Derm-it Trotter! Don't Swear About Skincare.
Feeling frustrated or overwhelmed with everything skin? Does the skinformation overload make you want to swear about skincare? Join Dr. Shannon C. Trotter, board certified dermatologist, as she talks with fellow dermatologists and colleagues in skincare to help separate fact from fiction and simplify the world of skin. After listening, you won’t swear about skincare anymore!
Derm-it Trotter! Don't Swear About Skincare.
The Truth Behind Boxed Warnings
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Boxed warnings can feel like a stop sign—but they don’t always reflect your personal risk. Dr. Nicholas Brownstone breaks down what these labels really mean, why they’re often added after approval, and how “association” (not proven causation) can still drive scary wording.
We also unpack class-wide warnings (like TB language on biologics and U.S. JAK inhibitor risks borrowed from older RA populations), why derm data can look very different, and how we counsel patients: put the warning in context, match it to your health profile, and monitor smartly—so fear doesn’t lead to undertreatment.
We take this by mouth for organ transplant, but we can put it on the skin topically to reduce inflammation in things like eczema. The jack inhibitors, which stands for Janus kinase, are oral pills that we take for eczema, atopic dermatitis. Uh, they have boxed warnings for things like serious infection, mortality, uh, malignancies. Reconsider or redesign class labeling and change the name from warning to special consideration or advisory. Most notably, hormone replacement therapy recently had a box warning removed. There was a box warning for blood clots, increased risks of blood clots, and that that was removed.
SPEAKER_01:And then another famous case was Have you or will you ever take a medication with a box warning?
SPEAKER_00:If the box warning is increased, welcome to Dermot Trotter, Don't Swear About Skin Care, where host Dr. Shannon C. Trotter, a board certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.
SPEAKER_01:Welcome to the Dermit Trotter Don't Swear About Skin Care podcast. I've got Dr. Nicholas Brownstone on the podcast today. He's a board-certified dermatologist, an assistant professor at Mount Sinai in New York, and podcast host of Cutaneous Miscellaneous. Welcome to the podcast, Nick. It's great to have you here.
SPEAKER_02:Well, thank you, Shannon. Obviously, you know I love dermatology podcasting. I love dermatrotter. Don't swear by skincare. That's got to be one of the best podcast names out there. So happy to be here. Uh, thank you so much.
SPEAKER_01:Of course. Thanks for the compliment. And we're going to talk about something today that I think interests a lot of people out there. This concept of a box warning, what people used to call like a black box warning, where basically, you know, the FDA goes out there, puts this big warning sign on medications. And I want to talk with you more about this because I know it's an interest of yours about what does this really mean? Because I think it does instill a lot of fear in people, right? About what is this about? What is it, you know, supposed to be from the standpoint of the FDA? Are they really just trying to provide a warning? Does it mean you can't take this medication? But first, I'm just going to have you kind of explain a little bit more about what is a box warning or what people used to kind of call a black box warning.
SPEAKER_02:Sure. I'm so glad you brought up the term black box warning. And I want to start off with this. There's no official term as black box warning. It's box or boxed warning. And why I bring this up is because black box sounds scary, right? Every time we hear a plane crash, we hear the word black box. That's the flight recorder. And funny enough, it's actually orange. So I don't even know where the word black box came from. Um when I hear black box, I get nervous. And I think it um makes patients and clinicians maybe a little bit worried when they shouldn't be. So I like the official term box or boxed warning. So why do we even have these things? And what are they? Boxed warnings are certain contraindications or serious warnings that a medication may be labeled, um, particularly those that may lead to death or serious injury. There would not be a boxed warning for an upset tummy or a headache. These are serious warnings that can lead to morbidity and mortality, we say in medicine. Um, and why do we have these? Well, uh stock Dr. Stephen Gowston, who was a former FDA bigwig and actually former acting uh surgeon general, testified in front of Congress regarding the FDA, and his quote was FDA was founded in response to concerns about safety. Attention to safety is everything that we do. So that's number one on the FDA's mind. Uh they'd much rather have a medication that's maybe very effective, but may have some safety signals be held back versus letting a medication release that could hurt somebody. Uh, or if there's some safety concerns, they want to make it crystal clear and maybe put a little extra warning so everyone's aware and there's not no, no one, you didn't tell me about that before. Just some brief history. Um, before in the United States, you can market a medication and just open up a company and sell it and no with no regulation, right? That's no good. So in 1938 and 1962, a couple of uh amendments and laws came into effect uh saying that when we release the medication, there's got to be safety and efficacy data. And then the black box or the box warning, I should say that we know it, was first introduced in 1979 and it's federally regulated.
SPEAKER_01:Wow. So it's I like how you call that out because it's really the FDA trying to just draw attention to something. But you're right, wording is important and semantics matter, and that is a scary thought when people hear that black box warning that somehow that's some how a bad thing, right? You said so I I think it's important that you know it's there. The FDA obviously thinks it's concerning enough to draw to somebody's attention, but it's not necessarily contraindication to take the medication. It's more just here's a little extra emphasis to make sure you didn't miss that this is important or something very serious, like you said, death, um, you know, or major injury that's gonna happen to a patient, not some of the common side effects that we would see. Now, I people are probably wondering out there, gosh, like how does a medication even get a box warning? Like, how does that even happen? Because I I think people are wondering like, is it just something that gets pulled out of thin air? Is there data that's reviewed? Is it patient reported? Does it happen before the medication gets approved? Or is it something that could happen later in the game with the medication on the market?
SPEAKER_02:Yeah, that's a great, that's a great, great question. And just before we jump into that, um, I want to talk about interpreting uh a boxed warning. So a boxed warning, um, there has to be a reasonable evidence of an association of a serious hazard with the drug, but a a definite causal relationship does not have to be established uh for a boxed warning. That's important. And boxed warnings are usually based on clinical data, but animal data may lead to a boxed warning in some cases. It doesn't all have to be um clinical data from humans. And and you're right, when does the box warning get slapped onto a medication? Um, most of the time it's in post-marketing studies, which means that a medication is approved by the FDA and then it's released to the public. And of course, the FDA, the government, doctors, patient advocacy groups are seeing how that medication performs in the real world, what side effects happen in the real world because clinical trials are only a couple of months at a time. Uh, what's going to happen in five years or 10 years? We can't, we don't know that in a clinical trial. So that's post-marketing studies. And there was a great study done on boxed warnings that looked at in the past decade. Um, and about 78% of boxed warnings were put on medications in post-marketing studies. So uncommon to see a boxed warning when a medication is released on day one.
SPEAKER_01:Yeah, and for our listeners out there, but they may not realize, and you and I have some experience with this with clinical trials, you know, you have smaller groups of patients. So it's not until that medication gets out and a larger group of people are being treated that we might start to see trends or things that could be concerning. So that's when sometimes the FDA would go back and maybe modify the label or add that box warning if they thought it was warranted. And I also like that you highlight the fact that, yeah, it doesn't have to demonstrate a cause-effect relationship. And that can be hard actually to prove, even when we're designing a study, but sometimes there can be an association that's seen. And so that's something that, you know, isn't necessarily always definitive. You're not going to show that cause-effect, but with that association could still be important enough to make people aware of. And then also that animal study piece, because I think everyone thinks, oh, this must have been shown definitely in humans to really have gotten the boxed warning and to know that this could actually be demonstrated in animals only, I think is something people need to be aware of because that doesn't always necessarily translate to humans. That is something that we kind of think of might be the case, but it may not be something we actually do see. So I like that you kind of consolidate that because I think it can be confusing how that occurs. And a lot of people think, oh, I would just think this would get it early on. Maybe that means something even worse if the medication got it later, but it's really just a matter of numbers and probably exposure and what we can truly see as well. And we talk about medications that get it. You know, I think you and I have both taken medications with box warnings, right? I actually took some ibuprofen earlier today for a headache that I had. And I think that that's something we're like, wait a minute, ibuprofen has a box warning. And that might surprise some people out there that common things that are over the counter can carry box warnings as well as prescription medications as well. So I was gonna have you, you know, talk a little bit, you know, about like kind of you know medications that people may not think of or realize that have box warnings, and maybe some of the things that are in dermatology that carry a box warning as well.
SPEAKER_02:Sure, sure. So just to look at the big picture again of boxed warnings, um, what are box warnings about? What kind of warnings um are they talking about? In this study that I mentioned that looked at all box warnings in the past decade, the number one um box warning had to do with drug addiction. The FDA is very nervous about getting people addicted to drugs. Okay, that makes sense, right? Number two is what's called hypersensitivity reactions. These are kind of drug reactions that are sometimes not known why they're happening, but they could happen, leading to maybe anaphylaxis, leading to a rash. Number three is infections. Number four is birth defects or suicidal tendencies. The FDA is very, very concerned about medications leading to suicide. And number five is cardiovascular events like a heart attack, uh, things along those lines. And I love what you said too about the animal data. It's something to really be stressed. In dermatology, we have a medication called protopic or tachyrolimus, topical, tachylimus, protopic. We take this by mouth for organ transplant, but we can put it on the skin topically to reduce inflammation in things like eczema or things like psoriasis. And there's a boxed warning for topical tacrolimus for a lymphoma risk. So that might seem kind of silly that I'm putting a cream on my skin and it's going to cause lymphoma. Well, some of that data did come from animal studies showing putting uh protopic, topical tachylimus on a mouse causes a lymphoma in the mouse. Uh, but they were used very, very high concentrations in that case. But that is something that helped lead to this boxed warning in protopic. And that might sound kind of silly to patients, but again, animal data could be used uh to support a boxed warning.
SPEAKER_01:And I think too, when you mentioned that as, you know, as dermatologists, us even knowing about that box warning, but we understand the context of it, you know, and how that came to be, that, you know, I don't hesitate to often use that medication in patients because the box warning exists. But I think that's part of the inadvertent risk sometimes you see with box warnings that there could be hesitation on the prescriber's end or even on the patient's end to potentially do something or take that medication without really knowing the context. Like what's the surrounding data or why was that actually put on there? Because sometimes too, you can actually see that class effect labeling. So I was gonna have you talk about that because that's kind of a good segue into that, where you know they might notice it as a class effect and maybe not with a particular medicine that we're gonna recommend, but unfortunately, guilty by association, it gets that labeling as well.
SPEAKER_02:Yes, yes. I'm gonna give everyone an example here. So let's say let's say you're in a grocery store and you have uh fruit juices. You have orange juice, apple juice, and maybe cranberry juice. I don't know. Is cranberry a fruit?
SPEAKER_01:Okay, I'm pretty sure it is, but okay, for purposes of the analogy. I think cucumbers are technically in the fruit family, according to my staff recently.
SPEAKER_02:Okay, so let's say you have you have apple, orange, cranberry, and cucumber juice. That's a fruit, okay, according to according to this analogy. Let's say you have all these fruit juices lined up, and let's say for some reason the apple juice was tainted. It was handled improperly, there was um was stored improperly, or there was uh bacteria in the apples that, hypothetically, when the apple juice was kind of produced. The grocer, the grocery store says, okay, the apple juice is tainted. We're gonna put a warning on all these fruit juices and say that all these fruit juices may be tainted as well. Even though apple is different from orange, it came from a different place, it was produced in a different place. That's the kind of the essence behind class labeling. In dermatology, we have a class of medications called biologics. These are medications that are made from a living cell. And um there's different, they block different chemicals within this class of biologics. But one medication uh was known to perhaps reactivate tuberculosis. We saw some um data that kind of showed that patients who took this medication had a little bit of reactivation of tuberculosis. Other medications that are biologics that block different chemicals that have come out later, there's been no evidence that there's been any tuberculosis risk. But still, the FDA put on the label that if you take these medications, these newer medications, there's still a risk of tuberculosis. And um, in fact, uh the National Psariasis Foundation and International Psirasis Council just put out a paper saying that these newer medications, namely the IL-23 inhibitors and IL-17 inhibitors, we do not need to check for tuberculosis before we start them. In fact, uh, for one of the medications, one of the IL-23 inhibitors, Risen Kizimmab for Skyrisi, there were 31 patients in the trial that were allowed to be admitted that had latent tuberculosis and they got the medication and nothing happened. So these medications, again, that have no data to show a reactivation of tuberculosis still have the label because of class labeling. Orange juice, apple juice, cucumber juice, they all got the label.
SPEAKER_01:Yeah, and I think that's kind of the scary part that, you know, again, in understanding that context is what's important, especially to have that conversation with patients, because I think they can relate to that. Kind of like if you've got a family member, maybe the black sheep of the family, right? But the whole family gets the bad reputation because of one person. And I try to remind my patients, hey, that one person doesn't necessarily represent your entire family or their values. It's unfortunate though that sometimes you do get that little bit of association with it, but we see that with medications. And I understand the FDA, they're not going to always find it or do studies to look for that. So they want to be overly cautious and maybe do that class labeling effect. But I think we also have to give patients the information so we can make a good decision if that drug is still appropriate for them or not. And I know we talked a little bit earlier about that ibuprofen I was popping that's got kind of the you know the box warning as well. Do you mind touching upon a few other medications that might surprise some of our audience members, you know, that actually, you know, have box warnings and they might not even realize that they're taking medications like that?
SPEAKER_02:Sure, yeah. So, you know, I love what you said about uh about that. You know, this is why we have to go to a doctor, not go to AI in the future, right? Because of some of these subtle points uh that your doctor has to kind of uh break down. Uh so yes, some some box warnings that may be familiar to patients in dermatology. Um, the the JAC inhibitors, which stands for Janus kinase, are oral pills that we take for eczema, atopic dermatitis. Uh, they have boxed warnings for things like serious infection, mortality, uh, malignancies, major adverse cardiovascular events like stroke, uh, like heart attack, and thrombosis, blood clots. Okay, these all sound really, really scary. And where do these come from? Well, they came from uh, again, a cousin of the medication, but not the medication, and that was studied in a different population, an older and sicker population, patients with rheumatoid arthritis, who were smokers, who had one cardiovascular risk factor. So, of course, if you study this medication in that population, you're gonna find all these scary side effects. But it turns out in dermatology, uh, with a younger, healthier population on average and treating atopic dermatitis, these box warnings are not really evidence-based. They were placed on the medication uh for class labeling in short. Um, and one of the things that we that we really see evidence-based with these medications, these jack inhibitors uh for atopic dermatitis, and namely abrocitinib and um upatocitinib, we see herpes reactivation, we see acne, we see uh increase in mild infections, and that's really it if you look at the data.
SPEAKER_01:Yeah, and and I think that gives people some reassurance once they go through that. Because if you just look at that box warning, it's definitely gonna make you do a second take. And not only I think the patient, but also our colleagues in Durham that are prescribing, I think that's where, again, you know, box warnings, I see the appropriateness where the FDA likes to bring them on, but there's also gonna create some of this hesitancy, and you wonder if patients then, you know, are under-treated because both maybe on the prescriber side or even the patient side, they're afraid to even have the conversation or walk through it or truly understand the data. And I think there's got to be people out there listening too that um have had even treatments of their dermatologists, maybe even something with Botox and not even know about the box warning. And I think that would shock people because you know, they would be like, wait a minute, it has a box warning and how many times have I had Botox but not even thought about it or had the conversation, you know, around it. I think again, because of the context around that. Have you ever had anyone come through your clinic or even ask you about that that's maybe come in for a Botox consult or a colleague of yours if you don't do Botox?
SPEAKER_02:Yeah, I I do do cosmetic treatments and Botox. No one's ever really brought it up because they don't really think of it as like a medication, but it is, you know, anything that we we put in our body by mouth or inject as a medication, but no one really really reads the label there. Uh but yeah, you know, and again, just going back to the Jack Inhibitor issue, we also see some headaches and some nausea. That's really the evidence that we see. Um, and you know, we kind of touched on this before, but yes, I'm always number one person to be conservative, and safety is my always my number one goal in clinic. I'm very conservative with patients. I bring them back in three months just to check on that spot, just to make sure nothing is changing. Uh, but I think there's definitely unintended consequences here. I think it scares patients a little bit too much, it scares clinicians a little bit too much. And, you know, if I could run the FDA or speak to the FDA, I would just tell them to at least put evidence in the package inserts about the box warning and say we we have uh great evidence, not so good evidence. Here's the evidence that we're using for this box warning. That might help some people interpret a little bit better. Uh and in fact, I did a paper uh comparing boxed warnings in other countries, other industrialized countries like Japan, like Europe, and they don't even exist there. Um in Japan, it's called the a red box warning, which is a little bit better, sounding better than black. And there's they only talked about possible infections for the Jack inhibitors, nothing about all-cause mortality, nothing about cardiovascular, nothing about um thrombosis, nothing about GI perforation, which is in the U.S. packaging for patocytinib. Um and it for malignancy, it says cases happen, but relationship is unknown. And then in Europe, it's called the package leaflet. And there's really not much scary language just saying that for an elderly patient over 65, perhaps you should try something first before you use a jack inhibitor. That's all we see in the in other countries which practice medicine uh like the US does in many cases.
SPEAKER_01:And that's fascinating because I think it shows you, you know, just you know, semantics, just your word choice, how that would, you know, if you see, oh, you have a leaflet or an insert versus, you know, oh, you have a box warning, I mean, that's definitely going to draw your attention differently. And then I love, we need to get you on an FDA sort of board recommendation, something here to put that evidence in, because I do think that would help, you know, guide the conversation. Where again, nobody wants to dismiss the importance. The FDA thinks it's important, they want to call these sort of safety issues out. So we can agree with that. But yes, putting it into context, I think that's really important with the information. So we might have to work on that, get you a point.
SPEAKER_02:Yes, I, you know, if I could tell the FDA about boxed warnings about labels, I would say include levels of evidence. You know, is this data evidence-based? Is this data coming from class labeling? Is this data based on animal studies? You know, just make it clear. Reconsider or redesign class labeling and change the name from warning to special consideration or advisory. That's language matters, and I think that's a little bit of a softer language versus warning. Because to me, warning means something's about to happen. Uh, but special consideration or advisory means okay, we should think about this but something's probably not gonna happen tomorrow or right away. So that's probably what I would recommend. Yeah.
SPEAKER_01:Yeah, there's a lot of power behind language, and I agree with you. I think that'd be a nice changeup that could really just put it in proper perspective for both sides to have that conversation. So you talked about FDA reconsidering. Do they ever reconsider boxed warnings? I think that's what we've heard a little bit of news about. So I was gonna have you touch upon that because that's been a hot topic recently, uh, this past November with HRT.
SPEAKER_02:Yes, yes. So box warnings can actually be taken away. It's pretty rare that that happens. Um, in this uh study that I mentioned that reviewed again all the boxed warnings uh in the past decade. Uh nine warnings were removed during this period, which is not not too many because a lot of box warnings were issued during this period. I think about 400 maybe were issued. Um, and that counts multiple box warnings per per medication. So if a medication has six or seven box warnings, that counts in that in that in that number. Um sorry, currently sorry, 400 medications currently have box warnings in this review. Um, and again, a medication could have could have multiple box warnings. So, yes, they can be removed as well. And in this, in this review. View nine removed. Most notably, hormone replacement therapy recently had a box warning removed. There was a box warning for blood clots, increased risks of blood clots, and that was removed. And then another famous case was a chantix or virincycline for smoking, smoking cessation. That uh classically or very well known to people had a box warning for suicidal ideation, suicidal tendency. And that box warning was removed as well by the FDA. And these have all been done because obviously studies have come out, which has given us evidence to the contrary. And the FDA thought it was compelling enough to remove. Of course, some of this is political, you know, who lobbies, who's persistent, right? But there's got to be studies that back this up. Otherwise, why are they doing this? And there's been studies that have come out about that. So even if the medication has a box warning, uh, physicians, doctors, Shannon, you and I, you know, our colleagues, uh, you know, this is what we do in our spare time. Uh, of course, we like to play golf and go to the beach and go to dinner with our friends, but this is what we do in our spare time. We look at medications, we look at what the data says so we can have a good conversation with our patients and reassure them. This is a real signal. This is not, you should worry about this, but don't worry about this.
SPEAKER_01:So if you have a patient that you're thinking about prescribing a medication that has a box warning on there and they're already coming to you sort of freaked out about the concept, how do you approach that conversation? You know, where you talk about like real world risk versus like, you know, what's regulatory sort of like caution, if you will. Like, how do you balance that conversation out?
SPEAKER_02:Yeah, this is hard. This is, you know, there's the science of medicine and then the art of medicine. Uh, this is where the art of medicine comes in. So if a medication has a box warning, um, I usually just tell the every patient that walks in, whether they're young or old, sick or healthy, I and I'm I'm giving them medication. I say you may see a box warning. Um, it likely won't apply to you. Uh, this warning came from an older population with other health issues. If that's obviously the case with the patient, which it usually is, because I'm usually seeing a younger population with atopic dermatitis, uh, for example. And then I tell them, based on my experience and based on the studies that are out there, here's what you actually might see. Here's the side effects that you're gonna notice. So that does two things. It kind of brings the idea up to them, it lets them know what they might expect, because the last thing you want or your staff wants is that the patient goes home, the pharmacist tells them about this, they see it in the packaging search, they hear about it online, hear about it from the friends, and they call you a little bit angry, extra phone call, extra conversation. Um, that's how I do it. Um, people might do it differently. Uh, but and of course, I don't think I do it every single time, but I try to do it most of the time, of course, in the appropriate clinical context with the patient that I'm dealing with.
SPEAKER_01:No, I would agree with you. And I I tell them because a lot of them, you know, will talk about the box warning. I tell them, well, it's only called this because I tell them they actually draw a box around it. But I said it's really just additional information for you to be aware of. And, you know, I said, you know, I'm not concerned based on who you are as a patient, your demographic, and where you're from. So I do put in context, say, hey, this is about you as a patient. This is how, you know, maybe the box warning came to be, depending upon the medication and what we're talking about. So just giving that little bit of context, I think, is helpful. And I also agree too that art of medicine, they're gonna be as concerned as you are as well. And you know, and some of those folks you need to have an additional conversation about, or they want a little bit deeper dive into why that came to be. But I think for the most part, patients do trust our opinion if we think it's the right medication for them and always understanding life, you know, there's no guarantees, right? There's risk with anything that we do. And then I think also getting them that context, like understanding, well, you know, you you take a baby aspirin every day, technically aspirin or that class of NSAIDs, those non-steroidal anti-inflammatory drugs, they also carry, you know, a box warning. So there are uncommon things that you tend to take every day, but you wouldn't even think twice about. You know, this is highlighted a little bit differently because it just gets a little bit of attention. And I think we just have to make it, you know, where patients understand it's a risk benefit and we're making recommendations that we often think are in their best interest. But obviously, we can't obviously give the guarantee, you know, that's going to be perfect. So I think that's great the way you put it in perspective for them. So I guess bottom line here before we kind of wrap up have you or will you ever take a medication with a box warning?
SPEAKER_02:If the box warning is increased muscle mass or less wrinkles or something like that, then I'll take that every day.
SPEAKER_01:Uh both talks, nobody cares about a box warning.
SPEAKER_02:Uh, you know, but yes, you know, I mean, thankfully I don't have to take any medications now. Uh hopefully, likely one day will, it happens as we age, I guess. Uh, you know, but but yes, you know, I I would if my doctor is confident about the treatment plan. And, you know, a lot of patients come to me, come to you, come to doctors, and they say, Well, you're the doctor. What do you think? What would you do? You know, they will they're they're coming to you for your expertise. Uh, so and you have to be confident enough and uh read read the studies, look up the data enough to say this is this is what I feel is the best treatment plan for you. And sometimes we're in a rock and a hard place. And I've seen this many times in my practice. I had had elderly patients who are smokers that have failed everything and that have terrible atopic dermatitis, terrible eczema, itching. And I say, well, we're between a rock and a hard place. This could increase some risks in you, but we we could we're gonna go with this and see what happens to you with informed consent. And then and they say, Well, let's do it. I say, stop smoking, uh, you know, if number one, and then we'll give this to you and we'll monitor you closely, but we're between a rock and a hard place. You're miserable, and we have to give you something. We we failed everything else. But I think informed consent's important. If somebody has a conversation with me and is confident about what they say, gives me informed consent, then sure, yes, I would certainly consider doing it.
SPEAKER_01:And that's what patients want to hear, right? I think that honesty that you just kind of convey that there are going to be times where you have to do a balance. It's a risk-benefit, you know, balance or talk that we have with patients because it is about treating them, getting them better, quality of life improvement. And sometimes, yes, we have medications that carry some risk. They could put it at a slight increased risk, but you can't always control that. And sometimes it's worth that risk for the potential benefit. So you're right, that's where the art of medicine comes in and where we can offer a great benefit for our patients. So, and I have to admit, yes, we already talked about I've done the ibuprofen, I let the residents practice botox to me all the time. So I I've definitely um been a part of some medications for the box morning, understanding what that carries and the risk, but but very comfortable knowing who I am and risk to me, that it's been totally worth it. And I think, you know, I got a little bit of wrinkling here, but if you watch it on video, you can see that you know the wrinkles are involved. People don't pay attention to box mornings. We always laugh about that.
SPEAKER_02:Right. That's totally true. Everything's about a risk-benefit in life, whether it's medicine or anything else you're doing. You got to weigh the risks and benefits, and that's uh good thing to talk to your doctor about, your provider about. And there's no question about that.
SPEAKER_01:Well, hopefully, I think now people aren't gonna look at box mornings in the same way. You know, maybe we can change the wording here. We're gonna get you on the committee to do that next so we can have information, uh, kind of calm down, maybe a little bit of the fear tactics that I feel like it's almost like a you know, a scare thing that has actually happened to our patients over time, and now people can approach this in a different way. And now also, too, I think people that are listening will be able to have that conversation, you know, a little bit more educated on the context surrounding the box warnings. Anything for conclusion, Nick, that you have to add?
SPEAKER_02:Yes, you know, box warnings, yes, they do serve an important role. I think they've got a little bit overboard. There's some unintended consequences now. Not everything is 100% evidence-based. Talk to your doctor, talk to your provider about it. And I'd love to be on the FDA, but why stop there? I mean, I'd love to be the president one day. I mean, I'd make I'd make I'd make taxes one dollar for everybody. I mean, how great would that be?
SPEAKER_01:So, okay, well, I'm voting for you, Nick.
SPEAKER_02:We got one, we got one vote at least. I need to I need many, many more, but at least we'll still we'll start there. But uh yeah, you know, great conversation. I'm really glad you wanted to talk about this topic for patients, uh, for other physicians, for even for dermatologists to hear a little bit about our perspective. So it's a good topic. I hope it gets discussed more and something I enjoy researching and talking about. You'll probably hear from me on this topic uh in the future.
SPEAKER_01:Well, thanks for coming on the podcast. Brownstone for president, everyone. So kind of get out there, get the vote in. He's a great writing candidate of our upcoming election. And I want to thank you all for listening. Stay tuned for the next episode of Dermotrotter Don't Swear About Skin Care.
SPEAKER_00:Thanks for listening to Dermot Trotter. For more about skincare, visit dermittrotter.com. Don't forget to subscribe, leave a review, and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.
