Breaking News

Legal marijuana 10 years on: The sky didn't fall in the Mile High state but challenges persist

October 30, 2023
Reporter, Morning Rounds Writer

Good morning. Lots to tell you about today, including how Colorado's pioneering legalization of marijuana has rolled out over the past decade, and what's going on with all the telehealth options big retailers are offering. Looking ahead, two developing stories reporters Adam Feuerstein, Megan Molteni, and Jason Mast are watching:

health

The sky didn't fall after Colorado pioneered legal marijuana, but all is not bliss

weedNicholas Florko/STAT

Just under 10 years ago, Colorado became the first state in the U.S. to allow people to buy recreational marijuana. Since then, more than $2.5 billion in tax revenue from the Colorado cannabis industry has flowed to rebuilding public schools and funding research into the drug's health effects. Neither youth cannabis rates nor crime have spiked, despite fears both would. While legalization has made what was once a black-market business more mainstream, some challenges persist, STAT's Nicholas Florko reports.

The state is still figuring out how to respond to increasingly strong cannabis products, especially as they may affect young people and people with pre-existing mental health conditions. Jobs in the industry are plummeting, with 10,481 cannabis jobs lost in 2022, according to a recent industry report. Diversity in dispensary ownership is still just a dream. And driving while high remains an issue. Nick has more here.


hospitals

Surprise: Staffing firms are billing hospitals more

Physician staffing firms, feeling the pain after a federal law banned surprise bills, are demanding extra payment from hospitals to stay afloat. Hospitals, desperate for doctors to staff their facilities, have little choice but to comply, even though major hospital chains said last week those expenses, known as physician subsidies, were up 20% to 40% from last year. It's a complicated problem that's gotten worse just as contract labor expenses ease up.

STAT's Tara Bannow explains why it's happening: Companies that employ the doctors who staff many emergency departments and operating rooms can no longer pad their bottom lines by "balance" billing patients for anything their insurance doesn't cover. A boon to patients dunned by out-of-network doctors who saw them at in-network hospitals, the law has had industry-wide ripple effects. But providers and analysts also blame health insurers, now emboldened to withhold reimbursement and cancel contracts. Read more.


climate change

Cardiovascular deaths from rising heat may double

This is how our bodies fight heat: Our hearts pump faster to send hot blood away from internal organs as we sweat to cool down. This is how heat kills: Our bodies can't cool down enough, damaging organs; if blood pressure falls too low or hearts beat too fast, heart attack, stroke, or heart failure may follow. That's why a warmer world means more people will die. A new study in Circulation predicts that over the coming decades, excess cardiovascular deaths could increase by as much as 233% annually in the U.S.

In the rosiest scenario, if global climate efforts bear fruit, those deaths would increase by 162%. Black adults would see more than four times the increase in deaths as white adults. Elderly adults would suffer more than younger adults, as would countries with more extreme heat, more population density, and fewer resources. Read more from STAT's Theresa Gaffney.



closer look

Telehealth options flood the market as retailers offer virtual care — self-pay onlybasket

Adobe 

Startups like Ro, Hims, and Thirty Madison grew rapidly as the pandemic made telehealth more appealing. Giants like Walmart and CVS have also bet on the direct-to-consumer model, building out their health care businesses with a mix of online and brick-and-mortar clinics, some of which accept insurance. Now new telehealth programs launched by large retailers let patients pick their medical concern off a menu, from erectile dysfunction to ear infections. They pay cash — no insurance accepted — to have a text or video visit with a provider.

"For a lot of these companies, all they really are interested in is: Can we offer the kinds of services that are cheap enough to provide that we don't have to worry about going to insurers?" said Alexander Lennox-Miller, lead analyst in healthcare IT at CB Insights. "As a solution to the health care crisis in the U.S., it isn't." STAT's Katie Palmer has more


children's health

Pediatricians urged to help prevent kids' expulsion from preschool

When you think about it, expelling a child from preschool because of "misbehavior" means removing that child from the place where kids learn how to get along with one another and become ready for school. Children expelled from preschool are 10 times as likely as their peers to drop out of high school and face incarceration. There's also the issue of implicit bias: Children who are Black, male, have developmental delays, or have experienced trauma are at higher risk of being expelled. 

In a policy update out today, the American Academy of Pediatrics acknowledges that safety concerns may underlie expulsion, but it also cites research showing preschool teachers may incorrectly assess Black boys to be older and have inappropriate expectations for behavior. As a remedy the academy recommends:

  • Pediatrician coordination of behavioral health providers to work with the family,
  • Teacher training to manage behavior, recognize implicit bias, and promote social-emotional regulation in preschoolers,
  • Lower student-teacher ratios, appropriate compensation, and access to mental health consultation.

practice of medicine

For VA doctors, telework is tied to lower burnout

Like many others in the pandemic's early days, doctors whose specialty allowed it shifted to telework in 2020. A new research letter in JAMA Network Open asked whether telework could mitigate physician burnout, citing small studies hinting that this was the case. The study authors queried doctors in 140 VA health systems about burnout and telework arrangements; more than 44,000 responded.

More than one-third of doctors reported burnout, with the highest levels in primary care and psychiatry. More than half of physicians didn't telework, and the odds of burnout were 57% higher for physicians who didn't have approval to telework compared with those who did and chose to do so full-time, with the exception of those in surgery, anesthesiology, and emergency medicine. "If flexible telework arrangements are associated with lower physician burnout, they have the potential to improve job retention and, in turn, patient care quality," the authors write.  


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What we're reading

  • What if men could make their own egg cells? Wall Street Journal

  • How much would you pay for peace of mind? The Cut
  • An exit interview with Bristol Myers Squibb CEO Giovanni Caforio, STAT
  • From a fledgling genetic science, a murky market for prediction, Undark
  • Paying for Covid pills will soon shift to insurers, STAT

Thanks for reading! More tomorrow,


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