Volume 50 No. 3 • Fall 2019
Today’s
Christian Doctor The Journal of the Christian Medical & Dental Associations
When “Cure” Doesn’t Come
My
CMDA
Story “I was first introduced to CMDA’s Women Physicians in Christ around 2012 by two friends/colleagues. After reviewing the literature from their annual conference, I knew this was something I wanted to experience for myself. The following year, I attended the WPC Annual Conference in Texas. I went alone, but felt very welcomed. I could not believe there was a medical conference that met my spiritual, emotional and intellectual needs all in one place! It was amazing to have the opportunity to worship, pray, laugh and cry together as we shared our stories. Since that time, I have had an opportunity to serve with a phenomenal group of women and develop long lasting friendships.
We have shared joys and hardships. I am grateful to be surrounded by this caring community of believers, and I look forward to experiencing all that God has in store for us in the future!” —Regina Frost, MD
Introduce Your Colleagues to CMDA Introduce your colleagues and friends to CMDA like Dr. Frost did, and you can develop lasting friendships with more than 19,000 healthcare professionals across the country who are part of this growing movement of “Transformed Doctors, Transforming the World.”
Visit www.joincmda.org or call 888-230-2637 to join us today. Paid Advertisement
CEO EDITORIAL
CMDA . . . YOU SMELL GREAT!
T
by Mike Chupp, MD
his issue of Today’s Christian Doctor marks the official handover of the responsibility of Chief Executive Officer of CMDA from Dr. David Stevens to me, as of September 1. I am most grateful to CMDA’s Board of Trustees, as well as Dr. Stevens and Dr. Gene Rudd, for their determination to see this Christian healthcare membership organization thrive through a leadership transition in its ninth decade. I truly believe that today’s Christian doctor is being motivated, educated and equipped to glorify God more than ever through the ministries of CMDA. In addition, our tent has expanded, as CMDA isn’t exclusively about physicians and dentists anymore. We have been joined by Christians from other healthcare professions including physician assistants, nurse practitioners, optometrists, podiatrists, physical rehab therapists, pharmacists and others. CMDA chapters can now be found on 315 healthcare training campuses across the United States and in at least 80 communities. During my last three years as Executive Vice President of CMDA, I have seen the fierce dedication and sacrifice of CMDA members who want to be the best stewards possible as they care for others in Christ’s name. They are using their privileged positions to represent Christ with excellent, compassionate patient care and train the next generation of Christians in healthcare. As the new CEO of CMDA, I wanted to understand what motivates our members to participate in this ministry and be counted. In January this year, we conducted an email poll of our graduate members that asked them to answer some basic but important questions, and more than 960 members responded. We asked this question: “What is important to you about your CMDA membership?” These two answers were given by the majority of respondents: 1. Equipping the next generation of Christians in healthcare (74 percent). 2. The voice of CMDA in the public square (62 percent). What was most inspiring to me was the answer to this question: “Even if there were no personal benefit to you, are you willing to continue your membership in order to support CMDA’s ministries to others?” More than 97 percent of the respondents answered this question with a resounding yes! CMDA members and volunteers understand the missional nature of this ministry that facilitates transformation of Christian healthcare professionals during all stages of their careers and equips them to carry out transformational ministry.
I was asked by an area director earlier this year about my experience with CMDA before Dr. Stevens invited me to join the team at headquarters in Bristol, Tennessee. I told her that when I would meet healthcare professionals in the U.S. or Africa who participated in one or more of the CMDA ministries, I usually recognized the “aroma of Christ” (2 Corinthians 2:15). I came to think of CMDA over the years as “Christian Medics with a Divine Aroma.” I honestly would not have imagined myself leaving clinical medicine and my role of Medical Superintendent at Tenwek Hospital in Kenya to be at the helm of any organization. But as I look back over my medical career, CMDA was there with me for the entire journey: from my first week of medical school when I joined a student-led CMDA Bible study; to resident fellowships and prayer times in faculty homes; to attending a CMDA Marriage Enrichment Weekend with my wife Pam in my second year of practice in Michigan; to going through the Saline Solution after it was released; and to attending multiple Continuing Medical and Dental Education conferences in Kenya and Greece. CMDA was HUGE in my professional and ministry life. It is now an amazing and exciting privilege to lead this organization at a time when it is needed “more than ever,” as Dr. Stevens says. In this edition of Today’s Christian Doctor, Joni Eareckson Tada, who is a longtime friend of CMDA and a champion for the disabled, tells us some of her own story. Joni seeks to help healthcare professionals better understand our role as healers, even when cure is not possible for our patients. You will also find articles on human trafficking and updates on new policies from the U.S. Department of Health and Human Services, plus a long-awaited and much-needed position statement on medical marijuana. Two Scripture verses that have been so meaningful in my ministry as a Christian surgeon with Southwestern Medical Clinic in Michigan and then in Kenya are from 2 Timothy 1:6-7: “For this reason I remind you to fan into flame the gift of God, which is in you…For God did not give us a spirit of timidity, but a spirit of power, of love and of self-discipline.” Our patients and their families, our co-workers and our staff need Christian healthcare professionals to fan the flame of God’s gifts in our own lives and in the lives of the next generation of healthcare professionals, until He comes. Transformed Doctors ➤ Transforming the World www.cmda.org 3
TO DAY ’ S C H R I S T I A N D O C TO R
contents
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The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.
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ransformed Doctors, 10 TTransforming the World 12 Cover Story
featuring Drs. Joshua & Hannah Evans
When “Cure” Doesn’t Come: Finding Deeper Healing
by Joni Eareckson Tada
How one patient became an advocate for finding purpose
18
H uman Trafficking and The Morning After Pill: Do They Go Together?
by Janie Christine Ogle, DO
A resident stands up for her beliefs while helping victims of human trafficking
22
HHS Protects Conscience Freedoms
by Jonathan Imbody
Discussing new federal policy reforms that impact Christians in healthcare
26
CMDA Statement on Medical Marijuana
Earn continuing education credits and learn more about this important topic 4 TODAY'S CHRISTIAN DOCTOR Fall 2019
34
Classifieds
EDITOR Mandi Mooney EDITORIAL COMMITTEE Gregg Albers, MD; John Crouch, MD; Autumn Dawn Galbreath, MD; Curtis E. Harris, MD, JD; Van Haywood, DMD; Rebecca Klint-Townsend, MD; Robert D. Orr, MD; Debby Read, RN AD SALES Margie Shealy 423-844-1000 DESIGN Ahaa! Design + Production PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). Today’s Christian Doctor®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Fall 2019, Volume L, No. 3. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2019, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tennessee. Undesignated Scripture references are taken from the Holy Bible, New International Version®, Copyright© 1973, 1978, 1984, Biblica. Used by permission
26 of Zondervan. All rights reserved. Other versions are noted in the text. Christian Medical & Dental Associations P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www. cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.
TRANSFORMATIONS
Announcing Promotions CMDA is excited to announce two promotions at the headquarters in Bristol, Tennessee. First, Jamey Campbell is now CMDA’s Chief Operating Officer (COO). After nearly a decade as the organization’s Vice President for Stewardship Development, Jamey moved into the COO position on July 1, 2019. Jamey has more than 25 years of experience in communications and development. After obtaining his bachelor’s degree in communication from East Tennessee State University in 1986, he worked in the commercial television field before beginning his career in corporate communications and development. Prior to joining CMDA, Jamey was on staff with former U.S. Senate Majority Leader Bill Frist, MD, East Tennessee State University Quillen College of Medicine and Precept Ministries International. Jamey and his wife Janeen are involved in their church where they teach a young adult Sunday School class and Jamey serves as a deacon. They have two adult children, Rachel and Emily, and one grandchild, Titus. When not working, Jamey enjoys photography, spending time with his family and traveling with Janeen.
The second promotion is George Courtney, who steps into the role of CMDA’s Vice President for Stewardship Development. George completed his bachelor’s degree at Liberty University in church ministries and Christian counseling. For more than 25 years, George has found much joy in helping families as they consider their personal stewardship. George served CMDA earlier in his career as the Director of Development and helping to organize the Changing Hearts Campaign. Before returning to CMDA, George served as the Vice President for Partner Engagement with Medical Benevolence Foundation. George and his wife Rose recently moved back to Bristol, Tennessee. Their son Noah is a junior in college.
SUPPORT CMDA
To learn more about CMDA's Stewardship Department and how you can support CMDA, visit www.cmda.org/support-cmda.
Your Member Resources Are you enjoying the latest editions of Today’s Christian Doctor and Christian Doctor’s Digest? These popular CMDA publications are valuable resources for you, which is one of the great benefits of your CMDA membership. Starting with this edition, we are now combining the mailings for these two publications in an effort to ensure the CDs arrive in one piece and to save on the increasing postage costs. As we have been doing, you also have access to the monthly Christian Doctor’s Digest podcast through the CMDA app, iTunes or the website. For more information, visit www.cmda.org/cdd. And here’s where we need your help to continue to serve you better! Are you interested in helping us go green by receiving both publications electronically? To update your subscription preferences, visit www.cmda.org/cdd. If you have any questions about these resources or other benefits of your membership with CMDA, please contact CMDA’s Member Services at memberservices@cmda.org or call 888-230-2637.
Transformed Doctors ➤ Transforming the World www.cmda.org 5
TRANSFORMATIONS
EVENTS For more information, visit www.cmda.org/events.
Women Physicians in Christ Annual Conference September 19-22, 2019 • Mobile, Alabama 2019 Resident Restoration Retreat September 20-22, 2019 • Westcliff, Colorado Remedy West 2019 October 5-6, 2019 • Riverside, California 2019 Midwest Fall Conference October 11-13, 2019 • Norton Shores, Michigan Paid Advertisement
Marriage Enrichment Weekend October 11-13, 2019 • South Lake Tahoe, California Marriage Enrichment Weekend November 8-10, 2019 • Hershey, Pennsylvania West Coast Winter Conference January 23-26, 2019 • Cannon Beach, Oregon 2020 CMDA National Convention April 16-19, 2020 • Covington, Kentucky Voice of Christian Doctor’s Media Training May 15-16, 2020 • Bristol, Tennessee
MEMORIAM & GIFTS Gifts received January through June 2019
Honor Dr. and Mrs. Robert Lerer in honor of Dr. Shari Falkenheimer Dr. Sloan Hildebrand in honor of Dr. Peter Dawson Ms. Andrea Shupert in honor of Dr. Emily E. Shupert HPM&B, Attorneys at Law in honor of Dr. Wayne Koch Rodney and Debra Deyton in honor of Dr. Gene Rudd Memory Nancy P. Oppedal in memory of Dr. Elmer G. Homme Dr. Terry Hake in memory of Dr. Elmer G. Homme Tom and Dora Heath in memory of Joyce Elizabeth Powell Ellis Edmund Hobertz in memory of Norma Hobertz Dr. Paul L. Wineland in memory of Dr. David Topazian Tom and Janet Titkemeier in memory of Ms. Margie Ann Ehmke Paulina Kim in memory of Yung Jin Kim Theodore Palmatier in memory of Dr. Matthew Seaman Dr. and Mrs. Sreedhar Rayudu in memory of Dr. Steven Rice Coffee High School Class of 1968 in memory of Dr. Steven Nicholas Rice Colleen Faust in memory of Dr. Arland Faust For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.
6 TODAY'S CHRISTIAN DOCTOR Fall 2019
April 16-19, 2020 Northern Kentucky Convention Center Covington, Kentucky (Cincinnati area)
PLENARY SPEAKERS
BE STRONG AND COURAGEOUS Rev. Bruce Boria Devotion Speaker
Ryan Kennedy Kay Arthur
Award-winning author
Mike Chupp, MD
Chief Executive Officer, CMDA
David Levy, MD
Neurosurgeon, author, speaker
Register online at www.cmda.org/nationalconvention
Christopher Yuan, DMin
Worship Leader
Speaker, author, Bible professor
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TRANSFORMATIONS
D
VIE Poster Session
o you know any students, residents or practicing professionals who are looking for an opportunity to be sharpened by like-minded believers while showcasing their research project? Please encourage them to join us for the fourth annual VIE Poster Session at the CMDA 2020 National Convention in Covington, Kentucky on April 16-19, 2020. Any pre-healthcare student, medical student, resident, fellow or faculty member in the healthcare field is eligible to participate. They can share their clinical vignette, case report/series, basic-science report, clinical/transaction report or literature review. We especially are looking for presentations in areas of spirituality, ethics, education, computational biology, mathematical modeling, biophysics, biotechnology, biomedical science, medicine, surgery, dentistry, nursing, medical humanities and more. Cash prizes are awarded for content and presentation. Plus, scholarships to attend the National Convention are also available. In 2019, more than 30 posters were presented, and a total of $1,700 was awarded to 10 winners in a variety of categories. Submission deadline is November 30, 2019. For more information and to submit an abstract, visit www.cmda.org/vie.
In Memoriam Our hearts are with the family members of the following CMDA members who have passed in recent months and years. We thank them for their support of CMDA and their service to Christ. • Allen Casebolt, MD – College Station, Texas – CMDA member since 1994
Regional Ministries Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 503-522-1950 west@cmda.org
Northeast Region Akeem Z. Walker, DMin P.O. Box 1216 Suffolk, VA 23439 609-502-2078 northeast@cmda.org
Midwest Region Allan J. Harmer, ThM, DMin 951 East 86th Street, Suite 200A Indianapolis, IN 46240 Office: 317-257-5885 cmdamw@cmda.org
Southern Region Grant Hewitt, MDiv P.O. Box 7500 Bristol, TN 37621 402-677-3252 south@cmda.org
• O val Dean, MD – Spokane, Washington – CMDA member since 1999
• Frederick D. Doe, MD – Roswell, New Mexico – CMDA member since 1997 • Timothy C. Pennell, MD – Winston Salem, North Carolina – CMDA member since 1979 • Noel T. Van Ness, MD – Redding, California – CMDA member since 1964
8 TODAY'S CHRISTIAN DOCTOR Fall 2019
TRANSFORMATIONS
New Name, Same Mission for Christian Physical Rehab Professionals therapists, as well as occupational therapists, speech therapists, orthotists, prosthetists, respiratory therapists and any other associated physical rehab professionals. This expansion of their membership is a wonderful addition to CMDA as it opens doors to help meet the needs of Christian rehab professionals.
During the Board of Trustees meeting at the 2019 CMDA National Convention, the board approved the name change of Christian Physical Therapists International (CPTI) to Christian Physical Rehab Professionals (CPRP). With this name change, CPRP will now be able to include physical
As a specialty section of CMDA, CPRP encourages, supports and builds up Christian physical rehab professionals spiritually and professionally. They were originally formed in 1982 as the National Association of Christian Physical Rehab Professionals, and then they officially joined CMDA as a specialty section in 2016. Our members are located throughout the United States and around the world. For more information and to get involved with CPRP, visit www.cmda.org/cprp.
In His Image encourages and provides great opportunities for international rotations during residency. I explored the option of long-term medical missions while spending a month overseas during my second year of residency at IHI. The faculty physicians and many of the program’s graduates have extensive experience in international medicine and were enthusiastic in helping to provide me with training and counsel for my future. After graduating from IHI, my family and I moved to Malawi, Africa. My husband teaches at a village school and I work at a hospital in the capital, treating patients and training Malawian family medicine residents. We are so incredibly thankful for the guidance and experiences God gave us through IHI as we prepared for service in Malawi!
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TRANSFORMED TRANSFORMED Doctors
Featuring DRS. JOSHUA & HANNAH EVANS CMDA: To get us started, tell us a little bit about your background (school, training, personal life, etc.) Joshua: My life has kept me in a pretty narrow radius. I grew up in the metro Detroit area and have not strayed far. I attended undergrad and medical school at Wayne State University and then did my pediatric training at Children’s Hospital of Michigan. I continued in academic pediatrics for about 10 years and transitioned into private practice about six years ago, and I currently practice in the city where I went to high school. Hannah: I grew up in a large, blended family in the upstate New York area. I attended SUNY Upstate Medical University in Syracuse, New York and trained at Christiana Care Health System in Delaware. About halfway through residency, I met Joshua at a CMDA singles’ winter conference. After I completed residency, we got married and I moved to Michigan. I now work at a community hospital outside Detroit. We have two young children, so life right now involves lots of snacks, silliness, outside time and PBS kids shows. CMDA: When did you first get involved with CMDA? Joshua: I became involved with CMDA during my second year of medical school. God was working in my life at that time through several events, and in CMDA I found a welcoming, loving, supporting group of friends who loved the Lord and encouraged me in my spiritual growth. Hannah: I first became involved in CMDA when I was a medical student. Our Christian Medical Fellowship group provided much needed encouragement, prayer and fellowship during this season of life. CMDA: And how have you been involved since then? Joshua: Since then, I have been involved in various ways with CMDA. I helped lead a regular Bible study for upper class medical students and residents for about three years. I attended several CMDA singles’ conferences in Colorado, which is how I met Hannah. I have served as the CMDA Michigan State Representative for just over six years. We 10 TODAY'S CHRISTIAN DOCTOR Fall 2019
have also attended several other conferences, including multiple National Conventions and Midwest retreats. Hannah: When I moved to Delaware, there was no existing local chapter, so a few others and I started one! One of the attending physicians in the group hosted at her home, and she and her family blessed me with many meals before meetings. They effectively became my family away from home, inviting me to be part of their birthday celebrations, recitals, etc. Now in Michigan, Joshua and I are involved with the Detroit area CMDA council. We like to go to the Fall Midwest Conference and the CMDA National Convention. Additionally, my Delaware friend convinced me to come to the Women Physicians in Christ Annual Conference years ago, and I’ve been hooked ever since. These women have been such a blessing to me! CMDA: Has faith always impacted your life and/or career? Joshua: I wish I could say that my faith was always a guiding force in my life and career, but I have had periods in my life where I sought my own way or made choices without considering what God would have of me. In His mercy, He has always worked good through those times in my life. Hannah: Yes, it has. In high school, I felt a leading toward medicine. Through college and the years thereafter, the Lord confirmed this direction for me. During the challenging seasons of training, there were moments when I would have walked away if the Lord asked me to. However, God has time and time again equipped me, settled my heart in times of un-
TRANSFORMING TRANSFORMING
the World
certainty and encouraged me to trust Him. As an emergency medicine physician, I regularly handle life and death situations, deliver difficult news and bear witness to suffering. I have spent a lot of time in prayer, asking the Lord to help me trusting Him with my life, as well as the lives of my patients. While many would question why I would pursue a vocation with so much stress (not to mention the crazy hours), I know God directed me here. When I get tired, overwhelmed or stressed, the Lord renews my strength and my heart. He has brought me thus far, and I know He will continue to lead me! CMDA: How have you incorporated your faith into your practice/and or career over the years? Joshua: My faith challenges me to slow down when my nature drives me to work quicker. This has given me opportunities to ask questions about the spiritual lives of my families that I would normally rush past. It is a lifelong work in progress. Hannah: Honestly, it is difficult to get to know a patient long enough to bring up spiritual concerns, but I have prayed the Lord would open my eyes to opportunities to be a light. I have on occasion prayed with patients or taken an opportunity to give spiritual encouragement. I believe my faith deepens my compassion for my patients—after all, they all need a doctor because of the effects of sin! Even if I never get to specifically talk about faith with a patient, I love the fact that I get to extend mercy and compassion to all ages and all walks of life. As a Christian physician, I know medicine is limited, but the Healer is not! CMDA: Have you been involved with CMDA mission opportunities? If so, how? Joshua: I have been to Albania to help with a Christian medical student conference, and I have been on a Medical Education International trip to China to discuss residency training. Hannah: I have not been on a mission trip with CMDA yet, but I’m hoping to soon! CMDA: What made you decide to become lifetime members? Joshua and Hannah: CMDA has meant so much to us throughout the years that we could never see a time where we would not want to be involved in some way. CMDA: How has CMDA impacted your marriage, especially as both of you are doctors?
Joshua and Hannah: Other than leading to us meeting, we have found so many wise friends who have walked the same road as us and have been willing to talk us through life. Many of the conference speakers have given us insight into marriage and relationships, and we have taken advantage of a marriage retreat as well. CMDA: What would you say is the biggest way CMDA has impacted your life? Joshua: In addition to my church, CMDA has been a steady compass throughout the years, a constant source of encouragement and a reminder to look beyond myself. It has also surrounding me with numerous Godly, wise counselors. Hannah: The biggest way CMDA has impacted my life has been through the personal relationships I have made within its ministries. To have prayerful support and encouragement by fellow Christian physicians has been so uplifting. CMDA: What’s one of your favorite memories from being involved with the ministries of CMDA? Joshua: I don’t think meeting my wife can be topped, but the friendship and support I found in CMDA during my second year of medical school remains an incredibly sweet time to me, not to mention a lot of skiing with CMDA friends. Hannah: I think my favorite memory would have to be when we went snow shoeing on the last day of the singles’ conference in Colorado. Though only considered a “date” by one of us, it was a great chance to get to know each other (and test one’s cardiovascular fitness). We talked for hours, but the most memorable part was when one of us ended up falling into a snow drift and the other splendidly documented it with a photograph. The sixth love language is humor. CMDA: CMDA’s vision is “Transformed Doctors, Transforming the World.” What does that mean to you? Joshua: As healthcare professionals, we have an opportunity to speak into the lives of hurting and lost people. This is even more important in a post-Christian culture where many of our patients may never step foot in a church. A life redeemed and transformed by Christ and supported by countless others who have gone before and walk alongside us cannot help but speak to the heart needs of those we are called to serve. Hannah: To me, this means that, as a physician with my heart set on Christ, caring for my patients is ministry.
Transformed Doctors ➤ Transforming the World www.cmda.org 11
When “Cure” Doesn’t Come Finding Deeper Healing by Joni Eareckson Tada
12 TODAY'S CHRISTIAN DOCTOR Fall 2019
I
know what it is like when the “cure” doesn’t come. At the age of 17, I made a careless dive into shallow water and broke my neck between the fourth and fifth cervical level. For years I prayed fervently to regain the use of my hands and legs, but that healing never came. Then, as I approached 40 years in my wheelchair, I began experiencing severe, chronic pain. This summer marks 52 years since I became a quadriplegic, and I still do not have answers for why pain is my constant companion. Add to this, my diagnosis of Stage III breast cancer in 2010. After months of chemotherapy and cancer-suppressing drugs, I was declared cancer-free— only to have a more aggressive form of that same cancer reoccur in late 2018. I know both sides of the coin: what it’s like to be cured, and what it’s like when healing doesn’t come. Physicians, nurses, therapists and other healthcare professionals are trained to cure—or at least “make things better.” So, I speak from experience: your patients are grateful for all you do. But, inevitably, you and I both know we will run up against the reality that sometimes a cure isn’t possible. What happens then? Have you failed as a healthcare professional? Have we patients run out of hope?
HEALING: PHYSICAL AND SPIRITUAL
When I severed my spinal cord and lost the use of my hands and legs, I entered a world of wheelchairs, doctors, medical and therapy appointments, access challenges and countless other obstacles. In those early days, I wanted to be healed more than anything else… like, now. How wonderful it would be, how glorifying to God, I thought, if I were to jump up out of my wheelchair giving praise to Him— what a powerful testimony that would be! I was always on the lookout for “something miraculous” to happen.
SHOW ME HOW TO LIVE!
Shortly after my release from the hospital in Maryland, I remember attending a healing crusade at the Hilton in Washington, D.C. Kathryn Kuhlman was well-known for reports of her miraculous ability to heal all sorts of ailments, and when I heard she would be holding services near our Maryland farm, I just had to attend. Ushers led my sister Jay and me to the wheelchair section of the big ballroom, where we sat among a large contingent of wheelchair users
and others with physical limitations. Our excitement grew as Kuhlman emerged onto the stage, illuminated by a spotlight and accompanied by the swell of organ music. All over the large room, people were apparently being healed. Soon it would be our turn, we thought! It felt as though I were at the pool of Bethesda, calling out to the Lord, “Jesus, come over here! In the wheelchair section! Heal us, too!” But then, even before the crusade was finished, ushers returned to escort us out. Jay and I found ourselves in a long line of wheelchair users, waiting for our turn for the elevator. Disappointment was written on everyone’s faces, and my heart churned, What now? Why didn’t God heal me? Over time, resentment and a complaining spirit took root in my heart. Christ the Healer seemed so far away. I became sullen and withdrawn. Finally, one night in desperation, I cried out to the Lord, “Oh, God, I can’t live this way! Please, if I’m not going to die, show me how to live!” It was a simple plea, but at least my heart was turning God-ward, rather than inward. I felt a glimmer of hope. From then on, instead of spending my days sulking, I asked Jay to help me get up in the morning and push me to the living room where my Bible sat on a music stand. With a rubber-tipped dowel in my mouth, I flipped through the pages of the Bible, trying to make sense of it all. God was answering that simple heartfelt plea. He was beginning a supernatural healing that would reach far Transformed Doctors ➤ Transforming the World www.cmda.org 13
deeper than any physical healing ever could. He was slowly uprooting resentment and bitterness by revealing Himself through His Word and drawing my heart closer to His. And it was happening in ways that never would have been possible before my accident.1
THE HIGHEST PRIORITY
With time, my perspective on healing began to change. I came to understand that God had a higher priority for my life than an instantaneous physical cure. When we look at healing in the Bible, we find that while it is true that Jesus took time to physically heal many people, He was most interested in their spiritual healing. In sending the 10 men with leprosy to the priests to be declared “clean,” He was also restoring them to fellowship with their community (Luke 17:11-14). Only after offering forgiveness of sins to the paralytic lowered through the roof did Jesus then offer physical healing (Mark 2:1-11). And most importantly, Jesus didn’t physically heal everyone. When it was time to move on, He did so, leaving behind multitudes unhealed (Mark 1:38). His larger mission took priority—“to seek and to save the lost” and to bring spiritual healing to a broken humanity (Luke 19:10, ESV). It wasn’t that Jesus did not care about the problems among those He didn’t heal physically; it’s just He was more concerned about their spiritual welfare than their physical hardships. As Jesus famously pointed out, it would be better for a person to be maimed than to live in a state of sin and rebellion (Matthew 5:29-30). As I’ve written elsewhere,2 “the core of God’s plan is to rescue us from sin and self-centeredness. Suffering—especially the chronic kind—is God’s choicest tool to accomplish this. It is a long process. But it means I can accept my paralysis as a chronic condition. When I broke my neck, it wasn’t a jigsaw puzzle I had to solve fast, or a quick jolt to get me back on track. My paralyzing accident was the beginning of a lengthy process of becoming like Christ”— and, in so doing, discovering the true purpose of my life.
THE PURPOSE OF OUR LIVES
When the cure doesn’t come, when fervent prayer for healing goes unanswered, the person with a chronic health condition needs to understand that his or her life still has meaning, value and purpose. How can we be so sure? Because no matter how “imperfect” an individual may find himself to be, he is still an image-bearer of his Maker, dearly loved by God and conferred with profound dignity and irrevocable purpose. We are all made in the image of God, and we all share equally in human dignity— regardless of our abilities or lack of them. To be made “in God’s image” is not a matter of what we do, it is a matter of 14 TODAY'S CHRISTIAN DOCTOR Fall 2019
whose we are—God’s—and what God intends us to be. His highest intention? That we be conformed to the image of Jesus Christ.3 Sadly, this truth has become obscured. When people learn that most quadriplegics cannot bathe, toilet, feed or dress themselves, they are quick to think, What a poor quality of life! But if people judge life value on one’s autonomy, abilities or inconvenient circumstances, they are missing the real purpose for living. God made us in His image, and that fact alone gives us a reason to exist: no matter what our abilities or disabilities, we are to be God-reflectors. And if God’s glory shines brightest through our weakness—which it does—then our inabilities become the best platform for God’s highest glory. That makes for great quality of life. It’s why as a quadriplegic, I need to instruct myself in whose image I bear. Yes, my body may be broken, but I am a God-reflector. I mirror a God who was pleased to make me in His image (Genesis 1:27). That is what gives me human dignity. Not my ability to walk or use my hands, or toilet myself or cut my own food. No, my dignity is rooted in Christ in me, the hope of glory (Colossians 1:27).
HELP FOR THE JOURNEY: THE HEALTHCARE PROFESSIONAL’S ROLE IN HEALING
Clearly, life with a disability or other chronic condition is anything but meaningless, purposeless or without value. Despite the challenges often associated with disability, it
disabilities and other chronic conditions. In a 2009 report,4 the National Council on Disability (NCD) observed that although more than 54 million Americans have some form of disability, and despite the fact that “people with disabilities comprise the most important health care consumer group in the United States,” it remains the case that “people with disabilities tend to be in poorer health and to use health care at a significantly higher rate than people who do not have disabilities. They also experience a higher prevalence of secondary conditions and use preventive services at a lower rate than others.”
can be an open door into deep times of spiritual growth, supernatural joy, Spirit-sent peace and unimaginable contentment—especially when the body of Christ comes alongside an individual with a disability, walking with them through difficulties and helping lead them to the all-sufficient grace found in Jesus Christ (2 Corinthians 12:9-10).
The NCD also noted, “people with disabilities are affected disproportionately by barriers to care. These barriers include health care provider stereotypes about disability, lack of appropriate training, and a lack of accessible medical facilities and examination equipment, sign language interpreters, and individualized accommodations.” The NCD found it particularly worrisome that “few professional health care training programs address disability issues in their curriculums,” concluding that “the absence of professional training on disability competency issues for health care practitioners is one of the most significant barriers that prevent people from receiving appropriate and effective health care.” Finding effective long-term solutions to these problems will take time and, in some cases, financial resources.5 Still, given their commitment to the dignity of every human per-
Still, life with a chronic condition can be hard. As a healthcare professional, how can you best help your patient on the journey toward discovering his or her God-given purpose in Christ? I offer three suggestions: First, as professionals on the front lines of the life-anddeath debates over abortion, physician-assisted suicide, euthanasia and the entire panoply of other emerging bioethical issues, you play a crucial role in resisting the pervasive cultural lie that it is somehow beneath one’s dignity to be weak and helpless. Your compassion underscores that a person with a chronic condition is not “better off dead than disabled.” We must all counter lies by being a voice for life—for the unborn, the elderly, the disabled, the medically fragile and the vulnerable. Because all people are created in the image of God and, therefore, possess a dignity that cannot be violated even when requested. Second, healthcare professionals can advocate for the adoption and integration of dignity-enhancing practices in all spheres of the healthcare world. It is a well-documented fact that the healthcare profession can be daunting for persons with Transformed Doctors ➤ Transforming the World www.cmda.org 15
son, Christian healthcare professionals ought to be in the vanguard of efforts to address these and other challenges faced by people with disabilities in the medical setting. In the meantime, on a day-to-day level, you can assist your patients with chronic conditions in the quest to discover meaning and purpose in their lives, notwithstanding the suffering they may be enduring. One practical way of doing this is to direct families struggling with disability to a Joni and Friends Family Retreat. Last summer, the ministry held 37 retreats domestically for families with special needs, providing five days of fun activities, networking with other families and spiritual fellowship. Another practical action point is to make encouraging resources available to your patients. Joni and Friends has developed a variety of practical resources to help people find hope in the midst of suffering. For example, the Beyond Suffering Bible was carefully crafted by the Joni and Friends team in partnership with Tyndale House Publishers to specifically address the issues people struggling with disability commonly face. More recently, Joni and Friends published a gift book entitled Infinite Hope. Complete with stories and insights about suffering and the goodness of God (many drawn from the Beyond Suffering Bible), along with my artwork, Infinite Hope is a wellspring of words and images designed to encourage readers to experience a fuller, deeper love for Christ, the Blessed Hope.6 Consider placing a copy of Infinite Hope or the Beyond Suffering Bible in your medical office waiting room. It is a small gesture, but often it is in the interludes of life—waiting in line at the grocery store 16 TODAY'S CHRISTIAN DOCTOR Fall 2019
or at the doctor’s office—where God speaks most clearly to a hurting heart. Don’t miss out on the opportunities to plant these seeds of reassurance. Find out more at joniandfriends. org. In closing, I leave with you this word of encouragement. The care that you as a healthcare professional offer involves so much more than seeking a physical cure. In your various ministrations—the caring word, the gentle touch, the pa-
tient listening—you bring healing, even when a cure is not possible. After all, everything you are and do is ultimately in service to the Great Physician, the One who alone brings true healing. NOTES 1 The anecdote related in the preceding four paragraphs is adapted from my devotional “Show Me How to Live!”, in Beside Bethesda: 31 Days Toward Deeper Healing (Colorado Springs, CO: NavPress, 2014), pp. 19-21. 2 From “Hardships that Hang On,” February 17 entry in Pearls of Great Price: 366 Daily Devotional Readings (Grand Rapids, MI: Zondervan, 2006). 3 For much more on this, see John F. Kilner, Dignity and Destiny: Humanity in the Image of God (Grand Rapids, MI: Eerdmans, 2015). 4 National Council on Disabilities, The Current State of Health Care for People with Disabilities (Washington, D.C.: 2009). Available: https://ncd.gov/rawmedia_ repository/0d7c848f_3d97_43b3_bea5_36e1d97f973d. pdf. 5 In its report, the NCD recommended a number of structural, systemic and practical reforms aimed at increasing access to healthcare for persons with disabilities and improving disability competency among medical professionals. 6 Information about these and many other resources can be found by visiting Joni and Friends at https://store.joniandfriends.org/.
JONI EARECKSON TADA is the founder and CEO of Joni and Friends International Disability Center. She is an international advocate for people with disabilities. A diving accident in 1967 left her, then 17, a quadriplegic in a wheelchair, without the use of her hands. After two years of rehabilitation, she emerged with new skills and a fresh determination to help others in similar situations. Joni has served on the National Council on Disability and the Disability Advisory Committee to the U.S. State Department. She has guided evangelism strategies among people with disabilities worldwide and has been awarded several honorary degrees including Doctor of Divinity from Westminster Theological Seminary; a Doctor of Humanitarian Services from California Baptist University; and a Doctor of Humane Letters by Indiana Wesleyan University. She is the author of more than 50 books and received the Gold Medallion Lifetime Achievement Award from the Evangelical Christian Publishers Association. Joni and her husband Ken have been married since 1982.
CMDA AND JONI AND FRIENDS Nearly one billion people around the world live with disabilities. Many of these individuals and their families live in poverty, pain and despair. Joni and Friends want to change this, and the ministry is committed to bringing the gospel and practical assistance to those impacted by disability around the globe. For the last 40 years, Joni and Friends’ mission has been to present the hope of the gospel to people affected by disability and their families through programs and outreaches around the world. To do this, they evangelize people affected by disabilities and their families; train, disciple and mentor people affected by disabilities; multiply disability effective churches; and promote a biblical worldview on disability through education and policy. These activities are accomplished through outreaches like family retreats, held both domestically and internationally, which offer a haven for families impacted by disability. Joni and Friends also facilitates Wheels for the World, which collects used wheelchairs, walkers, canes, etc. in the U.S., restores them to likenew condition and then distributes them internationally to children and adults with disabilities. Joni Eareckson Tada has served on CMDA’s Board of Reference for 25 years and has spoken at CMDA’s National Convention on multiple occasions. We are working together to increase the capabilities of our missionary members and their hospitals to better serve patients with disabilities. Joni and Friends has supplied expert faculty for our Continuing Medical & Dental Education conferences and at the annual Summit for missionary executives involved in healthcare missions. CMDA and Joni and Friends’ Christian Institute on Disability cooperate on public policy matters of concern to both organizations. For more information about CMDA’s mission outreaches, visit www.cmda.org/missions. For information on Joni and Friends’ Christian Institute on Disability, visit www.joniandfriends.org/ministries/ christian-institute-on-disability/.
Transformed Doctors ➤ Transforming the World www.cmda.org 17
HUMAN TRAFFICKING & THE MORNING AFTER PILL
Do They Go Together? by Janie Christine Ogle, DO
LEARN MORE
CMDA’s Commission on Human Trafficking equips, supports, motivates, sends and transforms CMDA members in their role to abolish human trafficking within the U.S. and abroad. For more information and to get involved, visit www.cmda.org/humantrafficking.
18 TODAY'S CHRISTIAN DOCTOR Fall 2019
W
hat choice will you make when you come to a fork in the road? Will you choose to stand up for what you believe, or will you stand by and conform to the world around you? When I was a medical student, I pondered when the time would come where I had to make that decision and if I would remain faithful to my belief. Thankfully, my CMDA group in medical school went through a CMDA devotional for medical students titled Living in the Lab without Smelling Like a Cadaver. This book taught me that obedience was not a choice to be made in the moment, but rather it is a resolute verdict made beforehand. Growing up I was surrounded with support and values from my church and its members. This support continued in medical school, but things changed as I entered residency. I felt like a sheep amidst wolves. I found myself like Esther of the Bible with an opportunity to take a stand for what I believe, though it could have cost me significantly in my career. Most of us are aware of the international tragedy of human trafficking. CMDA is actively involved in ministering to these victims by equipping Christian healthcare professionals to take a stand against it through their profession. As Christians, we recognize that such abuse of human life is evil against the only creation which bears the image of God Himself. Like countless other Christians in healthcare, I wanted to help make a difference for these victims but was unsure how to do so. Then, as a lowly intern, God dropped me in the right place at the right time, and I found myself working to create our hospital’s protocol for human trafficking victims. I spent countless hours poring over resources, including Dr. Jeff Barrows’ Toolkit called “Developing a Protocol for Reporting Victims of Human Trafficking,” which is available through hopeforjustice.org and can help improve a hospital’s protocol to serve those in desperate need. I put my heart and soul into it. God had given me an opportunity to be the voice and driver of this protocol. If God had not opened this opportunity, it may have stayed on my attending’s list of things to do. I had spent months on the project, and the protocol was approved. We then put together an order set to expedite and improve clarity of the protocol. I waited for the order set to be finalized, so I was ecstatic as I reviewed the final version of order set I had worked tirelessly on. As I perused, I recognized a change. It was an order I had intentionally left out: Levonorgestrel. I was angry and extremely disappointed. After a few days, I informed my supervising physicians that I did not know if I could continue on the project if they felt this addition to the order set was necessary. After waiting patiently for their response, I was disappointed to hear they felt it was necessary to include Levonorgestrel despite my concerns. To fully understand why this addition impacted me so much, it’s important to understand what Levonorgestrel truly is and how it made such a difference. For those not in the medical field, the name of Levonorgestrel isn’t well-known. However, it’s more commonly known by its brand name: Plan B. Levonorgestrel is a hormonal medication used to prevent pregnancy after unprotected sex, and it’s used as an emergency contraceptive and shouldn’t be used as a regular form of birth control. And so began my journey of major soul searching, praying and asking others to pray with me. I want to share some of that journey, as countless Christian Transformed Doctors ➤ Transforming the World www.cmda.org 19
Is it more humane to abort this child that might be abused or have severe neurologic deficits from alcohol, drugs or abuse suffered by the mother? This is essentially the same root question the apostle Paul asked the members of the Roman church, “And why not say, ‘Let us do evil that good may come’?” (Romans 3:8a, NKJV). Paul quickly condemns this thinking. Yes, sin and evil exist in this world, and sometimes people do extremely evil things to children and women; however, we are not God and do not know the plans He has for each life He created. Only God, as the Creator of human life, has the right and the sovereignty for those decisions.
healthcare professionals struggle with this topic, given some of the situations we see on a daily basis. Are there any situations where an abortifacient is okay? Even if I don’t agree with the use of this drug, does it mean I have to abandon the project all together? Is standing up for this one thing worth giving up on the entire project and all my hard work? My colleagues already know I’m pro-life and a Christian and I’m not ridiculed too much as it is, but is this going to make me the center of their Christian jokes? As I began soul searching, I asked myself three specific questions: 1. Is Levonorgestrel really an abortifacient? Yes, it can inhibit implantation of a fertilized egg. CMDA’s position statement on the Beginning of Human Life states that life begins at fertilization and lists detailed reasons for this belief.1 CMDA’s position statement on abortion states, “We oppose the practice of abortion and urge the active development and employment of alternatives.”2 2. Does the fact that many of these pregnancies aren’t wanted justify the use of Levonorgestrel? As healthcare professionals, we have unfortunately seen the horrible outcomes of children unwanted by their caregivers. But does that truly justify the use of Levonorgestrel? 20 TODAY'S CHRISTIAN DOCTOR Fall 2019
3. Can I continue to work on this project? As we discussed, it is an abortifacient; therefore, it is my belief that it is wrong to use, no matter the situation. My personal dilemma was that a protocol I created now included this as an option. Should I continue to work on the project, did that mean I was condoning the use of that medication for the intended purpose to arrest pregnancy? If I personally knew I rejected the protocol, was that enough? This is the fork in the road I had pondered. Would I have to choose what is easy versus what I knew was right? I prayed, searched the Scriptures and spoke with other Christian healthcare professionals. The initial consensus was that most of them did not agree with its use, but they also did not feel that it was ethical to withhold options from patients because of their beliefs. I understand the logic and I can rationalize this answer. God Himself does not withhold options from us just because they are wrong. He allows us to choose for ourselves. This led me to search the Scriptures over the free will of man versus God’s sovereignty. Does God withhold options from us? If not, then who is ultimately responsible for those decisions? Various Scriptures teach us it is our responsibility to answer for the decisions we make (Matthew 12:36, Romans 14:12). So I guess it is okay for me to still work with this team and be part of this protocol even as it is? Honestly, I think this is one of those questions only the Holy Spirit can guide and direct each person in their particular situation. What I felt was being obedient to God for my situation may not be how the Spirit leads in other individual situations. After praying through it all and searching the Scriptures myself, what continued to be impressed upon my heart was
that I did NOT want to have anything to do with this pill, despite the consequences. I came to this conclusion just a few days prior to meeting with the human trafficking team to discuss and finalize the order set. I walked into this meeting fully expecting I would be walking out no longer a member of the team. But God. Are these not some of the most beautiful words in Scripture? I met the emergency room attending physician just outside the room, and the first thing he said to me was, “I need to thank you.” I wasn’t sure I heard him correctly, but he said it again, “I need to thank you because you made me stop and think about this and pray about it. There were a lot of tears and prayers, and we decided to leave it out of the protocol.” Between the time both physicians initially told me the decision to use Levonorgestrel was final and the time when they changed their minds and took it out, the only intervention that occurred was prayer. God stepped in and said “No,” and He changed their hearts in order to accomplish His purpose. Ultimately, they decided the potential for pregnancy needed to be discussed, but they were not going to mandate to healthcare professionals how to discuss it or what options to include. The protocol was changed to include a communication order to discuss the potential for pregnancy in lieu of a medication order for Levonorgestrel. In the end, God had the final word and revealed His power in so doing. As He did so, He taught me several lessons through it. 1. Think. Don’t just accept what other Christians say is okay or acceptable without praying through it and searching the Scriptures yourself. God does not ask you to be as good as other Christians; instead, He asks us to be obedient as He guides us. We are not of this world, and we should not let others put us into their molds. 2. Obey. God will provide. He did not have to reward my obedience with a good outcome, and He does not always do so. He is good and perfect in all His ways, regardless of whether or not I was ridiculed by my coworkers or made to look like a fool for my beliefs. Yet, in His grace and kindness, He chose to allow things to work out as such in a positive way, and I am incredibly thankful. 3. Pray. While growing up, I often heard my pastor say that prayer is not preparation for work; instead, prayer is the work. Prayer is the most powerful tool I have, period. 4. Trust. Yes, God does not withhold from us the bad choices we could make. Yet, even God, in His sovereign-
ty, does not give us ALL the options. For it is only by the grace of God that I myself am not as evil as the very people who abuse these trafficked victims. He has kept me from much evil by concealing options I am unaware of. Yet, it is through making some bad decisions that we grow and He refines us. Only God in His infinite sovereignty, grace and mercy knows who can handle which options and who cannot. As finite humans with finite knowledge, we cannot make those distinctions. Even the CMDA position statement on physician-assisted suicide addresses the root of this by stating, “the sovereignty of God places a limit on human autonomy.”3 As Christian healthcare professionals, we are to be the hands and feet of Christ. When we see injustice, we are to obey when God leads us to stand against it. If you haven’t faced a similar situation yet in your career where you had to decide whether or not to stand up for your beliefs, it’s more than likely you will eventually. And as you face these situations, I pray you will be attentive to the Holy Spirit for His direction and leading. I pray it causes you to seek His face in prayer and in the Word. I pray you utilize resources like those CMDA develops, as well as the fellowship and community of Christian healthcare professionals through CMDA, to help you keep your eyes on Christ in the midst of your situation. And as you do, I pray God will bless you with more of Himself to guide you as you stand firm in His presence and His Word. BIBLIOGRAPHY 1h ttps://cmda.org/wp-content/uploads/2018/04/ BeginningofHumanLife-w-Addendum.pdf 2 https://www.cmda.org/resources/publication/abortionethics-statement 3h ttps://cmda.org/wp-content/uploads/2018/04/PhysicianAssisted-with-References.pdf
JANIE CHRISTINE OGLE, DO, is currently a sports medicine fellow at the University of Tennessee Health Science Center in Memphis, Tennessee. She received her bachelor’s of science in education from the University of Tennessee, Knoxville, attended medical school at the Via College of Osteopathic Medicine in Blacksburg, Virginia, and recently finished her pediatric residency at the University of Kentucky in Lexington, Kentucky. She has been a CMDA member since her first year of medical school and actively involved in the fight against human trafficking since that time as well. She also continues to pursue medicine as missions both in Memphis as well as in various countries around the world.
Transformed Doctors ➤ Transforming the World www.cmda.org 21
HHS Protects Conscience Freedoms by Jonathan Imbody
C
onscience-guided healthcare professionals and students received a healthy dose of positive federal policy advances in the last few months. CMDA played a role advocating on behalf of our members in each of the following federal policy reforms that relate to conscience freedom, gender issues and abortion.
1. New federal conscience rule combats coercion in healthcare.
WHAT
A new federal regulation (rule) by the U.S. Department Health and Human Services’ (HHS) Office for Civil Rights now implements 25 federal laws relating to conscience.
WHEN
HHS issued the final rule in May 2019, and it went into effect in July.
WHAT IT MEANS TO YOU
HHS officials explain, “The rule will protect healthcare providers, individuals, and other health care entities from having to provide, participate in, pay for, or refer for services which violate their conscience. This includes ensuring that nurses, doctors, or medical students cannot be forced to participate in procedures which violate their religious belief or moral convictions – that might include procedures like abortion, sterilization, or assisted suicide. It also protects the right of diverse faith-based health care institutions to retain their religious beliefs and identity as part of their mission of serving others.”1 Director of the HHS Office for Civil Rights Roger Severino said, “Finally, laws prohibiting government funded discrimination against conscience and religious freedom 22 TODAY'S CHRISTIAN DOCTOR Fall 2019
will be enforced like every other civil rights law. This rule ensures that healthcare entities and professionals won’t be bullied out of the health care field because they decline to participate in actions that violate their conscience, including the taking of human life. Protecting conscience and religious freedom not only fosters greater diversity in healthcare; it’s the law.”2
CMDA’S ROLE
CMDA provided data and commentary on the proposed rule that HHS officials cited in explaining the final rule. In explaining its final rule, HHS eight times referenced CMDA’s 2009 polling of faith-based health professionals by Kellyanne Conway. The polling of CMDA members and members of other faith-based health organizations revealed the extent of discrimination experienced by respondents, as well as their determination to adhere to moral and ethical codes even if forced to leave medicine as a result.
WHAT’S NEXT
A number of states, cities and pro-abortion groups have challenged the new conscience rule in federal court. In June, the Democrat-controlled U.S. House of Representatives used an appropriations minibus bill as a vehicle to repeal the rule. The White House issued a Statement of Administration Policy opposing the bill, noting, “The Administration strongly objects to the inclusion of section 240 of the
‘sex’ when it comes to protection against discrimination on the basis of sex.” The proposed rule would revise 2016 provisions of Section 1557 rule that redefined discrimination “on the basis of sex” to include gender identity (which the department had defined as one’s internal sense of being “male, female, neither, or a combination of male and female”) and termination of pregnancy. A federal court has said this expansive definition is likely unlawful. The rule issued proposes a return to the plain meaning of the words used by Congress in prohibiting sex discrimination. Under the proposed rule, HHS would continue to vigorously enforce Section 1557 prohibitions of discrimination on the basis of race, color, national origin, disability, age and sex in certain health programs, while ensuring that Section 1557 and Title IX regulations include the language Congress enacted that protects religious entities and prevents Title IX from requiring performance of, or payment for, abortions. GET INVOLVED
CMDA’s Washington Office links our members with Congress, the Administration and policy organizations in Washington, D.C.; presents life-honoring perspectives through the national media; and publishes resources on vital issues. To get involved, visit www.cmda.org/washington.
bill, which prohibits the HHS Office for Civil Rights from using appropriated funds to finalize, implement, or enforce the newly published conscience protection final rule.”3 CMDA works closely with religious freedom law firms that can defend the rule in federal court. To learn more, visit www.freedom2care.org/laws-regs-cases.
2. Transgender mandate reversal aims to restore biological definition regarding “sex discrimination.”
WHAT
A federal regulation proposed by HHS would restore a biology-based definition of “sex discrimination.” The previous White House administration’s rule re-defined “sex discrimination” to include gender perception and would have opened the door to prosecute under discrimination law any healthcare professional who declined to cooperate in transgender procedures, prescriptions and other requirements.
WHEN
HHS issued the proposed rule issued in May 2019 and the public comment period ended in August 2019.
WHAT IT MEANS TO YOU
In an email I received, HHS officials explain that the proposed rule “eliminates expansive definitions of the term
CMDA’S ROLE
The federal court decision that HHS referenced as key to its proposed rule is a preliminary nationwide injunction issued in 2016 by a federal district court judge against the previous administration’s transgender mandate rule. In that lawsuit, the Becket religious freedom law firm represented CMDA, a number of states and Franciscan Alliance, a Catholic health organization. For more information, visit www.transgendermandate.org.
WHAT’S NEXT
HHS will review comments and likely issue a final rule in late 2019 or early 2020. Meanwhile, CMDA’s court victory, which included a nationwide injunction, protects our members from enforcement of the transgender mandate.
3. New HHS policy curtails research using tissue from elective abortions.
WHAT
HHS cut off the use of federal funds for current research using fetal tissue obtained from elective abortions. The new policy also sets up a process for the HHS Secretary to engage a panel of experts to review future applications for research involving fetal tissue.
WHEN
HHS announced the new policy in June 2019.
WHAT IT MEANS TO YOU
In a memo dated June 5, HHS officials explained, “Promoting the dignity of human life from conception to natural death is one of the very top priorities of President Trump’s administration. Intramural research that requires Transformed Doctors ➤ Transforming the World www.cmda.org 23
new acquisition of fetal tissue from elective abortions will not be conducted. For new extramural research grant applications or current research projects in the competitive renewal process (generally every five years) that propose to use fetal tissue from elective abortions and that are recommended for potential funding through NIH’s [National Institutes of Health] two-level external scientific review process, an ethics advisory board will be convened to review the research proposal and recommend whether, in light of the ethical considerations, NIH should fund the research project—pursuant to a law passed by Congress.” No current extramural research projects (research conducted outside NIH, e.g., at universities, that are funded by NIH grants) will be affected during their currently approved project period. Meanwhile, HHS officials also explained, “NIH announced a $20 million funding opportunity for research to develop, demonstrate, and validate experimental models that do not rely on human fetal tissue from elective abortions. HHS is committed to providing additional funding to support the development and validation of alternative models.”
CMDA’S ROLE
In September 2018, CMDA joined other groups in a letter to HHS Secretary Alex Azar protesting the Food and Drug Administration’s contracting to purchase “fresh” aborted fetal organs from Advanced Bioscience Resources (ABR) for the purpose of creating humanized mice with human immune systems. ABR is among the entities referred for criminal investigation by both houses of Congress for potential collusion with abortion facilities as well as possibly profiting from the sale of fetal organs from aborted babies.
WHAT’S NEXT
When a relevant request for research funds arises, the HHS Secretary will convene an ethics advisory board to review the facts and make a funding recommendation. By law, the board will include 14 to 20 individuals, including at least one theologian, one ethicist and one physician. CMDA members who would like the Washington Office to recommend them to serve on any future review panel assembled by the HHS Secretary should send an email to washington@cmda.org with their CV and a note briefly outlining their relevant experience and interest in serving.
WANTED: DANIELS AND ESTHERS
Over the last 25 years, God has opened doors for significant influence by CMDA and our members in Washington, D.C. CMDA members have been serving in high
24 TODAY'S CHRISTIAN DOCTOR Fall 2019
profile federal government positions, testifying before Congress and providing expert counsel to lawmakers and policy makers behind the scenes. Like the biblical Daniel and Esther, they are serving as lights in the often-dark halls of power. Let us remember to pray for these servants—for courage, protection, effectiveness, encouragement and perseverance. Despite recent encouraging federal policy victories, many professional health organizations, politicians and activists continue to pound away relentlessly at the protections on which conscience-driven healthcare professionals depend to practice moral healthcare. The forces arrayed specifically against life-affirming healthcare professionals and generally against believers in the public square are well-funded, influential and determined. We face a battle of good versus evil, life versus death, the kingdom of God versus the kingdom of this world and the domain of darkness. If we are to remain true to our faith and our Lord, we must determine now not to shrink back in fear from this opposition but to engage in the battle. Every Christian healthcare professional and student would do well to pray that God would grant them the conviction of Daniel, who “…made up his mind that he would not defile himself…,” and the courage of Esther, who resolved to speak out to save lives, saying “…if I perish, I perish” (Daniel 1:8, ESV; Esther 4:16, ESV). BIBLIOGRAPHY 1h ttps://www.hhs.gov/about/news/2019/05/02/hhsannounces-final-conscience-rule-protecting-health-careentities-and-individuals.html 2h ttps://www.hhs.gov/about/news/2019/05/02/hhsannounces-final-conscience-rule-protecting-health-careentities-and-individuals.html 3h ttps://www.whitehouse.gov/wp-content/uploads/2019/06/ SAP_HR-2740.pdf
JONATHAN IMBODY serves as CMDA’s Vice President for Government Relations and also directs Freedom2Care, which focuses on freedom of faith, conscience and speech. His book Faith Steps equips Christians to engage in public policy.
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CMDA STATEMENT ON MEDICAL MARIJUANA
T
he Christian Medical & Dental Associations (CMDA) has developed this policy on “medical marijuana” with both an inherent belief that the Bible is the Word of God--that it speaks into our time and culture and that God gave us his creation to use to its fullest potential—and with the incorporation of scientific evidence which provides a window into the truths about God’s creation.
EXECUTIVE SUMMARY
The term “medical marijuana” refers to the insufficiently regulated use of the whole, unprocessed marijuana plant or its extracts to treat symptoms of illness and other conditions. Note that pharmaceutical-grade medications from components of the marijuana plant have been developed according to U.S. Food and Drug Administration (FDA) standards, but these medications are distinct from what is classified here as “medical marijuana.” The science supporting “medical marijuana” has been hotly debated and politicized after emerging on state referendums in recent years. The Bible which is our final authority for faith and practice, speaks to the creation mandate, promotion of the good, and the role of authority. The Bible does not solve every question of policy, but it does provide insights into the use of medical marijuana. The two main ingredients in marijuana are tetrahydrocannabinol (THC)—the “psychoactive” ingredient, responsible for the euphoria or “high”—and cannabidiol (CBD). Products may contain primarily THC, primarily CBD, or a mixture of both. THC levels are rising substantially in commercially available marijuana, and product containing concentrations greater than 15 percent are being considered for labeling as “hard drugs” in the Netherlands.1,2 State legalization of “medical marijuana” has not been accompanied by the rigorous scientific approval process with regulations for dosing, production, packaging and monitoring that have made FDA-approved medications safe and effective. In such states “medical marijuana” is often approved for conditions3 where research is inadequate.4 False advertising may mislead vulnerable patients and the public. “Medical” use may inadvertently result in addiction, increased risk of psychosis, mental or psychosocial impairment, lung damage when smoked, and complications for unborn children when used during pregnancy.4,5 The presence of “medical marijuana” dispensaries may increase access to recreational marijuana for minors.6 “Medical marijuana” legalization is associated with increased illicit marijuana use,7 is linked to increased emergency room visits for marijuana-intoxicated children,8 and has historically been a stepping stone to legalization of recreational marijuana.9 CMDA maintains that a reasonable and prudent physician should only recommend FDA-approved pharmaceutical-grade
26 TODAY'S CHRISTIAN DOCTOR Fall 2019
EARN CE CREDIT
You can now earn continuing education credits through Today’s Christian Doctor. Three hours of self-instruction are available for this article. See page 33 for more information. medications when the indications are clear, dosing is well-established, risk-benefit ratios have been investigated and can be applied to individual patients, delivery systems are safe, and careful monitoring is agreed upon. Physicians cannot assume that “medical marijuana” has the labeled amount of active ingredient and is devoid of contaminants and harmful additives. Rather than legalizing a drug by popular vote and political lobbying, CMDA encourages legalization via FDA approval through formal clinical and scientific studies of any marijuana-based therapeutic that has demonstrated medical efficacy and safety by randomized controlled trials. To augment this process, CMDA suggests rescheduling lower potency marijuana to Schedule II10 to enable medical research into the potential benefits and harms of the use of pharmaceutical-grade marijuana derivatives within established ethical research guidelines. FDA-approved marijuana medications should be prescribed and regulated like any other FDA-approved medication.
A. BIOLOGICAL
1. CANNABINOIDS: The genus Cannabis contains cultivars that are commonly referred to as “marijuana.” Although over 100 different cannabinoids as well as other compounds have been found in cannabis species, the two main cannabinoids, or active ingredients, are tetrahydrocannabinol (THC) and cannabidiol (CBD).4 THC is the “psychoactive” ingredient, responsible for the euphoria or “high” that comes from marijuana due to its partial agonist activity on type-1 cannabinoid receptors (CB1). CB1 receptors are found in the brain in high concentrations as well as other non-neural tissues such as the gastrointestinal tract and skeletal muscle. A small number of CB2 receptors are also in the brain.4
THC’s chemical structure is similar to the endogenous cannabinoids (specifically anandamide) which are neurotransmitters that bind to CB receptors.5 CBD has low affinity for CB1 and CB2 receptors and is not psychoactive; it is an agonist of the serotonin 5-HT1A receptor and appears to have anti-inflammatory, antioxidant, and neuroprotective properties.4 There are THC-type, CBD-type, and hybrid cannabis plants which have predominantly THC, CBD, or a mixture of both cannabinoids, respectively.4 2. “MEDICAL MARIJUANA”: Cannabis-derived products (dried flowers, resin, oil, sprays, creams, foods, capsules) may be delivered via smoking, inhaling, vaporizing, eating or drinking food products or beverages, topical applications, and suppositories. These products may contain THC alone, CBD alone, or some combination of both.4 These products are neither FDA-approved nor regulated for consistency in the amount of active compounds or safe processing; they may contain potentially hazardous contaminants or adulterants such as degradation products, microbes, heavy metals, pesticides, fertilizers, glass beads, lead, tobacco, cholinergic compounds, and solvents.4 3. RISING THC LEVELS: The natural levels of THC and CBD in Cannabis are under 1%.11 Using powerful lights, selective breeding, hydration, chemical fertilizers and special soils, the industry has created a new and more potent marijuana plant than the one of the 1960s and 1970s. The average THC content in the “new” marijuana exceeded 12% nationwide in 2014.5,11 Marijuana concentrates may contain 75% or more THC;5 associations of the use of such substances with addictive highs, psychosis, and other effects led one author who works in drug treatment programs to claim they are deserving of the label “hard drug,”11 like heroin and LSD. Although not yet implemented, recommendations have been made to revise the Netherlands Opium Act to place cannabis containing more than 15% THC in List 1 (hard drugs).1
B. BIBLICAL
1. THE BIBLE AS OUR FINAL AUTHORITY FOR FAITH AND PRACTICE: We believe the Bible speaks directly into every social, cultural, and political issue. The Bible does not solve every question of policy, but we do feel it provides insights into the use of medical marijuana. 2. THE CREATION MANDATE: Genesis relates that God gave humans dominion over all the earth with instructions to subdue it.12 We have a mandate to use everything our Creator has given us to its fullest potential and greatest good—to God’s glory. But the fall13 caused mankind to begin using creation for selfish and sinful purposes. The marijuana plant has potential good medicinal use for humanity. However, it also has the potential to harm individuals, society, and the environment. 3. PROMOTION OF THE GOOD: We believe Scripture clearly communicates God’s will that people everywhere—in all circumstances—be treated with love, humility, kindness, compassion, and selfcontrol. This means doing good and promoting the good to our neighbors – not evil.14 CMDA believes society should not approve the use of any medication unless there is (1) a strong evidence-base regarding the efficacy of such drugs in relieving specific symptoms or treating specific medical conditions as validated by a formal regulatory approval pathway, and (2) safe, pharmaceutical-grade, uniform-dosing options available.
4. ROLE OF AUTHORITY: We believe Scripture calls Christians to be submissive to governments and authorities.15 Since no government or authority is perfect or flawless, there clearly are limits to this submissiveness when the authorities and Biblical commands are in conflict.16 Leaders and teachers must give an account and are judged more strictly;17 physicians fill both roles and must be careful never to abuse that authority. Even in states where marijuana is legal for medicinal purposes, the respected authority of the physician’s role in society dictates that only FDA-approved, pharmaceutical-grade marijuana be dispensed or prescribed for treatment of conditions for which solid medical evidence of effectiveness exists and for which the benefits exceed potential harms.18 Cannabisinfused food and plant forms of marijuana have unknown and uncontrollable doses of active components (THC and CBD) and may be unsafely packaged, and therefore should be avoided.
C. SOCIAL
1. GENERAL: We believe all citizens of a country should consider the known and potential harmful and beneficial effects of marijuana on individuals and society. Experiences with the harms associated with prescription opioids, alcohol, and tobacco are relevant to the consideration of legalizing, prescribing, and dispensing marijuana. 2. SLIPPERY SLOPE TO RECREATIONAL MARIJUANA USE: The approval of medical marijuana has historically been a stepping stone to approving recreational marijuana. All states with legal recreational marijuana had prior legalization of medical marijuana.9 Evidence suggests that overall availability may lead to an increase in recreational usage, which could create a demand for legalization of recreational marijuana. For example, one nationwide study found that medical marijuana laws are associated with “increased prevalence of illicit cannabis use and cannabis use disorders.”7 States with legal medical marijuana have youth rates that surpass those in states that do not.19 One study from Oregon suggest that communities with a greater number of medical marijuana patients and licensed growers was associated with a higher prevalence of marijuana use among youth from 2006 to 2015. The authors suggest that changing community attitudes in these areas could be influential in teen behavior as well.6 Other studies have noted equivocal or contrasting findings.20such as increased frequency, could be hidden behind the choice of past-month use as a measure; the large surveys on which Sarvet et al’s data was extracted may not be representative at the state level; and the changes in attitudes and usage of marijuana in control non-MML states may actually be driven, and thus contaminated by, changes in MML states.(Chu YL. Commentary on Sarvet et al. (2018,21 3. COMMERCIALIZATION AND SOCIAL MEDIA: Individuals, small businesses, and corporations who profit from medical marijuana sales are looking to increase its usage. To this end, a variety of advertising venues, including social media platforms, are being used; advertising distortions regarding the benefits of marijuana are not uncommon. For example, in one cross-sectional study in Colorado, almost 70% of contacted marijuana dispensaries recommended cannabis products to treat nausea during pregnancy.22 Another study examined the website marketing practices of medical and recreational marijuana dispensaries across the U.S., finding that only a few advised about
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side effects and contraindications. 75% did not include age verification, making products available to youth with convenient online ordering.23 Exposure to medical marijuana advertising has been associated with greater marijuana use in minors.24 Physicians should warn their patients about false advertising and youth access. 4. OPIOID ADDICTION: There has been much hype about marijuana legalization providing a safer replacement for opioid use, with the potential to reduce opioid addiction and overdoses. Evidence is conflicting as to whether this is, in fact, the case,25 and caution must be used in looking at studies in this area because of bias,26 unreliability of self-reported use of drugs, the uncertainty of inferring individual substitution behaviors from state-level data relating marijuana legislation and opioid death rates,27 and other methodological problems. Because societal attitudes may have changed prior to either medical or recreational legalization6 and because opioid addiction is a complex issue with multiple antecedents that might represent events coinciding with marijuana legalization, it is difficult to define the associations of legalization of marijuana and opioid use. Samples of research: a. There are reports that opioid use has increased, rather than decreased, in states legalizing marijuana. In Colorado, for example, opioid use more than doubled among 10 to 19 year-olds after recreational legalization of marijuana.19 b. Legalization of marijuana in Colorado is associated with short-term reductions in opioid-related deaths.28 c. Medical legalization appears to be associated with “reductions in both prescriptions and dosages of Schedule III (but not Schedule II) opioids received by Medicaid enrollees.”29 d. A study that examined opioid use in patients following musculoskeletal trauma found that self-reported marijuana use during recovery was associated with an increased amount and duration of opioid use. However, many patients in this study had misperceptions that their marijuana use reduced both their pain and the amount of opioids used.30 e. Not only marijuana use but also use of alcohol, illegal methadone, and other opioids was found to increase in pregnant women after legalization of recreational marijuana in Washington State.31 Cannabis use was associated with an increased risk of developing nonmedical prescription opioid use and opioid use disorder.32
D. MEDICAL
1. FEDERAL DRUG ADMINISTRATION (FDA)-APPROVED MARIJUANA-DERIVED MEDICATIONS: (pharmaceutical-produced, qualitycontrolled and dose-specific medications): a. S ynthetic THC drugs: Dronabinol (Marinol and Syndros)33 and nabilone (Cesamet)34 have FDA approval for the treatment of chemotherapy-induced nausea and vomiting, and dronabinol is also used to treat loss of appetite and weight in patients with AIDS. A systematic review of anti-nausea efficacy of these medications revealed that side effects were greater and efficacy no better than with the use of traditional antinausea medications.35 These drugs are Schedule II or III (see the Table at the end for a description of scheduling categories). b. Cannabidiol (CBD) drugs: In June of 2018, the FDA approved the first natural marijuana plant-derived drug, Epidiolex, an oil for the treatment of seizures associated with two rare forms of childhood epilepsy (Lennox-Gastaut and Dravet syndromes).36 Epidiolex does not contain any THC and has
28 TODAY'S CHRISTIAN DOCTOR Fall 2019
been approved as a Schedule V medication. Schedule V substances are the least restrictive schedule of the Controlled Substances Act.37 (See the Table at the end for a description of scheduling categories.) c. C urrently there are no other FDA-approved uses for any component of the marijuana plant. “Off-label” use of FDA-approved drugs may be indicated in those occasions when the physician determines that there is significant scientific research evidence of benefit that outweighs any potential harm and the patient has failed other FDA-approved therapies; alternatively, there may be appropriate occasions when an FDA-approved drug is used “off-label” in a different form (e.g. oral solution instead of a capsule), for a different (but similar) patient population, or at a different dose.38 2. STUDIES: There are a number of concerns with the research in this area: a. P oor reliability: The research itself may be unreliable because of factors such as heterogeneity in the active ingredients and contaminants, lack of standard dosing, inadequate research into effects of highly potent types, and variability in the route of consuming marijuana. As an example of the latter, alterations in the number of puffs or volume inhaled may change with the potency of THC in the marijuana being smoked.39 It is important to note the nature of marijuana derivatives used in any studies—the THC and/or CBD level, delivery method, and quantity. For example, self-reported amount of smoking provides poor data compared to use of FDA-approved standard-dose pharmaceuticals. Conclusive studies can only be done with FDA-regulated medications or pharmaceutical-grade compounds. b. Regulatory barriers: Research on marijuana is hampered because of its classification as a Schedule I drug with intimidating bureaucratic regulations to overcome in order to obtain it for research. Much of the federal funding has been earmarked for studying the negative effects of marijuana, and inadequate money is available for investigating potential benefits.4 Additionally, some academic institutions may fear that conducting research with Schedule I substances could put their federal funding at risk. (See the Table at the end for a description of scheduling categories.) c. Insufficient data: In a system proven effective over many decades, medicine aims to establish the safety and effectiveness of treatment by requiring rigorous clinical trials before the FDA will recommend or release medications to large numbers of people. There is a lack of studies on the safety, efficacy, and short-term and long-term effects of marijuana, especially the high potency forms. There are also insufficient studies on the potential drug interactions between cannabis compounds and prescription and non-prescription medications. Researchers, scientific organizations, and representatives of the federal government claim that there is not enough evidence to support the use of marijuana as a beneficial drug and call for more research.40,41 d. Impediments: Researcher bias and obtaining properly controlled, adequately-sized, representative samples are among the methodological problems that may be anticipated in this research area.
e. Ethical issues: Adverse health effects of marijuana, especially use of high potency variants and smoking as the means of consumption, highlight ethical problems in exposing research subjects to harm when trying to document the safety or harm of specific consumer products. f. Caution: Weak or absent evidence about harmful effects of marijuana does not mean they do not exist; caution should be used when even limited evidence suggests a possibility of harm. 3. HEALTH EFFECTS OF CANNABIS USE: A review of the current literature regarding health effects of cannabis, while representing only a snapshot into a rapidly changing landscape and having some limitations, can be found in a recent report from The National Academies of Sciences, Engineering, and Medicine.4 According to this report, the therapeutic effects of cannabis or cannabinoids are as follows: a. S ubstantial evidence of effectiveness for treatment of: 1) Chronic pain in adults (cannabis) 2) Antiemetics in chemotherapy-induced nausea and vomiting (oral cannabinoids) 3) Patient-reported multiple sclerosis spasticity symptoms (oral cannabinoids) b. Moderate evidence of effectiveness for improving short-term sleep outcomes in patients with sleep disturbances associated with obstructive sleep apnea, fibromyalgia, chronic pain, and multiple sclerosis (cannabinoids, primarily nabiximols42) c. Limited evidence of effectiveness for: 1) Improving the wasting syndrome associated with HIV/ AIDS (cannabis and oral cannabinoids) 2) Clinician-measured multiple sclerosis spasticity symptoms (oral cannabinoids) 3) Symptoms of Tourette syndrome (THC capsules) 4) Improving anxiety symptoms in social anxiety disorders, as assessed by a public speaking test (cannabidiol) 5) Improving symptoms of posttraumatic stress disorder (nabilone—single, small, fair-quality trial) d. Limited evidence of a statistical association between cannabinoids and better outcomes after traumatic brain injury or intracranial hemorrhage e. Limited evidence they are ineffective for: 1) Improving dementia (cannabinoids) 2) Improving intraocular pressure in glaucoma (cannabinoids) 3) Reducing depressive symptoms in patients with chronic pain or multiple sclerosis (nabiximols, dronabinol, and nabilone) f. Insufficient evidence to support or refute the effectiveness of treatment for cancers, cancer-associated anorexia cachexia syndrome and anorexia nervosa, irritable bowel syndrome symptoms, epilepsy, spasticity due to spinal cord injury paralysis, symptoms of amyotrophic lateral sclerosis, chorea and certain symptoms of Huntington’s disease, motor symptoms of Parkinson’s disease, levodopa-induced dyskinesis, and dystonia. 4. MEDICAL COMPLICATIONS OF MARIJUANA USE: Despite the lack of research, some of the short-term and long-term effects of marijuana use are being uncovered. In all associations or lack thereof of marijuana use and health complications listed below, the conclusions are often drawn in the face of insufficient good quality and conflicting data and with the knowledge that research may not reflect the current products being used by consumers. Therefore,
future research will be needed to provide more definitive answers to questions about effects of marijuana use. a. C ancer: There is limited evidence of a statistical association between current, frequent, or chronic cannabis smoking and one type of testicular tumor, but not current sufficient evidence of associations between marijuana use and other cancer types in adults. There is minimal evidence that cannabis use during pregnancy is associated with a greater risk of cancer in offspring.4 b. Respiratory diseases: There is substantial evidence of an association between chronic marijuana smoking and chronic bronchitis and worsening respiratory symptoms.43 There is more limited evidence of an association with chronic obstructive pulmonary disease (COPD).4 c. I njury and death: Substantial evidence correlates cannabis use and increased risk of motor vehicle crashes.4 d. Pre-and perinatal exposure to maternal cannabis use: Use of marijuana during pregnancy increased in Washington State after legalization,31 and is on the rise nationally.44 According to a recent study, nearly 70 percent of approved marijuana dispensaries in Colorado recommended marijuana to pregnant mothers experiencing morning sickness.22 Marijuana has potentially serious effects on the developing fetus.44-46 A recent study documented that prenatal THC exposure adversely affects infant neurobehavior and child development up through the teen years,47 but other researchers feel data is lacking to draw conclusions about long-term effects.4 Overall review of current studies suggests a substantial association between maternal smoking of marijuana with lower birth weight babies and more limited evidence of a correlation with pregnancy complications for the mother and admission of the newborn to intensive care.4 eT een use: Heavy marijuana use can damage brain development in youth ages 13 to 18. There is evidence of an association between cannabis use and loss of concentration and memory, jumbled thinking, schizophrenia, and early onset paranoid psychosis.48 f. Psychosocial impairment: Moderate evidence correlates acute cannabis use with impaired learning, memory, and attention, and more limited evidence suggests that such impairments may be neurotoxic in that effects are sustained even after prolonged ab-
Transformed Doctors ➤ Transforming the World www.cmda.org 29
stinence from cannabis use.4,49,50 More limited associations exist between cannabis use and impaired academic achievement and outcomes, higher unemployment, lower income, and impaired social functioning.4 Neurocognitive effects also include a decline in IQ, memory problems, and attentional impairments.49,50 g. Mental health: There is substantial evidence of statistical association between cannabis use and the development of schizophrenia and other psychoses,51 with greater risk occurring among more frequent users.4 In two studies of patients with drug-induced psychosis (most or all being cannabis as the inciting drug), one-third to one-half of the patients later developed a schizophrenia-spectrum disorder.52,53 Those with drug-induced psychosis were equally as violent as schizophrenia patients who misused drugs.52 Moderate evidence associates cannabis use with increased incidence of developing depression; suicidal ideation, attempts, and completion; and social anxiety disorder. More limited evidence links cannabis use with certain increased symptoms (e.g. hallucinations) in psychotic disorders, development of bipolar disorder, the development and/or increased symptoms of anxiety disorders, and increased symptoms of posttraumatic stress disorder.4 h. H igh doses or use of some high potency and/or synthetic cannabis derivatives have produced the following effects: psychosis, mood alterations, panic attacks, cognitive impairment, dizziness, cardiovascular effects (tachycardia, hypertension, palpitations), nausea, appetite changes, and others.5 Mental impairment and distressing emotional states, such as paranoia, hallucinations, and psychosis, have caused people to harm themselves and others.52,54,55 i. Addiction: Use of marijuana can become problematic (marijuana use disorder) which may progress to addiction in some cases; when a person cannot stop using the drug despite interference with many aspects of daily life, use disorder is classified as addiction.5 A 2015 study suggests that “30 percent of those who use marijuana may have some degree of marijuana use disorder.”5 Marijuana use disorder is frequently “associated with dependence—in which a person feels withdrawal symptoms when not taking the drug.”5 A user may be dependent but not be addicted. Studies estimate that 9 percent of adults56 and 17 percent of teens who use marijuana will become dependent on it.5 In 2015 roughly 4 million people in the US were found to have a marijuana use disorder, and 138,000 sought treatment.5 In the same year in the Netherlands, more first-time entrants and more people overall entered treatment programs for cannabis use than for any other drug.1 Although modulation of smoking technique may partially blunt the effect of use of high potency cannabis,39 there is evidence that higher potency marijuana use is associated with increased severity of cannabis dependence.57 There is moderate evidence of an association between cannabis use and the development of substance dependence and/ or a substance abuse disorder for other substances, including tobacco, alcohol, and illegal drugs.4,58 j. Delivery method: Smoking is a harmful route of administration for any medicinal compound because of carcinogens and other harmful materials which are known to produce adverse effects on the lungs and other tissues. Marijuana joints may contain “particulate matter, toxic gases, reactive oxygen species,
30 TODAY'S CHRISTIAN DOCTOR Fall 2019
and polycyclic aromatic hydrocarbons at a concentration possibly 20 times that of tobacco smoke.”59 Histopathologic changes in bronchial inflammation that are similar to changes seen with smoking tobacco have been found in marijuana smokers.59 Only other delivery methods of FDA-approved cannabis compounds should be prescribed. 5. INACCURATE PUBLIC ANALYSIS AND USE OF RESEARCH: Current state medical marijuana laws specifically approve medical marijuana as treatment for illnesses such as HIV, ALS, hepatitis, Parkinson’s cancer, and glaucoma,3 even though the data from scientific studies is weak or even nonexistent in most of these diseases.4 As an example, multiple states include ALS on their list of approved illnesses for medical marijuana, but there have been only two small randomized double-blind clinical studies and the results of effectiveness were unequivocally negative.4 Washington D.C. does not restrict medical marijuana use to any specific disease.3,60 While scientific studies may eventually show benefit from cannabinoids for some of these illnesses, that is clearly not the case at this time. As a result, vulnerable and suffering patients are being misled and deceived. 6. PHYSICIAN RESPONSE TO “MEDICAL MARIJUANA”: a. I rresponsible behavior: One study found almost one half of cancer doctors say they have recently recommended medical marijuana to their patients, although 70 percent of them admitted they did not have sufficient knowledge to do so.61 Marijuana should not be discussed with, or prescribed to, patients without clear evidence-based guidelines supporting its use. b. Responsible behavior: The Cleveland Clinic and other reputable hospitals have prohibited physicians on staff from recommending “medical marijuana.”62 Dr. Paul Terpeluk, Medical Director at the Cleveland Clinic, summarizes why it does not make sense for physicians to prescribe it: “In the world of healthcare, a medication is a drug that has endured extensive clinical trials, public hearings and approval by the U.S. Food & Drug Administration (FDA). Medications are tested for safety and efficacy. They are closely regulated, from production to distribution. They are accurately dosed, down to the milligram. Medical marijuana is none of those things.”63
E. LEGAL AND PRACTICAL IMPLICATIONS:
1. MARIJUANA CLASSIFICATION: The U.S. still classifies marijuana in the same category as heroin, as a Schedule I Drug, which has “no currently accepted medical use and a high potential for abuse.”64 The United States Food and Drug Administration (FDA) does not recognize, regulate, or approve the marijuana plant as medicine. They state: “researchers haven’t conducted enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its cannabinoid ingredients) outweigh its risks in patients it’s meant to treat.”25 Because of the vast increase in marijuana potency and the potential for harm and addiction, there is a need for limiting access to marijuana. When medical benefits are established for FDA-approved, pharmaceutical-grade derivatives of marijuana, these substances have been classified as Schedule II (Syndros), III (Marinol),65 or V (Epidiolex).37 (See the Table at the end for a description of scheduling categories.) 2. STATE REGULATIONS: As of late 2018, thirty-three states, the District of Columbia, Guam and Puerto Rico have approved medi-
cal marijuana.9 Klieger et al evaluated laws in 28 states (including the District of Columbia) that had approved “medical marijuana,” as of February 2017.60 Besides specifying different qualifying diseases, the states varied in protections for patients against discrimination, in requirements for product safety testing, and in the range of packaging and labeling regulations.60 Enforcement and adequacy of state regulations is unclear. Although Colorado, for example, has packaging regulations,60 the number of children under 12 with marijuana ingestion visits to emergency rooms went from 0% to 2.4% of total visits after medical marijuana legalization.8 After recreational marijuana was legalized in 2014 in Colorado, increases in pediatric hospital visits and calls to poison control due to marijuana ingestion have continued to increase,66,67 with hospital visits doubling in 2017.67 The majority of exposures were due to ingestion of medical marijuana in a food product.8,66,67 State referenda approving the use of “medical marijuana,” essentially a form of potentially addictive and harmful herbal therapy, with the inability to monitor or control the dose of active compounds, without clear safety standards or clinical guidelines,60 and in the absence of evidence of effectiveness and a positive risk/benefit ratio, is unique in modern medicine. 3. LEGAL DICHOTOMY: When medical marijuana is legally allowed in a state, the state has agreed to allow consumers to purchase marijuana from regulated dispensaries if they have a physician’s prescription. However, because marijuana is a Schedule I Drug, physicians who prescribe medical marijuana (non-pharmaceutical grade, nonstandard dose, non-FDA-approved marijuana) from dispensaries are violating federal law, even if they are in compliance with state law. FDA-approved pharmaceutical grade standard dose medications derived from marijuana (e.g. Marinol) are legal in all states and physicians may prescribe them for appropriate indications and patients. The FDA cannot regulate marijuana edibles or any other forms of “medical marijuana” because marijuana is illegal; standard dosing and safety of these potentially pesticide and chemical-laden products4 are illusory. 4. PRACTICAL RECOMMENDATIONS: Rescheduling lower potency marijuana to Schedule II to make research easier and to allow FDA involvement in regulating marijuana on a national, rather than state, level seems reasonable. (See the Table at the end for a description of scheduling categories.) There should not be a double standard for prescription medications. All need to be subject to FDA regulations for safety of consumers and the respectability of the medical profession.
F. CMDA RECOMMENDATIONS FOR CHRISTIAN HEALTHCARE PROFESSIONALS
1. CMDA maintains that a reasonable and prudent physician should only recommend FDA-approved medications when the indications are clear, dosing is well-established, risk benefit ratios have been investigated and can be applied to individual patients, delivery systems are safe, and careful monitoring is agreed upon. 2. State legalization of “medical marijuana” has not been accompanied by the rigorous scientific approval process with regulations for dosing, production, packaging and monitoring that have made FDA-approved medications safe and effective. State-approved dispensaries are marketing a form of potentially addictive and harmful herbal therapy that does not meet modern safety and ef-
ficacy standards or clinical guidelines. Physicians cannot assume that “medical marijuana” is safe or effective for state-listed qualifying diseases or conditions, nor can they be sure that it has the labeled amount of active ingredient and is devoid of contaminants and harmful additives. 3. There are risks of significant short-term and long-term complications associated with marijuana use, including addiction; medical, mental health, psychosocial, and cognitive problems; and increasing the likelihood of problems for the unborn, children, and teens. These risks should make any medical use of marijuana a serious decision in which benefits clearly outweigh the risks. Given the inadequate research on marijuana benefits and the few conditions for which there are even moderate or better evidence of effectiveness (often accompanied by significant side effects), indications for prescribing marijuana are limited at this time. 4. Rather than legalizing marijuana for medical use by popular vote and political lobbying, CMDA encourages legalization via FDA approval through formal clinical and scientific studies of any marijuana-based therapeutic that has demonstrated medical efficacy and safety by randomized controlled trials. To augment this process, CMDA supports rescheduling lower potency marijuana to Schedule II to enable medical research into the potential benefits and harms of the use of pharmaceutical-grade marijuana derivatives within established ethical research guidelines and FDA supervision. 5. CMDA recommends that FDA-approved marijuana medications should be regulated and regarded like any other FDA-approved medication. Medications that have been approved by the FDA have been studied extensively and have undergone a lengthy and rigorous process before they are made available to the public. The FDA requires carefully conducted studies (clinical trials) in hundreds to thousands of human subjects to determine the benefits and risks of a possible medication. These medications have carefully regulated manufacturing processes, quality and purity standards, and standardized dosing and prescribing requirements.
G. CMDA RECOMMENDATIONS FOR THE CHRISTIAN COMMUNITY
Because of inadequate research, potential addiction and health hazards of marijuana use, inadequate regulation in state laws to ensure safety and efficacy, and misleading advertising, CMDA recommends the following: 1. Most medical conditions are best treated with FDA-approved medications that are devoid of addictive qualities and significant complications. Indications for prescribing marijuana are limited, and medications with fewer risks are the first line of therapy. However, in cases where primary treatments have not been adequate, and a trial of THC or CBD compounds might be considered, seek medical care from a qualified health professional who can prescribe currently available, pharmaceutical-grade, FDA-approved marijuana derivatives for appropriate conditions with proper monitoring. 2. Be wary of claims made about marijuana “benefits.” 3. “Medical marijuana” dispensaries may have products with unknown contaminants and additives, variable amounts of active ingredients, unproven efficacy, unclear short-term and long-term problems, and unsafe packaging. This is not medicine. 4. Smoking any product is never healthy and should not be con-
Transformed Doctors ➤ Transforming the World www.cmda.org 31
sidered “medicine.” 5. Be vigilant to ensure that children do not inadvertently have access to “medical marijuana” when visiting or in someone else’s care. 6. Encourage federal government authorities to change lower potency marijuana to Schedule II to enable better research to elucidate potential benefits and harms of pharmaceutical grade marijuana products under the auspices of the FDA. Approved by the Board of Trustees – February 20, 2019 CONTROLLED SUBSTANCES ACT SCHEDULING Schedule
Description of substances
I
No accepted medical use and a high potential for abuse
II
High potential for abuse with risk of severe psychological or physical dependence
III
Moderate to low potential for physical and psychological dependence. Abuse potential less than Schedule I and II, but more than IV.
IV
Low potentials for abuse and risk of dependence.
V
Lower potential for abuse than Schedule IV; preparations containing limited quantities of certain narcotics. Generally used for antidiarrheal, antitussive, and analgesic purposes. Examples
Heroin, LSD, marijuana Vicodin, hydromorphone, meperidine, cocaine, fentanyl, Ritalin Products with < 90mg codeine per dose (Tylenol with codeine), ketamine, anabolic steroids Xanax, Soma, Darvon, Valium, Ativan,, Ambien, Tramadol Cough preparations with < 200 mg codeine or per 100 mL (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin Adapted from: DEA. Drug Scheduling. https://www.dea.gov/drug-scheduling (accessed Feb. 7, 2019)
REFERENCES AND BIBLIOGRAPHY
1. European Monitoring Centre for Drugs and Drug Addiction. Netherlands Country Drug Report 2017. Luxembourg: Publications Office of the European Union; 2017. 2. Lemmens P. Dutch government pressured to reconsider planned re-scheduling of cannabis in drug law. Addiction 2014; 109(10): 1761-2. 3. Compassionate Certification Centers. List of Qualifying Helath Conditions For Medical Marijuana In Each State. October 26, 2017. https://www.compassionatecertificationcenters.com/list-ofqualifying-health-conditions-for-medical-marijuana-in-each-state/ (accessed Feb. 5 2019). 4. National Academies of Sciences Engineering and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press; 2017. 5. National Institute on Drug Abuse. Marijuana. June 2018. https://d14rmgtrwzf5a.cloudfront.net/ sites/default/files/1380-marijuana.pdf. 6. Paschall MJ, Grube JW, Biglan A. Medical marijuana legalization and marijuana use among youth in Oregon. The Journal of Primary Prevention 2017; 38(3): 329-41. 7. Hasin DS, Sarvet AL, Cerda M, et al. US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws 1991-1992 to 2012-2013. JAMA Psychiatry 2017; 74(6): 579-88. 8. Wang GS, Roosevelt G, Heard K. Pediatric Marijuana Exposures in a Medical Marijuana State. JAMA Pediatrics 2013; 167(7): 630-3. 9. National Conference of State Legislatures. State Medical Marijuana Laws. 1/23/2019. http://www. ncsl.org/research/health/state-medical-marijuana-laws.aspx (accessed Feb. 3 2019). 10. See the Table at the end of the statement for a description of drug scheduling categories. 11. Cort B. Weed, Inc. : the truth about THC, the pot lobby, and the commercial marijuana industry. Deerfield Beach, Florida: Health Communications, Inc.; 2017. 12. Genesis 1:28 13. Genesis 3 14. Matthew 22:36-40 15. Romans 13 16. Daniel 3 17. Hebrews 13:17 and James 3:1
32 TODAY'S CHRISTIAN DOCTOR Fall 2019
18. Hiippocratic Oath and Matthew 22: 36-40 19. Smart Approaches to Marijuana. Lessons Learned From Marijuana Legalization, 2018. https:// learnaboutsam.org/wp-content/uploads/2018/07/SAM-Lessons-Learned-From-MarijuanaLegalization-Digital-1.pdf. 20. A meta-analysis of 11 studies from four large national surveys compared adolescents’ past-month marijuana use prevalence pre-and post- changes in state medical marijuana laws (MMLs). Comparison between pre-post MML changes in MML states to changes in non-MML states over comparable time periods yielded non-significant differences between changes in adolescents’ past month use prevalence in the two states.(Sarvet AL, Wall MM, Fink DS, et al. Medical marijuana laws and adolescent marijuana use in the United States: a systematic review and meta-analysis. Addiction 2018; 113(6): 1003-16.) However, Chu argues that caution is indicated in accepting this conclusion for the following reasons: changes in other measurements of marijuana use, such as increased frequency, could be hidden behind the choice of past-month use as a measure; the large surveys on which Sarvet et al’s data was extracted may not be representative at the state level; and the changes in attitudes and usage of marijuana in control non-MML states may actually be driven, and thus contaminated by, changes in MML states.(Chu YL. Commentary on Sarvet et al. (2018): What do we still need to know about the impacts of medical marijuana laws in the United States? Addiction 2018; 113(6): 1017-8.) 21. A study comparing pre-post MML differences in teen use of marijuana, cigarettes, binge drinking, and other illicit or non-prescribed drugs found that MML enactment was associated with a decrease in the use of such substances for early adolescents, no change for 10th graders, but an increase in non-medical prescription opioid and cigarette use among 12th graders.The authors suggested that parents of younger children may have been more vigilant about warning about marijuana use after MML passage; limitations to their study were also discussed. Limitations include: substance use was self-reported, study only included school-attending adolescents, specific features of MMLs were not assessed, assumption that the passage of MML in one state did not affect the behaviors of individuals in nearby, non-MML states (perhaps this assumption is incorrect), concurrent policy changes may have confounded the relationships of interest.(Cerdá M, Sarvet AL, Wall M, et al. Medical marijuana laws and adolescent use of marijuana and other substances: Alcohol, cigarettes, prescription drugs, and other illicit drugs. Drug & Alcohol Dependence 2018; 183: 62-8.) 22. Dickson B, Mansfield C, Guiahi M, et al. Recommendations From Cannabis Dispensaries About First-Trimester Cannabis Use. Obstetrics & Gynecology 2018; 131(6): 1031-8. 23. Cavazos-Rehg PA, Krauss MJ, Cahn E, et al. Marijuana Promotion Online: an Investigation of Dispensary Practices. Prev Sci 2018. 24. D’Amico EJ, Rodriguez A, Tucker JS, Pedersen ER, Shih RA, D’Amico EJ. Planting the seed for marijuana use: Changes in exposure to medical marijuana advertising and subsequent adolescent marijuana use, cognitions, and consequences over seven years. Drug & Alcohol Dependence 2018; 188: 385-91. 25. National Institute on Drug Abuse. What is medical marijuana? June 2018 June 2018. https:// www.drugabuse.gov/publications/drugfacts/marijuana-medicine (accessed February 5 2019). 26. Example of bias: An article by Lucas (Lucas P. Rationale for cannabis-based interventions in the opioid overdose crisis. Harm Reduction Journal 2017; 14: 1-6) advocated for medical and recreational legalization of marijuana as a way to reduce opioid addiction and overdoses. However, the Methods section did not reveal the mechanism of article selection nor any other methods, no conflicting data was mentioned at all, and the author’s conflict of interest was noted in small print at the end of the article—he is VP and stockholder with a federally authorized medical cannabis production & research company in Canada. 27. Caputi TL, Sabet KA. Population-level analyses cannot tell us anything about individuallevel marijuana-opioid substitution. American Journal of Public Health 2018; 108(3): e12-e. 28. Livingston MD, Barnett TE, Delcher C, Wagenaar AC. Recreational Cannabis Legalization and Opioid-Related Deaths in Colorado, 2000-2015. American Journal of Public Health 2017; 107(11): 1827-9. 29. Liang D, Bao Y, Wallace M, Grant I, Shi Y. Medical cannabis legalization and opioid prescriptions: evidence on US Medicaid enrollees during 1993-2014. Addiction 2018; 113(11): 2060-70. 30. Bhashyam AR, Heng M, Harris MB, Vrahas MS, Weaver MJ. Self-Reported Marijuana Use Is Associated with Increased Use of Prescription Opioids Following Traumatic Musculoskeletal Injury. J Bone Joint Surg Am 2018; 100(24): 2095-102. 31. Grant TM, Graham JC, Carlini BH, Ernst CC, Brown NN. Use of marijuana and other substances among pregnant and parenting women with substance use disorders: Changes in Washington state after marijuana legalization. Journal of Studies on Alcohol and Drugs 2018; 79(1): 88-95. 32. Olfson M, Wall MM, Shang-Min L, Blanco C. Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States. American Journal of Psychiatry 2018; 175(1): 47-53. 33. h ttps://medlineplus.gov/druginfo/meds/a607054.html. Accessed Jan. 10, 2019. 34. h ttps://medlineplus.gov/druginfo/meds/a607048.html. Accessed Feb. 4, 2019 35. Smith LA, Azariah F, Lavender VTC, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database of Systematic Reviews 2015; (11). 36. h ttps://medlineplus.gov/druginfo/meds/a618051.html. Accessed Jan. 10, 2019. 37. United States Drug Enforcement Administration. FDA-approved drug Epidiolex placed in schedule V of Controlled Substance Act. September 27, 2018. https://www.dea.gov/ press-releases/2018/09/27/fda-approved-drug-epidiolex-placed-schedule-v-controlledsubstance-act (accessed Feb. 4 2019). 38. U.S. Food and Drug Administration. Understanding Unapproved Use of Approved Drugs “Off Label”. 2/05/2018. https://www.fda.gov/forpatients/other/offlabel/default.htm (accessed Feb. 4 2019). 39. Pol P, Liebregts N, Brunt T, et al. Cross-sectional and prospective relation of cannabis potency, dosing and smoking behaviour with cannabis dependence: an ecological study. Addiction 2014; 109(7): 1101-9.
40. The National Academies of Sciences, Engineering and Medicine recently called on the federal government to support better research, decrying the “lack of definitive evidence on using medical marijuana.” U.S. Secretary of Health and Human Services Alex Azar recently said there was “no such thing as medical marijuana.” (Wedell K. “No such thing as medical marijuana,” Health Secretary says. Dayton Daily News. 2018 March 2.) 41. Carney JK. Brief Commentary: Advocating for Blunt Policy. Annals of Internal Medicine 2019; 170(2): 121-. 42. An oromucosal spray containing both THC and CBD. It also has a brand name of Sativex and is on the FDA Fast Track for approval. (National Academies of Sciences Engineering and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press; 2017.) 43. Tashkin DP. Marijuana and Lung Disease. CHEST 2018; 154(3): 653-63. 44. Adashi EY. Brief Commentary: Marijuana Use During Gestation and Lactation—Harmful Until Proved SafeMarijuana Use During Gestation and Lactation. Annals of Internal Medicine 2019; 170(2): 122-. 45. Volkow ND, Compton WM, Wargo EM. The Risks of Marijuana Use During Pregnancy. JAMA 2017; 317(2): 129-30. 46. Grant KS, Petroff R, Isoherranen N, Stella N, Burbacher TM. Cannabis use during pregnancy: Pharmacokinetics and effects on child development. Pharmacol Ther 2018; 182: 133-51. 47. Jansson LM, Jordan CJ, Velez ML. Perinatal Marijuana Use and the Developing Child. JAMA: Journal of the American Medical Association 2018; 320(6): 545-6. 48. Dr. Phil Tibbo, one of the leaders in the medical field and initiator of Nova Scotia’s Weed Myths campaign targeting teens, has seen firsthand evidence of what heavy use can do as director of Nova Scotia’s Early Psychosis Program. His brain research shows that regular marijuana use leads to an increased risk of developing psychosis and schizophrenia, effectively exploding popular and rather blasé notions that marijuana is “harmless” to teens and “recreational use” is simply “fun and healthy.” Multiple researchers have all come to the same conclusion: the younger the brain, the worse the effects in both the short-term and long-term. (Tibbo P, Crocker CE, Lam RW, Meyer J, Sareen J, Aitchison KJ. Implications of Cannabis Legalization on Youth and Young Adults. Canadian Journal of Psychiatry 2018; 63(1): 65-71.) 49. Harvey PD. Smoking Cannabis and Acquired Impairments in Cognition: Starting Early Seems Like a Really Bad Idea. Am J Psychiatry 2019; 176(2): 90-1. 50. Morin J-FG, Afzali MH, Bourque J, et al. A Population-Based Analysis of the Relationship Between Substance Use and Adolescent Cognitive Development. American Journal of Psychiatry 2019; 176(2): 98-106. 51. Malone DT, Hill MN, Rubino T. Adolescent cannabis use and psychosis: epidemiology and neurodevelopmental models. British Journal of Pharmacology 2010; 160(3): 511-22. 52. Crebbin K, Mitford E, Paxton R, Turkington D. First-episode drug-induced psychosis: A medium term follow up study reveals a high-risk group. Social Psychiatry and Psychiatric Epidemiology 2009; 44(9): 710-5. 53. Arendt M, Rosenberg R, Foldager L, Perto G, Munk-Jørgensen P. Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: Follow-up study of 535 incident cases. The British Journal of Psychiatry 2005; 187(6): 510-5. 54. Korkmaz Sshc, Turhan L, İzci F, Sağlam S, Atmaca M. Sociodemographic and clinical characteristics of patients with violence attempts with psychotic disorders. European Journal of General Medicine 2017; 14(4): 94-8. 55. Douglas KS, Guy LS, Hart SD. Psychosis as a Risk Factor for Violence to Others: A MetaAnalysis. Psychological Bulletin; 2009. p. 679-706. 56. Lopez-Quintero C, Perez de los Cobos J, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence 2011; 115(1-2): 120-30. 57. Freeman TP, Winstock AR. Examining the profile of high-potency cannabis and its association with severity of cannabis dependence. Psychological Medicine 2015; 45(15): 3181-9. 58. Blanco C, Hasin DS, Wall MM, et al. Cannabis use and risk of psychiatric disorders: Prospective evidence from a US national longitudinal study. JAMA Psychiatry 2016; 73(4): 388-95. 59. Caviedes I, Labarca G, Silva CF, Fernandez-Bussy S. Marijuana Use, Respiratory Symptoms, and Pulmonary Function. Annals of Internal Medicine 2019; 170(2): 142-. 60. Klieger SB, Gutman A, Allen L, Pacula RL, Ibrahim JK, Burris S. Mapping medical marijuana: state laws regulating patients, product safety, supply chains and dispensaries, 2017. Addiction 2017; 112(12): 2206-16. 61. Braun IM, Wright A, Peteet J, et al. Medical Oncologists’ Beliefs, Practices, and Knowledge Regarding Marijuana Used Therapeutically: A Nationally Representative Survey Study. J Clin Oncol 2018; 36(19): 1957-62. 62. Hancock L. Cleveland Clinic, UH, MetroHealth staff docs prohibited from recommending medical marijuana. 2018 November 15. 63. Terpeluk P. Should “Medical Marijuana” Be Recommended for Patients? Why our answer is “no”. Jan. 10 2019. https://health.clevelandclinic.org/should-medical-marijuanabe-recommended-for-patients/?utm_campaign=cc+posts&utm_medium=social&utm_ source=facebook&utm_content=190107+medical&cvosrc=social+network.facebook. cc+posts&cvo_creative=190107+medical (accessed Jan. 12 2019). 64. DEA. Drug Scheduling. https://www.dea.gov/drug-scheduling (accessed Jan. 4, 2019 2019). 65. h ttps://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf. Accessed Feb. 5, 2019 66. Wang GS, Le Lait M-C, Deakyne SJ, Bronstein AC, Bajaj L, Roosevelt G. Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-2015. JAMA Pediatrics 2016; 170(9): Article. 67. Wang GS, Hoyte C, Roosevelt G, Heard K. The Continued Impact of Marijuana Legalization on Unintentional Pediatric Exposures in Colorado. Clinical Pediatrics 2019; 58(1): 114-6.
EARN CONTINUING EDUCATION
3 HOURS NOW AVAILABLE We are now offering continuing education credits through Today’s Christian Doctor. Three hours of self-instruction are available. To obtain continuing education credit, you must complete the online test and evaluation at https://www.surveymonkey. com/r/2019MedMarijuanaStatement. • This CE activity is complimentary for CMDA members. • The fee for non-CMDA members is $150.00. For payment information, visit www.cmda.org/cepayment. If you have any questions, please contact CMDA’s Department of Continuing Education Office at ce@cmda.org. Review Date: July 15, 2019 Original Release Date: August 24, 2019 Termination Date: August 23, 2022 EDUCATIONAL OBJECTIVES • Discuss the biology, chemistry, societal, legal and medical issues surrounding medical marijuana. • Describe the prevailing myths about medical marijuana. • Identify evidence-based statements on the possible health benefits and complications of using medical marijuana. • Teach family members, patients and community about medical marijuana by giving clear guidelines, warnings and recommendations. • Discuss how biblical principles speak into medical marijuana issues and controversies. ACCREDITATION The Christian Medical & Dental Associations is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. PHYSICIAN CREDIT The Christian Medical & Dental Associations designates this educational activity for a maximum of 3 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. DENTAL CREDIT CMDA is an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 1/1/2018 to 12/31/2022. Provider ID#218742. 3 Hours Self Instruction Available. No prior level of skill, knowledge, or experience is required (or suggested). DISCLOSURE None of these authors, planners or faculty have relevant financial relationships. Chris Hook, MD; James A. Avery, MD; Mandi Mooney, CMDA Today’s Christian Doctor Editor; Stan Cobb, DDS; Barbara Snapp, CE Administrator; Sharon Whitmer, EdD, MFT; and CE Committee Members CMDA CE Review Committee John Pierce, MD, Chair; Jeff Amstutz, DDS; Trish Burgess, MD; Lindsey Clarke, MD; Stan Cobb, DDS; Jon R. Ewig, DDS; Gary Goforth, MD; Elizabeth Heredia, MD; Curtis High, DDS; Bruce MacFadyen, MD; Dale Michels, MD; Shawn Morehead, MD; Michael O’Callaghan, DDS; and Richard Voet, MD THERE IS NO IN-KIND OR COMMERCIAL SUPPORT FOR THIS ACTIVITY.
Transformed Doctors ➤ Transforming the World www.cmda.org 33
CLASSIFIEDS To place a classified advertisement, contact communications@cmda.org.
GENERAL Affiliate Needed — Protect life and bring joy into the lives of couples unable to carry a pregnancy to full term. The National Embryo Donation Center (NEDC) has reached maximum capacity and needs an affiliate who shares the same Christian worldview and can provide the full range of services currently offered at the NEDC. Over 800 children have been born through embryo adoption at the NEDC since it was founded in 2003, and the program has garnered an outstanding reputation with a success rate above the national norm. Affiliate physician must be a reproductive endocrinologist (REI) who is board certified/board eligible. Contact Dr. Jeff Keenan at 865-777-0088 or email jkeenan@baby4me.net. Go to www.embryodonation.org.
DENTAL
Dentist — Dental office in Western New York seeking general dentist with at least two to five years’ experience. A new graduate would be considered depending on clinical experience. Established office of 20 years with plans for a new satellite office. Situated in a family-oriented small town, a wonderful village atmosphere and a short drive to the cultural offerings of a large city. Contact me at YourFuture@frontier.com.
MEDICAL ENT — We are a well-established, highlyrespected ENT private practice in Columbia,
34 TODAY'S CHRISTIAN DOCTOR Fall 2019
Physician/Medical Director — A physician/ medical director is needed at Shawnee Christian Healthcare Center in Louisville, Kentucky to join our team. We seek to transform our community by sharing the love of Christ in word and deed, to facilitate community development and holistic healthcare. Beginning salary between $180-200K with option for four to five-day work week, low night call (phone calls only), loan repayment options. For more information, go to shawneechristianhealthcare. org/employment. Send resumes to susan.maguire@shawneehealthcare.org.
YOUR COMPLETE SOURCE FOR SAFETY-NET PROVIDERS
WE PROVIDE: • LONG EXPIRATION DATES • CONSISTENT INVENTORY • NO MINIMUM AMOUNT PER ORDER • CUSTOMIZATION: NO SPECIFIC MEDICINES REQUIRED PER ORDER • DISCOUNTS FOR U.S. CHARITABLE CLINICS ON EVERY ORDER (while funds last) FREE SHIPPING AVAILABLE
For more information or to place an order go to:
www.blessing.org info@blessing.org or call: 918-250-8101
email:
HEALING THE HURTING, BUILDING HEALTHY COMMUNITIES, AND TRANSFORMING LIVES SINCE 1981
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Dentist — We are looking for a doctor who espouses the values and culture that we have here at Stout, Gordon & Prince Family Dentistry in Holland, Michigan. Our core values are integrity, quality treatment, compassion, communication, family, fun and faith. The opportunity is four days per week (Tuesday-Friday). May 2020. We invite you to check our website to get a feel for who we are. www.sgpdentistry.com or email us at drgordon@sgpdentistry.com.
OB/Gyn — Southwestern Medical Clinic, Center for Women’s Health is seeking a full time OB/Gyn to join our multi-disciplinary faith-based team. The preferred candidate will provide a full range of services including antepartum, intrapartum, postpartum, wellwoman care and gynecological care. Enjoy a collaborative and collegial relationship with your colleagues and team approach to care! Epic EHR. Over the past 50 years, Southwestern Medical Clinic of Lakeland Health has proudly served residents of Southwest Michigan and underserved communities all over the world! Join a mission-minded team that is passionate about providing Christ-centered medicine. Spectrum Health Lakeland, ranked a 15 Top Health System in the nation in 2019 by IBM Watson Health, is a teaching hospital, offering residency program in a variety of specialties. Recruitment and benefits package: competitive market-based compensation and benefits, relocation assistance provided in accordance with policy, interview expenses covered. Southwest Michigan is one of the most affordable places to live in Michigan, offering a relaxed quality of life, with a wide variety of outdoor and cultural activities only 90 minutes from Chicago. To learn more, please contact Kelli Dardas at kdardas1@lakelandhealth.org or 269-982-4801.
Pediatrician — Seeking pediatrician in Colorado. Well respected, busy, faith-based, fivedoctor pediatric group in Louisville, Colorado looking for a new physician. Excellent salary and benefits. Minutes from mountains, recreation, great schools. Contact cornerstonebabies@ yahoo.com or 303-673-9030.
MEDICINES FOR MISSIONS
Practice for Sale — Established thriving solo otolaryngology practice with excellent regional reputation for sale in Colorado. Full audiology services and mid level providers. EMR in place. Excellent local hospitals. Surgery center with ownership options. Contact cmdaentsale@ gmail.com for information.
South Carolina in search of an additional general otolaryngologist with subspecialty expertise in otology. Position is open to both new graduates and experienced physicians. Our practice strives for ideal patient care in a friendly, pleasant work environment. We serve the greater Columbia area through two office locations where we provide comprehensive ENT and allergy services, audiology services including hearing aids and CT scanning. Outpatient surgery is performed in our physicianowned ambulatory surgery center with potential buy in opportunity for physicians joining our practice. We offer a competitive compensation package. The Columbia area is a great place to live with year-round outdoor activities, family friendly community and easy access to mountains and coastal beaches. The cost of living here is relatively low. Theater, symphony, excellent dining, whitewater kayaking, fly fishing, NCAA Division I athletics and a host of other opportunities for recreation and community involvement are readily available. Please send resumes to HR@centamedical.com.
CMDA PLACEMENT SERVICES
BRINGING TOGETHER HEALTHCARE PROFESSIONALS TO FURTHER GOD’S KINGDOM We exist to glorify God by placing healthcare professionals and assisting them in finding God’s will for their careers. Our goal is to place healthcare professionals in an environment that will encourage ministry and also be pleasing to God. We make connections across the U.S. for physicians, dentists, other healthcare professionals and practices. We have an established network consisting of hundreds of opportunities in various specialties. You will benefit from our experience and guidance. Every placement carries its own set of challenges. We want to get to know you on a personal basis to help find the perfect fit for you and your practice.
P.O. Box 7500 • Bristol, TN 37621 888-690-9054 www.cmda.org/placement placement@cmda.org
“Our practice has a long history with CMDA. One of the partners in our practice was presented to us over 20 years ago by CMDA. Since we are a faith-based practice, we are looking for healthcare professionals with the same vision we have. The recruiters at CMDA have taken the time to understand our mission/vision and have worked with us to recruit Christian physicians and mid-levels for over 20 years. It has been my pleasure to work with various employees and recruiters with CMDA. In my position, I have had the opportunity to work with various recruiting agencies through the years, and CMDA has been and still is one of our most preferred agencies.” —Donna J. Warner Human Resources Manager Family Medical Center of Rocky Mount
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â&#x20AC;&#x153;An unusual medical, biological, and spiritual work. A great appreciation of the human body, life, and belief in God fills this book.â&#x20AC;?
JOSEPH E. MURRAY, Nobel Laureate, The New England Journal of Medicine
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