mdchat transcript december 7, 2010

8/8/2019 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



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



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



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?



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.



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



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



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



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



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



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



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



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



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



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



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



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


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



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



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



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


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

mdchat transcript december 7, 2010

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