Transcript of #MDchat for November 30, 2010

Follow @MD_chat for Regular Updates

Twitter.com/MD_chat
MDchat.org

Topics:
T2 IOM report on Vit D & Ca: How does this impact pt education? How do you
Topic 1 (T1) deal with conflicting/shifting recommendations?

T2 Sugar: How ramifying is the sugar in our food chain on health? Strange as it
Topic 2 (T2) sounds: might we need a policy on sugar?

Chat:
For tonight's #MDchat at 9pm, article on Vit D Calcium for one of the topics:
philbaumann http://ow.ly/3hSnb
Welcome to #MDchat! If you're new, feel free to join or just watch. We'll start
MD_Chat soon, but first introduce yourselves!
Good evening, all. Family doc in #RVA; multi-tasking as usual, but here to
RichmondDoc participate in #mdchat
OK, first topic coming up in a minute! When responding to a topic, please
MD_Chat prepend tweet with T1, T2, etc. Good luck! #MDchat
MD_Chat @RichmondDoc Good evening! #MDchat (Might be a slow start - we'll see ;)
T1 IOM report on Vit D Ca: How does this impact pt education? How do you
MD_Chat deal with conflicting/shifting recommendations? #MDchat
RichmondDoc @MD_Chat We shall see. I can monologue for a while if needed. #mdchat
RT @MD_Chat: T1 IOM report on Vit D Ca: How does this impact pt
mkmackey education? How do you deal w conflicting/shifting recommendations? #mdchat
http://j.mp/d5Z8gi @RichmondDoc Good evening, all. Family doc in #RVA;
healthgist multi-tasking as usual, but here to participate in #mdchat
 T1 As a health care provider, I think we need to be honest w/ pts when we're
RichmondDoc uncertain, when recs change, etc. #mdchat
T1 Complicated for oncologists since AI's (eg Arimidex) cause osteop. Data
rsm2800 lacking. We see many pts on megadose Vit D from PCP's #mdchat
T1 I think the IOM Vit D and calcium announcement simply highlights the need
RichmondDoc to keep on top of recs, admit uncertainty when present. #mdchat
chukwumaonyeije @GailZahtz Welcome to #mdchat
@MD_Chat Hi. Is the chat closed to MD's only? I'm involved w/ other med
GailZahtz chats from health communications w/a startup #hcsm project #mdchat
T1: Recommendations of any form are just that. Recommendations. Not
chukwumaonyeije commandments. They can change and vary dep on situation #mdchat
@GailZahtz #MDchat - I don't think you can 'close' anything on twitter to anyone
peds_id_doc :o) Welcome! We have students, nurses, other folks here
T1 I'm not that sure that the IOM report is all that definitive. Levels below 32
RichmondDoc result in increased markers of bone disease... #mdchat
GailZahtz @chukwumaonyeije Thank you! #mdchat
#mdchat Heyup. Not sure I know much about Vit D but I can chip in :) Peds ID
peds_id_doc Fellow from Upstate NY
T1 There is *correlation* between low vit D and other illnesses, but not
RichmondDoc causation. But the bone health seems reliable. #mdchat
murzee Hello, everyone. T1? #mdchat
@peds_id_doc While you can't close things on twitter, I also want to be
GailZahtz respectful and not barge in :) #mdchat
T1 ... but the IOM used a cut-off of 20. I think aiming to get above 32 is good for
RichmondDoc bones, can't promise other benefits. #mdchat
PAFPStudents So my med school nutrition notes are outdated again! #mdchat #MDchat
Forgot my intro.... Chuck Onyeije Maternal-Fetal Medicine specialist. Part time
chukwumaonyeije Android developer. Nerd. #mdchat
peds_id_doc @GailZahtz #mdchat [tip of the hat] but of course ;)
@PAFPStudents Sadly, that's going to be true for the rest of your medical career.
RichmondDoc #mdchat
T1 #mdchat Have not read the IOM report, will add it to my long Kindle list of
MaverickNY reading materials
 Hello Dr. Pierrette Mimi Poinsett unemployed pediatrician since 5/08, federal UI
yayayarndiva benefits cut off today #99er #mdchat
@PAFPStudents #mdchat T1 my immunology med school notes were outdated
peds_id_doc by the first lecture (no joke!)
@RichmondDoc Ah yes. Correlation vs. Causation. The bane of my existence...
chukwumaonyeije #mdchat
murzee Oh, The IOM report! The pendulum swings. #mdchat
@murzee T1 IOM report on Vit D Ca: How does this impact pt education? How
RichmondDoc do you deal with conflicting/shifting recommendations? #mdchat
#mdchat T1 I find if I don't understand it, how can I be expected to explain it to
peds_id_doc pts (and offer my own thoughts/opinions)...
Indeed! @murzee: In a multi-causality model there can be no panacea, tho' we
chukwumaonyeije want one #mdchat
@murzee IOM report, pendulum swings and interpretation/utilization of
chukwumaonyeije data/info sounds right up your alley... #mdchat
murzee In a multi-causality model there can be no panacea, tho' we want one #mdchat
#mdchat T1 I'm personally a little confused - I probably need to read the primary
peds_id_doc literature better, rather than derivative guidelines.
T1 I aim for Vit D levels above 32 b/c of the biochem markers and b/c it makes
RichmondDoc some sense; I wouldn't push any higher. #mdchat
murzee we have to think about the evolution -- nature is no fool #mdchat
RT @RichmondDoc: T1 As a health care provider, I think we need to be honest
ability4life w/ pts when we're uncertain, when recs change, etc. #mdchat
#mdchat T1 ...and therefore apply the guidelines in the proper context? medicine
peds_id_doc is an art after all, not (just) a science.
T1 I also realize this could be analogous to Vit B12 and homocysteine/MMA re: to
RichmondDoc vascular disease; might not bear out over time. #mdchat
Late to #MDchat Kathy Kastner, prepping for FamMed conference. Listening
ability4life mostly 2nite.But glad 4 discussion of VitD
T1 I'm intrigued by the research showing correlation of low Vit D and increased
RichmondDoc fall risk in elderly--but don't Rx for that reason. #mdchat
RT @RichmondDoc @murzee T1 How does this impact pt education? <=Isn't
GailZahtz this an issue with any info pts get outside of treating MD? #mdchat
 #mdchat: I would also add that the search for a panacea has lead medicine
chukwumaonyeije astray many times before #mdchat @murzee @RichmondDoc
When we get into small incremental differences at the margins, uncertainty
murzee grows. Things we know for sure: Smoking, asbestos --> CA #mdchat
@yayayarndiva welcome to #mdchat :o) The issue of the #99ers is close to
peds_id_doc home...I feel for you.
RT @RichmondDoc: T1 I'm intrigued by the research showing correlation of low
ability4life Vit D and increased fall risk in elderly--but don't Rx for that reason. #mdchat
T1: The IOM should study Vit D Levels in med students/residents - we need to
PAFPStudents get out more. Which recs will we get pimped on? #mdchat #MDchat
Does vit D prevent CA? Maybe at the margins, but the big diff is to eliminate
murzee smoking, other carcinogens, no? #mdchat
chukwumaonyeije @murzee Absolutely. #mdchat. Many elephants in the room before Vit. D defic.
@peds_id_doc sad but feelins are not going to pay for my food, shelter, gas, job
yayayarndiva search- I am so over this #mdchat #99ers
@ability4life Hi Kathy. Sidebar hi- don't want to disrupt conversation. Hope
GailZahtz things are going well for you in CA :) #mdchat
RT @RichmondDoc: research showing correlation of low Vit D and increased fall
ability4life risk in elderly--but don't Rx 4that reason. #mdchat #seniors
Evening all, glad to be here. The IOM should be ashamed, they had NO Vit D
sarasteinmd experts on the panel didnt use the draft critiques #mdchat
I'm concerned about jumping on a therapeutic bandwagon (eg. estrogen
chukwumaonyeije replacement) even with seemingly strong studies. #mdchat
@gailzahtz It's totally open! We want physicians' voices to breath of course - but
MD_Chat it's a fully public commons. #MDchat - Cheers! - Phil
@GailZahtz @murzee True--we need to cognizant of how we discuss/review info
RichmondDoc w/ pts for any condition/illness, etc. Be open/honest. #mdchat
Also, these pendulum swing are inefficient way of assimilating info. Need more
murzee middle ground and better rules. #mdchat
T1: So how do we address sexy study results in the media with patients..
chukwumaonyeije @RichmondDoc: @GailZahtz @murzee #mdchat
We need to do a better job educating public ab uncertainty in clinical research.
murzee #mdchat
 @PAFPStudents #mdchat T1 pimping is never the real issue - the real issue is
peds_id_doc what do the folks end up prescribing/testing for!
@chukwumaonyeije @GailZahtz @murzee I do a lot of shoulder-shrugging and
RichmondDoc then try to highlight the uncertainty inherent in all this. #mdchat
Education re uncertainty! RT @chukwumaonyeije: T1: So how do we address
murzee sexy study results in the media with patients.. #mdchat
@sarasteinmd I agree. The fact is Vit D deficient pts can be replenished easily
drpoppyBHRT w/minimal side effects potential benefit #mdchat
We also need better risk data to balance with benefits -- need better education on
murzee risk analysis/perception #mdchat
RT @GailZahtz: @RichmondDoc My question was more- isn't the conflicting
report pt comm indicative of a larger problem of pt comm in online age?T1
ability4life #mdchat
@RichmondDoc My question was more- isn't the conflicting report pt comm
GailZahtz indicative of a larger problem of pt comm in online age?T1 #mdchat
@murzee In many cases when I discuss risk I use charts/graphs/slides. Works
chukwumaonyeije for some learning styles. Sadly not all... #mdchat
@GailZahtz @RichmondDoc Not just pt comm, all science comm -- need better
murzee literacy #mdchat
RT @EinsteinMed: Study shows #obese women more likely to develop #ER
positive breast cancer recurrence and die from it. High insulin levels suspected.
napernurse #MDchat
socmed is the perfect way to address silly media reporting or silly research. I
sarasteinmd comment on newsblogs, tweet, run FB info site #HCSM #mdchat
Whose perception?RT @murzee: We also need better risk data to balance with
ability4life benefits need better education on risk analysis/perceptin #mdchat
@peds_id_doc T1 It is an issue b/c when attending docs don't agree w/ the
PAFPStudents evidence/lack of, there's not much we can do about it #MDchat
@murzee One study does not overshadow thousands of other studies with
drpoppyBHRT countering information. #mdchat
Amen 2 that RT @murzee: @GailZahtz @RichmondDoc Not just pt comm, all
ability4life science comm -- need better literacy #mdchat #hcsm #hcsmca
murzee @ability4life Public risk perception -- many studies show it is distorted #mdchat
 @chukwumaonyeije Perhaps opportunities for MD's themselves to discuss new
GailZahtz research online would benefit all md's pt communication? #mdchat
@drpoppyBHRT @murzee here's the first of many responses to the IOM study
sarasteinmd section. http://bit.ly/hjkOpA sad to doubt their integrity #mdchat
@PAFPStudents T1 #mdchat that's when you pull out the literature and educate
peds_id_doc the attendings --> bonus marks (at least where I work)
@chukwumaonyeije We need large scale education in addition to individual
murzee encounter #mdchat
Thnx. 4 clarifctn AbsolutelyRT @murzee: @ability4life Public risk perception --
ability4life many studies show it is distorted #mdchat #hcsmca#hcsm
RT: @murzee @GailZahtz @RichmondDoc Not just pt comm, all science comm
GailZahtz -- need better literacy <=AGREE think its possible #mdchat
@ability4life @RichmondDoc But wouldn't that correlation make it worth doing
AureliaCotta a blood test? Just in case? #mdchat
RT @RichmondDoc: @GailZahtz I think the issues of conflicting information and
GailZahtz patient comm can be addressed via SocMed. #mdchat <=AGREE
@murzee Not to mention professional education. There are new genetic risk
chukwumaonyeije tests which confuse seasoned MDs #mdchat
@PAFPStudents #mdchat T1 the real pain with guideline changes in the EXAMS
peds_id_doc - you have to ask yourself do they want the old or the new..?
RT @RichmondDoc: @GailZahtz I think the issues of conflicting information and
ability4life patient comm can be addressed via SocMed. #mdchat
RT @GailZahtz: RT: @murzee @GailZahtz @RichmondDoc Not just pt comm,
ability4life all science comm -- need better literacy <=AGREE think its possible #mdchat
@GailZahtz I think the issues of conflicting information and patient comm can
RichmondDoc be addressed via SocMed. #mdchat
RT @RichmondDoc: @GailZahtz I think the issues of conflicting information and
chukwumaonyeije patient comm can be addressed via SocMed. #mdchat
There is perception that benefits come w/o risk -- just look at the NLST trial, and
murzee the holy grail mentality ab that #mdchat
@AureliaCotta @ability4life I think following Vit D levels and aiming for
RichmondDoc appropriate levels re: bone health is fair game. #mdchat
 @chukwumaonyeije Do you think there is a lack of CME online? It appears that
GailZahtz there are many to help w/ issues like genetic risk.. #mdchat
@RichmondDoc I treat obesity and depression and chronic pain with vitamin D
sarasteinmd and have great success with all three #mdchat
@AureliaCotta @ability4life But I don't go higher than that as yet, and I don't
RichmondDoc promise any further benefits beyond bones. #mdchat
@peds_id_doc T1 Totally agreed Re: exams. Especially where they can make or
PAFPStudents break grades/board scores -puts a dent on residency app #MDchat
RT @sarasteinmd: @RichmondDoc I treat obesity and depression and chronic
ability4life pain with vitamin D and have great success with all three #mdchat
T1: IMHO many pts have an innate belief that vitamins can't possibly hurt them
rsm2800 blood tests accurately diagnose most diseases #mdchat
RT @RichmondDoc: @GailZahtz I think the issues of conflicting information and
CrescendoCG patient comm can be addressed via SocMed. #mdchat
good 2 know :) RT @RichmondDoc: @AureliaCotta But I don't go higher than
ability4life that as yet, and dn't promise further benefits beyond bones.#mdchat
@murzee Preg patients with diabetes fear insulin because it is a medicine when
chukwumaonyeije they should fear hyperglycemia... #mdchat
@murzee Risk tolerance and risk appraisal are skewed by society, media and
chukwumaonyeije culture. #mdchat
@sarasteinmd I have anecdotal benefits in my practice (and I think they may well
RichmondDoc bear out), but need to consider they may not. #mdchat
@RichmondDoc @ability4life uhh, perhaps lab levels are diff here, but 20-80 is
AureliaCotta low normal at my osteoporosis clinic. 80+ is normal #mdchat
Agree but 2 what endRT @chukwumaonyeije: @murzee Risk tolerance and risk
ability4life appraisal are skewed by society, media and culture. #mdchat #hcsmca
RT @chukwumaonyeije: @murzee Preg patients with diabetes fear insulin
murzee because it is a medicine when they should fear hyperglycemia #mdchat
@AureliaCotta @ability4life The research in the US I've seen says that markers of
RichmondDoc bone turnover normalize over 30-32. #mdchat
Agree wi yho RT @rsm2800: T1: IMHO many pts hav innate blief tht vit can't
ability4life possibly hurt blood tests accurately diagnse mst diseas #mdchat
 @rsm2800 T1 You're right--that's the misconception. But hyper-Vit A exists and
RichmondDoc is dangerous; beta-carotene and Vit E not benign. #mdchat
hjluks Late to show... as usual. What is the question at hand?? #mdchat
RT @chukwumaonyeije Risk tolerance and risk appraisal are skewed by society,
PAFPStudents media and culture. #MDchat
@hjluks T1 IOM report on Vit D Ca: How does this impact pt education? How
RichmondDoc do you deal with conflicting/shifting recommendations? #mdchat
@RichmondDoc My entire clinic is a testimony to walkers and canes. I'm happy
sarasteinmd to have something relatively benign to offer them! #mdchat
@RichmondDoc @sarasteinmd cartilage has vit D receptors too. Current
hjluks thinking that low level--> OA #mdchat
@rsm2800 Consumer research would suggest that this is the case, unfortunately.
CrescendoCG #mdchat
MD_Chat Shoulder tap: Next topic coming up in a few minutes. #MDchat
@RichmondDoc @ability4life I have osteoporosis, and at 32, I feel sick, and am
AureliaCotta in pain. #mdchat
@AureliaCotta @ability4life 30-32 ng/mL is the target dose for the labs we work
RichmondDoc with. #mdchat
It really boils down to science literacy and honesty by the providers about what
murzee we really know #mdchat
Vitamins and Neutraceuticals, herbals etc a BIG problem in a surgical practice...
hjluks bleeding, hepatic rxn with anesthesia, etc. #mdchat
I sure hope u have hcp that helpRT @AureliaCotta: @RichmondDoc
ability4life @ability4life I have osteoporosis, at 32, feel sick, and am in pain. #mdchat
@GailZahtz Lots of CME online. IMHO very little of if sticks . I see lots of
chukwumaonyeije memorable SM presentations online. Few memorable CME #MDCHAT
RT @sarasteinmd: @RichmondDoc I treat obesity and depression and chronic
drpoppyBHRT pain with vitamin D and have great success with all three #mdchat
@AureliaCotta @RichmondDoc @ability4life osteoporosis should not hurt...
hjluks osteomalacia does hurt !?!? #mdchat
@hjluks I see alot of improvement in pain including joint pain, but I dont know if
sarasteinmd anyone actually has structural improvement Wow #mdchat
 @RichmondDoc @ability4life Again, perhaps lab levels are measured differently
AureliaCotta there, but Reinhold Veith at UofT would disagree...... #mdchat
RT @rsm2800: T1: IMHO many pts have an innate belief that vitamins can't ..
chukwumaonyeije hurt them blood tests accurately diagnose most diseases #mdchat
RT @MD_Chat: Shoulder tap: Next topic coming up in a few minutes. Big fan of
hjluks shoulders :-) #mdchat
@chukwumaonyeije Do you think it's because the CME isn't done well? Would it
GailZahtz be better more like offline Education w/ peer-review? #mdchat
RT @murzee: RT @chukwumaonyeije: @murzee Preg patients with diabetes fear
AlisynGayle insulin because it is a medicine when they should fear hyperglycemia #mdchat
mkmackey @hjluks.. what dosing for Vit D is common in your ortho clinic? #mdchat
@AureliaCotta @ability4life I think that this speaks to the current uncertainty--
RichmondDoc the very topic we're discussing! Timely... :) #mdchat
hjluks @RichmondDoc thx #mdchat
RT @chukwumaonyeije: @murzee Risk tolerance and risk appraisal are skewed
sarasteinmd by society, media and culture << great observation! #mdchat
RT @RichmondDoc: @rsm2800 T1 You're right--that's the misconception. But
hyper-Vit A exists and is dangerous; beta-carotene and Vit E not benign.
AlisynGayle #mdchat
Can sm help changeRT @sarasteinmd: RT @chukwumaonyeije: @murzee Risk
ability4life tolerance and ppraisal skewed by socity, media culture #mdchat
Who determined what proper vit D level is... 30... 50.... 80? We have no
hjluks longitudinal studies to compare! #mdchat
@GailZahtz My vision for good CME would (actually) be something like
chukwumaonyeije #mdchat. Interactive/relevant/Evidence based/peer focused
RT @chukwumaonyeije: @GailZahtz My vision for good CME would (actually) be
GailZahtz something like #mdchat. Interactive/relevant/Evidence based/peer focused
Love it RT @MD_chat: T2 Sugar: How ramifying is sugar in r food chain on
ability4life health? Strange as it sounds: might we need policy on sugar?#MDchat
Yes. SM can help in terms of a true conversation / interaction @ability4life: Can
chukwumaonyeije sm help changeRT @sarasteinmd: @murzee #mdchat
@AlisynGayle they should fear weight gain - insulin is the biggest weight gainer
sarasteinmd of all the diabetes meds! #mdchat
 RT @chukwumaonyeije Risk tolerance and risk appraisal are skewed by society,
skewedup media and culture. #MDchat http://bit.ly/gjJcoc
@AureliaCotta @ability4life My main caveat is Vit B12 levels vascular
RichmondDoc dz/dementia: labs make sense, but no clinical benefits. #mdchat
@sarasteinmd I treat low serum Vitamin D levels with Vit D therapy, low cost,
drpoppyBHRT great clinical results #IsmellaBigPharmarat #mdchat
T2 Sugar: How ramifying is the sugar in our food chain on health? Strange as it
MD_Chat sounds: might we need a policy on sugar? #MDchat
RT @chukwumaonyeije: Yes. SM can help in terms of a true conversation /
interaction @ability4life: Can sm help changeRT @sarasteinmd: @murzee
ability4life #mdchat
@hjluks The closest I've seen so far (re Vit D levels) involves biochem markers
RichmondDoc and such; no real pt-focused evidence/info. #mdchat
@hjluks @RichmondDoc @ability4life I had osteomalacia when my D was 16.
AureliaCotta And fractures when D was 30-40 + osteoporosis #mdchat
@drpoppyBHRT I'm totally with you Poppy, especially here in Cleveland the land
sarasteinmd of eternal cloud cover! #mdchat
@mkmackey I dose between 2000-4000 Units/day if all other systems normal..
hjluks and serum levels rarely rise... #mdchat
@sarasteinmd also a prime cause for weight gain in NON-diabetics: insulin
DrJonathan secretion from carbohydrate ingestion #mdchat
hjluks @AureliaCotta been there... that's why I'm an orthopedist. #mdchat
T2 Not sure that we can easily have a policy limiting sugar, but I think it would be
RichmondDoc fair to require disclosure of sugar content. #mdchat
hjluks @RichmondDoc agreed... #mdchat
mkmackey @hjluks thanks #mdchat
murzee T2: Legislate sugar? Wow! Say more #mdchat
AureliaCotta @hjluks @RichmondDoc @ability4life Fractures suck FYI #mdchat
SM may openly show how we think, and this can help start the discussion
murzee @ability4life @chukwumaonyeije @sarasteinmd @murzee #mdchat
@AlisynGayle it takes some work to get hypervitaminosis A - more likely to go
sarasteinmd blind from Vit A deficiency - 5th leading cause #mdchat
 #mdchat T2 absolutely, in pediatrics. Childhood obesity is growing, leads to adult
peds_id_doc obesity, leads to chronic health problems...start early
hjluks @mkmackey welcome #mdchat
RT @RichmondDoc: T2 We lament when patients don't take charge of their
health, but we don't empower/inform patients to take charge of their health.
ability4life #mdchat
hjluks @MD_Chat what are you trying to say :-)?? #mdchat
@sarasteinmd @AlisynGayle It ain't easy to get hypervitaminosis A, but it can
RichmondDoc happen. Just noting that it ain't entirely benign. #mdchat
@hjluks: you continue 2 amaze @hjluks RT @AureliaCotta been there... that's
ability4life why I'm an orthopedist. #mdchat
RT @murzee: SM may openly show how we think, and this can help start the
GailZahtz discussion @ability4life @chukwumaonyeije @sarasteinmd @murzee #mdchat
#mdchat T2 but how/where to implement it? at the consumer level? The food
peds_id_doc processor? The farms...? #omnivoresdilemma
T2 We lament when patients don't take charge of their health, but we don't
RichmondDoc empower/inform patients to take charge of their health. #mdchat
@MD_chat T2: DGMS!!! (don't get me started). Issue is not just sugar but
chukwumaonyeije industrialized food production. #mdchat (#ThereISaidIt)
MD_Chat @hjluks http://ow.ly/3hTMO #MDchat ;)
@hjluks @RichmondDoc @ability4life But too often real symptoms/broken
AureliaCotta bones are dismissed as depression, old age aches/pains. #mdchat
RT @RichmondDoc: We lament when pts dont take charge of their health, but
CrescendoCG dont empower/inform patients to take charge. #mdchat
@chukwumaonyeije #mdchat Is it useful to use abbreviations if you then spell
peds_id_doc them out ;-) SWIM (see what I mean?)
RT @murzee: SM may openly show how we think, and this can help start the
ability4life discussion @ability4life @chukwumaonyeije @sarasteinmd @murzee #mdchat
RT @chukwumaonyeije: @MD_chat T2: DGMS!!! (don't get me started). Issue
ability4life is not just sugar but industrialized food production. #mdchat (#ThereISaidIt)
RT @chukwumaonyeije: @MD_chat T2: DGMS!!! (don't get me started). Issue
RichmondDoc is not just sugar but industrialized food production. #mdchat (#ThereISaidIt)
 @murzee TAX IT! LABEL IT! OUT the sugar contents in food!!! YESSSS! (in the
sarasteinmd information is power vein) #mdchat
Rather than legislate sugar (again may be erroneous panacea approach) need to
murzee address the whole lifestyle-nutrition axis #mdchat
RT @chukwumaonyeije: @MD_chat T2: DGMS!!! Issue is not just sugar but
murzee industrialized food production. #mdchat #mdchat
T2: Tobacco/Alcohol legislation and patient education - working well? Will it
PAFPStudents work for sugar? #MDchat
RT @RichmondDoc: T2 We lament when patients don't take charge of their
health, but we don't empower/inform patients to take charge of their health.
GailZahtz #mdchat
RT @AureliaCotta: @hjluks @RichmondDoc @ability4life But too often real
symptoms/broken bones are dismissed as depression, old age aches/pains.
ability4life #mdchat
RT @chukwumaonyeije: @MD_chat T2: DGMS!(dont get me started).Issue is
hjluks not just sugar but industrialized food production. #mdchat #mdchat
RT @RichmondDoc: RT @chukwumaonyeije: @MD_chat Issue is not just sugar
sarasteinmd but industrialized food production. #mdchat (#ThereISaidIt) #mdchat
Needs sugar tax RT @PAFPStudents: T2: Tobacco/Alcohol legislation and pt
ability4life education working well? Will it work 4 sugar? #MDchat
@GailZahtz we give out far too difficult change instructions - eg tobacco. We say
sarasteinmd quit (Hard to do) I say pick out 3 you can skip. #mdchat
RT @RichmondDoc: @sarasteinmd @AlisynGayle It ain't easy to get
hypervitaminosis A, but it can happen. Just noting that it ain't entirely benign.
AlisynGayle #mdchat
Agree! RT @sarasteinmd: TAX IT! LABEL IT! OUT the sugar contents in food!!!
murzee YESSSS! (in the information is power vein) #mdchat
chukwumaonyeije @peds_id_doc LOL (laughing out loud). #mdchat
T2 Will be tough to get meaningful nutrition info into patient's hands, but it
RichmondDoc should be a public policy priority. This matters. #mdchat
RT @murzee: We need more than just nutrition info -- we need to present public
ability4life with accessible alternatives, @RichmondDoc #mdchat
 @murzee Just what we need, food police...pretty soon people will be refused care
drpoppyBHRT for being obese when reasons are multifactorial. #mdchat
We need more than just nutrition info -- we need to present public with
murzee accessible alternatives, @RichmondDoc #mdchat
Even when we do empower patients with information, etc... many still choose to
hjluks disregard advice compliance vs. participation #mdchat
RT @RichmondDoc: T2 Will be tough to get meaningful nutrition info into
ability4life patient's hands, but it should be a public policy priority. This matters. #mdchat
RT @murzee: Agree! RT @sarasteinmd: TAX IT! LABEL IT! OUT the sugar
chukwumaonyeije contents in food!!! YESSSS! (in the information is power vein) #mdchat
RT @sarasteinmd: @GailZahtz we give out far too difficult change instructions -
ability4life eg tobacco. We say quit (Hard to do) I say pick out 3 you can skip. #mdchat
Compliance vs Participation.... http://goo.gl/WefpT BTW... never shoot video
hjluks when lying down on couch #doublechin :-( #mdchat
RT @murzee: We need more than just nutrition info -- we need to present public
mkmackey with accessible alternatives, @RichmondDoc #mdchat
hjluks @drpoppyBHRT yup :-( But we take the hit for it #mdchat
Agree! RT @sarasteinmd: @drpoppyBHRT @murzee its the food industry that
murzee needs policing not the consumers #obesity #mdchat
RT @sarasteinmd: @drpoppyBHRT @murzee it's the food industry that needs
chukwumaonyeije policing not the consumers #obesity #mdchat
RT @murzee: We need more than just nutrition info -- we need to present public
RichmondDoc with accessible alternativesoc, [agree!] #mdchat
drpoppyBHRT @hjluks Yes that is called freedom and autonomy. #mdchat
RT @sarasteinmd: @drpoppyBHRT @murzee it's the food industry that needs
ability4life policing not the consumers #obesity #mdchat
@drpoppyBHRT @murzee it's the food industry that needs policing not the
sarasteinmd consumers #obesity #mdchat
#mdchat T2 the difficulty in 'policing' the industry is that the regs are currently
peds_id_doc set up to support processed food --> high sugar
@drpoppyBHRT In many places in this country a person simply *cannot*
chukwumaonyeije autonomously choose a healthy diet #foodDeserts #mdchat
hjluks You are on a roll Chuck !!!! #mdchat
 @sarasteinmd Perhaps w/ more technology, more comm through MD social
GailZahtz media and time, more lifestyle change could occur for pts? #mdchat
RT @chukwumaonyeije: RT @sarasteinmd: @drpoppyBHRT @murzee its the
hjluks food industry that needs policing not the consumers #obesity #mdchat
@GailZahtz wouldnt that be wonderful - we're trying to get docs to tweet/blog
sarasteinmd etc, ppl want health info from reliable sources #HCSM #mdchat
RT @chukwumaonyeije: In many places in this country a person simply *cannot*
RichmondDoc autonomously choose a healthy diet #foodDeserts #mdchat
RT @DrJonathan: We too often approach this problem from consumer
perspective- any way to go after American's food producers instead to reduce
ability4life sugar? #mdchat
Some neighborhds do not have easy access to nutritious foods or safe exercise
murzee spaces @GailZahtz @sarasteinmd #mdchat
@hjluks LOL, I'm trying to control myself. This is one of my hot buttons.
chukwumaonyeije #mdchat
There are many low/non-sugar alternatives sitting right next to the problem -
PAFPStudents consumers still not choosing the right label #MDchat
@drpoppyBHRT @hjluks Adults have a right to make decisions I don't like, but
RichmondDoc the nation has a right to ensure accurate risk info. #mdchat
Looks like a start for good nutrition with the McDonalds issue in Calif for Happy
mkmackey Meals #mdchat
We too often approach this problem from consumer perspective- any way to go
DrJonathan after American's food producers instead to reduce sugar? #mdchat
@murzee @GailZahtz @sarasteinmd I saw a lady today trying to support family
sarasteinmd of 5 on minimum wage-lot of ramen noodles/peanut butter #mdchat
@chukwumaonyeije Education and self-awareness/reliance is necessary to make
drpoppyBHRT good decisions in every area of life. #mdchat
Xclnt Reality Check RT @murzee: Some neighborhds do nt hve easy access 2
ability4life nutritious foods safe xercise spces @GailZahtz @sarasteinmd #mdchat
Yep RT @murzee: Some neighborhds do not have easy access to nutritious foods
rsm2800 or safe exercise spaces @GailZahtz @sarasteinmd #mdchat
@chukwumaonyeije We live in a nation where the cheapest foods are calorie
RichmondDoc dense and the healthy alternatives are expensive/unavail. #mdchat
murzee RT @hjluks: You are on a roll Chuck !!!! #mdchat
hjluks @chukwumaonyeije so I've noticed.... keep goin' #mdchat
mkmackey Excellent In the trenches wellness discussion going on here at #mdchat
RT @hjluks: RT @chukwumaonyeije We live in a nation where the cheapest
ability4life foods are calorie dense and the healthy alternatives are expensive #mdchat
#mdchat T2 ...cheetos. Right at the door. Cheaper than fruit too. Higher
peds_id_doc calories. Easier to stay alive on a tight budget.
@sarasteinmd I believe that if there were #hcsm that had privacy options for
GailZahtz HCP's peer-reviewed info, many more would participate #mdchat
RT @peds_id_doc: @PAFPStudents #mdchat T2 ever walked into a posh food
ability4life store? First up - fruit and veg....tried the same in a 'less affluent neighborhood? ..
RT @chukwumaonyeije We live in a nation where the cheapest foods are calorie
hjluks dense and the healthy alternatives are expensive #mdchat
RT @sarasteinmd: @murzee @GailZahtz @sarasteinmd I saw a lady today
trying to support family of 5 on minimum wage-lot of ramen noodles/peanut
ability4life butter #mdchat
RT @murzee: Nutrition is a social issue, as is lifestyle. For us privileged SMers it
ability4life may be a choice. But for many not so. #mdchat
@PAFPStudents #mdchat T2 ever walked into a posh food store? First up - fruit
peds_id_doc and veg....tried the same in a 'less affluent neighborhood? ..
Nutrition is a social issue, as is lifestyle. For us privileged SMers it may be a
murzee choice. But for many not so. #mdchat
Our food policy subsidizes garbage loaded w HFCS, animals raised in deplorable
murzee conditions -- don't even know human health effects! #mdchat
RT @hjluks: RT @chukwumaonyeije We live in a nation where cheapest foods
sarasteinmd are calorie dense and healthy alternatives are expensive #mdchat
We're coming up on our hour. Before we wrap up, let's hear your parting wisdom.
MD_Chat #MDchat
@peds_id_doc This is why fast food value meals are a devil's bargain: cheap,
RichmondDoc calorie-filled but no true nutritional value. #mdchat
T2 People want to make the right decisions about their diet; they want info. But it
MattMerg needs to be reliable, trustworthy, and available #mdchat
 RT @mkmackey: Excellent In the trenches wellness discussion going on here at
ability4life #mdchat
@sarasteinmd @murzee @ability4life Agree w/ you all- nutrition is a social
GailZahtz economic issue and can only change w/social change. #mdchat
Can't wait to share at med health conf 4 topic: to twitter or not Before we wrap
ability4life up, let's hear your parting wisdom. #MDchat
Parting thoughts: Need integrated solutions, not one-offs. Societal AND
murzee individual responsibilities at play. #mdchat
RT @sarasteinmd: @MD_Chat Final thoughts, I wish health care providers
would return to see one, do one, teach one, using Soc med as the teaching tool
ability4life #mdchat
#mdchat - T2 so we all agree on the problem, but how on earth do we (or anyone)
peds_id_doc fix it...?
RT @murzee: Our food policy subsidizes garbage loaded w HFCS, animals raised
RichmondDoc in deplorable conditions -- don't even know human health effects! #mdchat
Thanks.. it never fails, I always gain insight from listening to discussion from
mkmackey #mdchat
@MD_Chat Final thoughts, I wish health care providers would return to see one,
sarasteinmd do one, teach one, using Soc med as the teaching tool #mdchat
RT @GailZahtz: @sarasteinmd @murzee @ability4life Agree w/ you all-
nutrition is a social economic issue and can only change w/social change.
ability4life #mdchat
.@ability4life @hjluks see here http://bit.ly/hekPi8 for inaccurate historical
AureliaCotta reason excess D was thought unsafe. #mdchat
#MDchat wrapup: TY everyone. It was a great group!!! Thanks for having me-
GailZahtz hope to come often and get to know all of you. Great chat!
#mdchat T2 going to promote The Omnivores Dilemma - Wifey is reading it,
peds_id_doc very interesting stuff. Should be mandatory for all!
philbaumann @peds_id_doc That's the 7.5 Trillion Dollar question. ;) #mdchat
Agree!RT @mkmackey: Thanks.. it never fails, I always gain insight from
ability4life listening to discussion from #mdchat
hjluks @GailZahtz Impressed!!! just read your 'about' section #mdchat
 Tnx :)RT @AureliaCotta: @ability4life @hjluks c here http://bit.ly/hekPi8 for
ability4life inaccurate historical reason xcss D ws thought unsafe.#mdchat
T2 Re:NYC calorie posting laws, I was originally skeptical about this, but I find
MattMerg myself, quite often, making decisions w/ this info #mdchat
.@ability4life @hjluks They confused D toxicity with a rare genetic disorder.
AureliaCotta Except they were wrong. #mdchat
RT @murzee: Agree! RT @sarasteinmd: @drpoppyBHRT @murzee its the food
AlisynGayle industry that needs policing not the consumers #obesity #mdchat
RT @hjluks: @GailZahtz Impressed!!! just read your 'about' section #mdchat
GailZahtz <=TY so much! So I'll count you in as a friend and ally :)))
ability4life RT @hjluks: @GailZahtz Impressed!!! just read your 'about' section #mdchat
Parting wisdom: As docs as a society we should prioritize helping pts get
RichmondDoc accurate info make health choices--for all of society. #mdchat
ability4life #MDchat Thanks Phil, and everyone. I'm jazzed and juiced as always.:) Kathy
That's a wrap! Good time, everyone! THANK you for participating. Next
MD_Chat #MDchat is next Tuesday 9pm Eastern. Transcript will be up later! :)

>>>Official End of Chat<<<

Post-Chat:
RT @MattMerg: Re:NYC calorie posting laws, originally skeptical,find myself
sarasteinmd making decisions w/ this info &lt; nice study showed same! #mdchat
murzee Thanks, everyone! great chat, as usual. #mdchat
{head smack)RT @AureliaCotta: .@ability4life @hjluks They confused D toxicity
ability4life with a rare genetic disorder. Except they were wrong. #mdchat
RT @RichmondDoc: Parting wisdom: As docs as a society we should prioritize
hjluks helping pts get accurate info make health choices--for all of society. #mdchat
RT @hjluks Compliance v Participation... http://goo.gl/WefpT BTW..never
rawarrior shoot video lying on couch #doublechin #mdchat /lol! still good vid
RT @hjluks: RT @chukwumaonyeije: @MD_chat T2: DGMS!(dont get me
started).Issue is not just sugar but industrialized food production. #mdchat
AlisynGayle #mdchat
 Ditto. Good Night. RT @murzee: Thanks, everyone! great chat, as usual.
chukwumaonyeije #mdchat
Thanks @murzee its nice having an epidemiologist on hand to keep the
mkmackey conversation in line... #mdchat
MD_Chat @chukwumaonyeije Good night! You were rollin' tonight! Thanks!! #MDchat
RT @chukwumaonyeije: RT @murzee: Agree! RT @sarasteinmd: TAX IT!
LABEL IT! OUT the sugar contents in food!!! YESSSS! (in the information is
ePatientDave power vein) #mdchat
@ability4life @AureliaCotta @hjluks Though, in fairness, the genetic condition
RichmondDoc was apparently not found till genetic testing avail. #mdchat
RT @chukwumaonyeije: Ditto. Good Night. RT @murzee: Thanks, everyone!
ability4life great chat, as usual. #mdchat
RT @RichmondDoc: @ability4life @AureliaCotta @hjluks But it also highlights
the importance of re-assessing what we *think* we know as time moves on.
ability4life #mdchat
We'll get one of you physicians to host #MDchat! You can do it. It's very cool to
MD_Chat watch the stream from this side. :)
RT @drpoppyBHRT: @chukwumaonyeije Education and self-awareness/reliance
ability4life is necessary to make good decisions in every area of life. #mdchat
@ability4life @AureliaCotta @hjluks But it also highlights the importance of re-
RichmondDoc assessing what we *think* we know as time moves on. #mdchat
sarasteinmd night all good one! #mdchat
@MD_Chat It's funny--the more I do this, the more likely I am to land right on
RichmondDoc the 140 more often than I'd imagine. #mdchat
I hate this argument. It takes more work to cook, but healthy dried beans are the
rawarrior cheapest food. Just 1 example. #MDchat
MD_Chat @richmonddoc Very good use of less than 140. Great parting thought! #MDchat
@RichmondDoc @ability4life @hjluks Of course, and it also shows the faults of
AureliaCotta RCT, the supposed gold standard. Sigh. #mdchat
RT @RichmondDoc: Parting wisdom: As docs as a society we should prioritize
RVAFamilyMag helping pts get accurate info make health choices--for all of society. #mdchat
Academic OB/GYN Podcast Episode 27: Journals for November 2010. Blog:
academicobgyn http://bit.ly/dUJcRl iTunes: http://bit.ly/dxklAS RT Pls #mdchat
 RT @academicobgyn: Academic OB/GYN Podcast Episode 27: Journals for
chukwumaonyeije November 2010. Blog: http://bit.ly/dUJcRl #mdchat
@AureliaCotta @ability4life @hjluks The RCT and well-designed meta-analysis
RichmondDoc are the best tools we have, albeit limited. #MDChat
RT @MD_Chat: The Social Physician by @BunnyEllerin http://bit.ly/gvrW9O
kathycorey #MDchat
More on TailorX #breast cancer trial. http://bit.ly/fd9P1K Einstein-Montefiore
EinsteinMed doc says results could spare 20k women/yr fr chemo. #MDchat
RT @sarasteinmd: @AlisynGayle it takes some work to get hypervitaminosis A -
AlisynGayle more likely to go blind from Vit A deficiency - 5th leading cause #mdchat
RT @sarasteinmd: @AlisynGayle they should fear weight gain - insulin is the
AlisynGayle biggest weight gainer of all the diabetes meds! #mdchat
TY new Docs for following and welcoming me into your #MDchat !
GailZahtz @CrescendoCG @sarasteinmd @drpoppyBHRT @mkmackey @hjluks @murzee

Twitter.com/MD_chat
MDchat.org
Moderated by @PhilBaumann
PhilBaumann.com
HealthIsSocial.com