Medical blog » Patients

Doctor shuts door on new Medicare patients

admin — Wed, 11 Feb 2009 10:02:09 +0000

WATSONVILLE – For the greater part of 2008, Dr. Chris O’Grady closed his doors to new Medicare patients.
He was already caring for so many elderly patients in his Watsonville-based family practice that he was often going home at 10 p.m.
Medicare paid him far less than he considered fair – and now the government was threatening to cut the rates again.
Many of the county’s primary care doctors have struggled before reaching the same conclusion.
On the one hand, they know Santa Cruz’s elderly and disabled Medicare patients are in critical need of primary care. On the other hand, they feel Medicare reimburses them far too little to see those patients.
In Dr. O’Grady’s case, this conflict was rendered more acute because of his special training: geriatrics.
The 44-year-old, silver-haired doctor says treating elderly patients carries lots of unique rewards, but also comes with complications. Older patients generally have more complex ailments – ranging from dementia to osteoporosis to hypertension. They need more frequent and longer appointments. They often land in the hospital, and doctors have to leave behind other patients to go check on them.
By last spring, Dr. O’Grady was overwhelmed with new elderly patients who thought they had nowhere else to turn.
Add to that the low reimbursement rate – Medicare pays poorly in Santa Cruz County compared to neighboring Santa Clara – and last summer, Congress was threatening to cut the rates by an additional 10 percent. (A federal funding formula calls for cutting doctors’ pay when Medicare costs grow faster than the national gross domestic product. Congress can override that requirement).
Dr. O’Grady decided he’d had enough. As president of the Santa Cruz County Medical Society, he’d grown tired of Congress turning a deaf ear to pleas from him and other local providers.
If enough doctors shut their doors on new patients, and that made those patients angry, then maybe, just maybe, Congress would do something.
“Until the patients complain, nothing’s going to happen,” O’Grady said. “If nobody on Medicare can get in to see a doctor, the politicians have to respond to that.”
But Dr. O’Grady never felt 100 percent comfortable with this method of protest. Many of his colleagues who’ve closed their doors to new Medicare patients share this ambivalence, he said.
“We’re at this uncomfortable point,” he said. “The patients are kind of stuck in the middle. It’s a standoff between doctors and Congress.”
On Jan. 1 of this year, Dr. O’Grady reopened his practice to new Medicare patients, on a limited basis. If the reimbursement rates don’t change in the next year, though, he plans to close it to new Medicare patients again, this time for good.
Jocelyn Wiener reports for the Center for California Health Care Journalism.

Cancer Patients Often Stranded in Health Insurance Nightmares

admin — Sat, 27 Dec 2008 00:09:02 +0000

THURSDAY, Feb. 5 (HealthDay News) — Last summer, Keith Blessington had just been told that he was eligible for private health insurance to replace his government-funded COBRA coverage when it ran out.
Then, the 55-year-old New Hampshire resident was diagnosed with late-stage stomach cancer, and everything changed.
Although the COBRA coverage paid for most of the cost of his initial surgery, by the time he got out of the hospital having had half his stomach and eight cancerous lymph nodes removed, Blessington found himself ineligible for virtually any private health insurance, because his cancer was now a daunting preexisting condition.
Blessington is still one of the lucky ones, because he managed to secure insurance through New Hampshire’s high-risk insurance pool. However, the coverage is costly, $1,120 a month to be exact.
Just to survive while he was unable to work, Blessington borrowed $40,000 on his credit card and cashed out his 401K retirement plan.
“I have enough money for another month or so to live on. My savings are gone,” Blessington, a freelance accountant, said recently.
. All the individuals profiled had health insurance at the time they were diagnosed with cancer.
“They’re stories about how insurance just doesn’t do the job,” said Christy Schmidt, a co-author of the report and senior policy director for the American Cancer Society. “We need to make sure we’re not just giving someone an insurance card. The insurance needs to be adequate.”
The report comes soon after another study found that more than 1 million of 12 million cancer survivors living in the United States have had to forgo care, including prescription drugs, for financial reasons. The problem was most pronounced among Hispanics and blacks.
And when you have cancer, health insurance coverage is paramount. “People have worse outcomes and are diagnosed at later-stage disease if they are uninsured,” Schmidt said.
“There can be high cost-sharing in insurance,” such as separate deductibles for different kinds of treatment and caps on benefits, Schmidt said. One woman maxed out the number of radiation treatments covered by her insurance but still needed more. She ended up not getting more radiation, even though her doctor had recommended it. One 10-year-old girl with leukemia has already reached her lifetime maximum and still needs more treatment.
Many people become too sick to work, and lose their employer-sponsored benefits. By law, they are eligible for COBRA for 18 months, but this is often prohibitively expensive.
The private insurance market often won’t cover people who have had cancer or, if they do, the premiums are again prohibitively expensive. One man, a 10-year survivor of prostate cancer, has to pay one-quarter of his income just to cover the premiums on his policy. Often, he goes without care just to cover the costs of the policy. And that doesn’t count his high deductible.
High-risk pools will cover some cancer patients, but not all, and that coverage is expensive. According to Schmidt, the New Hampshire high-risk pool that covers Blessington is one of the “nice” plans. That premium costs Blessington about $13,000 a year.
Other supposed public safety nets have their own problems. Some cancer patients too ill (either from the disease or the treatment) to work may qualify for disability benefits but might have to forgo Medicaid as a result. Individuals are not eligible for Medicare for two years after they have started on disability.
“I’m a cancer survivor myself,” Schmidt said. “You’re really fighting for your life, then you discover you’re really fighting with your insurance company or your insurance doesn’t do it for you, and you’re in a whole other world fighting on two fronts.”
for more on how to handle the high costs of cancer care.

Few Stroke Patients Get Clot-Busting Drug

admin — Tue, 16 Dec 2008 14:47:29 +0000

THURSDAY, Feb. 19 (HealthDay News) — A powerful clot-busting drug approved by the U.S. Food and Drug Administration for use in stroke patients in 1996 is still rarely used in Medicare patients, new research shows.
Only 2.4 percent of the more than 495,000 admissions for stroke at the 4,750 hospitals evaluated were given tissue plasminogen activator (tPA), said study author Dr. Dawn Kleindorfer, an associate professor of neurology at the University of Cincinnati College of Medicine. She was to present the finding Thursday at the International Stroke Conference in San Diego.
“The smaller your hospital was, the less likely it was to use tPA,” she noted. “The strongest association by far was how big your hospital is.”
Larger hospitals may be more likely to have a stroke team or to treat more strokes, and they were therefore more likely to use the drug, she said.
Kleindorfer reviewed national Medicare claims-based database records for every Medicare-eligible hospital discharge in the United States from July 1, 2005, through June 30, 2007.
give the clot-buster within the two-year study period, she found.
Across the United States, the use of tPA occurs in no more than 3 percent of all stroke patients, Kleindorfer noted. In this new study, the percent was even lower, at 2.4 percent.
Not every stroke patient is eligible to get tPA, she said. The drug is meant for ischemic stroke, the most common type (in which the blood vessel is clogged by a clot), and the drug must be given intravenously within the first three hours of the onset of symptoms.
Some patients don’t make it to the hospital within that time frame, Kleindorfer said, and others are ineligible due to factors such as bleeding in the brain or recent surgery.
Still, the low percentage noted in the study falls far short of the percent of people who should be eligible to get tPA, she said. In fact, Kleindorfer believes that up to 29 percent of stroke patients are probably eligible for the clot-buster drug if they get to medical care within the three-hour window.
From the study, Kleindorfer also found that “40 percent of the U.S. population lives in a city with a hospital that does not treat at the national average [of 3 percent].”
Use of the drug may have been higher, she said, if she had studied younger, non-Medicare patients. In younger patients, she said, it’s likely they would have fewer problems such as bleeding in the brain that would rule out use of tPA.
Another expert familiar with the study expressed disappointment at the low percent of tPA usage. “It’s still unfortunate that the number of hospitals that can provide acute stroke therapy is still limited,” said Dr. Ralph Sacco, chairman of the department of neurology at the University of Miami Miller School of Medicine.
The number of hospitals with stroke teams is increasing, he noted. As more hospitals are designated as a primary stroke center by the Joint Commission on Accreditation of Healthcare Organizations, the use of the drug may increase, experts said.
In the meantime, Kleindorfer had some simple, strong advice for family and friends of those suspected of having a stroke: “Call 9-1-1.” Getting help quickly is crucial, she said.
Once at the hospital, she said, tell staff right away that you believe your loved one is having a stroke. “Ask, ‘Do you have a stroke team?’ ‘What about that clot-buster medicine?’”
To learn more about tPA, visit the
.

Party offers cancer patients and their families a chance to give …

admin — Mon, 15 Dec 2008 06:00:11 +0000

When cancer strikes one member of a family, what seems like an intensely personal catastrophe can suddenly bring down the entire household.
But Sunday, for 200 men, women and children who know the disease’s terrible toll all too well, a holiday party hosted by a unique program for patients and their families offered a chance to give thanks, both for a happier ending and for the help they received in getting there.
“It’s like they don’t care about the cost,” said Chris Lancelotti, 38. “They were going to help us no matter what.”
He meant a small but big-hearted organization called Families Can. Since 1999, the nonprofit has helped cancer-stricken families in Santa Clara County in ways big and small, from covering mortgage payments to paying for baby-sitters and more. The party at the plush Palo Alto Hills Golf and Country Club was more than just an annual event. It was a way to connect with other cancer survivors.
Lancelotti was a typical client. After learning last year that he had testicular cancer, the paramedic and father of three was asked at Stanford Medical Center if he wanted to talk with a social worker.
“I had never thought I would be in the position to need social help,” he said. “But I signed the form, anyway. Thank God I did.”
Over the next several months, Families Can covered three mortgage payments, about $2,000 in credit card debt, and groceries for three months. Lancelotti said the assistance helped save
his marriage.
“I had no idea how much radiation and other treatment would leave me so tired and in pain,” he said. “My wife has been raising the children on her own for the past year.”
The party was an elegant, low-key affair. Young kids squealing in line to see Santa made the most noise. If you browsed by, it would have looked like just another holiday party, except for the telltale signs of chemotherapy, the men with fuzzy scalps and the women wearing bandannas. The host and founder of Families Can, Jackie Whittier, said only a few words of welcome and mostly mingled with the people she’s helped.
About 11 years ago, she was pregnant when liver cancer struck her husband, Bruce Kubicka. Sitting for hours in hospital waiting rooms, she learned from other spouses how difficult cancer had made family life, especially in money matters.
Later, when her father, Ron Whittier, a retired Intel executive, asked his adult children to come up with ideas for a foundation he was starting, she remembered what she had learned. And so Families Can was born.
“I came up with the idea because when my husband got cancer I had a baby in my tummy,” she said.
Money isn’t the only help, said Victoria Alvarez, who attended the party with her husband, Jesus Martinez, and their five children. Families Can enrolled her kids in a camp designed to help children understand and cope with a parent’s cancer.
“For a long time I couldn’t say the ‘C’ word to them,” Alvarez, 36, said. “Well, they got to learn in that program what Mommy has, that it’s OK to hug Mommy with that funny thing on her head when she comes back from the hospital.”
Beatriz Bravo, a medical social worker at Stanford Medical Center, had referred several of the partygoers to the organization for help.
“When a loved one in the family is hit by cancer, it puts a major stress on the whole family,” she said. “As I’ve said, nobody deals with cancer alone.”
or (408) 920-5767.

Hospital staff use petty cash to buy food for patients

admin — Thu, 11 Dec 2008 15:05:56 +0000

MONTHS after a country hospital served baked beans for three weeks because NSW Health had not paid its meat bill, staff are still using petty cash to buy food over the counter for patients because businesses are refusing to deal with the health service.
Meat supplies were cut off to 15 hospitals across the Greater Western Area Health Service in September after the Dubbo Meat Company waited four months for a $30,000 bill to be settled.
It is believed that since then managers from the area service have approached businesses for credit but have been refused, leaving staff to pay cash over the counter for sausages and mince for patients’ meals.
“Nobody wants to touch them,” one butcher said. “It’s awful because you don’t want to deny sick people, but when you are a struggling little business you can’t afford to wait so long for your money.”
has been told that nurses in the emergency department at Mudgee Hospital were buying blood glucose strips and alcohol testing kits from a pharmacy last week because suppliers have refused to provide them, and two toilets in the wards were blocked for two weeks this month because the plumber declined to fix the pipes unless he was paid $400 owed to him.
Staff have also been forced to use petty cash to buy light bulbs and computer paper because the companies supplying them have not been paid in months.
The Health Minister, John Della Bosca, said the area health service owed about $60 million when he took over the portfolio four months ago, and now owed less than $23 million.
The chairman of the Mudgee Health Council, James Lonergan, said running out of blood sugar tests for even one day in an emergency department showed how bad things had become.
“People here look at the State Government spending $5 million on crackers on New Year’s Eve when we can’t get a $400 bill paid.”
The owner of Dubbo Meat Company, Mark Knaggs, said hospital staff were “seriously embarrassed” at having to buy goods over the counter with petty cash.
“We were going backwards. Even if they had agreed to pay us smaller amounts regularly, we would have ridden it, but they didn’t.”
Kelvin Waterhouse sold his butchery in Nyngan last month, walking away angry that the local hospital regularly left him up to $4000 in debt and still owes him $1201.
“It is shocking, just unbelievable. The guy who bought my shop is going to honour the contract until June, and then he wants to wipe his hands of them,” Mr Waterhouse said.

Personal Health Query for Aging Patients: How Much Do You Drink?

admin — Fri, 05 Dec 2008 05:20:16 +0000

Is alcohol a tonic or a toxin? The question is especially critical to older people, whose overall medical picture gives alcohol the potential to be a health benefit or a life-shortening hazard.
Yet experts say that doctors rarely ask older patients how much and how often they drink. Not knowing the answers to these questions can result in misdiagnosis, medical complications and life-threatening accidents. Doctors may also fail to recognize the symptoms of
, a problem that is expected to become increasingly common as baby boomers, who have been found to drink more than previous generations, reach age 65 and beyond.
At the same time, older people who are in good health should know that moderate drinking under the right conditions may improve their health in several important ways. In a comprehensive review in the October issue of The Journal of the American Dietetic Association, Maria Pontes Ferreira and M. K. Suzy Weems described the myriad health benefits and risks of alcohol consumption by aging adults.
In summarizing the findings in an interview, Dr. Ferreira, a registered dietitian, said that “although there are a lot of benefits from moderate alcohol consumption, you can’t make a blanket statement; you have to look at the big picture.”
and reduce the risk of several important diseases, including cardiovascular diseases and
,” said Dr. Ferreira, a postdoctoral fellow at Haskell Indian Nations University in Lawrence, Kan. “But a lot of folks over 50 are already dealing with diseases associated with aging and medication use that can result in possible complications and drug interactions. And older people who abuse alcohol are consuming an inordinate amount of
that can displace important nutrients.”
Furthermore, Dr. Frederick C. Blow, professor of
Medical School and an expert on alcohol and aging, pointed out in an interview that “even at lower levels of consumption, alcohol can be problematic for older people.”
“Because of an increased sensitivity to alcohol and decreased tolerance as one ages, lower amounts of alcohol can have a bigger effect,” he said. “Older people get into trouble with doses of alcohol that wouldn’t be a problem with a younger person.”
Madeline A. Naegle, professor at the New York College of Nursing, fears that publicity about the benefits of alcohol has dangerously tipped the scales, prompting some people to think that “if one drink is good, two or three must be better.”
“Recommendations about drinking must be qualified by the level of a person’s health,” she emphasized in an interview.
and abuse among older adults in the November issue of The American Journal of Nursing, she noted: “Often clinicians fail to ask, ‘Do you drink alcohol?’ when obtaining medical histories and performing routine examinations. Because alcohol consumption is such a common practice, questions about drinking are necessarily part of a general health assessment.”
Evidence for the benefits of moderate alcohol consumption comes almost entirely from epidemiological, or population, studies that can reveal important associations but cannot prove cause and effect. There have been few randomized controlled clinical trials of alcohol use to definitively show that alcohol consumed in any amount by any group of people benefits health.
That said, here is what the studies indicate. It’s important to note that most findings refer to moderate consumption, defined as one alcoholic drink a day for women and up to two for men. Also, the benefits are confined to people who do not have ailments, like chronic
, or take medications, like psychoactive drugs, that would render any amount of alcohol risky.
and mortality.
While many studies have emphasized the benefits of red wine to cardiovascular health and longevity, more than 100 studies in 25 countries have linked these benefits to moderate consumption of any type of alcoholic beverage. On average, moderate drinkers 50 and older are less likely to suffer heart attacks and die prematurely than abstainers and heavy drinkers.
Diabetes.
Though it may seem counterintuitive, a controlled clinical trial of nondiabetic older women found that insulin sensitivity was improved among those who consumed two drinks a day. In studies of men with diabetes, drinking up to two drinks a day was associated with lower levels of factors linked to an increased risk of heart disease, like markers of inflammation and arterial dysfunction.
.
Although excessive alcohol drinking can raise the risk of dementia in older people, “there are emerging data to suggest that moderate alcohol intake — one to three drinks a day — is associated with a reduced risk of developing
and vascular dementia,” Dr. Ferreira and Dr. Weems wrote. In this case, they added, drinking wine confers the primary benefit; drinking beer, on the other hand, appears to raise the risk of dementia.
.
Several studies have suggested that elderly women who drink moderately tend to have better bone density. But chronic heavy drinking “can dramatically compromise bone quality and may increase osteoporosis risk,” H. Wayne Sampson of
Health Science Center in College Station has reported for the National Institute on Alcohol Abuse and Alcoholism. Furthermore, skeletal damage from excessive drinking is not reversible.
Psychosocial effects.
Although there is relatively little research on the effects of moderate alcohol consumption on mental and social well-being among the elderly, studies in retirement communities have noted an improvement in social interactions, health-related quality of life and survival.
Nutritional benefits.
Again, there is not a lot of research, but studies so far indicate that an alcoholic drink taken with meals can improve appetite and the consumption of calories and nutrients needed by many elderly people, Dr. Ferreira said.
Immoderate consumption of alcohol — more than three drinks a day — can be hazardous for people of all ages, but especially so for the elderly, who reach higher levels of blood alcohol faster and maintain them longer than younger people.
Yet, Dr. Blow said, “we don’t do well identifying older people who are getting into trouble with alcohol.”
Potential hazards include an increased risk of falls and vehicular accidents, a decline in short-term memory, a worsening of existing health problems and interactions with medications that may diminish the effectiveness of some drugs and increase the toxic effects of others.
Dr. Ferreira called alcohol abuse and alcoholism in aging adults “a silent epidemic.” Dr. Naegle wrote that “many older people pursue drinking patterns established earlier in life and may not realize that continuing to drink the same amount of alcohol as they did when they were younger may place them at risk for health problems.”
She recommended using diet and exercise to reduce cardiac risk; trying alternative relaxation methods like meditation,
and exercise; and, for those who drink, cutting down on the amount of alcohol consumed by mixing it with water, taking an hour to finish one drink and alternating alcohol with nonalcoholic drinks.

FDA Approves RiaSTAP for Treatment of Bleeding in Patients with …

admin — Thu, 04 Dec 2008 06:36:40 +0000

Washington, D.C. – infoZine – The U.S. Food and Drug Administration licensed RiaSTAP, an orphan drug for the treatment of bleeding in patients with a rare genetic defect known as congenital fibrinogen deficiency. Without treatment, these patients are at risk of potentially life-threatening bleeding.
People with congenital fibrinogen deficiency are unable to make sufficient amounts of fibrinogen, which plays an important role in blood coagulation by helping to form blood clots and prevent bleeding. Fibrinogen is manufactured in the liver and circulates in the blood plasma in a normal concentration of 250-400 mg/dL.
“This product offers much-needed treatment for the small number of patients with congenital fibrinogen deficiency,” said Jesse Goodman, M.D., M.P.H., director of the FDA’s Center for Biologics Evaluation and Research. “If bleeding occurs in the brain or other organs and is left untreated, it may lead to blood loss, organ damage and death.”
Fibrinogen deficiency affects only 150 to 300 people in the United States and is usually diagnosed at birth when newborns bleed from their umbilical cord site. Children with the defect need to curtail activities because of risk of bleeding from minor trauma.
RiaSTAP is an intravenous fibrinogen concentrate made from the plasma of healthy human blood donors. The product is indicated for patients who have no fibrinogen or low levels of the substance, an abnormality known as afibrinogenemia, or for those patients whose fibrinogen levels are below 50 mg/dL, an abnormality known as hypofibrinogememia. The product is not indicated for patients with dysfibrinogenemia, who may have normal fibrinogen levels but defective fibrinogen function. Patients such as these are at risk for both bleeding and clotting complications.
The licensing of RiaSTAP was supported by a study of 15 patients with afibrinogenemia who achieved the target level of fibrinogen expected to prevent bleeding after they received 70 mg/kg of the drug. In addition, plasma from 14 of the 15 patients showed increased maximum clot firmness, a surrogate marker likely to predict clinical benefit. Fever and headache were the most common adverse reactions.
Clinical benefit will be further verified in a postmarketing study which will include both afibrinogenemic and hypofibrinogenemic patients.
Orphan drugs are drugs or biologics intended for use in a rare disease or condition. Manufacturers are qualified to receive certain government benefits in exchange for developing such products. RiaSTAP [Fibrinogen Concentrate (Human)] was developed under the FDA’s accelerated approval regulations.
The drug is manufactured by CSL Behring, Marburg, Germany.

Congress Could Let Injured Patients Sue Device Makers

admin — Wed, 03 Dec 2008 13:33:41 +0000

A year ago today, the
that federal law bars lawsuits “challenging the safety or effectiveness of a medical device,” as long as the device is marketed in a form approved by the FDA.
The ruling, in a case called
, relied heavily on a federal law that regulates medical devices; now, some key congressional players are looking to change the law, this morning’s
reports.
Democrats Henry Waxman and Frank Pallone plan to introduce a House bill that would allow injured patients to sue device makers. In the Senate, Democrats Ted Kennedy and and Patrick Leahy plan to reintroduce a similar bill they rolled out last year.
1. “Consumers face the worse of all possible worlds,” a Georgetown professor told the NYT. “The F.D.A. has shown itself incapable of keeping dangerous products off the market, and now the Supreme Court has said patients cant sue companies for redress.”
2. “We are clearly very troubled by this legislation,” the general counsel for the medical device trade group told the paper. “Our concern is that it would undermine the F.D.A. process.”
Meanwhile, back at the court, a decision is expected this spring in
, which applies the questions from last year’s case to the drug industry.

Erectile dysfunction clinic 'exploited' patients

admin — Fri, 28 Nov 2008 19:31:02 +0000

Four men seeking treatment for erectile problems were exploited by a doctor who treated them as customers rather than patients, a report by the Health and Disability Commissioner has found.
The four men complained to the commissioner after they were seen at four different branches of the New Zealand's Men's Health Clinic which specialises in erectile dysfunction.
Health and Disability Commissioner Ron Paterson said the doctor, who was the sole practitioner at the clinic, failed in the following areas:
* He did not perform sufficient examinations of three men, aged 65, 68 an 75 suffering from erectile dysfunction before prescribing treatment, despite one of them being an diabetic with high blood pressure and another having a significant history of heart problems.
* When seeing a 21-year-old for premature ejaculation he did not ask about his sexual functioning or give the man psychosexual advice and education. He prescribed him clomipramine as a nasal spray which was not an approved form for the drug. The man suffered a nosebleed immediately after using it.
The doctor treated the men as customers rather than patients, Mr Paterson said.
“In each of the cases, the standard of assessment was below the standard expected of a medical practitioner.”
He was concerned the patients had been given leaflets to read and consent forms to sign before their first consultation, Mr Paterson said.
“When men who are first time patients are seeking treatment for a sensitive problem such as erectile dysfunction, particular care is needed to ensure the men understand their treatment options and do not feel pressured to purchase a recommended treatment.”
The men had been unable to give informed consent to treatment “and could not do so by simply completing a questionnaire and signing a consent form before their first consultation”, Mr Paterson said.
“What happened to the men in these cases verges on exploitation.”
Information about costs was particularly important when an expensive course of treatment was recommended, he said.
Mr Paterson recommended that the doctor apologise to the men and review his practice and patient treatment guidelines.

German Patients to Receive Medical Marijuana

admin — Tue, 25 Nov 2008 19:19:24 +0000

By Bruce Mirken Special to Salem-News.com
Pressure from the Bush Administration to keep marijuana illegal in other nations is fading.
(SAN FRANCISCO) – Germany is about to become the fifth country to allow at least some patients to use natural marijuana as medicine. According to a
, the German government recently notified four patients that they would be allowed to receive medical marijuana produced under the
Dutch governmentвЂ™s medical marijuana program. The German program remains limited to special cases.
Other German patients have been allowed to use a liquid extract made from Dutch cannabis, but for some patients the extract proved unsatisfactory. The patients are expected to receive their supply of whole marijuana around mid-January.
Other than the Netherlands, nations that have some sort of medical marijuana program sanctioned by their national governments вЂ” with varying levels of restrictions and limitations вЂ” include
.
Oh, and the U.S., which still provides medical marijuana to a handful of surviving patients in
that was closed to new enrollment in 1992.
Bruce Mirken has served as communications director for the Marijuana Policy Project since 2001. Prior to joining MPP, he was a freelance journalist covering health and social issues for a variety of publications. His news articles and op-ed columns appeared in such local and national publications as Men’s Health, The Advocate, In These Times, the San Francisco Examiner, the Miami Herald and many others. Along the way, he won 11 assorted journalism awards for his reporting and commentary.
LegalCountries December 8, 2008 1:12 pm
How about Spain and Italy?
A few years back I read that Spain also was allowing Medical Cannabis — in pill and infusion formula — for a limited number of patients; and I thought Italy also had a very small number of legal medical cannabis patients.
Has this changed, or am I not remembering correctly?
Editor: We will try to get this information for you.
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