Dear Dr. Roach: I go to a group of excellent dermatologists, but one aspect of their practice bothers me. Often, the doctor will recommend a 鈥減roduct,鈥� which the practice sells. They are not cheap. I spent almost $60 for two small tubes of hand cream and sunblock/moisturizer. When the doctor literally hands you the tubes and says you need them, it鈥檚 hard to say 鈥渘o.鈥� However, I wonder if I could not buy the equivalent products at the drugstore for far less. I am questioning the need for these products and the ethics of selling them out of a medical practice. A.R.
I think you are right to be concerned. The way your doctor is suggesting that you buy the product they recommend is perilously close to coercion. I think it would be reasonable to tell your doctor that you aren鈥檛 comfortable spending so much money and ask if they could recommend a less-expensive option.
听
Dear Dr. Roach: I am 66 and have multiple sclerosis. Should I get the shingles vaccine? On the one hand, I know it is recommended for everyone. However, I do have a compromised immune system, and it could be risky to inject a virus. Neither my family doctor nor my neurologist has an opinion 鈥� they say it is a toss-up. D.E.P.
There are two issues here: Could the shingles vaccine, which is a live virus, cause shingles? And secondly, can it cause your multiple sclerosis to flare? Both of these are somewhat controversial.
The first question is less so.
There is recent evidence that between the MS (or other autoimmune diseases) and its treatment, the immune system is still good enough to prevent any viral disease. But MS experts are divided on the second question.
Since your doctors haven鈥檛 been much help, I will say the risk of causing a flare of MS is theoretical and small, but the downside of shingles is so great that I would, in general, recommend the vaccine to someone in your position.
