New England Journal: 200 years of medical history

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EMBARGOED FOR RELEASE AT WEDNESDAY, JAN. 4, 2012 AT 5 P.M. EST - This illustration made available by the New England Journal of Medicine shows a diagram of a human heart in the article "Cases of Organic Diseases of the Heart and Lungs" by John C. Warren in the April 1, 1812, Issue of the journal. Unhappy with today's health care? Think of what it was like to be sick 200 years ago. No stethoscopes, antibiotics, X-rays or vaccines. Bloodletting was a common treatment. If you had a heart attack or a stroke, doctors put you in bed and hoped for the best. Into this medical dark age, two Boston doctors brought a beacon of light. Two centuries ago, they started what is now the New England Journal of Medicine with the idea that science should guide care medical treatment. (AP Photo/New England Journal of Medicine) EMBARGOED FOR RELEASE AT WEDNESDAY, JAN. 4, 2012 AT 5 P.M. EST - This illustration made available by the New England Journal of Medicine shows a diagram of a human heart in the article "Cases of Organic Diseases of the Heart and Lungs" by John C. Warren in the April 1, 1812, Issue of the journal. Unhappy with today's health care? Think of what it was like to be sick 200 years ago. No stethoscopes, antibiotics, X-rays or vaccines. Bloodletting was a common treatment. If you had a heart attack or a stroke, doctors put you in bed and hoped for the best. Into this medical dark age, two Boston doctors brought a beacon of light. Two centuries ago, they started what is now the New England Journal of Medicine with the idea that science should guide care medical treatment. (AP Photo/New England Journal of Medicine)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); Unhappy with today's health care? Think of what it was like to be sick 200 years ago.

No stethoscopes, antibiotics, X-rays or vaccines. Bloodletting was a common treatment. If you had a heart attack or a stroke, doctors put you in bed and hoped for the best. If you needed surgery, you got a few shots of whiskey and a bullet to bite.

Into this medical dark age, two Boston doctors brought a beacon of light. They started what is now the New England Journal of Medicine with the idea that science should guide care — not whoever argued loudest or had the most persuasive theory.

The first 100 copies in January 1812 were delivered by horseback. Today, 2 million people read the journal online every month. It is the oldest continuously publishing medical journal in the world, and it has touched lives in more ways than you may know. Some examples:

—Stroke victims now get clot-busting medicine, not dark rooms to ride out their brain trauma, because a 1995 study in the journal proved its benefit.

—Heart attack patients have arteries unclogged without surgery, then go home on medicines that studies in the journal showed could prevent future attacks.

—Women with early stage breast cancer can have just the lump removed followed by radiation instead of losing the whole breast, thanks to a 1985 study that found the lesser surgery just as good.

—Bone marrow and organ transplants — radical ideas when first tried half a century ago — are now routine. Even face transplants are becoming more common: three were described in last week's issue.

—Rehydration is now recognized as the main treatment for many diarrheal diseases. A journal article warned against bloodletting in 1832 as cholera ravaged New York City.

—People no longer suffer surgery without anesthesia, a field that grew from Henry Jacob Bigelow's 1846 report on the first successful use of inhaled ether.

—Medicine is more ethical, and study participants have more protections, because of a 1966 report in the journal about researchers failing to get informed consent. Another top journal had rejected the article as too controversial.

The New England Journal started decades before the American Medical Association was founded in 1847 and is widely credited with promoting evidence-based care.

"It has been very good for society," said Pat Thibodeau, head librarian and associate dean for the Medical Center Library at Duke University. "When I go in, I'm hoping my doctor has read the New England Journal of Medicine or something similar and is following that information."

"It's the cream of the crop," said Dr. Barron Lerner, a Columbia University physician and medical historian.

"They get the best research submitted to them, and they do an extremely good job of peer reviewing" to make sure it is solid, he said.

That's what Boston surgeon John Collins Warren and James Jackson, who helped found Massachusetts General Hospital, hoped for the journal, which is now published weekly. It got its current name in 1928, seven years after it was bought by the Massachusetts Medical Society.

Warren's father, John Warren, surgeon to George Washington's troops, wrote the first article, on chest pain. Doctors had been debating whether it was caused by plaque — "the cement that builds up in arteries" — or blood clots, said Dr. Jeffrey Drazen, the journal's editor-in-chief since 2000. Both proved correct — the "cement" fractures and allows a clot to form that blocks an artery, he said.

Heart care has been a journal specialty, and two prominent doctors — Elizabeth Nabel and Eugene Braunwald of Brigham and Women's Hospital — trace its evolution in this week's issue. Nabel is former director of the National Heart, Lung and Blood Institute and now is president of the Boston hospital.

They describe the first human cardiac catheterization — now a common diagnostic procedure — that Werner Forssman performed on himself in 1929. Under local anesthesia, he put a catheter into his arm and maneuvered it into his own heart.

For a heart attack, "it used to be that all we did was put people to bed for five weeks," but studies in the journal showed "that that was the worst thing you could do," said Dr. Jerome Kassirer, its top editor from 1991 to 1999.

The journal also helped prove "germ theory" and the nature of infectious diseases.

"People didn't realize you could infect people when you were using your dirty gloves or not using gloves. People didn't realize tuberculosis was communicable. They thought it emanated from clouds they called miasma, clouds of dirty smoke in cities," said Lerner, the Columbia historian.

Not all was grand in the journal's history, though, as Allan Brandt, a Harvard University medical historian writes in this week's issue.

When Harvard Medical School debated admitting female students in 1878, the journal expressed concern about men and women mingling during surgeries normally witnessed only by one sex. The school didn't admit women until 1945, when World War II caused a shortage of men.

The journal also agreed with mandatory sterilization of "mental defectives" in the early 20th century. "Most alarming," Brandt writes, was its declaration in 1934 that "Germany is perhaps the most progressive nation in restricting fecundity among its unfit." The journal later condemned Nazi medicine.

In recent years, it has tracked health policy, from the Clinton health care plan and the advent of managed care to current debates about Medicare.

There were oddball reports along the way, like the 2007 account of a cat named Oscar that had a knack for predicting when patients at a Providence, R.I., nursing home were close to death by curling up to them in their final hours.

The journal has printed few studies on alternative medicine because so little good research has been done on it, Drazen said. Unlike some other journals that like controversial research, the New England Journal tries to avoid it.

"People think the cutting edge is sharp. The cutting edge is very dull. It's very foggy and you don't know what the right answer is," so editors try to pick studies that are definitive enough to affect care, Drazen said.

That's why it publishes very few observational studies, the kind that in the 1990s led to pronouncements like "margarine is better than butter" only to be reversed by the next such study.

"Some of those are papers that we've seen and turned back," Drazen said. "I'm looking for a higher evidence standard."

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Online:

Journal and medical timeline: http://nejm200.nejm.org

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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2 Out of 3 Medical Students Don't Know When to Wash Their Hands

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It's cold and flu season, which means you should be washing your hands — a lot. And that rule should apply to health care workers most of all, to protect not just themselves but their patients. Problem is, most doctors are confused about when they're supposed to hit the sink, a new study of medical students finds.

Researchers at Hannover Medical School in Germany surveyed 85 medical students who were about to enter their clinical training — when they deal with actual patients. The surveys were administered as part of a lecture class that students must pass before initiating patient contact.

The doctors-to-be were given seven scenarios, five of which required hand-washing: before contact with patients, before preparing IV fluids, after removing gloves, after contacting patients' beds and after contact with vomit. (The other two scenarios did not require hand-washing.)

Only 1 in 5 students correctly identified what to do in all seven situations. And just 1 in 3 got all five hand-washing scenarios correct. Most students knew that they were supposed to wash their hands before contacting a patient, after touching their bed and after contacting vomit, but 15% to 20% could not correctly identify the other two hand-washing situations. (Last month, a study found that wearing gloves made health care workers less likely to wash their hands, which is dismaying since germs can travel through latex gloves.)

From the results, published in the American Journal of Infection Control, it's clear that doctors-in-training need more education about the importance of hand-washing, and more specifically, practical lessons on when to use either hand sanitizers or the sink. Previous studies have suggested that health care workers are confused about the protocol: a 2006 British survey found that 58% of medical students didn't know when to use the alcohol-based hand sanitizers.

So how can health care workers improve on their hand-washing compliance? This is a source of constant concern and study in hospitals. One thing that helps is to remind them that it's not only their own health, but also the health of their patients that's at stake. So, the next time you're in the hospital or at the doctor's office, and your physician doesn't wash his hands before beginning an exam, you might want to point him toward the sink.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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Why Medical Marijuana Laws Reduce Traffic Deaths

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States that legalize medical marijuana see fewer fatal car accidents, according to a new study, in part because people may be substituting marijuana smoking for drinking alcohol.

Sixteen states and the District of Columbia, have legalized medical marijuana since the mid-1990s. For the new study, economists looked at 1990-2009 government data on marijuana use and traffic deaths in the 13 states that had passed legalization laws during that time period. The data were from the National Household Survey on Drug Use and Health and the National Highway Traffic Safety Administration.

Comparing traffic deaths over time in states with and without medical marijuana law changes, the researchers found that fatal car wrecks dropped by 9% in states that legalized medical use — which was largely attributable to a decline in drunk driving. The researchers controlled for other factors like changes in driving laws and the number of miles driven that could affect the results.

Medical marijuana laws were not significantly linked with changes in daytime crash rates or those that didn't involve alcohol. But the rate of fatal crashes in which a driver had consumed any alcohol dropped 12% after medical marijuana was legalized, and crashes involving high levels of alcohol consumption fell 14%.

MORE: Study: Legal Medical Marijuana Doesn't Encourage Kids to Smoke More Pot

The authors found that medical marijuana laws reduced crashes in more men than women—by 13% compared to 9%— in line with data showing that men are more likely to register as medical marijuana users than women.

The overall reduction in traffic deaths was comparable to that seen after the national minimum drinking age was raised to 21, the authors note.

"We were astounded by how little is known about the effects of legalizing medical marijuana," lead author Daniel Rees, professor of economics at the University of Colorado-Denver, said in a statement. "We looked into traffic fatalities because there is good data, and the data allow us to test whether alcohol was a factor. ... Traffic fatalities are an important outcome from a policy perspective because they represent the leading cause of death among Americans ages 5 to 34."

The authors also found that in states that legalized medical use, there was no increase in marijuana smoking by teenagers — a finding seen in other studies as well. But, in many cases, the laws were linked with an increase in marijuana smoking among adults in their 20s; this rise was accompanied by a reduction in alcohol use by college age youth, suggesting that they were smoking weed instead.

Studies have consistently found that while mixing either marijuana or alcohol with driving is unadvisable, driving high is much safer than driving drunk. Research on stoned driving is inconsistent, with some studies finding impairment and others not; the alcohol data, however, is clear in establishing a link between drinking and significant deterioration in driving skills. The data also consistently shows that using both drugs together is worst of all.

MORE: Study: Whites More Likely to Abuse Drugs Than Blacks

Driving under the influence of marijuana seems to be less risky because people who are high tend to be aware that they are impaired and compensate, while alcohol tends to increase recklessness and create false confidence. Also, people are more likely to smoke weed at home or in private, rather than out at bars or other public events that require driving to get to.

The research was published by IZA, a nonprofit labor research organization associated with the University of Bonn in Germany. It is a working paper, which means it has not yet been subjected to peer review.

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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Mind Reading: Two Harvard Docs Talk About Making the Best Medical Choices

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Critical medical decisions can be difficult to make — even for two Harvard doctors. But Dr. Jerome Groopman, who is also a staff writer for the New Yorker, and his wife, Dr. Pamela Hartzband, have thought a great deal about doing it correctly.

In their recent book, Your Medical Mind: How to Decide What Is Right for You, they explain that a better understanding of your own personal values and history can help you cut through the swamp of statistics and make smart decisions.

TIME: So what are the different types of medical mindsets?

P.H.: The first one would be 'minimalist,' and the opposite of that is 'maximalist.' The minimalists like to do the least possible for medical problems and the maximalist wants to be ahead of the curve and do anything and more. For me, I am minimalist and [Dr. Groopman] is a maximalist.

J.G.: Another major category, which we also differentiate is 'believers' and 'doubters.' Believers are people who believe there must be a good solution for their medical problems someplace, and they just have to find it. Doubters are very focused on side effects and on unintended consequences. They are concerned that the treatment might be worse than the problem.

[We wondered about] how does anyone come to this? I'm a believer and maximalist, and [it comes from] how I was raised. We put in the book a structure so that each reader can look at his or her own lifestyle and understand how they arrived at that mindset.

I was brought up in a traditional Jewish home where doctors were like gods. My parents looked at natural healing and folklore practices from the shtetl as being totally nonsense. Anything that was without science or technology was thought to be foolish. The development of being a maximalist in part I think came from experience. For example, my father [died] at a young age of a massive heart attack. I looked to medicine to focus on the absolute maximum to treat people — in particular, thinking about my father's loss. In my own field, which is blood diseases and cancer, in order to try to save as many as you might, you had to go to extremes.

MORE: Mind Reading: Why Bad Math Can Ruin Your Health

P.H.: In my family, there was a lot of skepticism about expert opinion. It started when I was a baby. My father, who was an engineer and very interested in science, decided that it would be a good idea to approach childrearing in a scientific way.

My mother was an artist and freethinker and she had other ideas. She thought that the experts and doctors don't know anything. My parents have fortunately enjoyed very good health. They're in their 80s and that reinforces a minimalist and doubter point of view. If you believe you have generally good health, you don't want to do anything that might make matters worse.

One of the most difficult medical questions right now seems to be screening, particularly for prostate cancer. The studies suggest that men have to make a horrible choice between possibly dying of cancer or potentially becoming impotent and incontinent because of needless treatments after a false-positive result.

J.G.: [The studies haven't resolved the question. The big studies that were supposed to do so only measured deaths, not how people live.] They weren't measuring men living their last years with prostate cancer in their bones, which as a cancer specialist, I can tell you isn't a pleasant way to live. But [these men usually] die of heart attack or stroke, so they're not counted as deaths from prostate cancer.

To my mind, this is a gray zone. There is no clear answer. There are two different groups that come up with recommendations. The U.S. Preventive Services Task force says no screening, and the Urological Association says everyone should be screened. The middle ground is that each individual patient and doctor makes a choice that's right for that man. You have to be very careful. You need to really look deeply at these kinds of controversies.

Patients and doctors don't like uncertainty. The reality is that most of medicine is in the gray zone. So to say all PSA screening is worthless is wrong and to say every single man must have it is wrong too.

Our book really engages uncertainty and it says that you as an individual can understand the information and then you can understand yourself.

MORE: Prostate Cancer Screening: What You Need to Know

Do you think it's better to take one of these positions—like minimalist or maximalist— over the other?

J.G.: No. Take a simple thing like issue of [cholesterol-lowering] statins. The only person who can really judge the risks and benefits within the context of her or his life is the patient.

[A woman we describe in the book who had to make this decision] was a doubter and a minimalist. She decided, It's not worth it to me to take statins if my chance of having a heart attack is 1 in 100. She really thought it through. If she has a heart attack [and survives], she'll be disappointed but not regretful.

You also describe a woman who went against her own preferences and had surgery that was harmful to her.

P.H.: She couldn't stand up to her doctor. [And she regretted her choice.]

J.G.: One of the big messages of the book is that doctors have their own medical minds and that's why experts disagree when they are looking at the same information. This book empowers patients to stand up and express their own medical minds, because the language is powerful. Pam and I have been using [these terms] with our own patients to help them understand what choice is right for them.

If [the woman who had had the failed surgery] had had the language to say, 'My mindset is that I'm a minimalist and a doubter and if I need to do something, my first choice is to do something natural, and if that doesn't work, I'm willing to look at other options,' [she would probably have been able to say no to the surgery]. People feel intimidated to basically come up with a different answer for themselves. This book says don't be intimidated.

P.H.: And you can see if your point of view is very different from your doctor's. If you have different mindsets, hopefully you can communicate and work together. The doctor has to understand so [he or she] can help to work toward a resolution of the problem that is consistent with your point of view.

How does this idea fit with the push to have evidence-based guidelines for treatment that will just tell you what to do?

P.H.: Guidelines can be extremely helpful and they represent a lot of work and gathering of information and weighing back and forth of evidence. But they're not gospel. They're often based on studies that don't apply to many different people — pregnant women, for example, or older people or people with other medical problems.

J.G.: There are three key limitations of guidelines. The first is that they often don't apply to patients in the real world. Second, they represent the medical mindset of the community [that created the guidelines], which may not correspond to your doctor's medical mind or yours. Third, for internal medicine, like diabetes and heart disease, [guidelines often change]. There was a study done of 100 best practices guidelines. In one year, 14% were reversed; in two years, 23%; and in five-and-a-half years, half. It's not only because of new information, it's because a new community comes together, and they have different biases about risks and benefits.

When you drill this far down, you see all the uncertainties and it becomes easy to say, 'It's all subjective.' By that logic, people who say vaccines cause autism can be said to have just as much of a case as those who say they don't.

J.G.: There are certain parts of medicine that are completely amenable to strict guidelines. For example, infection control — you don't want someone putting a catheter in your vein without washing their hands first. [In] safety and emergency care, it's the same for everyone. But that is just one small slice of medicine.

How do you find and evaluate the information to make these decisions?

J.G.: The first question every patient should ask is, 'What is my chance of having a certain outcome with no treatment?' [In the case of statins, for example, a heart attack.] That gives the sense of, for you as an individual, what are you facing? It clears away the confusing clutter of statistics. Either your doctor can provide the information, or there are [risk] calculators at government or other well-respected websites. [You need to find out] what is my risk for something if I do nothing, and then you can really assess the positive impact and negative potential complications of the treatment.

P.H.: And when you're looking at these numbers, you want to be careful how the numbers are framed because that can be very confusing, too. In the case of the woman with elevated cholesterol, she's told her risk of heart attack would be reduced by 30% by taking a statin. Even as a minimalist and a doubter, that sounds like a big number because your mind plays tricks on you. It sounds like you're at 100% risk and now it's reduced by 30%. But it's not. Her risk from doing nothing is 1 in 100.

Or, for example, with bisphosphonates for osteoporosis, they will reduce the risk for fracture by 50%. What's your risk if you don't take them? If it's 2% and it goes to 1%, you still might want to take them, but at least you understand what that really means for you.

The next thing to do is, once you've looked at the numbers framed in a certain way, then you want to flip the frame and experience it the other way. When you talk about side effects of statins, it depends on the dose and which one you take. It varies between 1% and 10%. Ten percent sounds like a lot, but if you say 90% don't have side effects, that sounds a lot better.

J.G.: I think you as journalist and we as doctors and writers have a real responsibility to communicate with people in an understandable way. People make life and death decisions based on their interpretations of this information and it's very easy to be misled. A lot of this book is about how not to be misled.

See more of Healthland's "Mind Reading" series.

Maia Szalavitz is a health writer for TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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U.S. medical 'trash' saving lives abroad

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Priscilla was diagnosed with a brain tumor three years ago, but she is now thriving thanks to donated medical supplies.Third World hospitals are saving lives with discarded medical materials from the U.S.These supplies are clean, safe and unused but are thrown out for various reasonsBy salvaging surplus supplies, nonprofits are also reducing waste in America

(CNN) -- Doctors will often prepare for surgical procedures by opening instrument and supply kits that contain up to 100 items.

Many of these items, such as scalpels, needles or sponges, go unused; they're just not needed for that particular procedure. But because of government or hospital regulations in the United States, they are frequently thrown away, even when they are still wrapped.

"There are thousands of tons of medical supplies thrown away every day that are unused or clearly reusable," said Dr. Bruce Charash, a cardiologist in New York.

Fortunately, some nonprofit organizations, including Charash's Doc2Dock group, are finding ways to salvage these items and get them to people who need them desperately around the world.

In Uganda, for example, many medical facilities lack the necessary supplies and equipment needed to perform surgery. The outlook is normally grim for children such as Priscilla, who was diagnosed with a brain tumor when she was 7.

But one Ugandan hospital, CURE Children's Hospital in Mbale, has been able to operate on Priscilla and more than 1,100 other kids thanks to its partnership with MedShare, a nonprofit that collects surplus supplies and equipment from the U.S.

"Brain tumors happen to children all over the world," said Derek Johnson, executive director of CURE Uganda. "The main difference in Uganda is that there are so few resources. But we were able to save Priscilla with supplies we get from MedShare."

'Our trash becomes their riches'

In the United States, surgical supplies aren't the only useful medical items tossed away.

Richard St. Denis, one of the Top 10 CNN Heroes of 2011, collects discarded wheelchairs through his nonprofit, World Access Project. With help from another U.S.-based nonprofit, Hope Haven, the wheelchairs are refurbished by senior citizen volunteers and prison inmates in Iowa before being shipped to rural Mexico.

St. Denis first visited Mexico in 1997, and he met many people with disabilities who didn't have access to wheelchairs, walkers or canes.

"I was shocked to see people using branches for crutches, being pushed in wheelbarrows and crawling," said St. Denis, who lost the use of his legs during a skiing accident in 1976.

Now, he has a permanent residence in Mexico and continues to do everything he can to help the people around him.

"We want to distribute the more than 75,000 wheelchairs we estimate get thrown away in the U.S. every year," he said. "What we call our trash becomes their riches, and it makes an incredible difference in their lives."

A win-win for everyone

In addition to saving lives, there's another benefit to sending unused supplies abroad.

"We are diverting a certain amount of waste that would be landfilled," said Dr. William Rosenblatt, a professor of anesthesiology at Yale University School of Medicine and founder of the nonprofit Remedy.

"At the end of a surgical procedure, our staff surveys the scrub table where the kit items remain and segregates all the materials that have been unused," Rosenblatt said. "It gets sent down to (a) decontamination area, and Yale undergraduate students sort through it and take what is useful. From here, it is packaged in bulk and given to a charity to be taken overseas."

Sometimes, perfectly good equipment is thrown away.

"Why would (hospitals) throw out a working sonogram machine or a working hospital bed?" Charash said. "One, it's not pretty enough. Secondly, there might be new technology available. In general, no one wants to use a 2005 (model) if a 2012 is available."

Occasionally, a hospital will simply switch brands and get rid of an entire line of unused items.

Supply manufacturers have been known to send items directly to the nonprofits if a box is so much as dented in transport -- items that could mean life or death for an individual in a Third World hospital.

The need greatly outstrips the supply

"On my first trip to Africa, the hospital director showed me a patient dying of malaria," Charash said. "He showed me a room with hundreds of bottles of medicine that would save his life, but (the medicine was) not given to him because they had no intravenous lines.

"That day, our Doc2Dock container arrived with reconstituted IV lines and 3,000 to 4,000 syringes. The doctor got an IV line, the patient got the medicine and was saved."

But while unused medical equipment is saving many people around the world, only a small percentage of hospitals ever actually receive these items.

"If you look at the volume of appeals we get versus the amount we are able to help, we are able to find funding for a quarter of the bona-fide projects," said David Pass, chief advancement officer for MedShare. "There is a great need out there."

The effort to find more funding is worth it, said Tanya Weaver of the American Foundation for Children with AIDS. Her nonprofit works in four African countries and has been able to help more than 100,000 people there thanks to surplus medical supplies from a couple of hospitals.

"If we can do this with the help of just two U.S. hospitals, imagine how many more could be served if others got involved," Weaver said.

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Obama's Misguided Crackdown on Medical Marijuana

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Why is the government cracking down on medical marijuana, a $1.7 billion business in California alone — and one of the few that seems to be thriving in a moribund economy?

In early October, the Justice Department announced it would be targeting medical marijuana dispensaries in California. Calling large dispensaries "profiteers" that "hijacked" California's medical marijuana law and were "motivated not by compassion but by money," the state's four U.S. attorneys announced the arrests of two major dispensary owners and a lawyer they accused of making millions from growing the drug.

It was a reversal of President Obama's campaign promise to end the previous administration's legal pursuit of medical marijuana. Although Obama's justice department had previously abided by a memo, which said that prosecuting marijuana providers and patients who followed state law was not an "efficient use of federal resources," over the summer the administration changed tactics, expressing concern about "an increase in the scope of commercial cultivation, sale, distribution and use of marijuana for purported medical purposes." It began sending letters to dispensaries and their landlords threatening forfeiture of the property if marijuana sales did not stop.

The IRS has also begun its own crackdown on California dispensaries. It now claims that the dispensaries owe back taxes because all of their business deductions are illegal. In addition, the Bureau of Alcohol, Tobacco and Firearms recently warned gun dealers not to sell to users of medical marijuana.

MORE: More Evidence That Marijuana-Like Drugs May Help Prevent PTSD

Ironically, national support for medical marijuana is currently at a high, at about 70%, and more and more advocates are calling for total legalization of the drug. For the first time ever, Gallup found last week that more Americans support making marijuana use legal: 50% of Americans support legalization, with 46% opposed. That's up from just 12% in favor in 1969.

Support for legalization is even higher in younger age groups: 62% of those aged 18 to 29 want legal marijuana, while just 31% of those over 65 favor changing the current law. As boomers and even more weed-friendly Gen-Xers age, pro-legalization sentiment continues to grow.

Now add to that, support for legalization from the California Medical Association, the state's largest group representing doctors, with some 35,000 members. In this context, medical marijuana doesn't seem like a crime voters are clamoring to prosecute.

It's not likely that the federal crackdown will actually affect marijuana consumption, either. Studies repeatedly find little effect of law enforcement spending on demand for drugs. Indeed, a recent marijuana price analysis by a collective of geographers called The Floating Sheep (you can't make this stuff up!) — based on crowd-sourced data on the street value of marijuana by quantity, quality and location — found no correlation between the local cost of marijuana and the number of arrests for dealing or possession in the state.

MORE: Medical Marijuana Sales Grow to Rival Viagra's: New Report

Rather, price is correlated with location. As the Atlantic's Richard Florida describes it:

Their main finding is that marijuana prices rise the further a location is from the major center of production. Decreased supply leads to a rise in transportation costs and risk. Clearly pot prices are as low as they are in the Pacific Northwest and Florida for the same reasons that potatoes are cheap in Idaho and corn is cheap in Iowa — because they're close to the source, the places where the product is either grown, imported, processed, or all three.

(Incidentally, the nationwide average price for an ounce of high quality smoke: $377.02)

It seems unlikely that spending scarce federal dollars during a recession on a medical marijuana crackdown is going to win any awards for "efficient" use of government resources from either the right or the left. In fact, I seem to recall that there's a Senate committee desperately seeking quick budget cuts around now: in view of these facts, do you think they should slash schools, meals for seniors, health care spending, cancer research, unemployment benefits, firefighter or police salaries — or the war on medical marijuana?

MORE: U.S. Rules That Marijuana Has No Medical Use. What Does Science Say?

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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FDA, Medicare to review medical devices in tandem

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By Alina Selyukh

Fri Oct 7, 2011 3:23pm EDT

n">(Reuters) - U.S. health officials are launching a trial of a program meant to speed up Medicare payment decisions for new medical devices.

The Food and Drug Administration, which regulates the safety and effectiveness of the devices, will review new products in parallel with the Centers for Medicare and Medicaid Services, the agencies said on Friday.

The pilot program could help device makers avoid situations in which they receive FDA approval only to discover that their products fail to win coverage under Medicare, the federal insurance program for the elderly.

Currently, Medicare often does not begin its reviews until the FDA -- which is not supposed to take cost into consideration -- approves the products. A Medicare coverage decision can make or break a medical product.

"The parallel review program has the potential to increase patient access to innovative devices that improve clinical outcomes," CMS Chief Medical Officer Dr. Patrick Conway said in a statement. "Our goal is to reduce regulatory burden and improve patient outcomes."

The Advanced Medical Technology Association (Advamed), which represents device makers, said it was still looking at the program's details but supported any effort to boost timely reviews that are more predictable and efficient.

"However, we believe it is important to preserve the currently separate and distinct regulatory missions of FDA and CMS to ensure that each agency does not influence the functions and decisions of the other and to ensure the confidentiality of all proprietary information provided by manufacturers," Ann-Marie Lynch, Advamed's executive vice president for payment and healthcare delivery policy, said in a statement.

The FDA and the CMS said the "parallel review" process will not change their distinct standards. The agencies on Friday began accepting submissions for participation in the pilot program, which is voluntary and was proposed in September 2010.

For more on the program, please see www.fda.gov/parallel-review .

(Reporting by Alina Selyukh in Washington; Editing by Steve Orlofsky)

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Health Management

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Medical devices for world’s poorest on show

AppId is over the quota
AppId is over the quota
14 September 2011 Last updated at 00:12 GMT By Anna-Marie Lever Health reporter, BBC News Sidecar to the rescue: One of the medical innovations on display at the Institution of Mechanical Engineers

Voltage regulators, infrared sensor technology and ultrasound scanners are just some of the donated equipment lying redundant in the world's poorest countries.

According to the World Health Organization some three-quarters of medical devices given by rich countries to developing nations remain unused.

In response, the Institution of Mechanical Engineers has called for the development of technologies better suited to emerging nations.

Continue reading the main story In developing nations hearing loss is mainly caused by ear infections which damage the ear drum This means western world hearing aids developed for hearing loss from old age are not suitableThis prototype uses bone conduction to send vibrations to the ear, it looks more culturally appropriate, and is solar poweredAt its London headquarters, the organisation has been showcasing a range of technologies specifically engineered to work in challenging environments.

Currently the lack of electricity, spare parts and trained operators often means that technology developed in richer countries is totally unsuited to working in the developing world.

Prof Chris Lavy, an orthopaedic surgeon who has spent time in Africa, said: "One of the newest hospitals in sub-Saharan Africa was built with infrared sensors to turn the taps on in the operating theatres.

"Wonderful idea, but is it really appropriate in a country where there are no other infrared controlled taps and no engineer to fix them? Within a year most of them had failed, some of them in the off position, and some of them in the on position."

Innovative solutions

To make technology appropriate, the conference organisers' emphasise that it not low tech, but different tech, that is needed.

Continue reading the main story Antiretroviral drug inserted between silicone and HIV-positive motherBlocks transmission of virus to babyResearch has focused on laboratory studies and talking to mothers about acceptabilityTo roll out in three-five years if funding is availableThis idea was demonstrated by the innovations on show: a solar-powered hearing aid that overcomes the need for expensive batteries, a stethoscope that can connect to mobile phones allowing doctors to monitor hard-to-reach patients remotely, and a nipple shield for breastfeeding mothers who are HIV positive which blocks the transmission of the virus to their babies.

Dr Patrick Finlay, medical division chairman at the Institution of Mechanical Engineers, said: "Simple, inexpensive technologies engineered for use in the developing word have the potential to save thousands of lives.

"It's now up to the engineering and development communities to get these technologies out of the workshop and into the world's poorest countries."

The majority of the displayed technologies were at the prototype stage, needing expansive testing in the field, and funding, before they are able to reach the people who need them.

View the original article here

Peliculas Online

Read More

Medical devices for world’s poorest on show

AppId is over the quota
AppId is over the quota
14 September 2011 Last updated at 00:12 GMT By Anna-Marie Lever Health reporter, BBC News Sidecar to the rescue: One of the medical innovations on display at the Institution of Mechanical Engineers

Voltage regulators, infrared sensor technology and ultrasound scanners are just some of the donated equipment lying redundant in the world's poorest countries.

According to the World Health Organization some three-quarters of medical devices given by rich countries to developing nations remain unused.

In response, the Institution of Mechanical Engineers has called for the development of technologies better suited to emerging nations.

Continue reading the main story In developing nations hearing loss is mainly caused by ear infections which damage the ear drum This means western world hearing aids developed for hearing loss from old age are not suitableThis prototype uses bone conduction to send vibrations to the ear, it looks more culturally appropriate, and is solar poweredAt its London headquarters, the organisation has been showcasing a range of technologies specifically engineered to work in challenging environments.

Currently the lack of electricity, spare parts and trained operators often means that technology developed in richer countries is totally unsuited to working in the developing world.

Prof Chris Lavy, an orthopaedic surgeon who has spent time in Africa, said: "One of the newest hospitals in sub-Saharan Africa was built with infrared sensors to turn the taps on in the operating theatres.

"Wonderful idea, but is it really appropriate in a country where there are no other infrared controlled taps and no engineer to fix them? Within a year most of them had failed, some of them in the off position, and some of them in the on position."

Innovative solutions

To make technology appropriate, the conference organisers' emphasise that it not low tech, but different tech, that is needed.

Continue reading the main story Antiretroviral drug inserted between silicone and HIV-positive motherBlocks transmission of virus to babyResearch has focused on laboratory studies and talking to mothers about acceptabilityTo roll out in three-five years if funding is availableThis idea was demonstrated by the innovations on show: a solar-powered hearing aid that overcomes the need for expensive batteries, a stethoscope that can connect to mobile phones allowing doctors to monitor hard-to-reach patients remotely, and a nipple shield for breastfeeding mothers who are HIV positive which blocks the transmission of the virus to their babies.

Dr Patrick Finlay, medical division chairman at the Institution of Mechanical Engineers, said: "Simple, inexpensive technologies engineered for use in the developing word have the potential to save thousands of lives.

"It's now up to the engineering and development communities to get these technologies out of the workshop and into the world's poorest countries."

The majority of the displayed technologies were at the prototype stage, needing expansive testing in the field, and funding, before they are able to reach the people who need them.

View the original article here

Peliculas Online

Read More