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so this is a session about changing therapies and it is something that comes up fairly frequently so its a good practical topic you know when we get to the question part itd be best if you probably dont ask questions that are like very very specific to your own situation but anyway they dont want you to go back and tell dr. McCune that dr. badish that you need to change your therapy he probably wouldnt appreciate it so anyway Im going to begin discussing kind of when to change therapy what are some of the indications that you might need to consider in things and then get three people with me sherry habits one of our research coordinators from the University of Colorado and Steve Mathai is from Johns Hopkins University and ro Hamza manian from Stanford is stepping in for dr. hunter champion who couldnt make it from Pittsburgh yeah so thanks real huh yeah and so when to change therapy one of the indications might be continued clinical worsening despite the therapy that youre alre