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@justOncology

~ Musings on health, illness & evidence based medicine

@justOncology

Tag Archives: health

What Is Cancer?

09 Friday May 2014

Posted by @JustOncology in Uncategorized

≈ 2 Comments

Tags

accountable care, best practices, evidence based care, health, innovation, jay walker, mind the gap, oncology, stephen wilkins, tedmed, wellness

By Gregg A. Masters, MPH

It’s been a while since Dr. Just has been able to put pen to pad and update you on his journey (and their is lots to tell from group mergers to a continuing drama with EHR implementation) into social media and a ‘transition’ to full to part time practice in a multi-site community oncology practice. More soon from Dr. J aka @chemosabe1 – at least I’ve been told.

Meanwhile, below is a clip producer by Jay Walker the curator of TEDMED and noted Professor of Medicine and Engineering at the University of Southern California Keck School of Medicine and Viterbi School of Engineering oncologist David B, Agus, MD well worth a view!

Also, we had a great session today on ‘this week in oncology’ chatting with Stephen Wilkins the publisher of ‘Mind The Gap’ blog. You can listen here.

 

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The Advent of Cancer Immunotherapy: Addressing Unmet Needs Part 1

03 Wednesday Jul 2013

Posted by @JustOncology in health, immunotherapy, oncology

≈ 3 Comments

Tags

cancer, evidence based medicine, health, immunotherapy, innovation, integrative oncology, managed care, medical education, wellness

By Gregg A. Masters, MPH

The following is provided via the video series at the American Journal of Managed Care on ‘The Advent of Cancer Immunotherapy’, part 1 of a 3 part series:

 

In a discussion moderated by Dr. Peter Salgo, Drs. Jeffrey Weber, Michael Kolodziej, and Daniel J. George share their insights and perspectives on the rise of cancer immunotherapy, and its significance during a time in which cancer is recognized as the “new global pandemic” that has killed more than 600,000 US persons in 2012 alone.

 

For original source link, click here.

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Crowds Care for Cancer Challenge: Supporting Survivors the Finalists

25 Tuesday Jun 2013

Posted by @JustOncology in health, health innovation, healthIT, oncology, patient empowerment

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accountable care, cancer, coordinated care, crowds care for cancer, digital media, health, innovation, integrative oncology, medicine, survivorship

By Gregg A. Masters, MPH

Last month in a continuing commitment to advance the art and science of patient engagement in health the Office of the National Coordinator for Health Information Technology (ONC) teamed up with the National Cancer Institute (NCI) partnering with Health 2.0 Challenge and the Medstartr crowd funding platforms to field an innovative challenge on creating applications for the estimated 14 million cancer survivors in the United States.

Journey Forward: My Care Plan

For complete program details on the the ‘Crowds Care for Cancer: Supporting Survivors‘ challenge click here, and for the finalists now in the crowd funding optimization stage see the Medstartr finalists feature page here.

On This Week in Oncology, we chat with each of the three finalists in the competition, beginning with Journey Forward: My Care Plan, a project by Tiffany Devitt.

On Thursday, June 27th, 2013 at 1:30PM Pacific/4:30PM Eastern to join us live (or for an archived replay) with Patti Ganz, MD of the Journey Forward: My Care Plan team, click here.

PatientsWithPowerTogether AppBoth remaining Crowds Care for Cancer: Supporting Survivors Challenge finalists are scheduled as follows:

PatientWithPower: A project by PatientsWithPower | 11AM Pacific/2PM Eastern Friday, June 28th, 2013. For live or archived replay, click here.

Together: A project by Michelle Longmire | 11AM Pacific/2PM Eastern Tuesday, July 2nd 2013. For live or archived replay, click here. 

Please review each of the candidates in this important challenge and show your support accordingly. The leader board to date is as follows: PatientsWithPower, Journey Forward: My Care Plan followed by Together.

 

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Tumor Board: Is There Value in Multidisciplinary Case Consideration?

22 Wednesday May 2013

Posted by @JustOncology in health, hematology, oncology, patient empowerment, tumor board

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Tags

digital health, evidence based medicine, health, innovation, oncology, participatory medicine, tumor board

By Gregg A. Masters, MPH

When the American College of Surgeons Commission on Cancer picked up the accreditation football and in the spirit of the then Joint Commission on Accreditation of Hospitals ‘Joint Commission‘ began the promulgation of specific standards for the accreditation of aspiring ‘cancer programs’, at the center of this consideration was the multidisciplinary cancer conference also known as ‘tumor board.’tumor board

Via these standards there were both structural and certain process considerations to meet, but the underlying assumption or zeitgeist of the value proposition – better cancer care – was that ‘multidisciplinary’ engagement of cancer specialists in the diagnosis and treatment of cancer patients would produce superior outcomes.

Then in October of 2012 Keating et al published a study titled: ‘Tumor Boards and the Quality of Cancer Care’. While somewhat dated (interval 2001-2004), and not generally representative of community oncology practices per se (the sample was sourced in the Veteran’s Health System), the conclusions are none-the-less a compelling call to objectively demonstrate long held assumptions of the benefits of tumor board ‘collaboration’.

The background context for the study was noted as follows:

Despite the widespread use of tumor boards, few data on their effects on cancer care exist. We assessed whether the presence of a tumor board, either general or cancer specific, was associated with recommended cancer care, outcomes, or use in the Veterans Affairs (VA) health system.

While Keating et al concluded as follows:

We observed little association of multidisciplinary tumor boards with measures of use, quality, or survival. This may reflect no effect or an effect that varies by structural and functional components and participants’ expertise.

Following publication a series of pieces appeared in the professional press with eye catching headlines such as:

‘Tumor Boards May Not Really Impact Cancer Care‘, and ‘Little association of multidisciplinary tumor boards with effects on cancer care‘, but the title that grabbed our attention was an opinion piece in response to the Keating study offered by Douglas W. Blayney, MD, Stanford Cancer Institute, Stanford School of Medicine, titled: ‘Tumor Boards (team Huddles) Aren’t Enough to Reach the Goal‘.

Blayney details his reasoning and observation while cautioning against the potential ‘knee jerk’ over reaction by some to the Keating conclusions and ‘market aftermath’ as follows:

Tumor boards have too long a history for them to be easily
abandoned. Much like the “hurry-up” offense changed the conduct of huddles in football, tumor boards should also adapt to the changing times and technology. In the system studied by Keating et al. (1), there are only huddles and no feedback loop. Their measurement work provides a reason to change tumor board conduct.

On ‘This Week in Oncology‘, May 22nd, 2013 at 2PM Pacific/5PM Eastern Dr. Blayney is our very special guest. We’ll dive deeper into his thought process, rationale and recommendations to tweak the tumor board formula via technology and other process adds, to perhaps better align this important multi-disciplinary experience with improved patient outcomes.

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‘You Don’t Know Jack’ by Morgan Spurlock

20 Wednesday Feb 2013

Posted by @JustOncology in Uncategorized

≈ 2 Comments

Tags

cancer, clinical trials, digital media, evidence based medicine, health, innovation, Intel Science Fair, jack andraka, oncology, participatory medicine

By Gregg A. Masters, MPH

But you should! Get to know him here:

Earlier today we just finished chatting with Jack Andraka on This Week In Oncology. One of my favorite lines from the conversation is quoted below, Jack refers to the high school biology class as the:

absolute stifler of innovation

From which he none-the-less associates inspiration for his scientific inquiry. Suffice it to say, Jack was neither encouraged nor challenged by the curriculum, and found other ways to engage his mind and curiousity.

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@IBMwatson and the Future of Oncology Care

10 Sunday Feb 2013

Posted by @JustOncology in Uncategorized

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cancer, digital health, FutureMed, genomics, health, IBM Watson, Marty Kohn MD, oncology, wellness

By Gregg A. Masters, MPH

Another of the highlights of FutureMed 2013 was the track on ‘the future of oncology’. In addition to the promise of favorably impacting both the early diagnosis and thus treatment outcomes for pancreatic cancer via the discovery of Jack Andraka, Ronald Levy, MD of Stanford wove a beautiful narrative of hope and promise that might best be represented by the following quote:

My dream is to get rid of chemotherapy and do it with the immune system..

Dr. Levy’s concluding slide outlined the visioned future for oncology:

The Future of Oncology Care

Meanwhile one could not be but immensely inspired by the clinical decision support and powerful AI platform demonstration detailed by Marty Cohn, MD. Witness ‘IBM Watson Demo: Oncology Diagnosis and Treatment’ developed in conjunction with Memorial Sloan-Kettering Cancer Center:

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Biometric Monitoring Systems: A Role for Monitoring & Managing Cancer?

26 Saturday Jan 2013

Posted by @JustOncology in Uncategorized

≈ 1 Comment

Tags

bimetric scoring systems, ces 2013, digital health, health, michaeal singer, Quantified Self, vitality analyzer, wellness

By Gregg A. Masters, MPH

There is considerable (and growing) attention focused on the emerging role of ‘quantified self’ tools to improve our overall health status, enhance access, improve outcomes while also lowering the total cost of health care. At the recently concluded CES 2013 Conference and Exposition a Forbes article posed the following question:

CES 2013: The Year of The Quantified Self?

If you’ve not heard of the ‘Quantified Self‘ movement you will. Their website is chock full of information and health apps for the curious and motivated. The recent blog post: Future Normal: Quantified Self Tools at the Apple Store hints at the new normal now in sight. Or as overheard several times on the Silicon Valley circuit for at least the last three years and oft credited to William Gibson:

The future is already here. It’s just not evenly distributed yet

So in this entrepreneurial frenzy and resultant sea of digital health apps all chasing the holy grail to define and manifest a healthier America, much attention has rightfully focused on the capture, reporting and sharing of meaningful biometric data to maintain health, improve health literacy, better inform doctor/patient communications and ultimately support improved health outcomes.

Against this background, now ponder the following xPrize-esque(?) question:

Imagine if you could have a conversation with your body on a cellular level. What if you asked your cells, how am I really doing? Am I healthy? Is my treatment working? Is there anything I could be doing better?

And consider the following reply:

‘The Vitality Analyzer, an FDA approved Class II over-the-counter medical device that electrically measures your health, is a simple tool that helps you answer those questions. Based on well established technology, the Vitality Analyzer measures your health collecting information about your body’s cells and then translates it to a numeric score; your Vitality Index a global health indicator.’This Week in Oncology on the BlogTalk Radio Network | @justOncology

Sound interesting, if not a bit of an over the top claim to make? it did to me. So on the Wednesday, January 30th 2013 broadcast of ‘This Week in Oncology‘ we’ll chat with the inventor Michaeal Singer and dive deeper into the peer reviewed science supporting the ‘well established technology’ cited above.

To state the obvious, at least from the point of view of cancer patients wondering what is happening at the cellular level minimally in between those routine or non-routine follow-up visits to the oncologist, if this metric can reliability report on the underlying state of health or to the contrary tumor pathogenesis, this is the kind of ‘biomarker’ information most cancer patients would want to have.

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Can ‘Social Media’ Bridge the Gap Between Payers and Oncologists?

19 Monday Nov 2012

Posted by @JustOncology in Uncategorized

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Tags

@tumorboard, cancer, digital media, health, innovation, managed care, medical education, participatory medicine, social media, twitter

By Gregg A. Masters, MPH

The continued penetration of social media tools, platforms and derivatives into medicine in general and oncology in particular continues to make steady if not uneven headway into the workflow of medical groups, physician networks if not individual practices.

Still somewhat of a ‘show me the money’ value proposition, social media leverages widely accessible web-based and mobile technologies to create and share user-generated content in a collaborative and more often than not near real time social context. The ultimate promise is, that it’s effective uptake will enable new opportunities for physicians, other healthcare professionals and even certain ‘calcified institutions’ i.e., hospitals, to interact with patients in new and different ways.

In cancer care social media can serve as a platform for patient education (see: @Chemotopia) if not as an authoritative health messaging resource, where oncologists fulfill their role as trusted publishers if not de-facto ‘search nodes on the web’. Additionally many believe these emerging technologies can add to professional development, see @TumorBoard, knowledge sharing, and even where appropriate direct patient interaction, if key legal and privacy concerns can be addressed prospectively.


In the professional development department, the video below was shot on November 16 2012 at American Journal of Managed Care’s (AJMC) ‘Translating Evidence-Based Research Into Value-Based Decisions in Oncology’.

Featuring Dennis Scanlon, PhD, who addresses the ‘Importance of Payer/Provider Relationships’. Dr. Scanlon is Professor of Health Policy and Administration, The Pennsylvania State University, stresses: ‘it is very important to bridge the gap between providers and payers in oncology management’ as ‘there is a lot of variation in the cost and quality of care in oncology. The goal is to identify the appropriate payments for quality care.’

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The Shell Answer Man

01 Monday Oct 2012

Posted by @JustOncology in Uncategorized

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Tags

cancer, clinical trials, clinicaltrials, CME, digital media, evidence based medicine, health, Just Oncology, oncology, participatory medicine, social media, twitter

By Richard Just, MD

Over the past 37 years in practice, I’ve received thousands of requests from patients, family and friends to interpret results of clinical trials.  These requests have increased dramatically with the advent of the Internet.   Many of these reports involve poor trial design or are inappropriate for the patient under consideration.  Sometimes I’ve mumbled to myself “I feel like the Shell Answer Man”.  For those too young to remember, I’m referring to a Shell Oil Co. ad beginning in the 1960’s in which the ‘Shell Answer Man”, replete in his Shell gas station uniform, answered common questions about driving and the uses of gas and oil. He just memorized a script; sometimes I wish I had one.   

Over Labor Day weekend, while in Chicago for a family event, we turned on TV to catch up on the day’s news. As fate would have it, we stumbled upon a healthcare segment on the NBC affiliate.  The reporter was listing items individuals should consider in evaluating results of clinical trials.  It seemed to me that knowledge of these items would be very helpful to people who are not healthcare professionals; people who need some way to filter trials worth pursuing with their physicians.  The following are those questions:

  1. Are the patients in the trial separated into groups, with one receiving the drug or regimen being tested (“Experimental Group”) while the other is treated with the agent(s) considered standard treatment (“Controls”)?  These groups are many times labeled “arms.”  The Control Arm may be a placebo if there is no known standard treatment.  This does not mean the patient receives no treatment at all.  These types of studies are considered the “gold standard” of clinical trials in that they involve large numbers of patients who are followed for long periods of time.  This increases the likelihood that resultant findings are valid.  The downside is they take a long time to complete and are very expensive (about $1 billion from start to finish).
  2. What is the total number of patients entered into the trial?  As alluded to above, the more the better.  If one study includes 50 patients while another 350 (all other factors being equal), place more trust in the larger trial.
  3. What is the length of the study? In other words, how long are the patients followed? Again, the longer the better.
  4. Were the patients included in the trial representative of the proposed population to be studied?  For example, if the population to be studied involves pediatric patients, someone over 18 years of age should not be entered into the trial.
  5. Who is funding the study? Pay attention here. If the study is paid for by the company who developed the experimental agent, how likely are they to give a completely unbiased report? Of course we want to assume that they will, but unfortunately, some won’t.  A government supported trial is more likely to report balanced findings than an industry funded one. The reporter added that patients should note what the authors say about their study, i.e., do they make overly optimistic claims for their treatments?  Most investigators add some type of cautionary note, like “the proposed treatment looks promising pending further studies.”  This disclaimer recognizes that no study is perfect.  In fact, there has been a marked increase in the number of studies initially reporting positive results that were retracted when similarly designed trials were subsequently negative.  The end result has been a delay in patients receiving appropriate treatments and a horrible waste of money.
  6. I’m adding this one on my own. I’ve noticed that one of the most common mistakes people make is to search for clinical trials involving the wrong cancer, not realizing that we identify cancers by their organ-of-origin, not the organ where they spread (metastasize).  An example would be to collect articles about liver cancer instead of colon cancer that metastasized to liver.

As chairman of our hospital’s Investigational Review Committee, I and our members are in charge of reviewing proposed clinical trials conducted in our hospital district.  The above factors, as well as many others, are considered before studies are approved, denied or amendments recommended.  Consideration of the items discussed above could save everyone a lot of wasted time, and even lead to the retirement of the Shell Answer Man.

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More To The Henrietta Lacks Story

25 Wednesday Apr 2012

Posted by @JustOncology in Uncategorized

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Tags

cancer, clinical trials, elder wisdom, epatients, evidence based medicine, health, Henrietta lack, medical education, medicine, physician, physicians, research, social media, twitter, wellness

By Richard Just, MD

A few weeks ago, my wife and I attended “A Conversation With David ‘Sonny’ Lacks” at the California Center for the Arts, Escondido.  The event was a sellout with 900 attendees.  As it turns out, most of the colleges and universities in San Diego County designated “The Immortal Life of Henrietta Lacks” as the book discussed by students and faculty this past academic year.  The conversation was sponsored by California State University, San Marcos.  As an added bonus, Mr. Lacks’ daughter appeared with him on the podium.  I had previously attended a similar lecture with the author, Rebecca Skloot, at UCSD.

The story of Henrietta Lacks can be viewed from several vantage points.  As a medical oncologist, and Chairman of the Investigational Review Committee as well as Medical Director of the Research Institute at Palomar- Pomerado Health, ethics in medical research certainly occupies a position of paramount importance to me.  In fact, the book is being discussed locally primarily from this perspective.  Ms. Skloot points out that obtaining ‘Informed Consent’ from patients to do research on their tissue was not required, nor was it considered, in 1951 when Mrs. Lacks’ biopsy was obtained for research purposes.  Mr. Lacks stated he did not feel the family should receive financial compensation for using her tissue for research purposes.  But, Henrietta and the family should have been told that her cells were going to be used for research purposes, what the research involved, and knowledge of the results.  In other words, essentially informed consent as we now require in all patients undergoing clinical trials.

On the other hand, he did feel that the family should receive financial remuneration from the companies that commercialized his mother’s cells by selling them to labs around the world.  This proposal seems fair.  To date, no financial restitution has occurred.

But despite all this, Mr. Lacks maintains an air of dignity that engenders respect.  Throughout the evening, there was no expression of anger or hostility; no complaining.  When asked if he thought that racial discrimination played a role in how they were treated, Mr. Lacks said no, people of all races were treated the same at that time.  Sonny said that although no one from Johns Hopkins has ever formally apologized, they have honored his mother in other ways.

Sonny Lacks was 3 years old when his mother died.  So, he has no direct recollection of her.  In fact, the picture on the front of the book is the only picture of Henrietta in existence.  All that he and his daughter know about her they learned from his older siblings and Ms. Skloot’s research for the book.  When Henrietta was treated, Johns Hopkins was the only hospital in the state of Maryland that treated the uninsured.  Fast forward to the present and this sore is still festering in our country.  Mr. Lacks stated that he recently required stents placed in his coronary arteries on an urgent basis and he, like all the members of his family, is uninsured.  This brought an audible gasp from the audience.  He said he had $100,000.00 in unpaid bills, and he opined that health care should be a right as it is in other countries, not a privilege for only those who can afford it.  This elicited a vigorous round of applause from the audience .  I would add that the number of people in the U.S. who can afford access to healthcare is dwindling also. [Editor’s Note: For specific discussion on the impact in the Black community, see: ‘Blacks See Largest Decline in Health Insurance Coverage.’]

The closest we have to universal healthcare provided by government is Medicare and Medicaid (MediCal in California), see: ‘Medicare: The Basics.’  I recently crunched the numbers in my own situation at age 70 to decide whether or not to convert from my medical group’s health plan (since I’m still working to full Medicare coverage.  Plan A is free and mandatory at age 65.  But I needed Plan B, a Medicare Supplement Plan and Medicare Part D for prescription drugs.  Part B involves an annual fee of $140.00 + monthly premiums of $99.00 + something called “Modified Adjusted Gross Income” (MAGI).  The IRS now sends Medicare a report of my income and a graduated monthly charge is added to my premium.  The monthly total amounted to $259.70.  Added to that is the cost of the Supplement and Medicare Part D.  Then the out of pocket expenses including cost of drugs in the donut hole and now you’re talking “real money.”  Of course, you can opt for a Medicare HMO but choices are limited. So for effect, I will quote myself (drum roll please!):

My conclusion was that being insured does not equate to being covered, and I needed to be a CPA to figure this out.  So, I stayed with my group health plan.

The most poignant moment of the evening occurred when Henrietta’s granddaughter was asked how she felt her grandmother should be remembered.  Her answer:

The gift that keeps on giving.

Not a dry eye in the room.

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← Older posts

The ‘incident’

My life was essentially on autopilot. My oncology practice was very successful; in fact, too successful. All my time and energy was devoted to keeping pace with the increasing demands of the profession. Other pursuits, be they personal or professional, always seemed to take a back seat. My main unfulfilled passion was writing.

On January 7, 2011, everything changed. I had a new bovine aortic valve and three new coronary artery grafts. A life altering event, to say the least. Fortunately my recovery has been uneventful, and I had no evidence of muscle injury. So I’m extremely grateful for the pre-emptive surgery, and since I’m back to work on a part time basis, I now can devote some of my attention to writing.

For the past several years, a colleague, trusted advisor and friend of mine, Gregg Masters, had been prodding me to “just do it”, i.e., just start blogging, podcasting and life streaming my experiences in Medicine. He pointed out the value of my 36 years in clinical practice of hematology and medical oncology as 'elder wisdom' currency in relative short supply. In truth, there is certainly a lot to write about as the clinical knowledge base has grown enormously, to the point where management of all this information requires computers. Fortunately, technology has developed at a rapid rate also so that we can not only mine all this data to obtain meaningful information, but better disseminate it to each other, health plans (including government) and especially our patients. With the advent of social media including Twitter, Facebook and You Tube, this flow of information becomes a two way street allowing physicians to listen as well as talk. On a personal note, my wife published daily status updates during my surgery and through the post-operative period on a website called Caringbridge. She posted pictures as well as narrative. Colleagues, relatives, friends and patients had a window opened to them as to how I was doing, and they in turn wrote back notes of encouragement that touched me deeply.

When Gregg and I thought about it, his background not only in 'web 2.0' (social media) but perhaps more significantly his considerable experience in the business aspects of medicine brings value into the conversation as well. In today’s environment, physicians are constantly reminded that we not only are responsible for all aspects of caring for patients, but we are running a business as well. Years ago, I remember reading an excellent book called “The E-Myth Physician” by Michael Gerber. One of the chapters was devoted to the subject of “Money”. So Gregg’s knowledge complements my clinical background resulting in the birth of JustOncology.com.

Certainly there is no shortage of topics to discuss. Utilizing a variety of media: blogging (which addresses my passion for writing), audio and visual interviews with as many of the stakeholders in cancer care as possible, we hope to provide a forum for discussion of problems facing us. From these interactions, the desired outcome is to identify solutions that can only come from a collaborative effort.

Recent Posts

  • In Absentia
  • What Is Cancer?
  • Big Data, Government and Cancer Research: A Benefit for Patients?
  • The Advent of Cancer Immunotherapy: Addressing Unmet Needs Part 1
  • Crowds Care for Cancer Challenge: Supporting Survivors the Finalists
  • Tumor Board: Is There Value in Multidisciplinary Case Consideration?
  • ‘You Don’t Know Jack’ by Morgan Spurlock
  • @IBMwatson and the Future of Oncology Care

About

JustOncology.com is a joint publication of Richard Just, MD, aka @chemosabe1 on Twitter and Gregg Masters, MPH, aka @2healthguru on Twitter.

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