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Demystifying Medicine One Month at a Time

Author: glasshospital (page 1 of 72)

Medical Marijuana: Not Up to the Standard

This year Oklahoma voters made a clear choice to legalize medical marijuana, joining thirty other states that permit cannabis for medicinal use.

Unsurprisingly, immediately in the vote’s aftermath, patients began asking me to ‘prescribe’ medical marijuana licenses, as the new law stipulates users must have as a precondition for legal purchase. The new law does not, however, specify qualifying diagnoses for which medical marijuana might be clinically indicated.

My answer thus far has been, “Not now. Likely never.”

This has not been a popular response. One patient looked at me as if I’d put a lump of coal in his Halloween bag.

I’m not a fan of medical marijuana for several reasons. The main issue is the lack of proven medical efficacy. I know there are thousands of anecdotes from people whose pain or anorexia has been diminished by marijuana–and I’m genuinely glad for them. But I’d like to see better powered controlled trials of cannabis products head-to-head with accepted therapeutic agents. Having the FDA weigh in on marijuana’s safety and efficacy would also go a long way toward legitimizing pot’s medicinal use.

Another major problem is smoking the stuff. If we had proven, standardized dosing of edibles, I’d be more supportive of medicinal use. But smoking anything–tobacco, marijuana, vapor juice–is not a healthy practice, and one I counsel patients to avoid. I hear the arguments about the purity of pot and how it’s ‘more natural’ than manufactured tobacco products. The bottom line is that inhaling burning plant matter into your lungs is a terrible idea–regardless of the herb.

If voters want to legalize marijuana for recreational use, I have no objection–provided we put in place a legal framework to make sure that people don’t get hurt. Standardized dosing and measures to assure product consistency would be integral. And we’d need adequate enforcement to make sure that people aren’t impaired when at work or in other situations in which their marijuana use could jeopardize others.

Putting doctors in the middle of what amounts to a political, legal, social, and economic debate steers the medical profession in a race to the bottom–and let’s face it–our profession has enough problems already without being the gatekeepers of grass.

Remember that marijuana is still scheduled by the Drug Enforcement Administration as a Class I narcotic, defined as having “no accepted medical use and high potential for abuse.” So even though medical weed is now legal in my state, I have no interest in violating or abetting violations of federal law.

In fact, as it turns out, since I work at a university, our legal counsel is of the opinion that no provider in our system shall recommend marijuana, since our institution has numerous federal grants and funding streams and must therefore comply with all federal rules and regulations.

Some have suggested that given our national opioid epidemic, marijuana can serve as a safer alternative for pain control. Since most cannabis is homegrown, and where legalized a tax revenue source–this does make medical marijuana a more appealing alternative to propping up the seemingly ubiquitous heroin/fentanyl drug cartels.

This argument makes pot part of a harm reduction strategy, which I’d be more supportive of if the evidence were stronger.

Right now I see the pot economy as a Wild West with hundreds of entrepreneurs and medical professionals looking to stake claims in this new quasi-legal economy.

Get back to me when we have more state/federal legal congruence and clarity on the stuff’s true medical benefits.

This essay originally appeared as a Doximity Op-(m)ed.

Doximity

Have you heard of Doximity? There’s no reason why you would, unless you’re in the medical world.

Think of it as LinkedIn for doctors and other health care pros. Launched in 2011, Doximity now claims that more than 70% of U.S. physicians are members. If it’s true, that’s a pretty impressive number/captive audience.

They started an authors’ program, where medical pundits offer monthly columns.

My focus has always been on demystifying medicine for non-medical audiences, but I want to see if I can broaden the audience a bit.

My first column was a topic I’ve broached here before: how hospitals go quiet on weekends, which seems nonsensical to me. You can read it here.

The second monthly column just went up; it’s an exploration of why so much dialysis in the U.S. for people with end-stage renal disease (i.e. kidney failure) is of the variety known as “hemodialysis” as opposed to “peritoneal dialysis.” HD mostly involves patients going to centers three times a week for 3-4 hour sessions–which makes maintaining employment darn near impossible.

PD occurs at night, at home, and interestingly it works better (fewer side effects and better longevity) and it’s cheaper overall. So why do only 10% of dialysis patients use it?

In a word, money.

But the good news is that’s changing. Expect to see a significant increase in peritoneal dialysis in the next 5 years–from 10% of patients with end-stage renal disease, to 20% or more. You can read about it here.

End of Life Rallies

Let’s say your loved one is at the end of life. She’s 84, with advanced cancer that is no longer treatable.

A decision has been made to put her in hospice–which is a level of care more than an actual location. [Most hospice actually occurs at home.]

The patient waxes in and out of consciousness, sometimes lucid, but mostly not.

While no one is ready for her to die, this end-of-life process brings some solace–it’s what your loved one has indicated she wants, and the time at home without aggressive, often fruitless, medical treatment, allows other friends and family members to make visits and share stories.

One afternoon, she perks up and asks for a sandwich. This is surprising, because she’s barely eaten anything in the last ten days. But we get her that sandwich!

She nibbles at it, happy, but doesn’t eat much of it.

That afternoon, she’s talkative and engaged with others in a way that she hasn’t heretofore seemed able to muster.

Is she making a comeback? Healing from her illness?

More likely, this is what is called “rallying,” and while there’s ample anecdote of its occurrence in situations like this, we have very little understanding of it.

How does it happen? As a recent NYTimes article stated:

Physiologically, experts believe that the mind becomes more responsive when a hospice patient is taken off the extensive fluids and medications such as chemotherapy that have toxic effects. Stopping the overload restores the body to more of its natural balance, and the dying briefly become more like their old selves.

It’s deceiving because we think our loved one is getting better. And while she’s more like her old self, unfortunately, it’s not bound to last. Which is why it can be upsetting for some.

Spiritually, some suggest that the dying loved one is simply readying for transition–making sure that earthly concerns will be attended to in her absence and that final goodbyes may be uttered.

I’ve seen it–and especially in elders afflicted with dementia, it can be heartening to see them rally and seem to know what’s going on–accepting their impending death, and engaging with their loved ones before drifting off.

Can your city become a Blue Zone?

 

Tulsa is on a roll. With recent announcements about the openings of Gathering Place and a new Amazon fulfillment center, good news abounds. This week we have another opportunity to keep it rolling.

On Tuesday and Wednesday, our city will host visitors from Blue Zones, who will be here to help determine whether our community has what it takes to become a Blue Zone city.

What are Blue Zones?

Explorer Dan Buettner traveled the world to find the places where people live the longest and healthiest. In these places, which he named Blue Zones, people routinely live to 100 years of age, while still active and engaged.

Buettner formed a company to share the knowledge and practices of Blue Zones, and these initiatives have spread across more than 40 U.S. cities in nine states.

Blue Zones projects are designed to unite our community behind a common goal: transforming environments so there are more ways to make healthy choices easier.

More places to walk and bike outdoors. More healthy foods. And more purpose. All of which leads to more years to enjoy it all.

The Blue Zones matrix is not a turnkey solution. Their experts work in a diverse array of communities and bring scaffolding upon which we can build our own programming. We Tulsans must lead the way on implementation and operation.

Buettner will provide the event’s keynote address in a public presentation 6 p.m. Tuesday at OU-Tulsa’s Perkins Auditorium at the Learning Center on the Schusterman Campus.

Wednesday there’s an event called “Wine @Five,” which celebrates the social health aspects of Blue Zone communities. In addition, you’ll have the opportunity to meet Blue Zones personnel and many of our community stakeholders, ask questions, and share ideas. That event will take place at 5 p.m. at TCC’s Center for Creativity.

RSVPs are encouraged but not required.

Both events are free and open to the public — you can learn more about them and RSVP at this website: go.bluezonesproject.com/tulsa.

We hear all the time about how dismal our health outcomes are in Oklahoma. More people smoke, are overweight, and suffer from diabetes, mental illness and cardiovascular diseases than national averages.

We are near the bottom in terms of life expectancy, health promoting behaviors and access to health care. Nationally, our model of health care has emphasized the dousing of fires (“rescue care”) rather than fire prevention.

When I talk to patients, I boil down prevention to a few simple precepts that are easy to say but harder to do. Regular practice turns them into healthy behaviors. They are:

  • Get enough sleep.
  • Move your body throughout the day.
  • Eat well — a healthy assortment of foods. Mostly plants, and not too much.
  • Interact socially. Isolation is not good for the body, soul or mind.
  • Take some time to reflect on what you are grateful for.

These behaviors are practiced in Blue Zones across the world. They are not unique to those areas, and they can be more easily achieved here in Tulsa.

If finding a way to make life healthier as a core value speaks to you, then come learn about Blue Zones.

In addition to the two public events I mentioned earlier, there will be several theme-based focus groups taking place throughout the region on June 27. You can learn more about these at go.bluezonesproject.com/tulsa.

This week’s Blue Zones visit to Tulsa did not happen by chance. Many partners have been involved in bringing the site visit to life — including Mayor G.T. Bynum’s Office, the Tulsa Regional Chamber and the Tulsa Health Department. Local businesses, nonprofits, foundations and educational institutions have contributed time, talent and money to bring Blue Zones to Tulsa.

Here’s hoping that Tulsans can live healthier and longer and keep our city on a roll.

Dr. John Henning Schumann is president of the University of Oklahoma — Tulsa.

 

Costs of Care Redux: Extremis Edition

It’s not new to GlassHospital readers, but coverage of outrageous health care bills in the United States is having a bit of a moment.

At least two major news sources, NPR and Vox, are running series in which people who have received bills for health care that seem outrageous can share them with investigative journalists and get help.

Based on the success of her book An American Sickness, doctor/journalist/editor Elisabeth Rosenthal and Kaiser Health News are working with NPR to produce one of these stories for web and radio every month.

Story #1 told of a urine test (screening for drugs) that was billed at $17,850. This is not a joke.

Story #2 compared the difference in price between the same CT scan performed at a hospital vs. a freestanding radiology center. [Hint: hospitals are MUCH more expensive places to get tests done.] The same CT scan of a man’s abdomen performed at a local hospital was billed at thirty-three times the price of the outpatient center.

The most recent story featured a disabled Oklahoma librarian, who had surgery on her arthritic foot. When she had sticker shock at the charge of more than $115,000 for her surgery and three day hospital stay, she did a smart thing and asked for an itemized bill. The most outrageous finding? A charge of $15,076 for four tiny screws implanted in her foot.

The moral of these stories is a) hospitals and laboratories can egregiously mark up their prices, without warning, clarity, or fairness; b) if you are faced with such a bill, you simply MUST ask for an itemized list of charges if you want any hope of contesting them.

If you think charges for actual care can be outrageous, how about being charged for NOT getting care?

Vox tells one woman’s story of fainting, going to a nearby Emergency Department, then declining to be treated. Why did she decline? Fear of an exorbitant bill.

So what happened?

After being given an ice pack and a bandage, she declined treatment, went home, and subsequently received a bill for $5,751.

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