Jascha Hoffman

Bernard Ackerman, 72, Dies; Expert at Skin Diagnosis

By JASCHA HOFFMAN

Bernard Ackerman, a founding figure in the field of dermatopathology who trained a generation of doctors to recognize skin diseases under the microscope, died Friday at his home in Manhattan. He was 72.

The cause was heart failure, said his nephew Andy Zwick, who was his collaborator.

Dr. Ackerman was also a forceful voice on a wide range of subjects, including the causes of melanoma and the ethical issues that arise when doctors testify in court.

In the 1960s he developed a diagnostic method that involved viewing skin tissue at low magnification until he saw a broad pattern, which he called a silhouette. Only later would he zoom in to the cellular level to refine the diagnosis.

Dr. Ackerman trained a generation of doctors to use his method on an 18-headed microscope, through which they could view slides from dozens of cases at a sitting.

He was a prolific researcher, the author of more than 700 papers and more than 60 books.

“He had his detractors and he had his sycophants, but everyone recognized that he was the force in his field,” said Dr. Geoffrey Gottlieb, managing director of the Ackerman Academy of Dermatopathology, which Dr. Ackerman founded in 1999.

He often argued for unpopular positions. Recently he expressed strong skepticism that exposure to sunlight causes melanoma, saying the case was not proved. He also lamented what he saw as a trend toward overtreatment of benign skin conditions.

“There has been a mania for taking off these moles that are of no consequence,” he told The New York Times in 2005. “We’re talking about billions and billions of dollars being spent, based on hype.”

As a resident at the University of Pennsylvania hospital, Dr. Ackerman was sent to work at Holmesburg prison, where inmates were paid to endure exposure to toxic chemicals. His experience there led to a lifelong preoccupation with medical ethics.

After serving as an expert witness in more than 200 trials, Dr. Ackerman had a personal brush with the law in 2000, when he reluctantly reached a $2.7 million settlement in a malpractice suit in a skin cancer death in which he said there had been fraudulent medical testimony. In 2003, he started a Web site to expose expert witnesses whom he saw as unreliable; it can now be found at truthfultestimony.org.

He founded two professional journals, The American Journal of Dermatopathology and Dermatopathology: Practical and Conceptual, as well as the medical publisher Ardor Scribendi. With his nephew Andy Zwick in 1999, he started Derm101.com, an online resource for the diagnosis and treatment of skin diseases.

Albert Bernard Ackerman was born on Nov. 22, 1936, in Elizabeth, N.J. He earned his undergraduate degree at Princeton and his medical degree at Columbia. His medical residency was interrupted by two years of service at Andrews Air Force Base outside Washington.

In 1969, Dr. Ackerman was hired at the University of Miami, and in 1973, he joined the faculty of New York University Medical School, where he ran the Skin and Cancer Institute. His laboratory there was one of the first to screen for early signs of Kaposi’s sarcoma, a fatal skin cancer now understood to have been closely linked to the AIDS epidemic.

In 1992, he moved to Philadelphia to teach at Jefferson Medical College. He returned to New York City in 1999 to found his own institute, the Ackerman Academy of Dermatopathology, one of the largest training centers for the diagnosis of skin diseases in the world; it is now part of Dermpath Diagnostics, which is owned by Quest Diagnostics.

Dr. Ackerman recently endowed a professorship for the study of culture and medicine at Harvard University. This year, he donated his collection of antique microscopes to Massachusetts General Hospital.

His survivors also include his brother, James, of Pittsboro, N.C., and his sister, Susan, of Summit, N.J.

Asked to describe himself in an interview with a medical journal, Dr. Ackerman used the terminology of the microscope. He said he was “dogmatic and unyielding at scanning magnification” but “reasonable and accommodating at high power” and “humane and empathic up close.”

Little escaped his keen diagnostic eye. One of the last papers he published bore the title, “An Inquiry Into the Nature of the Pigmented Lesion Above Franklin Delano Roosevelt’s Left Eyebrow.”

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8th Annual Year in Ideas: Scrupulosity Disorder
By JASCHA HOFFMAN

In a paper published in the August issue of The Journal of Anxiety Disorders, Chris Miller and Dawson Hedges of Brigham Young University estimate that as many as one million Americans may suffer from a moral-anxiety-cum-mental-illness known as “scrupulosity disorder.” They define it as obsessive doubt about moral behavior often resulting in compulsive religious observance — and they warn that it can lead to depression, apathy, isolation and even suicide.

As the believing man’s version of obsessive-compulsive disorder, the diagnosis raises questions about where, exactly, the line is to be drawn between probity and perversity. It isn’t obvious how to treat someone who can’t sleep for worrying about their rectitude — or a devout Christian who is seized by the urge to exclaim, Goddamn! and repeatedly reproaches himself for it. Rather than try to fight off obsessive worrying, therapists might ask patients to give in to it, so that they can see that their supposed transgressions might be harmless. “If you believe in a God that’s all-knowing, you should trust him to know these blasphemous thoughts are mental noise and not what’s in your heart,” says Jon Abramowitz, director of the Anxiety and Stress Disorders Clinic at the University of North Carolina at Chapel Hill.

The diagnosis might raise some difficult issues. Ritual hand washing could seem compulsive in an atheist, but surely it isn’t for a Muslim, for whom such behavior is ordinary religious observance. Are the anxieties and fears that may accompany a passionate religious life themselves pathological? Abramowitz, who has treated scrupulous Christians, Muslims and Jews, is confident that a therapeutic approach to obsessive spirituality does not threaten religion. He says that when patients are gradually released from crippling doubt about their own virtue, they can emerge with a new sense of faith.

8th Annual Year in Ideas: Carbon Penance

By JASCHA HOFFMAN

We all contribute to climate change, but none of us can individually be blamed for it. So we walk around with a free-floating sense of guilt that’s unlikely to be lifted by the purchase of wind-power credits or halogen bulbs. Annina Rüst, a Swiss-born artist-inventor, wanted to help relieve these anxietes by giving people a tangible reminder of their own energy use, as well as an outlet for the feelings of complicity, shame and powerlessness that surround the question of global warming.

So she built a translucent leg band that keeps track of your electricity consumption. When it detects, via a special power monitor, that electric current levels have exceeded a certain threshold, the wireless device slowly drives six stainless-steel thorns into the flesh of your leg. “It’s therapy for environmental guilt,” says Rüst, who modeled her “personal techno-garter” on the spiked bands worn as a means of self-mortification by a monk in Dan Brown’s novel “The Da Vinci Code.” (Brown derived the idea from the bands worn by some celibate members of the conservative Catholic group Opus Dei.)

Rüst built her prototype while working at the Computing Culture group of the Media Lab at the Massachusetts Institute of Technology. She also designed the band to punish wearers if they don’t spend enough time talking to their carbon-fixing houseplants. But first Rüst may have to address a more mundane matter. When the spikes dug in, Rüst says, she noticed that the device “doesn’t hurt that much.”