Today's Christian Doctor - Winter 2019 by Christian Medical & Dental Associations

Volume 50 No. 4 • Winter 2019

Today’s

Christian Doctor The Journal of the Christian Medical & Dental Associations

Crisis in NICARAGUA

CMDA

Story

My CMDA story is a rich and long tale not easily shared through a single paragraph. I was introduced to CMDA during medical school and joined during my residency, and it’s been an active partner throughout my career. CMDA’s Placement Services helped me locate my first and only OB/Gyn practice that I have now been at for 18 years. My four daughters will never forget their many adventures at the CMDA Deer Valley Summer Conference in Colorado. I have been mentored in communicating my Christian hope to my patients, as well as encouraged through a CMDA National Convention. Years of listening to Christian Doctor’s Digest, along with CMDA’s other resources, equipped me thoroughly to give testimony before a Missouri Senate Committee on pro-life legislation just recently. My calling to be a Christian physician in an increasingly secular world has never been abandoned by CMDA.

Be encouraged that you are not alone. We are in a fellowship of Christian healthcare professionals, thousands strong scattered over the whole earth, connected through CMDA and through Christ!

—Brian T. Stephens, MD

Introduce Your Colleagues to CMDA Introduce your colleagues and friends to CMDA like Dr. Stephens 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

FROM THE CMDA PRESIDENT GLORIA HALVERSON, MD

AN EXCITING FUTURE

am writing this after completing our first Board of Trustees meeting with CMDA’s new CEO Dr. Mike Chupp, and I am excited! I can’t wait to see what God will do with and through CMDA in this next stage of the journey.

Why am I feeling so positive about our future? Let me explain.

I feel positive about our future because of our past. CMDA is now 88 years old, and we have grown tremendously in membership, ministries and influence in the last 25 years under the leadership of Dr. David Stevens and Dr. Gene Rudd. We have grown to more than 19,000 members, including physicians, dentists, pharmacists, physical therapists, optometrists, nurse practitioners and physician assistants. Plus, we share our resources and events with large numbers of non-members. We have built collaborations with many other like-minded organizations. A strong base, a strong staff and a strong board led us into this leadership change. Most of all, we go into the future with a God who is faithful. I feel positive about our future because of the way we transitioned the CEO position. Through a detailed vetting process, God made clear to the board that Dr. Chupp is the man to lead CMDA for such a time as this. The succession was planned well, as Dr. Stevens had an organized plan to mentor Mike and then gradually turn responsibilities over to him. Also, Dr. Stevens graciously has still been available for consultation these first months and is continuing to represent CMDA in public policy work. Jamey Campbell is the new Chief Operating Officer, and Dr. Rudd and Dr. Chupp have been available for guidance. Dr. Chupp had an ambitious and multifocal 100day plan for the beginning of his leadership, which is helping him to become better known to our staff, commissions and membership. If you have not had the opportunity to watch the video of Dr. Stevens interviewing Dr. Chupp, it is worth your time. (It is available for you at www.cmda.org/transition.) I feel positive about our future because of what is being done today. I am always in awe of how much CMDA is able to accomplish with such a small staff and volunteers. Our ministries are flourishing and growing. Campus & Community Ministries now works with 87 graduate groups and 315 campus ministries, plus we have 90 field staff around the country. Medical Education International and Global Health Outreach continue to send teams to both familiar locations and new places for ministry through healthcare. The new Center for Well-being is developing workshops and other resources for those struggling with burnout or in need of life coaching. This fall we hosted our first Remedy West Medical Missions Conference in California,

which supplements the Global Missions Health Conference in Kentucky, offering a closer opportunity for those on the West Coast. Specialty Sections continue to grow in number and activity. Our voice is being heard and respected in Washington, D.C. on issues affecting your individual practices. CMDA’s Ethics Committee is evaluating multiple topics to supply our members with more statements to help with complex issues. Plus, the new Church Commission is working to develop relationships with churches across the country. This commission will focus on medically and biblically-based information to deal with the complex bioethical issues on which our churches must take a stand. And there is so much more. I feel positive about our future because of the way we are headed there! We are looking to build on the strong foundation we have, but also to recognize and be proactive about the new issues we face in healthcare and culture. A new five-year strategic plan will be developed, as the board sees this as a wonderful opportunity and necessary obligation to take a fresh look at our ministries, the budget, staffing, visions for the future, etc. We will all work to make sure CMDA stays relevant and valuable to our membership. This is where you play a significant role. What is it you feel CMDA can do to go from great to even greater? How can CMDA help meet your needs in your practice and your life? What can you do to assist CMDA head down the right road into the future? We would love to hear from you, so please share your ideas at gloria.halverson@cmda.org. As leadership transitions can be tricky, we ask you to please pray for CMDA. And we want to be valuable to your colleagues, so please tell them about CMDA and invite them to join us. Corrie ten Boom said, “Never be afraid to trust an unknown future to a known God.” We know our God has been faithful and will continue to be faithful. This is His organization. Proverbs 16:3 says, “Commit your work to the Lord, and your plans will be established” (ESV). We are committed to the Lord and to you. Let’s look forward to an exciting future where transformed doctors can be transforming the world. 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

VO LU M E 5 0, N O. 4

WINTER 2019

The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.

10 12

Transformed Doctors, Transforming the World

featuring Peter E. Dawson, DDS

Crisis in Nicaragua

by Patricia “Trish” Burgess, MD, with Rolando Castillo

How God opened new doors for ministry despite a volatile political situation

The Lure of Money

by Autumn Dawn Galbreath, MD, MBA

Is your perspective of money affected by comparisons?

Marriage Maintenance

Classifieds

Cover Story

by Patti Francis, MD

Journeying through the rocky roads of a healthcare marriage

CMDA Statement on Recreational Marijuana

Earn Continuing Education credits and learn more about this important topic

4 TODAY'S CHRISTIAN DOCTOR Winter 2019

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, Winter 2019, Volume L, No. 4. 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 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

Find Connection in Your Specialty

mong all of our various ministries, CMDA’s Specialty Sections give you the unique opportunity to equip, network and fellowship with colleagues in your specific healthcare specialty. Organized by CMDA members, the sections listed below provide a wealth of resources for those who wish to connect with their colleagues. Don’t see a section for your specialty? Contact ccm@cmda.org for more information about starting a section.

Christian Academic Physicians and Scientists (CAPS) A community committed to helping one another navigate the difficulties of our profession and to living up to our faith-based calling. We endeavor to transform our academic communities through faith, fellowship and scholarship. www.cmda.org/caps Christian Physical Rehab Professionals (CPRP) Formerly Christian Physical Therapists International (CPTI), our mission is to encourage, instruct and challenge Christian physical rehab professionals to engage in a deeper walk with our Savior, equipping them to impact lives with the gospel and supporting them spiritually and professionally. www.cmda.org/cprp Christian Surgeons Fellowship A group of surgeons who encourage one another to show the loving care and compassion of Christ to the children and families, the staff and professional colleagues and to the communities and world we are called to serve. We meet annually for fellowship and encouragement. www.cmda.org/christiansurgeons Coalition of Christian Nurse Practitioners (CCNP) We encourage, educate and challenge members of advanced practice nursing to engage in a deeper, more fulfilling walk with our Savior, thereby equipping us to impact the lives of others with the gospel. www.cmda.org/ccnp Dermatology Section We enable Christian dermatologists to work together for deeper mutual support and understanding through providing an annual meeting, participating in and funding scholarships for medical mission trips, participating in tele-dermatology consultations and mentoring resident and students. www.cmda.org/dermatology Family Medicine Section We motivate, educate and equip Christian family physicians and family medicine residents to show the love of Jesus to our patients, their families, our colleagues, communities and the world. We use biblical principles to guide competent, compassionate and scientifically-sound family medicine. www.cmda.org/familymedicine

Fellowship of Christian Optometrists (FCO) An organization of Christian optometrists, optometry students and allied ophthalmic personnel committed to worldwide eye care missions and intra-professional Christian fellowship. www.cmda.org/fco Fellowship of Christian Plastic & Reconstructive Surgeons (FCPRS) We encourage, educate and challenge members to engage in a deeper, more fulfilling walk with our Savior, equipping us to impact the lives of others with the gospel. We also inform members about social and bioethical issues within the plastic and reconstructive surgery profession. www.cmda.org/plasticsurgery Neurology Section We seek to raise awareness among neurologists, neurology health professionals, neurology residents, fellows and medical students of the great need for neurological care—domestically and globally— and, through their response to those needs, share the gospel. www.cmda.org/neurology Psychiatry Section A fellowship of believing psychiatrists providing affiliation and support, clinical and academic collaboration, opportunity for deeper personal ministry, spiritual growth and mission to the community. We promote fellowship and provide community to support and encourage Christian physicians in the practice of psychiatry. www.cmda.org/psychiatry Ultrasound Education Section A multi-disciplinary group of healthcare professionals and Jesus followers who have a passion for using and teaching ultrasound, with the goal of equipping Christian international healthcare workers to incorporate ultrasound in the most challenging of settings. www.cmda.org/ultrasoundeducation Transformed Doctors ➤ Transforming the World www.cmda.org 5

TRANSFORMATIONS

Right of Conscience Conference

February 29, 2020 • 9 a.m. to 3:30 p.m. • Dallas, Texas

oin CMDA, Dallas Theological Seminar and the Christian Legal Society for a one-day conference exploring right of conscience from a medical, theological and legal perspective. Speakers include Farr A. Curlin, MD; Donna Harrison, MD; André Van Mol, MD; Scott Rae, Darrell Bock and more. This is a great opportunity for healthcare professionals and ministry leaders to gather and discuss the complex reality of mandated practice and issues related to right of conscience. What does one do when the law requires a practice one’s conscience believes is wrong? This area is becoming a challenge for believers in the gospel of Jesus Christ. We will explore the medical, legal and theological implications of tense situations that regularly arise. These include issues of gender and sexuality, end-of-life care and beginning-of-life care. How should healthcare professionals deal with each of these areas and what is ahead for us in an ever-changing culture? This is an event to discuss and equip believers in healthcare to live out the gospel in their practices in light of the current and prospective cultural contexts. For more information, visit www.cmda.org/events.

EVENTS For more information, visit www.cmda.org/events.

Northeast Winter Conference January 17-19, 2020 • North East, Maryland Greece Tour January 21-30, 2020 • Greece Foundations in Christian Coaching January 22-23, 2020 • Cannon Beach, Oregon West Coast Winter Conference January 23-26, 2020 • Cannon Beach, Oregon Marriage Enrichment Weekend January 24-26, 2020 • Palm Coast, Florida 2020 CMDA National Convention April 16-19, 2020 • Covington, Kentucky Italy Tour May 3-15, 2020 • Italy Voice of Christian Doctor’s Media Training May 15-16, 2020 • Bristol, Tennessee Marriage Enrichment Weekend October 23-25, 2020 • Kingston, Tennessee

MEMORIAM & GIFTS Gifts received July through September 2019

Memory Paulina Kim in memory of Mr. Myung Jin Kim Ivoclar Vivadent, Inc. in memory of Dr. Peter Dawson Dr. Bruce Stewart in memory of Dr. Peter Dawson Dr. Duane Ludwig in memory of Dr. Peter Dawson Dr. Amy Gentner in memory of Dr. Peter Dawson Dr. David W. McGuire in memory of Dr. Peter Dawson Robert and Bobbi Altman in memory of Dr. Peter Dawson Dr. and Mrs. Robert Frazer, Jr. in memory of Dr. Peter Dawson Joan S. Forrest in memory of Dr. Peter Dawson Dr. Naoki Hatano in memory of Dr. Peter Dawson Dr. Gordon Norton in memory of Dr. Peter Dawson Dr. Sheard A. Ber in memory of Dr. Peter Dawson Patricia and Dale Anglin in memory of Dr. Peter Dawson May Westra in memory of Dr. Donald Westra Joel and Ellen Gordon in memory of Dr. Bill Lawton Lucy Dolinsky in memory of Raymond H. Patrick Jola Johnson in memory of Raymond H. Patrick Tom and Dora Heath in memory of Walter Cochran Tom and Dora Heath in memory of Helen Carter Rainwater Tom and Dora Heath in memory of Setsuko Collier Tom and Dora Heath in memory of Grant Hill Tom and Dora Heath in memory of Barbara Gilley Cannon Tom and Dora Heath in memory of Malcolm Ray Bishop Tom and Dora Heath in memory of Kyle Mills, Jr. Tom and Dora Heath in memory of Beverly Hatchell Yancey Tom and Dora Heath in memory of Joseph Conrad Morris Tom and Dora Heath in memory of Frank Earl Greer Tom and Dora Heath in memory of Lena Mitchell Graham Tom and Dora Heath in memory of Davie Lee Day Dr. and Mrs. Leonard Hines in memory of Nicole Nippert For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.

6 TODAY'S CHRISTIAN DOCTOR Winter 2019

TRANSFORMATIONS

VICTORY IN FEDERAL COURT

fter three years, CMDA is pleased to announce that a federal court handed down a huge victory in October 2019 for the conscience rights of healthcare professionals across the nation. In Franciscan Alliance v. Azar, a federal regulation threatened to drive religious healthcare professionals out of practice if they would not perform gendertransition procedures that violate their medical judgment and beliefs, but this new ruling strikes down the regulation, ensuring that healthcare professionals can continue practicing their profession consistent with their conscience. In 2016, the U.S. Department of Health and Human Services (HHS) issued a regulation, applicable to virtually every healthcare professional in the country, that would have required them to perform gender-transition procedures on any patient referred by a mental health professional, even if the healthcare professional believed the treatment could harm the patient. Healthcare professionals who refused to violate their conscience would have faced severe consequences, including losing their jobs. The ruling that the regulation is unlawful aligns with two previous court decisions, accepted medical research and a recent HHS proposal, keeping the government out of the private medical decisions of patients. CMDA was a plaintiff in a lawsuit against the mandate, arguing that it was inconsistent with federal law and forced healthcare professionals to violate the Hippocratic Oath, which requires healthcare professionals to act in the best interest of their patients. In December 2016, two different federal courts ruled that the policy was an unlawful overreach by a federal agency and a violation of conscience rights of medical professionals. In May 2019, HHS released a proposed new rule to fix the transgender mandate and keep the federal government from interfering in decisions that should remain between healthcare professionals and their patients, but the previous rule remained on the books while the proposal was being considered. And in October, a Texas judge finalized his previous decision, agreeing that the mandate burdens religious freedom by forcing healthcare professionals of faith to violate deeply held religious beliefs.

LEARN MORE

CMDA is dedicated to serving as Christian voice on today’s current healthcare topics. For more information about this case and other bioethical and public policy issues, visit www.cmda.org/policy.

Becket Law represented us in each challenge of the transgender mandate, and we are grateful for their partnership and diligent oversight of this federal case to protect healthcare right of conscience. Becket is also currently fighting for the rights of religious healthcare professionals in another case called New York v. HHS. “It is critically important that doctors are able to continue serving patients in keeping with their consciences and their professional medical judgment, especially when it comes to the personal health choices of families and children,” said Luke Goodrich, vice president and senior counsel at Becket. “Doctors cannot do their jobs if government bureaucrats are trying to force them to perform potentially harmful procedures that violate their medical and moral judgment.” “[This] marks a major victory for compassion, conscience, and sound medical judgment,” said Goodrich. “Our clients look forward to joyfully continuing to serve all patients, regardless of their sex or gender identity, and continuing to provide top-notch care to transgender patients for everything from cancer to the common cold.” This is a significant victory for you as a CMDA member and for us as an organization, as well as for all Christians in healthcare. We thank God for His continuing guidance as we represent our members and speak out in the public square. SUPPORT CMDA

To support CMDA's continued efforts to protect your right of conscience, visit www.cmda.org/support.

Transformed Doctors ➤ Transforming the World www.cmda.org 7

TRANSFORMATIONS

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.

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Helmut C. Diefenthal, MD Minneapolis, Minnesota • Member since 1995 Larry D. Edwards, MD Jackson, Tennessee • Member since 1962 Elmer G. Hamme, MD Hanover, Pennsylvania • Member since 1949 Lee Hoffer, PhD, MD Temple, Texas • Member since 2000 David R. Holton, MD Albuquerque, New Mexico • Member since 1989 Dana A. Nottingham, MD Westerville, Ohio • Member since 1988 Allen L. Pelletier, MD North Augusta, South Carolina • Member since 1981 William J. Lawton, MD, FACP Sutton, Massachusetts • Member since 1964 Hughes Melton, MD Bristol, Virginia • Member since 1964 Peter E. Dawson, DDS Saint Petersburg, Florida • Member since 2010 Curtis C. Drevets, MD Wichita, Kansas • Member since 1955 Kurt D. Lindquist, MD Fargo, North Dakota • Member since 1985 Stanley Wallace, MD Bedford, Massachusetts • Member since 1984

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 P.O. Box 7500 Bristol, TN 37621 888-230-2637 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

Find Connection with a Local Ministry Group Through CMDA's Local Ministry Groups You can connect with others in your local healthcare community for fellowship, discipleship and more. To get involved and find a Local Ministry Group, visit www.cmda.org/ccm.

8 TODAY'S CHRISTIAN DOCTOR Winter 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

Christopher Yuan, DMin

Worship Leader

Speaker, author, Bible professor

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TRANSFORMED TRANSFORMED Doctors

Featuring PETER E. DAWSON, DDS CMDA Member Dr. Peter E. Dawson, renowned clinician, teacher, author and founder of the Dawson Academy, died on Saturday, July 27 at the age of 89. Known around the world for his work in restorative dentistry, occlusion, and diagnosing and treating temporomandibular disorders, Dr. Dawson was widely thought of as one of the most influential clinicians and teachers in dental history. Considered by some to be the “the most famous dentist in the world,” Dr. Peter Dawson practiced restorative and prosthodontic dentistry for more than 50 years after graduating from Emory University School of Dentistry in 1954. He combined active practice with an extremely busy teaching/lecturing schedule at national and international meetings, as well as at several universities.

“I have been richly blessed by God, and I have a burning desire to do what I can to bring His message to anyone who will listen.” —Peter E. Dawson, DDS

He founded the Dawson Academy for Advanced Dental Study in 1979, and he also developed a complete curriculum for advanced postgraduate study. According to the Dawson Academy, more than 40,000 dental professionals have learned to solve complex dental problems using the principles of occlusion that Dawson developed. Today, the Dawson Academy is a leading center for dental study, with a full curriculum of lectures and hands-on courses taught by a team of experts. Satellite Dawson Academies are now located in several states and many foreign countries. “Pete Dawson’s clinical knowledge of occlusion and all aspects of restorative dentistry has directly or indirectly touched every dentist on the planet,” said Dr. John Cranham, clinical director of the Dawson Academy. “But for the dentists that really studied and spent time with him, it was his concepts of family, faith and life balance that changed our lives. He had the ability to inspire us 10 TODAY'S CHRISTIAN DOCTOR Winter 2019

to understand and spend time on the things that matter most, and to do so before we realized how important they were.” Dr. Dawson authored five textbooks and hundreds of articles, including Functional Occlusion: From TMJ to Smile Design and The Complete Dentist. He was a leader in developing diagnostic and treatment protocols for TMJ disorders and orofacial pain. Because of this, he achieved recognition for his work and earned many accolades, including the ADA Distinguished Service Award, the highest honor given by the American Dental Association’s Board of Trustees. “As Christian dentists, the ‘necessary ought’ we face doesn’t include just providing adequate care for our patients,” Dr. Dawson wrote in an article published in the spring 2012 edition of Today’s Christian Doctor. “Instead, our Christian faith upholds us to even higher standards. Our Christian principles guide our practice, our professional ethics and our desire for a balanced life.”

TRANSFORMING TRANSFORMING

the World

This passion for encouraging healthcare professionals to lead balanced lives that include a strong emphasis on Christian values was given exceptional fulfillment through a partnership with CMDA to expand the dental aspect of CMDA’s ministry. Among his many honors, he cited the invitation to serve as a trustee of the Christian Medical & Dental Associations as the most special. For the last eight years, Dr. Dawson proudly served as a member of CMDA’s Board of Trustees. He was integral in the development of CMDA’s Dental Ministries and events like the Emerging Leaders in Dentistry Symposium. Through his endowment, the Peter E. Dawson Chair of Dentistry was created, and his generous financial support helped start CMDA’s Dental Residency (+) program. CMDA’s 2012 President’s Heritage Award was presented to Dr. Dawson as a result of his continued focus on using his faith to influence the dental community. “Pete had the greatest impact in markedly expanding our dental ministry,” said CEO Emeritus David Stevens, MD, MA (Ethics). “I was so impressed with Pete’s passion for God, his wisdom and his experience. Pete brought us a huge dental network of top Christian dentists, provided generous financial support and gave us wise advice. More than that, he became a loving father figure to all he met. He profoundly impacted my life and that of many other CMDA leaders.”

Together with his wife Jodie, they raised four children and eight grandchildren. His legacy as a “Transformed Doctor, Transforming the World” continues on through his family and the extended family he built through the Dawson Academy and CMDA’s Dental Ministries. “For many years, I’ve concentrated on sharing the clinical, technical and management concepts that are needed to build a successful practice. Through those years, I’ve met too many dentists who, in spite of dedication and hard work, fall short of having the fulfillment and contentment they’d like to have…especially in regard to balancing their professional goals with a happy family life and a great marriage. I knew that a close relationship with the Lord had profoundly influenced every part of my life, including how I practiced and how I performed as a husband and as a father. I also knew that it was the reason for that ‘peace that is beyond all understanding.’” —Peter E. Dawson, DDS

Transformed Doctors ➤ Transforming the World www.cmda.org 11

Crisis in NICARAGUA by Patricia “Trish” Burgess, MD, with Rolando Castillo

12 TODAY'S CHRISTIAN DOCTOR Winter 2019

t was one of those phone calls I dreaded receiving—a late night phone call from a team leader is usually not a good sign. That one phone call set off a chain of events that impacted our ministry in ways we could not have imagined. As the Director of CMDA’s Global Health Outreach (GHO), I’m responsible for the overall logistics and safety of the 40+ short-term healthcare mission teams we send around the world every year. We work closely with our national partners to balance the security needs of each team with our mission to spread the love of Christ through healthcare. Some countries are more high-risk than others, but Nicaragua was a fairly stable location with a full-time GHO Nicaragua Director, Rolando Castillo, who we coordinate with on a regular basis. We typically send about 10 teams to Nicaragua each year, and that’s why Rolando works as our in-country director. As our full-time staff member, Rolando directs and organizes all of the details for these Nicaraguan teams while also discipling local pastors, giving us a long-term impact through these short-term teams. In fact, many of the team members return to Nicaragua again and again as they develop relationships with translators, pastors and others in the country.

organizations protested to demand a fix to the unfair laws. The government sent out police and paramilitary forces in an attempt to contain those protesting. The protests quickly turned violent, with many injured and even killed on that first day. Rolando remembers seeing a number of young people peacefully demonstrating on the streets of the town the next day. Later that afternoon, more police officers were sent out to force the protesters to go home. In the meantime, riots broke out in other cities around the country. People began blocking roads in Managua as a sign of protest, and it began to be harder to move around some major streets. On Friday, the situation in Managua was becoming more tumultuous as thousands of students took to the streets in protest. That day, the team left Masaya and traveled to Granada for a day of tourism, which they were able to do with no problem as the city was safe—for the time being. “Later that afternoon, the manager of a restaurant where all our teams love to eat called to warn me that there were rumors of a possible march later than afternoon in the vicinity of the restaurant and possible clashes could happen,”

On April 16, 2018, Dr. Greg Griffin arrived in Masaya City, Nicaragua with a team of 27 healthcare professionals and logistics workers. During the week, the team saw more than 1,700 patients in the clinic and many came to know the Lord. But outside the clinic walls, the political situation in Nicaragua was deteriorating— and deteriorating quickly. On Wednesday, April 18, protests broke out in the capital city of Managua in response to announcements from President Daniel Ortega’s administration about measures to increase social security payments, reduce pensions and repress peaceful demonstrations. Young college students and civil society Transformed Doctors ➤ Transforming the World www.cmda.org 13

Rolando recalled. “And for our safety, she recommended we stay in the hotel.” Rolando took the call seriously, so the team stayed in the hotel for the evening. That night, they heard gunshots in the distance, along with loud firecrackers. At this point, Rolando and the team leader began having serious concerns for the team’s safety, and that’s when the team leader called us late in the night. Immediately, we began praying for the critical situation and the team’s safety. I also suggested they try to get to Managua as quickly as possible, where they would be flying out of, in case the protests worsened. The next morning, it took several phone calls from Rolando to local pastors in the area to figure out the best way to get to the hotel just outside of the airport as some of the roads were blocked. The team arrived safely and were able to fly home to the U.S. without any issues. Later in the week, the city of Granada turned to chaos as the city hall was burned, numerous businesses were vandalized and countless numbers of looters broke into stores. Meanwhile, our staff in the U.S. remained in constant contact with Rolando as we assessed the continually disintegrating situation. We cancelled the trip scheduled later in April, as Rolando had concerns about keeping the team safe and the patients and interpreters being able to travel to the clinic site. However, we were hopeful we would be able to send our next two teams scheduled in May. 14 TODAY'S CHRISTIAN DOCTOR Winter 2019

As the days and weeks passed, the situation became more and more dangerous as the number of protestors grew even larger, forcing major roads and cities to close. We heard more and more reports of the use of paramilitary police to control the protestors and that sniper fire killed and wounded hundreds of Nicaraguans. From the news and Rolando, we learned that schools were closed or hours limited, medical personnel were punished for trying to help injured protestors, restaurants and hotels lost business and eventually closed, and families were afraid to go outside or drive on the roads. As we prayed together with Rolando for discernment and wisdom for him in Nicaragua, GHO made the difficult decision to cancel all remaining teams to Nicaragua for the rest of the year. In addition, we made no plans to schedule future teams in 2019. This was essential, yet heartbreaking, to do. They are brothers and sisters to us, and it felt like we were abandoning them in their time of need. We often talk of obedience to Christ in going on a mission trip, but there is also a lesson in obedience at a closed door. Many of our team members serve in different locations around Nicaragua year after year and have established deep friendships with our Nicaragua team members, most of whom served as interpreters and pastors. Because of that, some of them felt we were abandoning our family in Nicaragua; however, we needed to keep the safety of our teams our primary concern. That feeling of abandonment spurred on our GHO team members in the U.S. to try and do something—anything— to help their friends in Nicaragua who were facing food

When the families arrived at a local church for food distribution, the local pastors gave them bags of food, plus they shared the gospel message. As time passed, more and more people came for food and to hear about the Lord. We were told they saw this gift as an offering directly from the Lord. The Catholic Church in Nicaragua started a national dialogue between the government and the protesters to negotiate peace, but it wasn’t fruitful. Different international groups and countries like the U.S., Canada, Costa Rica and the European Union tried to push President Ortega to cease the repression, but it took months for things to finally start to settle down. Finally, most of the violence stopped in October 2018, but much damage had been done. More than 500 were killed, while thousands were imprisoned. Plus, more than 100,000 Nicaraguans fled the country out of fear or the need to search for jobs. Hundreds of companies closed due to the economic recession, and inflation continued to rise. shortages and a lack of work as the nation’s economy crumbled amidst the violence. And out of that desire to continue to serve, we established the “Nicaragua Relief Fund.”

While we watched the situation unfold in Nicaragua from the U.S., it was easy to become discouraged. Our

Many of our team members in the U.S. donated money to the fund, along with their churches, to assist the pastors, interpreters, church members and others who had suffered the effects of the instability. In country, the cost of a basic basket of goods had increased by at least $100 since April, so lots of poor working families couldn’t afford even basic necessities to feed their families. Prior to the violence erupting, GHO sent two teams each year to help women who are victims of human trafficking, and these women and children were also going hungry. Rolando used the money from the Nicaragua Relief Fund to buy food for these needy families. We did have to be extremely cautious while doing this because money going in and out of the country was being watched closely. We did not want to inadvertently put our Nicaraguan team members in danger if the money were to be interpreted as though we were sending support for protestors.

GET INVOLVED

CMDA’s Global Health Outreach (GHO) is a short-term missions program that sends 40 to 50 medical, dental and surgical teams around the world each year to share the gospel and provide care to the poor. Sign up to travel on one of GHO’s short-term trips this year and join us in our efforts to transform the world. To find a trip that fits your schedule, visit www.cmda.org/gho.

Transformed Doctors ➤ Transforming the World www.cmda.org 15

around the world and inviting us to join Him, He has also opened doors into more surgical teams. When I did a site visit to the Dominican Republic, we were told by a local physician that he had been praying for a surgical team to come and help his country for 18 years. God was showing us His command in Acts 1:8 to go beyond Jerusalem and Judea and in to Samaria and the ends of the earth. It was exciting! It brought hope.

We didn’t forget our beloved Nicaragua, but I believe we responded to the Lord in humble obedience. Sometimes our heart cry is felt to be ignored, but God has continued to work in Nicaragua without us. Rolando has heard amazing testimonies of the Lord’s provision. The body of Christ in Nicaragua worked together to help each other.

Rolando Castillo serves as the Nicaragua Director with Global Health Outreach, coordinating the multiple trips again being sent to Nicaragua each year.

staff was dealing with the headaches of the logistics of cancelling multiple trips. As the doors literally shut for our teams to visit the country, we started wondering how we could continue to fulfill our mission of demonstrating the love of Jesus to the world through healthcare. But our answer was right in front of our eyes—we have a commandment to spread Jesus to the entire world, not simply Nicaragua. So we looked up from the work and the discouragement, only to see God opening multiple doors for our teams to visit new locations around the world. If the doors to Nicaragua had not closed, we would have never seen these new opportunities for GHO, let alone walked through the open doors. I believe God is at work in the Muslim community. He opened many doors into refugee care teams in the Middle East. We heard story after story of Jesus coming to them in dreams as we care for them in our clinics. He has opened new doors into our efforts to stop human trafficking as well. As He is showing us He is at work 16 TODAY'S CHRISTIAN DOCTOR Winter 2019

It’s been more than a year since that fateful phone call back in April 2018, and we are excited to announce our first GHO team returned to Nicaragua in July 2019. In fact, the Ministry of Health requested our medical teams visit certain areas that are in great need. This trip was long anticipated, and the team was extremely excited. They worked in a rural area of Nicaragua that took hours to get to, yet pastors from all over Nicaragua took long bus rides to join the team to help and serve alongside our GHO team. They all appreciated the unity of the team and the bonds as sisters and brothers in Christ reunited. Rolando believes this time of deep sadness and pain was a lesson for his entire country, especially for the Christian community in Nicaragua. 2 Chronicles 7:14 says, “If my people, who are called by my name, will humble themselves and pray and seek my face and turn from their wicked ways, then I will hear from heaven and will forgive their sin and will heal their land.” This was a verse of encouragement for lots of churches during this time, and it brought us all to our knees imploring God for mercy. When Rolando was able to begin meeting again with the discipleship groups he oversees, many expressed their pain and suffering but realized the Lord demands more from His people, including humble hearts and lives removed from sin. Certainly, many acknowledged that they had strayed from the Lord and that this situation made them return to their communion with God. They were also able to understand better the words of Peter in 1 Peter 5:10, “And the God of all grace, who called you to his eternal glory in Christ, after you have suffered a little while, will himself restore you and make you strong, firm and steadfast.”

Returning to Nicaragua by Andrew R. Schock, MSPA, PA-C Editor’s Note: Andrew and his wife Janelle were two of the team members on the final trip to Nicaragua in 2018, and they were both on the first team back to Nicaragua in 2019.

t was around 1:30 p.m. on Thursday afternoon in April 2018. As I roamed the clinic in Pacaya, Nicaragua to check on various departments of our clinic, I noticed our interpreters all intently checking their cell phones. Clinic continued to function in usual fashion through the end of the day, when Rolando gathered us to discuss some current events that had captured the attention of our Nicaraguan partners. Protests were taking place in the more populated areas of the country, and the look of concern on Rolando’s face told us all we needed to know. We quickly wrapped up clinic, ate with haste and proceeded directly to our hotel. The streets were nearly deserted. In the morning, the news informed us that things were stable, and we decided to head to clinic for our final day. Several team members later told me they heard explosions or gunshots during the night and didn’t sleep well. Per GHO custom, we ended clinic and proceeded to finish our trip with a day of relaxation in Grenada. There would be little relaxation this night, as the political unrest and violence dramatically worsened. Our plan changed by the next morning as there were reports of barricades and clashes, and things were continuing to worsen. Because of this Rolando led us along a more rural route back to Managua, and we arrived without any difficulty in what can only be described as providential. The next morning, we got to the airport and surprisingly took off without much difficulty.

The next morning as we gathered in our usual meeting location, Rolando walked in with a group of about 10 interpreters and other GHO employees. Talk about a flood of emotions! The remainder of the trip seemed to have a special feeling about it, with interpreters and team members from the U.S. forming and strengthening bonds as brothers and sisters in Christ. This close-knit unity seemed to propel us to greater love for our patients and our hosts and to greater effectiveness in our clinic and evangelism. The most dramatic development we noticed from the last 15 months was a greater depth of spiritual maturity in our Nicaraguan friends. They seemed to be more eager for fellowship and were pursuing spiritual maturity in a way we hadn’t seen in the past. Suffering and persecution have a way of separating wheat from chaff, and their suffering the last 15 months appears to have had a very painful, but constructive, purifying effect on their souls and their walk with Jesus Christ. There was much talk prior to the trip about how important it would be for us to just be there and encourage the Nicaraguan brethren, but they turned out to be the greatest and most important ministers on our entire brigade. Shouldn’t have been surprised in the least, but I was surprised. We all were. And we are better off for having been there with them.

Fast forward 15 months to July 20, 2019 as we arrived in Managua for the first GHO trip to Nicaragua since that 2018 trip. The anticipation of seeing our local friends, and co-laborers in Christ, was almost more than we could bear. While waiting for our baggage to arrive and our team to clear customs, we saw Rolando through the window, smiling at us. If you know Rolando, you know his smile can light up a room. This time I thought his face might rip in half.

Transformed Doctors ➤ Transforming the World www.cmda.org 17

time preparing for discipleship sessions. It sure has been a different year, but very busy serving God and trying to bring comfort and encouragement to so many pastors and their churches that I’ve been able to meet during my years with GHO. Only Jesus Christ is the solution to the problem of sin that overwhelms humanity.

Rolando’s words speak for themselves about how the Lord has worked through this situation: The Lord has been working in the lives of His people, just as the artist who perfects his painting with every single brushstroke. He built our strength in the same way as an athlete builds muscles by training every day, teaching us how to run the race to finish it. Thus, the Lord has brought us through this temporary fire, so we can become more like Him, purer in all our ways. Also during this time, we can see His faithful hand among my family, GHO staff, translators, pastors and their families, that all of us have been kept by the Lord fulfilling the promise He said to Abraham in Genesis 15:1, ‘Do not fear…I am a shield to you; Your reward shall by very great’ (NASB). I have also seen the generous hand of the Lord and His provision through friends and brothers. At some point during the crisis I was quite distressed, but one of those afternoons I got a call from brother Ron Brown and Dr. Trish telling me: ‘Rolando if you and your family have to get out of Nicaragua, do not hesitate to come here. We will give you a safe place to stay while you need it.’ Those words had so much meaning, because my heart was fearful and heavy. I want to thank CMDA and GHO from the deepest part of my heart, because despite not having a single team going to Nicaragua since last April, my assistant Roy and I have gotten our monthly financial support to keep providing for our families. Praise the Lord! Since I wasn’t going out with teams, I have been invited more to preach to other churches and spend more

18 TODAY'S CHRISTIAN DOCTOR Winter 2019

PATRICIA “TRISH” BURGESS, MD, joined CMDA as the new Global Health Outreach Director in 2018. Trish went to the University of Georgia for her undergraduate degree where she met her husband. She took two years off before attending medical school and worked as a firefighter in Athens, Georgia during this time. She attended the Medical College of Georgia and did her residency in emergency medicine at the University of Missouri in Kansas City. Dr. Burgess felt the call to shortterm missions early in her career. Her first mission trip was to Nicaragua. During this trip, she felt Him clearly telling her this was the reason He had created her, and His plans for her included continuing with short-term medical missions and leading teams. With GHO, Trish has also traveled to Cambodia, the Dominican Republic, El Salvador, Ethiopia, India, Kenya, Nicaragua, Moldova, Peru and Zambia.

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This article was originally published on The Point, CMDA’s weekly blog focusing on the issues facing Christians in healthcare. Visit www.cmda.org/thepoint to read more and join the conversation on breaking news stories in bioethics and healthcare. Our expert contributors also recommend additional resources and information.

ears ago, I heard a saying about how people can spend their extra money. The saying goes: ou can eat your money (spend it on fine dining), Y You can drive your money (spend it on luxury cars), You can live in your money (spend it on a nicer house), You can wear your money (spend it on pricey clothes), Or you can visit your money (spend it on travel).

Most people can do one or two of these things, but very few people can do more than that. I have always found this idea intriguing as my family and I considered how to budget the money we have been given. But it leaves out something very important we can do with our extra money, doesn’t it? We can give it away. Recently, I attended two back-to-back fundraising dinners for different organizations. At one of them, the testimonial speaker talked about how inspired he was by a friend who had donated a $3 million house to the organization. And at the second, I (a primary care physician) was at a table with two surgeons and a dermatologist. In both settings, my first response was to think how much less I have to give than the people around me. And that scarcity mentality quickly began feeding on itself: • “If this plastic surgeon can give so much more than I can, what use is the little I can give?” • “If this organization is getting $3 million houses, what use do they have for my little pittance?” • “If we hadn’t had all those student loans to pay off….” • “If we didn’t have three kids heading into college….”

THE LURE

It’s natural, isn’t it? We compare ourselves to those who have more than we do. I imagine that same plastic surgeon compares himself to wealthier surgeons, and the guy with the $3 million house compares himself to a neighbor with a $4 million house. There’s always someone with more, isn’t there? And even if there isn’t someone with more, there is still more out there to acquire. I would venture to guess that Amazon’s Jeff Bezos, currently the richest man in the world, still has things he thinks about being able to do if he had a little bit

OF MONEY by Autumn Dawn Galbreath, MD, MBA

20 TODAY'S CHRISTIAN DOCTOR Winter 2019

more money. I mean, John D. Rockefeller is considered to have been the richest person in modern history, and when a reporter asked him, “How much money is enough?” he replied, “Just a little bit more.” There is no end to human nature’s grasping and striving for just a little bit more. We are never fully satisfied, no matter how much we have or earn. One of the ancient world’s richest men, the writer of Ecclesiastes, said, “I have seen everything that is done under the sun, and behold, all is vanity and a striving after wind” (Ecclesiastes 1:14, ESV). I love the phrase “striving after wind” because that’s exactly what it is, isn’t it? We work and strive and try and grasp, but we can’t catch the wind any more than we can find satisfaction in the material world. What if we stopped striving after wind and began striving after God? How would it change our perspectives? I submit that it would change our perspectives on everything in this life, but most of all, it would change our perspectives on money. If our focus all day every day was on God and what He provides, would we begin to hold His provisions more loosely? Would we be more willing to let go of them? Would we even want to get rid of some of them in order to lighten our own burdens and further the kingdom work on earth? I am not speaking from any kind of moral high ground on this issue. Not only have I not “arrived” on this issue…I’m such a beginner that I can’t even imagine what the “finish line” would look like! But I do know I can choose what I compare. I can compare myself to Jeff Bezos or to the plastic surgeon across the table and always come up short. But if I compare myself to the 50 million Americans living in poverty (annual income less than $25,100 for a family of four) or to the average household income in the U.S. ($58,270) or to the median household income in the U.S. ($29,930) or to the median household income worldwide (less than $10,000), I am wealthy beyond belief. Did you know that if you earn more than $32,400 annually, you are in the top 1 percent of the wealthiest people in the entire world? I don’t know a single healthcare professional who doesn’t fall into that category. So if we are in the top 1 percent of earners in the world, how does God call us to view our possessions? • “ Whoever loves money never has money enough; whoever loves wealth is never satisfied with his income. This too is meaningless” (Ecclesiastes 5:10). • “Keep your lives free from the love of money and be content with what you have, because God has said, ‘Never will I leave you; never will I forsake you’” (Hebrews 13:5). • “No one can serve two masters. Either he will hate the one and love the other, or he will be devoted to the one

and despise the other. You cannot serve both God and Money” (Matthew 6:24). • “For the love of money is a root of all kinds of evil. Some people, eager for money, have wandered from the faith and pierced themselves with many griefs” (1 Timothy 6:10). I don’t see Scripture saying it is wrong to have money, but I do see caution after caution about how seductive money can be. About how it lures us to rely on it, and on ourselves, rather than on God. About how the love of money can never be satisfied and creates a lust for more and more. About how God provides us with whatever money we have—be it a lot or a little—and He expects us to use it further His kingdom. My question to all of us is this: Where in our lives are we relying on money or its trappings (power, security, possessions) rather than relying on God? And where is God calling us to give up money and possessions for His kingdom work? The opportunities to give are endless. There are hundreds of excellent, biblical ministries doing amazing work—ministries that could be doing even more if they had more money. How does God want you to reorganize your priorities in order to free up more for His glory? These are the questions I’m pondering myself, and I challenge you to join me. AUTUMN DAWN GALBREATH, MD, MBA, is an internist in San Antonio, Texas, where she lives with her husband David and their three children. Though they met in medical school, David now owns a restaurant in the San Antonio area. Between the two of them, they have experienced multiple career transitions and weathered the resultant stresses on their marriage and family. Autumn Dawn speaks to the issues of Christian marriage, being a working mother in the church and being a woman in healthcare with an engaging humor that brings perspective to these difficult issues. Autumn Dawn earned her medical degree from the University of Texas Medical School at San Antonio, where she also completed her internal medicine residency. She earned her MBA from Auburn University in Auburn, Alabama.

GET INVOLVED

CMDA’s Stewardship Department offers resources to help encourage CMDA members and aid them to be good stewards of the gifts given them by God, plus information to help protect their assets and provide for loved ones while building the kingdom of God. For more information, visit www.cmda.org/support.

Transformed Doctors ➤ Transforming the World www.cmda.org 21

GET INVOLVED

CMDA’s Marriage Enrichment Weekends provide healthcare couples the opportunity to nurture and grow in their marital relationships. These weekends offer a comfortable, get-away-from-it-all setting, allowing couples to communicate and experience a deeper appreciation for their marriage partnership. For more information and to register, visit www.cmda.org/marriage.

by Patti Francis, MD

y husband Ron and I love to hike. Give us a day, and you will find us on a well-loved trail near our home in California. Give us a weekend, and we’ll venture further afield. Give us a week, and who knows where we’ll end up. But know it will be a hiking trail which immerses us in the beauty of God’s creation. Our marriage has also been a journey. An adventurous one. When Ron and I first started out as a married couple, we were sure we were on the right path. Each of us thought we had the best possible traveling companion. But every journey has its hills and its valleys, and many journeys involve climbing difficult mountain paths. “My traveling companion could be doing things a bit differently,” we each thought. And, “Is my backpack carrying more than my share of the burden?” Throw in a few kids along the way, and the path seemed to get downright rocky! We embarked on that journey in 1977. I was starting my third year of medical school. Our first little unexpected 22 TODAY'S CHRISTIAN DOCTOR Winter 2019

detour was our daughter Corrie, born a month before I was to graduate. We weathered it pretty well. I started my internship a year later and stretched it out over two years. Erica, our second daughter, was born a month shy of my finishing pediatric residency (I didn’t do well in obstetrics, obviously!), but I joined a pediatric group a year later, of which I’m now the senior partner. Our trail got really steep and rocky once we moved to the suburbs and I became extremely busy with practice, church and the community in which we lived. Ron felt neglected and I felt unsupported. Was this the way it was going to be? It seemed like a terrible future. True, we had made a commitment to God, and to each other, that we were in this for life. Yet how could we endure? So we signed up for a Marriage Enrichment Weekend (MEW ) with CMDA. Okay, full disclosure: it was in Hawaii. I am definitely more amenable to change in the context of natural beauty like Hawaii. We learned some tools and realized our marriage was going to take some

1. We are both sinners in need of God’s grace.

We’ll never grasp it fully, but studying Philippians 2:3-4 has helped us lay down our selfish desires and to serve each other: “Do nothing from selfish ambition or conceit, but in humility count others more significant than yourselves. Let each of you look not only to his own interests, but also to the interests of others” (ESV ). Gary Smalley’s book I Promise lays out how our personal relationship with Christ is of the utmost importance in maintaining the love between us. We have to plug into the source of love, Christ Himself, before we can ever give that unconditional love to our spouse. Gary Chapman’s The Language of Apology is a book that convicted us deeply and which we’re still working on. How are you growing in your walk with the Lord?

2. We need to maintain our commitment to God and to each other.

serious work on both our parts. Though we never brought up the word “divorce,” the way we were communicating was taking us down separate paths. We were both being selfish. (Scott Stanley’s book A Lasting Promise: The Christian Guide to Fighting for Your Marriage really helped us in this area.) Now we’re into our 42nd year of marriage, and both of our daughters are married. Recently, our oldest daughter sent us an article on marriage communication! It was a good reminder of the need to keep working on our relationship. A lot has changed since that first MEW in 1992. We’ve read many books on marriage (we try to read one yearly), and we’ve attended or helped lead our church’s marriage workshops. These have been great, but the most positive impact on our marriage continues to be the MEWs. In fact, we joined CMDA’s Marriage Enrichment Commission 16 years ago, and so we are helping to lead MEWs ourselves. This forces us to keep reading and to keep talking. Looking back, here are the highlights of what we’ve learned since our first MEW:

We made a promise to embark on this journey together on our wedding day. That commitment is the glue that keeps us working on a better marriage, even when sometimes I’d rather not. God never gives up on us (just as He never gave up on Israel), so He is able to refuel our love for our spouse as we come to Him in prayer. Marriage researchers have produced an interesting graph on “marital satisfaction.” The line on the graph (a composite of thousands of marriages) heads steadily downward after the wedding until the couple has weathered their children’s teenage years, but then it rises higher than when they were first married. Many couples give up at the downward plunge, not realizing the best is yet to come. How strong is your commitment to God and to each other?

3. We need to set goals to keep us growing together, not apart.

Like a journey, we have to get in shape and be prepared for setbacks and detours. I’m dealing with some health issues, and my mom (who is nearing 100) requires a lot of my time. If Ron and I don’t plan ahead to spend time together, doing fun things, then one of us, for sure, won’t be happy. We have been backpacking for more than 40 years and are ready to hire horses or kids to carry the extra loads, but we have to keep ourselves in shape to make the trip. That does take setting goals. What goals do you need to discuss with your spouse? Transformed Doctors ➤ Transforming the World www.cmda.org 23

God’s Purpose for Marriage by Sally Puleo

hat is marriage, anyway? Just a piece of paper? Some see it as a romantic fusion of souls. That is, two hapless halves have found each other at last and now they are whole. Others see it as a clear-headed, business-like merger—a contract fulfilled, a checklist of responsibilities. Still others see marriage as a rite of passage—a step on the path to happiness. Which view is correct? Maybe none of them. Maybe, though, all of them, in the sense that each holds onto some truth. And there is a deeper truth still, that God designed marriage and He designed it for a purpose. And so, if we miss God’s intention, we set ourselves up for disappointment and unrealistic expectations. Our ears will then so easily hear the whisper, “Maybe you just married the wrong person.” My favorite book subtitle is Sacred Marriages by Gary Thomas: “What If God Designed Marriage to Make Us Holy More Than to Make Us Happy?” That is, the crucible of marriage is uniquely designed to burn away our selfishness. Perhaps the message of Christ’s forgiveness can only penetrate the heart of a spouse when an injured spouse offers “undeserved” forgiveness. And if a couple, with God’s help, is able to move forward out of a challenging season, their marital history becomes a sacred history, wrapped up in redemption. The very ingredients of a healthy marriage are the things we need for a growing walk of faith. The early years of Rob’s and my marriage were, for me, a rollercoaster of emotions. With small children to care for, his busy dental practice collided with my work as a nurse. My fatigue wore away my ability to enjoy, and sometimes even to endure, my husband. One day at my work at a nursing home, a dear elderly patron began to reminisce about her more than 60-year marriage. Had I heard her right? “Sixty years?” I blurted. “How did you do it?”

24 TODAY'S CHRISTIAN DOCTOR Winter 2019

She smiled, “I had some good years and some bad years.” I left the room convicted that my approach to my own marriage was shallow. I couldn’t handle a difficult week, let alone a bad year. I’ve never forgotten that encounter. God had shown me He was using my marriage as sandpaper in my life so I could become more like Him. The calloused, rough edges were being softened. May we who are married adjust our perspective to see God’s purpose for our marriages as we strain toward the finish line. Our Savior longs to say to us, “Well done, my good and faithful servant.”

SALLY PULEO is a nurse who is a missionary associate with the Assemblies of God. She has been married to her husband Rob, a dentist, for 32 years, and they have four children and two grandchildren. Currently, Sally and Rob are the chairs of CMDA’s Marriage Commission. When not traveling for mission work, they both enjoy living on a quiet dirt road in New Jersey in a town where the deer outnumber the population.

4. We have had some traveling companions on many of our journeys who hold us accountable along the way.

One such couple is also on the Marriage Enrichment Commission and we have similar personalities. We laugh when they argue, because we could be having the very same issue at another time. And they do likewise. It’s nice to know we are fellow strugglers along this sometimes glorious—but sometimes rough—road called marriage. I also have a few close girlfriends I can ask to pray for me when I’m struggling on a ledge and want to jump off. They pull me back into a safe zone. Who are your traveling companions who can pray for your marriage?

5. We need to persevere in prayer with God’s Word.

Hebrews 12:1-2 says, “…let us throw off everything that hinders and the sin that so easily entangles, and let us run with perseverance the race marked out for us. Let us fix our eyes on Jesus, the author and perfecter of our faith….” Praying together is an off-and-on practice in our marriage. I need to trust that God is working in Ron’s life to show him how important it is. Couples who

pray together have a less than 1 percent divorce rate! Who wouldn’t want that statistic on their side? Can you start praying or reading God’s Word together daily? The Bible is God’s love story for us. And marriage is a reflection and a taste of how amazing that love is. Marriage started in the garden and ends with the wedding feast of the Lamb. The fall happened in the garden, so it’s no surprise that the deepest struggles of life will occur in the most primary of human relationships. Marriage is the battleground of sin, and it’s the place where the cross is revealed as the only hope for life and joy. Marriage can be a testimony of how two sinners can receive God’s grace and reflect His glory to a broken world. And that, my fellow travelers, is a journey worth taking.

PATTI FRANCIS, MD, is a practicing pediatrician who has been in private practice for the last 35 years in Lafayette, California. She has two adult married daughters. She has been married to Ron for over 42 years, a result of serving on the Marriage Enrichment Commission for more than 20 of those, she is convinced! She loves to hike, backpack and take wildflower pictures wherever she travels. She has been involved in CMDA since her first year of medical school at Boston University School of Medicine.

Transformed Doctors ➤ Transforming the World www.cmda.org 25

CMDA Statement on Recreational Marijuana The Christian Medical & Dental Associations (CMDA) has developed this policy on “recreational 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 “recreational marijuana” refers to any form of marijuana, its derivatives, or synthetic derivatives used for recreational, non-medical purposes. Marijuana has been in the news constantly as American states and countries around the world have been asked to make important decisions about the decriminalization, legalization, and regulation of recreational marijuana. The Bible is our final authority for faith and practice which speaks to the creation mandate, promotion of the good, the role of authority, and being good stewards of the environment. The Bible does not solve every question of policy, but it does provide insight into the use of recreational marijuana.

You can now earn continuing education credits through Today’s Christian Doctor. Two hours of self-instruction are available for this article. See page 33 for more information.

The two main cannabinoids, or active ingredients, in marijuana are tetrahydrocannabinol, also called THC, and cannabidiol, or CBD. 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. THC is the euphoria-producing component sought by recreational users and levels have been steadily rising in marijuana plants and products. Recreational marijuana is federally illegal and is neither FDA-approved nor regulated. Recreational marijuana use and legalization have profound social implications, including associated increases in the following: accidents and death, access to marijuana for minors, crime, drug use and abuse, black market activity, and environmental problems. Low income populations may be affected at a higher incidence than others. The cost to society

26 TODAY'S CHRISTIAN DOCTOR Winter 2019

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of recreational marijuana legalization is greater than tax revenues produced from its sales. Because marijuana has been illegal in the United States until its recent, selective legalization in multiple states, and because it remains illegal federally, high-quality research regarding the safety or risks associated with current recreationallyused marijuana products (especially those containing high levels of THC) is sparse. However, a lack of studies on such products does not mean risk is absent. On the contrary, there is moderate to substantial evidence of health hazards with marijuana use, including associations with respiratory problems (when smoked), motor vehicle crashes, mental or psychosocial problems, increased incidence of schizophrenia and other mental health problems, and addiction. Maternal marijuana smoking is also associated with complications for unborn children. Future research on higher level THC products has the potential to demonstrate even more harm.

For these reasons, CMDA does not support the legalization or use of recreational marijuana. CMDA maintains that healthcare professionals should abstain and strongly advise against the use of recreational marijuana.

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).1 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.1 THC’s chemical structure is similar to the endogenous cannabinoids (specifically anandamide) which are neurotransmitters that bind to CB receptors.2 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.1 There are THC-type, CBD-type, and hybrid cannabis plants which have predominantly THC, CBD, or a mixture of both cannabinoids, respectively.1 2. Marijuana products: 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.1 Often the products produced for “medical” use are the same as those used recreationally, with the exception that recreational products always contain THC, which produces the “high.” 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.1 3. Rising THC Levels: The natural levels of THC and CBD in Cannabis are under 1%.3 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 2014.2,3 Marijuana concentrates may contain 75% or more THC;2 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,”3

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).4

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 or ethics, but it provides insights into the use of recreational marijuana. 2. The Creation mandate: Genesis relates that God gave humans dominion over all the earth with instructions to subdue it.5 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 fall6 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 self-control. This means doing good and promoting the good to our neighbors – not evil.7 Society should not condone harmful behaviors including the promotion and use of hallucinogenic, potentially addicting drugs, like marijuana. Scripture cautions us to not be mastered by anything,8 for when anything or person other than God is master, we are guilty of idolatry9 in not loving God with all of our heart, mind, body, and soul.10 4. Biblical admonitions against an altered state of mind: Multiple passages label drunkenness as sin and an undesirable behavior.11 Because an altered state of mind is intrinsic to marijuana use, it should not be used for recreational purposes.12 5. Role of authority: We believe Scripture calls Christians to be submissive to governments and authorities.13 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.14 Leaders and teachers must give an account and are judged more strictly;15 physicians fill both roles and must be careful never to abuse that authority. Christians, in general, are to “set an example for the believers in speech, in conduct, in love, in faith and in purity.”16 Whether or not recreational marijuana is legal in a particular jurisdiction, its use is a poor Christian witness. 6. Good stewardship of the environment according to 17 the creation mandate: The widespread growth of the marijuana industry, according to scientists, will have a deleterious impact on the environment due to deforestation (when grown on natural land) and excessive demands for water, power, pesticides, and fertilizers.18

Transformed Doctors ➤ Transforming the World www.cmda.org 27

C. SOCIAL

1. General: Citizens of a country should consider the known and potential harmful effects of recreational marijuana on individuals and society. Experiences with the harms associated with opioids, alcohol, and tobacco are relevant to the consideration of legalization of recreational marijuana use. 2. Low-income areas may suffer disproportionately with marijuana legalization: Recreational marijuana became available in licensed stores in Colorado in 2014.19 The vast majority of marijuana businesses in Denver service low-income minority neighborhoods.20 In Colorado, 20 percent of people with incomes under $25,000 consumed marijuana or THC products in 2014, while only 11 percent of those earning over $50,000 consumed the same products.21 3. Increased accidents and deaths: Between 2013 and 2016 in Colorado, the number of drivers involved in fatal crashes increased 40 percent, and the number of drivers who tested positive for marijuana use increased 145 percent. The prevalence of testing drivers for marijuana use did not change significantly during that time.22 According to the Colorado Department of Transportation, the number of fatalities with drivers testing positive for 5ng or greater THC decreased from 2016 to 2017.23 However, state law does not require coroners to test deceased drivers for THC, and not all perform the test. In addition, many police agencies do not test surviving drivers for THC if he or she has already failed a simpler alcohol breath test, thus failing to document drivers who are impaired by both THC and alcohol.22 Marijuana deaths and injuries have increased in Colorado as marijuana was named as the culprit in fatal fires, explosions, and suicides.21 4. Legalization leads to increased use and abuse, including among minors: All states with legal recreational marijuana had prior legalization of medical marijuana (see Table at the end of the statement).24 Evidence suggests that overall availability (whether from medical or recreational marijuana legalization) may lead to an increase in recreational usage among adults and minors. Examples: a. One nationwide study found that medical marijuana laws are associated with “increased prevalence of illicit cannabis use and cannabis use disorders” among adults.25 Marijuana use among those aged 18 to 25 is increasing in states where marijuana is legal.21 b. States with legal marijuana have youth rates that surpass those in states that do not.21 Colorado’s firsttime marijuana use among youth leads the nation, with a 65 percent increase since legalization.21 c. Communities with marijuana businesses have greater marijuana use rates among minors. 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

28 TODAY'S CHRISTIAN DOCTOR Winter 2019

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.26 There is some evidence that 11th graders, but not 8th graders, in Oregon have a higher marijuana use rate in communities without retail bans than in communities with bans.27 d. In Anchorage, where marijuana was legalized in 2015, school suspensions for cannabis use and possession have increased more than 141 percent from 2015 (when legalization was employed) to 2017.21 e. In both Washington and Oregon, recreational marijuana retailers have been cited for selling marijuana to minors.21 5. Commercialization and social media: Individuals, small businesses, and corporations who profit from 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. When advertisements or staff at marijuana dispensaries or retail stores imply benefits and/or safety (that may not be realistic), people may be enticed to use it. For example, in one cross-sectional study in Colorado, almost 70% of contacted marijuana dispensaries recommended cannabis products to treat nausea during pregnancy,28 in spite of data suggesting potential harm to fetuses.1,29-33 Another study examined the website marketing practices of medical and recreational marijuana dispensaries across the U.S., finding that only a few advised about side effects and contraindications. 75% did not include age verification, making products available to youth with convenient online ordering.34 Exposure to medical marijuana advertising has been associated with greater marijuana use in minors.35 Physicians should warn their patients about false advertising and the hype on social media. 6. 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,36 and caution must be used in looking at studies in this area because of bias,37 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,38 and other methodological problems. Because societal attitudes may have changed prior to either medical or recreational legalization26 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.21 b. Legalization of marijuana in Colorado is associated with short-term reductions in opioid-related deaths.39 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.”40 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.41 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.42 Cannabis use was associated with an increased risk of developing nonmedical prescription opioid use and opioid use disorder.43 7. Crime: Property crimes have increased in Colorado, Alaska, and Oregon since legalization of recreational marijuana.21 Black market activity has also increased post-legalization, as documented in both Colorado and Oregon; legalization makes illegal marijuana crops easier to conceal. Some of the illegal operations have been found in national forests or other environmentallyprotected areas, and damage has resulted in these areas.21 8. Profits over people: The emphasis on marijuana benefits in the form of excise taxes, job creation, and corporate profits represents a misguided effort to place profits over the well-being of society and individuals. In addition, the cost to society of state regulation, law enforcement, accidents, additional health care costs, high school dropouts, juvenile use, employer-related costs, and addiction programs will be substantial.21,44 One report found that “for every dollar gained in tax revenue, Coloradans spend approximately $4.50 to mitigate the effects of legalization.”44 9. Environmental problems: Commercial production of marijuana is fraught with environmental concerns. Marijuana requires a comparatively large amount of water45a yield of 130 bushels/acre, water requirements of 3000 gallons per bushel, and a growing season of 60 days (estimates to err on the side of the highest water needs per plant and nutrients. Its cultivation is associated with land clearing, erosion, surface water diversion, use of polluting pesticides and fertilizers, and wildlife poaching.18 When grown indoors, marijuana requires large amounts of energy21 with “potentially negative effects on climate.”18 Growing marijuana consumed 1% of the nation’s electricity in 2012, which is six times the amount of power used by the entire U.S. pharmaceutical

industry. Since then, marijuana cultivation has increased dramatically.21 The marijuana industry produced almost 400,000 pounds of CO2 emissions in 2016.44 A majority of the marijuana consumed in the United States is grown in California, primarily outdoors. There, illegal marijuana production thrives “in sensitive watersheds…which represent habitats for several rare state- and federally listed species,” and resulting environmental damage has been documented.18

D. MEDICAL

1. Studies: Because marijuana has been illegal in the United States until its recent, selective legalization in multiple states, and because it remains illegal federally, highquality research regarding the safety or risks associated with current recreationally-used marijuana products (especially those containing high levels of THC) is sparse. Studies of recreational products are largely limited to self-reported use and surveys of behaviors. There are large gaps in current knowledge regarding potential risks, and most of the information is in the form of correlations without a clear understanding of causation. It is uncertain whether the potential harms are a function of THC dose or levels in the body and/or of the amounts of other plant compounds or contaminants. In spite of these difficulties, useful information about recreational use of marijuana can be gleaned from research into medical uses as well as from self-report-type studies of recreational use. Prior to presenting such findings, an outline of problems with the research in this area includes: a. P oor reliability: The research itself has significant problems which limit its reliability. These include 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.46 It is important to note the nature of marijuana derivatives used in any studies—the THC level, delivery method, and quantity. For example, self-reported amount of smoking provides poor data compared to use of FDA-approved standarddose pharmaceuticals. Conclusive studies can only be done with FDA-regulated medications or pharmaceutical-grade compounds, but such products are less commonly used recreationally. b. Insufficient data: 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. c. Impediments: Researcher bias; difficulty with achieving double-blinded studies; and obtaining

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properly controlled, adequately-sized, representative samples are among the methodological problems that may be anticipated in this research area. d. 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. e. 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. 2. Medical complications of marijuana use: Despite the problems with research in this area, some of the shortterm and long-term effects of marijuana use are being uncovered. In all associations of marijuana use and health complications listed below, the quality of the evidence behind the conclusions is included when available. In the face of insufficient good quality data and conflicting data for some consequences of marijuana use, there may be harmful sequelae that exist but will not be fully elucidated until further research (especially longterm studies) is completed. The lack of current quality research on commonly used recreational marijuana products, especially highly potent THC substances, does not mean risk is absent. On the contrary, there is moderate to substantial evidence of health hazards with marijuana use, as listed below. Future research will be needed to provide more definitive answers to questions about effects of recreational marijuana use, and there is potential to find even more harm associated with higher level THC products. 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.1 b. Respiratory diseases: There is substantial evidence of an association between chronic marijuana smoking and chronic bronchitis and worsening respiratory symptoms.47 There is more limited evidence of an association with chronic obstructive pulmonary disease (COPD).1 c. Injury and death: Substantial evidence correlates cannabis use and increased risk of motor vehicle crashes.1 Among pediatric populations where cannabis use is legal, there is moderate evidence of increased risk of overdose injuries and respiratory distress.1 d. P re-and perinatal exposure to maternal cannabis use: Use of marijuana during pregnancy increased in Washington State after legalization,42 and is on the rise nationally.29 Marijuana has potentially serious

30 TODAY'S CHRISTIAN DOCTORâ&#x20AC;&#x201A; â&#x20AC;&#x201A; Winter 2019

effects on the developing fetus.29,30,33 A recent study documented that prenatal THC exposure adversely affects infant neurobehavior and child development up through the teen years,32 but other researchers feel data is lacking to draw conclusions about long-term effects.1 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.1 e. Teen use: Heavy marijuana use may 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.48,49 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 abstinence from cannabis use.1,50,51 More limited associations exist between cannabis use and impaired academic achievement and outcomes, higher unemployment, lower income, and impaired social functioning.1 Neurocognitive effects also include a decline in IQ, memory problems, and attentional impairments.50,51 g. M ental health: There is substantial evidence of statistical association between cannabis use and the development of schizophrenia and other psychoses,49 with greater risk occurring among more frequent users.1 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.1 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.2 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.2 A 2015 study suggests that “30 percent of those who use marijuana may have some degree of marijuana use disorder.”2 Marijuana use disorder is frequently “associated with dependence—in which a person feels withdrawal symptoms when not taking the drug.”2 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.2 In 2015 roughly 4 million people in the US were found to have a marijuana use disorder, and 138,000 sought treatment.2 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.4 Although modulation of smoking technique may partially blunt the effect of use of high potency cannabis,46 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.1,58 j. Delivery method: Smoked substances contain 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, 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

E. LEGAL

When recreational marijuana is legally allowed, the state has usually agreed to decriminalize,60rather than criminal offense. The offender usually must pay a fine and sometimes is required to take a class on drug abuse. After multiple civil infractions, some states make possession a criminal offense. (Hill KP. Marijuana : The Unbiased Truth About the World&apos;s Most Popular Weed. Center City, Minnesota: Hazelden Publishing; 2015. legalize, and regulate the sale of marijuana. In most states, this means that a limited amount of marijuana (intended for personal use) can be purchased at a regulated dispensary by anyone who is 21 years or older with valid government-issued identification. A common limit to the amount of marijuana that can be purchased in states that have legalized marijuana is one ounce.61 This “small” amount of marijuana is actually enough to make over 50 “joints” and represents an amount a dealer may carry.62,63 As of late 2018, the District of Columbia and ten states have approved recreational marijuana (see Table below) although the United States 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

F. CMDA RECOMMENDATIONS FOR THE CHRISTIAN HEALTHCARE PROFESSIONAL

1. Because of the health hazards and social ramifications of recreational marijuana use, CMDA does not support its legalization. 2. Because of the adverse health ramifications of marijuana use, and to provide a role model for the community that respects the Biblical principles in section B, healthcare professionals should abstain from using recreational marijuana. They should strongly advise their patients against the use of recreational marijuana, especially minors and pregnant women, due to potential harmful effects.

G. CMDA RECOMMENDATIONS FOR THE CHRISTIAN COMMUNITY

1. Because of the health hazards and social ramifications of recreational marijuana use, CMDA does not support its legalization. 2. Because of the adverse health ramifications of marijuana use, and to provide a role model for the community that respects the Biblical principles in section B, Christians should abstain from using recreational marijuana. Approved by the Board of Trustees – February 20, 2019 Table: State Recreational Marijuana Laws

States Legalizing Recreational Marijuana

Year passed

Year Medical Marijuana Legalized

Alaska

2014

1998

California

2016

2000

Colorado

2012 (Retail stores open 2014)

2000

District of Columbia

2014

1998

Maine

2016 (Moratorium on implementing retail sales until 2018)

1999

Massachusetts

2016

2012

Michigan

2018

2008

Nevada

2016

2000

Oregon

2014

1998

Vermont

2018 (limited—no legal production or sales; only allows possession of up to 1 oz. Public consumption illegal)

2004

Washington

2012

1998

(adapted from: http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx and http://www.ncsl.org/research/civil-and-criminal-justice/marijuana-overview.aspx)

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REFERENCES AND ENDNOTES

1. 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. 2. National Institute on Drug Abuse. Marijuana. June 2018. https:// d14rmgtrwzf5a.cloudfront.net/sites/default/files/1380-marijuana.pdf. 3. Cort B. Weed, Inc. : The Truth About THC, The Pot Lobby, and the Commercial Marijuana Industry. Deerfield Beach, Florida: Health Communications, Inc.; 2017. 4. European Monitoring Centre for Drugs and Drug Addiction. Netherlands Country Drug Report 2017. Luxembourg: Publications Office of the European Union; 2017. 5. Genesis 1:28 6. Genesis 3 7. Matthew 22:36-40 8. 1 Cor. 6:12 9. Deut. 20:3 10. Mark 12:29-30 11. Galatians 5:19-21; 1 Timothy 3:3; Titus 1:7; Eph. 5:18 12. Opioids also may cause an altered state of mind, but relief of severe pain may still dictate their prescription for short term use. Studies are equivocal on marijuana use and pain; the discussion here is apropos to recreational use, not medical use. 13. Romans 13 14. Daniel 3 15. Hebrews 13:17 and James 3:1 16. 1 Timothy 4:12 17. Genesis 1:28 18. Carah JK, Howard JK, Thompson SE, et al. High Time for Conservation: Adding the Environment to the Debate on Marijuana Liberalization. Bioscience 2015; 65(8): 822-9. 19. Ingold J. Colorado Marijuana Guide: 64 of your questions answered. Denver Post. Dec. 31, 2013; updated Feb. 16, 2016. https://www.thecannabist. co/2013/12/31/colorado-marijuana-guide-64-answers-commonly-askedquestions/1673/. 20. Migoya D, Baca R. Denver’s pot businesses mostly in low-income, minority neighborhoods. The Denver Post. orig. pub. Jan. 2, 2016 updated Jan. 23, 2017. 21. Smart Approaches to Marijuana. Lessons Learned From Marijuana Legalization, 2018. https://learnaboutsam.org/wp-content/uploads/2018/07/ SAM-Lessons-Learned-From-Marijuana-Legalization-Digital-1.pdf. 22. Migoya D. Exclusive: Traffic fatalities linked to marijuana are up sharply in Colorado. Is legalization to blame? The Denver Post. Orig. pub. Aug. 25, 2017 Updated Dec. 28, 2018. 23. Colorado Department of Transportation. Drugged Driving Statistics: Cannabis-Involved Fatalities in Colorado. https://www.codot.gov/safety/ alcohol-and-impaired-driving/druggeddriving/safety/alcohol-and-impaireddriving/druggeddriving/statistics (accessed Jan. 9 2019). 24. National Conference of State Legislatures. State Medical Marijuana Laws. 1/23/2019. http://www.ncsl.org/research/health/state-medical-marijuanalaws.aspx (accessed Feb. 3 2019). 25. Hasin DS, Sarvet AL, Cerda M, et al. US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws 1991-1992 to 20122013. JAMA Psychiatry 2017; 74(6): 579-88. 26. 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. 27. Hatch A. Researchers Tracking Public Health Impacts of Marijuana Legalization. April 14, 2017. https://nursing.wsu.edu/2017/04/14/13255/ (accessed Feb. 10 2019). 28. Dickson B, Mansfield C, Guiahi M, et al. Recommendations From Cannabis Dispensaries About First-Trimester Cannabis Use. Obstetrics & Gynecology 2018; 131(6): 1031-8. 29. 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-.

32 TODAY'S CHRISTIAN DOCTOR Winter 2019

30. 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. 31. Huizink AC. Prenatal cannabis exposure and infant outcomes: overview of studies. Prog Neuropsychopharmacol Biol Psychiatry 2014; 52: 45-52. 32. 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. 33. Volkow ND, Compton WM, Wargo EM. The Risks of Marijuana Use During Pregnancy. JAMA 2017; 317(2): 129-30. 34. Cavazos-Rehg PA, Krauss MJ, Cahn E, et al. Marijuana Promotion Online: an Investigation of Dispensary Practices. Prev Sci 2018. 35. 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. 36. National Institute on Drug Abuse. What is medical marijuana? June 2018 June 2018. https://www.drugabuse.gov/publications/drugfacts/marijuanamedicine (accessed February 5 2019). 37. 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. 38. Caputi TL, Sabet KA. Population-level analyses cannot tell us anything about individual-level marijuana-opioid substitution. American Journal of Public Health 2018; 108(3): e12-e. 39. Livingston MD, Barnett TE, Delcher C, Wagenaar AC. Recreational Cannabis Legalization and Opioid-Related Deaths in Colorado, 20002015. American Journal of Public Health 2017; 107(11): 1827-9. 40. Liang D, Bao Y, Wallace M, Grant I, Shi Y. Medical cannabis legalization and opioid prescriptions: evidence on US Medicaid enrollees during 19932014. Addiction 2018; 113(11): 2060-70. 41. Bhashyam AR, Heng M, Harris MB, Vrahas MS, Weaver MJ. SelfReported Marijuana Use Is Associated with Increased Use of Prescription Opioids Following Traumatic Musculoskeletal Injury. J Bone Joint Surg Am 2018; 100(24): 2095-102. 42. 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. 43. 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. 44. Centennial Institute. Economic and Social Costs of Legalized Marijuana: Colorado Christian University, 2018. 45. Marijuana requires more water for growth than many other plants. It takes about 22 liters of water a day per marijuana plant in northern CA. (Carah JK, Howard JK, Thompson SE, et al. High Time for Conservation: Adding the Environment to the Debate on Marijuana Liberalization. Bioscience 2015; 65(8): 822-9.) Another estimate for marijuana is 900 gallons of water per plant per season (https://www.marijuanaventure.com/report-on-waterusage/). Using estimates of 22,000 corn plants/acre, a yield of 130 bushels/ acre, water requirements of 3000 gallons per bushel, and a growing season of 60 days (estimates to err on the side of the highest water needs per plant), a corn plant does not require more than18 gallons of water per plant per season, or 1 liter per day. An average adult requires about 2.5 liters of water per day. 46. 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. 47. Tashkin DP. Marijuana and Lung Disease. CHEST 2018; 154(3): 653-63. 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. Malone DT, Hill MN, Rubino T. Adolescent cannabis use and psychosis: epidemiology and neurodevelopmental models. British Journal of Pharmacology 2010; 160(3): 511-22. 50. 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. 51. 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. 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 Meta-Analysis. 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. Twenty-two states and the District of Columbia have decriminalized small amounts of marijuana. (National Conference of State Legislatures. Marijuana Overview. Dec. 14, 2018. http://www.ncsl.org/research/civiland-criminal-justice/marijuana-overview.aspx (accessed Feb. 10 2019).) This makes possession of a small amount of marijuana (usually an ounce) a civil, rather than criminal offense. The offender usually must pay a fine and sometimes is required to take a class on drug abuse. After multiple civil infractions, some states make possession a criminal offense. (Hill KP. Marijuana : The Unbiased Truth About the World’s Most Popular Weed. Center City, Minnesota: Hazelden Publishing; 2015.) 61. Recreational Marijuana Laws by State--Updated. https://usaweed.org/ recreational-marijuana-laws-state/Feb. 12, 2019). 62. Hill KP. Marijuana : The Unbiased Truth About the World’s Most Popular Weed. Center City, Minnesota: Hazelden Publishing; 2015. 63. For more information on pros and cons of decriminalization, see: Hill KP. Marijuana : The Unbiased Truth About the World’s Most Popular Weed. Center City, Minnesota: Hazelden Publishing; 2015. 64. DEA. Drug Scheduling. https://www.dea.gov/drug-scheduling (accessed Jan. 4, 2019 2019).

EARN CONTINUING EDUCATION

2 HOURS NOW AVAILABLE We are now offering continuing education credits through Today’s Christian Doctor. Two 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/2019RecMarijuanaStatement. • This CE activity is complimentary for CMDA members. • The fee for non-CMDA members is $100.00. 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: October 15, 2019 Original Release Date: November 25, 2019 Termination Date: November 24, 2022

EDUCATIONAL OBJECTIVES • Define recreational marijuana. • Describe the biology, chemistry, societal, legal and medical issues surrounding recreational marijuana. • Discuss the prevailing myths about recreational marijuana. • Identify evidence-based statements on the possible health benefits and complications of using recreational marijuana. • Teach family members, patients and community about recreational marijuana by giving clear guidelines, warnings and recommendations. • Discuss how biblical principles speak into recreational 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 2 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

NURSE PRACTITIONER The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines. Nurse practitioners may receive up to 2 credits for completing this activity.

PHYSICIAN ASSISTANT AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit(s)™. by an organization accredited by the ACCME or a recognized state medical society. Physician assistants may receive up to 2 credits for completing this 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. 2 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. James Avery, MD; Stan Cobb, DDS; Chris Hook, MD; Mandi Mooney, CMDA Today’s Christian Doctor Editor; 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.

DENTAL Associate Dentist — Great opportunity available! Fox Valley Area, Illinois Christian dentist seeks associate dentist leading into partnership. Top rated schools and places to live in Illinois minutes from office. ArtisticSmileDoctor.com. Interested candidates, email us at Alias3637@gmail.com. Associate Dentist — We are a Southwest Suburban Chicago oral surgery practice seeking an associate. The office is looking for a doctor that exemplifies the core values and culture that characterize the practice including compassion, kindness, generosity and integrity. Join an exciting, updated and established practice performing a diverse scope of surgery. We are located 18 miles from Downtown Chicago in a community offering an amazing quality of life. Partnership opportunity available. Organization: Midwest Oral and Maxillofacial Surgery. Website: www.midwestomspalos.com. Contact: nickcudney@gmail.com.

MEDICAL

General Dermatologist — Atlanta North Dermatology is seeking a board certified/ board eligible Mohs surgeon and general dermatologist with excellent academic credentials and high personal character to join our multi-provider established office in Woodstock, Georgia. Dermatologists who are still doing their residency and fellowship training, as well as dermatologists who are currently in practice with experience, are encouraged to apply and will be strongly considered. Our ideal candidate for this position should have the desire and ability to promote patient, physician and staff satisfaction. Send CV to denise.sharp@ atlantanorthdermatology.com. OB/Gyn — Baptist Health is assisting Central Alabama Women’s Care (CAWC) to recruit additional OB/Gyn physicians to join their practice. This two-location practice has five highly experienced, caring, compassionate physicians. CAWC provides expert and courteous healthcare for women. Qualified candidates will be board certified/ eligible in obstetrics and gynecology. This opportunity offers access to the latest robotic technology. Contact PhysicianRecruitment@ baptistfirst.org for more information. OB/Gyn — Baptist Health is assisting OBGYN Associates of Montgomery, Alabama to recruit an additional OB/GYN physician to join their practice. This practice of seven physicians plus two part-time physicians and a laborist has been providing women’s healthcare for over 28 years and are proud to offer cutting edge obstetrical and gynecological care for all phases of life. The ideal candidate will be kind, compassionate and well-trained as well as board certified/board eligible in obstetrics and gynecology. Opportunity offers access to the latest robotic technology. Contact PhysicianRecruitment@baptistfirst.org for more information.

Family Medicine — Faculty Opportunity - Montgomery Family Medicine Residency Program is seeking a board certified family

Pediatrician — Baptist Health is seeking qualified board certified/eligible pediatricians for community practices.

34 TODAY'S CHRISTIAN DOCTOR Winter 2019

Pediatrician — Seeking a pediatrician for a group practice in Montgomery, Alabama. A busy general pediatrics group of four doctors looking for a full-time pediatrician to replace a retiring physician in Montgomery, Alabama. Four-day work week, attractive call, three hours from the beaches and solid patient base. Practice was established 37 years ago. All pediatricians are believers and are seeking a likeminded partner. Contact Den Trumbull at TrumbullD3@gmail.com or 334-273-9700.

YOUR COMPLETE SOURCE FOR MEDICAL MISSIONS

WE PROVIDE: • PRODUCTS FOR OVERSEAS & US MEDICAL MISSIONS • THE ABILIT Y TO CUSTOMIZE ORDERS • 30 YEARS OF E XPERIENCE FREE SHIPPING AVAILABLE

For more information or to place an order go to:

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HEALING THE HURTING, BUILDING HEALTHY COMMUNITIES, AND TRANSFORMING LIVES SINCE 1981

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Disciple-making Physicians — Do you long to see God work through your medical practice? We are the largest vasectomy reversal practice in the U.S. We plant God’s field for new birth in body and spirit. We train physicians spiritually and medically. If you proficiently enjoy simple skin suturing; if you want to make disciple-making disciples of Jesus among your patients; and if God is calling you to this work, we can train you in this medical ministry to fulfill the Great Commission. Come join us at our Warwick, Rhode Island location. We are also eager to talk with medical students about future clinic locations. Contact drdavid@thereversalclinic.com.

Compensation and benefits vary with each opportunity. Benefits include relocation assistance and future partnership opportunities. This is a chance to interview with well-established and respected practices with their own unique style. Contact PhysicianRecruitment@baptistfirst. org for more information.

MEDICINES FOR MISSIONS

Breast Medical Oncologist — We are a free-standing office located in beautiful Western North Carolina. We are surrounded by the Blue Ridge and Great Smoky Mountains and are close to the Biltmore Estate as well as DuPont State Park. Many wonderful activities can be found in our area. We are looking for a part-time breast medical oncologist to work two to three days a week in our Asheville office. If you are board certified and licensed in North Carolina and would love to be in the beautiful mountains of Western North Carolina, please contact us at jazraprovidenceimg@gmail.com and include your CV.

medicine physician to join the faculty. This growing, fully accredited, 8-8-8 communitybased program prefers candidates have at least two to three years of experience in officebased practice, be skilled in hospital and ICU medicine, and be very well versed in all forms of information technology. Typical duties of a faculty member include hospital and ICU medicine, private practice duties, precepting, lecturing, scholarly activities and curriculum management. This position offers a competitive academic salary with a production bonus, as well as relocation assistance. EOE. Contact PhysicianRecruitment@baptistfirst.org for more information.

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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CONTINUING EDUCATION CREDITS AVAILABLE INSIDE

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Continuing Education for CMDA Members

Through CMDAâ&#x20AC;&#x2122;s Department of Continuing Education, CMDA members can now earn free continuing education credits.

CMDA Live Events CMDA Online Courses CMDA Journal Articles For more information, visit www.cmda.org/ce.