I’m not sure what you’re asking - so maybe clarify if I’m missing the boat here.
Medicine has changed a LOT in 30 years. We have much better care for MI, CVA and trauma IMHO. HIV treatment is a lot better, good enough that I essentially never see AIDS patients in the ED.
But we’re all gonna die of something, and dementia/aging has been so far a VERY tough nut to crack, primarily because the basic science hasn’t been worked out hardly at all, never mind treatments that work. And infections are becoming a huge problem, because we use way too many antibiotics for conditions that may or may not need them and more importantly because we shovel them by the metric ton into animal feed, which causes resistance problems. Add in that there is minimal motivation by drug companies to sink dollars into antibiotic research, and it’s a big problem that’s just gonna get bigger.
Of course, the easiest way to improve health metrics is to get people to stop smoking, stop using drugs and lay off the double cheeseburgers. Good luck with that. (Smoking metrics are a LOT better than they were say in the 1950’s to 60’s, but we’re still paying the bill for that behavior, and the decline seems to have stabilized) And who the FUCK knows about marijuana use - we’re basically starting an uncontrolled experiment on the american public and we won’t know how it turns out for decades…
Although I’m almost positive the fix there (food choice) is through consumer behavior and public policy research. One of the most fascinating things I’ve seen in life is the psychology and folk wisdom surrounding food and nutrition.
The marijuana thing worries me though, as a bystander (my drug of choice is either a couple of beers or rye on the rocks). Due to our idiotic classification of marijuana being as bad as heroin, it was pretty much impossible to do any research on it for decades. What research WAS done was performed using ditch weed - the new stuff is super potent. So far, we’re seeing hyperemesis (basically you puke your shoes up) which responds somewhat to haldol (an antipsychotic with some dangerous side effects) and, interestingly enough, hot showers - really hot, and really prolonged. No one knows why, for either. This is new, too - only reported in the last few years, and I’d suspect it’s because of the marked increase in potency - but who knows?
More worrisome is a small but significant number of users who develop acute psychosis that acts a lot like schizophrenia, with the added bonus that unlike standard schizophrenia which has a number of treatments all of which work poorly, the marijuana associated type doesn’t respond to anything at all. Awesome. Who knows what else is going to show up a decade from now…
I mean, the fundamental principle of HMOs is rationing. Not that that is necessarily a bad word but this Step-Right-Up Grifty City, USA#1 we’re talkin’ about here. There’s actually a notable case and Supreme Court ruling on this:
Could be although from what I know it’s pretty uncommon - there are a couple of other things that predispose people to COPD - alpha 1 antitrypsin deficiency can give you COPD with no smoking history. Or, if he was smoking Mexican weed, the pesticide of choice for a long time down there was paraquat, which is to lungs what Trump is to politics. One benefit of legalization is (hopefully) that stuff is a thing of the past.
More worrisome is a small but significant number of users who develop acute psychosis that acts a lot like schizophrenia, with the added bonus that unlike standard schizophrenia which has a number of treatments all of which work poorly, the marijuana associated type doesn’t respond to anything at all.
Treatment-resistant cannabis-induced psychosis sounds an awful lot like the reefer madness they’ve been warning us about for decades. Maybe those dudes were just way ahead of their time.
Well, it was first described in 2004 - in my home city, actually. It’s worth noting that in addition to haldol, what it also responds to - invariably and usually rapidly - is the cessation of cannabis use.
Hadn’t heard about this. Do you have a link?
I was going to mention this. My cousin has this and I carry one allele (you need to be homozygous to have it, although even with one copy, being a cigarette smoker would be a particularly bad plan for me). Namath, it’d be worth mentioning this to your friend if he has mysterious lung problems and hasn’t been tested for it. Getting severe lung problems simply from weed smoke is very unlikely. Link to Wiki on condition:
A1AT deficiency remains undiagnosed in many patients. Patients are usually labeled as having COPD without an underlying cause. It is estimated that about 1% of all COPD patients actually have an A1AT deficiency. Testing is recommended in those with COPD, unexplained liver disease, unexplained bronchiectasis, granulomatosis with polyangiitis or necrotizing panniculitis.
Interesting - I’d never heard of it until last year. Yeah, good luck with the cessation stuff. My last patient last night was in for the fifth time in five months, been told each time what the problem is and his tox screen was (of course) positive for pot. So I told him the sixth time, and he was unhappy with the solution.
Right, I know it’s not that easy. I just mean it’s not irreversible like quite a number of alcohol or tobacco related problems are. From what I understand of it, once you’ve had it once, it recurs pretty rapidly if you return to using cannabis. BTW I agree the ramp-up in potency of cannabis products is kind of alarming and we don’t really know what they’ll do in the long term. I think CHS has probably always been around at some level but not diagnosed as a syndrome, but it’s extremely obvious that it’s on the rise. Hospital admissions for cyclic vomiting syndrome rose 50% between 2010 and 2014 in Colorado, with legalization there occurring in 2012.
I’d bet it’s more. You’d have to track down how many admits for other things like “intractable vomiting” “vomiting with dehydration” “intractable nausea and vomiting” and on and on (I think there are at least 10 different codes that you could use) and figure out how many were cannabis related. Which is why I view pretty much all medical statistics with a jaundiced eye…
But it’s totally fine cause it’s the free market. Who wants to let the GOVERNMENT and the LIBERALS decide when you die, when you can leave it up to salt of the earth free market capitalist corporations?
Colorado sold how many millions of dollars of legal herb and how many people got sick? Yes, mj is stronger now days but I’ve never seen people sick from smoking. Now, you take even a seasoned user and give them too much edibles when they aren’t used to the effects they are going to have a bad time. I see a lot of people do way too much their first time eating. The warning labels on CO warn to start with a 5-10 mg dose.
Well, it depends on how you ask the question, but if you’re very specific, like Mr. Oreo undoubtedly would have been, you certainly will get a range of answer from a doctors with a range of experience.
I’m not sure what you’re thinking here, but there is no pretty much no doctor who is going to lie when asked that question. If for no other reason than that particular lie would be damning in a malpractice suit.
That’s not to say they won’t mislead. For example a doctor who has been out of training and has done 100/yr, could correctly say “I do 100/yr”, which is not a lie, and probably sounds good. But lets say we’re talking about a very common procedure where you can find lots of guys who have done about 500/yr for 20yrs. Then 100/yr is nothing.
Of course, it depends on the procedure in question. I’m sure we could find certain procedures where the learning curve is such that there is not really a big difference between 100 or 1000. It’s something one either knows how to do or doesn’t. On the other hand there are other procedures where it may make a small or even massive difference.
So, the keys when you are trying to figure this out are doing quite a bit of research on the topic and probably talking to more than one doc. This is not something that not many patients do, so it’s very easy to come up with an answer to “How many have you done” that sounds good. But I’m quite sure no almost no doctor is actually going to answer that with a lie.