is very difficult for the public to understand the limitations of the medical literature, even an “informed consumer.” On the other hand, it has become all too common for the public to be manipulated via the Internet. This takes place even in pro-consumer forums such as Realself. For example, I do not know who you are or even if your are an “informed consumer.” Rather you may be someone who provides this procedure and not anxious to see someone raise questions about the true value of this service. I make no money from my position. I suspect that we can’t assume that you don’t since you have taken such care to mask your identity.