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Thick Skinned with an Insider’s Perspective, Adewole Adamson Questions Existing Dogma in Dermatology

Adewole Adamson, M.D, M.P.P. smiles wearing a white lab coat.
Adewole Adamson, M.D, M.P.P. Image courtesy of University of Texas at Austin.

When reggae star Bob Marley died in May 1982 from melanoma, a type of skin cancer, dermatologist and recent AAAS Annual Meeting presenter Adewole Adamson, M.D, M.P.P. was not yet born. But in May 2019, thirty-seven years later, Adamson said that sunscreen would not have saved the legend or any other Black person.

"If sunscreen was important in the prevention of melanoma in dark-skinned patients, then why have we never heard of an epidemic of melanoma in sub-Saharan Africa?" he argued in a recent op-ed that appeared in The Washington Post. The piece not only caused a spirited debate in the African American community, but it was also discussed on NBC's Today Show and the New York Times. Unhappy about how the discussion was handled on NBC with little to no scientific input, Adamson took matters into his own hands.  

“I decided to pull together all the evidence about melanoma, UV exposure and skin of color,” he says. “This work appeared in a 2020 JAMA Dermatology study where we showed there was basically scant evidence to support the relationship between sun exposure and melanoma in skin of color.”

For Adamson, lighting fuses by questioning existing dogma in dermatology, and by extension medicine, is an approach he has honed over the years. "I have a suspicion of anybody who tells me something in medicine is a game-changer," he says. "I’m not a Luddite, but I am always careful and cautious what the next overhyped or overpromoted thing is."

Adamson points to artificial intelligence for the diagnosis of melanoma as one example. Gene Expression Profiling (GEP) is another, which is increasingly being used to predict which melanomas are at elevated risk of metastasis. “Until we have clear evidence that 31 (the number of genes tested)-GEP results affect patient outcomes, we should not use it to influence care decisions in patients with thin melanoma (less than 1mm in depth into skin),” he says in an April 2020 viewpoint that appeared in JAMA Dermatology.

Adamson traces his entry into the field of machine learning and artificial intelligence to a phone call he received in January of 2018 while he worked on faculty at the University of North Carolina in Chapel Hill. It was a software engineer on the other end of the call who had recently read Adamson’s work about health disparities related to surgeries for melanoma. 

The caller told Adamson about a serious problem – that algorithms being used for skin cancer detection are potentially racist. Desperate for information, he asked Adamson if he had a database that he could use to create a fair machine learning algorithm. Adamson responded that he didn’t have the tech, but he wanted to lend his voice to the issue and highlight it more broadly in the scientific community.

“It ended up being a perspective piece and one of the more cited articles that I have ever written,” he says.

Ever since, learning and studying machine learning has been a calling for Adamson. Though he admits his first foray into the field was almost like falling into it by accident.

"I am not a computer scientist,” he says. “I don't program. I am not a coder. I am a health services and health policy researcher."

As an assistant professor at the Dell Medical School at the University of Texas at Austin, Adamson spends 80% of his time on research and the other on teaching and seeing patients, which he does twice a week. This dual role gives him the space to caution the field of dermatology and medicine, which in his view can at times too eagerly pursue and promote the newest shiny object.

Some of his cautionary advice has appeared recently in the New England Journal of Medicine, the paper would later land him an invitation to the AAAS Annual Meeting. “My experience at the AAAS Meeting was terrific. I got to virtually meet interesting people that I normally would never have run into within my usual conference circuit which involves primarily dermatologists,” he says. “It’s a wonderful feeling that what I write would move someone enough to reach out and invite me to speak.”

Beyond publishing papers and attending to patients, Adamson has also shown his passion for calling out injustices and racism, particularly against Black people. When Adamson was warned against writing about Albert Kligman, an influential dermatologist that conducted unethical experiments on Black prisoners, Adamson stood his ground.

"I had been told repeatedly by folks that this might damage my career," he says. "But I couldn't be silent about it."

His recent piece was published in JAMA Dermatology in November 2020 under the headline 'Reconsidering Named Honorifics in Medicine — the Troubling Legacy of Dermatologist Albert Kligman.’ 

“From the 1950s to the 1970s... Kligman led human subject research on prisoners, mostly African Americans with limited literacy," Adamson writes in the paper. "The experiments included exposure to chemicals such as dioxin, a carcinogen, and component of Agent Orange, [which is a herbicide and defoliant.]"

The blowback Adamson expected for publishing this article never came. Instead, when he posted the link on Twitterone of his followers expressed regret and appreciation for more understanding of the legacy Kligman left behind.

Adamson, who holds medical and public policy degrees from Harvard, has reserved his heaviest criticism for what he calls the ‘medical-industrial complex.’

“I am all for the profit motive driving innovation, but I think if you are going to tout something as being beneficial to patients you should prove it before you convince people to invest billions of dollars in it,” he says. “There are some artificial intelligence and diagnostics companies that are over-promising without actually doing the correct trials.”



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