Illinois approves child use of medical marijuana

Excerpted from “Child use of medical marijuana ahead in Ill.,” Baptist Press. January 13, 2015 — Children in Illinois will be eligible for medical marijuana prescriptions, according to rules announced by state health officials in late December. The rules by the Illinois Department of Public Health amend the medical marijuana pilot program approved by lawmakers in June. A handful of parents subsequently spearheaded a campaign to open the program to children under age 18, especially those who suffer from epileptic seizures.

Under the new rules, which went into effect on New Year's Day, children diagnosed with a qualifying debilitating condition will be able to obtain marijuana-infused products but not raw marijuana for smoking. To obtain the treatment, children need a signature from their own physician, an additional doctor's review and authorization and parental permission.

Supporters see the Illinois action as a step toward allowing children the potential benefits of medicinal marijuana. A hybrid marijuana strain called Charlotte's Web has a growing following of parents who believe it's an effective treatment for children suffering from severe seizures. Two U.S. drug companies have launched studies into the effects of CBD on childhood seizures but results will not be available for years. In the meantime, skeptics question whether the treatment is truly helpful.

Commentary

CMDA’s National Director of Campus & Community Ministries Dr. J. Scott Ries, MD: “It didn’t take long. The marijuana joy-ride train that seems to be traversing the nation stopped at a station in Illinois. With that state’s legislature legalizing the use of so-called ‘medical marijuana’ for children, it begs the question of what’s next.

“To be sure, there is hardly a more difficult scenario for a family and their physician than to see a child suffering from painful and tragic disorders that are difficult to control. I have sat beside parents as they bear the intensely painful burden of their child’s last moments on earth. I have held seizing children as yet another episode of their refractory seizures takes hold. However, this move opens a Pandora’s box of ethical and clinical concerns related to using marijuana products in children.

“Though it may be that newer genetically modified marijuana plant derivatives may have a lower THC component, low-THC is not no-THC. The truth is we simply do not know the ramifications of allowing children access to marijuana—be they short-term or long-term consequences.

“We do know that: the younger a person is exposed to marijuana, the greater their likelihood of addiction; the majority of the limited studies available on ‘medical marijuana’ are limited to animal models, not human subjects; and safer, better studied options are available for the scenarios for which marijuana has been legalized in Illinois.

“It seems political agenda and emotional response have trumped scientific rationale and a cautious primum non nocere. At best, what we can say pertaining to the use of marijuana in our children is we simply don’t know its consequence. At worst, it hails of even more problems to come.

“As I mentioned in a previous commentary, we would do well as Christian healthcare professionals to remember Paul’s counsel that while everything may be legal, everything is not necessarily good. ‘We are free to do all things, but there are things which it is not wise to do. We are free to do all things, but not all things are for the common good’ (1 Corinthians 10:23, BBE).”

Editor's Note: Though proponents claim that medical marijuana (ie. cannabinoid) has less addictive THC, "low THC is not the same as "no THC."

Resources

A five-part series on marijuana from Dr. Walt Larimore
The Effects of Marijuana by Donal O'Mathuna
University of Notre Dame Myths and Current Research

Woman gives birth from a transplanted womb

Excerpted from “World first: baby born after womb transplantation,” Medical News Today. October 6, 2014 — In September, a 36-year-old Swedish woman became the first ever to give birth from a transplanted womb. A new paper published in The Lancet provides a "proof of concept" report on the case. The woman received her womb from a 61-year-old family friend. As the recipient had intact ovaries, she was able to produce eggs, which were then fertilized using IVF prior to the transplant.

"Absolute uterine factor infertility" is the only type of female infertility still considered to be untreatable. Adoption and surrogacy have so far been the only options for women with absolute uterine factor infertility to acquire motherhood. However, the news of the first baby to be born from a woman who received a womb transplant brings hope to women with forms of absolute uterine factor infertility.

The researchers who performed the transplant - from the University of Gothenburg, Sweden - have been investigating the viability of womb transplantation for over 10 years. In 2013, the researchers initiated transplants in nine women with absolute uterine factor infertility who had received wombs from live donors. The Swedish woman who recently gave birth was one of these women. Although two of the women in the trial had to have hysterectomies during the initial months - because of severe infections and thrombosis - the team reported success in the other seven women.

According to Prof. Brännström, who led the team of researchers, "Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility. What is more, we have demonstrated the feasibility of live-donor uterus transplantation, even from a postmenopausal donor."

Commentary

CMDA National Director of Campus & Community Ministries J. Scott Ries, MD: “At first glance, it seems like a heartwarming tale of the newest medical ‘miracle’ and a triumph of life. But one doesn’t need to squeeze hard to deliver a very sour and sobering insight of what lies ahead. Though it is at its surface a sweet story of an otherwise impossible birth, deeply thinking and conscientious physicians must pause and ask, ‘At what cost?’

“Three things should deeply concern us in the pushing of these ethical boundaries:

1. How many developing babies will we immolate on the altar of innovation? This patient on three separate occasions nearly rejected her uterine transplant. How many babies will be sacrificed in future trials of uterine transplantation?
2. At what age do we stop? If it works for a 36-year-old woman, why not a 56-year-old woman? Or perhaps a 76-year-old woman? Where does the ‘right’ to bear a child end?
3. Why limit a uterine transplantation to only women? In this day of gay and transgender rights, why not allow a male partner to receive a uterine transplantation? If the barrier is simply vascular anastomosis and hormone infusion, why not permit gestation within the abdomen of a man?

“The story is both a wonder and a worry. That a uterus dormant for years can suddenly spring to life with mere influx of blood and hormone is wondrous testimony to its divine design.

“Yet if we abandon moral standards given by that same Designer, on what basis shall we then make these decisions? We have so quickly progressed from challenging the boundaries of moral standards to repudiating their existence altogether. As followers of the Way, we must infuse in our culture the distinction between what could be and what should be.”

Resources

CMDA Resources on Reproductive Technology
CMDA Ethics Statement – Assisted Reproductive Technology

Christian campus groups face persecution

Excerpted from “The Wrong Kind of Christian,” Christianity Today. August 27, 2014 — Two years ago, the student organization I worked for at Vanderbilt University got kicked off campus for being the wrong kind of Christians. In May 2011, Vanderbilt's director of religious life told me that the group I'd helped lead for two years, Graduate Christian Fellowship—a chapter of InterVarsity Christian Fellowship—was on probation. We had to drop the requirement that student leaders affirm our doctrinal and purpose statement, or we would lose our status as a registered student organization.

In writing, the new policy refers only to constitutionally protected classes (race, religion, sexual identity, and so on), but Vanderbilt publicly adopted an "all comers policy," which meant that no student could be excluded from a leadership post on ideological grounds.

Like most campus groups, InterVarsity welcomes anyone as a member. But it asks key student leaders—the executive council and small group leaders—to affirm its doctrinal statement, which outlines broad Christian orthodoxy and does not mention sexual conduct specifically. But the university saw belief statements themselves as suspect. It didn't matter to them if we were politically or racially diverse, if we cared about the environment or built Habitat homes. It didn't matter if our students were top in their fields and some of the kindest, most thoughtful, most compassionate leaders on campus. There was a line in the sand, and we fell on the wrong side of it.

Those of us opposed to the new policy met with everyone we could to plead our case and seek compromise. But as spring semester ended, 14 campus religious communities—comprising about 1,400 Catholic, evangelical, and Mormon students—lost their organizational status. After we lost our registered status, our organization was excluded from new student activity fairs. So our student leaders decided to make T-shirts to let others know about our group. Because we were no longer allowed to use Vanderbilt's name, we struggled to convey that we were a community of Vanderbilt students who met near campus. So the students decided to write a simple phrase on the shirts: WE ARE HERE.

And they are. They're still there in labs and classrooms, researching languages and robotics, reflecting God's creativity through the arts and seeking cures for cancer. They are still loving their neighbors, praying, struggling, and rejoicing. You can find them proclaiming the gospel in word and deed, in daily ordinariness. And though it is more difficult than it was a few years ago, ministry continues on campus, often on the margins and just outside the gates. God is still beautifully at work. And his mercy is relentless.

Commentary

CMDA’s National Director of Campus & Community Ministries J. Scott Ries, MD: “It is a remarkable story, but unfortunately not an isolated one. Just this week, InterVarsity announced that it has been booted off of all California State University campuses for the same reason, because they insist on a rational basis of faith as criteria for holding a leadership position.

“This is just the tip of the iceberg. In the last 18 months, two CMDA chapters have also been de-recognized for, yes, the exact same reason. At the University of Illinois, Chicago, we were told that because we require our student leaders to agree with CMDA’s statement of belief, we therefore violate their anti-discrimination policies. At the Case Western Reserve University School of Dental Medicine, our CMDA group was denied official recognition “because of the emphasis on God and especially because of the Bible sessions.”

"Thankfully, in both cases the Lord gave us favor after I sent a letter with assistance from Kim Colby, Sr. Legal Counsel for Christian Legal Society’s Center for Law and Religious Freedom to the respective deans, explaining that this misapplication of their policy actually was, in fact, discrimination at its core. Both universities promptly reversed their positions, and CMDA is thriving on both campuses. But it will get worse. Our 280 campus chapters will be a lightning rod as this storm builds.

“So why is official recognition important after all? Why not just exist under the radar, meet off campus and avoid the toil, expense and pain of fighting what has become a cultural landslide smothering both orthodox beliefs and religious pluralism? Because lack of recognition impedes ministry and increases the cost of doing ministry. Greg Jao, attorney and National Field Staff Director for InterVarsity, explains it well.

“When one group loses religious freedoms, we all lose religious freedoms. Historically, what starts at the university campus trickles into all of society. That remains true, but what has changed is the rapidity with which it now happens. It seems as though someone has poured accelerant onto the fire of intolerance that is consuming those who share the very faith that brought tolerance to this world.”

Resources

Standing Against Persecution: My Journey to Start a CMDA Campus Chapter
The Erosion of Tolerance by John Patrick, MD

New study shows effects of casually smoking marijuana

Excerpted from “Even casually smoking marijuana can change your brain, study says,” The Washington Post. April 16, 2014 — The days when people thought only heavy Cheech-and-Chong pot smokers suffered cognitive consequences may be over. A study in The Journal of Neuroscience says even casual marijuana smokers showed significant abnormalities in two vital brain regions important in motivation and emotion. “Some of these people only used marijuana to get high once or twice a week,” said co-author Hans Breiter, quoted in Northwestern University’s Science Newsline. “People think a little recreational use shouldn’t cause a problem, if someone is doing OK with work or school,” he said. “Our data directly says this is not the case.”


The study analyzed 20 pot smokers and 20 non-pot smokers between 18 and 25. Scientists asked them to estimate how much marijuana they smoked and how often they lit up over a three-month test period. Even those who smoked once a week showed brain abnormalities, while larger changes were seen in those who smoked more.

In the study, scientists compared the size, shape and density of the nucleus accumbens and the amygdala, which control emotion. Those who had smoked had abnormally large nucleus accumbens, an area of the brain that controls pleasure, reward, and reinforcement learning. In the brains of marijuana users, natural rewards are less satisfying.

Commentary

CMDA’s National Director of Campus & Community Ministries Dr. J. Scott Ries, MD: “Innocent until proven guilty...or dubious until proven safe?

“There is little dispute about the medical hazards of heavy marijuana use. What remain in question are the demonstrable potential effects of so-called ‘casual’ marijuana consumption.

“This study highlights apparent physical changes observed in the amygdala and nucleus accumbens of casual users compared to non-users. Granted, causality is not proven, but does it need to be for us to be concerned?

“Setting aside ‘legality,’ where does our duty begin with regard to caution of an unknown hazard? Should we, as those charged with advising the health of our patients, not demand evidence that such hazards are not present before acquiescing to the capricious eagre of our mercurial society?

“The most telling and scientifically accurate message should be that there is no known level of ‘safe’ recreational use of marijuana. Let us not retreat from wisely counseling our patients with Paul’s advice that while everything may be legal, everything is not good. “We are free to do all things, but there are things which it is not wise to do. We are free to do all things, but not all things are for the common good” (1 Corinthians 10:23, BBE).

Resources
Legalized recreation pot - A commentary from Dr. David Stevens
A five-part series on marijuana from Dr. Walt Larimore
The Effects of Marijuana, by Donal O’Mathuna

Using social media in clinical practice

Excerpted from "Docs Need to Get Up to Speed, Social Media Advocate Says," MedPage Today. August 15, 2013 -- Bertalan Mesko, MD, PhD, is counting on old media to convince more clinicians about the value of new media. The clinical genomics specialist has just published a handbook on social media in clinical practice -- and he hopes it will bring late adopters up to speed with their social-media-savvy colleagues, and even with some of their electronically empowered patients.

While "expert" patients voraciously pursue credible medical information and communities online, clinicians "usually lag behind," Mesko, who is based in Budapest, said in an email exchange with MedPage Today. Instead of disdaining this kind of behavior, doctors need to see themselves as a gatekeeper of vetted online information and activities, he said.

“Social media provides us with a lot of opportunities, but only if we know the potential limitations and security issues. Acquiring such knowledge takes years, and my goal with the handbook was to shorten this time significantly for those medical professionals who would like to become a bit more digital, but at the same time use these online tools in a secure way,” said Mesko in an online engagement via email.

“I think communication methods in real life and in the online world are the same. If medical professionals understand this and create a proper online presence, as well as give their patients a chance to communicate with them through certain online channels, the doctor-patient relationship can become more efficient by saving time for both parties. Using digital technologies, especially social media, is now an integral part of medical communication, and as more and more patients use these platforms, their physicians must be able to deal with this in an evidence-based manner,” said Mesko.

Commentary

CMDA Vice President and National Director of Campus & Community Ministries J. Scott Ries, MD: "Mention 'social media' during a conversation with one of your colleagues and observe the resulting reaction of the facial muscles. I predict you'll identify a subtle pupillary dilation, upturning of the corners of the mouth and an increase in pace of speech...or else you'll view a burrowing of the forehead creases, tightening of the lips and clenching of the jaw. When in past history has any other 'tool' ever evoked such emotional response from its users (or haters)?

"At its core, social media is indeed simply a tool—a forum to communicate, share ideas, explore information, engage conversation and create community. If you already embrace social media at some level, you won't be surprised to hear that I'm more likely to be contacted via Facebook than email by students, residents and even some doctors.

"If you find yourself beset with the clenched jaw, here are a few things that might help you dip your toe in the social media waters without catching a cold.

1. Recognize that social media does not equal Facebook. Not all of social media is Facebook. As social media expands, the relative amount of the landscape occupied by Facebook is diminishing. If Facebook seems daunting to you, choose another option to explore.
2. Peruse areas of CMDA’s social media engagement. CMDA is actively engaged with social media with both the current and upcoming generations of doctors.
3. Consider following just one blog, along with following their Twitter and/or Facebook posts. This will let you ease into the foray a bit without becoming overloaded.

For more practical insight into how to use social media, the benefits it can offer you and your practice and other information, check out Social Media in #Healthcare: Why You Should (Like) Social Media by Bill Reichart, MDiv.

"But won't social media consume any vestiges of time remaining in our overloaded schedules? Only if we let it. It's like when I was taking driver's ed as an inexperienced 15-year-old. In attempting to pass a slow moving truck, I was hesitant to exceed the speed limit. Seeing the approaching car, the instructor promptly pushed her 'instructor’s accelerator' to quickly get us by the truck, while calmly saying 'Control the car. Don't let the car control you.' So it is with social media. However you choose to engage, control it...don’t let it control you."

Resources
Social Media in #Healthcare: Why You Should (Like) Social Media by Bill Reichart, MDiv

CMDA's Social Media Pages

• Facebook
  
• CMDA Student Life Facebook
  
• Twitter
  
• YouTube

Doctors Badmouthing Doctors

Excerpted from “Doctors Badmouthing Other Doctors,” The New York Times. July 11, 2013 -- A physician friend recently disclosed that she was named in a malpractice lawsuit. Her revelation was rattling not only because there were no discernible errors in the care she provided, but also because another doctor had provoked the patient to hire a lawyer. “I’m shocked that nothing was done sooner,” the other doctor had said when the patient went for a second opinion. “You could have died.”
Surely, the doctor who had trashed his colleague was out of line. Throughout training and regularly at work, we are reminded of the importance of professionalism and respect. Shifting blame demoralizes other clinicians, undermines patient trust and compromises patient outcomes.

But it didn’t take long for me to recall instances when friends and I had been equally critical about other doctors’ work. Are we all capable of talking like that in front of patients? The answer, according to a recent study in The Journal of General Internal Medicine, is an unqualified and disturbing, “Yes.” “Doctors will throw each other under the bus,” said Susan H. McDaniel, lead author of the study and a professor of psychiatry and family medicine at the University of Rochester Medical Center. “I don’t think they even realize the extent to which they do that or how it can affect patients.”

“There is probably something reassuring in saying, ‘Boy, your doctor didn’t do a good job and now I’m going to take care of you,’” Dr. McDaniel noted. “But those kinds of comments are bad for the patient.” To help remedy this problem, Dr. McDaniel began a physician coaching program at the University of Rochester Medical Center a year and a half ago. “There’s a lot of attention focused on the patient experience, but I think we need to work on improving the clinician experience as well,” Dr. McDaniel said.

Commentary

CMDA Vice President and National Director of Campus & Community Ministries J. Scott Ries, MD -- “When I first read the title of this article, my initial reaction was, ‘I don’t do that.’ Then the rubber met the road. Just last week, a 7-year-old girl accompanied by her grandmother came to my clinic with the same abdominal pain that had been plaguing her for four days. Initially evaluated by her grandmother’s family physician, she had been diagnosed with a urinary tract infection and treated with antibiotics. Three days later, when the pain had not improved, she returned to that doctor. A repeat urinalysis was normal and they were sent home with instructions on how to treat constipation. “Later that day, they came to me. I had the advantage of both urinalysis results (neither remarkable) as I evaluated the healthy appearing child in front of me. But something didn’t seem quite right. A couple hours later, I whisked her off to meet the surgeon at the OR to intervene for her ruptured appendix. But before they left the clinic, the question came: ‘Should the other doctor have diagnosed this on Monday?’ Two things hit at me at once, freezing any potential response. The first was the reaction, ‘I’m just glad you brought her to me. She could have died.’ The second was the article adducing that very phrase.

“How should we respond when we encounter and disagree with the work of a colleague? Try answering these three questions before responding:

1. Will my response benefit my patient?
2. Will my response attempt to inflate trust in me, by diminishing that in another?
3. Am I representing well with my words the Physician I desire to emulate?

“If we are honest, our pejorative off-the-cuff responses are often (if not subconsciously) geared at building our own ego. Confident in our abilities, we want to make sure our patient shares our confidence in our prowess. But is this how the Great Physician treated His colleagues? Is this the grace with which the Great Physician has treated me? Ephesians 4:29 offers the answer that we need at this precise moment, ‘Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up according to their needs, that it may benefit those who listen’ (NIV 2011).”

Resources
Christian Physician's Oath
Christian Dentist's Oath
The Cry of the Patient--Are We Listening?

Problem with Medical Student Debt

Excerpted from "Tackling the Problem of Medical Student Debt," New York Times, by Pauline Chen, MD. December 13, 2012--The announcement from the University of California, Los Angeles, of a $100 million medical student scholarship fund should inspire all of us to question the fact that medical education in the United States is paid for largely by student debt. The new merit-based scholarships, established by entertainment executive David Geffen, will cover all educational, living and even some travel expenses for a fifth of next year's entering medical school class, some 33 students. Mr. Geffen and school officials hope that eventually the school will be able to pay for all medical students and free them from the obligation to take out student loans. "The cost of a world-class medical education should not deter our future innovators, doctors and scientists from the path they hope to pursue," Mr. Geffen said in a statement. "I hope in doing this that others will be inspired to do the same."

There are several reasons for the runaway costs. One is that the academic medical centers that house medical schools have become increasingly complex and expensive to run, and administrators have relied on tuition hikes to support research and clinical resources that may have only an indirect impact on medical student education. An equally important contributor to the problem has been our society's placid acceptance of educational debt as the norm, a prerequisite to becoming a doctor. Obtaining a medical education is like purchasing a house, a car or any other big-ticket item, the thinking goes; going into debt and then paying over time with interest is just the way the world works. And, say many observers, newly minted doctors will earn big salaries, allowing them easily to reimburse their loans.

While it is true that most doctors can pay off their debt over time, those insouciant observers fail to consider how loan burdens can weigh heavily on a young person's idealism and career decisions. These choices have enormous social repercussions. Despite the well-studied benefits of a diverse physician workforce, more than half of all medical students currently come from families with household incomes in the top quintile of the nation. Even more worrisome, student concerns about debt are exacerbating the nation's physician shortage. By the end of this decade, we will be short nearly 50,000 primary care physicians and an additional 50,000 doctors of any kind. Educators and groups like the Association of American Medical Colleges have been trying to address the problem of medical student debt for more than a decade. Some have suggested simply freezing costs or prorating debt according to the earning potential of a student's chosen area of specialty. But the real importance of Mr. Geffen's donation for the rest of us lies in not its historic largesse, nor its hopeful vision. Rather, it is in the dramatic impact one individual can make when he makes medical education a priority, and the inevitable question such a gesture raises: Why has our society been so slow to do the same? Click here to read full article.

Commentary

National Director of Campus & Community Ministries J. Scott Ries, MD: “The philanthropic commitments of people like Mr. Geffen and the Lerner family are certain to be influential on the lives of a number of future doctors. Their generosity not withstanding, the rising costs of medical education are well documented, as are its persuasive effects on specialty choice and practice location. But the question is, even if medical education were “free” for all students, would that be enough? The answer is no.

 

The primary areas in which Christian doctors struggle consistently fall into four categories:

1. Overload
2. Marriage
3. Parenting
4. Finances

Yes, finances. But wouldn’t eliminating medical school costs then quell that fourth category of problems? Not likely. Financial struggles faced by our colleagues are often not those related to medical school loans, per se. In fact, they typically present themselves after those loans have been, or are nearly, paid off.

There is a subtle, but strong, undercurrent toward a perspective of entitlement pervasive in medical training, and it doesn’t let go when we graduate. Perpetually elusive, “enough” seems always just around the next corner. And it’s this entitlement mentality that leads to the financial struggles so common among students and doctors alike.

The best antidote to entitlement is found in the occasional email I receive from a medical or dental student relating their desire to give a financial gift to CMDA. It’s not the largesse of the gift or even the fact that God brought CMDA to their mind that makes my day. It’s the outpouring of their entitlement-free heart that brings a sense of grateful joy. “For where your treasure is, there will your heart be also” (Matthew 6:21, NIV 1984).

You may not have the resources to endow the medical education costs of a cadre of future doctors. But you do possess the antidote for entitlement…giving. It’s just what the Good Doctor ordered."