#MDchat transcript Healthcare Social Media Transcript From: Tue Aug 30 18:00:00 PDT 2011 To: Tue Aug 30 19:00:00 PDT 2011 change time periodNew! Explore ana lytics f or this time period: #MDchat analytics Explore the world of healthcare social media: Healthcare Conferences - Healthcare Tweet Chats - All Healthcare Hashtags Learn more about #MDchat at The Healthcare Hashtag ProjectMD_chat Welcome everybody to the #MDchat show, st aring you . We'll begi n in a moment, but let's hear introductions. I'm @PhilBaumann Tue Aug 30 18:00:07 PDT 2011 RyanMadanickMD @MD_chat Evening e veryone, Ryan Madan ick, MD; GI Doc @UNC_Health_Care , #meded chat moderator #MDchat Tue Aug 30 18:03:39 PDT 2011 JediPD Hi there folks. #mdchat Tue Aug 30 18:04:51 PDT 2011 MD_chat "Alt ernative" Medicine: Medicine is medicin e, but how do you wo rk with patients seeking al ternatives t o tradition? #MDchat Tue Aug 30 18:05:04 PDT 2011 apjonas Hi folks, Pat Jonas, MD Holistic Family Physician OH #MDChat Tue Aug 30 18:05:44 PDT 2011 RyanMadanickMD @JediPD good evening #mdchat Tue Aug 30 18:05:47 PDT 2011 AfternoonNapper @MD_chat ePatient sitt ing i n! #MDchat #MDChat Tue Aug 30 18:06:02 PDT 2011
From: Tue Aug 30 18:00:00 PDT 2011To: Tue Aug 30 19:00:00 PDT 2011
change time period
New! Explore ana lytics for this time period: #MDchat analytics
Explore the world of healthcare social media: Healthcare Conferences - Healthcare Tweet Chats - All HealthcareHashtags
Learn more about #MDchat at The Healthcare Hashtag Project
MD_chat Welcome everybody to the #MDchat show, staring you. We'll begin in a moment, butlet's hear introductions. I'm @PhilBaumannTue Aug 30 18:00:07 PDT 2011
RyanMadanickMD @MD_chat Evening everyone, Ryan Madanick, MD; GI Doc @UNC_Health_Care ,#meded chat moderator #MDchatTue Aug 30 18:03:39 PDT 2011
JediPD Hi there folks. #mdchatTue Aug 30 18:04:51 PDT 2011
MD_chat "Alternative" Medicine: Medicine is medicine, but how do you work with patientsseeking al ternatives to tradition? #MDchatTue Aug 30 18:05:04 PDT 2011
apjonas Hi folks, Pat Jonas, MD Holistic Family Physician OH #MDChatTue Aug 30 18:05:44 PDT 2011
RyanMadanickMD @JediPD good evening #mdchatTue Aug 30 18:05:47 PDT 2011
RyanMadanickMD @MD_chat I guess this is T1? #MDchatTue Aug 30 18:06:04 PDT 2011
EllenRichter Hi folks! I always enjoy reading this group's chat! Ellen, a critical care RN & legalconsultant in Florida, playing with Spotify :) #MDchatTue Aug 30 18:06:17 PDT 2011
NateOsit Hi all, Nate here- your friendly Health IT geek! Hoping we're done w/ naturaldisasters for the week up here in the Northeast! #MDchatTue Aug 30 18:06:29 PDT 2011
RyanMadanickMD @AfternoonNapper #MDchat #MDChatTue Aug 30 18:06:35 PDT 2011
JediPD Hi Ryan. Mr Dictionary! And Strategist. #mdchatTue Aug 30 18:07:08 PDT 2011
RyanMadanickMD @AfternoonNapper welcome to the fun #mdchatTue Aug 30 18:07:39 PDT 2011
ElinSilveous Hi everyone. Elin here. Looking forward to #MDChatTue Aug 30 18:07:41 PDT 2011
MD_chat @afternoonnapper @ryanmadanickmd @ellenrichter Good evening! #MDchatTue Aug 30 18:07:45 PDT 2011
MD_chat @apjonas Good evening! #MDchatTue Aug 30 18:08:01 PDT 2011
apjonas T1 I first clarify boundaries of natural, medical, alternative and complementarypractices to set stage. #MDChatTue Aug 30 18:08:12 PDT 2011
rachelcogar Hello - Rachel Cogar, Dir of Mktg for large urology group in Charlotte, NC #MDchatTue Aug 30 18:08:26 PDT 2011
talkabouthealth Hi, Murray from TalkAboutHealth. Will be mostly browsing:) #mdchatTue Aug 30 18:08:31 PDT 2011
MD_chat Here's tonight's topic in case you missed it http://ow.ly/6haMT #MDchatTue Aug 30 18:08:40 PDT 2011
RyanMadanickMD @EllenRichter Hey there Ellen; maybe we can tag-team a topic for #rnchat and#meded chat this week? #mdchatTue Aug 30 18:08:42 PDT 2011
apjonas @MD_chat I'm trained in 7-8 moda lities beyond traditional , so I teach pt thedifference and the financial differences w/insurance #MDChatTue Aug 30 18:09:56 PDT 2011
EllenRichter @RyanMadanickMD Sure, I'd be up for that! :) Lets talk after? #MDchatTue Aug 30 18:09:59 PDT 2011
Yeakley Hey from Charlotte NC. First time listening in and looking forward to the chat.#mdchatTue Aug 30 18:10:01 PDT 2011
RyanMadanickMD @EllenRichter sure, I'll be here #MDchatTue Aug 30 18:10:13 PDT 2011
RyanMadanickMD T1 It's important for my patients to understand what my expertise is in; I do notdiscount non-allopathic tx... (1/x) #mdchatTue Aug 30 18:10:43 PDT 2011
JediPD Problem with alternate drug therapies in cancer is the interactions withchemotherapy and radiation. #mdchatTue Aug 30 18:12:28 PDT 2011
talkabouthealth T1 Love this topic. I am struggling to define boundaries for TalkAboutHealth. Who arethe experts and do they have reqd credentials. #mdchatTue Aug 30 18:12:32 PDT 2011
RyanMadanickMD T1 ...when patients ask my opinion about other therapies, glad to provide; but toprescribe or recommend? out of my field (2/x) #mdchatTue Aug 30 18:12:51 PDT 2011
TaborF Hi everybody. I'm a #meded chatter who is new to mdchat #mdchatTue Aug 30 18:13:36 PDT 2011
apjonas T1 Definitions matter a lot. There are alternative practices, but no alternative"medicine". Pts don't understand $ boundaries #MDChatTue Aug 30 18:13:45 PDT 2011
RyanMadanickMD T1 My recent blog post about this: "Doc, can I use this natural supplement?"http://t.co/0lz4Ga8 (3/3) #mdchatTue Aug 30 18:14:18 PDT 2011
AfternoonNapper Devil's advocate question: weren't alternative medicines just medicine? Why are they
now defined as alternatives? #MDChatTue Aug 30 18:14:38 PDT 2011
RyanMadanickMD @TaborF Hi Tabor, good to see you here! #mdchatTue Aug 30 18:15:09 PDT 2011
MD_chat @yeakley @TaborF Welcome. Feel free to watch or join in. Friendly, smart grouphere! #MDchatTue Aug 30 18:15:28 PDT 2011
JediPD Natural Supplements and Coumadin is one of the big bugaboos. that is worrisome@RyanMadanickMD #mdchatTue Aug 30 18:15:34 PDT 2011
AbnormalFacies T1: I don't always wait for patients to ask; if I'm concerned alternative therapy may behurting, I offer unsolicited advice #MDChat (1/2)Tue Aug 30 18:15:52 PDT 2011
ElinSilveous Are w/discussion alternative medicine, complementary medicine, integrative
medicine, CAM, or all of it? TY. #MDChatTue Aug 30 18:15:57 PDT 2011
talkabouthealth T1 See trend of complementary medicine toward health lifestyle, acupuncture, etc.Alternative medicine difficult regarding evidence. #mdchatTue Aug 30 18:16:07 PDT 2011
TaborF @RyanMadanickMD Thanks! #mdchatTue Aug 30 18:16:13 PDT 2011
apjonas T1 I treat lots of holistic believers of various beliefs massage and energy therapists,herbalists, chiropractors, pastors, accupunc #MDChatTue Aug 30 18:16:20 PDT 2011
RyanMadanickMD @AfternoonNapper We don't really say "alternative medicine". more like "alternativetherapies" #mdchatTue Aug 30 18:16:20 PDT 2011
ManonC1sports Hi to all, We need to be open to supplements or else patients will not tell us and usethem anyway #mdchatTue Aug 30 18:16:33 PDT 2011
AbnormalFacies T1: And when they do ask, I simply tell them what I would do . Also, 9 times out of 10,"there is no research to support this" #MDChat (2/2)Tue Aug 30 18:16:42 PDT 2011
RyanMadanickMD @JediPD yes, def agree with that #mdchatTue Aug 30 18:16:49 PDT 2011
RyanMadanickMD V True>> RT @ManonC1sports : Hi to all, We need to be open to supplements orelse patients will not tell us and use them anyway #mdchatTue Aug 30 18:17:00 PDT 2011
drseisenberg Our cancer patients bring in bags and bags of supps. Gotta sort through 'em.#mdchatTue Aug 30 18:17:35 PDT 2011
TaborF As long as supplements don't have dangerous side effects/interactions, I am veryopen to patients using them. #mdchatTue Aug 30 18:17:40 PDT 2011
RyanMadanickMD @AbnormalFacies What u will prob learn is pts don't always want 2 hear about rsrch2 support it...the rsrch is friend, internet, etc #mdchat
DrAttai Important to let pts know that you want to know what they are taking and you're opento discussion #mdchatTue Aug 30 18:18:13 PDT 2011
JediPD There's a fairly large industry that deals with cancer outside of evidence basedmedicine. Case in point Steve McQueen and Lae trile! #mdchat
Tue Aug 30 18:18:25 PDT 2011
TaborF The difficulty is finding reliable information about efficacy or side effects. #mdchatTue Aug 30 18:18:26 PDT 2011
apjonas T1 Many physicians invent response to pt questions out of disrespect and ignoranceof evidence, sometimes even pathetic lies #MDChatTue Aug 30 18:18:38 PDT 2011
AfternoonNapper Is there a central list of common supplements/alternative therapies and issues theypresent re: traditional medicine? #MDChatTue Aug 30 18:19:07 PDT 2011
RyanMadanickMD Usually have to search onl ine for these RT @TaborF : The difficulty is finding reliableinformation about efficacy or side effects. #mdchatTue Aug 30 18:19:15 PDT 2011
drseisenberg Integrative oncology is significant movement in the cancer realm. Must be evidence-based. #mdchatTue Aug 30 18:19:27 PDT 2011
RyanMadanickMD "Integrative" better term RT @drseisenberg : Integrative oncology is significantmovement in the cancer realm. Must be evidence-based #mdchatTue Aug 30 18:19:57 PDT 2011
ManonC1sports Only some supplements have decent studies and I do tell patients, them that I won'tencourage what I don't think will help #mdchatTue Aug 30 18:19:59 PDT 2011
ElinSilveous Here's an NIH resource that might be help ful: National Center for Complementaryand Alternative Medicine [NCCAM] http://ow.ly/6hb9l #MDChatTue Aug 30 18:19:59 PDT 2011
apjonas T1 The NCCAM of gov has over 400 therapies listed and defined. GermanCommission E great science on herbs effects & side effects #MDChatTue Aug 30 18:20:46 PDT 2011
TaborF It's important to listen to what patients are doing and not feel threatened or defensiveif taking something I didn't prescribe. #mdchatTue Aug 30 18:21:04 PDT 2011
JediPD I think since most medicine is based on plants, there are some legit human e ffects(eg. digitalis) but we need facts on MTD etc. #mdchat
ElinSilveous Ouch RT @apjonas : T1 Many physicians invent response to pt questions out ofdisrespect and ignorance of evidence, sometimes... #MDChatTue Aug 30 18:21:16 PDT 2011
talkabouthealth I worry about term "natural" being used to sell supplements/alternatives. Veryattractive to patients. Need to educate them on mkg. #mdchatTue Aug 30 18:21:28 PDT 2011
DrAttai Here's another site from MD Anderson: http://t.co/4Bq3HHj #mdchatTue Aug 30 18:21:28 PDT 2011
ManonC1sports I am sure there are products that can work but that tradional medicine is unaware ofat this time ,research HAS to continue #mdchatTue Aug 30 18:21:36 PDT 2011
TaborF A lot of alternative therapies probably work by placebo effect (just like a lot of"traditional" therapies) #mdchatTue Aug 30 18:22:21 PDT 2011
RyanMadanickMD T1 my biggest concerns with CAM: 1) pts think always safe; 2) think "natural"=better;3) exchanging more beneficial 4 less benef tx #mdchatTue Aug 30 18:22:25 PDT 2011
apjonas T1 Physicians need to be better at admitting lack of knowledge and making ptunderstand disease care insurance they have. #MDChatTue Aug 30 18:22:25 PDT 2011
JediPD There is for instance a lot of talk about Acai berries and good health. Where is theevidence? #mdchatTue Aug 30 18:22:32 PDT 2011
DrAttai And one more site from MSKCC: http://t.co/3es8asp #mdchatTue Aug 30 18:22:55 PDT 2011
RyanMadanickMD T1 Opium is natural...safe? #mdchatTue Aug 30 18:23:09 PDT 2011
ManonC1sports Yes up to 30 % effect or more RT @TaborF : A lot of alternative therapies probablywork by placebo effect #mdchatTue Aug 30 18:23:18 PDT 2011
drseisenberg SIO = Society of Integrative Oncology http://t.co/vNUp73V #mdchatTue Aug 30 18:23:36 PDT 2011
DrAttai @RyanMadanickMD @talkabouthealth Agree - "natural" implies safe and often that'snot the case #mdchatTue Aug 30 18:23:36 PDT 2011
apjonas T1 Manure is natural bu t unsafe. #MDChatTue Aug 30 18:23:40 PDT 2011
talkabouthealth MT @RyanMadanickMD big concerns w CAM 1)pts think always safe 2)think"natural"=better 3)exchanging more beneficial 4 less benef tx #mdchatTue Aug 30 18:23:48 PDT 2011
implies safe and often that's not the case #mdchatTue Aug 30 18:23:49 PDT 2011
Yeakley Thanks RT Elin Silveous NIH resource: National Center for Complementary andAlternative Medicine [NCCAM] http://t.co/n27Ks4N #MDChatTue Aug 30 18:23:58 PDT 2011
JediPD On the other side(just to be balanced) studies are promoted by industries topropagate a product. Oh the web we weave! #mdchatTue Aug 30 18:24:05 PDT 2011
FDALawyers MT @RyanMadanickMD : biggest con w CAM: 1) pts thk always safe; 2) thinknatural=better; 3)exchanging more beneficial 4 less benef tx #mdchatTue Aug 30 18:24:10 PDT 2011
FDALawyers @RyanMadanickMD Using German Commission E monographs for natural meds isa good start #mdchatTue Aug 30 18:24:34 PDT 2011
RyanMadanickMD LOL RT @apjonas : T1 Manure is natural but unsafe. #mdchatTue Aug 30 18:24:56 PDT 2011
ElinSilveous Great reason for patients/consumers to question benefits, risks & costs of options! RT@apjonas : T1 Manure is natural but unsafe. #MDChatTue Aug 30 18:25:08 PDT 2011
FDALawyers @RyanMadanickMD Except to plants #mdchatTue Aug 30 18:25:21 PDT 2011
rachelcogar You DO have a point ;-) RT @apjonas T1 Manure is natural but unsafe. #MDChatTue Aug 30 18:25:38 PDT 2011
RyanMadanickMD T1 Herbal Remedies' Potential Dangers by @sanjayguptacnn http://t.co/5tZOiDm via@TIME #mdchatTue Aug 30 18:25:42 PDT 2011
drseisenberg Monroe E. Wall and Mansukh C. Wani isolated "chemo" from the bark of the Pacificyew tree, Taxus brevifolia and named it taxol. #mdchatTue Aug 30 18:25:51 PDT 2011
AfternoonNapper What is the best way to get pts to preempitively think about if theirsupplements/alternatives are safe? Posters/ads/other? #MDChat
FDALawyers @drseisenberg Yes, but taxol is not safe if used incorrectly #mdchatTue Aug 30 18:26:28 PDT 2011
TaborF Often, what people really want is someone to talk to. Acupuncturist may have moretime for you than MD, so helps you feel be tter. #mdchatTue Aug 30 18:26:34 PDT 2011
RyanMadanickMD @talkabouthealth @JediPD yes that is often the case...but at least they try to doresearch #mdchatTue Aug 30 18:26:41 PDT 2011
RyanMadanickMD @TaborF This is why it is so important to talk to patients! #mdchatTue Aug 30 18:26:57 PDT 2011
FDALawyers @drseisenberg Taxol risk benefit weighs in favor. But isnt even "safe" if usedcorrectly #mdchatTue Aug 30 18:26:58 PDT 2011
RyanMadanickMD @FDALawyers thank you #mdchatTue Aug 30 18:27:08 PDT 2011
FDALawyers @TaborF So talk to your nurses and pharamcists. We want to talk to patients(sometimes) #mdchatTue Aug 30 18:27:27 PDT 2011
apjonas T1 internet eliminates docs claim of not knowing side effects of herbs, NCCAM hasgood lists of 5 types of CAP side effects #MDChat
Tue Aug 30 18:27:30 PDT 2011
ManonC1sports Note the Web sites like Epocrates has a natural med dictionnary and you can checkinteractions of meds #mdchatTue Aug 30 18:27:40 PDT 2011
RyanMadanickMD @AfternoonNapper I recommend always discussing w/doc who knows u best(usually PCP) #mdchatTue Aug 30 18:27:44 PDT 2011
drseisenbergTalk 2 them openly MT @AfternoonNapper : What is best way to get pts to think abt iftheir supplements are safe? Posters/ads/other? #mdchatTue Aug 30 18:27:45 PDT 2011
DrAttai @TaborF acupuncture practitioners are becoming more aware of chemo and other"western" drugs -I find many in my area quite educated #mdchatTue Aug 30 18:27:55 PDT 2011
JediPD Taxol has an MTD and known toxicity and is used selectively for cancer not for"health." @FDALawyers @drseisenberg #mdchatTue Aug 30 18:28:22 PDT 2011
FDALawyers @JediPD known toxicity =/= non toxic #mdchatTue Aug 30 18:29:02 PDT 2011
drseisenberg Authentically listening to patients provides the opening for them to authenticallylisten to us. Even about sups... #mdchatTue Aug 30 18:29:10 PDT 2011
ManonC1sports Integrative is a key word with medicine now I think we are all faced with all kinds oftherapies emerging #mdchatTue Aug 30 18:29:56 PDT 2011
FDALawyers @talkabouthealth Accept that some are safe. Others are questionable. #mdchatTue Aug 30 18:30:00 PDT 2011
JediPD Always ask patients list all OTC & natural medicines they take. Look for interactions.Some elderlies are walking pharmacies! #mdchatTue Aug 30 18:30:21 PDT 2011
NateOsit Good2know! RT @ManonC1sports : Note the Web sites like Epocrates has a naturalmed dictionnary and you can check interactions of meds #MDchatTue Aug 30 18:30:43 PDT 2011
ElinSilveous Ken Pelletier, MD at Stanford & UofA is also a credible source for evidence-basedCAM. #MDChatTue Aug 30 18:30:44 PDT 2011
TaborF @DrAttai True. I would rather work with other practitioners than think of ourselves inopposition. #mdchatTue Aug 30 18:30:58 PDT 2011
DrAttai @ManonC1sports We have to figure out which therapies work well together andwhich ones will clash #mdchatTue Aug 30 18:30:59 PDT 2011
drseisenberg Thoughts about probiotics? #mdchatTue Aug 30 18:31:05 PDT 2011
RyanMadanickMD @MDChat can you make a list of the resources for us? #mdchatTue Aug 30 18:31:27 PDT 2011
JediPD Dannon! RT “ @drseisenberg : Thoughts about probio tics? #mdchat ”Tue Aug 30 18:31:51 PDT 2011
RyanMadanickMD Basically same as above RT @drseisenberg : Thoughts about probiotics? #mdchatTue Aug 30 18:31:53 PDT 2011
talkabouthealth Could be added to trials? RT @DrAttai : @ManonC1sports We have to figure outwhich therapies work well together & which ones clash #mdchat
ManonC1sports We have to try our best to not work in isolation and maintain discussions betweenpeople giving these therapies and us md's #mdchatTue Aug 30 18:32:11 PDT 2011
RyanMadanickMD BUT our formulary has removed ALL probiotics from inpt hosp sec to poss fungemiaRT @drseisenberg : Thoughts about probiotics? #mdchatTue Aug 30 18:32:21 PDT 2011
ManonC1sports Agree RT @DrAttai : @ManonC1sports We have to figure out which therapies workwell together and which ones will clash #mdchatTue Aug 30 18:32:27 PDT 2011
drseisenberg True integration is about honest communication and collaboration between doctorsand integrative practitioners. #mdchatTue Aug 30 18:32:44 PDT 2011
FDALawyers @RyanMadanickMD Some ID docs love probiotics. #mdchatTue Aug 30 18:32:59 PDT 2011
RyanMadanickMD Most rsrch is lacking, though occasionally some studies are (+) RT @drseisenberg :Thoughts about probiotics? #mdchatTue Aug 30 18:33:03 PDT 2011
drseisenberg Hmmm MT @RyanMadanickMD : BUT our formulary has removed ALL probioticsfrom inpt hosp sec to poss fungemia #mdchatTue Aug 30 18:33:31 PDT 2011
JediPD The degree of difficulty rises exponentially wi th multiple drugs. ONLY One to oneinteraction is known. @ManonC1sports @drattai #mdchatTue Aug 30 18:33:48 PDT 2011
drseisenberg VSL#3 ??? #mdchatTue Aug 30 18:34:04 PDT 2011
apjonas T1 probiotics very effective for eczema in breast fed babies, etc, etc. #MDChatTue Aug 30 18:34:09 PDT 2011
RyanMadanickMD @drseisenberg Same as others VSL #3 #mdchatTue Aug 30 18:34:25 PDT 2011
ManonC1sports In France a prescription of antibiotics often goes hand in hand with probioticprescritions as my patients tell me #mdchatTue Aug 30 18:34:44 PDT 2011
RyanMadanickMD @drseisenberg for C diff prevention, there is systematic review I'll find for you#mdchatTue Aug 30 18:34:46 PDT 2011
drseisenberg Align??? #mdchatTue Aug 30 18:34:51 PDT 2011
ElinSilveous Alternative Medicine Resources for Specific Conditions, Dr. Kenneth R. Pelletier -The Best Alternative Medicine http://t.co/ft37hgH #MDChatTue Aug 30 18:35:12 PDT 2011
FDALawyers @RyanMadanickMD @JediPD @ManonC1sports @drattai You mean synergistic?Coz else, you can use e.g. lexicomp #mdchatTue Aug 30 18:35:27 PDT 2011
DrAttai @RyanMadanickMD @JediPD @ManonC1sports Yes, and many even "healthy" areon multiple meds / supplements, cancer pts even more so #mdchatTue Aug 30 18:35:30 PDT 2011
FDALawyers @ElinSilveous Or natural medicines #mdchatTue Aug 30 18:35:37 PDT 2011
JediPD That is being recommended here too by IDs. @ManonC1sports #mdchatTue Aug 30 18:35:41 PDT 2011
drseisenberg GI doc I know with gives out Align samples like "vitamin Al" #mdchatTue Aug 30 18:35:43 PDT 2011
AbnormalFacies @RyanMadanickMD Actually, funny you say that - my school gave us a "difficult"standardized patient who was anti-Western medicine #MDChatTue Aug 30 18:36:16 PDT 2011
apjonas T1 Medical practice is medical, including everything billable using ICD codes. Notbillable=not medical may be helpful dogma #MDChatTue Aug 30 18:36:29 PDT 2011
ElinSilveous @RyanMadanickMD I think Duke has a Center for Integrative Medicine... #MDChatTue Aug 30 18:37:10 PDT 2011
DrAttai @apjonas but discussion regarding supplements / interactions is billable , based ontime #mdchatTue Aug 30 18:37:21 PDT 2011
TaborF Always good to remember that western biomedical paradigm is not the onlyworldview out there, need to respect others too. #mdchatTue Aug 30 18:37:28 PDT 2011
JediPD it may be synergistic, antagonistic or catalytic. It may increase AUC or reverse@FDALawyers @ryanmadanickmd @manonc1sports @drattai #mdchatTue Aug 30 18:37:34 PDT 2011
ManonC1sports It is not yet main stream here RT @JediPD : That is being recommended here too byIDs. @ManonC1sports #mdchatTue Aug 30 18:37:35 PDT 2011
drseisenberg Lots of patients on "green drinks". Fruit and veggie pill s too. How about just REALveggies? #mdchatTue Aug 30 18:38:08 PDT 2011
RyanMadanickMD Meta-analysis of probiotics to prevent Abx-assoc diarrhea and tx C diffhttp://t.co/JhuMSB6 #mdchat cc @drseisenbergTue Aug 30 18:38:24 PDT 2011
apjonas @DrAttai vitamins and supplements are medical #MDChatTue Aug 30 18:38:26 PDT 2011
RyanMadanickMD @ElinSilveous yes I think you 're right #MDChatTue Aug 30 18:38:42 PDT 2011
EllenRichter @TaborF Great point :) #MDchatTue Aug 30 18:38:53 PDT 2011
DrAttai @TaborF many other medical systems have been around a lot longer than westernmedicine and for some diseases may be more effective #mdchatTue Aug 30 18:38:56 PDT 2011
talkabouthealth @drseisenberg Yes, so many different diets as well. #mdchatTue Aug 30 18:38:58 PDT 2011
talkabouthealth @drseisenberg Yes, so many different diets as well. #mdchatTue Aug 30 18:38:58 PDT 2011
JediPD Agree, but with the caveat of some "evidence" not grandma's recipes. @TaborF#mdchatTue Aug 30 18:39:04 PDT 2011
FDALawyers @JediPD Inc. AUC often associated with Cyp450 system. Thats often easy to lookup. Exact extent, difficult to tell. #mdchatTue Aug 30 18:39:06 PDT 2011
RyanMadanickMD @AbnormalFacies LOL, that's awesome, was it a OSCE? #MDChatTue Aug 30 18:39:11 PDT 2011
drseisenberg THX RT @RyanMadanickMD : Meta-analysis of probiotics to preven t Abx-assocdiarrhea and tx C diff http://t.co/Gp2HWx5 #mdchat #mdchatTue Aug 30 18:39:28 PDT 2011
DrAttai @apjonas yes I meant many herba ls, etc not commonly thought of as supplements,but agree #mdchatTue Aug 30 18:40:24 PDT 2011
RyanMadanickMD @drseisenberg sure #mdchatTue Aug 30 18:40:48 PDT 2011
AbnormalFacies @RyanMadanickMD No OSCE, just a typical session. Let's just say I know not topush, but I will still give my $.02 on CAM every time #MDChatTue Aug 30 18:40:52 PDT 2011
AfternoonNapper Patients also may turn to alternative when western medicine seems to be failing. Iknow I did. #MDChatTue Aug 30 18:40:54 PDT 2011
FDALawyers @talkabouthealth True, but no studies to show efficacy. Just safety. #mdchatTue Aug 30 18:40:54 PDT 2011
JediPD AUC = Area under the curve is for all meds that undergo elimination. P450 is aspecific mechanism for many drugs no t all @FDALawyers #mdchatTue Aug 30 18:41:30 PDT 2011
ElinSilveous Hopefully, #PCORI & comparative effectiveness research will yield info to helpproviders AND patients make more informed decisions. #MDChatTue Aug 30 18:41:32 PDT 2011
apjonas @DrAttai @apjonas Herbals are medical. All over the medical literature in FM. Weenjoy a vast array of therapies in western med #MDChatTue Aug 30 18:42:20 PDT 2011
EllenRichter Heating up #cancer ? Can it help? "The Annals of Extreme Surgery" NYTimeshttp://t.co/L5AQGLD #RNchat #MDchatTue Aug 30 18:42:32 PDT 2011
drseisenberg We can learn from each other; evidence-based is key MT @TaborF Western
biomedical is not only worldview there, need respect others #mdchatTue Aug 30 18:42:32 PDT 2011
ManonC1sports If we tell patient we can't help them they often need support and turn to alternativetherapy RT @AfternoonNapper : #mdchatTue Aug 30 18:42:41 PDT 2011
CelebrityDx @ElinSilveous NCCAM has a small budget is not up-to-date; nothing about folkremedies in recent news e.g. bit.ly/nYrfla #mdchatTue Aug 30 18:42:55 PDT 2011
DrAttai @apjonas I agree but many docs don't think the same way #mdchatTue Aug 30 18:43:08 PDT 2011
apjonas T1 Few pts seeing a western doc expect to pay for services but pay Reiki master andmassage therapist cash. #MDChatTue Aug 30 18:43:31 PDT 2011
JediPD Undergoing trials. Cumbersome but no magic bullet! @EllenRichter #mdchatTue Aug 30 18:43:40 PDT 2011
TheresaJahn @drseisenberg I agree, real fruit and veggies is the way to go .. the more colour onthe plate the better! #mdchatTue Aug 30 18:43:43 PDT 2011
RyanMadanickMD Many of us here are more open to alternatives RT @DrAttai : @apjonas I agree butmany docs dont think the same way #mdchatTue Aug 30 18:43:52 PDT 2011
RyanMadanickMD Paradox? RT @apjonas : T1 Few pts seeing a western doc expect to pay for servicesbut pay Reiki master and massage therapist cash. #mdchatTue Aug 30 18:44:10 PDT 2011
talkabouthealth Need to figure out how to pay for testing efficacy of supplements. Should governmenthave budget for this? @drseisenberg @TaborF #mdchatTue Aug 30 18:44:40 PDT 2011
ManonC1sports That's why I think we need to work hand in hand with people giving them thealternative tx,they do have more time to give support #mdchatTue Aug 30 18:44:43 PDT 2011
FDALawyers @RyanMadanickMD I think they think they already paid for the services (insurance)#mdchatTue Aug 30 18:44:45 PDT 2011
AILucero Lots of patients on "green drinks". Fruit and veggie pills too. How about just REALveggies? #mdchat via @drseisenbergTue Aug 30 18:44:47 PDT 2011
drseisenberg Color me healthy RT @TheresaJahn : I agree, real fruit and veggies is the way to go ..the more colour on the plate the better! #mdchatTue Aug 30 18:44:51 PDT 2011
apjonas T1 Few western docs have liability insurance for non-medical therapies so have tounderstand legal bundaries better. #MDChatTue Aug 30 18:45:01 PDT 2011
JediPD My concerns are more with interaction. If there is PROOFINESS of efficacy! There is alot of cancer to be treated and cured! #mdchatTue Aug 30 18:45:23 PDT 2011
DrAttai @apjonas yes! and we have problems collecting $10 copays sometimes! #mdchatTue Aug 30 18:45:32 PDT 2011
FDALawyers @apjonas Often depends on the definition of practice of medicine (varies from stateto state.) #mdchatTue Aug 30 18:45:37 PDT 2011
CelebrityDx @ElinSilveous NIH consumer health info is redundant, balkanized http://t.co/4461Zfq#mdchatTue Aug 30 18:45:48 PDT 2011
TaborF Hard to get funding for trials for things that can't be patented (like herbs). Makesevidence slow to gather. #mdchatTue Aug 30 18:46:27 PDT 2011
EllenRichter Good point! RT @apjonas T1 Few western docs have liability insurnce for non-medical Rxs so have to understand legal bundaries better #MDChatTue Aug 30 18:46:35 PDT 2011
Dermdoc T1 Isn't it OK to integrate alternatives to tradition with tradition. Patient this weekusing natural aloe for rash. It's helping. #mdchatTue Aug 30 18:46:43 PDT 2011
drseisenberg Well-designed trials with $ support RT @talkabouthealth : How 2 pay 4 testingefficacy of supplements. Should government budget 4? #mdchatTue Aug 30 18:47:11 PDT 2011
CelebrityDx @JediPD What do u think about the Hitchens' case & personalized cancermedicine? http://t.co/M4wAe7W #mdchatTue Aug 30 18:47:43 PDT 2011
FDALawyers @TaborF Difficult yes. But, NIH often supportive. Alternatively, if chemical entity canbe isolated, may be patentable. #mdchatTue Aug 30 18:48:00 PDT 2011
RyanMadanickMD @drseisenberg @talkabouthealth Oh the skeptics would have a field day with thesekinds of studies... #mdchatTue Aug 30 18:48:01 PDT 2011
JediPD For example: There is actual proof of Curcumin and cancer cell effect in vitro. The isalso valid data on Green tea EGC and T cells. #mdchat
Tue Aug 30 18:48:03 PDT 2011
apjonas T1 Look at vitamin D literature=vast. No shareholder value to Med-ind-complex sodissed and undercut initially like pol candidate #MDChatTue Aug 30 18:48:05 PDT 2011
drseisenberg y MT @Dermdoc : T1 Isnt it OK 2 integrate alternatives 2 tradition with tradition.Patient using natural aloe for rash. Its helping. #mdchatTue Aug 30 18:48:05 PDT 2011
drseisenberg I know :( RT @RyanMadanickMD : @drseisenberg @talkabouthealth Oh the skepticswould have a field day with these kinds of studies... #mdchatTue Aug 30 18:48:38 PDT 2011
talkabouthealth Depends on treatment, need to define. MT @Dermdoc T1 Isnt it OK to integratealternatives w/ tradition. Natural aloe for rash, helps #mdchatTue Aug 30 18:48:41 PDT 2011
CelebrityDx @drseisenberg @talkabouthealth No gov't $ for testing supplements, let consumersorganize to do it http://t.co/ZTRLDQp #mdchatTue Aug 30 18:49:18 PDT 2011
RyanMadanickMD I prefer Omicron 3 RT @drseisenberg : Omega 3 fatty acids: GO! #mdchatTue Aug 30 18:49:36 PDT 2011
TaborF @Dermdoc Aloe good for sunburn too, per patient of mine. #mdchatTue Aug 30 18:50:03 PDT 2011
apjonas @talkabouthealth @Dermdoc if u "sell" it as alternative, you have no malpracticeinsurance protecting you if problems arise #MDChatTue Aug 30 18:50:18 PDT 2011
drseisenberg TY RT @RyanMadanickMD : I prefer Omicron 3 RT @drseisenberg : Omega 3 fattyacids: GO! #mdchatTue Aug 30 18:50:33 PDT 2011
JediPD It must have been a c-kit mutation! Imatinib works @CelebrityDx : Hitchens' case &personalized cancer medicine? http://t.co/eqLFhuN #mdchat ”Tue Aug 30 18:51:03 PDT 2011
apjonas T1 Omega 3 fatty acids = best chemical i've seen in med practice. Vit D3 may be 2nd.#MDChatTue Aug 30 18:51:56 PDT 2011
RyanMadanickMD Which med specialty has biggest use of non-traditional txs? GI? Derm?Rheum/ortho? #mdchatTue Aug 30 18:52:03 PDT 2011
ManonC1sports Interesting RT @JediPD : It must have been a c-kit mutation! Imatinib works@CelebrityDx : Hitchens case http://t.co/pnwzIph #mdchat ” #mdchatTue Aug 30 18:52:10 PDT 2011
JediPD The current costs for bringing a drug to market is $1,000,000,000.00 That is 9 zeros.#mdchatTue Aug 30 18:52:45 PDT 2011
DrAttai @RyanMadanickMD my guess would be rheum or oncology #mdchatTue Aug 30 18:52:50 PDT 2011
ElinSilveous Great Question! RT @RyanMadanickMD : Which med specialty has biggest use ofnon-traditional txs? GI? Derm? Rheum/ortho? #mdchatTue Aug 30 18:53:13 PDT 2011
apjonas @RyanMadanickMD Family Medicine since you forgot to ask. Ivory tower blinders?#MDChatTue Aug 30 18:53:13 PDT 2011
drseisenberg Which supps have "enough" evidence that we're good with them in the rightcircumstance? EFAs? Vit D? Probiotics? #mdchat
FDALawyers @JediPD Depends on who you ask, anywhere from 150 million to 1.2 Billion#mdchatTue Aug 30 18:53:19 PDT 2011
CelebrityDx @JediPD I wonder if the days of RCTs as the gold standard are numbered #mdchatTue Aug 30 18:53:31 PDT 2011
drseisenberg ONCODUDES RT @RyanMadanickMD : Which med specialty has biggest use ofnon-traditional txs? GI? Derm? Rheum/ortho? #mdchatTue Aug 30 18:53:44 PDT 2011
FDALawyers @DrAttai Favorite chemical = aspirin. #mdchatTue Aug 30 18:54:04 PDT 2011
ElinSilveous Proven txs or quack? Oncology? RT @RyanMadanickMD : Which med specialty hasbiggest use of non-traditional txs? GI? Derm? Rheum... #mdchatTue Aug 30 18:54:12 PDT 2011
RyanMadanickMD Let's get back to the "N of 1" studies RT @CelebrityDx : @JediPD I wonder if the daysof RCTs as the gold standard are numbered #mdchatTue Aug 30 18:54:20 PDT 2011
ManonC1sports I would say GI and Fam MD RT @RyanMadanickMD : Which med specialty hasbiggest use of non-traditional #mdchatTue Aug 30 18:54:33 PDT 2011
CelebrityDx @JediPD Yes & that's unsustainable, we've proposed a new model
http://t.co/ZTRLDQp #mdchatTue Aug 30 18:54:52 PDT 2011
MD_chat Before we wrap up, let's hear your concluding thoughts. #MDchatTue Aug 30 18:55:01 PDT 2011
Dermdoc @apjonas do you mean li terally sell? If not, how is it any different from any other off-label use recommended for treatment? #mdchatTue Aug 30 18:55:14 PDT 2011
RyanMadanickMD@apjonas Nah, I knew you'd say that! I was asking abou t subspecs b/c primary careit's highly prevalent #mdchatTue Aug 30 18:55:24 PDT 2011
ManonC1sports In family med popular with patients is glucosamine ,melatonine,and St John's Worth#mdchatTue Aug 30 18:55:26 PDT 2011
Dermdoc @talkabouthealth Does it? I'm not sure when it wouldn 't be appropriate (if at thepatient's behest) #mdchatTue Aug 30 18:55:47 PDT 2011
JediPD RCTrials will probably go from Phase I/II straight to conforming III. The regs need tobe modified by judicious docs @CelebrityDx #mdchatTue Aug 30 18:55:53 PDT 2011
RyanMadanickMD @MD_chat can you make a list of the resources for us? #mdchat #mdchatTue Aug 30 18:56:06 PDT 2011
DrAttaiturmeric, omega 3, vit D - all good stuff #mdchatTue Aug 30 18:56:32 PDT 2011
CelebrityDx @RyanMadanickMD @JediPD Do you al l know this group that does "n-of-one"cancer medicine? www.n-of-one.com #mdchatTue Aug 30 18:56:54 PDT 2011
RyanMadanickMD @MD_chat My parting thoughts: Not all therapies are safe; always consider risks andbenefits of med/CAM types of tx #mdchatTue Aug 30 18:56:58 PDT 2011
apjonas @Dermdoc @apjonas Your attitude= difference. If you believe it is alternative, forgetyour malpractice coverage for that encounter. #MDChatTue Aug 30 18:57:13 PDT 2011
talkabouthealth As many have said, need communication w/ patient for informed decisions. #mdchatTue Aug 30 18:57:17 PDT 2011
JediPD N=1 data can only be done with "chemosensitivity Assays" which has 99% true negand 78%true pos. #mdchat @RyanMadanickMD @celebritydxTue Aug 30 18:57:22 PDT 2011
AfternoonNapper Personal al t favs: peppermint, ginger, lavender, tea tree, methyl B-12, accupunctureand massage. #MDChatTue Aug 30 18:57:23 PDT 2011
RyanMadanickMD @CelebrityDx interesting #mdchatTue Aug 30 18:57:30 PDT 2011
ElinSilveous It's OK for a Doc or med professional to say, "I/we don't know" when i t comes to#CAM & unproven consumer heal th care choices. #MDChatTue Aug 30 18:57:30 PDT 2011
EllenRichter @MD_chat Good topic! Boy the conversation went steady right through! Thanks forthe great tweets folks! I like hearing al l the views #MDchatTue Aug 30 18:57:32 PDT 2011
DrAttai Keep the communication open with patients - encourage them to discuss othertherapies, get yourself educated as well #mdchatTue Aug 30 18:58:29 PDT 2011
JediPDProbability data that we rely on needs large Ns. The law of large or reasonable
numbers to give you 95%CI #mdchatTue Aug 30 18:58:43 PDT 2011
TheresaJahn @drseisenberg All 3 have pretty decent research depending on the case. #mdchatTue Aug 30 18:59:04 PDT 2011
RyanMadanickMD Nice chat tonight all #mdchatTue Aug 30 18:59:42 PDT 2011
drseisenberg Final thought: Be open-minded. Be evidence-based. Be human. Be kind. Be alistener. Be authentic. Be you. #mdchatTue Aug 30 18:59:46 PDT 2011
