Monthly Archives: February 2019

Private Health Care

By Dr David Laing Dawson

As Donald Trump famously said, “Who knew health care was so complicated?”

In Ontario recently, with the Ford government, the words “privatization” and “health care” were connected in the same sentence.

At the least it seems privatization once again surfaced as a possible means of fixing two persistent problems in our publicly funded care. The first of these problems is wait times for certain investigative procedures and certain kinds of surgeries. (For the most part these are all investigations and surgeries that can wait; that is they are not life threatening emergencies. And when I do get my appointment for an MRI of my knee I know I may have to wait a few hours, or be bumped if some urgent case arises.)

The second is so called hallway medicine. People admitted to hospital lying on gurneys in the hallways waiting for beds. This is indeed a complicated issue but not one that can be resolved by throwing the word privatization around.

But rather than address these issues I am writing this to call out a seldom mentioned problem with a “private” system of health care. And that is over treatment. If the patient is rich or his insurance very good the many private clinics in the USA are given an incentive to over investigate and over treat. Scans, blood tests, pills, surgeries, and residential care.

And to some extent the nature of the over treatment is then dictated by what the insurance company is willing to pay for. This is one aspect of the opioid epidemic. In many cases medicare or insurance will pay for pills being prescribed but not physiotherapy or gym membership. And over treatment is not benign.

Some early democratic presidential candidates are promoting medicare for all. Immediately other “experts” and politicians are saying we (the USA) can’t afford medicare for all. Nobody points out, and this is true, if you take all the money the US pays now for Medicare and divide it by the entire population, their per person cost is already higher than our (Canadian) per person cost and we cover everybody.

It is, compared to Canada, the wild west down here (as I am writing this in Florida). I have just watched TV ad after TV ad for prescription medicine, surgeries, assistive devices paid for by medicare, and then, seemingly unrelated but pertinent I think, an ad for a little packet of spring water along with testimonials of curing cancer, being able to walk again after paralysis, and good fortune in the form of a lottery win that paid off the mortgage and a check for $17000 inexplicably arriving in the mail.

I think the experts mentioned above are right. The USA cannot afford a full public universal health system, at least not without a massive public health information/promotion/prevention campaign, and not without accepting a whole bunch more regulation and over sight.

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Reflections on Marx, Religion and Opiates For the Masses

By Dr David Laing Dawson

When Karl Marx opined that religion is the opium for the masses it was not the throw away line it is today. I am writing this as I watch the sun set over the gulf of Mexico and smoke my $5 robusto and sip my $20 dollar bourbon.

Within my limited historical scholarship it seems to me that humans, ever since evolution bestowed upon them the awareness of suffering, temporality, and death, have been seeking substances to dampen, or ideas to vanquish, the horrifying experience of that reality.

While some of those substances (LSD, mescaline, ecstasy, opium!) give one a temporary sense of alternate and eternal realities, others merely dampen it.

As I write this the clouds briefly accrue a God-like glow of crimson and then slip into filaments of white against the darkening sky, and the temperature drops a few degrees at this moment on this region of a small planet. I go inside to replenish my glass. Our two dogs come with me; one, oblivious to my thoughts, wants to share his chew toy with me.

While religions, all of them, from the old and organized, to new and old ideas of enlightenment and “oneness with the universe” attempt to obliterate the terror of being sentient beings with limited life spans, substances like marijuana and alcohol merely dampen that reality.

And while religion works for many it has also been the unholy source of corruption, perversion, suffering and death for others.

With a sweater it is warm enough to sit outside and miraculously the WiFi reaches a chair by the barbecue. The sky has become both misty and mystical. A scattering of stars appears between the low clouds. I know I should leave my cigar alone, for the second half will give me an overdose of nicotine and a dry mouth through the night. The replenished glass of bourbon with much ice to soften it will let my eyes linger on the beauty of the night without too many intrusive thoughts.

Marijuana would let me do the same I’m sure.

It is one of those realities that could be used to argue both for and against intelligent design: anything that can make us feel good, or relieve us of the terror of existence, when used excessively, can harm us. I will leave the cigar butt in the ashtray and I resolve to not replenish my glass again. The dogs lie on the cool patio stones beside my chair.

My companion comes out to join me, commenting how lovely it is, and asking if I would like a refill. My resolve vanishes as quickly as a startled gecko.

We sit together in the balmy night air, breezes bringing mist from the gulf, the dogs at our feet, and I think how quickly time passes, and I tell myself to stay in the moment.

Marijuana and Schizophrenia – Part II

By Dr David laing Dawson

It struck me recently the reason marijuana has been such a popular recreational drug is that while it causes distortions in perception (time passing, speed, sound, colour, light, music, intensity, memory, touch, focus etc) thanks to THC, it also contains differing amounts of CBD, a potent anti-anxiety, anti-arousal agent.

Usually such distortions in perception, especially for the naïve user, would lead to anxiety, arousal, sometimes fear and panic, and could obviously hasten along an evolution to psychosis. And some people do report very negative experiences after smoking a joint.

Clearly it is the CBD portion of the drug that allows those perceptual distortions to be pleasurable.

I am absolutely sure that marijuana does not cause schizophrenia, but it could easily hasten it along, especially with heavy use. On the other hand CBD is an effective, and so far apparently safe, anti-anxiety drug and possibly safer for controlling anxiety than prescription lorazepam.

But, as I have pointed out to teenagers who asked for marijuana prescriptions to quell the pain of a breakup, impending exams, getting a part-time job, they should and need to be experiencing anxiety. Some anxiety is necessary for growth, for learning, for engaging with the world.

Many boys who smoke daily from, say age 16 to 23, are still obviously, in many ways, 16 when you meet them at 23.

CBD yes as a good medicine.

Marijuana in moderation, at least until achieving some level of maturity.

Marijuana and Schizophrenia

By Marvin Ross

pot
Courtesy of pixaby.com

Now that marijuana is legal in Canada and in many US states, understanding the role of this substance in the development of schizophrenia is even more crucial. Schizophrenia has long been thought to be associated with pot smoking but the causality has been in doubt.

In my book, Schizophrenia Medicine’s Mystery Society’s Shame published in 2008, I cited the research that was current at that time.

The classic study was that of a long term follow up of Swedish conscripts aged 18-20 in 1969-70. A total of 50,087 young people representing over 97% of that country’s 18-20 male population reported on their use of cannabis, other drugs and on several other social and psychological characteristics. The researchers then looked at hospital admissions for schizophrenia amongst this group. It was found that cannabis was associated with an increased risk of developing schizophrenia. The greater the use then the greater the risk. The researchers concluded that there was no question but that the link between the two was causal. Cannabis use caused schizophrenia and the link was not explained by the use of other psychoactive drugs or personality traits.

However, it has also been hypothesized that schizophrenia leads to a greater use of marijuana likely because people are trying to medicate themselves. A number of years after the above study was published, Scottish researchers looked at all the studies that had been done on the link between cannabis and schizophrenia between 1966 and the end of 2004. That study agreed with the original findings. Early use of cannabis does appear, it said, to increase the risk of psychosis and that cannabis is an independent risk factor for both psychosis and the development of psychotic symptoms. Again, it has been argued that prodromal symptoms of schizophrenia lead to an increased use of marijuana. Then, while the disease is developing, being stoned speeds up the developing deficits of the disease.

Malcom Gladwell in the New Yorker and New York Times reporter Alex Berenson recently wrote about the correlation between marijuana use and violent crime. Gladwell cited a National Institute of Medicine research report and Berneson produced a book on the topic called Tell Your Children: The Truth about Marijuana, Mental Health and Violence.

Marijuana researchers objected strenuously to the link of marijuana to crime and I tend to agree. But Gladwell also linked pot use to schizophrenia and that too set off the marijuana researchers. Ziva Cooper, one of the authors of the National Academy of Medicine report, objected to the association of marijuana with schizophrenia. She said that the National Academy did find a link between marijuana and schizophrenia but that they also found a link between using cannabis and improved cognitive outcomes for people with psychotic disorders.

Now that I can also believe but the researcher is mixing apples with oranges. Marijuana is comprised of THC which is the hallucinogenic and CBD which is not. It is the THC that can push people to psychosis and when smoking pot, you do not know how much of each is in the joint. And, of course, the potency of pot today is much greater than it was in my day.

According to a research update in Psychiatric Times “Cannabidiol (CBD), the second most active ingredient in marijuana, has been hypothesized to have antipsychotic effects—in contrast to tetrahydrocannabinol (THC), which may promote or worsen psychosis”. Recent research in the American Journal of Psychiatry found that “CBD has beneficial effects in patients with schizophrenia. As CBD’s effects do not appear to depend on dopamine receptor antagonism, this agent may represent a new class of treatment for the disorder”.

However, people should be aware that when you smoke a joint or nibble an edible, you have no idea how much THC or CBD is in the product.

And, as the brain continues to develop till about the age of 25, those under that age should be cautious particularly if they have a family history.