2 posts tagged “Dr. Rick Bedlack”

Dr. Rick Bedlack weighs in on telemedicine

Posted 1 month ago by

Do you have difficulty getting to your doctor’s appointments? Ever thought about using telemedicine? Connecting online can make it easier to get the care you need. Here, Dr. Rick Bedlack (a tenured associate professor of Medicine/Neurology at Duke University and the director of the Duke ALS Clinic that’s partnering with PatientsLikeMe in the current Lunasin study) explains the basics of telemedicine, his “Tele-ALS” program and how telemedicine could improve patient clinical trial experiences in the future.

Telemedicine 101: How does it work?

“Telemedicine” connects patients and their doctors through secure video conferencing programs (similar to “FaceTime”). Both parties need to have a computer, tablet or smartphone, and a video conferencing program that has been approved for use by the doctor’s institution. I have been offering this type of care to patients with ALS for several years now, through separate “Tele-ALS” programs at the Durham VA Medical Center (VAMC) and Duke University.

The pros of telemedicine

  • No travel: The main benefit of Tele-ALS is that it allows patients with ALS who live in rural areas to continue to connect with their ALS specialist throughout their disease, even when travel becomes difficult or impossible.
  • Symptoms management: This connection facilitates expert identification and management of the many modifiable symptoms patients with ALS experience throughout their illness, such as drooling, thick secretions, excessive laughing and crying, cramps, spasticity, pain, insomnia, anxiety, depression, and constipation.
  • Tech troubleshooting: It also facilitates identification and triage of equipment problems such as malfunctions in speech generating devices or power wheelchairs.
  • Keeping patients in the know: I have personally found it to be very useful in keeping patients informed about exciting research and alternative options and in this manner helping them stay hopeful throughout their illness.
  • More accessible clinical trials: In the next year, I will pilot the first ever totally virtual ALS clinical trial. Instead of making “in person” study visits, this trial will conduct all required visits via Tele-ALS. This should make participation much simpler and more attractive for patients and families.

The cons

There are some down sides to Tele-ALS…

  • From a patient’s perspective, many have told me they miss coming in and meeting in person with all the members of my team. Not all patients have a computer, tablet or smartphone, or Internet access.
  • From my perspective, I miss not being able to perform a detailed neurological exam. Given this limitation, I would not offer Tele-ALS to a patient I had never seen before —only to those whom I have already examined and confirmed the diagnosis in person.
  • From an administrator’s perspective, there currently is no way to bill for a typical Tele-ALS visit. This is the main reason that more clinics are not offering it. We are only able to offer it at Duke because of a generous grant from the North Carolina Chapter of ALSA.
  • Finally, there is a silly rule that prevents us from crossing state lines with this care model. The VAMC has found a way around this rule and VA providers can now offer telemedicine, including Tele-ALS, “anywhere to anywhere.” Hopefully non-VA hospitals will figure out how to do this soon.
telemedicine

telemedicine

Going forward

As we work out some of the problems with billing and crossing state lines, I think telemedicine and especially Tele-ALS clinics are going to become much more common. If my upcoming virtual research study shows good compliance and adherence, Tele-ALS will be increasingly used in trials to minimize participant burdens as well.

For more information:

www.telehealth.va.gov

www.dukealsclinic.com/telemedicine

Have you tried telemedicine? Why or why not? Join PatientsLikeMe and share your experience with the community.

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The record on research: A chat with Duke’s Dr. Rick Bedlack

Posted March 7th, 2017 by

“This is the fastest enrolling trial in ALS history.”

 

A brightly-colored blazer and the determination to make a difference for ALS patients are two of Dr. Rick Bedlack’s defining characteristics. Dr. Bedlack is a tenured associate professor of Medicine/Neurology at Duke University. He’s also the director of the Duke ALS Clinic that’s partnering with PatientsLikeMe in the current Lunasin study. We recently spoke with him about his background with ALS and the ins and outs of the study.

He saw his first patient with ALS in the late 1990s during his residency at Duke.  He says, “I remember being amazed by the person’s history and neurological exam findings, intrigued by the mysteries of why this was happening, and horrified when I heard my attending physician say ‘you have 2-3 years. There is nothing we can do. Go and get your affairs in order.’” Driving home that day, he decided to build a program for people with ALS that would give them options for living the best possible life with the disease and for participating in research that would stimulate some hope.

Fast forward to March of 2016 when the Lunasin study started. What’s Lunasin and why does it matter to the ALS community? Lunasin is a peptide first extracted from soybeans, which has several potential mechanisms by which it could help a person with ALS. “I first heard about it in a video that my ALSUntangled team was asked to review. In this, a man named Mike McDuff reported that he had ALS, started taking a Lunasin-containing supplement regimen, and unexpectedly experienced dramatic improvements in his speech and swallowing,” says Rick.

He found Mike McDuff and validated his ALS reversal. “One possible explanation for his ALS reversal is that the Lunasin regimen really works,” he says. “Other possible explanations are that Mr. McDuff has an undiagnosed ALS-mimic syndrome, or that his body is somehow naturally ‘resistant’ to this disease. I am testing all these hypotheses in my ALS Reversals program.”

The Lunasin study is a clinical trial of the exact same Lunasin-containing regimen that Mike McDuff took when he experienced his ALS reversal. Because they’re looking for the largest signal ever in an ALS trial, they’ve been able to incorporate some unusual design features into this trial:

  • The inclusion criteria are very broad. There are no cutoffs related to disease duration or breathing function.
  • There are no placebos. All 50 people in the trial will get the real treatments.
  • There are very few in-person visits. Most of the visits are virtual, with participants logging into PatientsLikeMe to enter measurements we teach them to make.
  • The results of the study are available in real time. Anyone can go onto PatientsLikeMe and type in “Lunasin Duke Virtual Trial” and see what participants are saying is happening to them.

“I appreciate the frustration many people with ALS have expressed about the way most of our trials are designed and I wanted to do something different to help them,” says Dr. Bedlack. “It took longer than I expected to get the study open. Constipation is much more common on the Lunasin regimen than I expected, and drop outs have been higher than I hoped thus far.”

The IRB-approved protocol is published so that anyone who wants to try the Lunasin regimen outside the trial can do so using the exact same products and doses, and even record their same outcome measures on PatientsLikeMe.

So, what’s the end game of this study? Dr. Bedlack comments, “I hope to find a way to reverse ALS or at least slow it down. If that does not happen, then I hope I can at least show that this unusual design enrolls more quickly and retains study participants better than a more traditional ALS trial. This is the fastest enrolling trial in ALS history.”

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