THE ANALYSIS of the views of over 17 000 patients with psoriasis is a staggering task. Krueger et al,1 as reported in this issue of the ARCHIVES, received a 44% return from all of the members of the National Psoriasis Foundation, who were surveyed to assess the realities of living with psoriasis and having it treated. This study provides very powerful information about a disease of central importance to all dermatologists. There are important messages for us about our attitudes as practicing dermatologists, as 32% of the patients with severe psoriasis surveyed said that treatment was not aggressive enough. Our caution in embarking on systemic therapy, with all its attendant risks and requirements for patient explanation, monitoring, and expense, is understandable. The results of the survey, however, raise a nagging and often unvoiced concern. Is it easier for us to play down the benefits and play up the risks of systemic therapy to avoid the added worry that this course of action would place on our practice? Are we denying our patients effective therapy through our unaggressive treatment attitudes?