Legalizing Marijuana, Really?

Delegate Heather Mizeur, who is a candidate for Governor of Maryland, is running on the platform to legalize marijuana.  Such a platform is a far cry for those of us who are in health care.  According to Heather, marijuana is safer than alcohol and tobacco.  But, most importantly, it's taxable.  She is proposing a $50-an-ounce tax from the grower to the distributor and then an 8% tax when sold at retail.

According to Heather, no one has died from too much THC being ingested; I guess that's where the "safety" of marijuana comes in.  You can die of alcohol poisoning by ingesting too much alcohol, but I guess marijuana would put you to sleep before you could smoke too much.  

Then there is a state senator from Montgomery County who is proposing similar legislation for the upcoming legislative session on decriminalizing marijuana.   He says that Heather needs a new platform in that his legislation will pass before Heather has a chance to get elected.  I can't imagine running on a platform of legalizing marijuana to increase tax revenues by $150 million a year when this is the same individual who has led the charge to prevent the drilling for natural gas in western Maryland.  The tax revenues from natural gas would far exceed the legalization of marijuana; and I know that there is considerable debate on the safety of the drilling, but why not give it a shot?  

By the way, the effects of marijuana on the body are the same as smoking cigarettes.  It affects the lungs, the heart, elevates blood pressure and causes cancer.  It's addictive just like alcohol and tobacco and its effects are longer lasting than those of alcohol.  Quite honestly, none of the above is good for you so why add to the list by legalizing marijuana?

Improving Maternal and Child Health Around the World

In the December issue of The Rotarian, there is an interesting article on the work that the Rotary Foundation is doing around the world.  The article looks at the experiences and vital statistics related to mothers dying during pregnancy, infant mortality and births attended by skilled health personnel. 

In looking at simply mothers dying during pregnancy or childbirth, the results are staggering in six of the eight countries studied.  In Afghanistan, the risk of dying during pregnancy or childbirth is 1 in 32.  In Botswana it’s 1 in220; Brazil 1 in 910; Cambodia it’s 1 in 150; Finland it’s 1 in 12,200; India 1 in170; Rwanda it’s 1 in 54 and in the US it’s 1 in 2400.  So what’s the difference between first (Finland) to worst (Afghanistan)?  The government in Finland provides every expectant mother with a gift of baby clothes, diapers, bath supplies and bedding, including a mattress.  The only requirement is that they seek prenatal care before their fourth month of pregnancy.  In Afghanistan, the reason for their high maternal mortality rate is war.  A ten-day walk to some hospitals while in labor; vast areas with land mines; health professionals have fled the Taliban rule and they have the highest maternal mortality rate ever recorded in the world at 6,507 per 100,000. 

I applaud Rotary for their work and scratch my head as to why the US rate is so high considering how much we spend on health care annually.   According to the article, our maternal mortality rate has doubled since 1987 with some of the reason being better reporting, but we have to do more with both pre and post-natal care.  We are the only developed country that does not mandate paid leave for women after they give birth.  In Finland, it’s 18 weeks paid at 70%; actually in each of the other six countries, except Botswana, they all have mandated paid maternity leave ranging from 90 to 120 days paid at 100%.   Clearly, there are some lessons to be learned.

Things I Think That I Think

I am going to try something different with my blog from time to time.  This week I am going to briefly provide some perspective on some things that are on my mind.  Anyone from Pittsburgh or who follows the Pittsburgh Steelers remembers Myron Cope.  Myron was the color commentator for the Steelers broadcast on WTAE radio, and he also offered commentary throughout each week on that same radio station.  His tidbits of commentary were reflected in “Shirt Pocket Notes” or “Some Things I Think I Think.”  So, my tidbits of commentary are as follows:

This AM, I read in Paul Levy’s blog on the emergence of a new medical device, the iPhone flashlight.  He included an exchange in his blog about one physician who now uses it to look into his patient’s mouth during routine examinations.  Another commented on using it in ICU to identify a bleeding vessel.  That’s a great application for the iPhone, but just think about where you take your iPhone, where you place it and how often you clean it.  Yikes!  I have some significant reservations on the cleanliness of each and every iPhone.

I saw on Friday that the NFL acted to suspend for one game an official who cursed at a Washington Redskin player the weekend before last.  I am glad that they acted as swiftly as they did.  I am sick of officials who are paid to be neutral and unbiased, but make the game more about them than the game itself.  College basketball comes to mind in a big way.  College basketball referees will show their bias toward a coach, a player and a team more often than any other sport.  There is far too much inconsistency with their calls during games; and a lot of times, it seems to be payback.

I would like the popcorn and Milk Dud concession for the next year as we approach the mid-term elections on 2014.  If you think politics are contentious now, the “best” is yet to come.  The Affordable Care Act popularity is at a 33% favorable rating.  No real functioning Health.gov website, cancellations in coverage, security breaches, calls to delay implementation from Democrats and an upcoming “fix” date of November 30 that will come and go still without a fix.   And yet, mid-term elections will happen in early November 2014 with lots of seats up for grabs by either party in both the House and the Senate.  There will be lots of finger pointing on the ACA alone; this is going to be fun if our stomachs can take it.

Community Health Needs

On Wednesday, we had our quarterly Community Advisory Board meeting.  One of the key agenda items was the next iteration of our Community Health Needs Assessment and a request to the Board members to select three best practices from a list of best practices that we felt would address the greatest need under our identified needs areas, which are Access & Socio Economics; Healthy Lifestyles & Wellbeing, and Disease Management. 

The specific needs under Access & Socio Economics include children in poverty, primary care access, dental access for adults, health literacy and homelessness.  Under Healthy Lifestyles, the needs are smoking, physical inactivity, domestic violence, fall related injury & death and healthy weight.  Those needs under Disease Management include behavioral health, diabetes, heart disease, hypertension and asthma. 

I have attached the list of best practices.  So if you would like to submit your three suggested best practices under each needs area for our region, feel free to do so.  You can direct them to Nancy Forlifer, Director of Community Health and Wellness at nforlifer@wmhs.com.  The greater the awareness of the needs, the greater the input and the better the outcome.

From the Community Advisory Board, the three top best practices were as follows:

Access – Support dental access efforts; Education on health literacy and an education campaign on when to go the ED vs. Urgent Care, “Is it Safe to Wait?”

Healthy Lifestyles – 95210 (For kids: 9 hours of sleep per day, 5 servings of fruits and vegetables each day, 2 hours of screen time per day, 1 hour of physical activity per day and 0 sugary drinks on any day); Everybody Walk and Tobacco free environment.

Disease Management – Integration of mental and physical health; targeting the sickest patients for disease management and working with the primary care physician and three best practices tied for fourth: depression screening w/ referral to crisis counselor; screening prescription drug use and social support community.

The exercise was well received and the awareness of many of these areas of need by our board members has been heightened.

Medical Errors

I was at a meeting a few weeks ago and the presenter kept using the statistic that hospitals are the 3rd leading cause of death in the US.  I was dumbfounded. Really?  I couldn’t believe it so I immediately Googled it.

What the actual data says is that out of the ten leading causes of death, heart disease is #1 with almost 600,000 deaths each year, cancer is second with 575,000 deaths and chronic respiratory diseases at #3 with 138,000 deaths.  Strokes are at #4 and accidents with unintentional injuries are the fifth leading cause.  Was that where they were placing all of those hospital deaths? Under accidents?  But no mention of hospitals specifically. 

Then it hit me, medical errors account for anywhere from 200,000 to 400,000 deaths per year according to a study that was done and published in the Journal of Patient Safety.  The 200,000 to 400,000 deaths put medical errors in hospitals as #3.   I haven’t read the study, but they couldn’t pin it down a little more accurately.  Are there medical errors? Of course, there are.  Do some result in deaths?  Yes.  But, with 4800 hospitals in the US, that would be 83 deaths per year attributable to medical errors in each hospital. 

I guess rather than quibble about the numbers, we should be focused on preventing the errors.  And as Dr. Marty Makary says in his book, “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care,” start with eliminating variation in the practice of medicine and increase accountability throughout the hospital.  We are all focused on patient safety as our number one priority; now we have to step it up no matter what the numbers reflect.