Monday, March 24, 2014

Gun Violence and Doctors

Dear Daniel: An article titled "Guns are a health issue-doctors shouldn't be muzzled" published in todays's Miami Herald highlights the the fact that, despite our politicians denial, guns are a health issue. Together with my colleagues Drs. Judith Schaechter and Tommy Schechtman we continue to raise awareness about the growing epidemic of gun related injuries and deaths among children and young adolescents. In 2010, 15,576 children and teenagers were injured by firearms — three times more than the number of U.S. soldiers injured in the war in Afghanistan. According to the New England Journal of Medicine, nationally, guns still kill twice as many children and young people than cancer, five times as many than heart disease and 15 times more than infection. Worst of all the unquestionable epidemic of firearm injuries morphed into an endemic , a self-sustaining illness maintained in the population without the need for external inputs. This has been described in an article by Katherine Kaufer Christoffel titled " Firearm Injuries: Epidemic Then, Endemic Now." Despite these indisputable, disturbing and troubling facts our politicians, Democrats and Republicans alike, refuse to accept this reality ! They care more about NRA rankings than our precious children injured and killed by firearms. The recent decision by President Obama to put the surgeon general nominee on hold because he dares to support gun control epitomized the reality detachment of our political cast, or maybe the dominating control of the NRA. W will continue our fight to defend our children's health and lives regardless of the outcome of the 11th Circuit Court of Appeals decision and need your support. Yours Bernd

Wednesday, March 12, 2014

Medical Marijuana

Medical marijuana is now going mainstream and that's to a large extent due to the efforts of physicians and journalists such as Sanjay Gupta. Gupta is the creator of a CNN program titled "Weed" which is being screened on CNN. Having watched this emotionally charged program I can only come to the conclusion that the world, according to Gupta, can be divided into "good" marijuana social entrepreneurs and "bad" cold-hearted doctors and scientists. Those doctors and scientists come across as cerebral and unemotional whereas the poor patients and their advocates are featured as the vanguards of medicine and science. In Sanjay Guptas's world individual case reports supersede any clinical study and the subjective improvement of individuals is served as clinical evidence. Yes, it is true that case reports, defined as the scientific documentation of a single clinical observation, have a time-honored and rich tradition in medicine and scientific publication. Yes, case reports and series have a high sensitivity for detecting novelty and therefore remain one of the cornerstones of medical progress BUT there findings have to be validated by rigorous randomized clinical trials!! This applies to marijuana, too. Systematic review and meta-analysis of double-blind randomized controlled trials that compare cannabis preparation to placebo are often not as convincing as the case reports of marijuana use may suggest. For example, a systematic review and meta-analysis of double-blind randomized controlled trials that compared any cannabis preparation to placebo among subjects with chronic pain revealed that cannabis treatment is moderately efficacious for treatment of chronic pain, but beneficial effects may be partially (or completely) offset by potentially serious harms. More evidence from larger, well-designed trials is needed to clarify the true balance of benefits to harms. These forms of critical differentiation are missing in Dr. Gupta's reporting. Meanwhile Dr. Guptas proudly declared that he wants to "double down" on his reporting and we will have to endure more of his unscientific rants. But don't worry! CNN will win big in the primetime viewership rating scale and can thereby charge higher advertising rates on Gupta's programs. What can we learn? Marijuana is big business for all involved, except for us doctors who have to clean up the mess and get paid pittance from the health insurance companies for our efforts. Yours Bernd

Sunday, March 09, 2014

Medical Marijuana in Florida

The proponents of medical marijuana are gaining political strength and support and have almost unlimited financial support to promote their issues. Therefore, its important to keep abreast of the latest developments and news: In today's Miami Herald an article titled "Medical marijuana poised for ad-war win" reports that a January 2013 poll found medical-marijuana support at 70 percent. A Kitchens Group survey in July found 71 percent approval. Public Policy Polling surveys in October and this January, respectively, found 62 percent and 65 percent support. And Quinnipiac University’s poll in November found the highest support for the concept, 82 percent. Florida attitudes have been changing along with the nation’s. In November, a Quinnipiac University survey found that 48 percent of registered voters favored legalization for adults and 46 percent were opposed. The Republican state Senate district poll, conducted last month by the Tarrance Group, found that 47 percent of likely voters favored outright legalization and 48 percent opposed legalization. And voters strongly backed lighter prison sentences for nonviolent drug offenders. A major difference between the two polls: The Tarrance poll was in selected Republican-held state Senate districts where voters are more conservative; the Quinnipiac survey was a statewide survey that polled all types of voters.The Senate poll indicated that support for Charlotte’s Web stood at 79 percent in favor, 18 percent opposed — mirroring support for the broader medical-marijuana effort. Compared with a similar GOP Senate poll in April, support shifted a net 24 percentage points in favor of Charlotte’s Web. Voters by 65-28 percent favored reducing prison sentences for nonviolent drug offenders and, by 78-15 percent, they supported prison-diversion programs for those convicted of nonviolent crimes. BUT its also important to understand that the argument that medical marijuana leads to complete legalization can be a potent tool to defeat the proposed amendment. In my opinion it crucial to point out that the proponents of medical marijuana are painting a very rosy picture of marijuana's alleged medical benefits claiming treatment success for diabetes,multiple sclerosis, cancer and glaucoma. District 25 Florida House Representative Charles David "Dave" Hood, Jr., a Republican, even suggest that the federal government knew about its benefits since 1975 but continued to ban the medical application of marijuana! This is a blatantly false and misleading statement based on conspiracy theories. As medical professionals we should emphasize that there are VERY limited known medical applications and that clinical trials are necessary to verify and substantiate those claims. Furthermore, we should inform the public that we do have FDA approved cannabinoids available in the US for > 20 years! Dronabinol (Marinol) FDA approved in United States as Schedule I drug for appetite stimulation (1992) and for nausea (1985); moved to Schedule III effective July 2, 1999. Nabilone (Cesamet) Originally approved by the FDA for use in the US in 1985, but removed from the market until re-approved by the FDA on May 15, 2006 and made available in US pharmacies on Aug. 17, 2006. Other products could follow IF clinical efficacy, indications and safety can be established and verified. In my opinion the Florida House and Senate engages in legislative malpractice by approving a form of medical marijuana for the treatment of epilepsy WITHOUT clinical trials and the absence of any research that is needed to protect patients from potential adverse effects and harm. If physicians would engage in such behavior we would be sued by the very law firm which supports the legislation of medical marijuana. As a result of this legislation licensed marijuana dispensaries, often owned and operated by non-medical "social entrepreneurs", would engage in the practice of medicine without a license by dispensing a medical marijuana strain to a group of highly vulnerable children suffering from intractable seizures. Who will be responsible for long-term follow up of potential adverse effects??? Who will be hold liable for potential harm? Legislation by emotion is plain and simple insane!! We must engage in the battle and focus on the fact that if medical marijuana is approved then the camel is getting his nose under the tent and legalization will eventually follow soon. Furthermore, we must make it loud and clear that medical marijuana will seep into the adolescent population and will cause grave long-term harm. Lets not give up the fight!! Yours Bernd