Interesting public endorsements of marijuana research or legalization

I was actually pretty surprised that California voters voted down an initiative that would have legalized marijuana in the State of California (I mean, California!?)  Personally, I think it's medicinal use should be weighed against it's known side-effects just like any other medication.  I doubt many patients would want to take a prescription pill for pain that could cause drowsiness, multitasking problems, lowered sperm count or increased appetite.  However, research on marijuana as a medicine has been limited by its illegality.  It's pretty tough to do clinical trials in which the participants in the study have to admit to committing a crime.

Marijuana Majority (h/t Boing Boing) is a pretty interesting website on endorsements regarding the legalization or legitimization of marijuana research and/or use.

I'm not surprised to see endorsements from Willie Nelson or Kanye West, but I'm gratified to see endorsements from the California Medical Association and the American Medical Association.  On the other hand, I'm more surprised the see endorsements from The Economist and the Financial Times, not to mention from so many prosecutors and law enforcement officers.  And Glenn Beck?  Sarah Palin?  Wow.  Just wow.

I never thought Pat Robertson and I would agree on anything.  Who knew?  Mysterious ways, indeed...

Fatalities Linked to Monster Energy Drinks

Bloomberg News is reporting five recent deaths in young people who drank Monster shortly before their deaths.  The FDA notes that these are voluntary reports and allegations at this time.

The concern is that energy drinks can contain very large amounts of caffeine; far beyond standard cola beverages or coffee drinks. ER doctors treated over 13,000 patients in 2009 between 18 and 25 years old for symptoms involving energy drinks with or without other substances.

Currently, labeling the caffeine content is not required since the drinks are marketed as dietary supplements and not foods or drugs.

Should Lance Armstrong Still Be a Hero to Cancer Patients?

Armstrong has already been banned for life from cycling and lost his Tour de France titles due to overwhelming evidence that he cheated during those years by using performance enhancing drugs, including anabolic "body-building" steroids.

His comeback win in the Tour de France after diagnosis and treatment of metastatic testicular cancer was lionized, and he went on to found the Livestrong foundation for cancer survivors.

At 28 years old at the time of his diagnosis, he would not have been unusually young for it.  Testicular cancer is the most common malignancy in men of the 20-34 year age range.  On the other hand, using anabolic steroids with an undiagnosed testicular cancer would enhance its growth and spread in the same way that a woman on hormone replacement would fuel the growth of an undiagnosed ovarian or breast cancer.  Whether the steroid abuse could even outright cause a testicular cancer is not well known, but certainly it has been linked to pituitary gland, prostate gland and liver cancers.

As this article points out, using blood-doping agents and blood transfusion was not a common or particularly available practice early in Armstrong's career.  This leads to a real question of whether Armstrong's use of steroids caused or stimulated his testicular cancer.  I'd agree that anyone who can come out the other side of metastatic cancer has had to use some incredible internal resources.  On the other hand, I'm not so sure it's a good message to send cancer patients and young athletes to have Armstrong continuing to be so visibly involved in Livestrong at this  point.

Barry Ritholtz on George Carlin

Barry Ritholtz, one of my favorite economics daily reads comments on his use of George Carlin to proffer investment advice.  The advice itself is posted in the Wall Street Journal's Market Watch, and is a good read about investing and also about the human condition.

Barry goes on to cite and link to George Carlin's epic rant on The American Dream.  IMHO, truer words never spoken.  NSFW, and waaaaay before "the 1%" became a household word.

Technology in Medicine

This is a thoughtful piece in the New York Times discussing the evolution of technology in medicine.  It is less about breakthroughs in imaging or surgical techniques than it is about the role of technology at the bedside and the continued value of physical examination and of human rapport.

It is particularly evocative to me because of my somewhat unique place within the history of contemporary medicine.  As a doctor in practice now for twenty years, I trained at a time when many of my teachers were incredibly skilled in the physical examination.  Dr. Shaver, the cardiology professor, was famous for being as accurate as and echocardiogram.  For that matter, the echocardiogram was relatively new.  The safety of fetal ultrasound was still not known.  I assisted in as many open gall bladder removals as laparoscopic one because laparoscopy was cutting-edge at the time, no pun  intended.  At the same time, medical students were beta-testers of a program to help doctors make difficult diagnoses based on symptoms and findings such as physical exam abnormalities or blood test or X Ray results.  In other words, I entered medicine at a time of tremendous change in the development and use of technologies and also the very ways in which medicine is practiced.

Like the younger doctor in this article, my "ectopic brain" of pocket-sized books and cards has been happily replaced with an iPhone and dozens of incredibly useful medical applications. Like the older doctor, I have learned the real value of time spent with patients in gathering useful information, performing a skilled examination, establishing real and lasting trust, and coming to agree on plans and treatments.  Like both doctors, I have used electronic medical systems for years, but since I can't touch type and maintain eye contact with patients like the younger doctor (40-60 wpm, thank you very much), I rely on note taking and voice recognition transcription.

Something not really addressed in this article is the incredible opening of information available to everyone on the internet.  I think it's great that patients are now able to find useful information or share it without having to go to medical libraries to find it.  Internet information requires as much critical thought as any other kind, but an interested patient is an informed patient!

MediCare Open Enrollment is October 15 through December 7

Coming into the end of the year, this is your chance to change or enroll in a MediCare Part D plan.  Part D is optional, and adds coverage of prescription medicines through a number of commercial insurance companies in conjunction with MediCare.  MediCare Part A and B continue to cover hospital and outpatient medical needs such as hospitalizations, surgeries, doctor visits, lab tests or X-Rays.

The Part D Plan Finder is an easy way to identify plans you might like based on your zip code, the medicines you take, and what pharmacies you use.

These plans generally cover generic pills, so you mainly want to look at coverage of brand name pills you take, or ones that are shots or inhaled, since these tend to be the most expensive.  Also, please feel free to ask us if less expensive but equally good medicines are an option for you.

Please, please, please remember TANSTAAFL.  There Ain't No Such Thing As A Free Lunch.  If it looks to good to be true, it is.

 MediCare Health Plans With Drug Coverage that have zero dollar deductibles and zero copays on medications are worth every penny.

AARP MediCareCompete SecureHorizons (HMO) is an HMO.  That's why it says (HMO) right next to the name.

We have found that it is nearly impossible to get tests scheduled or referrals authorized with this plan.  If you don't like "Canadian Socialist health care", don't pick this plan.  If you want a zero deductible/zero copay plan and don't mind waiting over 3 months to get an MRI authorized for your knee pain, this is the plan for you.

However, this is not the plan for us.  We will not accept or keep patients who carry this plan.  It is simply too time-consuming and aggravating to get necessary care for our patients with it.

"Be so good they can't ignore you."

Steve Martin (the comedian, actor and art collector) passed on some advice for aspiring performers that really seems to resonate for anyone trying to turn a job into a career that they actually find challenging, stimulating and enjoyable.

I bring this up because I have a lot of patients who are young and trying to get a leg up in a famously down economy.

The idea here is that over a 10 year period of time, he simply focused on how to do what he did really, really well.  It may be that becoming happy, recognized and well-compensated for what you do may be less a matter of looking for "the perfect job" than putting your head down and doing what your job calls for really, really well. 

h/t Lifehacker