Medical Marijuana Buzzes Ahead

It’s flown a bit under the radar, but the medical marijuana business in Ohio is moving ahead, slowly but surely.  The Ohio State Medical Board has been meeting to determine which conditions can properly be the subject of a medical marijuana recommendation.  People have been registering to participate in the program.  Medical marijuana dispensaries are open and operating, and the Ohio Board of Pharmacy has been issuing licenses to dispensary employees.  And new jobs have been created, too.

2133Let’s start with the jobs.  One website looked at reports from the Ohio Department of Commerce and other state regulators and determined that, in the year since medical marijuana dispensaries first opened, 4,275 new jobs have been created.  That number includes 951 state-licensed dispensary employees, as well as 1,686 people working for cultivators, testing labs, and processors.

There are now 49 regulated medical marijuana dispensaries found at different locations across the state, including a number in Columbus.  (If you are over 21, you can see the list here.).  More than 70,000 Ohioans are registered with the state’s medical marijuana program, and the average person who uses the products is more than 55 years old.  Many apparently use the products to deal with chronic pain.  Reports indicate that nearly 56,000 Ohioans have bought more than $50 million in medical marijuana products at the dispensaries, and prices have come down as more dispensaries open and more product becomes available.

In the meantime, the State Medical Board has been meeting to consider the conditions that may appropriately qualify for a medical marijuana recommendation from a doctor.  Only this week, the Medical Board denied a request by long-suffering fans of the Cleveland Browns and Cincinnati Bengals to qualify their fanship as a disease that can be treated with marijuana to ease the pain of constant losses, but also voted to move anxiety and autism forward as potentially qualifying conditions.

Ohio tends to be a cautious place, and it took a cautious approach to medical marijuana.  So far, at least, the cautious approach seems to be working.

“Burn-out” As A Medical Condition

Every few years, the World Health Organization produces a new version of the International Classification of Diseases, a catalog of acknowledged medical conditions that is used as a diagnostic guide by health care providers.  With every new version of the ICD, there seems to be some controversy about whether or not a particular ailment or complaint should be recognized.

burnoutThis year, the “should it be included or not” controversy swirls around “burn-out.”  Apparently there has been a long, ongoing debate about whether “burn-out” should be recognized as a medical condition, and the WHO has now weighed in with a “yes”:  the ICD-11 lists “burn-out” and defines it as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed.”  According to the WHO, “burn-out” syndrome is characterized by “1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy.”  Notably, the ICD-11 tries to draw a kind of line in the sand by stating that “burn-out” “refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

My guess is that many — if not all — workers have, at some particular point or another in their careers, experienced “burn-out” as defined by the WHO.  Jobs typically involve stress, and it’s almost inevitable that there will be periods where multiple obligations pile on top of each other, leaving the worker feeling overwhelmed, exhausted, and dissatisfied.  But . . . should “burn-out” be viewed as a medical condition?  What, exactly, is a doctor supposed to do for a patient who presents with classic “burn-out” symptoms — prescribe a three-month vacation, or a new job, or new job responsibilities, or a change in the patient’s workplace manager?  Will employers be required to allow leaves of absence, beyond their designated vacation periods, for employees whose doctors diagnose them with “burn-out,” and will health insurers be required to pay for vacations as a form of treatment?  By classifying “burn-out” as a diagnosable health condition, aren’t we really going far down the road of “medicalizing” common aspects of our daily lives?

And can “burn-out” really be limited to the “occupational context,” as the ICD-11 instructs, or will the same concepts underlying workplace “burn-out” ultimately be recognized in other areas, like family or marital or college “burn-out”?  Here’s a possible answer to that question:  the ICD-11 now recognizes video gaming, with cocaine, and alcohol, and gambling, as a potential source of addiction.

Cannabusiness

Cannabis sativa — the name of the plant species that includes marijuana and industrial hemp — seems to have gone mainstream in modern America.

When I was walking through LaGuardia Airport last week for my flight back to Columbus, I passed a shop that featured the above advertisement for cannabis sativa seed oil, as an “herbal fix for problem skin” with “100% naturally derived ingredients.”  And Kish and I have been to parties where people our age have knowledgeably and seriously discussed the claimed health benefits of cannabis-infused oils and creams for conditions like sore shoulders and aching backs.  For years, people who have pushed for legalization have claimed that the plant could produce many different types of useful products — and now it seems those claims are being realized.

If cannabis products are being accepted by the masses for skin care and health care purposes, it’s a pretty good indicator that cannabis has become big business.  In America, there aren’t many product areas that are bigger than skin care and health care.

Beards And Bacteria

Beards seem to be a source of endless fascination for medical researchers and health care reporters.  Ever since Peter Griffin grew a beard that served as home to a nest of birds on Family Guy, their prevailing view seems to be that male facial hair must be host to countless forms of microbial life and teeming with potential disease-causing agents.

bird-beard-peterSome stories contend that the coarser nature of beard hair makes it more likely to trap food particles, note that stroking beards can cause a transfer of germs, and offer helpful observations like “If someone [is] eating dairy products it can get stuck in their beard and become a bit rancid.”  In another recent incident, a microbiologist took swabbings from beards, pronounced himself appalled by the results, and provoked stories with leads like this one on the USA Today website:  “Beard hygiene is important unless you want to have the equivalent of a dirty toilet seat growing out of your face, according to a microbiologist who swabbed a bunch of beards and was shocked by the results.”

Makes you want to cringe any time you’re in the vicinity of some stranger with a rancid sour milk-scented hairy toilet seat on this face, doesn’t it?

So, speaking as a guy who’s had a beard for the last 20 years, it was refreshing to see a new bit of research that counters the notion that beards are germ-ridden potential public health disasters waiting to spread plague and illness throughout the population.  A study published in the Journal of Hospital Infection found that clean-shaven men are more than three times more likely to have a challenging form of infection-causing bacteria called MRSA (for methicillin-resistant staph aureus) on their cheeks than bearded guys, and also are more likely to have faces with staphylococcus aureus, which can cause skin and respiratory infections and food poisoning.

Why would this be true?  Researchers think that those two forms of bacteria might form colonies and breed in the microabrasions caused by men repeatedly scraping their faces with sharp objects (otherwise known as shaving).  And, even more intriguing, a separate analysis indicates that beards may be home to microbes that actually kill bacteria, which could lead to the development of new forms to antibiotics — which something that the world desperately needs because bacteria are becoming increasingly resistant to the current array of antibiotics.

That’s right:  in the space of a single article, beards go from filthy petri dishes of lurking disease to the potential salvations of the human race!  I think I’ll celebrate by guzzling some dairy products and letting a few drops find a whiskery home.

The Hospital Of The Future

Richard has a splendid story in today’s Pittsburgh Post-Gazette about the hospital of the future.  Appearing on the last day of his internship there, it’s a thought-provoking think piece about what the hospital of the future might look like.

IMG_1112I would expect communications technology to change hospitals, as it has changed law firms, retail stores, and just about every other business you can think of.  To me, the most interesting part of the piece was about the physical design of hospitals, and specifically how hospitals are striving to make their facilities more inviting and capable of being “branded.”  Rather than the institutional, brightly lit corridors most of us know, the new hospitals are warmer, gentler in their design and lighting, and chock full of things like gardens and coffee shops.  They’re bound to be less depressing than the sterile, wholly functional designs of the past.

In that respect, Richard’s article made me think of colleges, and how their focus has changed from the professor and the classroom and the curriculum to the posh student centers, rec centers, and health clubs that so many schools have built to attract more applicants.  We can bemoan the decline of serious scholarship on campus, but colleges clearly have recognized that they are competing for paying students and are willing to build what is needed to attract them.  As hospital systems become more competitive for patients — and in Columbus, we’ve got three gigantic ones duking it out — they’re bound to follow suit.

Crutches And Couches

Since my surgery yesterday, I’ve kept my left foot elevated above my heart, to try to minimize swelling, and avoided putting any weight on my left foot, to avoid bending the pins that are straightening my toes. That means I’ve made two new friends — our family room couch and my crutches.

1394631752489In our house, the couch is the province of Kish, Penny, and Kasey; I’m a chair guy. I’m also happy to report that in nearly 32 years of marriage I’ve never slept on the couch before. Last night I broke that record. It’s just easier to stay on the first floor right now, and couches are well-suited to constructing teetering towers of pillows to serve as a platforms for my bandaged hoof. With the aid of some pain medication, I slept pretty well last night, and my main concern is keeping the dogs from jumping up on me.

I’ve also been fortunate to never have used crutches before. They’a bit awkward, and I’ve got to watch slipping on the rugs on our hardwood floors, but I’m starting to get the hang of them. I can hobble around, after a fashion.

Some time in the distant past, some now anonymous person invented the first crutch. Like the splint, the crutch is one of the basic medical care devices that has been used for millennia; it apparently dates back to ancient Egypt. On behalf of all modern users of this ancient device, I’d like to thank it’s true inventor — whoever you were.

The Value Of A Good Nurse

Today’s outpatient procedure at the East Side Surgical Center demonstrated the value of a good nurse — and how essential they are in the modern world of healthcare.

From the outset, after I completed the registration materials, I was in the realm of nurses. Pre-operation, a friendly nurse adjusted my crutches to the right height, got me changed into surgical garb, took my vitals, created my ID bracelets, gave me my initial medication, and set up the blood vessel portal for the anesthetic to be administered, among other tasks that I wasn’t even aware of thanks to our relaxed conversation. She was a real pro.

After the surgery, I awoke to the company of another nurse who checked the dressing on my foot, explained that the operation had gone well, took my blood pressure, gently engaged me in a slow-talking conversation as the anesthetic fog gradually lifted, steadied me on my crutches, then wheeled me out to where Kish was waiting for me with the car. She was great, too.

In our penny-pinching health care system, doctors have to focus on doing the high-level procedures for which they are so well trained, and nurses carry the load of performing the other medical, and administrative, and human interaction duties that need to be completed. We can only keep costs under control — and also create an experience where the patients truly feel like they are receiving care — if we have a corps of kind, pleasant, professional nurses who make the system run.

I’m happy to report that I received excellent nursing care from some wonderful people at the East Side Surgical Center on my visit this morning. Of course, the best care of all is at home, where Kish is saddled with keeping an eye on me while I’m flat on my back for a few days.

Pocket Hospitals

My doctor is a big believer in preventative medicine.  He’s also a bargain shopper.  Even though I have no symptoms of heart problems, he’s been after me to have a heart scan to perform “calcium scoring” and determine whether there are plaque deposits that might cause a problem in the future.  When he heard I could have the procedure performed for only $95, he really encouraged it.

IMG_1603So, yesterday morning I drove to the Ohio Health Westerville medical campus off Polaris Parkway on the north side of Columbus.  The facility is in one of those buildings you see around large cities throughout the nation — trim and brick, three stories, spread out, with lots of free parking.  I’d made a reservation, so I walked right in to a bright and spacious reception area, paid my $95, filled out a form, and was escorted to a room that featured one big piece of high technology equipment.  I stretched out on a platform without having to remove any clothing, a friendly technician attached a few electrodes underneath my shirt, and the machine then moved me back and forth through a spinning circular device and instructed me on when to hold my breath as x-ray pictures of my heart and lungs were taken.

There are ways to hold down health care costs, and this facility is one of them.  It’s in an area where land is cheap.  It offers a few services — I saw an emergency room, a surgery center, and the x-ray and scanning suite as I walked in — but doesn’t try to provide every form of care that a person might possibly need.  It competes with other providers, which helps to keep costs down.  In Columbus, there are dozens of these little pocket hospitals where you can go to have a scan, a colonoscopy, or arthroscopic surgery on your elbow, among other forms of routine health care activities.  The pocket hospitals employ hundreds of doctors, nurses, technicians, receptionists, and other staffers.

Yesterday the whole process took about 20 minutes from start to finish, and then I was out the door and headed to work.  It was cheap, easy, and convenient.  How often do you end up saying that after your encounters with the American health care system?

The Network Issue

Another area in which the Affordable Care Act will have an impact on health care in America is beginning to get some attention.  It has to do with the “provider networks” — that is, the collection of doctors, hospitals, and other health care facilities and personnel being offered by some of the new insurance plans.

The Affordable Care Act posed some difficult challenges for insurers.  Under the statute, they were required to include a number of new, mandatory forms of coverage in their health care plans.  That requirement, obviously, limited the ability of insurers to control the costs of particular plans by tailoring the kinds of care covered by those plans.  But the insurers still need to figure out a way to control costs, because their plans need to be competitively priced.

There aren’t a lot of remaining cost-control options. One is to tinker with things like co-payments and deductibles and increase the non-premium payments that the insureds must make when they use health care.  Another is to limit the networks to particular health care providers who, due to location or contractual agreement or some other consideration, are offering health care at lower prices than their competitors.

That’s the gist of an article in the Wall Street Journal by a cancer patient whose existing policy has been canceled and who can’t find a substitute policy that includes all of the providers that have given her the unique combination of care that has allowed her to beat the odds and survive.  It’s an indication of the kind of long-term effects that will play out over time, as the Affordable Care Act reshapes the health care market.  In the individual market, at least, Americans who are used to going to whichever doctor and hospital they choose may need to change their habits — and they probably won’t be very happy about it.

Consumer Reports Meets Healthcare.gov

When Kish and I need to buy a car, a major appliance, or some other significant product, we typically consult Consumer Reports.  There we find objective evaluations of our potential purchases by knowledgeable analysts, written in plain English accessible to the non-gearheads and non-techies among us.

So, I was interested when Consumer Reports tackled the process of trying to use Healthcare.gov, the federal government’s health exchange website.  It makes sense when you think about it.  One of the primary goals of the Affordable Care Act is to get uninsured consumers to buy insurance, so why not have one of the country’s preeminent consumer publications take a look at the process from the consumer’s standpoint?

Unfortunately, the Consumer Reports review of the Healthcare.gov process isn’t very encouraging.  It notes that of the nearly 9.5 million people who apparently tried to register on Healthcare.gov in the first week of its operation, only 271,000 — about 1 in 35 — were successful.  The article then provides tips about how to increase your chances of successfully navigating the website, offered by a software pro who has taken a careful look.  (You can find the software pro’s blog, which addresses some of the problems he has found with the website, here.)  Among other issues, he finds the instructions “garbled” and “needlessly complicated,” advises that you should simply ignore error messages that do not match reality, recommends that you immediately try a new user name, password, and security questions if “anything at all doesn’t go right,” and suggests that you check your e-mailbox frequently for a confirmatory e-mail, because Healthcare.gov will time you out if you don’t respond promptly.  The software guy also notes that many people are experiencing problems because of a crucial design error on the website:  it loads “cookies” and other code onto user computers during the registration process that prove to be too large for Healthcare.gov to accept back.

Consumer Reports also recommends that potential users “[s]tay away from Healthcare.gov for at least another month if you can,” because “[h]opefully that will be long enough for its software vendors to clean up the mess they’ve made.”  This advice is particularly interesting, because Consumer Reports also believes that the best source of information about healthcare options for consumers who are looking to buy health insurance themselves is through the health insurance marketplace in their state and Healthcare.gov — if it could only be made to work.

 

Happily Bionic

How many people do you know who have an artificial hip, or knee, or some other body part?  If you are like me, you know many such people.  They used to walk with tortured gaits, wincing as they favored their “bad knee” or “bad hip.”  Then they went under the knife, endured rehabilitation, and now are happily pain-free and advocates of joint replacements.

Such operations are not without risk, of course.  They involve major surgery.  Dr. Science, who is having both knees replaced, explained the procedure:  the surgeon slices the leg open, uses a whining bone saw to cut through the tibia and femur, removes the unattached knee, replaces it with the artificial knee, and then securely anchors the new knee to the bones above and below.  When you’ve had such a significant operation, you’re going to need lots of recuperation time.  And, of course, artificial knees and hips can fail, and most in any case have a limited life span — so if you’re young enough, you might need to undergo another operation in 12, or 15, or 18 years.

Still, my friends who’ve had successful joint replacements swear by their new bionic body parts.  Their failing knees and hips forced them to endure intense, constant pain for years.  Now, that pain is gone, and they can scarcely believe how wonderful it is to walk, or climb stairs, or sit without feeling like you’re being stabbed by demons.  Is it any wonder, then, that our bionic friends are among the loudest proponents of such surgery?

Without fanfare, we are living through the bionic revolution in medicine, where high-tech, full-scale replacements of joints have become commonplace and we peacefully coexist with friends who fall within the technical definition of cyborgs.

Dying With Dementia

Several recent studies about dementia among America’s aged are profoundly disturbing — especially for those of us who aspire to live to a ripe old age.

IMG_1111One study, by the Alzheimer’s Association, concludes that one in three elderly dies with Alzheimer’s disease or some other form of dementia.  The dementia does not necessarily directly cause death,  but does contribute to an earlier demise because the senior forgets to take her medication, or is unable to recognize symptoms that should lead to prompt treatment.  Another study, led by an economist from the RAND Corporation, concludes that 15 percent of Americans over age 71 — about 3.8 million people — have dementia, and that number will increased to 9.1 million by 2040.  The study also found that the direct health care costs for dementia patients, at nursing homes and other care facilities, is $109 billion, and the costs of care also are expected to increase dramatically.

As a society, we must worry about how we are going to pay for such care, but as individuals we worry about becoming one of those statistics.  If you’ve been around someone with dementia, you realize it is an awful way to go.  So many of the afflicted appear to be perpetually frightened, or angry, or both.  They don’t recognize family members, or understand when people are trying to help them.  The disease works terrible, fundamental changes to their personalities and characters, turning the quick-minded former executive into a simpleton or the happy, encouraging aunt into a bitter font of hateful, deeply wounding comments.

So much of life’s joy and richness comes from our interaction with spouses, children, and loved ones; what must it be like to be stripped of those pleasures, left to cope with strangers with only a dim understanding of who you are and why you are there?  It’s a depressing, terrifying prospect.

Picking Out A Skilled Nursing Facility For A Loved One

You’re happy that your loved one has survived a serious health problem — then you realize with a jolt, perhaps with a nudge from a social worker, that you must figure out where that person will go when they are discharged tomorrow.  But . . . how do you decide where?  We haven’t been trained for these kinds of decisions.

Although hospital social workers won’t express an opinion, they’ll give you names and, if you live in Columbus or another metropolitan area, probably will tell you that you’re lucky because there are many options.  Sometimes, however, broad choice can be less a blessing than a curse.  How do you narrow the field down to the one place that is the best choice for your loved one?

photo-89There’s lots of information out there, but what does it mean?  There are ratings on-line, but how are they developed?  If you’re in your 50s, talk to your friends and you’ll learn that many of them have already gone through the process with their parents.  They may recommend a place or warn you away from a place that they describe, in awful terms, as a kind of institutional hell on earth.  You appreciate the warnings, but it also scares you to know that such places may exist and a bad decision may land your loved one there.  The significance of your decision seems increasingly overwhelming.

So you go visit places, because everyone says to do so — and you realize that the places look pretty much the same.  There’s a chipper female administrator who takes you on a tour.  The facilities are ranch-style, with no stairs, and are brightly lit and decorated.  You hear about the therapy equipment and nurse-and-therapist-to-patient ratios as the professional staff walk briskly past, look in at a resident’s room that looks just like the resident’s room you saw in the last facility you visited, and scan the therapy room with its machines and balls and mock stairsteps.  They all look pretty much the same, too.

You see the residents, of course.  After the initial shock of seeing crumpled figures in wheelchairs and beds — poor, hurting, older people unlike the healthy, vigorous folks you see every day — you realize that’s why the facility is there.  You can’t disqualify a place because you encounter a groaning older person gesturing at you with an outstretched, scrawny, grasping arm and a haunted look in their eyes, because virtually every place has them.  You just try not to imagine your loved one eating next to that poor soul, because you can’t.

You soon understand that the tours and the chipper administrators and recommendations and warnings from your friends can only get you so far.  How can you tell whether this place, or that place, has the kind of patient, upbeat therapists who can give a scared, exhausted person the incentive to get out of bed and try to walk again, or talk again, or use their injured arm?  How do you know how the food will taste if it must be prepared in low-sodium, pureed form because your loved one needs to relearn how to swallow — and is it even possible for bland pureed food to be appetizing?  How do you know whether the seemingly competent staff will really pay careful attention to your  loved one, rather than the angry man causing the commotion three doors down?

You really can’t know, of course.  It’s an impossible decision that you must make, but you do the best you can, trying to weigh the competing considerations and hoping that your instincts move you in the right direction.  Mostly, you hope.

Why I’m Thankful This Thanksgiving

As this Thanksgiving Day dawns, I am thankful for many things.

First and foremost, I am thankful for my lovely wife, Kish, who is a truly wonderful person.  This year we celebrated our 30th wedding anniversary, and thanks to her patience, sense of humor, and generous spirit, they have been 30 fantastic years.  We are happily looking forward to many more to come.

I am thankful for Richard and Russell, our strapping and interesting sons, who are pursuing their dreams and passions with the independence and sense of adventure that is essential to personal success — however you might define it — in our rapidly changing world.  I’m thankful to every teacher who worked so hard to help shape the intelligent, creative young men whom we are happy to welcome home for the Thanksgiving meal.

I am thankful to live in this great country, where freedom is our birthright and our beliefs in democracy and tolerance and fairness are shared by so many people of good will.  I am thankful for my mother, brother and sisters, for my uncles and aunts and cousins, for our neighbors and friends, for my partners, clients, and colleagues, and for our Webner House readers, all of whom add such richness and texture to our lives.

And this Thanksgiving, especially, I am thankful for the American medical system — for the well-trained doctors, for the miraculous procedures and equipment, for the cheerful and professional nurses, and for the dedicated rehabilitation specialists and therapists and assistants who aid those who are hurting.  When you have a loved one who is experiencing health issues, it is so deeply reassuring to know that they are in the hands of gentle, caring people who will do their very best to help them get well.

Happy Thanksgiving to everyone!

 

The Questions I’d Like To Hear Answered Tonight

Everyone focuses on the candidates and their preparation for presidential debates, but the moderators deserve attention, too.  After all, it’s the questions the the moderator will ask tonight that will drive the “debate.”

The format for tonight’s debate will consist of six 15-minute segment on topics that have already been announced.  The moderator will open each segment with a question, each candidate will have two minutes to respond, and then the moderator will guide a discussion.  The six topics are:  The Economy – I; The Economy – II; The Economy – III; Health Care; The Role of Government; Governing.

Here are the questions on those topics that I’d like to see asked tonight:

The Economy – I:  Both of you have talked about balancing the budget, a process which would require cuts in spending.  Please identify one specific federal program that you would be willing to eliminate in its entirety in order to achieve a balanced budget.

The Economy – II:  We’ve been reading for years now about the debt crisis in Greece, Italy, and other Eurozone countries.  Should we be learning a lesson from what is happening in Europe, and if so what is that lesson?

The Economy – III:  Do you agree with how the Federal Reserve has managed monetary policy in response to the economic recession?  If not, what would you have done differently?

Health Care:  In your view, should the federal government be involved in attempting to force Americans to lead more healthy lifestyles in the interests of controlling health care costs that are caused by obesity, smoking, and other lifestyle choices?

The Role of Government:  In your view, should the federal government ever make loans or offer tax breaks to particular companies or industries in furtherance of long-term goals, such as increasing sustainable energy sources?

Governing:  What can we do to avoid contrived, stopgap political compromises, like the “debt supercommittee” that failed to agree on debt reduction measures, and get back to a federal government in which Congress actually passes appropriations bills, budgets, and other legislation and the President then signs or vetoes those bills, as the Constitution contemplates?

I’d like to see short, pointed questions, and some follow-up that doesn’t allow candidates to dodge the questions.  No touchy-feely subjects, either (especially on a topic like “governing”).  We’ve got some serious, concrete problems in this country; those problems should be discussed in concrete terms.