Linda Alvarez MD, MBA

TIDBIT TUESDAY! Use of Cannabis and Other Pain Treatments Among Adults with Chronic Pain in US States with Medical Cannabis Programs Mark C. Bicket, MD, PhD1; Elizabeth M. Stone, MSPH2; Emma E. McGinty, PhD2 Excerpt JAMA Network Open. 2023;6(1) Methods In this cross-sectional study, we surveyed a representative sample of adults aged 18 years or older with chronic pain who lived in the 36 states (and Washington, DC) with active medical cannabis programs in March to April 2022 (eTable 1 in Supplement 1). We fielded the survey using the National Opinion Research Center (NORC) AmeriSpeak panel. This probability-based panel includes about 54 000 members and is sourced from a sample covering 96% of US households with a recruitment rate of 34%.5 We defined chronic noncancer pain using the National Health Interview Survey (NHIS) criterion of pain unrelated to cancer on most days or every day in the past 6 months.6 The survey was conducted from March 3, 2022, to April 11, 2022. A screener survey consented and identified people with chronic pain (response rate: 75.4%), who were invited to complete the full survey (eTable 2 in Supplement 1). We assessed self-reported use (ever, past 12 months, past 30 days) of medical cannabis, pharmacologic treatments (prescription opioids, prescription nonopioid analgesics, and over-the-counter analgesics), common nonpharmacologic treatments (physical therapy, meditation, cognitive behavioral therapy), and substitution of cannabis in place of these treatments for chronic pain. All analyses incorporated survey sampling weights to generate estimates representative of the 36 included states and Washington, D.C. The investigation was approved by the Johns Hopkins Bloomberg School of Public Health institutional review board and followed the STROBE reporting guideline for cross-sectional studies. Statistical analysis was performed using Stata statistical software version 15 (StataCorp).

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Managing patients with multiple chronic conditions who are on multiple medications represents a critical yet often overlooked challenge in healthcare, driving unnecessary hospitalizations, higher costs, and poor outcomes. Solving this problem is crucial to realizing the next frontier in value-based care and advancing population health. Interim results from prospective research conducted at Mass General Brigham highlight the power of FeelBetter’s platform, which has been shown to reduce healthcare utilization by 0.37 events per patient, translating into $3.3 million in potential annual savings per clinical pharmacist. This marks a significant breakthrough in proactive, data-driven medication management, with the potential to reshape care delivery for high-risk patients. A big thank you to Dr. Lisa Rotenstein and the incredible teams at MGB and FeelBetter for tackling this urgent need and contributing to such important research. Stay tuned for the final results—this is only the beginning! #healthcareinnovation #NAACOS2024 #AI #polypharmacy #medicationmanagement #valuebasedcare #ACO #populationHealth #pharmacologicalIntelligence #healthcareinnovation

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Heading into #NationalInfertilityAwarenessWeek, our round-up is all about the clinics. The latest best list was unveiled, alongside some horrific stories of negligence. The TL:DR? The too-few fertility doctors in the U.S. (only ~1.300) are under strain. The good news is Conceive is here with the support. 📚    1/Newsweek released its 2nd annual list of 125 best U.S. fertility clinics, determined through a survey, CDC metrics, fertility accreditation data, and Google reviews. Weill Cornell took top spot (shout-out to our medical advisor there, Dr. Alexis Melnick!)  https://lnkd.in/eBfEgvTA 2/Study shows correlation between high doses + prolonged duration of gonadotropins during IVF and increased embryonic mosaicism alongside diminished live birth rates, making docs reconsider dosage and duration protocols. 👀 https://lnkd.in/ecjXdpex 3/"PIEZO-ICSI", a new kind of ICSI, looks promising. 💦 https://lnkd.in/eQh7SNj5 4/A Nashville fertility clinic has shut down suddenly, citing financial difficulties and ghosting its patients, leaving their embryos and eggs in limbo. Our hearts break💔  https://lnkd.in/e5PFqmuR 5/In Newport Beach, CA, embryos were accidentally destroyed after they came in contact with hydrogen peroxide while an employee was cleaning. 😱 https://lnkd.in/eUFegTbc 6/Macron’s government is doing what it can to support more people getting access to IVF in a bid to curb declining birth rates. We need to think more like France. 🇫🇷 https://lnkd.in/eU4VJbzv 7/Fertility treatments won't likely cause a relapse of MS, says new analysis. Phew.  https://lnkd.in/eUXyPUFJ 8/Nelly and Ashanti are getting hot in herrr with at-home fertility test company Proov. https://lnkd.in/eWjQTFEA 9/The Dems are trying to repeal it and the GOP is having none of it, but if you want a little history of AZ’s draconian 19th century abortion ban, Vox has it. https://lnkd.in/e_ZyekmA 10/Join us 4/28 at 10:30am in Central Park for a Walk of Hope with RMA of New York to raise money for Resolve. Wear orange! 🧡 https://lnkd.in/euHNYazd 11/We have a must-read newsletter that comes out on Fridays. Sign up here! https://lnkd.in/eZBEYJwA

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Episode 3 of our Social Determinants of Health Series with the Centers for Disease Control and Prevention has just dropped on YouTube! I'm so grateful to be cohosting this series with Zami Hyemingway, MSW to discuss the social determinants of health for gender-expansive people! The fourth and season end episode will be launching on Trans Day of Remembrance, 11/20/2025. So catch up and check out the last one in just under two weeks! https://lnkd.in/gRXySCN5

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Health equity doesn’t exist in any state in the Union. Disparities are often manifested by non-medical drivers fueled by political determinants. Systemically, value-based care is meant to address these. Inherently, VBC frameworks are architecturally designed to close these gaps. Sadly, we are far from it as economic and payment models still incentivize services for isolated fees. It’s time for change! How? What do you think it’s needed? While progress is underway, what changes are still missing?

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After the 2024 election, reproductive healthcare policies are poised for change, and as leaders in benefits and healthcare, it’s crucial we stay informed. With new state measures expanding abortion rights in places like Arizona, Colorado, and New York, and public support strong for contraceptive coverage, we're seeing a shift that will likely affect health plans and compliance standards across the board. At Stork Club, we’re committed to helping companies support their employees’ reproductive care needs at every stage of life. This means bridging gaps in access, reducing maternal mortality, and helping parents build their families while advancing their careers. As policies evolve, we’re here with the tools and insights you need to stay ahead. Let’s keep this conversation going—together, we can build a healthier, more supportive future. https://lnkd.in/g9k9p82J

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As any #economist will tell you, #incentives matter. The earning differential dissuades all #clinician types from choosing #primarycare careers. Despite the idea that #physician replacements would go into primary care, turns out they also go for the money, thus still leaving a gap in primary care. As nurse practitioners and physician assistants have no requirement to do residency or be board certified for, in many states, equal practice scope and equivalent jobs, they prefer the highest paid procedure-oriented jobs, in specialities & in cities. #Ruralhealth still suffers massive shortages. Hospitals, increasingly #privateequity owned, also prefer to hire cheaper, less trained doctor alternatives who can be moved from specialty to specialty with no training needs compared to the 3-7 years of added residency training that doctors do. Any employer (but especially abusive ones) will choose the least expensive, most easily replaced workforce. Then employers do not feel the need to fix burnout, rather feel comfortable burning through employees quickly, knowing they can be easily replaced. Replacing doctors actually worsened the perverse incentives for abusive employers in #healthcare. I worked within #government when this push to replace doctors was happening. I now look back and see how I contributed to destruction of my own profession, when I thought I was doing a good thing to increase access and to promote collaborative teams. In fact while I was envisioning win-win-wins, it was just a naive way to accelerate towards win-lose. If we had been able to replace primary care doctors with cheaper alternatives, as government had wanted, then the government-led cuts in payment might have been sustainable. Instead, we still have workforce shortages, long wait times, cost barriers, people getting sicker, more expensive care from avoidable illnesses. Meanwhile primary care practices are going under, doctors are retiring early, and many current medical students are planning non-clinical careers. I honestly do not know who will be caring for all of us as we age and cannot avoid getting needed care.

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***From Best Practices to Next Practices*** Newly released OCED (Organization for Economic Co-operation and Development) report on #BetterHealth and #Productivity at the Workplace stresses "Ecosystem development and collaboration in corporate health initiatives and digital health solutions offer significant value through": ⭐ Enhanced innovation by collaborating with various stakeholders. ⭐Providing a comprehensive approach to corporate health by integrating various aspects. ⭐Increasing reach and impact of health programs. ⭐Sharing expertise among partners. ⭐Promoting sustainability and scalability of initiatives. ⭐Improving user experience and regulatory compliance. ⭐Driving efficiency, cost-effectiveness, and improved outcomes. ⭐Fostering scalability, diversity, and impact in health interventions. ⭐Creating a supportive environment for innovation, knowledge sharing, and collective growth. #CorporateWellness #DigitalHealth #EmployeeProductivity #HealthProgrammes #WearableTech #MarketTrends #HealthTech #EmployeeWellBeing. https://lnkd.in/grCrBcHd

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"The institutions and rules that have allowed the US to hobble through the preuniversal coverage period need to be proactively reimagined." A great piece in JAMA, Journal of the American Medical Association Health Forum by Sherry Glied outlines the 3 key steps for improving health insurance coverage through our multi-tiered system: 1. in the context of continued variation in coverage generosity, a minimum publicly acceptable scope of benefits and cost-sharing should the same across types of coverage 2. make it easier for people to move seamlessly from one form of coverage to another 3. in the context of near universal coverage, safety net institutions could focus get reimbursed for delivering the services local communities need with excellent quality and patient satisfaction. https://lnkd.in/eMFwDPcT #universalcoverage #access #equity

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Finally, the moment has arrived! Using an innovative new Breathing Disturbances metric, sleep apnea notifications come to the latest Apple Watch. And congratulations to Sai Parthasarathy, MD, ASAA longtime research partner! "For more informed conversations with their healthcare providers, users can export a PDF that shows when sleep apnea may have occurred, three months of breathing disturbance data, and additional information. Educational articles are also available within the Health app to help users learn more about sleep apnea. The sleep apnea notification algorithm was developed using advanced machine learning and an extensive data set of clinical-grade sleep apnea tests. The feature was then validated in a clinical study — unprecedented in size for sleep apnea technology. In the clinical validation study, every participant identified by the algorithm had at least mild sleep apnea. Sleep apnea notifications come to Apple Watch, further expanding its capabilities as an intelligent guardian for users’ health. “Empowering consumers everywhere to have the ability to reliably identify the presence of abnormal breathing patterns during sleep can help uncover a woefully underdiagnosed and serious medical condition such as sleep apnea,” said Sai Parthasarathy, MD, University of Arizona Health Sciences Center for Sleep, Circadian, and Neurosciences’s professor and director in Tucson, Arizona. “This is a major step forward in improving public health.” https://lnkd.in/e5__3MpV

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Dr. Ronald Klatz, MD, DO Worldhealth.net Plastic pollution may now affect the human urinary tract. #Microplastics (MPs) entering the body through inhalation, ingestion, or skin contact have been linked to inflammation, cellular damage, metabolic changes and reduced cell viability. The detection of MPs in the urinary tract, alongside limited knowledge of impact, is an increasing concern. #worldhealth #publichealth #pollution #EPA #urinarytractdisease #regenerativemedicine #antiaging #aging #health #research https://lnkd.in/gF2WDDxz

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Exploring the Cannabis Knowledge Gap in Medical Marijuana Amongst Resident Physicians A 2022 study published in BMC Primary Care highlights a significant knowledge gap regarding medical marijuana among internal medicine residents at Mount Sinai Morningside-West in NYC. Below are some key findings from the study: Docs don't know where to look! Residents indicated a lack of accessible and reliable resources on MM. This highlights the urgent need for integrating medical cannabis education into medical training programs, as well as developing accessible learning tools and texts. Young doctors really do want more education! Approximately 80% of residents expressed a strong desire for more comprehensive education on MM, covering its use, indications, contraindications, and potential side effects. Less than 10% felt substantially knowledgeable about medical cannabis, and only about 1% reported having a high level on knowledge on the topic This relatively recent study underscores the critical need for education on medical marijuana to ensure that physicians are well-prepared to discuss and recommend medical cannabis as a treatment option. By addressing this gap, we can improve patient care and outcomes. To equip future physicians with the necessary skills and knowledge, it's crucial to develop targeted educational tools that address the therapeutic potential and safe use of cannabis. #cannabisismedicine #cannabiseducation #doctors Read the study yourself: Makki I, Zheng-Lin B, Kohli M. Medical marijuana knowledge and attitudes amongst internal medicine residents. BMC Prim Care. 2022;23(1):38. Published 2022 Mar 3. doi:10.1186/s12875-022-01651-9 #MedicalMarijuana #MedicalEducation #InternalMedicine #Healthcare #ChronicPain #CannabisEducation

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New research explores the connections between body composition and Alzheimer’s Disease (AD), focusing on obesity and its impact on AD risk factors. This review offers a holistic look at how factors like lean mass, bone mass, and adiposity play a role in the progression of AD. With AD affecting roughly 50 million people globally, this study provides insight into the complex interplay between AD and body composition, highlighting inflammation and genetic factors. Findings reveal that excess visceral fat not only promotes systemic inflammation but also drives neuroinflammation, a key contributor to AD pathology. For healthcare practitioners, these insights underscore the importance of a whole-body approach when assessing AD risks, emphasising innovative strategies for prevention and early diagnosis. Read the full review to see how understanding body composition could lead to advancements in AD management. 📄 Read more 👇🏻

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Discover the nuanced relationship between cannabis use, binge drinking, and mental health in adolescents and young adults through our latest comprehensive analysis. Our exploration delves into how these factors interact differently based on gender and other demographic variables, providing critical insights that can influence future healthcare policies and interventions. For a deeper understanding, check out the new blog on this at CED Clinic: https://lnkd.in/eCTMJfwt ___ Key takeaways from the study include: ✚ Gender significantly moderates the impact of binge drinking on depressive symptoms, with females experiencing more pronounced effects. ✚ Adolescents may use marijuana to self-medicate depressive symptoms, supporting the Self-Medication Model across both genders. ✚ There is a strong concurrent association between marijuana use, binge drinking, and depressive symptoms, particularly among females. __ If you like, read the full article and gain a more detailed understanding of these complex interactions. The original study is here, for those interested in the research details: http://bit.ly/3WiJSh0 Let’s stir up some thoughts! -How could these findings shake up our current understanding or approach to mental health in young adults? -Could this be the wake-up call for more tailored interventions, or just another ripple in the research ocean? ⭐️ Join the discussion and share your views on what these insights mean for future research and practice. Every comment helps this information reach other eyes, and could be the secret ingredient to inspire someone else to get involved!

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Check out this great podcast about BioOx, a wellness company based on the science of ROx (Reservoir Oxygen)! 

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From the AMMG E-Journal, New DNA Clock May Change How We Measure Aging: https://lnkd.in/eRyq-7UW. "Can we finally stop the aging process? Researchers at Brigham and Women’s Hospital (BWH) are hoping so after developing a DNA clock that may unlock the secrets of aging. These new epigenetic clocks can more accurately predict biological aging and the effectiveness of anti-aging treatments. This study introduces a machine-learning model capable of distinguishing between genetic factors that either accelerate or decelerate the aging process, a distinction not made by previous models." READ MORE HERE: https://lnkd.in/eRyq-7UW #DNAClock #AMMG #AgeManagementMedicine #CMEEducation #ContinuingMedicalEducation #CMEConferences

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What can functional medicine testing reveal about your gut? 🔍🌿 These tests identify imbalances and specific bacterial issues. Understanding these can help tailor a personalized plan to improve your gut health. 🌟 #FunctionalTesting #GutHealth #SozoFunctionalMedicine https://lnkd.in/gaumVePb

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