#MDchat transcript

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MD_chat

Welcome everybody to the #MDchat show, staring you. We'll begin in a moment, but let's hear introductions. I'm @PhilBaumann
Tue Aug 30 18:00:07 PDT 2011

RyanMadanickMD

@MD_chat Evening everyone, Ryan Madanick, 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

"Alternative" Medicine: Medicine is medicine, but how do you work with patients seeking alternatives to 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 sitting in! #MDchat #MDChat

Tue Aug 30 18:06:02 PDT 2011

RyanMadanickMD EllenRichter

@MD_chat I guess this is T1? #MDchat

Tue Aug 30 18:06:04 PDT 2011

Hi folks! I always enjoy reading this group's chat! Ellen, a critical care RN & legal consultant in Florida, playing with Spotify :) #MDchat
Tue Aug 30 18:06:17 PDT 2011

NateOsit

Hi all, Nate here- your friendly Health IT geek! Hoping we're done w/ natural disasters for the week up here in the Northeast! #MDchat
Tue Aug 30 18:06:29 PDT 2011

RyanMadanickMD

@AfternoonNapper #MDchat #MDChat

Tue Aug 30 18:06:35 PDT 2011

JediPD

Hi Ryan. Mr Dictionary! And Strategist. #mdchat

Tue Aug 30 18:07:08 PDT 2011

RyanMadanickMD

@AfternoonNapper welcome to the fun #mdchat

Tue Aug 30 18:07:39 PDT 2011

ElinSilveous

Hi everyone. Elin here. Looking forward to #MDChat

Tue Aug 30 18:07:41 PDT 2011

MD_chat

@afternoonnapper @ryanmadanickmd @ellenrichter Good evening! #MDchat

Tue Aug 30 18:07:45 PDT 2011

MD_chat

@apjonas Good evening! #MDchat

Tue Aug 30 18:08:01 PDT 2011

apjonas

T1 I first clarify boundaries of natural, medical, alternative and complementary practices to set stage. #MDChat
Tue Aug 30 18:08:12 PDT 2011

rachelcogar

Hello - Rachel Cogar, Dir of Mktg for large urology group in Charlotte, NC #MDchat
Tue Aug 30 18:08:26 PDT 2011

talkabouthealth

Hi, Murray from TalkAboutHealth. Will be mostly browsing:) #mdchat

Tue Aug 30 18:08:31 PDT 2011

MD_chat

Here's tonight's topic in case you missed it http://ow.ly/6haMT #MDchat

Tue 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? #mdchat
Tue Aug 30 18:08:42 PDT 2011

apjonas

@MD_chat I'm trained in 7-8 modalities beyond traditional, so I teach pt the difference and the financial differences w/insurance #MDChat
Tue Aug 30 18:09:56 PDT 2011

EllenRichter

@RyanMadanickMD Sure, I'd be up for that! :) Lets talk after? #MDchat

Tue Aug 30 18:09:59 PDT 2011

Yeakley

Hey from Charlotte NC. First time listening in and looking forward to the chat. #mdchat
Tue Aug 30 18:10:01 PDT 2011

RyanMadanickMD

@EllenRichter sure, I'll be here #MDchat

Tue Aug 30 18:10:13 PDT 2011

RyanMadanickMD

T1 It's important for my patients to understand what my expertise is in; I do not discount non-allopathic tx... (1/x) #mdchat
Tue Aug 30 18:10:43 PDT 2011

JediPD

Problem with alternate drug therapies in cancer is the interactions with chemotherapy and radiation. #mdchat
Tue Aug 30 18:12:28 PDT 2011

talkabouthealth

T1 Love this topic. I am struggling to define boundaries for TalkAboutHealth. Who are the experts and do they have reqd credentials. #mdchat
Tue Aug 30 18:12:32 PDT 2011

RyanMadanickMD

T1 ...when patients ask my opinion about other therapies, glad to provide; but to prescribe or recommend? out of my field (2/x) #mdchat
Tue Aug 30 18:12:51 PDT 2011

TaborF

Hi everybody. I'm a #meded chatter who is new to mdchat #mdchat

Tue 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 #MDChat
Tue 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) #mdchat
Tue 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? #MDChat
Tue Aug 30 18:14:38 PDT 2011

RyanMadanickMD

@TaborF Hi Tabor, good to see you here! #mdchat

Tue Aug 30 18:15:09 PDT 2011

MD_chat

@yeakley @TaborF Welcome. Feel free to watch or join in. Friendly, smart group here! #MDchat
Tue Aug 30 18:15:28 PDT 2011

JediPD

Natural Supplements and Coumadin is one of the big bugaboos. that is worrisome @RyanMadanickMD #mdchat
Tue 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 be hurting, 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. #MDChat
Tue Aug 30 18:15:57 PDT 2011

talkabouthealth

T1 See trend of complementary medicine toward health lifestyle, acupuncture, etc. Alternative medicine difficult regarding evidence. #mdchat
Tue Aug 30 18:16:07 PDT 2011

TaborF

@RyanMadanickMD Thanks! #mdchat

Tue 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 #MDChat
Tue Aug 30 18:16:20 PDT 2011

RyanMadanickMD

@AfternoonNapper We don't really say "alternative medicine". more like "alternative therapies" #mdchat
Tue 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 use them anyway #mdchat
Tue 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 #mdchat

Tue Aug 30 18:16:49 PDT 2011

RyanMadanickMD

V True>> RT @ManonC1sports: Hi to all, We need to be open to supplements or else patients will not tell us and use them anyway #mdchat
Tue Aug 30 18:17:00 PDT 2011

drseisenberg

Our cancer patients bring in bags and bags of supps. Gotta sort through 'em. #mdchat
Tue Aug 30 18:17:35 PDT 2011

TaborF

As long as supplements don't have dangerous side effects/interactions, I am very open to patients using them. #mdchat
Tue Aug 30 18:17:40 PDT 2011

RyanMadanickMD

@AbnormalFacies What u will prob learn is pts don't always want 2 hear about rsrch 2 support it...the rsrch is friend, internet, etc #mdchat

Tue Aug 30 18:18:07 PDT 2011

DrAttai

Important to let pts know that you want to know what they are taking and you're open to discussion #mdchat
Tue Aug 30 18:18:13 PDT 2011

JediPD

There's a fairly large industry that deals with cancer outside of evidence based medicine. Case in point Steve McQueen and Laetrile! #mdchat
Tue Aug 30 18:18:25 PDT 2011

TaborF

The difficulty is finding reliable information about efficacy or side effects. #mdchat
Tue Aug 30 18:18:26 PDT 2011

apjonas

T1 Many physicians invent response to pt questions out of disrespect and ignorance of evidence, sometimes even pathetic lies #MDChat
Tue Aug 30 18:18:38 PDT 2011

AfternoonNapper

Is there a central list of common supplements/alternative therapies and issues they present re: traditional medicine? #MDChat
Tue Aug 30 18:19:07 PDT 2011

RyanMadanickMD

Usually have to search online for these RT @TaborF: The difficulty is finding reliable information about efficacy or side effects. #mdchat
Tue Aug 30 18:19:15 PDT 2011

drseisenberg

Integrative oncology is significant movement in the cancer realm. Must be evidencebased. #mdchat
Tue Aug 30 18:19:27 PDT 2011

RyanMadanickMD

"Integrative" better term RT @drseisenberg: Integrative oncology is significant movement in the cancer realm. Must be evidence-based #mdchat
Tue Aug 30 18:19:57 PDT 2011

ManonC1sports

Only some supplements have decent studies and I do tell patients, them that I won't encourage what I don't think will help #mdchat
Tue Aug 30 18:19:59 PDT 2011

ElinSilveous

Here's an NIH resource that might be helpful: National Center for Complementary and Alternative Medicine [NCCAM] http://ow.ly/6hb9l #MDChat
Tue Aug 30 18:19:59 PDT 2011

apjonas

T1 The NCCAM of gov has over 400 therapies listed and defined. German Commission E great science on herbs effects & side effects #MDChat
Tue Aug 30 18:20:46 PDT 2011

TaborF

It's important to listen to what patients are doing and not feel threatened or defensive if taking something I didn't prescribe. #mdchat
Tue Aug 30 18:21:04 PDT 2011

JediPD

I think since most medicine is based on plants, there are some legit human effects (eg. digitalis) but we need facts on MTD etc. #mdchat

Tue Aug 30 18:21:12 PDT 2011

ElinSilveous

Ouch RT @apjonas: T1 Many physicians invent response to pt questions out of disrespect and ignorance of evidence, sometimes... #MDChat
Tue Aug 30 18:21:16 PDT 2011

talkabouthealth

I worry about term "natural" being used to sell supplements/alternatives. Very attractive to patients. Need to educate them on mkg. #mdchat
Tue Aug 30 18:21:28 PDT 2011

DrAttai

Here's another site from MD Anderson: http://t.co/4Bq3HHj #mdchat

Tue Aug 30 18:21:28 PDT 2011

ManonC1sports

I am sure there are products that can work but that tradional medicine is unaware of at this time ,research HAS to continue #mdchat
Tue 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) #mdchat
Tue 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 #mdchat
Tue Aug 30 18:22:25 PDT 2011

apjonas

T1 Physicians need to be better at admitting lack of knowledge and making pt understand disease care insurance they have. #MDChat
Tue Aug 30 18:22:25 PDT 2011

JediPD

There is for instance a lot of talk about Acai berries and good health. Where is the evidence? #mdchat
Tue Aug 30 18:22:32 PDT 2011

DrAttai

And one more site from MSKCC: http://t.co/3es8asp #mdchat

Tue Aug 30 18:22:55 PDT 2011

RyanMadanickMD

T1 Opium is natural...safe? #mdchat

Tue Aug 30 18:23:09 PDT 2011

ManonC1sports

Yes up to 30 % effect or more RT @TaborF: A lot of alternative therapies probably work by placebo effect #mdchat
Tue Aug 30 18:23:18 PDT 2011

drseisenberg

SIO = Society of Integrative Oncology http://t.co/vNUp73V #mdchat

Tue Aug 30 18:23:36 PDT 2011

DrAttai

@RyanMadanickMD @talkabouthealth Agree - "natural" implies safe and often that's not the case #mdchat
Tue Aug 30 18:23:36 PDT 2011

apjonas

T1 Manure is natural but unsafe. #MDChat

Tue 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 #mdchat
Tue Aug 30 18:23:48 PDT 2011

RyanMadanickMD

Exactly RT @DrAttai: @RyanMadanickMD @talkabouthealth Agree - "natural" implies safe and often that's not the case #mdchat
Tue Aug 30 18:23:49 PDT 2011

Yeakley

Thanks RT Elin Silveous NIH resource: National Center for Complementary and Alternative Medicine [NCCAM] http://t.co/n27Ks4N #MDChat
Tue Aug 30 18:23:58 PDT 2011

JediPD

On the other side(just to be balanced) studies are promoted by industries to propagate a product. Oh the web we weave! #mdchat
Tue Aug 30 18:24:05 PDT 2011

FDALawyers

MT @RyanMadanickMD: biggest con w CAM: 1) pts thk always safe; 2) think natural=better; 3)exchanging more beneficial 4 less benef tx #mdchat
Tue Aug 30 18:24:10 PDT 2011

FDALawyers

@RyanMadanickMD Using German Commission E monographs for natural meds is a good start #mdchat
Tue Aug 30 18:24:34 PDT 2011

RyanMadanickMD

LOL RT @apjonas: T1 Manure is natural but unsafe. #mdchat

Tue 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. #MDChat
Tue Aug 30 18:25:08 PDT 2011

FDALawyers

@RyanMadanickMD Except to plants #mdchat

Tue Aug 30 18:25:21 PDT 2011

rachelcogar

You DO have a point ;-) RT @apjonas T1 Manure is natural but unsafe. #MDChat
Tue Aug 30 18:25:38 PDT 2011

RyanMadanickMD

T1 Herbal Remedies' Potential Dangers by @sanjayguptacnn http://t.co/5tZOiDm via @TIME #mdchat

Tue Aug 30 18:25:42 PDT 2011

drseisenberg

Monroe E. Wall and Mansukh C. Wani isolated "chemo" from the bark of the Pacific yew tree, Taxus brevifolia and named it taxol. #mdchat
Tue Aug 30 18:25:51 PDT 2011

AfternoonNapper

What is the best way to get pts to preempitively think about if their supplements/alternatives are safe? Posters/ads/other? #MDChat
Tue Aug 30 18:26:09 PDT 2011

FDALawyers

@drseisenberg Yes, but taxol is not safe if used incorrectly #mdchat

Tue Aug 30 18:26:28 PDT 2011

TaborF

Often, what people really want is someone to talk to. Acupuncturist may have more time for you than MD, so helps you feel better. #mdchat
Tue Aug 30 18:26:34 PDT 2011

RyanMadanickMD

@talkabouthealth @JediPD yes that is often the case...but at least they try to do research #mdchat
Tue Aug 30 18:26:41 PDT 2011

RyanMadanickMD

@TaborF This is why it is so important to talk to patients! #mdchat

Tue Aug 30 18:26:57 PDT 2011

FDALawyers

@drseisenberg Taxol risk benefit weighs in favor. But isnt even "safe" if used correctly #mdchat
Tue Aug 30 18:26:58 PDT 2011

RyanMadanickMD

@FDALawyers thank you #mdchat

Tue Aug 30 18:27:08 PDT 2011

FDALawyers

@TaborF So talk to your nurses and pharamcists. We want to talk to patients (sometimes) #mdchat
Tue Aug 30 18:27:27 PDT 2011

apjonas

T1 internet eliminates docs claim of not knowing side effects of herbs, NCCAM has good 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 check interactions of meds #mdchat
Tue Aug 30 18:27:40 PDT 2011

RyanMadanickMD

@AfternoonNapper I recommend always discussing w/doc who knows u best (usually PCP) #mdchat
Tue Aug 30 18:27:44 PDT 2011

drseisenberg

Talk 2 them openly MT @AfternoonNapper: What is best way to get pts to think abt if their supplements are safe? Posters/ads/other? #mdchat
Tue 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 #mdchat
Tue 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 #mdchat
Tue Aug 30 18:28:22 PDT 2011

FDALawyers

@JediPD known toxicity =/= non toxic #mdchat

Tue Aug 30 18:29:02 PDT 2011

drseisenberg

Authentically listening to patients provides the opening for them to authentically listen to us. Even about sups... #mdchat
Tue 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 of therapies emerging #mdchat
Tue Aug 30 18:29:56 PDT 2011

FDALawyers

@talkabouthealth Accept that some are safe. Others are questionable. #mdchat
Tue 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! #mdchat
Tue Aug 30 18:30:21 PDT 2011

NateOsit

Good2know! RT @ManonC1sports: Note the Web sites like Epocrates has a natural med dictionnary and you can check interactions of meds #MDchat
Tue Aug 30 18:30:43 PDT 2011

ElinSilveous

Ken Pelletier, MD at Stanford & UofA is also a credible source for evidence-based CAM. #MDChat
Tue Aug 30 18:30:44 PDT 2011

TaborF

@DrAttai True. I would rather work with other practitioners than think of ourselves in opposition. #mdchat
Tue Aug 30 18:30:58 PDT 2011

DrAttai

@ManonC1sports We have to figure out which therapies work well together and which ones will clash #mdchat
Tue Aug 30 18:30:59 PDT 2011

drseisenberg

Thoughts about probiotics? #mdchat

Tue Aug 30 18:31:05 PDT 2011

RyanMadanickMD

@MDChat can you make a list of the resources for us? #mdchat
Tue Aug 30 18:31:27 PDT 2011

JediPD

Dannon! RT @drseisenberg: Thoughts about probiotics? #mdchat

Tue Aug 30 18:31:51 PDT 2011

RyanMadanickMD

Basically same as above RT @drseisenberg: Thoughts about probiotics? #mdchat

Tue Aug 30 18:31:53 PDT 2011

talkabouthealth

Could be added to trials? RT @DrAttai: @ManonC1sports We have to figure out which therapies work well together & which ones clash #mdchat

Tue Aug 30 18:31:56 PDT 2011

ManonC1sports

We have to try our best to not work in isolation and maintain discussions between people giving these therapies and us md's #mdchat
Tue Aug 30 18:32:11 PDT 2011

RyanMadanickMD

BUT our formulary has removed ALL probiotics from inpt hosp sec to poss fungemia RT @drseisenberg: Thoughts about probiotics? #mdchat
Tue Aug 30 18:32:21 PDT 2011

ManonC1sports

Agree RT @DrAttai: @ManonC1sports We have to figure out which therapies work well together and which ones will clash #mdchat
Tue Aug 30 18:32:27 PDT 2011

drseisenberg

True integration is about honest communication and collaboration between doctors and integrative practitioners. #mdchat
Tue Aug 30 18:32:44 PDT 2011

FDALawyers

@RyanMadanickMD Some ID docs love probiotics. #mdchat

Tue Aug 30 18:32:59 PDT 2011

RyanMadanickMD

Most rsrch is lacking, though occasionally some studies are (+) RT @drseisenberg: Thoughts about probiotics? #mdchat
Tue Aug 30 18:33:03 PDT 2011

drseisenberg

Hmmm MT @RyanMadanickMD: BUT our formulary has removed ALL probiotics from inpt hosp sec to poss fungemia #mdchat
Tue Aug 30 18:33:31 PDT 2011

JediPD

The degree of difficulty rises exponentially with multiple drugs. ONLY One to one interaction is known. @ManonC1sports @drattai #mdchat
Tue Aug 30 18:33:48 PDT 2011

drseisenberg

VSL#3??? #mdchat
Tue Aug 30 18:34:04 PDT 2011

apjonas

T1 probiotics very effective for eczema in breast fed babies, etc, etc. #MDChat
Tue Aug 30 18:34:09 PDT 2011

RyanMadanickMD

@drseisenberg Same as others VSL#3 #mdchat

Tue Aug 30 18:34:25 PDT 2011

ManonC1sports

In France a prescription of antibiotics often goes hand in hand with probiotic prescritions as my patients tell me #mdchat
Tue Aug 30 18:34:44 PDT 2011

RyanMadanickMD

@drseisenberg for C diff prevention, there is systematic review I'll find for you #mdchat
Tue Aug 30 18:34:46 PDT 2011

drseisenberg ElinSilveous

Align??? #mdchat
Tue Aug 30 18:34:51 PDT 2011

Alternative Medicine Resources for Specific Conditions, Dr. Kenneth R. Pelletier The Best Alternative Medicine http://t.co/ft37hgH #MDChat
Tue Aug 30 18:35:12 PDT 2011

FDALawyers

@RyanMadanickMD @JediPD @ManonC1sports @drattai You mean synergistic? Coz else, you can use e.g. lexicomp #mdchat
Tue Aug 30 18:35:27 PDT 2011

DrAttai

@RyanMadanickMD @JediPD @ManonC1sports Yes, and many even "healthy" are on multiple meds / supplements, cancer pts even more so #mdchat
Tue Aug 30 18:35:30 PDT 2011

FDALawyers

@ElinSilveous Or natural medicines #mdchat

Tue Aug 30 18:35:37 PDT 2011

JediPD

That is being recommended here too by IDs. @ManonC1sports #mdchat

Tue Aug 30 18:35:41 PDT 2011

drseisenberg

GI doc I know with gives out Align samples like "vitamin Al" #mdchat
Tue 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 #MDChat
Tue Aug 30 18:36:16 PDT 2011

apjonas

T1 Medical practice is medical, including everything billable using ICD codes. Not billable=not medical may be helpful dogma #MDChat
Tue Aug 30 18:36:29 PDT 2011

ElinSilveous

@RyanMadanickMD I think Duke has a Center for Integrative Medicine... #MDChat

Tue Aug 30 18:37:10 PDT 2011

DrAttai

@apjonas but discussion regarding supplements / interactions is billable, based on time #mdchat
Tue Aug 30 18:37:21 PDT 2011

TaborF

Always good to remember that western biomedical paradigm is not the only worldview out there, need to respect others too. #mdchat
Tue 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 #mdchat
Tue Aug 30 18:37:34 PDT 2011

ManonC1sports

It is not yet main stream here RT @JediPD: That is being recommended here too by IDs. @ManonC1sports #mdchat
Tue Aug 30 18:37:35 PDT 2011

drseisenberg

Lots of patients on "green drinks". Fruit and veggie pills too. How about just REAL veggies? #mdchat
Tue Aug 30 18:38:08 PDT 2011

RyanMadanickMD

Meta-analysis of probiotics to prevent Abx-assoc diarrhea and tx C diff http://t.co/JhuMSB6 #mdchat cc @drseisenberg
Tue Aug 30 18:38:24 PDT 2011

apjonas

@DrAttai vitamins and supplements are medical #MDChat

Tue Aug 30 18:38:26 PDT 2011

RyanMadanickMD

@ElinSilveous yes I think you're right #MDChat

Tue Aug 30 18:38:42 PDT 2011

EllenRichter

@TaborF Great point :) #MDchat

Tue Aug 30 18:38:53 PDT 2011

DrAttai

@TaborF many other medical systems have been around a lot longer than western medicine and for some diseases may be more effective #mdchat
Tue Aug 30 18:38:56 PDT 2011

talkabouthealth

@drseisenberg Yes, so many different diets as well. #mdchat

Tue Aug 30 18:38:58 PDT 2011

talkabouthealth

@drseisenberg Yes, so many different diets as well. #mdchat

Tue Aug 30 18:38:58 PDT 2011

JediPD

Agree, but with the caveat of some "evidence" not grandma's recipes. @TaborF #mdchat
Tue Aug 30 18:39:04 PDT 2011

FDALawyers

@JediPD Inc. AUC often associated with Cyp450 system. Thats often easy to look up. Exact extent, difficult to tell. #mdchat
Tue Aug 30 18:39:06 PDT 2011

RyanMadanickMD

@AbnormalFacies LOL, that's awesome, was it a OSCE? #MDChat

Tue Aug 30 18:39:11 PDT 2011

drseisenberg

THX RT @RyanMadanickMD: Meta-analysis of probiotics to prevent Abx-assoc diarrhea and tx C diff http://t.co/Gp2HWx5 #mdchat #mdchat
Tue Aug 30 18:39:28 PDT 2011

DrAttai

@apjonas yes I meant many herbals, etc not commonly thought of as supplements, but agree #mdchat
Tue Aug 30 18:40:24 PDT 2011

RyanMadanickMD

@drseisenberg sure #mdchat

Tue Aug 30 18:40:48 PDT 2011

AbnormalFacies

@RyanMadanickMD No OSCE, just a typical session. Let's just say I know not to push, but I will still give my $.02 on CAM every time #MDChat
Tue Aug 30 18:40:52 PDT 2011

AfternoonNapper

Patients also may turn to alternative when western medicine seems to be failing. I know I did. #MDChat
Tue Aug 30 18:40:54 PDT 2011

FDALawyers

@talkabouthealth True, but no studies to show efficacy. Just safety. #mdchat

Tue Aug 30 18:40:54 PDT 2011

JediPD

AUC = Area under the curve is for all meds that undergo elimination. P450 is a specific mechanism for many drugs not all @FDALawyers #mdchat
Tue Aug 30 18:41:30 PDT 2011

ElinSilveous

Hopefully, #PCORI & comparative effectiveness research will yield info to help providers AND patients make more informed decisions. #MDChat
Tue Aug 30 18:41:32 PDT 2011

apjonas

@DrAttai @apjonas Herbals are medical. All over the medical literature in FM. We enjoy a vast array of therapies in western med #MDChat
Tue Aug 30 18:42:20 PDT 2011

EllenRichter

Heating up #cancer? Can it help? "The Annals of Extreme Surgery" NYTimes http://t.co/L5AQGLD #RNchat #MDchat
Tue 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 #mdchat
Tue Aug 30 18:42:32 PDT 2011

ManonC1sports

If we tell patient we can't help them they often need support and turn to alternative therapy RT @AfternoonNapper: #mdchat
Tue Aug 30 18:42:41 PDT 2011

CelebrityDx

@ElinSilveous NCCAM has a small budget is not up-to-date; nothing about folk remedies in recent news e.g. bit.ly/nYrfla #mdchat
Tue Aug 30 18:42:55 PDT 2011

DrAttai

@apjonas I agree but many docs don't think the same way #mdchat
Tue Aug 30 18:43:08 PDT 2011

apjonas

T1 Few pts seeing a western doc expect to pay for services but pay Reiki master and massage therapist cash. #MDChat
Tue Aug 30 18:43:31 PDT 2011

JediPD

Undergoing trials. Cumbersome but no magic bullet! @EllenRichter #mdchat

Tue Aug 30 18:43:40 PDT 2011

TheresaJahn

@drseisenberg I agree, real fruit and veggies is the way to go .. the more colour on the plate the better! #mdchat
Tue Aug 30 18:43:43 PDT 2011

RyanMadanickMD

Many of us here are more open to alternatives RT @DrAttai: @apjonas I agree but many docs dont think the same way #mdchat
Tue Aug 30 18:43:52 PDT 2011

RyanMadanickMD

Paradox? RT @apjonas: T1 Few pts seeing a western doc expect to pay for services but pay Reiki master and massage therapist cash. #mdchat
Tue Aug 30 18:44:10 PDT 2011

talkabouthealth

Need to figure out how to pay for testing efficacy of supplements. Should government have budget for this? @drseisenberg @TaborF #mdchat
Tue Aug 30 18:44:40 PDT 2011

ManonC1sports

That's why I think we need to work hand in hand with people giving them the alternative tx,they do have more time to give support #mdchat
Tue Aug 30 18:44:43 PDT 2011

FDALawyers

@RyanMadanickMD I think they think they already paid for the services (insurance) #mdchat
Tue Aug 30 18:44:45 PDT 2011

AILucero

Lots of patients on "green drinks". Fruit and veggie pills too. How about just REAL veggies? #mdchat via @drseisenberg
Tue 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! #mdchat
Tue Aug 30 18:44:51 PDT 2011

apjonas

T1 Few western docs have liability insurance for non-medical therapies so have to understand legal bundaries better. #MDChat
Tue Aug 30 18:45:01 PDT 2011

JediPD

My concerns are more with interaction. If there is PROOFINESS of efficacy! There is a lot of cancer to be treated and cured! #mdchat
Tue Aug 30 18:45:23 PDT 2011

DrAttai

@apjonas yes! and we have problems collecting $10 copays sometimes! #mdchat
Tue Aug 30 18:45:32 PDT 2011

FDALawyers

@apjonas Often depends on the definition of practice of medicine (varies from state to state.) #mdchat
Tue Aug 30 18:45:37 PDT 2011

CelebrityDx

@ElinSilveous NIH consumer health info is redundant, balkanized http://t.co/4461Zfq #mdchat

Tue Aug 30 18:45:48 PDT 2011

TaborF

Hard to get funding for trials for things that can't be patented (like herbs). Makes evidence slow to gather. #mdchat
Tue Aug 30 18:46:27 PDT 2011

EllenRichter

Good point! RT @apjonas T1 Few western docs have liability insurnce for nonmedical Rxs so have to understand legal bundaries better #MDChat
Tue Aug 30 18:46:35 PDT 2011

Dermdoc

T1 Isn't it OK to integrate alternatives to tradition with tradition. Patient this week using natural aloe for rash. It's helping. #mdchat
Tue Aug 30 18:46:43 PDT 2011

drseisenberg

Well-designed trials with $ support RT @talkabouthealth: How 2 pay 4 testing efficacy of supplements. Should government budget 4? #mdchat
Tue Aug 30 18:47:11 PDT 2011

CelebrityDx

@JediPD What do u think about the Hitchens' case & personalized cancer medicine? http://t.co/M4wAe7W #mdchat
Tue Aug 30 18:47:43 PDT 2011

FDALawyers

@TaborF Difficult yes. But, NIH often supportive. Alternatively, if chemical entity can be isolated, may be patentable. #mdchat
Tue Aug 30 18:48:00 PDT 2011

RyanMadanickMD

@drseisenberg @talkabouthealth Oh the skeptics would have a field day with these kinds of studies... #mdchat
Tue Aug 30 18:48:01 PDT 2011

JediPD

For example: There is actual proof of Curcumin and cancer cell effect in vitro. The is also 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 so dissed and undercut initially like pol candidate #MDChat
Tue 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. #mdchat
Tue Aug 30 18:48:05 PDT 2011

drseisenberg

I know :( RT @RyanMadanickMD: @drseisenberg @talkabouthealth Oh the skeptics would have a field day with these kinds of studies... #mdchat
Tue Aug 30 18:48:38 PDT 2011

talkabouthealth

Depends on treatment, need to define. MT @Dermdoc T1 Isnt it OK to integrate alternatives w/ tradition. Natural aloe for rash, helps #mdchat
Tue Aug 30 18:48:41 PDT 2011

drseisenberg

Omega 3 fatty acids: GO! #mdchat

Tue Aug 30 18:49:12 PDT 2011

CelebrityDx

@drseisenberg @talkabouthealth No gov't $ for testing supplements, let consumers organize to do it http://t.co/ZTRLDQp #mdchat
Tue Aug 30 18:49:18 PDT 2011

RyanMadanickMD

I prefer Omicron 3 RT @drseisenberg: Omega 3 fatty acids: GO! #mdchat

Tue Aug 30 18:49:36 PDT 2011

TaborF

@Dermdoc Aloe good for sunburn too, per patient of mine. #mdchat
Tue Aug 30 18:50:03 PDT 2011

apjonas

@talkabouthealth @Dermdoc if u "sell" it as alternative, you have no malpractice insurance protecting you if problems arise #MDChat
Tue Aug 30 18:50:18 PDT 2011

drseisenberg

TY RT @RyanMadanickMD: I prefer Omicron 3 RT @drseisenberg: Omega 3 fatty acids: GO! #mdchat

Tue 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. #MDChat
Tue Aug 30 18:51:56 PDT 2011

RyanMadanickMD

Which med specialty has biggest use of non-traditional txs? GI? Derm? Rheum/ortho? #mdchat
Tue 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 #mdchat
Tue 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. #mdchat
Tue Aug 30 18:52:45 PDT 2011

DrAttai

@RyanMadanickMD my guess would be rheum or oncology #mdchat

Tue Aug 30 18:52:50 PDT 2011

ElinSilveous

Great Question! RT @RyanMadanickMD: Which med specialty has biggest use of non-traditional txs? GI? Derm? Rheum/ortho? #mdchat
Tue Aug 30 18:53:13 PDT 2011

apjonas

@RyanMadanickMD Family Medicine since you forgot to ask. Ivory tower blinders? #MDChat
Tue Aug 30 18:53:13 PDT 2011

drseisenberg

Which supps have "enough" evidence that we're good with them in the right circumstance? EFAs? Vit D? Probiotics? #mdchat

Tue Aug 30 18:53:18 PDT 2011

FDALawyers

@JediPD Depends on who you ask, anywhere from 150 million to 1.2 Billion #mdchat
Tue Aug 30 18:53:19 PDT 2011

CelebrityDx

@JediPD I wonder if the days of RCTs as the gold standard are numbered #mdchat
Tue Aug 30 18:53:31 PDT 2011

drseisenberg

ONCODUDES RT @RyanMadanickMD: Which med specialty has biggest use of non-traditional txs? GI? Derm? Rheum/ortho? #mdchat
Tue Aug 30 18:53:44 PDT 2011

FDALawyers

@DrAttai Favorite chemical = aspirin. #mdchat

Tue Aug 30 18:54:04 PDT 2011

ElinSilveous

Proven txs or quack? Oncology? RT @RyanMadanickMD: Which med specialty has biggest use of non-traditional txs? GI? Derm? Rheum... #mdchat
Tue 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 days of RCTs as the gold standard are numbered #mdchat
Tue Aug 30 18:54:20 PDT 2011

ManonC1sports

I would say GI and Fam MD RT @RyanMadanickMD: Which med specialty has biggest use of non-traditional #mdchat
Tue Aug 30 18:54:33 PDT 2011

CelebrityDx

@JediPD Yes & that's unsustainable, we've proposed a new model http://t.co/ZTRLDQp #mdchat
Tue Aug 30 18:54:52 PDT 2011

MD_chat

Before we wrap up, let's hear your concluding thoughts. #MDchat

Tue Aug 30 18:55:01 PDT 2011

Dermdoc

@apjonas do you mean literally sell? If not, how is it any different from any other offlabel use recommended for treatment? #mdchat
Tue Aug 30 18:55:14 PDT 2011

RyanMadanickMD

@apjonas Nah, I knew you'd say that! I was asking about subspecs b/c primary care it's highly prevalent #mdchat
Tue Aug 30 18:55:24 PDT 2011

ManonC1sports

In family med popular with patients is glucosamine ,melatonine,and St John's Worth #mdchat
Tue Aug 30 18:55:26 PDT 2011

Dermdoc

@talkabouthealth Does it? I'm not sure when it wouldn't be appropriate (if at the patient's behest) #mdchat
Tue Aug 30 18:55:47 PDT 2011

JediPD

RCTrials will probably go from Phase I/II straight to conforming III. The regs need to be modified by judicious docs @CelebrityDx #mdchat
Tue Aug 30 18:55:53 PDT 2011

RyanMadanickMD

@MD_chat can you make a list of the resources for us? #mdchat #mdchat
Tue Aug 30 18:56:06 PDT 2011

DrAttai

turmeric, omega 3, vit D - all good stuff #mdchat

Tue Aug 30 18:56:32 PDT 2011

CelebrityDx

@RyanMadanickMD @JediPD Do you all know this group that does "n-of-one" cancer medicine? www.n-of-one.com #mdchat
Tue Aug 30 18:56:54 PDT 2011

RyanMadanickMD

@MD_chat My parting thoughts: Not all therapies are safe; always consider risks and benefits of med/CAM types of tx #mdchat
Tue Aug 30 18:56:58 PDT 2011

apjonas

@Dermdoc @apjonas Your attitude= difference. If you believe it is alternative, forget your malpractice coverage for that encounter. #MDChat
Tue Aug 30 18:57:13 PDT 2011

talkabouthealth

As many have said, need communication w/ patient for informed decisions. #mdchat
Tue Aug 30 18:57:17 PDT 2011

JediPD

N=1 data can only be done with "chemosensitivity Assays" which has 99% true neg and 78%true pos. #mdchat @RyanMadanickMD @celebritydx
Tue Aug 30 18:57:22 PDT 2011

AfternoonNapper

Personal alt favs: peppermint, ginger, lavender, tea tree, methyl B-12, accupuncture and massage. #MDChat
Tue Aug 30 18:57:23 PDT 2011

RyanMadanickMD

@CelebrityDx interesting #mdchat

Tue 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 it comes to #CAM & unproven consumer health care choices. #MDChat
Tue Aug 30 18:57:30 PDT 2011

EllenRichter

@MD_chat Good topic! Boy the conversation went steady right through! Thanks for the great tweets folks! I like hearing all the views #MDchat
Tue Aug 30 18:57:32 PDT 2011

DrAttai

Keep the communication open with patients - encourage them to discuss other therapies, get yourself educated as well #mdchat
Tue Aug 30 18:58:29 PDT 2011

JediPD

Probability data that we rely on needs large Ns. The law of large or reasonable

numbers to give you 95%CI #mdchat

Tue Aug 30 18:58:43 PDT 2011

TheresaJahn

@drseisenberg All 3 have pretty decent research depending on the case. #mdchat
Tue Aug 30 18:59:04 PDT 2011

RyanMadanickMD

Nice chat tonight all #mdchat

Tue Aug 30 18:59:42 PDT 2011

drseisenberg

Final thought: Be open-minded. Be evidence-based. Be human. Be kind. Be a listener. Be authentic. Be you. #mdchat
Tue Aug 30 18:59:46 PDT 2011