Are most doctors biased against the use of medical and recreational marijuana?

Health care professionals are worried about the long-term use of medical and recreational marijuana. (Dr. Noorali Bharwani)
Health care professionals are worried about the long-term use of medical and recreational marijuana. (Dr. Noorali Bharwani)

Government of Canada’s plan to end the prohibition on recreational pot use is going through the parliament and will soon become a law.

Although cannabis plant has a history of medicinal use dating back thousands of years across many cultures, scientifically the use of medical cannabis is controversial.

Unfortunately, we do not live in a perfect world. Majority of the people are blessed with good health. Some of them maintain their good health by way of pursuing healthy lifestyle.

Others are not so fortunate. Some suffer from chronic incurable diseases, chronic pain, and significant disabilities. They need more than regular comfort and painkillers.

As doctors, our job is to relieve pain and suffering. So what is the role of marijuana in relieving pain and suffering? How can we prevent abuse? Can we find a right balance between proper use of marijuana, harm reduction and abuse? That is not going to be easy.

We are still struggling to get alcohol abuse under control. Alcohol abuse has already taken many innocent lives by way of motor vehicle collisions, brain damage and domestic violence.

Now the health care system and law enforcement agencies will have to deal with marijuana abuse and its unfortunate consequences. Although marijuana is legalized for medical use only, it is already available in the market for drug abuse. Soon recreational use of marijuana will become legal.

Legalising recreational marijuana is going to be a money making business. Ottawa has agreed to give the provinces and territories 75 per cent of tax revenues from the sale of marijuana. But the doctors are worried. Statistics show Canadians have one of the highest rates of non-medical marijuana usage in the world.

A report in the Globe and Mail (December 13, 2017) by Geordon Omand says, “There is little to no research to support the supposed benefits of medical cannabis, and what evidence exists suggests that using marijuana as medicine may do more harm than good.” Family doctors’ associations support this statement across Canada.

There is limited evidence to suggest cannabis can reduce nausea and vomiting during chemotherapy, improve appetite in people with HIV/AIDS, and reduce chronic pain and muscle spasms.

Like any other medication marijuana is not without adverse effects. Short-term use increases the risk of both minor and major adverse effects. Common side effects include dizziness, feeling tired, vomiting, and hallucinations.

Long-term effects of cannabis are not clear. Concerns include memory and cognition problems, risk of addiction, schizophrenia in young people, and the risk of children taking it by accident. American Academy of Paediatrics opposes the legalization of medical cannabis.

The College of Family Physicians of Canada has advised its members to use cannabis for chronic pain or anxiety only for those patients who have not responded to conventional treatment. It should not be used for anxiety or insomnia.

According to the Canadian Medical Association Journal (August 9, 2016) Canadian doctors are divided about how permissive new marijuana rules should be. A recent Canadian Medical Association survey shows just over half (51.7 per cent) oppose allowing cannabis use in public spaces. Many preferred setting the minimum age for purchase at 21 or 25 (45.7 per cent).

The guidelines and policies issued to date by most medical licensing bodies consistently state that more information is required on the medical risks and therapeutic benefits of marijuana.

Physicians have been advised to have necessary clinical knowledge to engage in a meaningful consent discussion with patients.

Health care professionals, law enforcement agencies and many families are going to face lots of challenges in the futures. Hope all goes well.

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Tanned Skin is Damaged Skin

Protect your health by using broad-spectrum sunscreen, insect repellent with DEET, good quality sunglasses and a wide-brimmed hat. Apply the sunscreen first, then DEET.
Protect your health by using broad-spectrum sunscreen, insect repellent with DEET, good quality sunglasses and a wide-brimmed hat. Apply the sunscreen first, then DEET.

Blistering sun is here. People are out and about. The winter was so long that it is a relief to get out and walk, jog, golf, bike, get some tan and vitamin D and do other activities. Not to mention people enjoy some beer and barbequed meat.

While you are enjoying all that do not forget to dress properly and use sunscreen. At the same time do not forget to use DEET, good quality sunglasses and wide-brimmed hat. It is important to prevent skin cancer. Each year we go through this drill to emphasise the importance of preventing disfiguring skin cancers including lethal melanoma.

There are three types of skin cancers. Basal cell cancer (BCC) and squamous cell cancer (SCC) are not lethal but can leave you with scars and deformities. Then there is melanoma. If not detected and treated early melanoma can be lethal.

When exposed to sunrays, some people burn easily and others slowly. Those who burn easily have a higher risk of skin cancer than others. But everybody is at some risk of getting skin cancer including people with dark skin.

Here are eight Health Canada sunscreen safety tips:

  1. Choose a high SPF. Use a broad-spectrum sunscreen with a Sun Protection Factor (SPF) of at least 30. The sunscreen should also say “broad-spectrum” on the label, to screen out most of the UVA and UVB rays.
  2. Look for “water resistant” sunscreen.
  3. Read application instructions. For best results, be sure to follow the instructions on the product label.
  4. Use lots of sunscreen. Use the recommended.
  5. Apply it often. Apply sunscreen before heading outside and use a generous amount. Reapply 20 minutes after going outside and at least every two hours after that. Cover exposed areas generously, including ears, nose, the tops of feet and backs of knees. Reapply sunscreen often to get the best possible protection especially if you are swimming or sweating heavily.
  6. Protect yourself. Sunscreen and insect repellents can be used safely together. Apply the sunscreen first, then the insect repellent.
  7. Sunscreens and babies. Do not put sunscreen on babies less than six months of age. Keep them out of the sun and heat as their skin and bodies are much more sensitive than an adult’s.
  8. Test for an allergic reaction. Before using any product on you or your child check for an allergic reaction, especially if you have sensitive skin. Apply it to a small patch of skin on the inner forearm for several days in a row. If the skin turns red or otherwise reacts, change products.

All sunscreens have a sun protection factor (SPF) on their labels. Imagine that your skin normally begins to burn after 10 minutes in full sun without any protection. A 30 SPF sunscreen would provide 30 times the protection of no sunscreen. Anything higher than SPF 30 has no major advantage.

Sunscreen remains effective for three years, but it does expire, so check the date on the container. Remember, tanned skin is damaged skin and it can turn into cancer. Have a safe and wonderful summer.

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Balancing risks and benefits of using heartburn and peptic ulcer disease pills in seniors.

Esophagitis and peptic ulcer disease. (Dr. Noorali Bharwani)
Esophagitis and peptic ulcer disease. (Dr. Noorali Bharwani)

About 25 per cent of Canadian seniors suffer from three or more chronic illnesses and are on six or more medications per day.

One of the medications is Pantoloc. Pantoloc (pantoprazole) belongs to the family of medications called proton pump inhibitors (PPIs).

First introduced in 1989, PPIs are among the most widely utilized medications worldwide, both in the ambulatory and inpatient clinical settings. These medications are central in the management of reflux disease and are unchallenged with regards to their efficacy.

Pantoloc is the fifth most commonly prescribed drug. It is used for patients who have heartburn (GERD or gastro oesophageal reflux disease) or inflamed oesophagus (esophagitis). It is also used for peptic ulcer disease (duodenal or gastric ulcers).

The prevalence of heartburn and reflux disease increases with age and elderly are more likely to develop severe disease.

Treating inflamed oesophagus (esophagitis) due to reflux:

PPIs are indicated for short-term treatment of mild esophagitis. Treatment is usually for four to eight weeks duration. But if you have moderate esophagitis with endoscopic evidence of Barrett’s oesophagus (a premalignant inflammation of the oesophagus) and severe esophagitis grade C or D, then you need long-term to lifelong treatment with PPI.

Peptic ulcer disease

Peptic ulcer disease usually occurs in the stomach and proximal duodenum. It is caused by infection with Helicobacter pylori bacteria and use of nonsteroidal anti-inflammatory drugs (NSAID).

Short-term PPI use for treatment of peptic ulcer disease is recommended for two to 12 weeks, unless maintenance therapy is clearly indicated, such as ongoing NSAID use.

If PPI is so effective then what is the problem. The problem is, and the studies have shown, once a patient is started on PPI, the symptoms are not reviewed and patients stay on them for years with no valid indication.

Long-term use of PPIs is not without risks, including vitamin B12 deficiency, osteoporosis, pneumonia and C. difficile associated diarrhea (colitis). A recent study suggests that the heartburn drugs may be associated with an increased risk of dementia and kidney disease.

What should patients and health care providers do?

There is an interesting website (deprescribing.org) that helps patients understand the rationale for deprescribing certain medications.

If the decision is made to deprescribe, the key to success is monitoring for rebound hyperacidity. Regular follow-up over the following four to 12 weeks is critical to assess for and manage adverse symptoms to deprescribing PPIs.

An article on the Mayo Clinic website by Avinash K. Nehra, MD et al titled “Proton Pump Inhibitors: Review of Emerging Concerns,” says that based on current recommendations, the American Gastroenterological Association does not recommend routine laboratory monitoring or use of supplemental calcium, vitamin B12, and magnesium in patients taking PPIs daily.

Nehra’s current practice is to check creatinine levels yearly, complete blood cell counts every other year, and vitamin B12 levels every five years in patients receiving long-term PPI therapy.

In summary, the best strategy is to prescribe PPIs at the lowest dose on a short-term basis when appropriately indicated so that the potential benefits outweigh any adverse effects associated with the use of PPIs, says Nehra.

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There are many health benefits to eating bananas.

A bowl of mixed fruit. (Dr. Noorali Bharwani)
A bowl of mixed fruit. (Dr. Noorali Bharwani)

More than 100 billion bananas are eaten each year worldwide.

North Americans eat an average of 27 pounds of bananas per person per year – making it the most heavily consumed fruit in America.

“A medium-sized banana provides about 105 calories with virtually no fat, cholesterol or sodium,” says Joanne Hutson, a Mayo Clinic Health System registered dietitian and certified diabetes educator. Her article appears on the Mayo Clinic website.

“Nobody gets fat or develops diabetes from eating too many bananas,” says Jessica D. Bihuniak, Ph.D., R.D., an assistant professor of clinical nutrition at New York University Steinhardt School of Culture, Education, and Human Development. Bihuniak is quoted in a Consumer Magazine article on bananas (April 18, 2018).

But some carb- and calorie-conscious consumers have relegated bananas to the “do not eat” list because of the fruit’s high sugar and calorie count relative to some other fruits.

That rationale is misguided, Bihuniak says. Virtually, there is no harm from eating too much of any fruit. And as with all fruits, bananas are loaded with a bevy of nutrients, some of which promote a healthy heart, gut, and waistline.

I love eating bananas. I was born and raised in Musoma, Tanzania on the shores of Lake Victoria. We used to get our bananas from the neighbouring country of Uganda. The weekly boat from Uganda would arrive at the port of Musoma. The port was about five kilometers from our house. We did not own a car but I was a keen biker. Every Sunday morning when the boat would arrive from Uganda carrying bananas, I would go on my bike to the port and buy one or two large hanging clusters of bananas and take them home on my bike. I was about 13-years-old. Those were the days!

I still love eating bananas. Individual banana fruit is 75 per cent water and 25 per cent dry matter. Cooking bananas represent a major food source and a major income source for many farmers.

The highest consumption of bananas is in countries such as Uganda, Burundi, and Rwanda. The majority of bananas North Americans eat come from Latin and South America. However, they are grown in more than 100 countries with tropical climates.

Bananas are perhaps best known for their potassium count, that governs heart rate, blood pressure, and nerve and muscle function. The body carefully maintains levels of potassium and sodium to keep fluid levels in balance.

A banana can help prevent muscle cramps after exercise, says Hutson. They also provide a good source of vitamins C and B6, as well as magnesium.

An average banana also contains about three grams of fiber, which can help provide a feeling of fullness plus aid the digestion process. These insoluble fiber components help maintain healthy gut bacteria and enzymes needed to digest foods and benefit the immune system.

Bananas are very convenient and portable – in their own sealed package. Simply grab and go for a quick mini breakfast or snack.

Banana is a portable fruit like an apple. It can be carried with you when you go to work, go for a walk or go biking and jogging. Enjoy!

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