Should Marijuana Be Legal?

[MiracleforMD]

I will bite. I know this thread has happened before and turned into a similar ****storm. But with the legalization of marajuana in CO and WA, it brings up an interesting talking point about state rights. Is it appropriate for the federal government to spend large amounts of limited resources restricting something in an area where the majority has voted for its legality?

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[type b pharmD]

I will bite. I know this thread has happened before and turned into a similar ****storm. But with the legalization of marajuana in CO and WA, it brings up an interesting talking point about state rights. Is it appropriate for the federal government to spend large amounts of limited resources restricting something in an area where the majority has voted for its legality?

Of course not. A better question might be, is it appropriate for the federal government to take action to prevent one state from unduly imposing on another state ?

The whole thing is now about states rights.

Colorado and washington having a thriving recreational marijuana industry, will mean access and use and abuse will increase in nearby states and arguably within the entire US, since people will no longer having to buy from the cartels, nationwide trafficking becomes a minor hassle at most when you just drive across the state line and buy weed at a store.

 

[peteB]

But smoking reduces healthcare costs...

Umm... really?

I guess you could argue that it kills people off earlier so it reduces costs that way. But if that's the case, are you advocating for killing people??

 

[SpecterGT260]

Umm... really?

I guess you could argue that it kills people off earlier so it reduces costs that way. But if that's the case, are you advocating for killing people??

it doesnt even do that though.... Smokers don't die suddenly as a rule. They cost more in chronic care than they save via shorter life span.

 

[SpecterGT260]

Of course not. A better question might be, is it appropriate for the federal government to take action to prevent one state from unduly imposing on another state ?

The whole thing is now about states rights.

Colorado and washington having a thriving recreational marijuana industry, will mean access and use and abuse will increase in nearby states and arguably within the entire US, since people will no longer having to buy from the cartels, nationwide trafficking becomes a minor hassle at most when you just drive across the state line and buy weed at a store.

states rights coming to the forefront and talk of secession... where have I heard this before...

 

[link2swim06]

Umm... really?

I guess you could argue that it kills people off earlier so it reduces costs that way. But if that's the case, are you advocating for killing people??

peteB, I am simply calling out false statements when I read them. You claimed smoking is burdening our healthcare...it isn't. Asking me if I want people to die is a straw man avoiding your earlier statement.

it doesnt even do that though.... Smokers don't die suddenly as a rule. They cost more in chronic care than they save via shorter life span.

Specter several studies disagree with you. Smokers have lower lifetime healthcare costs.

 

[SpecterGT260]

peteB, I am simply calling out false statements when I read them. You claimed smoking is burdening our healthcare...it isn't. Asking me if I want people to die is a straw man avoiding your earlier statement.



Specter several studies disagree with you. Smokers have lower lifetime healthcare costs.

Id like to see some... because I have heard several (dozens) of sources talk about the toll that smoking takes on the healthcare system.

A quick googling yields studies from non-USA countries which draw conclusions on models based on, but not actually using, historical data.

 

[JP2740]

My thread is a ****ing hit man

 

[SpecterGT260]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360912/

 

[link2swim06]

http://healthland.time.com/2009/08/04/does-prevention-really-cut-health-care-costs/

http://www.sciencedaily.com/releases/2008/02/080204212858.htm

http://www.forbes.com/sites/timwors...moking-do-not-cost-health-care-systems-money/

http://www.emaxhealth.com/10/20732.html

 

[SpecterGT260]

that isnt a paper.... or a study...

 

[link2swim06]

that isnt a paper.... or a study...

Reload, I just added a few, they are articles, but they cite the corresponding studies.

 

[SpecterGT260]

http://www.ncbi.nlm.nih.gov/core/lw...age to zoom&p=PMC3&id=1360912_hesr_142_f2.jpg

from the paper I linked a minute ago

 

[JP2740]

http://www.sciencedaily.com/releases/2008/02/080204212858.htm

Pieter van Baal et al.



no.

could it be?

 

[link2swim06]

http://www.ncbi.nlm.nih.gov/core/lw...age to zoom&p=PMC3&id=1360912_hesr_142_f2.jpg

from the paper I linked a minute ago

Of course, on a yearly basis smokers cost more. They die early though...reducing lifetime health care costs.

Read those articles. Especially the forbes article.

 

[SpecterGT260]

http://healthland.time.com/2009/08/04/does-prevention-really-cut-health-care-costs/

http://www.sciencedaily.com/releases/2008/02/080204212858.htm

http://www.forbes.com/sites/timwors...moking-do-not-cost-health-care-systems-money/

http://www.emaxhealth.com/10/20732.html

I saw all of these when I Googled.

Problems: Forbes -
Scientific Daily - that is a hypothetical population based on dutch figures. Doest apply
Forbes: The european care model is different from ours. Again it doesnt apply to what we are talking about. If we exploded our primary care expenditures then sure, maybe non-smokers would catch up in terms of cost in their old age.
emaxhealth - repeat of the other two studies.

 

[SpecterGT260]

Pieter van Baal et al.



no.

could it be?

I think I am missing something here

 

[JP2740]

I think I am missing something here

peteB?

 

[SpecterGT260]

Of course, on a yearly basis smokers cost more. They die early though...reducing lifetime health care costs.

Read those articles. Especially the forbes article.

The UK has a different approach to care than we do. Those numbers dont apply to US patients. Because we do not have universal healthcare for primary care our residents tend not to go in unless they have an issue. Longevity won't offset this cost in our system, or at least I havent seen anything yet that leads to this conclusion. I'm seeing a stronger argument AGAINST universal healthcare

 

[link2swim06]

I saw all of these when I Googled.

Problems: Forbes -
Scientific Daily - that is a hypothetical population based on dutch figures. Doest apply
Forbes: The european care model is different from ours. Again it doesnt apply to what we are talking about. If we exploded our primary care expenditures then sure, maybe non-smokers would catch up in terms of cost in their old age.
emaxhealth - repeat of the other two studies.

But you have no data to show lifetime cost to refute what I provided. This is what we were taught at some point in med school (granted, that doesn't mean it is correct). But I am sure there are several other studies supporting this idea.

 

[link2swim06]

http://usatoday30.usatoday.com/news/health/2009-04-08-fda-tobacco-costs_N.htm

"Supporters of the FDA bill cited figures from the Centers for Disease Control and Prevention that smokers cost the country $96 billion a year in direct health care costs, and an additional $97 billion a year in lost productivity.

A White House statement supporting the bill, which awaits action in the Senate, echoed the argument by contending that tobacco use "accounts for over a $100 billion annually in financial costs to the economy."

However, smokers die some 10 years earlier than nonsmokers, according to the CDC, and those premature deaths provide a savings to Medicare, Social Security, private pensions and other programs.

Vanderbilt University economist Kip Viscusi studied the net costs of smoking-related spending and savings and found that for every pack of cigarettes smoked, the country reaps a net cost savings of 32 cents."


Conclusion in the UNITED STATES, net savings.

 

[SpecterGT260]

http://www.nejm.org/doi/full/10.1056/NEJM199710093371506

Here we go. I trust this one a little more than I do some dutch computer model as reported by MSNBC

That is a little crazy

 

[link2swim06]

http://www.nejm.org/doi/full/10.1056/NEJM199710093371506

Here we go. I trust this one a little more than I do some dutch computer model as reported by MSNBC

That is a little crazy

Regardless it is a mute fact for physicians. The objective to reduce morbidity and mortality is always greater than to save money.

I only brought this up in response to peteB because we should avoid propagating things that are false.

 

[SpecterGT260]

Regardless it is a mute fact for physicians. The objective to reduce morbidity and mortality is always greater than to save money.

I only brought this up in response to peteB because we should avoid propagating things that are false.

Yeah. It's pretty striking though... kinda 180* opposite what we are taught all along the way, and not even just in medicine. Still a little mindblown

 

[JP2740]

Do your part on reducing health care costs buy some cigarettes now

 

[peteB]

peteB, I am simply calling out false statements when I read them. You claimed smoking is burdening our healthcare...it isn't. Asking me if I want people to die is a straw man avoiding your earlier statement.



Specter several studies disagree with you. Smokers have lower lifetime healthcare costs.

Could you explain why? I believe what you're saying but I don't have time to read all of those articles. It seems to me that smokers would cost more because they are more prone to disease, and treating disease costs money. That makes logical sense to me. So what's reducing their costs?

 

[peteB]

http://usatoday30.usatoday.com/news/health/2009-04-08-fda-tobacco-costs_N.htm

"Supporters of the FDA bill cited figures from the Centers for Disease Control and Prevention that smokers cost the country $96 billion a year in direct health care costs, and an additional $97 billion a year in lost productivity.

A White House statement supporting the bill, which awaits action in the Senate, echoed the argument by contending that tobacco use "accounts for over a $100 billion annually in financial costs to the economy."

However, smokers die some 10 years earlier than nonsmokers, according to the CDC, and those premature deaths provide a savings to Medicare, Social Security, private pensions and other programs.

Vanderbilt University economist Kip Viscusi studied the net costs of smoking-related spending and savings and found that for every pack of cigarettes smoked, the country reaps a net cost savings of 32 cents."


Conclusion in the UNITED STATES, net savings.

OK, I see. So the reason they cost less is because they die early. That makes sense. But do we want people to die early? I mean, that's not what I want. I don't want to reduce costs that way. Not only do they die early, they also suffer a lot more due to the myriad diseases that smoking causes. So.... getting people to smoke isn't the right way to reduce healthcare costs.

 

[JP2740]

Could you explain why? I believe what you're saying but I don't have time to read all of those articles. It seems to me that smokers would cost more because they are more prone to disease, and treating disease costs money. That makes logical sense to me. So what's reducing their costs?

The fast life my friend. You may have never experienced it.

Pumps money into the economy and leads to an early death. Old age ain't all it's hyped up to be.

 

[SpecterGT260]

Could you explain why? I believe what you're saying but I don't have time to read all of those articles. It seems to me that smokers would cost more because they are more prone to disease, and treating disease costs money. That makes logical sense to me. So what's reducing their costs?

However, smokers die some 10 years earlier than nonsmokers, according to the CDC, and those premature deaths provide a savings to Medicare, Social Security, private pensions and other programs.

Vanderbilt University economist Kip Viscusi studied the net costs of smoking-related spending and savings and found that for every pack of cigarettes smoked, the country reaps a net cost savings of 32 cents."

Of course, on a yearly basis smokers cost more. They die early though...reducing lifetime health care costs.

Read those articles. Especially the forbes article.

Come on, Peter... srsly

 

[peteB]

Do your part on reducing health care costs buy some cigarettes now

Or you could just kill yourself now, that would save a lot more

 

[SpecterGT260]

peteB, I am simply calling out false statements when I read them. You claimed smoking is burdening our healthcare...it isn't. Asking me if I want people to die is a straw man avoiding your earlier statement.
.

This is becoming a theme

 

[SpecterGT260]

OK, I see. So the reason they cost less is because they die early. That makes sense. But do we want people to die early? I mean, that's not what I want. I don't want to reduce costs that way. Not only do they die early, they also suffer a lot more due to the myriad diseases that smoking causes. So.... getting people to smoke isn't the right way to reduce healthcare costs.

Regardless it is a mute fact for physicians. The objective to reduce morbidity and mortality is always greater than to save money.

I only brought this up in response to peteB because we should avoid propagating things that are false.

Come on, Peter. Srsly

 

[peteB]

Come on, Peter... srsly

Sorry Specter, you're rubbing off on me, I'm not reading everything properly

So fine, I amend my statement to say that smokers cost our healthcare system more "per year" than overall.

I think that matters too, because that affects how much money we have in the system at any given time.

It's like this, many of us are in six figure debt right now- over time we will make it up, but it still affects what we can do in the meantime. The fact that I may make over 150k in the future doesn't do anything if I need 150k now. It's a lot worse for a smoker because it takes a lot longer for the benefits to outweigh the costs. You have to wait until 10 years (at least) after they're dead.

 

[SpecterGT260]

.

I think that matters too, because that affects how much money we have in the system at any given time.
.

That isn't how numbers work. Its a rolling system with net savings. Basically the more smokers the more money in the system no matter how its cut

The smoker will have less money... is that what you meant?

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[peteB]

The fast life my friend. You may have never experienced it.

Pumps money into the economy and leads to an early death. Old age ain't all it's hyped up to be.

I wouldn't call dying a slow and agonizing death from a smoking-related illness living "the fast life" even if you end up dying before old age.

 

[peteB]

That isn't how numbers work. Its a rolling system with net savings. Basically the more smokers the more money in the system no matter how its cut

The smoker will have less money... is that what you meant?

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No, I meant the system will have less money on a yearly basis. In a year the system has a certain amount of money to work with (the budget, so to speak). If some people take out more than they should because they are sicker due to smoking, then there's less that year for everyone else.

Now you might say that the people who died early due to smoking who weren't there that year balances it out. Maybe it does, I dunno. I don't know if smoking kills people equally like that, or some people who smoke end up living way longer but with more diseases and wash out the "benefits" of others dying early. I'm also suspect of these studies because how do you really know how long a person would have lived w/o smoking? There are tons of potential biases in these studies.

I'll accept that smoking doesn't drive up healthcare costs in the long term because people die early. That does make sense to me, and apparently the data agrees with that. But I am suspicious. I have a feeling the tobacco companies are behind these studies.

In that case, maybe opening up all the drugs for easy access would be the solution to our healthcare crisis!! Just kill everyone off early!

But in the short term you might see problems like overcrowding, facilities being overburdened, etc. I don't know for sure, but it seems possible.

Let's also not forget the economic productivity cost tied to smoking related illness. Is the gain to the economy from the tobacco industry enough to compensate for that?

 

[JP2740]

I have a feeling the tobacco companies are behind these studies.

 

[peteB]

lol. go ahead and laugh it up buddy. laughter makes you live longer, or so they say. don't do it too much or it might counter the societal cost-saving benefits of your smoking

 

[peteB]

Biggest problem with smoking and obesity and the like is that the bad effects are delayed. Knowing the risks is not the same as having experienced the risks first-hand. It's one thing for someone to tell you something hurts and another to actually feel the pain yourself. If only there was some way to get people to experience the risks (without permanently hurting them), then they would be better equipped to make a decision about their behavior. I'd be willing to bet most people would change their minds. Obviously this is impossible.

 

[calvnandhobbs68]

Yeah. It's pretty striking though... kinda 180* opposite what we are taught all along the way, and not even just in medicine. Still a little mindblown

I would look at some of the letters to the authors before making up your mind about this study. They bring up some very valid points about the models the authors are using.

 

[SpecterGT260]

I would some of the letters to the authors before making up your mind about this study. They bring up some very valid points about the models the authors are using.

Did they mention something in the discussion? I don't have the means to look right now

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[peteB]

I would some of the letters to the authors before making up your mind about this study. They bring up some very valid points about the models the authors are using.

You're right- there are definitely issues with the study. Their points are indeed valid.

 

[45408]

I've never seen an MVC associated with marijuana use (and a drug/tox screen is part of our routine panel on trauma patients), but I've seen dozens of drunk people crash. I've never seen any disease burden from marijuana, but I just basically watched a 40-year old guy bleed to death from varices from alcoholic liver disease two weeks ago.

It's ridiculous hypocrisy to allow alcohol but to ban marijuana. I'm not advocating we ban alcohol, so I think it's legitimate to legalize marijuana. I do think it would probably be a bad idea for a physician to use it though, because it would be a potentially significant liability for "working under the influence," even if it was a few days prior.

 

[link2swim06]

I would look at some of the letters to the authors before making up your mind about this study. They bring up some very valid points about the models the authors are using.

Which study? There are a handful that reached the same conclusion. Maybe there will be a meta soon.

 

[bauber]

Perhaps doctors could begin telling patients that do choose to use cannabis that they should really use a vaporizer because it does not produce any smoke.

 

[peteB]

I've never seen an MVC associated with marijuana use (and a drug/tox screen is part of our routine panel on trauma patients), but I've seen dozens of drunk people crash. I've never seen any disease burden from marijuana, but I just basically watched a 40-year old guy bleed to death from varices from alcoholic liver disease two weeks ago.

It's ridiculous hypocrisy to allow alcohol but to ban marijuana. I'm not advocating we ban alcohol, so I think it's legitimate to legalize marijuana. I do think it would probably be a bad idea for a physician to use it though, because it would be a potentially significant liability for "working under the influence," even if it was a few days prior.

How about we legalize marijuana and ban alcohol? Then people can have something to use recreationally but at the same time prevent all those nasty effects you mentioned.

 

[link2swim06]

How about we legalize marijuana and ban alcohol? Then people can have something to use recreationally but at the same time prevent all those nasty effects you mentioned.

But that would be logical. Politics isn't logical.

 

[Doudline]

Sure, legalize away, especially if you don't mind the IQ drop of more than half a standard deviation.

 

[evilbooyaa]

I can't believe I have to argue with med students why it's bad to be obese or smoke. I thought this would be a no brainer for a person getting an MD.

I'm not saying it's not bad to be obese or be a smoker, or someone who drinks alcohol regularly

All I (and Specter and some others ITT) are saying is that being these things does not make you less fit to talk to a patient about the medical diseases that are being caused by their symptoms.

If I smoke one pack a month, am I not allowed to even discuss smoking cessation in my 3 packs per day patient, on the basis of me being hypocritical?

If I drink socially, is it hypocritical for me to tell my alcoholic patient with cirrhosis to lay off the alcohol?

I've spoken to patients before, and told them the following, "Hey, so your weight/COPD/Alcohol is a serious issue in relation to your X disease. If you continue down this path you will reduce your personal life expectancy". If they decide to listen, good for them. If they don't, GOOD FOR THEM. They have the information and have made an informed decision on whether they want to quit or not. Whether I am obese, smoke, or drink alcohol shouldn't be affecting their mindset.

I will say that in terms of prevention of future diseases (in relation to weight/smoking/alcohol) all you can do is give them the information, even though they don't have medical issues as of yet from their habits. Most of them won't quit unless they see a family member having an adverse medical event, but that's just how it goes. Preaching to them that not doing all the stuff that brings them joy in preparation for their future years and insisting that they stop eating fast food (or other relatable things) is not rapport building for the vast, VAST majority of patients.

I've told people that if I get to a point where I am never allowed to eat my favorite foods in life ever again (and by that I don't mean "in moderation", but if a cheeseburger would set off my eventual decompensated CHF), then that life to me is no longer worth living.

 

[NickNaylor]

Sure, legalize away, especially if you don't mind the IQ drop of more than half a standard deviation.

lolwut

Pretty sure the only demonstrated issues with pot (including this one) are when used in younger folks during brain development.