User login
-
div[contains(@class, 'header__large-screen')]
div[contains(@class, 'read-next-article')]
div[contains(@class, 'main-prefix')]
div[contains(@class, 'nav-primary')]
nav[contains(@class, 'nav-primary')]
section[contains(@class, 'footer-nav-section-wrapper')]
footer[@id='footer']
section[contains(@class, 'nav-hidden')]
div[contains(@class, 'ce-card-content')]
nav[contains(@class, 'nav-ce-stack')]
div[contains(@class, 'view-medstat-quiz-listing-panes')]
div[contains(@class, 'pane-article-sidebar-latest-news')]
Biden administration’s new test-to-treat program pits pharmacists against physicians
The Biden administration’s new test-to-treat program is simple on the surface: if you feel like you may have COVID-19, go to a pharmacy, get tested, and, if positive, get treated with an antiviral medication on the spot.
One large physicians’ group is concerned that the program leaves doctors on the margins, and may put patients at risk if there are adverse effects from the medications. Pharmacists groups, on the other hand, say the program is too restrictive, according to an article by the research group Advisory Board.
Recently, the White House announced that more than 1,000 pharmacy clinics across the United States had registered to participate in the initiative, according to CNN. Ordering of the drugs is underway in many of these clinics, a White House official told the network.
Besides retail clinics in chain pharmacies, the antivirals will also be available in community health centers, long-term-care facilities, and Veterans Health Administration clinics, according to a statement from the U.S. Department of Health and Human Services.
The two antiviral pills authorized by the U.S. Food and Drug Administration include Pfizer’s Paxlovid, for people 12 and older, and Merck’s molnupiravir, for adults. Either drug has to be taken within 5 days after symptoms appear to be effective in preventing serious illness.
The need for speed is a major reason why the government chose to work with retail clinics that are more accessible than most primary care offices. However, the American Medical Association (AMA), the National Community Pharmacists Association (NCPA), and the American Pharmacists Association (APhA) have publicly criticized the administration’s approach.
The pharmacists’ groups are concerned that the program is limited only to pharmacies with clinics on site, thus restricting the number of pharmacies qualified to participate. Fourteen pharmacy groups, including the NCPA and the APhA, have also sent a letter to the Biden administration urging it to remove barriers to pharmacies ordering the medications.
The groups also want permission as “clinically trained medication experts” to prescribe the drugs and ensure their safe use.
The AMA on March 4 took issue with the prescribing component, saying that “the pharmacy-based clinic component of the test-to-treat plan flouts patient safety and risks significant negative health outcomes.”
In the AMA’s view, prescribing Paxlovid without a patient’s physician being present poses a risk for adverse drug interactions, as neither the nurse practitioners in retail clinics nor the pharmacists who dispense the drug have full knowledge of a patient›s medical history.
The next day, the AMA released another statement, saying it was reassured by comments from administration officials “that patients who have access to a regular source of care should contact their physician shortly after testing positive for COVID-19 to assess their treatment options.”
“Traditional doctor-only approach”
Having patients call their doctors after testing positive for COVID in a pharmacy “strikes me as unnecessary in the vast majority of cases, and it will delay treatment,” Robert Wachter, MD, professor and chair of the department of medicine at the University of California San Francisco, said in an interview. “In this case, it seems like the AMA is taking a very traditional doctor-only approach. And the world has changed. It’s much more of a team sport than an individual sport, the way it was years ago.”
Dr. Wachter said he has the utmost respect for pharmacists’ ability to screen prescriptions for adverse drug interactions. “We’re required to do medication reconciliation when patients see us,” he says. “And in many hospitals, we delegate that to pharmacists. They’re at least as good at it if not better than physicians are.”
While it’s essential to know what other medications a patient is taking, he noted, pharmacies have computer records of all the prescriptions they’ve filled for patients. In addition, pharmacies have access to complete medication histories through Surescripts, the company that enables electronic prescribing transactions between prescribers and pharmacies.
Drug interactions “not trivial”
Preeti Malani, MD, the chief health officer and a professor of medicine in the division of infectious diseases at the University of Michigan in Ann Arbor, told this news organization that the potential interactions between Paxlovid and some other medications are “not trivial.”
However, she said, “The really dangerous drugs are the ones for people who have had organ transplants and the like. Those aren’t individuals who are going to shop at a pharmacy.”
Besides the antirejection drugs, Dr. Wachter said, there can be serious interactions with cholesterol-lowering medications. If a person is taking Lipitor, for instance, “Someone would have to make the decision on whether it’s ok for me to stop it for a while, or to lower the dose. But I trust the pharmacist to do that as well as anybody.”
Except for these potential drug interactions with Paxlovid, the antiviral medications are “quite safe,” he said, adding that being able to treat people who test positive for COVID-19 right away is a big advantage of the test-to-treat program, considering how difficult it is for many people to get access to a doctor. That delay could mean that the antivirals are not prescribed and taken until they are no longer effective.
Both Dr. Wachter and Dr. Malani said that the widespread distribution of pharmacies and their extended hours are other big pluses, especially for people who can’t easily leave work or travel far to visit a physician.
Dr. Malani cautioned that there are still kinks to work out in the test-to-treat program. It will be a while before the retail clinics all have the antiviral drugs, and many pharmacies don’t have clinics on site.
Still, she said people can still go to their physicians to be tested, and presumably those doctors can also write antiviral prescriptions. But it’s not clear where the antivirals will be available in the near term.
“Right now, we’re playing catch-up,” Dr. Malani said. “But pharmacies are an important piece of the puzzle.”
Looking at the big picture, she said, “We know that neither vaccination nor natural infection provides long lasting immunity, and so there will be a role for antivirals in order to make this a manageable illness. And when you’re talking about millions of cases, as we were having a few months ago, the health system can’t field all those patients. So we do need a system where I can go to a pharmacy and get a test and treatment.”
A version of this article first appeared on Medscape.com.
The Biden administration’s new test-to-treat program is simple on the surface: if you feel like you may have COVID-19, go to a pharmacy, get tested, and, if positive, get treated with an antiviral medication on the spot.
One large physicians’ group is concerned that the program leaves doctors on the margins, and may put patients at risk if there are adverse effects from the medications. Pharmacists groups, on the other hand, say the program is too restrictive, according to an article by the research group Advisory Board.
Recently, the White House announced that more than 1,000 pharmacy clinics across the United States had registered to participate in the initiative, according to CNN. Ordering of the drugs is underway in many of these clinics, a White House official told the network.
Besides retail clinics in chain pharmacies, the antivirals will also be available in community health centers, long-term-care facilities, and Veterans Health Administration clinics, according to a statement from the U.S. Department of Health and Human Services.
The two antiviral pills authorized by the U.S. Food and Drug Administration include Pfizer’s Paxlovid, for people 12 and older, and Merck’s molnupiravir, for adults. Either drug has to be taken within 5 days after symptoms appear to be effective in preventing serious illness.
The need for speed is a major reason why the government chose to work with retail clinics that are more accessible than most primary care offices. However, the American Medical Association (AMA), the National Community Pharmacists Association (NCPA), and the American Pharmacists Association (APhA) have publicly criticized the administration’s approach.
The pharmacists’ groups are concerned that the program is limited only to pharmacies with clinics on site, thus restricting the number of pharmacies qualified to participate. Fourteen pharmacy groups, including the NCPA and the APhA, have also sent a letter to the Biden administration urging it to remove barriers to pharmacies ordering the medications.
The groups also want permission as “clinically trained medication experts” to prescribe the drugs and ensure their safe use.
The AMA on March 4 took issue with the prescribing component, saying that “the pharmacy-based clinic component of the test-to-treat plan flouts patient safety and risks significant negative health outcomes.”
In the AMA’s view, prescribing Paxlovid without a patient’s physician being present poses a risk for adverse drug interactions, as neither the nurse practitioners in retail clinics nor the pharmacists who dispense the drug have full knowledge of a patient›s medical history.
The next day, the AMA released another statement, saying it was reassured by comments from administration officials “that patients who have access to a regular source of care should contact their physician shortly after testing positive for COVID-19 to assess their treatment options.”
“Traditional doctor-only approach”
Having patients call their doctors after testing positive for COVID in a pharmacy “strikes me as unnecessary in the vast majority of cases, and it will delay treatment,” Robert Wachter, MD, professor and chair of the department of medicine at the University of California San Francisco, said in an interview. “In this case, it seems like the AMA is taking a very traditional doctor-only approach. And the world has changed. It’s much more of a team sport than an individual sport, the way it was years ago.”
Dr. Wachter said he has the utmost respect for pharmacists’ ability to screen prescriptions for adverse drug interactions. “We’re required to do medication reconciliation when patients see us,” he says. “And in many hospitals, we delegate that to pharmacists. They’re at least as good at it if not better than physicians are.”
While it’s essential to know what other medications a patient is taking, he noted, pharmacies have computer records of all the prescriptions they’ve filled for patients. In addition, pharmacies have access to complete medication histories through Surescripts, the company that enables electronic prescribing transactions between prescribers and pharmacies.
Drug interactions “not trivial”
Preeti Malani, MD, the chief health officer and a professor of medicine in the division of infectious diseases at the University of Michigan in Ann Arbor, told this news organization that the potential interactions between Paxlovid and some other medications are “not trivial.”
However, she said, “The really dangerous drugs are the ones for people who have had organ transplants and the like. Those aren’t individuals who are going to shop at a pharmacy.”
Besides the antirejection drugs, Dr. Wachter said, there can be serious interactions with cholesterol-lowering medications. If a person is taking Lipitor, for instance, “Someone would have to make the decision on whether it’s ok for me to stop it for a while, or to lower the dose. But I trust the pharmacist to do that as well as anybody.”
Except for these potential drug interactions with Paxlovid, the antiviral medications are “quite safe,” he said, adding that being able to treat people who test positive for COVID-19 right away is a big advantage of the test-to-treat program, considering how difficult it is for many people to get access to a doctor. That delay could mean that the antivirals are not prescribed and taken until they are no longer effective.
Both Dr. Wachter and Dr. Malani said that the widespread distribution of pharmacies and their extended hours are other big pluses, especially for people who can’t easily leave work or travel far to visit a physician.
Dr. Malani cautioned that there are still kinks to work out in the test-to-treat program. It will be a while before the retail clinics all have the antiviral drugs, and many pharmacies don’t have clinics on site.
Still, she said people can still go to their physicians to be tested, and presumably those doctors can also write antiviral prescriptions. But it’s not clear where the antivirals will be available in the near term.
“Right now, we’re playing catch-up,” Dr. Malani said. “But pharmacies are an important piece of the puzzle.”
Looking at the big picture, she said, “We know that neither vaccination nor natural infection provides long lasting immunity, and so there will be a role for antivirals in order to make this a manageable illness. And when you’re talking about millions of cases, as we were having a few months ago, the health system can’t field all those patients. So we do need a system where I can go to a pharmacy and get a test and treatment.”
A version of this article first appeared on Medscape.com.
The Biden administration’s new test-to-treat program is simple on the surface: if you feel like you may have COVID-19, go to a pharmacy, get tested, and, if positive, get treated with an antiviral medication on the spot.
One large physicians’ group is concerned that the program leaves doctors on the margins, and may put patients at risk if there are adverse effects from the medications. Pharmacists groups, on the other hand, say the program is too restrictive, according to an article by the research group Advisory Board.
Recently, the White House announced that more than 1,000 pharmacy clinics across the United States had registered to participate in the initiative, according to CNN. Ordering of the drugs is underway in many of these clinics, a White House official told the network.
Besides retail clinics in chain pharmacies, the antivirals will also be available in community health centers, long-term-care facilities, and Veterans Health Administration clinics, according to a statement from the U.S. Department of Health and Human Services.
The two antiviral pills authorized by the U.S. Food and Drug Administration include Pfizer’s Paxlovid, for people 12 and older, and Merck’s molnupiravir, for adults. Either drug has to be taken within 5 days after symptoms appear to be effective in preventing serious illness.
The need for speed is a major reason why the government chose to work with retail clinics that are more accessible than most primary care offices. However, the American Medical Association (AMA), the National Community Pharmacists Association (NCPA), and the American Pharmacists Association (APhA) have publicly criticized the administration’s approach.
The pharmacists’ groups are concerned that the program is limited only to pharmacies with clinics on site, thus restricting the number of pharmacies qualified to participate. Fourteen pharmacy groups, including the NCPA and the APhA, have also sent a letter to the Biden administration urging it to remove barriers to pharmacies ordering the medications.
The groups also want permission as “clinically trained medication experts” to prescribe the drugs and ensure their safe use.
The AMA on March 4 took issue with the prescribing component, saying that “the pharmacy-based clinic component of the test-to-treat plan flouts patient safety and risks significant negative health outcomes.”
In the AMA’s view, prescribing Paxlovid without a patient’s physician being present poses a risk for adverse drug interactions, as neither the nurse practitioners in retail clinics nor the pharmacists who dispense the drug have full knowledge of a patient›s medical history.
The next day, the AMA released another statement, saying it was reassured by comments from administration officials “that patients who have access to a regular source of care should contact their physician shortly after testing positive for COVID-19 to assess their treatment options.”
“Traditional doctor-only approach”
Having patients call their doctors after testing positive for COVID in a pharmacy “strikes me as unnecessary in the vast majority of cases, and it will delay treatment,” Robert Wachter, MD, professor and chair of the department of medicine at the University of California San Francisco, said in an interview. “In this case, it seems like the AMA is taking a very traditional doctor-only approach. And the world has changed. It’s much more of a team sport than an individual sport, the way it was years ago.”
Dr. Wachter said he has the utmost respect for pharmacists’ ability to screen prescriptions for adverse drug interactions. “We’re required to do medication reconciliation when patients see us,” he says. “And in many hospitals, we delegate that to pharmacists. They’re at least as good at it if not better than physicians are.”
While it’s essential to know what other medications a patient is taking, he noted, pharmacies have computer records of all the prescriptions they’ve filled for patients. In addition, pharmacies have access to complete medication histories through Surescripts, the company that enables electronic prescribing transactions between prescribers and pharmacies.
Drug interactions “not trivial”
Preeti Malani, MD, the chief health officer and a professor of medicine in the division of infectious diseases at the University of Michigan in Ann Arbor, told this news organization that the potential interactions between Paxlovid and some other medications are “not trivial.”
However, she said, “The really dangerous drugs are the ones for people who have had organ transplants and the like. Those aren’t individuals who are going to shop at a pharmacy.”
Besides the antirejection drugs, Dr. Wachter said, there can be serious interactions with cholesterol-lowering medications. If a person is taking Lipitor, for instance, “Someone would have to make the decision on whether it’s ok for me to stop it for a while, or to lower the dose. But I trust the pharmacist to do that as well as anybody.”
Except for these potential drug interactions with Paxlovid, the antiviral medications are “quite safe,” he said, adding that being able to treat people who test positive for COVID-19 right away is a big advantage of the test-to-treat program, considering how difficult it is for many people to get access to a doctor. That delay could mean that the antivirals are not prescribed and taken until they are no longer effective.
Both Dr. Wachter and Dr. Malani said that the widespread distribution of pharmacies and their extended hours are other big pluses, especially for people who can’t easily leave work or travel far to visit a physician.
Dr. Malani cautioned that there are still kinks to work out in the test-to-treat program. It will be a while before the retail clinics all have the antiviral drugs, and many pharmacies don’t have clinics on site.
Still, she said people can still go to their physicians to be tested, and presumably those doctors can also write antiviral prescriptions. But it’s not clear where the antivirals will be available in the near term.
“Right now, we’re playing catch-up,” Dr. Malani said. “But pharmacies are an important piece of the puzzle.”
Looking at the big picture, she said, “We know that neither vaccination nor natural infection provides long lasting immunity, and so there will be a role for antivirals in order to make this a manageable illness. And when you’re talking about millions of cases, as we were having a few months ago, the health system can’t field all those patients. So we do need a system where I can go to a pharmacy and get a test and treatment.”
A version of this article first appeared on Medscape.com.
Which companies aren’t exiting Russia? Big pharma
Even as the war in Ukraine has prompted an exodus of international companies — from fast-food chains and oil producers to luxury retailers — from Russia,
Airlines, automakers, banks, and technology giants — at least 320 companies by one count — are among the businesses curtailing operations or making high-profile exits from Russia as its invasion of Ukraine intensifies. McDonald’s, Starbucks, and Coca-Cola announced a pause in sales recently.
But drugmakers, medical device manufacturers, and health care companies, which are exempted from U.S. and European sanctions, said Russians need access to medicines and medical equipment and contend that international humanitarian law requires they keep supply chains open.
“As a health care company, we have an important purpose, which is why at this time we continue to serve people in all countries in which we operate who depend on us for essential products, some life-sustaining,” said Scott Stoffel, divisional vice president for Illinois-based Abbott Laboratories, which manufactures and sells medicines in Russia for oncology, women’s health, pancreatic insufficiency, and liver health.
Johnson & Johnson — which has corporate offices in Moscow, Novosibirsk, St. Petersburg, and Yekaterinburg — said in a statement, “We remain committed to providing essential health products to those in need in Ukraine, Russia, and the region, in compliance with current sanctions and while adapting to the rapidly changing situation on the ground.”
The reluctance of drugmakers to pause operations in Russia is being met with a growing chorus of criticism.
Pharmaceutical companies that say they must continue to manufacture drugs in Russia for humanitarian reasons are “being misguided at best, cynical in the medium case, and outright deplorably misleading and deceptive,” said Jeffrey Sonnenfeld, DBA, a professor at the Yale School of Management who is tracking which companies have curtailed operations in Russia. He noted that banks and technology companies also provide essential services.
“Russians are put in a tragic position of unearned suffering. If we continue to make life palatable for them, then we are continuing to support the regime,” Dr. Sonnenfeld said. “These drug companies will be seen as complicit with the most vicious operation on the planet. Instead of protecting life, they are going to be seen as destroying life. The goal here is to show that Putin is not in control of all sectors of the economy.”
U.S. pharmaceutical and medical companies have operated in Russia for decades, and many ramped up operations after Russia invaded and annexed Crimea in 2014, navigating the fraught relationship between the United States and Russia amid sanctions. In 2010, Vladimir Putin, then Russian prime minister, announced an ambitious national plan for the Russian pharmaceutical industry that would be a pillar in his efforts to reestablish his country as an influential superpower and wean the country off Western pharmaceutical imports. Under the plan, called “Pharma-2020” and “Pharma-2030,” the government required Western pharmaceutical companies eager to sell to Russia’s growing middle class to locate production inside the country.
Pfizer, Johnson & Johnson, Novartis, and Abbott are among the drugmakers that manufacture pharmaceutical drugs at facilities in St. Petersburg and elsewhere in the country and typically sell those drugs as branded generics or under Russian brands.
Pfizer’s CEO, Albert Bourla, said on CBS that the giant drugmaker is not going to make further investments in Russia, but that it will not cut ties with Russia, as multinational companies in other industries are doing.
Pharmaceutical manufacturing plants in Kaluga, a major manufacturing center for Volkswagen and Volvo southwest of Moscow, have been funded through a partnership between Rusnano, a state-owned venture that promotes the development of high-tech enterprises, and U.S. venture capital firms.
Russia also has sought to position itself as an attractive research market, offering an inexpensive and lax regulatory environment for clinical drug trials. Last year, Pfizer conducted in Russia clinical trials of Paxlovid, its experimental antiviral pill to treat covid-19. Before the invasion began in late February, 3,072 trials were underway in Russia and 503 were underway in Ukraine, according to BioWorld, a reporting hub focused on drug development that features data from Cortellis.
AstraZeneca is the top sponsor of clinical trials in Russia, with 49 trials, followed by a subsidiary of Merck, with 48 trials.
So far, drugmakers’ response to the Ukraine invasion has largely centered on public pledges to donate essential medicines and vaccines to Ukrainian patients and refugees. They’ve also made general comments about the need to keep open the supply of medicines flowing within Russia.
Abbott has pledged $2 million to support humanitarian efforts in Ukraine, and Pfizer, based in New York, said it has supplied $1 million in humanitarian grants. Swiss drug maker Novartis said it was expanding humanitarian efforts in Ukraine and working to “ensure the continued supply of our medicines in Ukraine.”
But no major pharmaceutical or medical device maker has announced plans to shutter manufacturing plants or halt sales inside Russia.
In an open letter, hundreds of leaders of mainly smaller biotechnology companies have called on industry members to cease business activities in Russia, including “investment in Russian companies and new investment within the borders of Russia,” and to halt trade and collaboration with Russian companies, except for supplying food and medicines. How many of the signatories have business operations in Russia was unclear.
Ulrich Neumann, director for market access at Janssen, a Johnson & Johnson company, was among those who signed the letter, but whether he was speaking for the company was unclear. In its own statement posted on social media, the company said it’s “committed to providing access to our essential medical products in the countries where we operate, in compliance with current international sanctions.”
GlaxoSmithKline, headquartered in the United Kingdom, said in a statement that it’s stopping all advertising in Russia and will not enter into contracts that “directly support the Russian administration or military.” But the company said that as a “supplier of needed medicines, vaccines and everyday health products, we have a responsibility to do all we can to make them available. For this reason, we will continue to supply our products to the people of Russia, while we can.”
Nell Minow, vice chair of ValueEdge Advisors, an investment consulting firm, noted that drug companies have been treated differently than other industries during previous global conflicts. For example, some corporate ethicists advised against pharmaceutical companies’ total divestment from South Africa’s apartheid regime to ensure essential medicines flowed to the country.
“There is a difference between a hamburger and a pill,” Mr. Minow said. Companies should strongly condemn Russia’s actions, she said, but unless the United States enters directly into a war with Russia, companies that make essential medicines and health care products should continue to operate. Before U.S. involvement in World War II, she added, there were “some American companies that did business with Germany until the last minute.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. KHN senior correspondent Arthur Allen contributed to this article.
Even as the war in Ukraine has prompted an exodus of international companies — from fast-food chains and oil producers to luxury retailers — from Russia,
Airlines, automakers, banks, and technology giants — at least 320 companies by one count — are among the businesses curtailing operations or making high-profile exits from Russia as its invasion of Ukraine intensifies. McDonald’s, Starbucks, and Coca-Cola announced a pause in sales recently.
But drugmakers, medical device manufacturers, and health care companies, which are exempted from U.S. and European sanctions, said Russians need access to medicines and medical equipment and contend that international humanitarian law requires they keep supply chains open.
“As a health care company, we have an important purpose, which is why at this time we continue to serve people in all countries in which we operate who depend on us for essential products, some life-sustaining,” said Scott Stoffel, divisional vice president for Illinois-based Abbott Laboratories, which manufactures and sells medicines in Russia for oncology, women’s health, pancreatic insufficiency, and liver health.
Johnson & Johnson — which has corporate offices in Moscow, Novosibirsk, St. Petersburg, and Yekaterinburg — said in a statement, “We remain committed to providing essential health products to those in need in Ukraine, Russia, and the region, in compliance with current sanctions and while adapting to the rapidly changing situation on the ground.”
The reluctance of drugmakers to pause operations in Russia is being met with a growing chorus of criticism.
Pharmaceutical companies that say they must continue to manufacture drugs in Russia for humanitarian reasons are “being misguided at best, cynical in the medium case, and outright deplorably misleading and deceptive,” said Jeffrey Sonnenfeld, DBA, a professor at the Yale School of Management who is tracking which companies have curtailed operations in Russia. He noted that banks and technology companies also provide essential services.
“Russians are put in a tragic position of unearned suffering. If we continue to make life palatable for them, then we are continuing to support the regime,” Dr. Sonnenfeld said. “These drug companies will be seen as complicit with the most vicious operation on the planet. Instead of protecting life, they are going to be seen as destroying life. The goal here is to show that Putin is not in control of all sectors of the economy.”
U.S. pharmaceutical and medical companies have operated in Russia for decades, and many ramped up operations after Russia invaded and annexed Crimea in 2014, navigating the fraught relationship between the United States and Russia amid sanctions. In 2010, Vladimir Putin, then Russian prime minister, announced an ambitious national plan for the Russian pharmaceutical industry that would be a pillar in his efforts to reestablish his country as an influential superpower and wean the country off Western pharmaceutical imports. Under the plan, called “Pharma-2020” and “Pharma-2030,” the government required Western pharmaceutical companies eager to sell to Russia’s growing middle class to locate production inside the country.
Pfizer, Johnson & Johnson, Novartis, and Abbott are among the drugmakers that manufacture pharmaceutical drugs at facilities in St. Petersburg and elsewhere in the country and typically sell those drugs as branded generics or under Russian brands.
Pfizer’s CEO, Albert Bourla, said on CBS that the giant drugmaker is not going to make further investments in Russia, but that it will not cut ties with Russia, as multinational companies in other industries are doing.
Pharmaceutical manufacturing plants in Kaluga, a major manufacturing center for Volkswagen and Volvo southwest of Moscow, have been funded through a partnership between Rusnano, a state-owned venture that promotes the development of high-tech enterprises, and U.S. venture capital firms.
Russia also has sought to position itself as an attractive research market, offering an inexpensive and lax regulatory environment for clinical drug trials. Last year, Pfizer conducted in Russia clinical trials of Paxlovid, its experimental antiviral pill to treat covid-19. Before the invasion began in late February, 3,072 trials were underway in Russia and 503 were underway in Ukraine, according to BioWorld, a reporting hub focused on drug development that features data from Cortellis.
AstraZeneca is the top sponsor of clinical trials in Russia, with 49 trials, followed by a subsidiary of Merck, with 48 trials.
So far, drugmakers’ response to the Ukraine invasion has largely centered on public pledges to donate essential medicines and vaccines to Ukrainian patients and refugees. They’ve also made general comments about the need to keep open the supply of medicines flowing within Russia.
Abbott has pledged $2 million to support humanitarian efforts in Ukraine, and Pfizer, based in New York, said it has supplied $1 million in humanitarian grants. Swiss drug maker Novartis said it was expanding humanitarian efforts in Ukraine and working to “ensure the continued supply of our medicines in Ukraine.”
But no major pharmaceutical or medical device maker has announced plans to shutter manufacturing plants or halt sales inside Russia.
In an open letter, hundreds of leaders of mainly smaller biotechnology companies have called on industry members to cease business activities in Russia, including “investment in Russian companies and new investment within the borders of Russia,” and to halt trade and collaboration with Russian companies, except for supplying food and medicines. How many of the signatories have business operations in Russia was unclear.
Ulrich Neumann, director for market access at Janssen, a Johnson & Johnson company, was among those who signed the letter, but whether he was speaking for the company was unclear. In its own statement posted on social media, the company said it’s “committed to providing access to our essential medical products in the countries where we operate, in compliance with current international sanctions.”
GlaxoSmithKline, headquartered in the United Kingdom, said in a statement that it’s stopping all advertising in Russia and will not enter into contracts that “directly support the Russian administration or military.” But the company said that as a “supplier of needed medicines, vaccines and everyday health products, we have a responsibility to do all we can to make them available. For this reason, we will continue to supply our products to the people of Russia, while we can.”
Nell Minow, vice chair of ValueEdge Advisors, an investment consulting firm, noted that drug companies have been treated differently than other industries during previous global conflicts. For example, some corporate ethicists advised against pharmaceutical companies’ total divestment from South Africa’s apartheid regime to ensure essential medicines flowed to the country.
“There is a difference between a hamburger and a pill,” Mr. Minow said. Companies should strongly condemn Russia’s actions, she said, but unless the United States enters directly into a war with Russia, companies that make essential medicines and health care products should continue to operate. Before U.S. involvement in World War II, she added, there were “some American companies that did business with Germany until the last minute.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. KHN senior correspondent Arthur Allen contributed to this article.
Even as the war in Ukraine has prompted an exodus of international companies — from fast-food chains and oil producers to luxury retailers — from Russia,
Airlines, automakers, banks, and technology giants — at least 320 companies by one count — are among the businesses curtailing operations or making high-profile exits from Russia as its invasion of Ukraine intensifies. McDonald’s, Starbucks, and Coca-Cola announced a pause in sales recently.
But drugmakers, medical device manufacturers, and health care companies, which are exempted from U.S. and European sanctions, said Russians need access to medicines and medical equipment and contend that international humanitarian law requires they keep supply chains open.
“As a health care company, we have an important purpose, which is why at this time we continue to serve people in all countries in which we operate who depend on us for essential products, some life-sustaining,” said Scott Stoffel, divisional vice president for Illinois-based Abbott Laboratories, which manufactures and sells medicines in Russia for oncology, women’s health, pancreatic insufficiency, and liver health.
Johnson & Johnson — which has corporate offices in Moscow, Novosibirsk, St. Petersburg, and Yekaterinburg — said in a statement, “We remain committed to providing essential health products to those in need in Ukraine, Russia, and the region, in compliance with current sanctions and while adapting to the rapidly changing situation on the ground.”
The reluctance of drugmakers to pause operations in Russia is being met with a growing chorus of criticism.
Pharmaceutical companies that say they must continue to manufacture drugs in Russia for humanitarian reasons are “being misguided at best, cynical in the medium case, and outright deplorably misleading and deceptive,” said Jeffrey Sonnenfeld, DBA, a professor at the Yale School of Management who is tracking which companies have curtailed operations in Russia. He noted that banks and technology companies also provide essential services.
“Russians are put in a tragic position of unearned suffering. If we continue to make life palatable for them, then we are continuing to support the regime,” Dr. Sonnenfeld said. “These drug companies will be seen as complicit with the most vicious operation on the planet. Instead of protecting life, they are going to be seen as destroying life. The goal here is to show that Putin is not in control of all sectors of the economy.”
U.S. pharmaceutical and medical companies have operated in Russia for decades, and many ramped up operations after Russia invaded and annexed Crimea in 2014, navigating the fraught relationship between the United States and Russia amid sanctions. In 2010, Vladimir Putin, then Russian prime minister, announced an ambitious national plan for the Russian pharmaceutical industry that would be a pillar in his efforts to reestablish his country as an influential superpower and wean the country off Western pharmaceutical imports. Under the plan, called “Pharma-2020” and “Pharma-2030,” the government required Western pharmaceutical companies eager to sell to Russia’s growing middle class to locate production inside the country.
Pfizer, Johnson & Johnson, Novartis, and Abbott are among the drugmakers that manufacture pharmaceutical drugs at facilities in St. Petersburg and elsewhere in the country and typically sell those drugs as branded generics or under Russian brands.
Pfizer’s CEO, Albert Bourla, said on CBS that the giant drugmaker is not going to make further investments in Russia, but that it will not cut ties with Russia, as multinational companies in other industries are doing.
Pharmaceutical manufacturing plants in Kaluga, a major manufacturing center for Volkswagen and Volvo southwest of Moscow, have been funded through a partnership between Rusnano, a state-owned venture that promotes the development of high-tech enterprises, and U.S. venture capital firms.
Russia also has sought to position itself as an attractive research market, offering an inexpensive and lax regulatory environment for clinical drug trials. Last year, Pfizer conducted in Russia clinical trials of Paxlovid, its experimental antiviral pill to treat covid-19. Before the invasion began in late February, 3,072 trials were underway in Russia and 503 were underway in Ukraine, according to BioWorld, a reporting hub focused on drug development that features data from Cortellis.
AstraZeneca is the top sponsor of clinical trials in Russia, with 49 trials, followed by a subsidiary of Merck, with 48 trials.
So far, drugmakers’ response to the Ukraine invasion has largely centered on public pledges to donate essential medicines and vaccines to Ukrainian patients and refugees. They’ve also made general comments about the need to keep open the supply of medicines flowing within Russia.
Abbott has pledged $2 million to support humanitarian efforts in Ukraine, and Pfizer, based in New York, said it has supplied $1 million in humanitarian grants. Swiss drug maker Novartis said it was expanding humanitarian efforts in Ukraine and working to “ensure the continued supply of our medicines in Ukraine.”
But no major pharmaceutical or medical device maker has announced plans to shutter manufacturing plants or halt sales inside Russia.
In an open letter, hundreds of leaders of mainly smaller biotechnology companies have called on industry members to cease business activities in Russia, including “investment in Russian companies and new investment within the borders of Russia,” and to halt trade and collaboration with Russian companies, except for supplying food and medicines. How many of the signatories have business operations in Russia was unclear.
Ulrich Neumann, director for market access at Janssen, a Johnson & Johnson company, was among those who signed the letter, but whether he was speaking for the company was unclear. In its own statement posted on social media, the company said it’s “committed to providing access to our essential medical products in the countries where we operate, in compliance with current international sanctions.”
GlaxoSmithKline, headquartered in the United Kingdom, said in a statement that it’s stopping all advertising in Russia and will not enter into contracts that “directly support the Russian administration or military.” But the company said that as a “supplier of needed medicines, vaccines and everyday health products, we have a responsibility to do all we can to make them available. For this reason, we will continue to supply our products to the people of Russia, while we can.”
Nell Minow, vice chair of ValueEdge Advisors, an investment consulting firm, noted that drug companies have been treated differently than other industries during previous global conflicts. For example, some corporate ethicists advised against pharmaceutical companies’ total divestment from South Africa’s apartheid regime to ensure essential medicines flowed to the country.
“There is a difference between a hamburger and a pill,” Mr. Minow said. Companies should strongly condemn Russia’s actions, she said, but unless the United States enters directly into a war with Russia, companies that make essential medicines and health care products should continue to operate. Before U.S. involvement in World War II, she added, there were “some American companies that did business with Germany until the last minute.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. KHN senior correspondent Arthur Allen contributed to this article.
Addiction expert says CBD may help people cut cannabis use
PARIS – Following the suspension of the decree that banned the sale of cannabidiol (CBD) flowers, raw cannabis is again available in France for over-the-counter sales. The “feel-good” plant is praised for its relaxing properties.
The suspension of the ban, which lasted for 3 weeks, is a mixed blessing for businesses that sell CBD-based products in France. Professional organizations in this booming sector filed a petition with France’s highest administrative court, the Council of State. At the end of January, the court suspended the government decree that banned the sale of cannabis-derived CBD flowers and leaves; however, it has yet to hand down a final decision as to the legality of the decree.
In just a few years, numerous shops have opened across France. They no longer have to settle for selling processed CBD products such as chocolate, oils, cookies – even wine. They can resume the sale of CBD hemp, which mainly comes in clusters of flower buds and can be smoked or used as an infusion.
Cannabis-derived CBD must have less than 0.2% tetrahydrocannabinol (THC) to be considered “feel-good hemp,” which is used in various consumer goods (such as food, cosmetics, and e-cigarette liquids) and is praised for its calming effects. But not all hemp is the same. Medical hemp, which is currently in clinical trials, combines varying doses of CBD and THC. And then there is THC-rich psychotropic hemp, which is illegal to sell.
The government’s decree cites health concerns as a justification for the ban. While uncertainties remain, “research studies have shown that CBD acts on dopamine and serotonin receptors in the brain. ... Therefore, using CBD can produce psychoactive, sedative, and sleep-inducing effects.” In addition to a preventive approach, the authorities cite the difficulties in distinguishing cannabis-derived CBD from THC-rich illegal cannabis – difficulties that complicate efforts in the war on drugs.
The government’s position sows confusion among consumers, who are attracted by the arguments in favor of CBD and intrigued by the promise of the substance’s calming effects. This confusion is heightened by the fact that there are not enough scientific data either to declare that CBD poses a real risk or, alternatively, to confirm that it has beneficial effects. While some studies have suggested that CBD has a potential benefit for treating anxiety, pain, and sleep problems, others suggest that it may instead be a placebo effect.
What actual benefit can be expected from CBD-derived products, in particular from using the plant’s raw extracts? We asked Dan Velea, MD, an addiction psychiatrist in Paris, to give us his thoughts.
What do you think of the government’s position of banning the sale of cannabis-derived CBD flowers and leaves?
Dr. Velea: I don’t understand the reasoning behind this ban. Unlike THC, CBD is not an addictive substance. We’ve suspected that CBD had beneficial effects ever since noting that, just like THC, it could bind to the two types of cannabinoid receptors found in our bodies, CB1 and CB2, but without inducing a psychotropic effect or giving rise to dependence.
The CBD-derived products that are available on the market have infinitesimal amounts of THC – the threshold is 0.2% – which pose no risk. These products seem to be a particularly good alternative for certain at-risk users who are looking for a way that will help them cut down on their use of “traditional” cannabis, which has THC. However, due to a lack of research, the benefits of CBD cannot be confirmed.
Now that the decree’s been suspended, we can leave behind the ideological debate that has been built around cannabis in France. It’s time to focus only on discussions based on science. On that note, we also have to encourage people to do more research into cannabis’s therapeutic value.
You believe that CBD can help people cut down on their cannabis use. Is that based on what you see in your practice as an addiction specialist?
Dr. Velea: Of course, they don’t get the same dazzling effect that’s produced by THC, very high concentrations of which are often found in cannabis. But for them, the sensation they get from CBD is still pleasant. They describe it as having a soothing and fun effect; they quite like it. Given that the vast majority of people use cannabis recreationally, we can consider that this effect is no small benefit.
Even those who are highly dependent prefer to alternate, using CBD during the day and having just one THC joint in the evening. This makes them feel a lot better. In addition, it clearly reduces the health risks. In my opinion, CBD can be viewed as an alternative for people whose cannabis use is problematic. If a patient asks me about it, I give them an unequivocal answer: There are fewer risks associated with CBD than with regular cannabis.
Isn’t there still a risk for abuse? A dose of cannabidiol that shouldn’t be exceeded?
Dr. Velea: Honestly, apart from the harmful effects of smoking CBD, I don’t see any health risks associated with its use. I’ve never had a patient present with complaints after using these products. No one has ever told me that they became addicted or experienced psychotropic effects. There are no changes in behavior, even at high doses. It should be mentioned that World Health Organization experts hold that there’s no abuse or dependence potential associated with the use of pure CBD. Furthermore, they say that the product is generally well tolerated.
What other actual benefits does CBD have? People mention its relaxing, even anxiolytic, effects.
Dr. Velea: CBD-derived products are praised for their relaxing properties, which particularly help improve one’s sleep. It’s a question of knowing whether these are actual benefits or whether a placebo effect is involved here – something that would be enhanced in a person who firmly believes that these products bring about a sense of well-being. Even when CBD is used for pain relief, we can’t rule out the placebo effect as playing an important role in the outcome.
Some patients with serious diseases have been able to find comfort by using CBD. However, because there haven’t been any well-designed randomized studies, we’ve never been able to show clearly that the beneficial effect comes from the product itself. It’s also possible that the soothing, muscle-relaxing effect induced by CBD’s stimulation of cannabinoid receptors is actually what’s helping to relieve the pain. But this has yet to be proved.
So, what position can a doctor take toward patients who express their desire to use CBD-derived products?
Dr. Velea: Without reliable studies to back them up, it’s difficult to say. Also, at the moment, there are legal gray areas that don’t allow doctors to take a position. As a result, users are put at a disadvantage and not given the opportunity to make the choice to use CBD-derived products in an informed manner. Even so, I think that as long as we don’t have scientific data, the use of these products must be limited to recreational use with the aim of bringing about relaxation. In the case of a sleep disorder, for example, doctors can’t replace standard therapeutic management aimed at improving the patient’s sleep cycles. For now, the only genuinely interesting aspect of CBD that I can see is that it makes it possible to cut down on the use of THC-containing cannabis.
A version of this article first appeared on Medscape.com.
PARIS – Following the suspension of the decree that banned the sale of cannabidiol (CBD) flowers, raw cannabis is again available in France for over-the-counter sales. The “feel-good” plant is praised for its relaxing properties.
The suspension of the ban, which lasted for 3 weeks, is a mixed blessing for businesses that sell CBD-based products in France. Professional organizations in this booming sector filed a petition with France’s highest administrative court, the Council of State. At the end of January, the court suspended the government decree that banned the sale of cannabis-derived CBD flowers and leaves; however, it has yet to hand down a final decision as to the legality of the decree.
In just a few years, numerous shops have opened across France. They no longer have to settle for selling processed CBD products such as chocolate, oils, cookies – even wine. They can resume the sale of CBD hemp, which mainly comes in clusters of flower buds and can be smoked or used as an infusion.
Cannabis-derived CBD must have less than 0.2% tetrahydrocannabinol (THC) to be considered “feel-good hemp,” which is used in various consumer goods (such as food, cosmetics, and e-cigarette liquids) and is praised for its calming effects. But not all hemp is the same. Medical hemp, which is currently in clinical trials, combines varying doses of CBD and THC. And then there is THC-rich psychotropic hemp, which is illegal to sell.
The government’s decree cites health concerns as a justification for the ban. While uncertainties remain, “research studies have shown that CBD acts on dopamine and serotonin receptors in the brain. ... Therefore, using CBD can produce psychoactive, sedative, and sleep-inducing effects.” In addition to a preventive approach, the authorities cite the difficulties in distinguishing cannabis-derived CBD from THC-rich illegal cannabis – difficulties that complicate efforts in the war on drugs.
The government’s position sows confusion among consumers, who are attracted by the arguments in favor of CBD and intrigued by the promise of the substance’s calming effects. This confusion is heightened by the fact that there are not enough scientific data either to declare that CBD poses a real risk or, alternatively, to confirm that it has beneficial effects. While some studies have suggested that CBD has a potential benefit for treating anxiety, pain, and sleep problems, others suggest that it may instead be a placebo effect.
What actual benefit can be expected from CBD-derived products, in particular from using the plant’s raw extracts? We asked Dan Velea, MD, an addiction psychiatrist in Paris, to give us his thoughts.
What do you think of the government’s position of banning the sale of cannabis-derived CBD flowers and leaves?
Dr. Velea: I don’t understand the reasoning behind this ban. Unlike THC, CBD is not an addictive substance. We’ve suspected that CBD had beneficial effects ever since noting that, just like THC, it could bind to the two types of cannabinoid receptors found in our bodies, CB1 and CB2, but without inducing a psychotropic effect or giving rise to dependence.
The CBD-derived products that are available on the market have infinitesimal amounts of THC – the threshold is 0.2% – which pose no risk. These products seem to be a particularly good alternative for certain at-risk users who are looking for a way that will help them cut down on their use of “traditional” cannabis, which has THC. However, due to a lack of research, the benefits of CBD cannot be confirmed.
Now that the decree’s been suspended, we can leave behind the ideological debate that has been built around cannabis in France. It’s time to focus only on discussions based on science. On that note, we also have to encourage people to do more research into cannabis’s therapeutic value.
You believe that CBD can help people cut down on their cannabis use. Is that based on what you see in your practice as an addiction specialist?
Dr. Velea: Of course, they don’t get the same dazzling effect that’s produced by THC, very high concentrations of which are often found in cannabis. But for them, the sensation they get from CBD is still pleasant. They describe it as having a soothing and fun effect; they quite like it. Given that the vast majority of people use cannabis recreationally, we can consider that this effect is no small benefit.
Even those who are highly dependent prefer to alternate, using CBD during the day and having just one THC joint in the evening. This makes them feel a lot better. In addition, it clearly reduces the health risks. In my opinion, CBD can be viewed as an alternative for people whose cannabis use is problematic. If a patient asks me about it, I give them an unequivocal answer: There are fewer risks associated with CBD than with regular cannabis.
Isn’t there still a risk for abuse? A dose of cannabidiol that shouldn’t be exceeded?
Dr. Velea: Honestly, apart from the harmful effects of smoking CBD, I don’t see any health risks associated with its use. I’ve never had a patient present with complaints after using these products. No one has ever told me that they became addicted or experienced psychotropic effects. There are no changes in behavior, even at high doses. It should be mentioned that World Health Organization experts hold that there’s no abuse or dependence potential associated with the use of pure CBD. Furthermore, they say that the product is generally well tolerated.
What other actual benefits does CBD have? People mention its relaxing, even anxiolytic, effects.
Dr. Velea: CBD-derived products are praised for their relaxing properties, which particularly help improve one’s sleep. It’s a question of knowing whether these are actual benefits or whether a placebo effect is involved here – something that would be enhanced in a person who firmly believes that these products bring about a sense of well-being. Even when CBD is used for pain relief, we can’t rule out the placebo effect as playing an important role in the outcome.
Some patients with serious diseases have been able to find comfort by using CBD. However, because there haven’t been any well-designed randomized studies, we’ve never been able to show clearly that the beneficial effect comes from the product itself. It’s also possible that the soothing, muscle-relaxing effect induced by CBD’s stimulation of cannabinoid receptors is actually what’s helping to relieve the pain. But this has yet to be proved.
So, what position can a doctor take toward patients who express their desire to use CBD-derived products?
Dr. Velea: Without reliable studies to back them up, it’s difficult to say. Also, at the moment, there are legal gray areas that don’t allow doctors to take a position. As a result, users are put at a disadvantage and not given the opportunity to make the choice to use CBD-derived products in an informed manner. Even so, I think that as long as we don’t have scientific data, the use of these products must be limited to recreational use with the aim of bringing about relaxation. In the case of a sleep disorder, for example, doctors can’t replace standard therapeutic management aimed at improving the patient’s sleep cycles. For now, the only genuinely interesting aspect of CBD that I can see is that it makes it possible to cut down on the use of THC-containing cannabis.
A version of this article first appeared on Medscape.com.
PARIS – Following the suspension of the decree that banned the sale of cannabidiol (CBD) flowers, raw cannabis is again available in France for over-the-counter sales. The “feel-good” plant is praised for its relaxing properties.
The suspension of the ban, which lasted for 3 weeks, is a mixed blessing for businesses that sell CBD-based products in France. Professional organizations in this booming sector filed a petition with France’s highest administrative court, the Council of State. At the end of January, the court suspended the government decree that banned the sale of cannabis-derived CBD flowers and leaves; however, it has yet to hand down a final decision as to the legality of the decree.
In just a few years, numerous shops have opened across France. They no longer have to settle for selling processed CBD products such as chocolate, oils, cookies – even wine. They can resume the sale of CBD hemp, which mainly comes in clusters of flower buds and can be smoked or used as an infusion.
Cannabis-derived CBD must have less than 0.2% tetrahydrocannabinol (THC) to be considered “feel-good hemp,” which is used in various consumer goods (such as food, cosmetics, and e-cigarette liquids) and is praised for its calming effects. But not all hemp is the same. Medical hemp, which is currently in clinical trials, combines varying doses of CBD and THC. And then there is THC-rich psychotropic hemp, which is illegal to sell.
The government’s decree cites health concerns as a justification for the ban. While uncertainties remain, “research studies have shown that CBD acts on dopamine and serotonin receptors in the brain. ... Therefore, using CBD can produce psychoactive, sedative, and sleep-inducing effects.” In addition to a preventive approach, the authorities cite the difficulties in distinguishing cannabis-derived CBD from THC-rich illegal cannabis – difficulties that complicate efforts in the war on drugs.
The government’s position sows confusion among consumers, who are attracted by the arguments in favor of CBD and intrigued by the promise of the substance’s calming effects. This confusion is heightened by the fact that there are not enough scientific data either to declare that CBD poses a real risk or, alternatively, to confirm that it has beneficial effects. While some studies have suggested that CBD has a potential benefit for treating anxiety, pain, and sleep problems, others suggest that it may instead be a placebo effect.
What actual benefit can be expected from CBD-derived products, in particular from using the plant’s raw extracts? We asked Dan Velea, MD, an addiction psychiatrist in Paris, to give us his thoughts.
What do you think of the government’s position of banning the sale of cannabis-derived CBD flowers and leaves?
Dr. Velea: I don’t understand the reasoning behind this ban. Unlike THC, CBD is not an addictive substance. We’ve suspected that CBD had beneficial effects ever since noting that, just like THC, it could bind to the two types of cannabinoid receptors found in our bodies, CB1 and CB2, but without inducing a psychotropic effect or giving rise to dependence.
The CBD-derived products that are available on the market have infinitesimal amounts of THC – the threshold is 0.2% – which pose no risk. These products seem to be a particularly good alternative for certain at-risk users who are looking for a way that will help them cut down on their use of “traditional” cannabis, which has THC. However, due to a lack of research, the benefits of CBD cannot be confirmed.
Now that the decree’s been suspended, we can leave behind the ideological debate that has been built around cannabis in France. It’s time to focus only on discussions based on science. On that note, we also have to encourage people to do more research into cannabis’s therapeutic value.
You believe that CBD can help people cut down on their cannabis use. Is that based on what you see in your practice as an addiction specialist?
Dr. Velea: Of course, they don’t get the same dazzling effect that’s produced by THC, very high concentrations of which are often found in cannabis. But for them, the sensation they get from CBD is still pleasant. They describe it as having a soothing and fun effect; they quite like it. Given that the vast majority of people use cannabis recreationally, we can consider that this effect is no small benefit.
Even those who are highly dependent prefer to alternate, using CBD during the day and having just one THC joint in the evening. This makes them feel a lot better. In addition, it clearly reduces the health risks. In my opinion, CBD can be viewed as an alternative for people whose cannabis use is problematic. If a patient asks me about it, I give them an unequivocal answer: There are fewer risks associated with CBD than with regular cannabis.
Isn’t there still a risk for abuse? A dose of cannabidiol that shouldn’t be exceeded?
Dr. Velea: Honestly, apart from the harmful effects of smoking CBD, I don’t see any health risks associated with its use. I’ve never had a patient present with complaints after using these products. No one has ever told me that they became addicted or experienced psychotropic effects. There are no changes in behavior, even at high doses. It should be mentioned that World Health Organization experts hold that there’s no abuse or dependence potential associated with the use of pure CBD. Furthermore, they say that the product is generally well tolerated.
What other actual benefits does CBD have? People mention its relaxing, even anxiolytic, effects.
Dr. Velea: CBD-derived products are praised for their relaxing properties, which particularly help improve one’s sleep. It’s a question of knowing whether these are actual benefits or whether a placebo effect is involved here – something that would be enhanced in a person who firmly believes that these products bring about a sense of well-being. Even when CBD is used for pain relief, we can’t rule out the placebo effect as playing an important role in the outcome.
Some patients with serious diseases have been able to find comfort by using CBD. However, because there haven’t been any well-designed randomized studies, we’ve never been able to show clearly that the beneficial effect comes from the product itself. It’s also possible that the soothing, muscle-relaxing effect induced by CBD’s stimulation of cannabinoid receptors is actually what’s helping to relieve the pain. But this has yet to be proved.
So, what position can a doctor take toward patients who express their desire to use CBD-derived products?
Dr. Velea: Without reliable studies to back them up, it’s difficult to say. Also, at the moment, there are legal gray areas that don’t allow doctors to take a position. As a result, users are put at a disadvantage and not given the opportunity to make the choice to use CBD-derived products in an informed manner. Even so, I think that as long as we don’t have scientific data, the use of these products must be limited to recreational use with the aim of bringing about relaxation. In the case of a sleep disorder, for example, doctors can’t replace standard therapeutic management aimed at improving the patient’s sleep cycles. For now, the only genuinely interesting aspect of CBD that I can see is that it makes it possible to cut down on the use of THC-containing cannabis.
A version of this article first appeared on Medscape.com.
Victor Test, MD, FCCP, receives Medal of Valor from AMA
The American Medical Association (AMA) honored CHEST Board Member Victor J. Test, MD, FCCP, with the AMA Medal of Valor for his work on behalf of patients and his community during the COVID-19 pandemic.
The award, which recognizes physicians who demonstrate courage under extraordinary circumstances, was presented to Dr. Test because of his quick decisive actions during the onset of the pandemic, including personally securing personal protective equipment to supply the critical care faculty and fellows at the Texas Tech University hospital in Lubbock and building plexiglass and PVC chambers for the physicians and nursing staff caring for patients with COVID-19.
Read more here.
The American Medical Association (AMA) honored CHEST Board Member Victor J. Test, MD, FCCP, with the AMA Medal of Valor for his work on behalf of patients and his community during the COVID-19 pandemic.
The award, which recognizes physicians who demonstrate courage under extraordinary circumstances, was presented to Dr. Test because of his quick decisive actions during the onset of the pandemic, including personally securing personal protective equipment to supply the critical care faculty and fellows at the Texas Tech University hospital in Lubbock and building plexiglass and PVC chambers for the physicians and nursing staff caring for patients with COVID-19.
Read more here.
The American Medical Association (AMA) honored CHEST Board Member Victor J. Test, MD, FCCP, with the AMA Medal of Valor for his work on behalf of patients and his community during the COVID-19 pandemic.
The award, which recognizes physicians who demonstrate courage under extraordinary circumstances, was presented to Dr. Test because of his quick decisive actions during the onset of the pandemic, including personally securing personal protective equipment to supply the critical care faculty and fellows at the Texas Tech University hospital in Lubbock and building plexiglass and PVC chambers for the physicians and nursing staff caring for patients with COVID-19.
Read more here.
Off to the races with The CHEST Foundation
The CHEST Foundation cordially invites CHEST members and colleagues, health care professionals, and others to champion lung health and attend the annual Belmont Stakes Dinner and Auction, Saturday, June 11, in New York at the beautiful Water Club overlooking the East River.
Hosted by CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, this year’s celebration will include a lively cocktail reception, a silent and live auction, dinner, and a rooftop after-party for young professionals to network with colleagues and CHEST leadership and take the challenge for a chance to win great prizes, including a Peloton, ultrasound machine, and access to CHEST courses and events. Fully immerse yourself in the event, and wear your race-day best!
This year, we are honoring two outstanding patients and advocates, Betsy Glaeser and Fred Schick, for their remarkable achievements in patient empowerment and access. Glaeser, who was diagnosed with nontuberculous mycobacteria (disease NTM) more than 20 years ago, pioneered opportunities for NTM-specific research funding and runs a hundreds-strong support group for people with NTM and bronchiectasis. Schick, who has pulmonary fibrosis, is an active ambassador in the patient community in Chicago and also leads local support groups for others with the disease.
All proceeds from the evening’s events will benefit the CHEST Foundation’s continued work toward bringing impactful, informative resources to patients.
As the patient-focused philanthropic arm of the American College of Chest Physicians, the CHEST Foundation is on a mission to champion lung health and strives to give health care professionals, patients, and caregivers opportunities to come together, give back, and advocate for change.
Since its inception, the Foundation has provided more than $8 million in research grants and $3 million in community grants, created free patient education resources for more than 80 disease states, and provided thousands of units of personal protective equipment and $1 million for pandemic relief efforts through COVID-19 Reaction Microgrants.
Support the continued work of the Foundation – and watch some of the most exciting few minutes in sports among colleagues and friends – at this year’s Belmont Stakes Dinner and Auction. To purchase a ticket, or to learn more about sponsorship benefits or underwriting opportunities, contact Angela Perillo at [email protected] or +1 (224) 521-9520.
The CHEST Foundation cordially invites CHEST members and colleagues, health care professionals, and others to champion lung health and attend the annual Belmont Stakes Dinner and Auction, Saturday, June 11, in New York at the beautiful Water Club overlooking the East River.
Hosted by CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, this year’s celebration will include a lively cocktail reception, a silent and live auction, dinner, and a rooftop after-party for young professionals to network with colleagues and CHEST leadership and take the challenge for a chance to win great prizes, including a Peloton, ultrasound machine, and access to CHEST courses and events. Fully immerse yourself in the event, and wear your race-day best!
This year, we are honoring two outstanding patients and advocates, Betsy Glaeser and Fred Schick, for their remarkable achievements in patient empowerment and access. Glaeser, who was diagnosed with nontuberculous mycobacteria (disease NTM) more than 20 years ago, pioneered opportunities for NTM-specific research funding and runs a hundreds-strong support group for people with NTM and bronchiectasis. Schick, who has pulmonary fibrosis, is an active ambassador in the patient community in Chicago and also leads local support groups for others with the disease.
All proceeds from the evening’s events will benefit the CHEST Foundation’s continued work toward bringing impactful, informative resources to patients.
As the patient-focused philanthropic arm of the American College of Chest Physicians, the CHEST Foundation is on a mission to champion lung health and strives to give health care professionals, patients, and caregivers opportunities to come together, give back, and advocate for change.
Since its inception, the Foundation has provided more than $8 million in research grants and $3 million in community grants, created free patient education resources for more than 80 disease states, and provided thousands of units of personal protective equipment and $1 million for pandemic relief efforts through COVID-19 Reaction Microgrants.
Support the continued work of the Foundation – and watch some of the most exciting few minutes in sports among colleagues and friends – at this year’s Belmont Stakes Dinner and Auction. To purchase a ticket, or to learn more about sponsorship benefits or underwriting opportunities, contact Angela Perillo at [email protected] or +1 (224) 521-9520.
The CHEST Foundation cordially invites CHEST members and colleagues, health care professionals, and others to champion lung health and attend the annual Belmont Stakes Dinner and Auction, Saturday, June 11, in New York at the beautiful Water Club overlooking the East River.
Hosted by CHEST President-Elect Doreen Addrizzo-Harris, MD, FCCP, this year’s celebration will include a lively cocktail reception, a silent and live auction, dinner, and a rooftop after-party for young professionals to network with colleagues and CHEST leadership and take the challenge for a chance to win great prizes, including a Peloton, ultrasound machine, and access to CHEST courses and events. Fully immerse yourself in the event, and wear your race-day best!
This year, we are honoring two outstanding patients and advocates, Betsy Glaeser and Fred Schick, for their remarkable achievements in patient empowerment and access. Glaeser, who was diagnosed with nontuberculous mycobacteria (disease NTM) more than 20 years ago, pioneered opportunities for NTM-specific research funding and runs a hundreds-strong support group for people with NTM and bronchiectasis. Schick, who has pulmonary fibrosis, is an active ambassador in the patient community in Chicago and also leads local support groups for others with the disease.
All proceeds from the evening’s events will benefit the CHEST Foundation’s continued work toward bringing impactful, informative resources to patients.
As the patient-focused philanthropic arm of the American College of Chest Physicians, the CHEST Foundation is on a mission to champion lung health and strives to give health care professionals, patients, and caregivers opportunities to come together, give back, and advocate for change.
Since its inception, the Foundation has provided more than $8 million in research grants and $3 million in community grants, created free patient education resources for more than 80 disease states, and provided thousands of units of personal protective equipment and $1 million for pandemic relief efforts through COVID-19 Reaction Microgrants.
Support the continued work of the Foundation – and watch some of the most exciting few minutes in sports among colleagues and friends – at this year’s Belmont Stakes Dinner and Auction. To purchase a ticket, or to learn more about sponsorship benefits or underwriting opportunities, contact Angela Perillo at [email protected] or +1 (224) 521-9520.
Chest Infections and Disaster Response
Addressing disparities of socioeconomic status, race, and education in vaccine hesitancy and uptake
Vaccine hesitancy is described by the World Health Organization (WHO) as a “delay in acceptance or refusal of vaccination, despite availability of vaccine services.”1 Disparities in COVID-19 vaccine uptake, in addition to preexisting views of vaccine hesitancy, are consistently in the mainstream news.
The United States has a high rate of vaccine hesitancy, with a third of the country surveyed in 2021 stating they were unlikely to become vaccinated against COVID-19.2 This is in contrast to over 90% of people in Australia, China, and Norway saying they were highly likely to become vaccinated. Prepandemic, however, vaccination rates for preventable respiratory illness were already suboptimal. In fact, in 2019, the WHO declared vaccine hesitancy a top 10 priority due to the threat low vaccination causes on a global level.1
U.S. health care systems’ cost to patients may serve as a disincentive for health care utilization, decreasing health care contacts. Further, changes in insurance can lead to provider discontinuity, which may erode the trusted patient-physician relationship. These realities may contribute to vaccine hesitancy that has been inversely correlated to both number of health care visits and trust in health care providers. Vaccine hesitancy exacerbates health disparities.1 Health literacy (understanding of health), education level, and general vaccine knowledge contribute to vaccine hesitancy also. Additionally, high social vulnerability (a score calculated from factors related to socioeconomic status, race, household makeup, housing type, and transportation) is strongly inversely correlated with vaccination rates. In places with both high social vulnerability and vaccine hesitancy, the vaccine-hesitant individuals have far fewer vaccinations.3
Providers can impact vaccine uptake. Broadly, efforts to understand and address issues of trust in health care are needed. Educational materials should be disseminated to high-risk and medically underserved communities. At medical appointments, assessment of vaccination status, followed by providing individualized information regarding vaccine benefits and specific concerns may help increase uptake. In a survey of high-risk adults, only 14.8 and 18.5% of patients stated that the pneumococcal vaccine was offered to them in the last year and 5 years, respectively.1 Providers can have a strong impact on people obtaining vaccines; over half of patients receive vaccines when their provider recommends it.1,4 As a medical community focused on respiratory health, we need to prioritize offering vaccinations during inpatient and outpatient encounters.
By Jamie R. Felzer, MD, MPH
Network Member
Cassie C. Kennedy, MD, FCCP
Vice Chair, Council of Networks
Dr. Felzer is a Fellow and Dr. Kennedy is Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
References
1. Gatwood J et al. Am J Health Promot. 2021;35:908.
2. Wong LP et al. Infect Dis Poverty. 2021;10:122.
3. Crane MA et al. Health Aff (Millwood). 2021;40:1792.
4. Strully KW et al. Front Public Health. 2021;9:645268.
Addressing disparities of socioeconomic status, race, and education in vaccine hesitancy and uptake
Vaccine hesitancy is described by the World Health Organization (WHO) as a “delay in acceptance or refusal of vaccination, despite availability of vaccine services.”1 Disparities in COVID-19 vaccine uptake, in addition to preexisting views of vaccine hesitancy, are consistently in the mainstream news.
The United States has a high rate of vaccine hesitancy, with a third of the country surveyed in 2021 stating they were unlikely to become vaccinated against COVID-19.2 This is in contrast to over 90% of people in Australia, China, and Norway saying they were highly likely to become vaccinated. Prepandemic, however, vaccination rates for preventable respiratory illness were already suboptimal. In fact, in 2019, the WHO declared vaccine hesitancy a top 10 priority due to the threat low vaccination causes on a global level.1
U.S. health care systems’ cost to patients may serve as a disincentive for health care utilization, decreasing health care contacts. Further, changes in insurance can lead to provider discontinuity, which may erode the trusted patient-physician relationship. These realities may contribute to vaccine hesitancy that has been inversely correlated to both number of health care visits and trust in health care providers. Vaccine hesitancy exacerbates health disparities.1 Health literacy (understanding of health), education level, and general vaccine knowledge contribute to vaccine hesitancy also. Additionally, high social vulnerability (a score calculated from factors related to socioeconomic status, race, household makeup, housing type, and transportation) is strongly inversely correlated with vaccination rates. In places with both high social vulnerability and vaccine hesitancy, the vaccine-hesitant individuals have far fewer vaccinations.3
Providers can impact vaccine uptake. Broadly, efforts to understand and address issues of trust in health care are needed. Educational materials should be disseminated to high-risk and medically underserved communities. At medical appointments, assessment of vaccination status, followed by providing individualized information regarding vaccine benefits and specific concerns may help increase uptake. In a survey of high-risk adults, only 14.8 and 18.5% of patients stated that the pneumococcal vaccine was offered to them in the last year and 5 years, respectively.1 Providers can have a strong impact on people obtaining vaccines; over half of patients receive vaccines when their provider recommends it.1,4 As a medical community focused on respiratory health, we need to prioritize offering vaccinations during inpatient and outpatient encounters.
By Jamie R. Felzer, MD, MPH
Network Member
Cassie C. Kennedy, MD, FCCP
Vice Chair, Council of Networks
Dr. Felzer is a Fellow and Dr. Kennedy is Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
References
1. Gatwood J et al. Am J Health Promot. 2021;35:908.
2. Wong LP et al. Infect Dis Poverty. 2021;10:122.
3. Crane MA et al. Health Aff (Millwood). 2021;40:1792.
4. Strully KW et al. Front Public Health. 2021;9:645268.
Addressing disparities of socioeconomic status, race, and education in vaccine hesitancy and uptake
Vaccine hesitancy is described by the World Health Organization (WHO) as a “delay in acceptance or refusal of vaccination, despite availability of vaccine services.”1 Disparities in COVID-19 vaccine uptake, in addition to preexisting views of vaccine hesitancy, are consistently in the mainstream news.
The United States has a high rate of vaccine hesitancy, with a third of the country surveyed in 2021 stating they were unlikely to become vaccinated against COVID-19.2 This is in contrast to over 90% of people in Australia, China, and Norway saying they were highly likely to become vaccinated. Prepandemic, however, vaccination rates for preventable respiratory illness were already suboptimal. In fact, in 2019, the WHO declared vaccine hesitancy a top 10 priority due to the threat low vaccination causes on a global level.1
U.S. health care systems’ cost to patients may serve as a disincentive for health care utilization, decreasing health care contacts. Further, changes in insurance can lead to provider discontinuity, which may erode the trusted patient-physician relationship. These realities may contribute to vaccine hesitancy that has been inversely correlated to both number of health care visits and trust in health care providers. Vaccine hesitancy exacerbates health disparities.1 Health literacy (understanding of health), education level, and general vaccine knowledge contribute to vaccine hesitancy also. Additionally, high social vulnerability (a score calculated from factors related to socioeconomic status, race, household makeup, housing type, and transportation) is strongly inversely correlated with vaccination rates. In places with both high social vulnerability and vaccine hesitancy, the vaccine-hesitant individuals have far fewer vaccinations.3
Providers can impact vaccine uptake. Broadly, efforts to understand and address issues of trust in health care are needed. Educational materials should be disseminated to high-risk and medically underserved communities. At medical appointments, assessment of vaccination status, followed by providing individualized information regarding vaccine benefits and specific concerns may help increase uptake. In a survey of high-risk adults, only 14.8 and 18.5% of patients stated that the pneumococcal vaccine was offered to them in the last year and 5 years, respectively.1 Providers can have a strong impact on people obtaining vaccines; over half of patients receive vaccines when their provider recommends it.1,4 As a medical community focused on respiratory health, we need to prioritize offering vaccinations during inpatient and outpatient encounters.
By Jamie R. Felzer, MD, MPH
Network Member
Cassie C. Kennedy, MD, FCCP
Vice Chair, Council of Networks
Dr. Felzer is a Fellow and Dr. Kennedy is Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
References
1. Gatwood J et al. Am J Health Promot. 2021;35:908.
2. Wong LP et al. Infect Dis Poverty. 2021;10:122.
3. Crane MA et al. Health Aff (Millwood). 2021;40:1792.
4. Strully KW et al. Front Public Health. 2021;9:645268.
FeNO guidelines. Marijuana use in pregnancy.
Airway disorders
FeNO guidelines and the art of clinical medicine
The American Thoracic Society (ATS) recently published new guidelines on the use of fractional exhaled nitric oxide (FeNO) in the management of asthma (Khatri S. Am J Respir Crit Care Med. 2021;204[10]:e97-e109). The previous iteration dealt with questions about the interpretation of FeNO levels. However, the updated guidelines address a single question: Should patients with asthma in whom treatment is being contemplated undergo FeNO testing?
Several roles of nitric oxide (NO) have been discovered, including as a marker of eosinophilic airway inflammation or T2-inflammation. The fraction of NO during steady-state exhalation, easily measured by a handheld device, is a standardized quantitative noninvasive method to assess severity of airway eosinophilic inflammation. However, factors like concomitant sinusitis, bronchoconstriction, obesity, and smoking can also affect FeNO levels, and interpretation is context-dependent. Moreover, some biologic agents have variable effects on FeNO while still being effective in controlling T2 inflammation. Therefore, FeNO is neither the broadest nor the most sensitive signal of T2 inflammation, and there is much unknown about using FeNO to guide asthma treatment. Heterogeneity is one of the many challenges, as different endotypes and clinical subsets vary in the inflammatory pathways leading to airway hyperresponsiveness and remodeling.
The panel assessed the value of FeNO testing in improving asthma control questionnaire scores (ACT, ACQ-7), oral corticosteroid use, asthma exacerbations, lung function, health care utilization, and cost-effectiveness. FeNO-guided therapy compared with therapy without FeNO reduced exacerbations and oral corticosteroid use, though effect size was modest. Among other outcomes, while the trend favored FeNO, it did not reach statistical significance. Adverse effects of FeNO testing were trivial, and the cost is moderate though dependent on the institution size and testing frequency. Thus, for clinicians who manage adults and children 4 years of age and older, in whom treatment for asthma is being considered, it is suggested that FeNO testing be done in addition to usual care. The guidelines do not recommend specific steps to modify treatment based on FeNO results but suggest a decision framework, reminding us that clinical context is key and FeNO is merely one signal. In recognizing its own fallibility, this document suggests that in the continually evolving world of asthma, the art of clinical medicine still reigns supreme.
Uddalak Majumdar, MDDr. Majumdar is a Fellow, Pulmonary & Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Sleep medicine
Marijuana use in pregnancy
Marijuana is the most commonly used illegal drug in the United States. According to the CDC, about 1 in 20 women report using marijuana while pregnant (https://www.cdc.gov/marijuana/health-effects/pregnancy.html). As states legalize marijuana for medicinal or recreational purposes, its use by pregnant women could increase even further. While some use it to ease morning sickness and anxiety, they may not be aware that it can pose risks.
Research has been raising concerns about the effects of marijuana use during pregnancy for years. A study from 1978 linked maternal cannabis use with children’s behavioral problems and deficits in language comprehension, visual perception, attention, and memory (Life Sci. 1995;56[23-24]:2159-68). ). More recent research has linked use to low birth weight, reduced IQ, autism, delusional thoughts, and attention problems, although some other studies have not identified such associations.
A new study shows that children of women who use marijuana during or soon after pregnancy were twice as likely to become anxious, aggressive, or hyperactive. This corresponded with widespread reductions in immune-related gene expression in the placenta, which correlated with anxiety and hyperactivity (Proc National Acad Sci. 2021;118[47]e2106115118).
Chemicals from marijuana can be passed to the baby through breast milk. THC is stored in body fat and slowly released over time. Exposure could still occur even after stopping use (Marijuana use during pregnancy and lactation. ACOG Committee Opinion, Number 722, October 2017).
Studies have shown that THC can pass through the mother’s bloodstream to the placenta and the fetus. This occurs independent of how cannabis is consumed (smoking, vaping, eating, or oils/creams). Patients should be educated that no amount has been proven safe to use during pregnancy or breastfeeding.
Anita Rajagopal, MD, FCCP, Respiratory-Related Sleep Disorders Section, Member-at-Large
Dr. Rajagopal is Network Medical Director, Community Physician Network, Sleep Medicine/Medical Director, Community Health Network Sleep-Wake Disorders Center, Community Health Network, Indianapolis, Indiana.
Airway disorders
FeNO guidelines and the art of clinical medicine
The American Thoracic Society (ATS) recently published new guidelines on the use of fractional exhaled nitric oxide (FeNO) in the management of asthma (Khatri S. Am J Respir Crit Care Med. 2021;204[10]:e97-e109). The previous iteration dealt with questions about the interpretation of FeNO levels. However, the updated guidelines address a single question: Should patients with asthma in whom treatment is being contemplated undergo FeNO testing?
Several roles of nitric oxide (NO) have been discovered, including as a marker of eosinophilic airway inflammation or T2-inflammation. The fraction of NO during steady-state exhalation, easily measured by a handheld device, is a standardized quantitative noninvasive method to assess severity of airway eosinophilic inflammation. However, factors like concomitant sinusitis, bronchoconstriction, obesity, and smoking can also affect FeNO levels, and interpretation is context-dependent. Moreover, some biologic agents have variable effects on FeNO while still being effective in controlling T2 inflammation. Therefore, FeNO is neither the broadest nor the most sensitive signal of T2 inflammation, and there is much unknown about using FeNO to guide asthma treatment. Heterogeneity is one of the many challenges, as different endotypes and clinical subsets vary in the inflammatory pathways leading to airway hyperresponsiveness and remodeling.
The panel assessed the value of FeNO testing in improving asthma control questionnaire scores (ACT, ACQ-7), oral corticosteroid use, asthma exacerbations, lung function, health care utilization, and cost-effectiveness. FeNO-guided therapy compared with therapy without FeNO reduced exacerbations and oral corticosteroid use, though effect size was modest. Among other outcomes, while the trend favored FeNO, it did not reach statistical significance. Adverse effects of FeNO testing were trivial, and the cost is moderate though dependent on the institution size and testing frequency. Thus, for clinicians who manage adults and children 4 years of age and older, in whom treatment for asthma is being considered, it is suggested that FeNO testing be done in addition to usual care. The guidelines do not recommend specific steps to modify treatment based on FeNO results but suggest a decision framework, reminding us that clinical context is key and FeNO is merely one signal. In recognizing its own fallibility, this document suggests that in the continually evolving world of asthma, the art of clinical medicine still reigns supreme.
Uddalak Majumdar, MDDr. Majumdar is a Fellow, Pulmonary & Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Sleep medicine
Marijuana use in pregnancy
Marijuana is the most commonly used illegal drug in the United States. According to the CDC, about 1 in 20 women report using marijuana while pregnant (https://www.cdc.gov/marijuana/health-effects/pregnancy.html). As states legalize marijuana for medicinal or recreational purposes, its use by pregnant women could increase even further. While some use it to ease morning sickness and anxiety, they may not be aware that it can pose risks.
Research has been raising concerns about the effects of marijuana use during pregnancy for years. A study from 1978 linked maternal cannabis use with children’s behavioral problems and deficits in language comprehension, visual perception, attention, and memory (Life Sci. 1995;56[23-24]:2159-68). ). More recent research has linked use to low birth weight, reduced IQ, autism, delusional thoughts, and attention problems, although some other studies have not identified such associations.
A new study shows that children of women who use marijuana during or soon after pregnancy were twice as likely to become anxious, aggressive, or hyperactive. This corresponded with widespread reductions in immune-related gene expression in the placenta, which correlated with anxiety and hyperactivity (Proc National Acad Sci. 2021;118[47]e2106115118).
Chemicals from marijuana can be passed to the baby through breast milk. THC is stored in body fat and slowly released over time. Exposure could still occur even after stopping use (Marijuana use during pregnancy and lactation. ACOG Committee Opinion, Number 722, October 2017).
Studies have shown that THC can pass through the mother’s bloodstream to the placenta and the fetus. This occurs independent of how cannabis is consumed (smoking, vaping, eating, or oils/creams). Patients should be educated that no amount has been proven safe to use during pregnancy or breastfeeding.
Anita Rajagopal, MD, FCCP, Respiratory-Related Sleep Disorders Section, Member-at-Large
Dr. Rajagopal is Network Medical Director, Community Physician Network, Sleep Medicine/Medical Director, Community Health Network Sleep-Wake Disorders Center, Community Health Network, Indianapolis, Indiana.
Airway disorders
FeNO guidelines and the art of clinical medicine
The American Thoracic Society (ATS) recently published new guidelines on the use of fractional exhaled nitric oxide (FeNO) in the management of asthma (Khatri S. Am J Respir Crit Care Med. 2021;204[10]:e97-e109). The previous iteration dealt with questions about the interpretation of FeNO levels. However, the updated guidelines address a single question: Should patients with asthma in whom treatment is being contemplated undergo FeNO testing?
Several roles of nitric oxide (NO) have been discovered, including as a marker of eosinophilic airway inflammation or T2-inflammation. The fraction of NO during steady-state exhalation, easily measured by a handheld device, is a standardized quantitative noninvasive method to assess severity of airway eosinophilic inflammation. However, factors like concomitant sinusitis, bronchoconstriction, obesity, and smoking can also affect FeNO levels, and interpretation is context-dependent. Moreover, some biologic agents have variable effects on FeNO while still being effective in controlling T2 inflammation. Therefore, FeNO is neither the broadest nor the most sensitive signal of T2 inflammation, and there is much unknown about using FeNO to guide asthma treatment. Heterogeneity is one of the many challenges, as different endotypes and clinical subsets vary in the inflammatory pathways leading to airway hyperresponsiveness and remodeling.
The panel assessed the value of FeNO testing in improving asthma control questionnaire scores (ACT, ACQ-7), oral corticosteroid use, asthma exacerbations, lung function, health care utilization, and cost-effectiveness. FeNO-guided therapy compared with therapy without FeNO reduced exacerbations and oral corticosteroid use, though effect size was modest. Among other outcomes, while the trend favored FeNO, it did not reach statistical significance. Adverse effects of FeNO testing were trivial, and the cost is moderate though dependent on the institution size and testing frequency. Thus, for clinicians who manage adults and children 4 years of age and older, in whom treatment for asthma is being considered, it is suggested that FeNO testing be done in addition to usual care. The guidelines do not recommend specific steps to modify treatment based on FeNO results but suggest a decision framework, reminding us that clinical context is key and FeNO is merely one signal. In recognizing its own fallibility, this document suggests that in the continually evolving world of asthma, the art of clinical medicine still reigns supreme.
Uddalak Majumdar, MDDr. Majumdar is a Fellow, Pulmonary & Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Sleep medicine
Marijuana use in pregnancy
Marijuana is the most commonly used illegal drug in the United States. According to the CDC, about 1 in 20 women report using marijuana while pregnant (https://www.cdc.gov/marijuana/health-effects/pregnancy.html). As states legalize marijuana for medicinal or recreational purposes, its use by pregnant women could increase even further. While some use it to ease morning sickness and anxiety, they may not be aware that it can pose risks.
Research has been raising concerns about the effects of marijuana use during pregnancy for years. A study from 1978 linked maternal cannabis use with children’s behavioral problems and deficits in language comprehension, visual perception, attention, and memory (Life Sci. 1995;56[23-24]:2159-68). ). More recent research has linked use to low birth weight, reduced IQ, autism, delusional thoughts, and attention problems, although some other studies have not identified such associations.
A new study shows that children of women who use marijuana during or soon after pregnancy were twice as likely to become anxious, aggressive, or hyperactive. This corresponded with widespread reductions in immune-related gene expression in the placenta, which correlated with anxiety and hyperactivity (Proc National Acad Sci. 2021;118[47]e2106115118).
Chemicals from marijuana can be passed to the baby through breast milk. THC is stored in body fat and slowly released over time. Exposure could still occur even after stopping use (Marijuana use during pregnancy and lactation. ACOG Committee Opinion, Number 722, October 2017).
Studies have shown that THC can pass through the mother’s bloodstream to the placenta and the fetus. This occurs independent of how cannabis is consumed (smoking, vaping, eating, or oils/creams). Patients should be educated that no amount has been proven safe to use during pregnancy or breastfeeding.
Anita Rajagopal, MD, FCCP, Respiratory-Related Sleep Disorders Section, Member-at-Large
Dr. Rajagopal is Network Medical Director, Community Physician Network, Sleep Medicine/Medical Director, Community Health Network Sleep-Wake Disorders Center, Community Health Network, Indianapolis, Indiana.
President’s report
New year, new CHEST President. Same as it has always been, except it has never been this way before. In past years, the transition of the CHEST Presidency occurred at our annual meeting, with a formal handover of leadership and a large reception. While there’s no Presidential football to hand over or secret codes to change for the incoming administration, there are usually several pending issues related to ongoing endeavors that need to be discussed between the outgoing and incoming leadership, in addition to some pearls of wisdom and the figurative “keys to the car.”
Now that CHEST has changed its President’s year to transition alongside the calendar year, there are few associated formalities. I awakened on New Year’s Day with my new title and the associated responsibility. Past President Steve Simpson, the mensch that he is, sent along with my colluding spouse a lovely and inspirational message for me to peruse, full of thoughtful advice and reflections on his year as President. I don’t know if this has ever been done before, but it is a tradition that I fully intend on continuing at the end of my term.
What has CHEST been up to during the first few months of my tenure? January saw us hold our first Board of Regents meeting for 2022, as well as the meeting of the CHEST Critical Care SEEK editorial board, where they worked to put together Volume 32, which will be out later this year. Watching some of the best and brightest medical minds from around the country discuss hot topics in critical care was a great experience (even if I didn’t have much to offer this august group), but the educational content was secondary to the interactions. Not only are these really smart folks teaching and learning from each other, but many of them are also clearly long-term colleagues, and watching this medical meeting was a lot like watching a reunion of friends who hadn’t seen each other in years. And, it struck me that what I’ve really been missing the most in the context of the social isolation that has accompanied the medical challenges of the pandemic is the pleasure of meeting in person with other folks to share stories, tell jokes, commiserate a bit, and catch up on the time that COVID-19 has stolen from us.
As we move further into 2022, I’m hoping that CHEST and our sister societies can help make up for this lost time by giving us the chance to meet in person once again. And to help build these experiences, we held an experiential design team along with our annual CHEST Program Committee meeting in February. Not only will the 2022 annual meeting in Nashville have the opportunity to hear from and network the best and brightest in pulmonary, critical care, and sleep medicine, but to celebrate our getting back together for the first time in years, we are also putting together some special surprises that CHEST has never done before. Keep an eye out for sneak peaks of these plans later in the spring and summer.
Another of our foci in 2022 is our ongoing push to help historically disenfranchised groups feel more engaged with CHEST. Many of you contributed to last year’s initiative to gather data on the kinds of things that we can do better, and I’ve just put together a presidential task force to develop final recommendations to further our goals of improving diversity, equity, and inclusion and to present to the Board of Regents for our April meeting.
Hopefully, many of you have seen some of the “Pardon the Introduction” series that CHEST has been featuring on its social media channels. We’ve put these together to showcase some of our leadership, their experiences, and opportunities for our members to get more involved with the College. Selfishly, I admit that they have also served as an excuse for me to catch up with some old friends and share our CHEST stories. We will be continuing to produce this series throughout the year; please let us know if there are specific folks you’d like us to feature!
Lastly, I wanted to thank the many of you who have reached out to me with questions, comments, and feedback. One of my main initiatives for the year is to make sure we are meeting the needs of as many of our members as possible, and this is something we can only do well if the lines of communication are wide open. Please continue to reach out to me, either by emailing me at [email protected] or messaging me on Twitter @ChestPrez.
New year, new CHEST President. Same as it has always been, except it has never been this way before. In past years, the transition of the CHEST Presidency occurred at our annual meeting, with a formal handover of leadership and a large reception. While there’s no Presidential football to hand over or secret codes to change for the incoming administration, there are usually several pending issues related to ongoing endeavors that need to be discussed between the outgoing and incoming leadership, in addition to some pearls of wisdom and the figurative “keys to the car.”
Now that CHEST has changed its President’s year to transition alongside the calendar year, there are few associated formalities. I awakened on New Year’s Day with my new title and the associated responsibility. Past President Steve Simpson, the mensch that he is, sent along with my colluding spouse a lovely and inspirational message for me to peruse, full of thoughtful advice and reflections on his year as President. I don’t know if this has ever been done before, but it is a tradition that I fully intend on continuing at the end of my term.
What has CHEST been up to during the first few months of my tenure? January saw us hold our first Board of Regents meeting for 2022, as well as the meeting of the CHEST Critical Care SEEK editorial board, where they worked to put together Volume 32, which will be out later this year. Watching some of the best and brightest medical minds from around the country discuss hot topics in critical care was a great experience (even if I didn’t have much to offer this august group), but the educational content was secondary to the interactions. Not only are these really smart folks teaching and learning from each other, but many of them are also clearly long-term colleagues, and watching this medical meeting was a lot like watching a reunion of friends who hadn’t seen each other in years. And, it struck me that what I’ve really been missing the most in the context of the social isolation that has accompanied the medical challenges of the pandemic is the pleasure of meeting in person with other folks to share stories, tell jokes, commiserate a bit, and catch up on the time that COVID-19 has stolen from us.
As we move further into 2022, I’m hoping that CHEST and our sister societies can help make up for this lost time by giving us the chance to meet in person once again. And to help build these experiences, we held an experiential design team along with our annual CHEST Program Committee meeting in February. Not only will the 2022 annual meeting in Nashville have the opportunity to hear from and network the best and brightest in pulmonary, critical care, and sleep medicine, but to celebrate our getting back together for the first time in years, we are also putting together some special surprises that CHEST has never done before. Keep an eye out for sneak peaks of these plans later in the spring and summer.
Another of our foci in 2022 is our ongoing push to help historically disenfranchised groups feel more engaged with CHEST. Many of you contributed to last year’s initiative to gather data on the kinds of things that we can do better, and I’ve just put together a presidential task force to develop final recommendations to further our goals of improving diversity, equity, and inclusion and to present to the Board of Regents for our April meeting.
Hopefully, many of you have seen some of the “Pardon the Introduction” series that CHEST has been featuring on its social media channels. We’ve put these together to showcase some of our leadership, their experiences, and opportunities for our members to get more involved with the College. Selfishly, I admit that they have also served as an excuse for me to catch up with some old friends and share our CHEST stories. We will be continuing to produce this series throughout the year; please let us know if there are specific folks you’d like us to feature!
Lastly, I wanted to thank the many of you who have reached out to me with questions, comments, and feedback. One of my main initiatives for the year is to make sure we are meeting the needs of as many of our members as possible, and this is something we can only do well if the lines of communication are wide open. Please continue to reach out to me, either by emailing me at [email protected] or messaging me on Twitter @ChestPrez.
New year, new CHEST President. Same as it has always been, except it has never been this way before. In past years, the transition of the CHEST Presidency occurred at our annual meeting, with a formal handover of leadership and a large reception. While there’s no Presidential football to hand over or secret codes to change for the incoming administration, there are usually several pending issues related to ongoing endeavors that need to be discussed between the outgoing and incoming leadership, in addition to some pearls of wisdom and the figurative “keys to the car.”
Now that CHEST has changed its President’s year to transition alongside the calendar year, there are few associated formalities. I awakened on New Year’s Day with my new title and the associated responsibility. Past President Steve Simpson, the mensch that he is, sent along with my colluding spouse a lovely and inspirational message for me to peruse, full of thoughtful advice and reflections on his year as President. I don’t know if this has ever been done before, but it is a tradition that I fully intend on continuing at the end of my term.
What has CHEST been up to during the first few months of my tenure? January saw us hold our first Board of Regents meeting for 2022, as well as the meeting of the CHEST Critical Care SEEK editorial board, where they worked to put together Volume 32, which will be out later this year. Watching some of the best and brightest medical minds from around the country discuss hot topics in critical care was a great experience (even if I didn’t have much to offer this august group), but the educational content was secondary to the interactions. Not only are these really smart folks teaching and learning from each other, but many of them are also clearly long-term colleagues, and watching this medical meeting was a lot like watching a reunion of friends who hadn’t seen each other in years. And, it struck me that what I’ve really been missing the most in the context of the social isolation that has accompanied the medical challenges of the pandemic is the pleasure of meeting in person with other folks to share stories, tell jokes, commiserate a bit, and catch up on the time that COVID-19 has stolen from us.
As we move further into 2022, I’m hoping that CHEST and our sister societies can help make up for this lost time by giving us the chance to meet in person once again. And to help build these experiences, we held an experiential design team along with our annual CHEST Program Committee meeting in February. Not only will the 2022 annual meeting in Nashville have the opportunity to hear from and network the best and brightest in pulmonary, critical care, and sleep medicine, but to celebrate our getting back together for the first time in years, we are also putting together some special surprises that CHEST has never done before. Keep an eye out for sneak peaks of these plans later in the spring and summer.
Another of our foci in 2022 is our ongoing push to help historically disenfranchised groups feel more engaged with CHEST. Many of you contributed to last year’s initiative to gather data on the kinds of things that we can do better, and I’ve just put together a presidential task force to develop final recommendations to further our goals of improving diversity, equity, and inclusion and to present to the Board of Regents for our April meeting.
Hopefully, many of you have seen some of the “Pardon the Introduction” series that CHEST has been featuring on its social media channels. We’ve put these together to showcase some of our leadership, their experiences, and opportunities for our members to get more involved with the College. Selfishly, I admit that they have also served as an excuse for me to catch up with some old friends and share our CHEST stories. We will be continuing to produce this series throughout the year; please let us know if there are specific folks you’d like us to feature!
Lastly, I wanted to thank the many of you who have reached out to me with questions, comments, and feedback. One of my main initiatives for the year is to make sure we are meeting the needs of as many of our members as possible, and this is something we can only do well if the lines of communication are wide open. Please continue to reach out to me, either by emailing me at [email protected] or messaging me on Twitter @ChestPrez.
Meet our new CHEST President-Designate
We are happy to introduce John (Jack) D. Buckley, MD, MPH, FCCP, who will serve his term as CHEST President in 2024. A pulmonologist and critical care physician with an extensive background in education, he currently serves as the division leader of Pulmonary and Critical Care Medicine for the Henry Ford Medical Group and Health System.
Dr. Buckley received his undergraduate degree from Kalamazoo College and medical degree from Wayne State University. His residency in internal medicine and fellowships in pulmonary and critical care and health services research were completed at Indiana University. He additionally earned a Master of Public Health degree, also from Indiana University.
His impressive academic record includes authoring or co-authoring more than 40 publications and book chapters, as well as presenting over 100 lectures at international conferences. As a former fellowship program training director at two institutions, Dr. Buckley has long been committed to championing and furthering pulmonary and critical care medical education. In a collaboration between the Chinese Thoracic Society and CHEST, he served 6 years on a steering committee to help establish pulmonary and critical care medicine as a subspecialty in China. He and the group assisted with the development of fellowship training programs and presented at several Chinese Thoracic Society annual meetings and board review events.
For Dr. Buckley’s dedication to advancing PCCM education and faculty development, he received the CHEST Master Clinician Educator Award in 2016 and has been an annual Distinguished CHEST Educator (DCE) recipient since the award’s inception in 2017.
Dr. Buckley has been an active and engaged member of CHEST since 1997. He has served in leadership roles across many domains of the organization, including CHEST 2022 Congress Italy, Chair of the CHEST 2013 Scientific Program Committee, Board of Regents, Compensation Committee, Governance Committee, Training and Transitions Committee (Chair, 2011-2012) and Bylaws Committee (Chair, 2010-2012), Honor Lecture and Awards Committee, and the Affiliate NetWork. He currently serves on the CHEST SEEKTM Pulmonary Medicine Editorial Board and is the Chair of the Pulmonary Medicine Board Review.
We look forward to welcoming Dr. Buckley as CHEST President in 2024.
We are happy to introduce John (Jack) D. Buckley, MD, MPH, FCCP, who will serve his term as CHEST President in 2024. A pulmonologist and critical care physician with an extensive background in education, he currently serves as the division leader of Pulmonary and Critical Care Medicine for the Henry Ford Medical Group and Health System.
Dr. Buckley received his undergraduate degree from Kalamazoo College and medical degree from Wayne State University. His residency in internal medicine and fellowships in pulmonary and critical care and health services research were completed at Indiana University. He additionally earned a Master of Public Health degree, also from Indiana University.
His impressive academic record includes authoring or co-authoring more than 40 publications and book chapters, as well as presenting over 100 lectures at international conferences. As a former fellowship program training director at two institutions, Dr. Buckley has long been committed to championing and furthering pulmonary and critical care medical education. In a collaboration between the Chinese Thoracic Society and CHEST, he served 6 years on a steering committee to help establish pulmonary and critical care medicine as a subspecialty in China. He and the group assisted with the development of fellowship training programs and presented at several Chinese Thoracic Society annual meetings and board review events.
For Dr. Buckley’s dedication to advancing PCCM education and faculty development, he received the CHEST Master Clinician Educator Award in 2016 and has been an annual Distinguished CHEST Educator (DCE) recipient since the award’s inception in 2017.
Dr. Buckley has been an active and engaged member of CHEST since 1997. He has served in leadership roles across many domains of the organization, including CHEST 2022 Congress Italy, Chair of the CHEST 2013 Scientific Program Committee, Board of Regents, Compensation Committee, Governance Committee, Training and Transitions Committee (Chair, 2011-2012) and Bylaws Committee (Chair, 2010-2012), Honor Lecture and Awards Committee, and the Affiliate NetWork. He currently serves on the CHEST SEEKTM Pulmonary Medicine Editorial Board and is the Chair of the Pulmonary Medicine Board Review.
We look forward to welcoming Dr. Buckley as CHEST President in 2024.
We are happy to introduce John (Jack) D. Buckley, MD, MPH, FCCP, who will serve his term as CHEST President in 2024. A pulmonologist and critical care physician with an extensive background in education, he currently serves as the division leader of Pulmonary and Critical Care Medicine for the Henry Ford Medical Group and Health System.
Dr. Buckley received his undergraduate degree from Kalamazoo College and medical degree from Wayne State University. His residency in internal medicine and fellowships in pulmonary and critical care and health services research were completed at Indiana University. He additionally earned a Master of Public Health degree, also from Indiana University.
His impressive academic record includes authoring or co-authoring more than 40 publications and book chapters, as well as presenting over 100 lectures at international conferences. As a former fellowship program training director at two institutions, Dr. Buckley has long been committed to championing and furthering pulmonary and critical care medical education. In a collaboration between the Chinese Thoracic Society and CHEST, he served 6 years on a steering committee to help establish pulmonary and critical care medicine as a subspecialty in China. He and the group assisted with the development of fellowship training programs and presented at several Chinese Thoracic Society annual meetings and board review events.
For Dr. Buckley’s dedication to advancing PCCM education and faculty development, he received the CHEST Master Clinician Educator Award in 2016 and has been an annual Distinguished CHEST Educator (DCE) recipient since the award’s inception in 2017.
Dr. Buckley has been an active and engaged member of CHEST since 1997. He has served in leadership roles across many domains of the organization, including CHEST 2022 Congress Italy, Chair of the CHEST 2013 Scientific Program Committee, Board of Regents, Compensation Committee, Governance Committee, Training and Transitions Committee (Chair, 2011-2012) and Bylaws Committee (Chair, 2010-2012), Honor Lecture and Awards Committee, and the Affiliate NetWork. He currently serves on the CHEST SEEKTM Pulmonary Medicine Editorial Board and is the Chair of the Pulmonary Medicine Board Review.
We look forward to welcoming Dr. Buckley as CHEST President in 2024.
A mentor in medicine ... a mentor in life
Edward Carl Rosenow III, MD, Master FCCP
November 2, 1934 - December 21, 2021
We remember our close friend and colleague
On Monday, January 3, 1972, in Rochester, Minnesota, the weather was as expected - a high of 20 F and a low of -50 F. At 7:30 that morning, a group of three young physicians, residents in internal medicine on a month-long rotation in the inpatient pulmonary ward in one of the Mayo Clinic hospitals, was awaiting the arrival of the staff consultant to begin the rounds. It was the very first day of his first-year residency at Mayo for one of the residents. He had applied for residency training to begin in July but, instead, accepted Mayo’s offer to join the residency program 6 months earlier, in January – in Minnesota. That new resident was me. The pulmonary consultant had a friendly and disarming demeanor and gentle visage. He introduced himself to me with a smile, saying, “Welcome to Mayo. I am Ed Rosenow. Let me know if I can be of help in your training.”
Thus began my almost half-century’ relationship with Ed. During my residency in internal medicine and fellowship in pulmonary and critical care medicine, he was a constant and dependable fount of wisdom and knowledge. His daily lectures with chest x-rays after the morning rounds were legendary. By one estimate, he had collected over 4,500 chest x-rays to teach. These were hard copies and heavy to carry around. Ed lugged them under his arms daily for the lectures (there were no digital radiology or CT or MRI scanners then).
Ed was voted the “teacher of the year” every year for countless years. He was my first teacher in bronchoscopy and esophagoscopy. At that time, the division of pulmonary diseases was known as the division of thoracic diseases, and consultants in thoracic diseases performed bronchoscopy and rigid esophagoscopy.
Ed exemplified the best in compassion, amicability, collegiality, thoughtfulness, and a caring personality. In addition to possessing superb clinical acumen, he volunteered in local medical clinics for the less fortunate. In my mind, it is not too farfetched to describe Ed as “A man for all seasons.”*
Among Ed’s many professional accomplishments, his dedication and loyalty to the American College of Chest Physicians (CHEST) and the CHEST Foundation remain unsurpassed. In the years before and after he became the President of CHEST, Ed spent countless hours rewriting the ‘constitution’ of the organization, its bylaws. Many of the current committee structures, rules, and regulations are based on Ed’s work. During a meeting of the regents, one regent exclaimed, ”ACCP is Rosenow and Rosenow is ACCP!”
Ed was a founding member of the CHEST Foundation, the philanthropic arm of the College. Ed’s constant encouragement of young pulmonologists to participate in CHEST surely resulted in a significant increase in their membership. He was the ceaseless force behind my work and deep involvement with CHEST and the CHEST Foundation.
Describing my long association with Ed transcends this note. Suffice it to say that my being named the first Edward W. and Betty Knight Scripps Professor of Medicine in Honor of Edward C. Rosenow III, MD at Mayo Medical School is the greatest honor that I fondly cherish. I like to think that Ed strived for nearly a half-century to help me be a good person and a good doctor. I often question myself if I have met his goal. This question will linger in my mind for the rest of my life.
Udaya B. S. Prakash, MD, Master FCCP, Rochester, MN
Past President, American College of Chest Physicians (2002-2003)
*A man for all seasons: A man who is ready to cope with any contingency and whose behavior is always appropriate to every occasion. The English grammarian Robert Whittington (1480-1553) applied this description to the English statesman and scholar Sir Thomas More (1478-1535), and Robert Bolt used it as the title of his 1960 play about More.
My association with Dr. Rosenow dates back to 2002. I was attending the CHEST annual meeting, and I saw Dr. Rosenow walking toward me. He came up and said, “Hi. My name is Ed Rosenow. What is yours?” “Suhail Raoof,” I answered. Taking me aside, we spent almost a half-hour discussing my family, where I work, my career goals, and how the College could help me achieve some of those goals. His unassuming nature, humility, and sincere desire to help rang out loud and clear.
That day proved to be a turning point in my life. For the next almost 17 years, Ed and I set up monthly calls to connect. Each time, he was eager to listen and know what was happening in my life—the good, the bad, the important, and the mundane. My problems would become his problems; solutions to my problems would become joint solutions. He guided me on my path to leadership with CHEST, culminating in my presidency.
Ed taught thousands of his colleagues the true meaning and power of mentorship. Early in his career, he realized that true happiness comes from helping and guiding others. Dr. Rosenow experienced a sense of genuine happiness and pride in witnessing the accomplishments of his friends and trainees. His gentle ways, unparalleled kindness, and modesty made him the quintessential role model, who one and all tried to emulate.
Aptly stated by Dr. John Studdard, FCCP, one of his students at Mayo Clinic, “Ed Rosenow was the finest doctor I have ever known, but an even better person. He balanced a great intellect and curiosity with great humility, was an incredible teacher, educator, and mentor, and all of this with a special sense of humor.”
Among his many positive traits, Ed possessed two qualities that played very important roles in his life— inquisitiveness and perseverance. In the early 1960s, there was a paucity of information on drug-induced lung disease. He embraced this gap in medical knowledge, resolved to fill it, and, for the next almost 50 years, Dr. Rosenow extensively researched, published, and lectured on drug-related lung injury.
Ed felt strongly that a good pulmonologist had to be a skilled chest radiologist. He was instrumental in introducing “Chest Imaging for the Pulmonologist” sessions at the annual CHEST meetings. With his enduring cataloging of consultation cases and collection of teaching file chest x-rays, it is no wonder that he amassed one of the best teaching resources, including some of the most rare lung conditions.
Ed was a visionary. He envisioned CHEST to be a closely knit “family of professionals,” united in the desire to provide compassionate care of the highest order to patients and help each colleague accomplish their goals and aspirations. During his CHEST presidency, he and Dr. Bart Chernow realized the importance of having a philanthropic arm of the College that would support worthy projects through fundraising. Soon after the establishment of the CHEST Foundation, he became its President and then Chair.
Dr. Rosenow’s hard work, dedication, and unwavering commitment to professional and social organizations he served earned him the highest of accolades and honors. He had the rare distinction of being recognized as a Master by two professional organizations—CHEST and the American College of Physicians. Awards of the highest order were showered upon him by the Mayo Clinic, including establishing the Mayo Fellows Hall of Fame of Outstanding Teachers. Several endowed professorships and honors are named after him. The award he cherished most was the Karis Award (karis meaning “to care” in Greek). When I asked him how he felt to be the recipient of so many awards, he blushed and said, “Gee, there were plenty others who deserved them more than me. I was just doing my job.”
To everyone he met, Ed emphasized the importance of the “culture of caring and giving.” He taught his students that medicine is not a profession; it is a way of life. It is as much an art as it is a science. He reiterated his platinum rule to “Take care of every patient like you would want a member of your family cared for.”
Today, thousands of his students, including me, are deeply indebted to Dr. Rosenow for the impactful and profound role he played in our lives and for teaching us the core values that really matter. He left an indelible mark on our profession and our outlook. He redefined our responsibilities to our patients and colleagues. In his own quiet and effective way, Ed nurtured and inspired us to dream, think, persevere, and accomplish. His legacy will live on as we try to emulate his teachings, exceptional qualities, and humanistic approach. He will be missed greatly.
“His life was gentle, and the elements mixed so well in him that Nature might stand up and say to all the world,” ‘This was a man’.” Shakespeare
Suhail Raoof, MD, Master FCCP, New York, NY
Past President, American College of Chest Physicians (2011-2012)
Edward Carl Rosenow III, MD, Master FCCP
November 2, 1934 - December 21, 2021
We remember our close friend and colleague
On Monday, January 3, 1972, in Rochester, Minnesota, the weather was as expected - a high of 20 F and a low of -50 F. At 7:30 that morning, a group of three young physicians, residents in internal medicine on a month-long rotation in the inpatient pulmonary ward in one of the Mayo Clinic hospitals, was awaiting the arrival of the staff consultant to begin the rounds. It was the very first day of his first-year residency at Mayo for one of the residents. He had applied for residency training to begin in July but, instead, accepted Mayo’s offer to join the residency program 6 months earlier, in January – in Minnesota. That new resident was me. The pulmonary consultant had a friendly and disarming demeanor and gentle visage. He introduced himself to me with a smile, saying, “Welcome to Mayo. I am Ed Rosenow. Let me know if I can be of help in your training.”
Thus began my almost half-century’ relationship with Ed. During my residency in internal medicine and fellowship in pulmonary and critical care medicine, he was a constant and dependable fount of wisdom and knowledge. His daily lectures with chest x-rays after the morning rounds were legendary. By one estimate, he had collected over 4,500 chest x-rays to teach. These were hard copies and heavy to carry around. Ed lugged them under his arms daily for the lectures (there were no digital radiology or CT or MRI scanners then).
Ed was voted the “teacher of the year” every year for countless years. He was my first teacher in bronchoscopy and esophagoscopy. At that time, the division of pulmonary diseases was known as the division of thoracic diseases, and consultants in thoracic diseases performed bronchoscopy and rigid esophagoscopy.
Ed exemplified the best in compassion, amicability, collegiality, thoughtfulness, and a caring personality. In addition to possessing superb clinical acumen, he volunteered in local medical clinics for the less fortunate. In my mind, it is not too farfetched to describe Ed as “A man for all seasons.”*
Among Ed’s many professional accomplishments, his dedication and loyalty to the American College of Chest Physicians (CHEST) and the CHEST Foundation remain unsurpassed. In the years before and after he became the President of CHEST, Ed spent countless hours rewriting the ‘constitution’ of the organization, its bylaws. Many of the current committee structures, rules, and regulations are based on Ed’s work. During a meeting of the regents, one regent exclaimed, ”ACCP is Rosenow and Rosenow is ACCP!”
Ed was a founding member of the CHEST Foundation, the philanthropic arm of the College. Ed’s constant encouragement of young pulmonologists to participate in CHEST surely resulted in a significant increase in their membership. He was the ceaseless force behind my work and deep involvement with CHEST and the CHEST Foundation.
Describing my long association with Ed transcends this note. Suffice it to say that my being named the first Edward W. and Betty Knight Scripps Professor of Medicine in Honor of Edward C. Rosenow III, MD at Mayo Medical School is the greatest honor that I fondly cherish. I like to think that Ed strived for nearly a half-century to help me be a good person and a good doctor. I often question myself if I have met his goal. This question will linger in my mind for the rest of my life.
Udaya B. S. Prakash, MD, Master FCCP, Rochester, MN
Past President, American College of Chest Physicians (2002-2003)
*A man for all seasons: A man who is ready to cope with any contingency and whose behavior is always appropriate to every occasion. The English grammarian Robert Whittington (1480-1553) applied this description to the English statesman and scholar Sir Thomas More (1478-1535), and Robert Bolt used it as the title of his 1960 play about More.
My association with Dr. Rosenow dates back to 2002. I was attending the CHEST annual meeting, and I saw Dr. Rosenow walking toward me. He came up and said, “Hi. My name is Ed Rosenow. What is yours?” “Suhail Raoof,” I answered. Taking me aside, we spent almost a half-hour discussing my family, where I work, my career goals, and how the College could help me achieve some of those goals. His unassuming nature, humility, and sincere desire to help rang out loud and clear.
That day proved to be a turning point in my life. For the next almost 17 years, Ed and I set up monthly calls to connect. Each time, he was eager to listen and know what was happening in my life—the good, the bad, the important, and the mundane. My problems would become his problems; solutions to my problems would become joint solutions. He guided me on my path to leadership with CHEST, culminating in my presidency.
Ed taught thousands of his colleagues the true meaning and power of mentorship. Early in his career, he realized that true happiness comes from helping and guiding others. Dr. Rosenow experienced a sense of genuine happiness and pride in witnessing the accomplishments of his friends and trainees. His gentle ways, unparalleled kindness, and modesty made him the quintessential role model, who one and all tried to emulate.
Aptly stated by Dr. John Studdard, FCCP, one of his students at Mayo Clinic, “Ed Rosenow was the finest doctor I have ever known, but an even better person. He balanced a great intellect and curiosity with great humility, was an incredible teacher, educator, and mentor, and all of this with a special sense of humor.”
Among his many positive traits, Ed possessed two qualities that played very important roles in his life— inquisitiveness and perseverance. In the early 1960s, there was a paucity of information on drug-induced lung disease. He embraced this gap in medical knowledge, resolved to fill it, and, for the next almost 50 years, Dr. Rosenow extensively researched, published, and lectured on drug-related lung injury.
Ed felt strongly that a good pulmonologist had to be a skilled chest radiologist. He was instrumental in introducing “Chest Imaging for the Pulmonologist” sessions at the annual CHEST meetings. With his enduring cataloging of consultation cases and collection of teaching file chest x-rays, it is no wonder that he amassed one of the best teaching resources, including some of the most rare lung conditions.
Ed was a visionary. He envisioned CHEST to be a closely knit “family of professionals,” united in the desire to provide compassionate care of the highest order to patients and help each colleague accomplish their goals and aspirations. During his CHEST presidency, he and Dr. Bart Chernow realized the importance of having a philanthropic arm of the College that would support worthy projects through fundraising. Soon after the establishment of the CHEST Foundation, he became its President and then Chair.
Dr. Rosenow’s hard work, dedication, and unwavering commitment to professional and social organizations he served earned him the highest of accolades and honors. He had the rare distinction of being recognized as a Master by two professional organizations—CHEST and the American College of Physicians. Awards of the highest order were showered upon him by the Mayo Clinic, including establishing the Mayo Fellows Hall of Fame of Outstanding Teachers. Several endowed professorships and honors are named after him. The award he cherished most was the Karis Award (karis meaning “to care” in Greek). When I asked him how he felt to be the recipient of so many awards, he blushed and said, “Gee, there were plenty others who deserved them more than me. I was just doing my job.”
To everyone he met, Ed emphasized the importance of the “culture of caring and giving.” He taught his students that medicine is not a profession; it is a way of life. It is as much an art as it is a science. He reiterated his platinum rule to “Take care of every patient like you would want a member of your family cared for.”
Today, thousands of his students, including me, are deeply indebted to Dr. Rosenow for the impactful and profound role he played in our lives and for teaching us the core values that really matter. He left an indelible mark on our profession and our outlook. He redefined our responsibilities to our patients and colleagues. In his own quiet and effective way, Ed nurtured and inspired us to dream, think, persevere, and accomplish. His legacy will live on as we try to emulate his teachings, exceptional qualities, and humanistic approach. He will be missed greatly.
“His life was gentle, and the elements mixed so well in him that Nature might stand up and say to all the world,” ‘This was a man’.” Shakespeare
Suhail Raoof, MD, Master FCCP, New York, NY
Past President, American College of Chest Physicians (2011-2012)
Edward Carl Rosenow III, MD, Master FCCP
November 2, 1934 - December 21, 2021
We remember our close friend and colleague
On Monday, January 3, 1972, in Rochester, Minnesota, the weather was as expected - a high of 20 F and a low of -50 F. At 7:30 that morning, a group of three young physicians, residents in internal medicine on a month-long rotation in the inpatient pulmonary ward in one of the Mayo Clinic hospitals, was awaiting the arrival of the staff consultant to begin the rounds. It was the very first day of his first-year residency at Mayo for one of the residents. He had applied for residency training to begin in July but, instead, accepted Mayo’s offer to join the residency program 6 months earlier, in January – in Minnesota. That new resident was me. The pulmonary consultant had a friendly and disarming demeanor and gentle visage. He introduced himself to me with a smile, saying, “Welcome to Mayo. I am Ed Rosenow. Let me know if I can be of help in your training.”
Thus began my almost half-century’ relationship with Ed. During my residency in internal medicine and fellowship in pulmonary and critical care medicine, he was a constant and dependable fount of wisdom and knowledge. His daily lectures with chest x-rays after the morning rounds were legendary. By one estimate, he had collected over 4,500 chest x-rays to teach. These were hard copies and heavy to carry around. Ed lugged them under his arms daily for the lectures (there were no digital radiology or CT or MRI scanners then).
Ed was voted the “teacher of the year” every year for countless years. He was my first teacher in bronchoscopy and esophagoscopy. At that time, the division of pulmonary diseases was known as the division of thoracic diseases, and consultants in thoracic diseases performed bronchoscopy and rigid esophagoscopy.
Ed exemplified the best in compassion, amicability, collegiality, thoughtfulness, and a caring personality. In addition to possessing superb clinical acumen, he volunteered in local medical clinics for the less fortunate. In my mind, it is not too farfetched to describe Ed as “A man for all seasons.”*
Among Ed’s many professional accomplishments, his dedication and loyalty to the American College of Chest Physicians (CHEST) and the CHEST Foundation remain unsurpassed. In the years before and after he became the President of CHEST, Ed spent countless hours rewriting the ‘constitution’ of the organization, its bylaws. Many of the current committee structures, rules, and regulations are based on Ed’s work. During a meeting of the regents, one regent exclaimed, ”ACCP is Rosenow and Rosenow is ACCP!”
Ed was a founding member of the CHEST Foundation, the philanthropic arm of the College. Ed’s constant encouragement of young pulmonologists to participate in CHEST surely resulted in a significant increase in their membership. He was the ceaseless force behind my work and deep involvement with CHEST and the CHEST Foundation.
Describing my long association with Ed transcends this note. Suffice it to say that my being named the first Edward W. and Betty Knight Scripps Professor of Medicine in Honor of Edward C. Rosenow III, MD at Mayo Medical School is the greatest honor that I fondly cherish. I like to think that Ed strived for nearly a half-century to help me be a good person and a good doctor. I often question myself if I have met his goal. This question will linger in my mind for the rest of my life.
Udaya B. S. Prakash, MD, Master FCCP, Rochester, MN
Past President, American College of Chest Physicians (2002-2003)
*A man for all seasons: A man who is ready to cope with any contingency and whose behavior is always appropriate to every occasion. The English grammarian Robert Whittington (1480-1553) applied this description to the English statesman and scholar Sir Thomas More (1478-1535), and Robert Bolt used it as the title of his 1960 play about More.
My association with Dr. Rosenow dates back to 2002. I was attending the CHEST annual meeting, and I saw Dr. Rosenow walking toward me. He came up and said, “Hi. My name is Ed Rosenow. What is yours?” “Suhail Raoof,” I answered. Taking me aside, we spent almost a half-hour discussing my family, where I work, my career goals, and how the College could help me achieve some of those goals. His unassuming nature, humility, and sincere desire to help rang out loud and clear.
That day proved to be a turning point in my life. For the next almost 17 years, Ed and I set up monthly calls to connect. Each time, he was eager to listen and know what was happening in my life—the good, the bad, the important, and the mundane. My problems would become his problems; solutions to my problems would become joint solutions. He guided me on my path to leadership with CHEST, culminating in my presidency.
Ed taught thousands of his colleagues the true meaning and power of mentorship. Early in his career, he realized that true happiness comes from helping and guiding others. Dr. Rosenow experienced a sense of genuine happiness and pride in witnessing the accomplishments of his friends and trainees. His gentle ways, unparalleled kindness, and modesty made him the quintessential role model, who one and all tried to emulate.
Aptly stated by Dr. John Studdard, FCCP, one of his students at Mayo Clinic, “Ed Rosenow was the finest doctor I have ever known, but an even better person. He balanced a great intellect and curiosity with great humility, was an incredible teacher, educator, and mentor, and all of this with a special sense of humor.”
Among his many positive traits, Ed possessed two qualities that played very important roles in his life— inquisitiveness and perseverance. In the early 1960s, there was a paucity of information on drug-induced lung disease. He embraced this gap in medical knowledge, resolved to fill it, and, for the next almost 50 years, Dr. Rosenow extensively researched, published, and lectured on drug-related lung injury.
Ed felt strongly that a good pulmonologist had to be a skilled chest radiologist. He was instrumental in introducing “Chest Imaging for the Pulmonologist” sessions at the annual CHEST meetings. With his enduring cataloging of consultation cases and collection of teaching file chest x-rays, it is no wonder that he amassed one of the best teaching resources, including some of the most rare lung conditions.
Ed was a visionary. He envisioned CHEST to be a closely knit “family of professionals,” united in the desire to provide compassionate care of the highest order to patients and help each colleague accomplish their goals and aspirations. During his CHEST presidency, he and Dr. Bart Chernow realized the importance of having a philanthropic arm of the College that would support worthy projects through fundraising. Soon after the establishment of the CHEST Foundation, he became its President and then Chair.
Dr. Rosenow’s hard work, dedication, and unwavering commitment to professional and social organizations he served earned him the highest of accolades and honors. He had the rare distinction of being recognized as a Master by two professional organizations—CHEST and the American College of Physicians. Awards of the highest order were showered upon him by the Mayo Clinic, including establishing the Mayo Fellows Hall of Fame of Outstanding Teachers. Several endowed professorships and honors are named after him. The award he cherished most was the Karis Award (karis meaning “to care” in Greek). When I asked him how he felt to be the recipient of so many awards, he blushed and said, “Gee, there were plenty others who deserved them more than me. I was just doing my job.”
To everyone he met, Ed emphasized the importance of the “culture of caring and giving.” He taught his students that medicine is not a profession; it is a way of life. It is as much an art as it is a science. He reiterated his platinum rule to “Take care of every patient like you would want a member of your family cared for.”
Today, thousands of his students, including me, are deeply indebted to Dr. Rosenow for the impactful and profound role he played in our lives and for teaching us the core values that really matter. He left an indelible mark on our profession and our outlook. He redefined our responsibilities to our patients and colleagues. In his own quiet and effective way, Ed nurtured and inspired us to dream, think, persevere, and accomplish. His legacy will live on as we try to emulate his teachings, exceptional qualities, and humanistic approach. He will be missed greatly.
“His life was gentle, and the elements mixed so well in him that Nature might stand up and say to all the world,” ‘This was a man’.” Shakespeare
Suhail Raoof, MD, Master FCCP, New York, NY
Past President, American College of Chest Physicians (2011-2012)