9 Nov 2018

Families support GP's controversial 'miraculous' eczema cream

From Checkpoint, 5:19 pm on 9 November 2018

A prominent GP in South Auckland is vowing to fight on after the High Court upheld a controversial tribunal decision sanctioning him for his treatment of eczema patients.

Joe Williams is not a dermatologist but has researched and treated eczema for decades and has published a book about it.

He said he treated thousands of desperate people who suffer from the skin condition and could not get any relief from specialists.

"When they come in, some of them are so bad, and some of them have been treated by, I'm sorry, dermatologists, and they are still quite bad," he said.

"And when they come to see us, their eczema clears."

That's due to his controversial treatment that has many of his supporters posting tributes online, but has the medical authorities worried.

So worried, they sanctioned him while an independent investigation was underway to see if his treatment was doing more harm than good.

Te Kou O Rehua Panapa said his son Isaiah had extreme eczema as a baby. He couldn't sleep and was constantly scratching himself.

"He had a lot of rawness under the creases of his body," he said.

"We spent a lot of time with specialists to try and find a cure for his skin. By the time he turned six months it was severe."

And after seeing six different doctors who couldn't give him anything to help, he couldn't believe the immediate relief his son had after one dose of a cream prescribed by Dr Williams.

The cream is a mix of a steroid and an antifungal cream, which he calls "betaclom".

He said he gave strict instructions on how to use it, but the Health Practitioners Disciplinary Tribunal ruled that he shouldn't have prescribed a potent steroid for use on children's faces.

The tribunal also ruled he didn't keep very good medical records.

That was back in 2017. He appealed the decision and then in September this year the High Court upheld it, saying Dr Williams at the very least should have listened to the colleagues who had written to him to warn him of his practice.

The punishment was a $10,000 fine, and on top of that, $145,000 in tribunal and court costs.

He also had to pay for a supervisor to keep an eye on him for three years and report back to the medical council.

But many eczema sufferers around the country say they are worried they won't be able to get what they describe as Dr Williams' "miraculous" cream.

Dr Joe Williams.

Dr Joe Williams. Photo: RNZ / Nick Munro

Lolina Avia used to live in Auckland but moved to Christchurch. When their house recently burnt down, they lost the last of the betaclom cream along with everything else.

Leila, Ms Avia's daughter, said on top of the itch and discomfort, she was also bullied.

"People like to make fun of me and stuff," she said.

"And they say 'Oh my God, it's the eczema girl'."

Ms Avia said it was taking a toll on her daughter, and she got little relief from the Locoid cream she used.

She said the products prescribed by other doctors just paled in comparison to the betaclom.

"You have one cream compared to all those bottles and tubes she has and Dr Williams' cream has been, what's the word, damn good," she said.

There's universal agreeement that the cream works - because of the steroid.

There's also agreement that potent steroids are dangerous. The experts say it can lead to thinning of the skin and to suppression of the adrenal glands, among other side effects.

When Dr Williams mixed the steroid cream and the antifungal cream, he said it diluted the strength of the steroid. However, the tribunal heard expert medical evidence that although the amount of steroid was halved, it's potency could actually have increased.

But doctors who disagree with that point of view are now speaking up.

Richard Aron, an eczema specialist from Cape Town in South Africa, said he could not understand it.

"It makes no sense to me, I can't stand that all," he said.

"Because to suggest that if you put 300g of potent steroid on the skin in effect you are creating the effect of 600g... I can't see that."

Te Kou o Rehua Panapa using the "betaclom" cream - a mix of a steroid and an antifungal cream to treat his son's eczema.

Te Kou o Rehua Panapa using the "betaclom" cream - a mix of a steroid and an antifungal cream to treat his son's eczema. Photo: RNZ / Nick Munro

Dr Aron said his own success, which had also garnered interest and a dedicated online following, prompted professional jealousy from other doctors.

"If what Joe Williams is doing and what I am doing is correct, or are successful treatment approaches, it puts in the shadows the conventional treatment that these practitioners are doing," he said.

"Because it's saying what they are doing is not effective as it might be, and basically it becomes an ego-threat. I think most doctors will have a measure of egocentricity and if someone else tells us that what we are doing is wrong, it's discomforting to say the least."

But the lawyer representing the independent investigators of Dr Williams, Anita Miller, said nothing could be further from the truth.

"I completely reject that suggestion," she said.

"The dermatologists who raised these concerns work in the public sector. This is not a case of professional competition."

Ms Miller said there was no doubt the cream was effective, but said it was due to the high risk of harm that doctors were simply not supposed to contravene the guidelines when using steroids.

"Dr Williams' prescribing of this potent steroid, the combination, was reminiscent of the uncontrolled prescribing of potent steroids of the 1960s and 1970s," she said.

Dr Williams still sees many patients who continue to line up at his Mt Wellington practice. But he now has to mix a less potent cream for children under the age of 12.

Te Kou o Rehua Panapa said his online petition had almost 7500 signatures and once it does, he would take it to parliament.

"He's a hero to a lot of families," he said.

"So for us to hear that he has been charged and has been fined such a hefty fine, it's gut-wrenching and we are quite upset about it, hence the reason why I'm so passionate about getting his name cleared."

Dr Williams said people with eczema have been neglected and misunderstood, and doctors worldwide need to do more to treat it.

"I'd do it all over again," he said.

"I will keep doing this for people. My judge are the people that I treat."