Repurposing Medications—Chicken Manure, Erectile Dysfunction, and Finding the Golden Needle in the Haystack of Absurdity

Abstract

My dad grew up on a chicken farm. One winter in my youth, while at an extended family gathering in his little farm town in mid-Missouri, I was complaining to him about my severe chapped lips. "Well, farmers around here would tell you to put chicken [manure] on chapped lips. That's a sure cure." Looking around the circle of conversation, I saw several relatives, farmers, and locals affirming this statement. For the next dozen years I was perplexed by the recommendation and silent about any further lip concerns.Fast forward 35 years, and, I suspect like many readers of JAMA Dermatology, I see patients in the dermatology office with outlandish claims of successful therapies. I began my dermatology career trying to listen empathetically, but could only hear Patsy Cline's "Crazy" playing somewhere in the back of my mind. There was no science! There was no evidence! I needed to shepherd these poor patients down the path of reason and scientific validity! After several humbling clinical experiences and review of a tongue-in-cheek publication on the lack of scientific evidence that parachutes reduce the risk of injury when jumping from a plane, 1 I began to soften. I don't practice alternative, holistic, or Eastern medicine, to my knowledge, but I don't bash it either. I don't judge patients' claims too harshly, and I almost never tell them their suggestions definitely won't work. Truthfully, I have recommended the addition of duct tape in my over-the-counter wart treatment regimens, and I have shrugged my shoulders with indifference when patients request to use Vicks VapoRub in the treatment of their elderly onychomycosis. Neither of these products was brought to market to treat these conditions. It was patient experience, belief systems, and word of mouth that often brought about the larger treatment movements, and eventually more rigorous studies. 2,3 In this month's JAMA Dermatology, Ibrahim et al 4 and Albers et al 5 each report a separate small series of patients with severe Hailey-Hailey disease recalcitrant to many conventional therapies who responded remarkably and quickly to lowdose, compounded oral naltrexone. This discovery seems to have its origins in patient word of mouth; specifically through online Hailey-Hailey disease support groups. Where once there was a water cooler or barber shop around which remedy anecdotes were swapped, today's patient is online, connected to large volumes of information and to others with similar con-Opinion EDITORIAL jamadermatology.com (Reprinted)

An Internet-based survey study of patients with hidradenitis suppurativa: Use of the Internet for disease-related information

“…One advantage of the Internet is that it allows patients to connect and share recommendations, which has even led to the discovery of new treatments such as low-dose naltrexone for Hailey-Hailey disease. 4,5 A disadvantage is that there is no regulation of the sources, which can result in the spread of false-even harmful-information.…”