Mark's Musings - August 5

Below is an aggregation of the stories I posted on LinkedIn since my last edition. I curate them through the prism of an "intersection of chronic pain and appropriate treatment" and so they come attached with my opinion.

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Medical Marijuana in Pennsylvania (330 views)

Interesting advertisement on Twitter over the weekend, selling a direct connection between medical #cannabis and #opioids. They are promoting a substitution ("Get OFF the Suboxone") for a substitution (Suboxone & Subutex are part of Medication Assisted Treatment to replace Rx and illicit opioids). Their first suggested step is to "Meet our medical marijuana doctors who can answer all of your questions." We'll see if this is a trend around Pennsylvania and other states whose medical cannabis programs explicitly or implicitly state that medical #marijuana can be an opioid substitute (for more info read my 1/24/19 blogpost "Marijuana & Opioids"). One of the more intriguing and innovative things Pennsylvania included is their "Chapter 20" legislative mandate for research. Recognizing a need for more clinical studies, they are encouraging them in-state. Here's how the legislature phrased it:

"It is the intention of the General Assembly to create a mechanism whereby this Commonwealth's medical schools and hospitals may provide advice to grower/processors and dispensaries in the areas of patient health and safety, medical applications and dispensing and management of controlled substances, among other areas. It is the further intention of the General Assembly to create a mechanism whereby the Commonwealth may encourage research associated with medical marijuana."

Of course, whomever becomes a clinical registrant has a predisposition towards marijuana being medicinal so the starting point is not wholly unbiased. But most clinical studies start with a premise that they'e either trying to prove or disprove so this isn't that much different. For those who are undecided whether marijuana is medicine but are open to science giving them evidence to sway their opinion, any additional research can be helpful.

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Friday Five -7/26/19 (209 views)

A great aggregation of important "ergonomics, occupational health, safety, human performance, or human factors" info from Quin Bond. One of his articles includes a reference to "Walking Works Wonders," which is an "evidence based intervention, involving innovative health education designed to increase physical activity and reduce sedentary behaviour at work." Because, you know, "Motion is Lotion." Quin also included a study about acceptance of wearable technology in the workplace. Interestingly, the more the employer focused on workplace safety as a goal, and invited the employees to be part of the selection process, the more accepting they were of the addition. That's something to consider as the use of wearables at the workplace (and for compliance with medical treatment) becomes more widely used.

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Adherence to Aerobic Activity Guidelines Not Up Since 2008 (294 views)

In follow-up to the post above here's some bad news. "There was a significant increase in time spent on sedentary behavior ... There was an increase in the weighted proportion of people not adhering to the PAG (Physical Activity Guidelines for Americans) for aerobic activity and reporting long sedentary time." So while you're reading this ... Stand up! Do some laps! Walk some stairs! PAG is an outreach of the Office of Disease Prevention and Health Promotion and you can see how physical activity fits perfectly within that scope. They even have a "Move Your Way" campaign that includes a variety of tools to help get the word out.

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AI Will Be Smarter Than Physicians (498 views)

"Complexity will not go away. Data will continue its assault on our cognitive skills. A solution is to recognize that the role of the clinician is shifting to something that might appeal to Hippocrates and patients. It's the role of the compassionate clinician—empowered by technology's cognitive prowess—to provide the basis for a new medical paradigm." I have heard from multiple forward-thinking clinicians that technology will not replace the physician but instead add to their knowledge base & efficiency so they can focus on the more "human" aspect of delivering care. Nobody truly knows the overall and lasting impact of technology, but one thing we know for sure - with the amount of information compounding daily, making it actionable becomes increasingly difficult without some help. Here are some additional resources to read/consider:

• “Will Artificial Intelligence Replace Dermatologists?”
• “Artificial intelligence enhances MRI scans”
• “The A.I. Diet (Forget government-issued food pyramids. Let an algorithm tell you how to eat.)”
• And if you're available on July 24-25, 2020 you can attend "Current Applications and Future of Artificial Intelligence in Cardiology by the Mayo Clinic" in San Francisco

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In a flash of clarity, lives marred by drugs find meaning (312 views)

A hopeful story of three people that changed their lives from #addiction to #recovery in a "flash of clarity." But none of them arrived there in the same way or on the same timeline. The article's authors e-Mailed a simple question to 125 people: "What are the two or three things that people who achieve sustained recovery from addiction have in common?" A total of 82 responded with variations of "support and connection ... emotional benchmarks ... medications ... Notably, there was no unanimity." The chief medical officer of the Boston Health Care for the Homeless Program offered this insight: "People who achieve sustained recovery have MEANING IN LIFE" (and I think she meant to capitalize those last three words). Since you never know what will create that epiphany, you can never give up.

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Managing the Risk Impacts of Opioids in the Workplace - Subscription Required (421 views)

If you are a subscriber to the Employment Practices Liability Consultant (EPLiC) outreach of the International Risk Management Institute, Inc. (IRMI), check out the article entitled "Managing the Risk Impacts of Opioids in the Workplace" that I co-authored with the estimable Don Phin, Esq. in their latest edition. Here is how we segmented the article:

• Opioid Addiction Is a Huge Problem
• How Did We Get Here?
• What To Do Post-Workers Comp Injury
• ADA Protections and Accommodations
• FMLA Leave
• Using Naloxone To Reverse Opioid Overdose in the Workplace
• Training Opportunities

Here is our conclusion: "While we remain in the midst of an epidemic, progress is being made, largely driven by awareness of the problem and efforts by the government, medical community, community groups and employers."

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How Data Analytics Has Curbed the Prescription of Opioids in Philly (315 views)

This is an example of making a positive impact by merging data, outcomes, common sense and compassion. By reducing #opioid prescriptions from 99% to 25% for women that had cesarean deliveries and changing their Emergency Department electronic system default to allow a max of 3 day supply (instead of options for 7, 14 or 21 days), Jefferson Health is making a difference. The initial script for pain, especially for opioid naive patients, is so incredibly important to not overdo because excess pills often end up in the wrong hands. Fortunately, throughout the country, the concept of an initial 30-day supply is quickly becoming extinct. Note that none of these efforts suggest eradicating prescription opioids as an option for clinicians and patients. Instead, it's the application of logic for when and how they should be used and how many to give. Looking for (and acting on) red flags and being "judicious" when prescribing (individualized treatment - not a novel concept) should be part of the prescriber's toolbox. It takes more effort - and payers need to reimburse appropriately - but it will be worthwhile in the long run.

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How Neuroplasticity Changes Over Your Brain’s Lifetime (693 views)

#Neuroplasticity is an incredibly important concept to understand. I learned this several years ago from behavioral psychologists and TBI treatment providers constantly repeating the term as a roadmap for hope.

"Because of neuroplasticity, you are not stuck with the brain you’re born with or that you have at any given time in your life. If you make the effort to intentionally guide neuroplastic change, you can improve your brain and mental health."

Let that sink in. There is hope.

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Workers choose less caloric foods when workplace cafeterias alter their 'choice architecture' (499 views)

I can only speak for myself, but calorie counts on restaurant menus have often changed my choices. Actually, I CAN speak for others because when in a group we've had discussions about "I love salads but ... wait ... how many calories?" At Massachusetts General Hospital (whose employees see the health implications of making bad choices on a daily basis), it's red-yellow-green (bad-ok-good) signage but essentially the same result. Transparency on "cost" - you can eat something delicious but it might hang around (your midsection) for awhile - creates epiphanies. And, oftentimes, better choices. This is something an employer can encourage - even implement if they have a cafeteria / snack area - for wellness. Employees that practice wellness are going to be more productive, so consider this an investment in the business.

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5 powerful words you can say to patients (285 views)

I'll give away the punchline - the five words are “It’s going to be OK.” But invest one minute and read the entire op-ed from this internal medicine physician about how a clinician's words, tone and attitude can have an uplifting result (or the complete opposite) on someone faced with health questions. "I truly believe that over 90 percent of our everyday job as a physician involves being a good communicator." He's not wrong. Some very helpful input from two clinicians:

Annie Marsh, a FNPc (Family Nurse Practitioner) in Utah: "I volunteer at a free clinic treating patients without insurance and who are in poverty. I’ve found that on average they are more afraid as their health literacy is lower than a traditional clinic. This reassurance for them is key. I had a patient yesterday that I told she was going to be ok several times AND she was still worried."

Brittney Buse, a Medical Director in CA : "you have to remember though that there is a lot of fear in the culture of medicine on the provider end as well, what if I say "it's going to be ok" and it's not, will I be sued? will the patient accuse me of being insensitive? While everyone knows I am a strong proponent of changing the dialogue of medicine, not everything falls on individual doctors when the whole system is broken."

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In addition, I published one blogpost:

• "Mark's Musings - July 29" on July 30

And I published one new vlog on my YouTube channel:

• "The Journey (of Stone Mountain)" on August 2

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#PreventTheMess + #CleanUpTheMess = The Answer.