Re: sidual dysplasia
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sun Jan 4 08:58:13 2004
You could also take the position that using Aldara, while well
intentioned, could have a negative side effect unbeknownst to anyone and
thus could do her harm. OTOH, it could do nothing and thus be "snake
oil," so to speak, and she's out time, hope (yes, she will have a
glimmer of hope when you give her treatment), and money.
If she is having surgery regardless, then I see no point to it, and
there could be unintentional negatives.
Just another view. . .
Garry
At Sat, 3 Jan 2004, Karen Lee wrote:
>
>--- Charlie Chambers <cchamber@gorge.net> wrote:
>> I think it's a dangerous proposition. One of
>> the reasons to do the LEEP
>> is for treatment, but the other is to insure
>> that no contiguous areas
>> of frank carcinoma are present.
>
>Help me to understand how Aldara use could
>confound the pathology so as to obscure
>continguous areas of frank carcinoma. And thank
>you for taking the time with this. This is very
>helpful as I know I'm sticking my toe into theicy
>pond with great intentions, which often count for
>naught.
>Karen
>
> You are using
>> an "experimental"
>> treatment at best for someone with an increased
>> risk of cervical
>> carcinoma. The only way that I could see this
>> happening is with
>> informed consent and with IRB approval.
>> Different story with someone
>> with LGSIL who you are observing to allow
>> spontaneous resolution, and
>> then hoping to expedite with the Aldara.
>> On Jan 3, 2004, at 9:42 AM, Karen Lee wrote:
>>
>> > So, this week I had a 22yo who had 2 N Paps
>> in
>> > the last 2 years. The recent one was LGSIL;
>> colp
>> > with 2 Bx, both HGSIL with glandular
>> involvement!
>> > So, of course she will have LEEP. I discussed
>> > this with the Doc I refer these to and
>> wondered
>> > how he felt about my Tx her with Aldara while
>> > awaiting the LEEP. He wasn't troubled by it,
>> so
>> > yesterday she had her first Tx. What do you
>> all
>> > think?
>> >
>> > Karen Lee, ARNP
>> >
>> > --- "art fougner, md" <evsono@pipeline.com>
>> > wrote:
>> >> I don't believe MgSO4 was approved for
>> >> eclampsia. and ASA antedates the
>> >> FDA. OTH off label indications put the onus
>> >> totally on the practitioner
>> >> so ...
>> >>
>> >> art
>> >>
>> >> At Fri, 2 Jan 2004, RModugno@aol.com wrote:
>> >>>
>> >>> Content-Type: multipart/alternative;
>> >>
>> >
>>
>boundary="-----------------------------1073081945"
>> >>>
>boundary="-----------------------------1073081945"
>> >>> -------------------------------1073081945
>
>boundary="-----------------------------1073081945"
>> >>> Content-Type: text/plain;
>> charset="US-ASCII"
>> >>> -------------------------------1073081945
>> >>> Content-Transfer-Encoding: 7bit
>> >>> -------------------------------1073081945
>> >>> In a message dated 1/2/2004 1:58:24 PM
>> >>> -------------------------------1073081945
>> Eastern
>> >> Standard Time,
>> >>> cchamber@gorge.net writes:
>> >>> I was then chastised
>> >>>> by a physician because I was using this
>> off
>> >> label
>> >>>> and was very liable for lawsuit. I
>> discussed
>> >> it
>> >>>> with the Aldara rep who, of course, could
>> >> not
>> >>>> recommend that usage.
>> >>>
>> >>> Once a drug is apporved by the FDA - you
>> can
>> >> use it for "off-label" uses
>> >>> provided there is medical literature to
>> back
>> >> up this use.
>> >>> e.g.terbutaline is not approved for the
>> >> treatment of premature labor.
>> >>>
>> >>> Robert Modugno MD MBA FACOG
>> >>> Marietta, GA
>> >>> http://www.novaobgyn.yourmd.com
>> >>>
>> >>> -------------------------------1073081945
>> >>> Content-Type: text/html; charset="US-ASCII"
>> >>> -------------------------------1073081945
>> >>> Content-Transfer-Encoding: quoted-printable
>> >>>
>> >>> In a message dated 1/2/2004 1:58:24 PM
>> Eastern
>> >> Standard Time, cchamber gorge.net writes:
>> >>> I was then chastised> by a physician b
>> cause I
>> >> was using this off label> and was very
>> liable
>> >> for lawsuit. I discussed it> with the
>> Aldara
>> >> rep who, of course, could not> ecommend
>> that
>> >> usage.
>> >>> Once a drug is apporved by the FDA - you
>> can
>> >> use it for "off-label" us s provided there
>> is
>> >> medical literature to back up this use.
>> >>> e.g.terbutaline is not approved for the
>> >> treatment of premature labor.
>> >>>
>> >>> Robert Modugno MD MBA FACOG
>> >>> Marietta, GA
>> >>> http://www.novaobgyn.yourmd.com
>> >>>
>> >>> -------------------------------1073081945--
>> >>>
>> >>> -------------------------------1073081945--
>> >>
>> >> --
>> >> art fougner, md
>> >> ich bin ein New Yorker
>> >
>>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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