Influencing Doctors

I'm not surprised when I read this recent study that shows that physicians are affected by pharmaceutical marketing. While in practice I often saw doctors prescribing extremely expensive new drugs which had much less expensive generic alternatives (which patients frequently requested). And politicians seem no different.

I was fortunate enough to go to McGill University medical school, where, even in the 1970s, we were not allowed to accept gifts from drug companies, and required to use generic, and not brand drug names.

In this study, Hadland SE et al. JAMA Intern Med 2018 May 14, researchers identified nearly 370,000 physicians who prescribed opioids in 2015. Of these, 7% received roughly US$9 million (≈$350 per physician) in nonresearch payments related to opioid products during 2014. About 2% of physicians received payments received $1000 or more. Total U.S. opioid prescriptions decreased slightly overall from 2014 to 2015 but increased among physicians who received payments; those who received payments wrote about 9% more opioid prescriptions than those who did not.

Drug companies were undoubtedly aware that they were contributing to their profits at the expense of the opioid epidemic in the US population.

Marijuana - More News and Not Innocuous

Now that cannibis is becoming legal in many states, it is important to become aware of its limitations and side effects.

Although it has many proven uses, including pain management, anxiety and even epilepsy, sellers have been marketing it as a miracle drug for all diseases. It is not.

PREGNANCY

Marijuana should NOT be used in pregnancy. It does not treat the first trimester nausea. Studies have shown that THC (the active ingredient) can stimulate changes in brain cells, especially developing cells, that are similar to those found in schizophrenia and autism (Guennewig B et al. Transl Psychiatry 2018 Apr 25). Unfortunately, women of childbearing age, who know to avoid alcohol, might consider THC a safe alternative for recreational use.

BREAST FEEDING

THC is excreted in breast milk after ingestion (Baker T et al. Obstet Gynecol 2018 May ). Since it can affect developing brain cells in babies it should not be used while breast feeding.

COGNITIVE EFFECT - Still called DOPE

There was probably a reason marijuana was called "dope". In a recent study, Scott JC et al. JAMA Psychiatry 2018 Apr 18, researchers found that Marijuana use was associated with decrements in cognitive function — learning, speed of information processing, delayed memory, attention, and various facets of executive function. Fortunately these were back to normal after 72 hours of abstinence.

FALSE MEMORIES?

I am surprised this has not yet been tweeted by certain politicians as an explanation of why states with legalization voted in certain ways! This study, Doss MK et al. Biol Psychiatry 2018 May 9, examined memories of words and pictures. Two days after shown these, the group given THC had false recognition of words and pictures that had not been presented.

Marijuana has some therapeutic uses, but the side effects should be understood. It is not innocuous, and like alcohol, its recreational uses can result in cognitive effects.