Cannabis Myths vs Reality

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Cannabis Myths vs Reality

We asked you for your (health-related) opinion on cannabis use—specifically, the kind with psychoactive THC, not just CBD. We got the above-pictured, below-described, spread of responses:

  • A little over a third of you voted for “It’s a great way to relax, without most of the dangers of alcohol”.
  • A little under a third of you voted for “It may have some medical uses, but recreational use is best avoided”.
  • About a quarter of you voted for “The negative health effects outweigh the possible benefits”
  • Three of you voted for “It is the gateway to a life of drug-induced stupor and potentially worse”

So, what does the science say?

A quick legal note first: we’re a health science publication, and are writing from that perspective. We do not know your location, much less your local laws and regulations, and so cannot comment on such. Please check your own local laws and regulations in that regard.

Cannabis use can cause serious health problems: True or False?

True. Whether the risks outweigh the benefits is a personal and subjective matter (for example, a person using it to mitigate the pain of late stage cancer is probably unconcerned with many other potential risks), but what’s objectively true is that it can cause serious health problems.

One subscriber who voted for “The negative health effects outweigh the possible benefits” wrote:

❝At a bare minimum, you are ingesting SMOKE into your lungs!! Everyone SEEMS TO BE against smoking cigarettes, but cannabis smoking is OK?? Lung cancer comes in many forms.❞

Of course, that is assuming smoking cannabis, and not consuming it as an edible. But, what does the science say on smoking it, and lung cancer?

There’s a lot less research about this when it comes to cannabis, compared to tobacco. But, there is some:

❝Results from our pooled analyses provide little evidence for an increased risk of lung cancer among habitual or long-term cannabis smokers, although the possibility of potential adverse effect for heavy consumption cannot be excluded.❞

Read: Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium

Another study agreed there appears to be no association with lung cancer, but that there are other lung diseases to consider, such as bronchitis and COPD:

❝Smoking cannabis is associated with symptoms of chronic bronchitis, and there may be a modest association with the development of chronic obstructive pulmonary disease. Current evidence does not suggest an association with lung cancer.❞

Read: Cannabis Use, Lung Cancer, and Related Issues

Cannabis edibles are much safer than smoking cannabis: True or False?

Broadly True, with an important caveat.

One subscriber who selected “It may have some medical uses, but recreational use is best avoided”, wrote:

❝I’ve been taking cannabis gummies for fibromyalgia. I don’t know if they’re helping but they’re not doing any harm. You cannot overdose you don’t become addicted.❞

Firstly, of course consuming edibles (rather than inhaling cannabis) eliminates the smoke-related risk factors we discussed above. However, other risks remain, including the much greater ease of accidentally overdosing.

❝Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected.❞

Note: that “more frequent” for inhaled cannabis, is because more people inhale it than eat it. If we adjust the numbers to control for how much less often people eat it, suddenly we see that the numbers of hospital admissions are disproportionately high for edibles, compared to inhaled cannabis.

Or, as the study author put it:

❝There are more adverse drug events associated on a milligram per milligram basis of THC when it comes in form of edibles versus an inhaled cannabis. If 1,000 people smoked pot and 1,000 people at the same dose in an edible, then more people would have more adverse drug events from edible cannabis.❞

See the numbers: Acute Illness Associated With Cannabis Use, by Route of Exposure

Why does this happen?

  • It’s often because edibles take longer to take effect, so someone thinks “this isn’t very strong” and has more.
  • It’s also sometimes because someone errantly eats someone else’s edibles, not realising what they are.
  • It’s sometimes a combination of the above problems: a person who is now high, may simply forget and/or make a bad decision when it comes to eating more.

On the other hand, that doesn’t mean inhaling it is necessarily safer. As well as the pulmonary issues we discussed previously, inhaling cannabis has a higher risk of cannabinoid hyperemesis syndrome (and the resultant cyclic vomiting that’s difficult to treat).

You can read about this fascinating condition that’s sometimes informally called “scromiting”, a portmanteau of screaming and vomiting:

Cannabinoid Hyperemesis Syndrome

You can’t get addicted to cannabis: True or False?

False. However, it is fair to say that the likelihood of developing a substance abuse disorder is lower than for alcohol, and much lower than for nicotine.

See: Prevalence of Marijuana Use Disorders in the United States Between 2001–2002 and 2012–2013

If you prefer just the stats without the science, here’s the CDC’s rendering of that:

Addiction (Marijuana or Cannabis Use Disorder)

However, there is an interesting complicating factor, which is age. One is 4–7 times more likely to develop a substance abuse disorder, if one starts use as an adolescent, rather than later in life:

See: Likelihood of developing an alcohol and cannabis use disorder during youth: Association with recent use and age

Cannabis is the gateway to use of more dangerous drugs: True or False?

False, generally speaking. Of course, for any population there will be some outliers, but there appears to be no meaningful causal relation between cannabis use and other substance use:

Is marijuana really a gateway drug? A nationally representative test of the marijuana gateway hypothesis using a propensity score matching design

Interestingly, the strongest association (where any existed at all) was between cannabis use and opioid use. However, rather than this being a matter of cannabis use being a gateway to opioid use, it seems more likely that this is a matter of people looking to both for the same purpose: pain relief.

As a result, growing accessibility of cannabis may actually reduce opioid problems:

Some final words…

Cannabis is a complex drug with complex mechanisms and complex health considerations, and research is mostly quite young, due to its historic illegality seriously cramping science by reducing sample sizes to negligible. Simply put, there’s a lot we still don’t know.

Also, we covered some important topics today, but there were others we didn’t have time to cover, such as the other potential psychological benefits—and risks. Likely we’ll revisit those another day.

Lastly, while we’ve covered a bunch of risks today, those of you who said it has fewer and lesser risks than alcohol are quite right—the only reason we couldn’t focus on that more, is because to talk about all the risks of alcohol would make this feature many times longer!

Meanwhile, whether you partake or not, stay safe and stay well.

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  • California Is Investing $500M in Therapy Apps for Youth. Advocates Fear It Won’t Pay Off.

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    With little pomp, California launched two apps at the start of the year offering free behavioral health services to youths to help them cope with everything from living with anxiety to body acceptance.

    Through their phones, young people and some caregivers can meet BrightLife Kids and Soluna coaches, some who specialize in peer support or substance use disorders, for roughly 30-minute virtual counseling sessions that are best suited to those with more mild needs, typically those without a clinical diagnosis. The apps also feature self-directed activities, such as white noise sessions, guided breathing, and videos of ocean waves to help users relax.

    “We believe they’re going to have not just great impact, but wide impact across California, especially in places where maybe it’s not so easy to find an in-person behavioral health visit or the kind of coaching and supports that parents and young people need,” said Gov. Gavin Newsom’s health secretary, Mark Ghaly, during the Jan. 16 announcement.

    The apps represent one of the Democratic governor’s major forays into health technology and come with four-year contracts valued at $498 million. California is believed to be the first state to offer a mental health app with free coaching to all young residents, according to the Department of Health Care Services, which operates the program.

    However, the rollout has been slow. Only about 15,000 of the state’s 12.6 million children and young adults have signed up for the apps, school counselors say they’ve never heard of them, and one of the companies isn’t making its app available on Android phones until summer.

    Advocates for youth question the wisdom of investing taxpayer dollars in two private companies. Social workers are concerned the companies’ coaches won’t properly identify youths who need referrals for clinical care. And the spending is drawing lawmaker scrutiny amid a state deficit pegged at as much as $73 billion.

    An App for That

    Newsom’s administration says the apps fill a need for young Californians and their families to access professional telehealth for free, in multiple languages, and outside of standard 9-to-5 hours. It’s part of Newsom’s sweeping $4.7 billion master plan for kids’ mental health, which was introduced in 2022 to increase access to mental health and substance use support services. In addition to launching virtual tools such as the teletherapy apps, the initiative is working to expand workforce capacity, especially in underserved areas.

    “The reality is that we are rarely 6 feet away from our devices,” said Sohil Sud, director of Newsom’s Children and Youth Behavioral Health Initiative. “The question is how we can leverage technology as a resource for all California youth and families, not in place of, but in addition to, other behavioral health services that are being developed and expanded.”

    The virtual platforms come amid rising depression and suicide rates among youth and a shortage of mental health providers. Nearly half of California youths from the ages of 12 to 17 report having recently struggled with mental health issues, with nearly a third experiencing serious psychological distress, according to a 2021 study by the UCLA Center for Health Policy Research. These rates are even higher for multiracial youths and those from low-income families.

    But those supporting youth mental health at the local level question whether the apps will move the needle on climbing depression and suicide rates.

    “It’s fair to applaud the state of California for aggressively seeking new tools,” said Alex Briscoe of California Children’s Trust, a statewide initiative that, along with more than 100 local partners, works to improve the social and emotional health of children. “We just don’t see it as fundamental. And we don’t believe the youth mental health crisis will be solved by technology projects built by a professional class who don’t share the lived experience of marginalized communities.”

    The apps, BrightLife Kids and Soluna, are operated by two companies: Brightline, a 5-year-old venture capital-backed startup; and Kooth, a London-based publicly traded company that has experience in the U.K. and has also signed on some schools in Kentucky and Pennsylvania and a health plan in Illinois. In the first five months of Kooth’s Pennsylvania pilot, 6% of students who had access to the app signed up.

    Brightline and Kooth represent a growing number of health tech firms seeking to profit in this space. They beat out dozens of other bidders including international consulting companies and other youth telehealth platforms that had already snapped up contracts in California.

    Although the service is intended to be free with no insurance requirement, Brightline’s app, BrightLife Kids, is folded into and only accessible through the company’s main app, which asks for insurance information and directs users to paid licensed counseling options alongside the free coaching. After KFF Health News questioned why the free coaching was advertised below paid options, Brightline reordered the page so that, even if a child has high-acuity needs, free coaching shows up first.

    The apps take an expansive view of behavioral health, making the tools available to all California youth under age 26 as well as caregivers of babies, toddlers, and children 12 and under. When KFF Health News asked to speak with an app user, Brightline connected a reporter with a mother whose 3-year-old daughter was learning to sleep on her own.

    ‘It’s Like Crickets’

    Despite being months into the launch and having millions in marketing funds, the companies don’t have a definitive rollout timeline. Brightline said it hopes to have deployed teams across the state to present the tools in person by midyear. Kooth said developing a strategy to hit every school would be “the main focus for this calendar year.”

    “It’s a big state — 58 counties,” Bob McCullough of Kooth said. “It’ll take us a while to get to all of them.”

    So far BrightLife Kids is available only on Apple phones. Brightline said it’s aiming to launch the Android version over the summer.

    “Nobody’s really done anything like this at this magnitude, I think, in the U.S. before,” said Naomi Allen, a co-founder and the CEO of Brightline. “We’re very much in the early innings. We’re already learning a lot.”

    The contracts, obtained by KFF Health News through a records request, show the companies operating the two apps could earn as much as $498 million through the contract term, which ends in June 2027, months after Newsom is set to leave office. And the state is spending hundreds of millions more on Newsom’s virtual behavioral health strategy. The state said it aims to make the apps available long-term, depending on usage.

    The state said 15,000 people signed up in the first three months. When KFF Health News asked how many of those users actively engaged with the app, it declined to say, noting that data would be released this summer.

    KFF Health News reached out to nearly a dozen California mental health professionals and youths. None of them were aware of the apps.

    “I’m not hearing anything,” said Loretta Whitson, executive director of the California Association of School Counselors. “It’s like crickets.”

    Whitson said she doesn’t think the apps are on “anyone’s” radar in schools, and she doesn’t know of any schools that are actively advertising them. Brightline will be presenting its tool to the counselor association in May, but Whitson said the company didn’t reach out to plan the meeting; she did.

    Concern Over Referrals

    Whitson isn’t comfortable promoting the apps just yet. Although both companies said they have a clinical team on staff to assist, Whitson said she’s concerned that the coaches, who aren’t all licensed therapists, won’t have the training to detect when users need more help and refer them to clinical care.

    This sentiment was echoed by other school-based social workers, who also noted the apps’ duplicative nature — in some counties, like Los Angeles, youths can access free virtual counseling sessions through Hazel Health, a for-profit company. Nonprofits, too, have entered this space. For example, Teen Line, a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental Health Services, is free nationwide.

    While the state is also funneling money to the schools as part of Newsom’s master plan, students and school-based mental health professionals voiced confusion at the large app investment when, in many school districts, few in-person counseling roles exist, and in some cases are dwindling.

    Kelly Merchant, a student at College of the Desert in Palm Desert, noted that it can be hard to access in-person therapy at her school. She believes the community college, which has about 15,000 students, has only one full-time counselor and one part-time bilingual counselor. She and several students interviewed by KFF Health News said they appreciated having engaging content on their phone and the ability to speak to a coach, but all said they’d prefer in-person therapy.

    “There are a lot of people who are seeking therapy, and people close to me that I know. But their insurances are taking forever, and they’re on the waitlist,” Merchant said. “And, like, you’re seeing all these people struggle.”

    Fiscal conservatives question whether the money could be spent more effectively, like to bolster county efforts and existing youth behavioral health programs.

    Republican state Sen. Roger Niello, vice chair of the Senate Budget and Fiscal Review Committee, noted that California is forecasted to face deficits for the next three years, and taxpayer watchdogs worry the apps might cost even more in the long run.

    “What starts as a small financial commitment can become uncontrollable expenses down the road,” said Susan Shelley of the Howard Jarvis Taxpayers Association.

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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  • Why We Remember – by Dr. Charan Ranganath

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    As we get older, forgetfulness can become more of a spectre; the threat that one day it could be less “where did I put my sunglasses?” and more “who is this person claiming to be my spouse?”.

    Dr. Ranganath explores in this work the science of memory, from a position of neurobiology, but also in application. How and why we remember, and how and why we forget, and how and why both are important.

    There is a practical element to the book too; we read about things that increase our tendency to remember (and things that increase our tendency to forget), and how we can leverage that information to curate our memory in an active, ongoing basis.

    The style of the book is quite casual in tone for such a serious topic, but there’s plenty of hard science too; indeed there are 74 pages of bibliography cited.

    Bottom line: while filled with a lot of science, this is also a very human book, and a helpful guide to building and preserving our memory.

    Click here to check out “Why We Remember”, and learn how to hold on to what matters the most!

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  • The Fast-Mimicking Diet

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Live, Fast, Live Long

    This is Dr. Valter Longo. He’s a biogerontologist and cell biologist, whose work has focused on fasting and nutrient response genes, and how we can leverage them against diseases and aging in general.

    We reviewed his book recently:

    The Longevity Diet: Discover The New Science To Slow Aging, Fight Disease, And Manage Your Weight – by Dr. Valter Longo

    What does he want us to know?

    What to eat

    Dr. Longo recommends a mostly plant-based diet (especially vegetables, whole grains, and legumes), but also having some fish. The bulk of our dietary fats, however, he says are best coming from olive oil and nuts.

    He also advises aiming for nutritional density of vitamins and minerals in our diet, and/but supplementing with a multivitamin once every few days to cover any gaps.

    If in doubt choosing between plant-based whole foods, he recommends that we choose those our ancestors will have eaten.

    Read more: Longevity Diet For Adults

    When to eat

    Dr. Longo recommends time-restricted eating within a 12-hour window per day.

    See also: Intermittent Fasting: We Sort The Science From The Hype

    However, he also recommends (additionally or separately; it’s up to us; additionally is better but the point is it still has excellent benefits separately too) his “fast-mimicking diet” (FMD), which involves eating according to what we said in “What to eat”, but restricting it to 750 kcal per day, 5 days in a row, but not necessarily 5 days per week.

    For example, the following was a 3-month study that involved doing this for only one 5-day cycle per month:

    ❝Three FMD cycles reduced body weight, trunk, and total body fat; lowered blood pressure; and decreased insulin-like growth factor 1 (IGF-1). No serious adverse effects were reported.

    A post hoc analysis of subjects from both FMD arms showed that body mass index, blood pressure, fasting glucose, IGF-1, triglycerides, total and low-density lipoprotein cholesterol, and C-reactive protein were more beneficially affected in participants at risk for disease than in subjects who were not at risk.

    Thus, cycles of a 5-day FMD are safe, feasible, and effective in reducing markers/risk factors for aging and age-related diseases.❞

    ~ Dr. Min Wei et al. ← Dr. Longo was

    Note: the introduction mentions FMD in mice, but this is just referencing previous studies. This study is about FMD in humans!

    Read in full: Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease

    Want to know more?

    You might like this (text-based) interview with Dr. Longo, with the Health Sciences Academy:

    Eat, fast and live longer? Interview with Professor Valter Longo

    Take care!

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  • Yes, blue light from your phone can harm your skin. A dermatologist explains

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Social media is full of claims that everyday habits can harm your skin. It’s also full of recommendations or advertisements for products that can protect you.

    Now social media has blue light from our devices in its sights.

    So can scrolling on our phones really damage your skin? And will applying creams or lotions help?

    Here’s what the evidence says and what we should really be focusing on.

    Max kegfire/Shutterstock

    Remind me, what actually is blue light?

    Blue light is part of the visible light spectrum. Sunlight is the strongest source. But our electronic devices – such as our phones, laptops and TVs – also emit it, albeit at levels 100-1,000 times lower.

    Seeing as we spend so much time using these devices, there has been some concern about the impact of blue light on our health, including on our eyes and sleep.

    Now, we’re learning more about the impact of blue light on our skin.

    How does blue light affect the skin?

    The evidence for blue light’s impact on skin is still emerging. But there are some interesting findings.

    1. Blue light can increase pigmentation

    Studies suggest exposure to blue light can stimulate production of melanin, the natural skin pigment that gives skin its colour.

    So too much blue light can potentially worsen hyperpigmentation – overproduction of melanin leading to dark spots on the skin – especially in people with darker skin.

    Woman with skin pigmentation on cheek
    Blue light can worsen dark spots on the skin caused by overproduction of melanin. DUANGJAN J/Shutterstock

    2. Blue light can give you wrinkles

    Some research suggests blue light might damage collagen, a protein essential for skin structure, potentially accelerating the formation of wrinkles.

    A laboratory study suggests this can happen if you hold your device one centimetre from your skin for as little as an hour.

    However, for most people, if you hold your device more than 10cm away from your skin, that would reduce your exposure 100-fold. So this is much less likely to be significant.

    3. Blue light can disrupt your sleep, affecting your skin

    If the skin around your eyes looks dull or puffy, it’s easy to blame this directly on blue light. But as we know blue light affects sleep, what you’re probably seeing are some of the visible signs of sleep deprivation.

    We know blue light is particularly good at suppressing production of melatonin. This natural hormone normally signals to our bodies when it’s time for sleep and helps regulate our sleep-wake cycle.

    By suppressing melatonin, blue light exposure before bed disrupts this natural process, making it harder to fall asleep and potentially reducing the quality of your sleep.

    The stimulating nature of screen content further disrupts sleep. Social media feeds, news articles, video games, or even work emails can keep our brains active and alert, hindering the transition into a sleep state.

    Long-term sleep problems can also worsen existing skin conditions, such as acne, eczema and rosacea.

    Sleep deprivation can elevate cortisol levels, a stress hormone that breaks down collagen, the protein responsible for skin’s firmness. Lack of sleep can also weaken the skin’s natural barrier, making it more susceptible to environmental damage and dryness.

    Can skincare protect me?

    The beauty industry has capitalised on concerns about blue light and offers a range of protective products such as mists, serums and lip glosses.

    From a practical perspective, probably only those with the more troublesome hyperpigmentation known as melasma need to be concerned about blue light from devices.

    This condition requires the skin to be well protected from all visible light at all times. The only products that are totally effective are those that block all light, namely mineral-based suncreens or some cosmetics. If you can’t see the skin through them they are going to be effective.

    But there is a lack of rigorous testing for non-opaque products outside laboratories. This makes it difficult to assess if they work and if it’s worth adding them to your skincare routine.

    What can I do to minimise blue light then?

    Here are some simple steps you can take to minimise your exposure to blue light, especially at night when it can disrupt your sleep:

    • use the “night mode” setting on your device or use a blue-light filter app to reduce your exposure to blue light in the evening
    • minimise screen time before bed and create a relaxing bedtime routine to avoid the types of sleep disturbances that can affect the health of your skin
    • hold your phone or device away from your skin to minimise exposure to blue light
    • use sunscreen. Mineral and physical sunscreens containing titanium dioxide and iron oxides offer broad protection, including from blue light.

    In a nutshell

    Blue light exposure has been linked with some skin concerns, particularly pigmentation for people with darker skin. However, research is ongoing.

    While skincare to protect against blue light shows promise, more testing is needed to determine if it works.

    For now, prioritise good sun protection with a broad-spectrum sunscreen, which not only protects against UV, but also light.

    Michael Freeman, Associate Professor of Dermatology, Bond University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    Don’t Forget…

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  • “You Just Need to Lose Weight” And 19 Other Myths About Fat People – by Aubrey Gordon

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve previously reviewed another book by this author, “What We Don’t Talk About When We Talk About Fat”, and this time, she’s doing some important mythbusting.

    The titular “you just need to lose weight” is a commonly-taken easy-out for many doctors, to avoid having to dispense actual treatment for an actual condition. Whether or not weight loss would help in a given situation is often immaterial; “kicking the can down the road” is the goal.

    Most of the book is divided into 20 chapters, each of them devoted to debunking one myth. Think of it like 10almonds’ “Mythbusting Friday” edition (indeed, we did one about obesity), but with an entire book, and as much room as she needs to provide much more detail than we can ever get into in a single article.

    And far from being a mere polemic, she does indeed provide that detail—this is clearly a very well-researched book, above and beyond the author’s own personal experience. Further, all the key points are illustrated and articulated clearly, making the book’s ideas very comprehensible.

    The style is pop-science, but with frequent bibliographical references for relevant sources.

    Bottom line: for some readers, this book will come as a great validation; for others, it may be eye-opening. Either way, it’s a very worthwhile read.

    Click here to check out “You Just Need to Lose Weight” And 19 Other Myths About Fat People, and get those myths cleared out!

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  • How old’s too old to be a doctor? Why GPs and surgeons over 70 may need a health check to practise

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    A growing number of complaints against older doctors has prompted the Medical Board of Australia to announce today that it’s reviewing how doctors aged 70 or older are regulated. Two new options are on the table.

    The first would require doctors over 70 to undergo a detailed health assessment to determine their current and future “fitness to practise” in their particular area of medicine.

    The second would require only general health checks for doctors over 70.

    A third option acknowledges existing rules requiring doctors to maintain their health and competence. As part of their professional code of conduct, doctors must seek independent medical and psychological care to prevent harming themselves and their patients. So, this third option would maintain the status quo.

    PeopleImages.com – Yuri A/Shutterstock

    Haven’t we moved on from set retirement ages?

    It might be surprising that stricter oversight of older doctors’ performance is proposed now. Critics of mandatory retirement ages in other fields – for judges, for instance – have long questioned whether these rules are “still valid in a modern society”.

    However, unlike judges, doctors are already required to renew their registration annually to practise. This allows the Medical Board of Australia not only to access sound data about the prevalence and activity of older practitioners, but to assess their eligibility regularly and to conduct performance assessments if and when they are needed.

    What has prompted these proposals?

    This latest proposal identifies several emerging concerns about older doctors. These are grounded in external research about the effect of age on doctors’ competence as well as the regulator’s internal data showing surges of complaints about older doctors in recent years.

    Studies of medical competence in ageing doctors show variable results. However, the Medical Board of Australia’s consultation document emphasises studies of neurocognitive loss. It explains how physical and cognitive impairment can lead to poor record-keeping, improper prescribing, as well as disruptive behaviour.

    The other issue is the number of patient complaints against older doctors. These “notifications” have surged in recent years, as have the number of disciplinary actions against older doctors.

    In 2022–2023, the Medical Board of Australia took disciplinary action against older doctors about 1.7 times more often than for doctors under 70.

    In 2023, notifications against doctors over 70 were 81% higher than for the under 70s. In that year, patients sent 485 notifications to the Medical Board of Australia about older doctors – up from 189 in 2015.

    While older doctors make up only about 5.3% of the doctor workforce in Australia (less than 1% over 80), this only makes the high numbers of complaints more starkly disproportionate.

    It’s for these reasons that the Medical Board of Australia has determined it should take further regulatory action to safeguard the health of patients.

    So what distinguishes the two new proposed options?

    The “fitness to practise” assessment option would entail a rigorous assessment of doctors over 70 based on their specialisation. It would be required every three years after the age of 70 and every year after 80.

    Surgeons, for example, would be assessed by an independent occupational physician for dexterity, sight and the ability to give clinical instructions.

    Importantly, the results of these assessments would usually be confidential between the assessor and the doctor. Only doctors who were found to pose a substantial risk to the public, which was not being managed, would be obliged to report their health condition to the Medical Board of Australia.

    The second option would be a more general health check not linked to the doctor’s specific role. It would occur at the same intervals as the “fitness to practise” assessment. However, its purpose would be merely to promote good health-care decision-making among health practitioners. There would be no general obligation on a doctor to report the results to the Medical Board of Australia.

    In practice, both of these proposals appear to allow doctors to manage their own general health confidentially.

    Surgeons operating in theatre
    Older surgeons could be independently assessed for dexterity, sight and the ability to give clinical instructions. worradirek/Shutterstock

    The law tends to prioritise patient safety

    All state versions of the legal regime regulating doctors, known as the National Accreditation and Registration Scheme, include a “paramountcy” provision. That provision basically says patient safety is paramount and trumps all other considerations.

    As with legal regimes regulating childcare, health practitioner regulation prioritises the health and safety of the person receiving the care over the rights of the licensed professional.

    Complicating this further, is the fact that a longstanding principle of health practitioner regulation has been that doctors should not be “punished” for errors in practice.

    All of this means that reforms of this nature can be difficult to introduce and that the balance between patient safety and professional entitlements must be handled with care.

    Could these proposals amount to age discrimination?

    It is premature to analyse the legal implications of these proposals. So it’s difficult to say how these proposals interact with Commonwealth age- and other anti-discrimination laws.

    For instance, one complication is that the federal age discrimination statute includes an exemption to allow “qualifying bodies” such as the Medical Board of Australia to discriminate against older professionals who are “unable to carry out the inherent requirements of the profession, trade or occupation because of his or her age”.

    In broader terms, a licence to practise medicine is often compared to a licence to drive or pilot an aircraft. Despite claims of discrimination, New South Wales law requires older drivers to undergo a medical assessment every year; and similar requirements affect older pilots and air traffic controllers.

    Where to from here?

    When changes are proposed to health practitioner regulation, there is typically much media attention followed by a consultation and behind-the-scenes negotiation process. This issue is no different.

    How will doctors respond to the proposed changes? It’s too soon to say. If the proposals are implemented, it’s possible some older doctors might retire rather than undergo these mandatory health assessments. Some may argue that encouraging more older doctors to retire is precisely the point of these proposals. However, others have suggested this would only exacerbate shortages in the health-care workforce.

    The proposals are open for public comment until October 4.

    Christopher Rudge, Law lecturer, University of Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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