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      "title": "The fallacy of white privilege",
      "body": "Facts to consider during black history month: \nPrior to US independence, nearly half of white immigrants to the colonies were enslaved (convicts or indentured servants). Unlike black slaves, who were encouraged to marry and raise families, white slaves were expected to remain celibate, eliminating the chance their future progeny might benefit from their poor circumstance. \n As of 1810, less then 3% of U.S. families owned slaves.   Prior to waves of disenfranchised Germans and Irish immigrants, the total US population in 1810 was 8 million (free + enslaved); however, the free population more than doubled with the wave of immigrants in the early 1800s.  Immigration from other countries pre-Emancipation put slave ownership at less than 1% of Americans. In 1810, more than 40% of U.S. blacks were free men, albeit geographically restricted. \nBy the time of the Civil war, half the African American population was already free and benefiting from economic privilege that apologists erroneously ascribe only to non-blacks.  These facts, individually and collectively, disprove any sweeping rhetoric about \"white privilege\" stemming from enslavement.   99% of Americans didn't participate in slavery.\n\nWhat about indirectly benefiting: also untrue, if for no other reason than half of \"blacks\", being free, benefited from the \"privilege\" which apologists incorrectly assert is inherent to \"non-blacks\", and these free blacks and their progeny benefited from enslaved whites as well.  Whether African, Irish or German, few immigrants were welcomed upon arrival - usually the opposite,  In short, we of every race are privileged to live in a nation of freedom and opportunity. Why are ethnic remembrances important then? For emotional support, not to rewrite history. Emotions are not logical or factual, however there is little harm in assuaging the emotions by letting ethnic groups be heard and helping them celebrate the unique gifts they bring to human history and the unique greatness of the U.S. \n\nDisclosure: According to 23andme results, Dr Frank is German, Irish, African and Russian.",
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      "body": "The U.S. faces a growing elderly population with increasing medical needs and worrisome long-term care costs. As a physician for primarily geriatric (persons over 65) and complex patients, the questions I hear frequently involve Medicare.  Understandably, the questions are usually about what their insurance covers, and these are the common topics:\n\nMedicare is available at 65; the cost is lowest if the person or their spouse has worked full-time for at least 10 years.   It is important to enroll in Medicare on time for, unlike Social Security, when a person reaches eligibility but enrolls late, they incur increased monthly Medicare penalties for a lifetime.  You read that correctly: if you enroll in Medicare late, you will pay for that delay the rest of your life.  Apparently it is that important the government control your healthcare.\nMedicare is broken into parts A, B C and D. \n\nPart A is excellent hospitalization coverage, which most people understand.  Everyone under part A has a deductible every year.  Most people do not understand this.\n\nPart B pays for roughly 80% of outpatient healthcare after annual deductible; 20% of outpatient costs are the patient responsibility. \nAlso misunderstood: emergency room, same-day surgery and observation status are only covered by Part B; Medicare regulation states it is not hospitalization.   Roughly one-third of what laypersons consider “hospitalization” is not – it is “observation”, so the patient gets billed at least 20% of those charges.  \n\nPart C is optional – called Medicare Advantage it has more coverage flexibility conforming to individual needs and can wrap parts A, B and D into one plan. The overall coverage for Medicare Advantage is not only more comprehensive than traditional Medicare; but also can reduce the need for “medi-gap” insurance (supplemental plans addressing the 20% of uncovered cost mentioned above). \n\nPart D is prescription drug coverage, an excellent financial deal for patients on chronic medication.",
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      "title": "Patient Access to Medical Marijuana - the Michigan Dilemma",
      "body": "In Michigan, Marijuana/Cannabis is legal.  Local communities may opt-in for either medical marijuana, recreational marijuana or both. Rural communities such as ours are rightfully considering support for medical marijuana dispensaries; currently patients with pain and seizures must drive three hours for the nearest dispensary.\nDispensaries are highly regulated, highly taxed and require businesses to spend nearly half a million dollars to open, which limits availability to patients.  As a physician and educator, I remain concerned about the misinformation regarding marijuana but remain hopeful this community demonstrates compassion toward patients hoping for some relief from suffering known to be alleviated by marijuana and its biologically active compounds.  \nFor recreational purposes, the word marijuana refers to the leaves and female flowers of the cannabis plant, the only parts containing compounds known to create the “high” when activated by heat.   In contrast, medical cannabis (medical marijuana) is the whole plant or chemicals in the plant used for medical purposes, focusing on two main cannabinoids.\nCannabinoids are substances in cannabis acting in the body via cannabinoid receptors.  Humans have naturally-occurring cannabinoids receptors in brain, spinal cord and nerves, including the nerves in the gastrointestinal tissues.  Two most-studied cannabinoids are:\n•\tTetrahydrocannabinol (THC) which can stop nausea and causes the psychoactive effect of \"getting high\";\n•\tCannabidiol (CBD) which does not cause psychoactive effect. (This substance is now approved by the FDA to reduce seizures in epilepsy).\nPain and Muscle Spasms. Clinical trials with cannabis using varying ratios of THC to CBD demonstrate cannabinoids may be useful in neuropathy, spasticity due to multiple sclerosis, and other symptoms caused by nerve dysfunction.\nOutside the US, cannabis extracts are legal as capsules (CannadorR), with the main constituents being THC and CDB in a ratio of 2:1. Rectal suppositories are also available to deliver THC in patients who cannot swallow safely or have intractable vomiting.  Studies in Multiple Sclerosis (MS) demonstrate improvement in pain and spasticity at daily doses of THC ranging from 7.5mg to 27.5mg.\nMost research using oral preparations has targeted neuropathic pain and spasticity associated with multiple sclerosis (MS). These trials suggest that dronabinol (up to 25 mg daily) significantly reduces pain compared to placebo (50% “improved” on dronabinol compared to 30% on placebo). Dronabinol available by prescription for patients who can swallow capsules, however the FDA indication is for nausea and chronic wasting.\nOne study with 12-month follow-up concluded there may be sustained relief for pain associated with multiple sclerosis.  30% of cannabinoid-treated participants had relief at 12 months compared to 15% on placebo, with dose limited to 25mg THC daily. This suggests pain relief \nmay be sustained without increasing doses, unlike conventional pain medications.\nResults consistently indicated that cannabis significantly reduced pain intensity, with patients reporting 34%-40% decrease on cannabis compared to 17-20% on placebo.  (A 30% decrease in pain intensity is generally associated with reports of improved life quality.)  In a similar study, the effect of 25 mg doses of smoked cannabis at various potencies, administered three times daily for 14 days demonstrated that 9.4% THC produced some analgesic effects in patients who failed respond to conventional pain medication. \nSeizures.  Epidiolex (a CBD formulation) was approved by the FDA in 2018 to treat seizures in children and adults in whom traditional anti-seizure medications are ineffective; clinical studies showed seizures decreased by 41.9% when compared to 17.2% in placebo.  Other studies showed that when added to prescription medications, CBD further reduced seizures by 36.5%. \nThus, when conventional treatments do not work (roughly 30% of people with epilepsy), it is reasonable to consider CBD oil.  Unfortunately pharmaceutical-grade CBD cost for one year is roughly $32,000, similar to most new anti-epileptics.  In contrast, whole plant cannabis costs about $5,000 per year. \nLimitations. Cannabis is not a panacea; it fails to control overactive bladder and fails to stop the side-effect tremors from Parkinson’s and Schizophrenia medications.  It has no effect on cancer survival and can interfere with some psychiatry and neurology medications.\nIn considering cannabis, communities should be mindful that the medications currently used for pain or spasticity also have adverse effects. Opioids produce sedation, nausea, constipation and dependence, Tricyclic antidepressants and antiepileptic drugs commonly prescribed for chronic pain cause sedation, constipation, dizziness, heart arrhythmias and urine retention.  Muscle spasm medications cause sedation and syncope.  Benzodiazepines cause sedation, falls, memory lapses and worsen dementia. In short, all currently available medications for chronic pain have side-effects, including death from overdose. \nUnlike traditional pain medications, fatal overdose with cannabis alone does not occur. Therefore, judgments on benefits and risks of cannabinoids as medicines should be viewed within the broader context of risk-benefit of other agents as well. \nA local medical dispensary allows patients and their physicians an additional tool to alleviate chronic suffering and improve life quality in a regulated setting.",
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