The JCMS Dermatology Podcast with Dr Kirk Barber

"We used to think that cutis marmorata was an unserious bend. What we understand now is that it is often connected to very serious incidents of decompression sickness.”In this special Editor’s Choice edition of the JCMS Podcast, Dr. Kirk Barber ventures beneath the surface with renowned Canadian cave diver and underwater explorer Jill Heinerth.Jill takes us inside the spectacular and unforgiving world of cave diving, where meticulous preparation and strict safety protocols can mean the difference between life and death. She and Kirk explore the parallels between technical diving and medicine, including how the checklist discipline used by divers has helped improve safety in operating rooms.The conversation also examines the effects of diving on the skin. Jill explains how decompression sickness can present as cutis marmorata, or “skin bends”—a mottled, bruise-like rash that may appear alongside serious neurological symptoms. She discusses why symptoms can develop gradually after a dive, how an apparently routine recreational dive can result in decompression illness, and why physicians should ask patients with unusual rashes about recent diving and air travel.They also discuss wetsuits, dry suits, latex reactions, cold-water exposure, infection risks and the significant amount of ultraviolet exposure experienced by divers and others who spend their lives on and around the water.About Jill HeinerthJill Heinerth is one of the world’s most accomplished cave divers and underwater explorers. Over a career spanning more than three decades and thousands of dives, she has explored submerged caves, flooded mines and polar waters around the world. She was the first person to dive inside Antarctic iceberg caves and was part of the team that created the first three-dimensional map of an underwater cave system.Jill is the Royal Canadian Geographical Society’s first Explorer-in-Residence and an Honorary Vice-President of the Society. She is a recipient of Canada’s Polar Medal, the Sir Christopher Ondaatje Medal for Exploration and the Explorers Club’s William Beebe Award, and has been inducted into the International Scuba Diving Hall of Fame. She is also an author, photographer, filmmaker and climate advocate. Her most recent documentary is Diving into the Darkness, looking back at her remarkable career. Her books include the memoir Into the Planet: My Life as a Cave Diver and the children’s book Chester the Manatee and the Very, Very, Terribly Bad Itch.Many thanks to Sun Pharma Canada for their support of the 2026 JCMS Editor's Choice season.Dr. Barber and his guests receive no financial reimbursement for the production of this podcast.For more great CDA podcasts, check out Dermalogues, our residents podcast hosted by Dr. Kerri Purdy.To learn more about the work of the Canadian Dermatology Association, visit dermatology.ca.The JCMS Dermatology Podcast is produced by David McGuffin and Graham McGuffin of ExploreProductions.caMusic by Lee Rosevere.

“Three months after taking these tablets, she was 80 per cent better—without the risk, expense and everything that went with those procedures.”“It is life-changing for a lot of patients, and it has been a real practice changer for me.”What if one of the most effective treatments for melasma isn’t a topical cream or laser—but a low-dose oral medication?In this episode of JCMS Author Interviews, Dr. Kirk Barber speaks with Vancouver dermatologists Dr. Vincent Richer and Dr. Allison Sutton about their article, “Low-Dose Oral Tranexamic Acid as a Standard Treatment for Melasma: Are We There Yet?”, published in the May/June issue of the Journal of Cutaneous Medicine and Surgery.Dr. Richer and Dr. Sutton explain why oral tranexamic acid has become a practice-changing treatment for many of their patients. They discuss its effectiveness compared with topical treatments and laser procedures, including cases in which patients have experienced dramatic improvements after only a few months.The conversation also addresses the questions surrounding longer-term use. Because melasma is a chronic condition that frequently returns when treatment stops, should oral tranexamic acid be continued beyond the three-to-six-month period typically studied in clinical trials?Drs. Richer, Sutton and Barber examine dosage, patient screening and the risk of thrombosis, as well as considerations involving oral contraceptives, hormone replacement therapy, pregnancy and sun exposure. They also explore the continuing role of sunscreen, hydroquinone, botanical brighteners and laser therapy in a comprehensive treatment plan.A practical and potentially practice-changing discussion about treating melasma safely, effectively and for the long term.Dr. Vincent Richer is a clinical faculty member in the Department of Dermatology and Skin Science at the University of British Columbia. He practises at Pacific Derm in Vancouver, with a focus on medical and cosmetic dermatology, laser surgery and pigment disorders.Dr. Allison Sutton is a clinical faculty member in the Department of Dermatology and Skin Science at the University of British Columbia and the founder of West Dermatology in Vancouver. Her practice focuses on cosmetic and aesthetic dermatology.Dr. Barber and his guests do not receive any financial reimbursement for the production of this podcast.For more great CDA podcasts check out Dermalogues, our Residents podcast hosted by Dr Kerri Purdy. New episodes are coming out in October 2026.To learn more about the work of the Canadian Dermatology Association, please visit our website at dermatology.caThis podcast is produced by David McGuffin and Graham McGuffin of ExploreProductions.ca

“With artificial cognition, we have the ability to outsource the entire thinking or reasoning process itself. And that’s what we call cognitive surrender: the adoption of AI outputs without verification, without much internal engagement at all.”What happens to clinical judgment when physicians begin relying on artificial intelligence—and what happens when that technology is taken away?In this special Editor’s Choice episode of JCMS Author Interviews, Dr. Kirk Barber speaks with Canadian academic Steven Shaw, assistant professor of marketing at King’s Business School, King’s College London, and formerly of the Wharton School at the University of Pennsylvania.Shaw introduces the concept of “cognitive surrender”: accepting AI-generated conclusions without independently reasoning through or verifying them. They examine what this could mean in medicine, where incorrect or unchallenged answers can have serious consequences.Their conversation explores emerging evidence of deskilling among experienced clinicians who use AI-assisted diagnostic tools, as well as the risk of “never-skilling” when medical trainees outsource parts of the learning process before developing their own expertise.They also consider how AI is changing the doctor–patient relationship. Can AI scribes create more time for meaningful conversation—or does being recorded inhibit trust and disclosure? What happens when patients arrive with their own AI-generated diagnoses? And when a physician’s judgment differs from an AI recommendation, which one is more likely to be trusted?A timely discussion about AI, medical education and how clinicians can benefit from new technologies without surrendering the critical judgment on which good medicine depends.This episode is supported by an educational grant from Sun Pharma Canada through the CDA Corporate Supporter Program.Dr. Barber and his guests do not receive any financial reimbursement for the production of this podcast.For more great CDA podcasts check out Dermalogues, our Residents podcast hosted by Dr Kerri Purdy. New episodes are coming out in October 2026.To learn more about the work of the Canadian Dermatology Association, please visit our website at dermatology.caThis podcast is produced by David McGuffin and Graham McGuffin of ExploreProductions.ca

“There’s probably a whole field that’s been affected by the sun and the resulting DNA damage.”An actinic keratosis may appear to be an isolated lesion—but it can also signal a much larger field of sun-damaged, precancerous skin.Dr. Kirk Barber speaks with Dr. Steven Feldman about field cancerization and how its size should influence the treatment of actinic keratoses.They discuss the difference between treating individual lesions and an entire field, the role of topical therapies, and whether approved treatment limits reflect the much larger areas of precancerous change dermatologists encounter in clinical practice. They also consider how clinicians balance cancer prevention against treatment discomfort, patient age, overall health and the relatively low risk of an individual actinic keratosis progressing to skin cancer.Their wide-ranging conversation explores the difficulty of clinically defining a field, the cumulative effects of sun damage, the potential cosmetic benefits of field therapy and the need for a more nuanced approach to sun protection.The conversation is based on the JCMS article “The Characterization of the Relationship Between Field Cancerization and the Number of Actinic Keratoses.”Dr. Steven Feldman is a professor of dermatology, pathology, social sciences and health policy at Wake Forest University School of Medicine in North Carolina. He also leads the Center for Dermatology Research.For more on the treatment of actinic keratoses, listen to Episode 82 of JCMS Author Interviews, featuring Dr. Christopher Chew and an Australian perspective on managing the condition.Dr. Barber and his guest do not receive any financial reimbursement for the production of this podcast.For more great CDA podcasts, check out Dermalogues, our residents podcast hosted by Dr. Kerri Purdy.To learn more about the work of the Canadian Dermatology Association, please visit our website at dermatology.caThis podcast is produced by David McGuffin and Graham McGuffin of ExploreProductions.ca

Reports of ticks are surging across Canada as blacklegged ticks expand into regions once too cold or dry to support established populations. What is driving their spread—and what does it mean for the risk of Lyme disease and other tick-borne illnesses?In this special Editor’s Choice episode, Dr. Kirk Barber speaks with Dr. Katie Clow, one of Canada’s leading researchers in tick ecology and tick-borne disease. They discuss how climate change, migratory birds, wildlife and changing habitats are reshaping the country’s tick populations. Dr. Clow explains how ticks find and attach to their hosts, how the bacteria responsible for Lyme disease moves from a tick’s gut into its saliva, and why removing a tick promptly can reduce the risk of transmission.The conversation also examines striking regional differences in infection rates, the emergence of anaplasmosis and Rocky Mountain spotted fever, the challenges of controlling ticks in the environment, and the potentially alarming arrival of invasive species such as the Asian longhorned tick in North America.Dr. Clow is an associate professor at the University of Guelph’s Ontario Veterinary College, where her research explores the connections between human, animal and environmental health.This episode is supported by an educational grant from Sun Pharma Canada through the CDA Corporate Supporter Program.Dr. Barber and his guests do not receive any financial reimbursement for the production of this podcast.For more great CDA podcasts check out Dermalogues, our Residents podcast hosted by Dr Kerri Purdy.To learn more about the work of the Canadian Dermatology Association, please visit our website at dermatology.caThis podcast is produced by David McGuffin and Graham McGuffin of ExploreProductions.ca