Transcript of #MDchat for November 30, 2010

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Topics:
Topic 1 (T1) Topic 2 (T2) T2 IOM report on Vit D & Ca: How does this impact pt education? How do you deal with conflicting/shifting recommendations? T2 Sugar: How ramifying is the sugar in our food chain on health? Strange as it sounds: might we need a policy on sugar?

Chat:
philbaumann MD_Chat RichmondDoc MD_Chat MD_Chat MD_Chat RichmondDoc mkmackey healthgist For tonight's #MDchat at 9pm, article on Vit D Calcium for one of the topics: http://ow.ly/3hSnb Welcome to #MDchat! If you're new, feel free to join or just watch. We'll start soon, but first introduce yourselves! Good evening, all. Family doc in #RVA; multi-tasking as usual, but here to participate in #mdchat OK, first topic coming up in a minute! When responding to a topic, please prepend tweet with T1, T2, etc. Good luck! #MDchat @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 deal with conflicting/shifting recommendations? #MDchat @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 education? How do you deal w conflicting/shifting recommendations? #mdchat http://j.mp/d5Z8gi @RichmondDoc Good evening, all. Family doc in #RVA; 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

skewedup RichmondDoc drpoppyBHRT MD_Chat ability4life RichmondDoc AureliaCotta sarasteinmd hjluks DrJonathan hjluks RichmondDoc hjluks mkmackey murzee AureliaCotta murzee sarasteinmd

RT @chukwumaonyeije Risk tolerance and risk appraisal are skewed by society, media and culture. #MDchat http://bit.ly/gjJcoc @AureliaCotta @ability4life My main caveat is Vit B12 levels vascular dz/dementia: labs make sense, but no clinical benefits. #mdchat @sarasteinmd I treat low serum Vitamin D levels with Vit D therapy, low cost, great clinical results #IsmellaBigPharmarat #mdchat T2 Sugar: How ramifying is the sugar in our food chain on health? Strange as it 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 #mdchat @hjluks The closest I've seen so far (re Vit D levels) involves biochem markers and such; no real pt-focused evidence/info. #mdchat @hjluks @RichmondDoc @ability4life I had osteomalacia when my D was 16. And fractures when D was 30-40 + osteoporosis #mdchat @drpoppyBHRT I'm totally with you Poppy, especially here in Cleveland the land of eternal cloud cover! #mdchat @mkmackey I dose between 2000-4000 Units/day if all other systems normal.. and serum levels rarely rise... #mdchat @sarasteinmd also a prime cause for weight gain in NON-diabetics: insulin secretion from carbohydrate ingestion #mdchat @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 fair to require disclosure of sugar content. #mdchat @RichmondDoc agreed... #mdchat @hjluks thanks #mdchat T2: Legislate sugar? Wow! Say more #mdchat @hjluks @RichmondDoc @ability4life Fractures suck FYI #mdchat SM may openly show how we think, and this can help start the discussion @ability4life @chukwumaonyeije @sarasteinmd @murzee #mdchat @AlisynGayle it takes some work to get hypervitaminosis A - more likely to go 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 hjluks mkmackey ability4life peds_id_doc GailZahtz ability4life hjluks ability4life ability4life peds_id_doc murzee murzee sarasteinmd MD_Chat RichmondDoc MattMerg

RT @hjluks: You are on a roll Chuck !!!! #mdchat @chukwumaonyeije so I've noticed.... keep goin' #mdchat Excellent In the trenches wellness discussion going on here at #mdchat RT @hjluks: RT @chukwumaonyeije We live in a nation where the cheapest foods are calorie dense and the healthy alternatives are expensive #mdchat #mdchat T2 ...cheetos. Right at the door. Cheaper than fruit too. Higher calories. Easier to stay alive on a tight budget. @sarasteinmd I believe that if there were #hcsm that had privacy options for HCP's peer-reviewed info, many more would participate #mdchat RT @peds_id_doc: @PAFPStudents #mdchat T2 ever walked into a posh food 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 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 butter #mdchat RT @murzee: Nutrition is a social issue, as is lifestyle. For us privileged SMers it may be a choice. But for many not so. #mdchat @PAFPStudents #mdchat T2 ever walked into a posh food store? First up - fruit 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 choice. But for many not so. #mdchat Our food policy subsidizes garbage loaded w HFCS, animals raised in deplorable conditions -- don't even know human health effects! #mdchat RT @hjluks: RT @chukwumaonyeije We live in a nation where cheapest foods 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. #MDchat @peds_id_doc This is why fast food value meals are a devil's bargain: cheap, calorie-filled but no true nutritional value. #mdchat T2 People want to make the right decisions about their diet; they want info. But it needs to be reliable, trustworthy, and available #mdchat

ability4life GailZahtz ability4life murzee ability4life peds_id_doc RichmondDoc mkmackey sarasteinmd ability4life AureliaCotta GailZahtz peds_id_doc philbaumann ability4life hjluks

RT @mkmackey: Excellent In the trenches wellness discussion going on here at #mdchat @sarasteinmd @murzee @ability4life Agree w/ you all- nutrition is a social 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 up, let's hear your parting wisdom. #MDchat Parting thoughts: Need integrated solutions, not one-offs. Societal AND 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 #mdchat #mdchat - T2 so we all agree on the problem, but how on earth do we (or anyone) fix it...? RT @murzee: Our food policy subsidizes garbage loaded w HFCS, animals raised in deplorable conditions -- don't even know human health effects! #mdchat Thanks.. it never fails, I always gain insight from listening to discussion from #mdchat @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 #mdchat RT @GailZahtz: @sarasteinmd @murzee @ability4life Agree w/ you allnutrition is a social economic issue and can only change w/social change. #mdchat .@ability4life @hjluks see here http://bit.ly/hekPi8 for inaccurate historical reason excess D was thought unsafe. #mdchat #MDchat wrapup: TY everyone. It was a great group!!! Thanks for having mehope to come often and get to know all of you. Great chat! #mdchat T2 going to promote The Omnivores Dilemma - Wifey is reading it, very interesting stuff. Should be mandatory for all! @peds_id_doc That's the 7.5 Trillion Dollar question. ;) #mdchat Agree!RT @mkmackey: Thanks.. it never fails, I always gain insight from listening to discussion from #mdchat @GailZahtz Impressed!!! just read your 'about' section #mdchat

ability4life MattMerg AureliaCotta AlisynGayle GailZahtz ability4life RichmondDoc ability4life MD_Chat

Tnx :)RT @AureliaCotta: @ability4life @hjluks c here http://bit.ly/hekPi8 for inaccurate historical reason xcss D ws thought unsafe.#mdchat T2 Re:NYC calorie posting laws, I was originally skeptical about this, but I find myself, quite often, making decisions w/ this info #mdchat .@ability4life @hjluks They confused D toxicity with a rare genetic disorder. Except they were wrong. #mdchat RT @murzee: Agree! RT @sarasteinmd: @drpoppyBHRT @murzee its the food industry that needs policing not the consumers #obesity #mdchat RT @hjluks: @GailZahtz Impressed!!! just read your 'about' section #mdchat <=TY so much! So I'll count you in as a friend and ally :))) RT @hjluks: @GailZahtz Impressed!!! just read your 'about' section #mdchat Parting wisdom: As docs as a society we should prioritize helping pts get accurate info make health choices--for all of society. #mdchat #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 #MDchat is next Tuesday 9pm Eastern. Transcript will be up later! :)

>>>Official End of Chat<<< Post-Chat:
sarasteinmd murzee ability4life hjluks rawarrior AlisynGayle RT @MattMerg: Re:NYC calorie posting laws, originally skeptical,find myself making decisions w/ this info &lt; nice study showed same! #mdchat Thanks, everyone! great chat, as usual. #mdchat {head smack)RT @AureliaCotta: .@ability4life @hjluks They confused D toxicity with a rare genetic disorder. Except they were wrong. #mdchat RT @RichmondDoc: Parting wisdom: As docs as a society we should prioritize helping pts get accurate info make health choices--for all of society. #mdchat RT @hjluks Compliance v Participation... http://goo.gl/WefpT BTW..never 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 #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 reRichmondDoc 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

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