Download - MDchat Transcript December 7, 2010
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Transcript of #MDchat for November 23, 2010
Follow @MD_chat for Regular Updates
Twitter.com/MD_chat
MDchat.org
Moderated by Phil BaumannTwitter.com/PhilBaumann
MD_Chat Welcome to #MDchat everyone! Before we start the chat,introduce yourselves!
Mtnmd @MD_chat Hi, all! #mdchathealthewoman @MD_chat Hi, Shelley here #MDchat
EinsteinMedHello MDchat-ers! Paul Moniz joining from Albert EinsteinCollege of Medicine in NYC. #MDchat
peds_id_doc#mdchat Nick Bennett - Peds ID Fellow in Upstate NY (actually,currently in Massachusetts, but let's not quibble)
RichmondDoc
Mark; family doc in #RVA; unsure if the WiFi will hold out, but
will try to participate... #MDchat
peds_id_doc#mdchat - I see a couple of familiar faces - hello ladies :o)@healthewoman @mtnmd
apjonas #mdchat Pat Jonas, MD Ohio Holistic family doc. Hi everyone.
Mtnmd@peds_id_doc @healthewoman Hi, Nick. So great to see you!#MDchat
MD_Chat
OK, we'll start with our first topic in a minute. Please prepend
your responses to topics with T1, T2, etc. Good luck! #MDchat
Mtnmd@RichmondDoc @EinsteinMed You, too, Mark and Paul!!#MDchat
MD_Chat
T1 CME, Industry versus Self-funded: Discuss pros/cons of each,in terms of ethics and practicality. #MDchat See http://bit.ly/ifsxQ7
RichmondDoc @Mtnmd @EinsteinMed Hola, amigos! #MDchat
Mtnmd @DrGottfried YW!! #MDchat is on if you like to join!!EinsteinMed @Mtnmd Hi Kelly - glad you're in the house 2nte. #MDchat
8/8/2019 MDchat Transcript December 7, 2010
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peds_id_doc#mdchat T1 - industry sponsored CME always makes me uneasy...I feel as if I'm being coerced at every step. Makes me feel dirty...
RichmondDoc
T1 Ethics wise, in my mind, no question: non-industry funded is best. Ideally, should minimize/remove contact w/
PhRMA/industry. #MDchat
peds_id_doc#mdchat T1 however, the quality is usually pretty good, and they obviously have the money to put it all together.
peds_id_doc
#mdchat T1 I have no evidence I AM being coerced...just anagging doubt about the whole thing. I tend to ignore industry CME emails.
GailZahtzHi, sorry I'm a tad late. For the next hour I will be chatting aboutmedicine and #HCSM at #mdchat
RichmondDoc
T1 The cost is an issue that has to be acknowledged, but I think moving towards less and less PhRMA contact is the right step.#MDchat
DrJenGunter Say no to pharma #MDchat
RichmondDoc
@peds_id_doc T1 There is some research that any give PhRMA
makes results in some sense of obligation in return. #MDchat
apjonas
T1 In CME the goal may dictate the sponsoring, outside vs insideand general funding spt vs specific topic funding spt. #mdchat#mdchat
healthewomanT1: Industry funded CME has zero credibility imho #MDchat; Ipretty much ignore industry funded CME
Mtnmd
Fantastic topic! Pharma co.'s aren't evil, they are just good at what
they do, which is serve their shareholders. #MDchat
healthgisthttp://j.mp/d5Z8gi ♻ @DrJenGunter Say no to pharma#MDchat
RichmondDocT1 AAFP has a reasonable compromise (for now): no directPhRMA control on material, no name-brand meds, etc. #MDchat
healthewoman
T1: Now when I read an article, even if it's in the NEJM or GreenJournal, I check the authors employer bios in the fine print
#MDchat
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RichmondDocT1 Other groups have suggested ensuring that docs won't need topass through exhibit hall to get to the program site. #MDchat
EinsteinMed
T1 @RichmondDoc Non-industry funded generally viewed ashaving more creds , reality is not enough $ privately to fulfill CME
needs. #MDchat
MtnmdMedicine is off track, partially because a large amt of informationdoctors get is about which drug to use for x condition. #MDchat
EinsteinMed
RT @healthewoman: T1: Now when I read an article, even if it's inthe NEJM or Green Journal, I check the authors employer bios inthe fine print #MDchat
Mtnmd
#MDChat We are missing out on a huge number of effective
treatments who don't have deep pockets.
apjonas
T1 Ethical sensitivity is what it is=mandatory at all times.Professionalism is a positive term in realm of ethical sens.#MDCHAT #mdchat
DrJenGunterEven if speaker good pharma influences lecture topics and many docs go out for pharma dinners at these meetings #MDchat
GailZahtz Is the real risk the pharm companies who sponsor or the MD's who take money for talks to promote? #mdchatDrJenGunter At Kaiser no pharma involvement in CME (NCal) #MDchat
nickdawson
T1 - I'd like to better understand the feeling about industry funded. Is it like free education, or like diploma mill education?#mdchat
RichmondDoc
RT @DrJenGunter: Even if speaker good pharma influences
lecture topics and many docs go out for pharma dinners at thesemeetings #MDchat
healthewoman
T1: more rebellious every day, encourage pts to avoid medications via good self-care, non-pharmacologic options, only use rx if nec#MDchat
apjonas
T1 Non-Pharm sponsorship is a reasonable goal over time, but orgsurvival trapped short time w/Pharma=dilemma ($29M for
AAFP)#mdchat #mdchat
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Mtnmd
#MDchat I follow studies on wellness gt;than most Drs.The amt of egregious shenanigans is astounding. Leads Drs 2 think no benefitin wellness
EinsteinMed
@Mtnmd e.g., niacin to lower cholesterol. How many docs
actually recommend that first before statins? Flushing can bemanaged. #MDchat
RichmondDoc@nickdawson Not so much like that: PhRMA/industry sponsorCME in return for getting booths, logos on syllabi, etc. #MDchat
RichmondDoc
@nickdawson This reduces costs for docs to attend the program(in some cases, like PriMed, program is crazy cheap)--but adspresent. #MDchat
peds_id_doc
@RichmondDoc #mdchat T1 - it's not just the obligation, but theconcern than familiarity with a med will bias my prescribinginappropriately
Mtnmd
@healthewoman #MDchat right on, it is amazing how effectivesimple measures, rather than pharms are for MANY of ptsconditions.
healthewoman
@nickdawson Industry funded CME can be (i.e. usually is) CMEpaid for by pharma/med device co's to promote their products#MDchat
nickdawson@RichmondDoc thanks for clarifying - so very different than say aprovider org offering CME events? #mdchat
MDTalk At Kaiser no pharma involvement in CME (NCal) #MDchat http://bit.ly/ew8O6L
Mtnmd@EinsteinMed #MDchat Yes, the niacin thing really confoundsme. Great example.
peds_id_doc@nickdawson #mdchat T1 - I think they want us to pretend it'sfree education, and nothing more than that...
apjonas@EinsteinMed @Mtnmd I rec diet/exercise for months beforeNiacin, Omega 3 fish oil for trig etc#MDCHAT #mdchat
GailZahtz
RT @Mtnmd: Med off track-info drs get re which drug to use for x
cond #MDchat lt;=If the drug info is peer reviewed does it matter who pays?
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EinsteinMed
RT @Mtnmd: #MDchat I follow studies on wellness gt;than mostDrs.The amt of egregious shenanigans is astounding. Leads Drs 2think no benefit in wellness
healthewoman
T1: I do most of my CME on-line, bypass meetings, advertising,
industry-funded anything #MDchat
Mtnmd@peds_id_doc #MDchat That is excellent point, the familiarity iskey. We can, as humans, only know so many tx. They fill our pail.
RichmondDoc
@peds_id_doc T1 I think both are concerns: are we really learning about the right stuff, and might we feel obligated towardsponsors #MDchat
apjonas
T1 CME is in many forms. Docs have many traditions
w/insensitivity to corp influence. Need to wake up the ethicalsensitivity#mdchat #mdchat
RichmondDoc
@nickdawson Even provider organizations typically underwriteCME from PhRMA $--including AAPF, VAFP, Peds organizations,etc. #MDchat
nickdawson @healthewoman thanks. Understand the concern now. #mdchat
Mtnmd RT @mdTalk @DrJenGunter At Kaiser no pharma involvement inCME (NCal) #MDchat http://bit.ly/ew8O6L
peds_id_doc@GailZahtz #mdchat T1 - it matters if the peer review is paid for
by the drug manufacturer...how much can you trust it?
RichmondDoc
T1 As CME moves increasingly on-line, MDs could access goodprograms at low cost. But some amount of in-person CMErequired. #MDchat
EinsteinMed
@apjonas Reimbursement structure means too few docs havetime to counsel pts on diet/ nutrition amp; monitor themeffectively. Sadly #MDchat
peds_id_doc
@healthewoman #mdchat T1 - Me too, but even there I findplenty of drug-funded CME. Easy to ignore emails, harder to avoidif less obvious
Mtnmd
@apjonas @EinsteinMed #MDchat That is what the books say to
do, but very few do it. Too much enthusiasm for HMG CoA RedInhib.
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RichmondDoc
@Mtnmd @peds_id_doc I rely on Medical Letter, Prescriber'sLetter for info on new treatments/Rx: no industry support(subscription). #MDchat
nickdawson
@EinsteinMed @apjonas off topic, agree with your assessment of
reimbursement structure. Hope for change with reform/ACOs?#mdchat
GailZahtz
@peds_id_doc Exactly my question. Aren't we really talkingabout paid md presentations- they have an ethical duty inresearch #mdchat
apjonas
T1 NO we aren't learning the right stuff dt $ incentives in system(I just lost 2% bonus from Anthem for not statinizing pts)
#MDCHAT #mdchat
DrJenGunterI have seen docs who promote their pharma relationsip !#MDchat
Mtnmd
@GailZahtz YES That is the point. Saw huge blitz on TV re: choldrugs saving country. Next day vitamins will kill U -sameauthor.. #MDchat
GailZahtz
RT @Mtnmd: @GailZahtz YES That is the point. Saw huge blitzon TV re: chol drugs saving country. Next day vitamins will kill U-same author.. #MDchat
EinsteinMed
RT @apjonas: T1 NO we aren't learning the right stuff dt $incentives in system (I just lost 2% bonus from Anthem for notstatinizing pts)#MDCHAT #mdchat
RichmondDoc
T1 Generally speaking, more PhRMA contact leads to care
decisions that tend *not* to favor pts; hence, less contact is betterIMHO. #MDchat
peds_id_doc
@GailZahtz #MDchat T1 - yes, ethical obligation to do it right, andsome I'm sure do that, but have they be inadvertently biasedtoo...?
Mtnmd
@GailZahtz @peds_id_doc There is TONS of marketing theory atthe heart of it. Recent reports outline how this works. Drs not
immune.#MDchat
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drsteventucker@EinsteinMed And most docs have no serious training in lifestylemgmt or nutrition. Drugs though r easy for us :( #mdchat
peds_id_doc @DrJenGunter #mdchat T1 - docs promoting pharma ties - scary!
apjonas
T1 CME is victimized by slick Dogma Merchants w/big pharma
$. Docs like comfort. No CME about $4 drugs, good/bad/ugly ones#mdchat #mdchat
Mtnmd
@RichmondDoc @peds_id_doc #MDchat Those are greatsources! I would say still influenced by the social norm, butMUCH less.
GailZahtz
@peds_id_doc I'm not sure what you mean by inadvertantly biased. I believe ethical MD's are ethical regardless of funding
#mdchat
RichmondDoc
@Mtnmd @GailZahtz @peds_id_doc Some of our colleagues would like to believe they're immune to influence, though nottrue. #MDchat
drsteventucker@Mtnmd @GailZahtz @peds_id_doc Docs not immune equalsDocs highly influenced! #mdchat
RichmondDoc
@Mtnmd @peds_id_doc I think they're the best options for new meds and Rx review; not perfect, but centralize info as it develops.#MDchat
nickdawsonT1 for patients, is there an easy way to discover close ties topharma, device, et al? Any kind of registry or reporting? #mdchat
Mtnmd
RT @RichmondDoc T1 gt;PhRMA contact leads 2 care decisionstht tend not 2 favor pts; hence,lt;contact is better IMHO.
#MDchat
DrJenGunter
Have seen one who allowed advertising an web site! -gt; RT“@peds_id_doc: @DrJenGunter #mdchat T1 - docs promotingpharma ties - scary!”
Mtnmd@drsteventucker @GailZahtz @peds_id_doc Exactamundo! :)#mdchat
RichmondDoc
@nickdawson ProPublica launched their Dollars for Docs
database; seems to be the best available public option for now.#MDchat
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apjonas
T1 Since the research is getting polluted, CME about it smells butcovered up by free meal and power of print and evenEBM#mdchat #mdchat
mkmackey @nickdawson many listings available publicly for this #mdchat
RichmondDoc@nickdawson http://www.propublica.org/topic/dollars-for-doctors/ #MDchat
Mtnmd@nickdawson #MDchat Recent studies indicate recommendedguidelines for reporting conflict are not being followed
GailZahtz
@RichmondDoc @Mtnmd No-one is immune when $ is involved.So all need to take a hard look at motive BEFORE making match.@peds_id_doc #mdchat
peds_id_doc@RichmondDoc #mdchat T1 - I THINK I'm immune...but becauseI'm not CERTAIN, this is why I'm leery of the whole thing. ;o)
RichmondDoc@nickdawson T1 eventually the Sunshine Act will require morepublicity and more active reporting, but not in place yet. #MDchat
Mtnmd@DrJenGunter @peds_id_doc #MDchat They are so used to it, itis like blue on a blue wall.
DrJenGunter T1 know of a doc who let pharma sponsor book tour #MDchat
GailZahtz
RT @drsteventucker: @Mtnmd @GailZahtz @peds_id_doc Docsnot immune equals Docs highly influenced! #mdchat lt;=Yes r uimplying docs r human?:)
EinsteinMedPts get suspicious /annoyed when they see pharma reps in doc
waiting rooms and stacks of rx samples in full view. #MDchat
NoirPride
Oh no ! RT @AmJNurs: RT @pfanderson: #Pharma ghostwriting
clinical TEXTBOOKS? http://is.gd/ijjww #hcsm #mdchat#rnchat #ptsafety
RichmondDoc
RT @peds_id_doc: @RichmondDoc T1 - I THINK Im immune... but because Im not CERTAIN, this is why Im leery of the wholething. [Ditto!] #MDchat
drsteventucker@nickdawson There is a new registry for honoraria, etc. Anyoneknow the link? #mdchat
peds_id_doc@Mtnmd @nickdawdon #mdchat T1 - really, I'm shocked. :-| lt;--shocked face, not
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GailZahtzOn the flip side- is there an appropriate place where everyonefeels comfortable with pharma in research or CME? #MDChat
Mtnmd@GailZahtz #MDchat I really like online CME as it is direct, to thepoint and I can choose topic, vendor.
nickdawsonRT @EinsteinMed: Pts get annoyed when they see pharma reps indoc waiting rooms and stacks of rx samples in full view. #mdchat
peds_id_doc
@GailZahtz @mtnmd #mdchat T1 - I have written stuff for onlineCME, entirely self-created and NON-Pharma related. Just goodmedicine.
EinsteinMed
@drsteventucker re: lack of sufficient nutrition training. Recentstudy in Academic Medicine lays it out: http://bit.ly/gvRequ
#MDchat
GailZahtz
RT @peds_id_doc: @GailZahtz @mtnmd #mdchat T1 - I have written stuff for online CME, entirely self-created and NON-Pharma related. Just good medicine.
drsteventucker@GailZahtz Pharma does nealry all the clinical research - notcomfy with that thought either. #mdchat
DrJenGunter Practices should promote if pharma free, no? #MDchatGailZahtz @peds_id_doc Where could we find it? #MDChat
healthewoman
@GailZahtz @Mtnmd Quality on-line CME available via Boardrecertification and specialty societies, e.g. ABOG/ACOG T1#MDchat
Mtnmd@peds_id_doc @GailZahtz #MDchat Where did you publish? W/a CME company?
GailZahtz
RT @healthewoman: @GailZahtz @Mtnmd Quality on-line CMEavailable via Board recertification and specialty societies, e.g. ABOG/ACOG T1 #MDchat
murzee
Funds 65% of all research RT @drsteventucker: @GailZahtzPharma does nealry all the clinical research - not comfy with thatthought #mdchat
DrJenGunter
@GailZahtz If pharma wants cleanest research should give
unrestricted grant #MDChat
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peds_id_doc
@GailZahtz #mdchat T1 - Pharma funded research is sadly needed, lack of grants from elsewhere, and of course for FDA approval
GailZahtz
RT @murzee: Funds 65% of all research RT @drsteventucker:
@GailZahtz Pharma does nealry all the clinical research - notcomfy with that thought #mdchat
apjonas
T1 Reps nice people. Samples new! drugs sometimes helpful inisolated places (like every private office). But not needed by mostpts #mdchat
MD_Chat OK, next topic coming up in a few moments! #MDchat
GailZahtz
@DrJenGunter I think for the most part, pharma does want clean
research. At least clean enough to pass FDA ;) #MDChat
Mtnmd@healthewoman #MDchat HA, then we have to get on to topic of
board cert! That was hot topic on Sermo this week. :)
drsteventucker@EinsteinMed Great link! Sad and sobering as it is. Thanks andsend me what you read! #mdchat
murzee
Agree w COI, but where is WIIFM? RT @DrJenGunter:@GailZahtz If pharma wants cleanest research should giveunrestricted grant #mdchat
peds_id_doc
@Mtnmd @gailzahtz #mdchat T1 - I've written things for WebMD/eMedicine. Had to get the article/quiz approved but itcame out as expected
RichmondDoc
@apjonas But samples are a false economy, esp for chronic meds.Can get pts hooked on meds that are expensive over time.
#MDchat
GailZahtz
@peds_id_doc If pharma funding is needed, and they're giving it,isn't there a way everyone can feel okay about it? Research is nec#MdChat
drsteventuckerRT @EinsteinMed: RE: insufficient nutrition training. Recentstudy in Acad Med lays it out: http://bit.ly/gvRequ #mdchat
EinsteinMed
Empowered pts do, but not others RT @RichmondDoc:
@EinsteinMed Pts *should* be willing to ?? docs if PhRMA repsin waiting room. #MDchat
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murzee
FDA research irrelevant tho RT @GailZahtz: @DrJenGunter ...pharma does want clean research. At least clean enough to passFDA ;) #mdchat
DrJenGunter
many pharma studies are me too isomers that only serve to
extend patent when combined with Nexium style marketing#MDchat
MD_Chat
T2 Aspirin Effect on CA: Lancet reports it may lower % of certaincancers. #MDchat How will u discuss w Patients? See http://bit.ly/eBAgZ2
apjonasHow does anti-rep reconcile with pro-new drug research position?How about anti/anti or pro/ pro? T3 #mdchat #mdchat
peds_id_doc
@drsteventucker @gailzahtz #mdchat T1 - clinical trials HAVE to be industry funded, they make money for the company in the longrun
murzee Need to separate pharma research from marketing in #mdchat
drsteventucker@peds_id_doc @GailZahtz Cynical question: How much betteroff are we w/ Pharma? Cost:benefit wise? Case studies? #mdchat
murzee
RT @DrJenGunter: many pharma studies are me too isomersthat only serve to extend patent when combined with Nexiumstyle marketing #mdchat
RichmondDoc
@GailZahtz @peds_id_doc If there is need for PhRMA $, thenunrestricted grants are the best of the bad options. Still sketchy,tho. #MDchat
peds_id_doc
@GailZahtz @drjengunter #mdchat T1 - yes, has to pass FDA
muster. FDA trial audits are damn tough.
DrJenGunterRT “@BurbDoc: @DrJenGunter Me-too Isomers = Asshattery”#MDChat
peds_id_docRT @DrJenGunter: @GailZahtz If pharma wants cleanestresearch should give unrestricted grant #MDChat
mkmackey T1 Samples intended for new prescribing patients to ensure nodrug allergies, interactions - good intentions #mdchat
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GailZahtz
@drsteventucker @peds_id_doc If over half the funding isindustry, and we need more funding, I think we have to make it
work #MDChat
apjonas
@RichmondDoc @apjonas Working poor used to get atb samples,
now $4 generic. No one gives samples for chronic use unlessidiot.?? #mdchat
drsteventucker@RichmondDoc @apjonas Hooked on Avastin, Herceptin,Rituxan - maintenance therapies!!! $$$ #mdchat
DrJenGunter
RT “@yayayarndiva: @DrJenGunter have y'all seen the show,The Doctors? Glitzy informercial masquerading as education#MDChat
RichmondDoc
@apjonas T3 I think PhRMA drastically over-estimates itsRamp;D costs; have not been able to pin down how much $actually goes there. #MDchat
Mtnmd
@drsteventucker @EinsteinMed #MDchat Yes, Drs get 2 hours of biomed nutrition, no clinical at all, usually. No wonder they areuncomfortbl
fentonslee
RT “@yayayarndiva: @DrJenGunter have y'all seen the show,The Doctors? Glitzy informercial masquerading as education#MDChat
GailZahtzRT @peds_id_doc: @GailZahtz @drjengunter #mdchat T1 - yes,has to pass FDA muster. FDA trial audits are damn tough.
apjonas T1Rumor is that it is fading in interest#mdchat #mdchat
DrJenGunter
T3 pharma LOVES to talk up R and D what about $70 million
CEO salaries? #MDChat
drsteventucker@MD_Chat Jury is in on that (then out, then in)...Advise commonsense approach, identify those not suitable first #mdchat
RichmondDocT2 Notice that the presentation doesn't report how many peoplemight end up with GI bleeds, intracranial bleeds, etc? #MDchat
EinsteinMed
@CarlyRM Absolutely true . Samples are free/fast which makespts/docs happier. But can contribute to antibiotic resistance
#MDchat
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peds_id_doc
@GailZahtz #MDchat T1 - as @drjengunter said, unrestrictedgrants (including unrestricted publications without pre-screening)
would be gr8
GailZahtz
@drsteventucker @peds_id_doc Cynical conversation...it doesn't
seem there's a choice- so it goes on the med-comm to keep itethical #MDChat
DrJenGunter
RT @peds_id_doc: @GailZahtz #MDchat T1 - as @drjenguntersaid, unrestricted grants (including unrestricted publications
without pre-screening) would be gr8
murzeeT2: risk-benefit analysis needed, as in everything. Cheap drug, yet
AEs not clear and who can benefit not clear. #mdchat
apjonas
T1 CME good Q cause it ties in all the other phoniness. Ethicalsensitivity=NO FREE LUNCHES and confronting peers repharma #MDCHAT #mdchat
RichmondDocT2 really hard for me to determine how this might change ASA Rx
w/o knowing the possible AEs/harm resultant from it. #MDchat
peds_id_doc
@DrJenGunter #mdchat T3 - Ramp;D funding includes clinicaltrial costs, which include expensive investigator meetings at 5*resorts...
murzee
T1: Pharma funding not black/white. US has decided to keephealthcare in market model. Hard to restrict one sector, no?#mdchat
peds_id_doc@DrJenGunter #mdchat T3 - ...also study participant payments,could be hundreds of bucks per pt. ethical dilemma there also...
GailZahtz
Regardless of pharma, most Doc use drugs which were arehospital formulary in the places where they started/ are now?#MDChat
DrJenGunter
RT @peds_id_doc: @DrJenGunter #mdchat T3 - Ramp;Dfunding includes clinical trial costs, which include expensiveinvestigator meetings at 5* resorts...
drsteventucker
@RichmondDoc T2 - I was told, have not read, that bleeding
issues assessed in article and pale in comparison to cancerreductions? #mdchat
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RichmondDocT2 I think the best way to deal w/ ASA Rx is to follow the currentCVD recs and consider in pts w/ higher risk CA. #MDchat
peds_id_doc@GailZahtz #mdchat Yes, we tend to prescribe what we're mostfamiliar with. Pharm influence aims to change that familiarity.
RichmondDoc@drsteventucker T2 It might be in there, not in the abstract or theconclusion. I'll try to read more as time allows. #MDchat
GailZahtz
@peds_id_doc Yes, unrestricted grants would be great! Who'sgoing to pay for it? Pharm won't unless forced to. @drjengunter#MdChat
EinsteinMed
T2: Pts who take low-dose #aspirin long term (decades!) wantanswer: How do you predict/prevent gastro bleeds before they
occur? #mdchat
apjonas
RT @murzee: T2: risk-benefit analysis needed, as in everything.Cheap drug, yet AEs not clear and who can benefit not clear.#mdchat
Mtnmd
RT @RichmondDoc T2 I think the best way to deal w/ ASA Rx isto follow the current CVD recs and consider in pts w/ higher risk CA. #MDchat
murzee
Pales in comp to RCT costs! RT @DrJenGunter @peds_id_docDrJenGunter #mdchat T3 - Ramp;D ... investigator meetings at5* resorts... #mdchat
GailZahtz
RT @peds_id_doc: #mdchat Yes, we tend to prescribe what isfamiliar Pharm influence aims to change that lt;=Changing ascript for free coffee?
RichmondDoc @apjonas Some pharmacies give *free* Abx Rx. A lot of folks stillattracted to samples for chronic meds... #MDchat
Mtnmd
T2/T1 These two questions are connected. Why wasn't thereMultiM$ study done on grape seed extract and ca prevention?Pharm $ #MDchat
drsteventucker
@RichmondDoc While I am for aspirin the CVD guidelines are agood read. Less benefit than we think, esp in primary prevention
#mdchat
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DrJenGunterOf course, FDA also needs to ban direct to consumer advertising(that's like biased CME for patients) #MDchat
drsteventucker@EinsteinMed Same way I predict who is going to get GI relatedmalignancy! ;) #mdchat
DrJenGunter I think there can be responsible pharma funding, rules needed likeno fancy off site investigator meetings! #MDchat
peds_id_doc
@GailZahtz @drjengunter #mdchat T3 - ironically, investigatorpayments from RCTs often go to fund self-directed research!That's cool, IMHO.
drsteventuckerRT @EinsteinMed T2: Same way I predict who is going to get GIrelated malignancy! ;) #mdchat
murzee
RT @RichmondDoc: @apjonas Some pharmacies give *free* AbxRx. A lot of folks still attracted to samples for chronic meds...#mdchat
RichmondDoc@drsteventucker T2 Agree: use of ASA in CVD prevention has
been scaled back some b/c of risk/benefit analysis. #MDchat
lizditz
RT @DrJenGunter: Of course, FDA also needs to ban direct toconsumer advertising (that's like biased CME for patients)#MDchat YES
DrJenGunter
@Mtnmd bc the companies making grape seed extract don't wantthe risk of bad outcome or making claims, otherwise need FDA involv. #MDChat
peds_id_doc
@murzee @drjengunter #mdchat RCT costs are odd though -include payments to patients and investigators. Ive brought in
100's of k's for dept
EinsteinMed
T2: Thoughts? @TIME on prophylactic use of aspirin for those athigh risk of developing cancer early. http://bit.ly/g97eoH#MDchat
GailZahtz@murzee @RichmondDoc @apjonas Med costs are a big issue forchronic patients. Samples aren't nec bad for pts. #MdChat
Mtnmd
RT @lizditz: RT @DrJenGunter: Of course, FDA also needs to ban
direct to consumer advertising (that's like biased CME forpatients) #MDchat YES
8/8/2019 MDchat Transcript December 7, 2010
http://slidepdf.com/reader/full/mdchat-transcript-december-7-2010 17/21
RichmondDoc
RT @DrJenGunter: Of course, FDA also needs to ban direct toconsumer advertising (thats like biased CME for patients)#MDchat
peds_id_doc
RT @lizditz: RT @DrJenGunter: Of course, FDA also needs to ban
direct to consumer advertising (that's like biased CME forpatients) #MDchat YES
DrJenGunter@GailZahtz samples exist to get patient hooked and make the sale#MDChat
RichmondDoc
@GailZahtz @murzee @apjonas Giving for samples for pts on Rxis one thing, but PhRMA wants us to use them to start pts on high$ Rx. #MDchat
murzee@GailZahtz @murzee @RichmondDoc @apjonas Free abx not sogood:low threshold --gt; resistance #mdchat
Mtnmd@DrJenGunter #MDChat There are good in vitro studies, etc, costis absolutely prohibitive as system exists.
PASlave
RT @DrJenGunter: many pharma studies are me too isomersthat only serve to extend patent when combined with Nexiumstyle marketing #MDchat
RichmondDoc
@murzee @GailZahtz @apjonas Totally agree: not endorsing thepractice, but noting that necessary Rx can be low cost if needed.#MDchat
EinsteinMed@nickdawson That's when it's time to hit the door.... re:lunch/pens standing b/w you and ur doc! #MDchat
drsteventucker
RT @RichmondDoc: @GailZahtz @murzee @apjonas There is no
free lunch #mdchat
peds_id_docRT @murzee: @GailZahtz @murzee @RichmondDoc @apjonasFree abx not so good:low threshold --gt; resistance #mdchat
murzee
RT @GailZahtz: @murzee @RichmondDoc @apjonas In my exppts r rarely reimbursed 4 participating. amp; market dictates RCTcosts #mdchat
DrJenGunter
@Mtnmd in vitro does not = in vivo and many naturals have failed
randomized trials. No incentive for natural manufac. To go legit#MDChat
8/8/2019 MDchat Transcript December 7, 2010
http://slidepdf.com/reader/full/mdchat-transcript-december-7-2010 18/21
MD_ChatOur hour is almost up. As you tie up the second topic, give us yourparting thoughts! #MDchat
GailZahtz
@RichmondDoc @DrJenGunter Sounds like there are strong benefits and deterrents. Free Rx not black amp; White @murzee
@apjonas #MDChat
murzee
2 think otherwise is naive, agree RT @drsteventucker: RT@RichmondDoc: @GailZahtz @murzee @apjonas There is no freelunch #mdchat
Mtnmd
RT @DrJenGunter @PASlave many pharma studies R me tooisomers -only serve2 extend patent when combined w/ Nexiumstyle marketing #MDchat
apjonas
@GailZahtz @murzee @RichmondDoc @apjonas drug not bad but setting up pt to be on pricy rx not good. Free to poorpharma pgm soln #mdchat
RichmondDoc
RT @DrJenGunter: many pharma studies are me too isomersthat only serve to extend patent when combined with Nexiumstyle marketing #MDchat
apjonasRT @drsteventucker: RT @RichmondDoc: @GailZahtz @murzee@apjonas There is no free lunch RIGHT ON! #mdchat
murzee@GailZahtz @RichmondDoc @DrJenGunter @murzee @apjonasNothing is black and white, that is my point #mdchat
GailZahtz
RT @murzee: @GailZahtz @RichmondDoc @DrJenGunter@murzee @apjonas Nothing is black and white, that is my point#mdchat lt;=Agree 100%
RichmondDoc
@apjonas @GailZahtz @murzee But God forbid those companiesever choose to end or change their programs: indenturedpatients? #MDchat
drsteventuckerParting thought: Patients amp; Docs must exercise personalresponsibility for health amp; costs. Eat less, save more. #mdchat
EinsteinMed
@DrJenGunter Re: samples. Convenience factor huge , esp re:meds 4 non-chronic conditions. One-stop shopping 4 pts. Not all
bad. #mdchat
8/8/2019 MDchat Transcript December 7, 2010
http://slidepdf.com/reader/full/mdchat-transcript-december-7-2010 19/21
murzee@RichmondDoc @apjonas @GailZahtz Still like the market modelof healthcare? :) #mdchat
RichmondDoc
Final thoughts: as physicians our duty is to our PATIENTShealth/safety/wellness. Any/all PhRMA contact must be in that
context. #MDchat
MTw1tter
@drsteventucker But would people do that eat less, save moreduring festive seasons such as Christmas/New Year/Chinese New
Year? #mdchat
GailZahtz@RichmondDoc There's always baby aspirin and fish oil (joking-grin) @apjonas @murzee #MDChat
peds_id_doc
#mdchat parting thoughts - pharma funding is a necessary evil ,
but one that need not adversely impact pt care if we're all aware of issues
Mtnmd #MDchat Heading into meeting. Thanks for interesting chat!!
peds_id_doc
RT @RichmondDoc: Final thoughts: as physicians our duty is toour PATIENTS health/safety/wellness. Any/all PhRMA contactmust be in that context. #MDchat
RichmondDoc @murzee @apjonas @GailZahtz Never said I did! #MDchat
GailZahtzFinal thought- I err on the side of giving physicians more creditthan being sold our for free coffee #MDChat
apjonas
RT @drsteventucker: Parting thought: Patients amp; Docs mustexercise personal responsibility for health amp; costs. Eat less,save more. #mdchat
peds_id_doc
#mdchat - thanks everyone, as usual stimulating conversation and
some great thoughts and ideas :o)
BurbDoc
RT @lizditz: RT @DrJenGunter: Of course, FDA also needs to bandirect to consumer advertising (that's like biased CME forpatients) #MDchat YES
murzee
RT @drsteventucker: Parting thought: Patients amp; Docs mustexercise personal responsibility for health amp; costs. Eat less,save more. #mdchat
murzee @drsteventucker Agree, less is definitely more! #mdchat
8/8/2019 MDchat Transcript December 7, 2010
http://slidepdf.com/reader/full/mdchat-transcript-december-7-2010 20/21
GailZahtz
#MDChat thanks for another great chat! It goes so quickly. Feelfree to be in touch during week, though all our schedules arecrazy.
apjonas
Physicians: emphasize Kick Ass Ethical Sensitivity at all times.
Be ready to hug a colleague into freedom from pollution #mdchat#mdchat
murzeeThanks, all! Sorry to have missed the 1st 1/2, but really enjoyedthe 2nd! #mdchat
MD_Chat
Well, that was energizing! THANK you everybody, as always!Transcript will be up later. Next #MDchat same time next week! -@PhilBaumann
<<<OFFICIAL END OF CHAT>>>
<<<FOLLOW-UP CHATTER>>>
drsteventuckerThanks everyone and @MDchat - Goodnight from steamy Singapore #mdchat
chpisyianymes
@mdchat BlazeonMARZ crylat ddChefMom Wht u drink?RTiamshesheisrida: Omg I'm tipsy! Its gonna be a long night. Lolhttp://ciqf.t6h.ru/cbKXC
EinsteinMed
FT: More transparency /private/govt $ needed for CME. As we'veseen with meds for BP, s/times older, cheap generics work best.#MDchat
apjonas @MD_Chat Thanx for great Q and leadership! #mdchat
murzee@GailZahtz Some studies show that a branded pen is enough tochange rx practices - all ab relationships IMO #mdchat
murzee @MD_Chat @PhilBaumann Thanks, Phil! #mdchat
napernurse
RT @Mtnmd: @healthewoman #MDchat right on, it is amazinghow effective simple measures, rather than pharms are for MANY of pts conditions.
apjonas @murzee You caught up nicely #mdchat
8/8/2019 MDchat Transcript December 7, 2010
http://slidepdf.com/reader/full/mdchat-transcript-december-7-2010 21/21
GailZahtz
RT @murzee: @GailZahtz Studies show a branded pen is enoughto change rx practices -all ab relationships IMO #mdchat lt;=Peer-reviewed? LOL
RichmondDoc Good night, all. Have a great week! #MDchat
EinsteinMed
Great volley 2nte. Hour flew by. Look forward to next Tues. night.Have a gr8 week. Thx @PhilBaumann for organizing. #MDchat#hcsm
murzee @GailZahtz yup, peer-reviewed, in JAMA #mdchat
chinitafuriosa
RT @RichmondDoc: Final thoughts: as physicians our duty is toour PATIENTS health/safety/wellness. Any/all PhRMA contactmust be in that context. #MDchat
whoashutit_down
RT @lizditz: RT @DrJenGunter: Of course, FDA also needs to bandirect to consumer advertising (that's like biased CME forpatients) #MDchat YES
whoashutit_down
RT @DrJenGunter: many pharma studies are me too isomersthat only serve to extend patent when combined with Nexiumstyle marketing #MDchat
MD_Chat @apjonas My pleasure - thanks for participating! #MDchat
philbaumann @EinsteinMed Thanks! Gr8 to have you contribute! #MDchat
EinsteinMed
Final FT: Remembering Elizabeth Edwards and her conviction onhealthcare reform via @AHCJ_Pia http://bit.ly/e37XSA #MDchat#hcsm #epatients
napernurseRT @Mtnmd: #MDChat We are missing out on a huge number of effective treatments who don't have deep pockets.
EinsteinMed
@PhilBaumann Always a learning/sharing experience. Sincetweeting my emails have gotten a lot shorter! Pos. side effect.#MDchat