New study suggests weight loss drugs like Ozempic could help with knee pain. Here’s why there may be a link
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.
The drug semaglutide, commonly known by the brand names Ozempic or Wegovy, was originally developed to help people with type 2 diabetes manage their blood sugar levels.
However, researchers have discovered it may help with other health issues, too. Clinical trials show semaglutide can be effective for weight loss, and hundreds of thousands of people around the world are using it for this purpose.
Evidence has also shown the drug can help manage heart failure and chronic kidney disease in people with obesity and type 2 diabetes.
Now, a study published in the New England Journal of Medicine has suggested semaglutide can improve knee pain in people with obesity and osteoarthritis. So what did this study find, and how could semaglutide and osteoarthritis pain be linked?
Osteoarthritis and obesity
Osteoarthritis is a common joint disease, affecting 2.1 million Australians. Most people with osteoarthritis have pain and find it difficult to perform common daily activities such as walking. The knee is the joint most commonly affected by osteoarthritis.
Being overweight or obese is a major risk factor for osteoarthritis in the knee. The link between the two conditions is complex. It involves a combination of increased load on the knee, metabolic factors such as high cholesterol and high blood sugar, and inflammation.
For example, elevated blood sugar levels increase the production of inflammatory molecules in the body, which can damage the cartilage in the knee, and lead to the development of osteoarthritis.
Weight loss is strongly recommended to reduce the pain of knee osteoarthritis in people who are overweight or obese. International and Australian guidelines suggest losing as little as 5% of body weight can help.
But losing weight with just diet and exercise can be difficult for many people. One study from the United Kingdom found the annual probability of people with obesity losing 5% or more of their body weight was less than one in ten.
Semaglutide has recently entered the market as a potential alternative route to weight loss. It comes from a class of drugs known as GLP-1 receptor agonists and works by increasing a person’s sense of fullness.
Semaglutide for osteoarthritis?
The rationale for the recent study was that while we know weight loss alleviates symptoms of knee osteoarthritis, the effect of GLP-1 receptor agonists was yet to be explored. So the researchers set out to understand what effect semaglutide might have on knee osteoarthritis pain, alongside body weight.
They randomly allocated 407 people with obesity and moderate osteoarthritis into one of two groups. One group received semaglutide once a week, while the other group received a placebo. Both groups were treated for 68 weeks and received counselling on diet and physical activity. At the end of the treatment phase, researchers measured changes in knee pain, function, and body weight.
As expected, those taking semaglutide lost more weight than those in the placebo group. People on semaglutide lost around 13% of their body weight on average, while those taking the placebo lost around 3% on average. More than 70% of people in the semaglutide group lost at least 10% of their body weight compared to just over 9% of people in the placebo group.
The study found semaglutide reduced knee pain significantly more than the placebo. Participants who took semaglutide reported an additional 14-point reduction in pain on a 0–100 scale compared to the placebo group.
This is much greater than the pain reduction in another recent study among people with obesity and knee osteoarthritis. This study investigated the effects of a diet and exercise program compared to an attention control (where participants are provided with information about nutrition and physical activity). The results here saw only a 3-point difference between the intervention group and the control group on the same scale.
The amount of pain relief reported in the semaglutide trial is also larger than that reported with commonly used pain medicines such as anti-inflammatories, opioids and antidepressants.
Semaglutide also improved knee function compared to the placebo. For example, people who took semaglutide could walk about 42 meters further than those on the placebo in a six-minute walking test.
How could semaglutide reduce knee pain?
It’s not fully clear how semaglutide helps with knee pain from osteoarthritis. One explanation may be that when a person loses weight, there’s less stress on the joints, which reduces pain.
But recent studies have also suggested semaglutide and other GLP-1 receptor agonists might have anti-inflammatory properties, and could even protect against cartilage wear and tear.
While the results of this new study are promising, it’s too soon to regard semaglutide as a “miracle drug” for knee osteoarthritis. And as this study was funded by the drug company that makes semaglutide, it will be important to have independent studies in the future, to confirm the findings, or not.
The study also had strict criteria, excluding some groups, such as those taking opioids for knee pain. One in seven Australians seeing a GP for their knee osteoarthritis are prescribed opioids. Most participants in the trial were white (61%) and women (82%). This means the study may not fully represent the average person with knee osteoarthritis and obesity.
It’s also important to consider semaglutide can have a range of side effects, including gastrointestinal symptoms and fatigue.
There are some concerns that semaglutide could reduce muscle mass and bone density, though we’re still learning more about this.
Further, it can be difficult to access.
I have knee osteoarthritis, what should I do?
Osteoarthritis is a disease caused by multiple factors, and it’s important to take a multifaceted approach to managing it. Weight loss is an important component for those who are overweight or obese, but so are other aspects of self-management. This might include physical activity, pacing strategies, and other positive lifestyle changes such as improving sleep, healthy eating, and so on.
Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney and Christina Abdel Shaheed, Associate Professor, School of Public Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Recommended
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
A new emergency procedure for cardiac arrests aims to save more lives – here’s how it works
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.
As of January this year, Aotearoa New Zealand became just the second country (after Canada) to adopt a groundbreaking new procedure for patients experiencing cardiac arrest.
Known as “double sequential external defibrillation” (DSED), it will change initial emergency response strategies and potentially improve survival rates for some patients.
Surviving cardiac arrest hinges crucially on effective resuscitation. When the heart is working normally, electrical pulses travel through its muscular walls creating regular, co-ordinated contractions.
But if normal electrical rhythms are disrupted, heartbeats can become unco-ordinated and ineffective, or cease entirely, leading to cardiac arrest.
Defibrillation is a cornerstone resuscitation method. It gives the heart a powerful electric shock to terminate the abnormal electrical activity. This allows the heart to re-establish its regular rhythm.
Its success hinges on the underlying dysfunctional heart rhythm and the proper positioning of the defibrillation pads that deliver the shock. The new procedure will provide a second option when standard positioning is not effective.
Using two defibrillators
During standard defibrillation, one pad is placed on the right side of the chest just below the collarbone. A second pad is placed below the left armpit. Shocks are given every two minutes.
Early defibrillation can dramatically improve the likelihood of surviving a cardiac arrest. However, around 20% of patients whose cardiac arrest is caused by “ventricular fibrillation” or “pulseless ventricular tachycardia” do not respond to the standard defibrillation approach. Both conditions are characterised by abnormal activity in the heart ventricles.
DSED is a novel method that provides rapid sequential shocks to the heart using two defibrillators. The pads are attached in two different locations: one on the front and side of the chest, the other on the front and back.
A single operator activates the defibrillators in sequence, with one hand moving from the first to the second. According to a recent randomised trial in Canada, this approach could more than double the chances of survival for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard shocks.
The second shock is thought to improve the chances of eliminating persistent abnormal electrical activity. It delivers more total energy to the heart, travelling along a different pathway closer to the heart’s left ventricle.
Evidence of success
New Zealand ambulance data from 2020 to 2023 identified about 1,390 people who could potentially benefit from novel defibrillation methods. This group has a current survival rate of only 14%.
Recognising the potential for DSED to dramatically improve survival for these patients, the National Ambulance Sector Clinical Working Group updated the clinical procedures and guidelines for emergency medical services personnel.
The guidelines now specify that if ventricular fibrillation or pulseless ventricular tachycardia persist after two shocks with standard defibrillation, the DSED method should be administered. Two defibrillators need to be available, and staff must be trained in the new approach.
Though the existing evidence for DSED is compelling, until recently it was based on theory and a small number of potentially biased observational studies. The Canadian trial was the first to directly compare DSED to standard treatment.
From a total of 261 patients, 30.4% treated with this strategy survived, compared to 13.3% when standard resuscitation protocols were followed.
The design of the trial minimised the risk of other factors confounding results. It provides confidence that survival improvements were due to the defibrillation approach and not regional differences in resources and training.
The study also corroborates and builds on existing theoretical and clinical scientific evidence. As the trial was stopped early due to the COVID-19 pandemic, however, the researchers could recruit fewer than half of the numbers planned for the study.
Despite these and other limitations, the international group of experts that advises on best practice for resuscitation updated its recommendations in 2023 in response to the trial results. It suggested (with caution) that emergency medical services consider DSED for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard treatment.
Training and implementation
Although the evidence is still emerging, implementation of DSED by emergency services in New Zealand has implications beyond the care of patients nationally. It is also a key step in advancing knowledge about optimal resuscitation strategies globally.
There are always concerns when translating an intervention from a controlled research environment to the relative disorder of the real world. But the balance of evidence was carefully considered before making the decision to change procedures for a group of patients who have a low likelihood of survival with current treatment.
Before using DSED, emergency medical personnel undergo mandatory education, simulation and training. Implementation is closely monitored to determine its impact.
Hospitals and emergency departments have been informed of the protocol changes and been given opportunities to ask questions and give feedback. As part of the implementation, the St John ambulance service will perform case reviews in addition to wider monitoring to ensure patient safety is prioritised.
Ultimately, those involved are optimistic this change to cardiac arrest management in New Zealand will have a positive impact on survival for affected patients.
Vinuli Withanarachchie, PhD candidate, College of Health, Massey University; Bridget Dicker, Associate Professor of Paramedicine, Auckland University of Technology, and Sarah Maessen, Research Associate, Auckland University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Share This Post
-
How To Boost Your Memory Immediately (Without Supplements)
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.
How To Boost Your Memory (Without Supplements)
While we do recommend having a good diet and taking advantage of various supplements that have been found to help memory, that only gets so much mileage. With that in mind…
First, how good is your memory? Take This 2-Minute Online Test
Now, that was a test of short term memory, which tends to be the most impactful in our everyday life.
It’s the difference between “I remember the address of the house where I grew up” (long-term memory) and “what did I come to this room to do?” (short-term memory / working memory)
First tip:
When you want to remember something, take a moment to notice the details. You can’t have a madeleine moment years later if you wolfed down the madeleines so urgently they barely touched the sides.
This goes for more than just food, of course. And when facing the prospect of age-related memory loss in particular, people tend to be afraid not of forgetting their PIN code, but their cherished memories of loved ones. So… Cherish them, now! You’ll struggle to cherish them later if you don’t cherish them now. Notice the little details as though you were a painter looking at a scene for painting. Involve more senses than just sight, too!
If it’s important, relive it. Relive it now, relive it tomorrow. Rehearsal is important to memory, and each time you relive a memory, the deeper it gets written into your long-term memory until it becomes indelible to all but literal brain damage.
Second tip:
Tell the story of it to someone else. Or imagine telling it to someone else! (You brain can’t tell the difference)
And you know how it goes… Once you’ve told a story a few times, you’ll never forget it later. Isn’t your life a story worth telling?
Many people approach memory like they’re studying for a test. Don’t. Approach it like you’re preparing to tell a story, or give a performance. We are storytelling creatures at heart, whether or not we realize it.
What do you do when you find yourself in a room and wonder why you went there? (We’ve all been there!) You might look around for clues, but if that doesn’t immediately serve, your fallback will be retracing your steps. Literally, physically, if needs be, but at least mentally. The story of how you got there is easier to remember than the smallest bit of pure information.
What about when there’s no real story to tell, but we still need to remember something?
Make up a story. Did you ever play the game “My granny went to market” as a child?
If not, it’s a collaborative memory game in which players take turns adding items to a list, “My granny went to market and bought eggs”, My granny went to market and bought eggs and milk”, “my granny went to market and bought eggs and milk and flour” (is she making a cake?), “my granny went to market and bought eggs and milk and flour and shoe polish” (what image came to mind? Use that) “my granny went to market and bought eggs and milk and flour and shoe polish and tea” (continue building the story in your head), and so on.
When we actually go shopping, if we don’t have a written list we may rely on the simple story of “what I’m going to cook for dinner” and walking ourselves through that story to ensure we get the things we need.
This is because our memory thrives (and depends!) on connections. Literal synapse connections in the brain, and conceptual contextual connections in your mind. The more connections, the better the memory.
Now imagine a story: “I went to Stonehenge, but in the background was a twin-peaked mountain blue. I packed a red suitcase, placing a conch shell inside it, when suddenly I heard a trombone, and…” Ring any bells? These are example items from the memory test earlier, though of course you may have seen different things in a different order.
So next time you want to remember things, don’t study as though for a test. Prepare to tell a story!
Try going through the test again, but this time, ignore their instructions because we’re going to use the test differently than intended (we’re rebels like that). Don’t rush, and don’t worry about the score this time (or even whether or not you saw a given image previously), but instead, build a story as you go. We’re willing to bet that after it, you can probably recite most of the images you saw in their correct order with fair confidence.
Here’s the link again: Take The Same Test, But This Time Make It Story-Worthy!
Again, ignore what it says about your score this time, because we weren’t doing that this time around. Instead, list the things you saw.
What you were just able to list was the result of you doing story-telling with random zero-context images while under time pressure.
Imagine what you can do with actual meaningful memories of your ongoing life, people you meet, conversations you have!
Just… Take the time to smell the roses, then rehearse the story you’ll tell about them. That memory will swiftly become as strong as any memory can be, and quickly get worked into your long-term memory for the rest of your days.
Share This Post
-
New News From The Centenarian Blue Zones
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.
From Blue To Green…
We sometimes write about supercentenarians, which word is usually used in academia to refer to people who are not merely over 100 years of age, but over 110 years. These people can be found in many countries, but places where they have been found to be most populous (as a percentage of the local population) have earned the moniker “Blue Zones”—of which Okinawa and Sardinia are probably the most famous, but there are others too.
This is in contrast to, for example “Red Zones”, a term often used for areas where a particular disease is endemic, or areas where a disease is “merely” epidemic, but particularly rife at present.
In any case, back to the Blue Zones, where people live the longest and healthiest—because the latter part is important too! See also:
- Lifespan: how long we live
- Healthspan: how long we stay healthy (portmanteau of “healthy lifespan”)
Most of our readers don’t live in a Blue Zone (in fact, many live in the US, which is a COVID Red Zone, a diabetes Red Zone, and a heart disease Red Zone), but that doesn’t mean we can’t all take tips from the Blue Zones and apply them, for example:
- The basics: The Blue Zones’ Five Pillars Of Longevity
- Going beyond: The Five Key Traits Of Healthy Aging
You may be wondering… How much good will this do me? And, we do have an answer for that:
When All’s Said And Done, How Likely Are You To Live To 100?
Now that we’re all caught-up…
The news from the Blues
A team of researchers did a big review of observational studies of centenarians and near-centenarians (aged 95+). Why include the near-centenarians, you ask? Well, most of the studies are also longitudinal, and if we’re doing an observational study of the impact of lifestyle factors on a 100-year-old, it’s helpful to know what they’ve been doing recently. Hence nudging the younger-end cutoff a little lower, so as to not begin each study with fresh-faced 100-year-olds whom we know nothing about.
Looking at thousands of centenarians (and near-centenarians, but also including some supercentenarians, up the age of 118), the researchers got a lot of very valuable data, far more than we have room to go into here (do check out the paper at the bottom of this article, if you have time; it’s a treasure trove of data), but one of the key summary findings was a short list of four factors they found contributed the most to extreme longevity:
- A diverse diet with low salt intake: in particular, a wide variety of plant diversity, including protein-rich legumes, though fish featured prominently also. On average they got 57% and 65% of their energy intake from carbohydrates, 12% to 32% from protein, and 27% to 31% from fat. As for salt, they averaged 1.6g of sodium per day, which is well within the WHO’s recommendation of averaging under 2g of sodium per day. As a matter of interest, centenarians in Okinawa itself averaged 1.1g of sodium per day.
- Low medication use: obviously there may be a degree of non-causal association here, i.e. the same people who just happened to be healthier and therefore lived longer, correspondingly took fewer medications—they took fewer medications because they were healthier; they weren’t necessarily healthier because they took fewer medications. That said, overmedication can be a big problem, especially in places with a profit motive like the US, and can increase the risk of harmful drug interactions, and side effects that then need more medications to treat the side effects, as well as direct iatrogenic damage (i.e. this drug treats your condition, but as the cost of harming you in some other way). Naturally, sometimes we really do need meds, but it’s a good reminder to do a meds review with one’s doctor once in a while, and see if everything’s still of benefit.
- Getting good sleep: not shocking, and this one’s not exactly news. But what may be shocking is that 68% of centenarians reported consistently getting enough good-quality sleep. To put that into perspective, only 35% of 10almonds readers reported regularly getting sleep in the 7–9 hours range.
- Rural living environment: more than 75% of the centenarians and near-centenarians lived in rural areas. This is not usually something touted as a Blue Zones thing on lists of Blue zones things, but this review strongly highlighted it as very relevant. In the category of things that are more obvious once it’s pointed out, though, this isn’t necessarily such a difference between “country folk” and “city folk”, so much as the ability to regularly be in green spaces has well-established health benefits physically, mentally, and both combined (such as: neurologically).
And showing that yes, even parks in cities make a significant difference:
Want to know more?
You can read the study in full here:
A systematic review of diet and medication use among centenarians and near-centenarians worldwide
Take care!
Share This Post
Related Posts
-
How to Eat (And Still Lose Weight) – by Dr. Andrew Jenkinson
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.
You may be wondering: what diet is he recommending?
The answer is: some guiding principles aside…. He’s not recommending a diet, per se.
What this book does instead is outline why we eat too much ← link is to where we previously had this author as a spotlight featured expert on this topic! Check it out!
He goes into a lot more detail than we ever could have in our little article, though, and this book is one of those where the reader may feel as though we have had a few classes at medical school. The style, however, is very comprehensible and accessible; there’s no obfuscating jargon here.
Once we understand the signalling that goes on in terms of hunger/satiety, and the signalling that goes on in terms of fat storage/metabolism, we can simply choose to not give our bodies the wrong signals. Yes, it’s really that simple. It feels quite like a cheat code!
Bottom line: if you’d like a better understanding of what regulates our body’s “set point” in weight/adiposity, and what can change it (for better or for worse), then this is the book for you.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
What is ‘doll therapy’ for people with dementia? And is it backed by science?
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.
The way people living with dementia experience the world can change as the disease progresses. Their sense of reality or place in time can become distorted, which can cause agitation and distress.
One of the best ways to support people experiencing changes in perception and behaviour is to manage their environment. This can have profound benefits including reducing the need for sedatives.
One such strategy is the use of dolls as comfort aids.
Jack Cronkhite/Shutterstock What is ‘doll therapy’?
More appropriately referred to as “child representation”, lifelike dolls (also known as empathy dolls) can provide comfort for some people with dementia.
Memories from the distant past are often more salient than more recent events in dementia. This means that past experiences of parenthood and caring for young children may feel more “real” to a person with dementia than where they are now.
Hallucinations or delusions may also occur, where a person hears a baby crying or fears they have lost their baby.
Providing a doll can be a tangible way of reducing distress without invalidating the experience of the person with dementia.
Some people believe the doll is real
A recent case involving an aged care nurse mistreating a dementia patient’s therapy doll highlights the importance of appropriate training and support for care workers in this area.
For those who do become attached to a therapeutic doll, they will treat the doll as a real baby needing care and may therefore have a profound emotional response if the doll is mishandled.
It’s important to be guided by the person with dementia and only act as if it’s a real baby if the person themselves believes that is the case.
What does the evidence say about their use?
Evidence shows the use of empathy dolls may help reduce agitation and anxiety and improve overall quality of life in people living with dementia.
Child representation therapy falls under the banner of non-pharmacological approaches to dementia care. More specifically, the attachment to the doll may act as a form of reminiscence therapy, which involves using prompts to reconnect with past experiences.
Interacting with the dolls may also act as a form of sensory stimulation, where the person with dementia may gain comfort from touching and holding the doll. Sensory stimulation may support emotional well-being and aid commnication.
However, not all people living with dementia will respond to an empathy doll.
It depends on a person’s background. Shutterstock The introduction of a therapeutic doll needs to be done in conjunction with careful observation and consideration of the person’s background.
Empathy dolls may be inappropriate or less effective for those who have not previously cared for children or who may have experienced past birth trauma or the loss of a child.
Be guided by the person with dementia and how they respond to the doll.
Are there downsides?
The approach has attracted some controversy. It has been suggested that child representation therapy “infantilises” people living with dementia and may increase negative stigma.
Further, the attachment may become so strong that the person with dementia will become upset if someone else picks the doll up. This may create some difficulties in the presence of grandchildren or when cleaning the doll.
The introduction of child representation therapy may also require additional staff training and time. Non-pharmacological interventions such as child representation, however, have been shown to be cost-effective.
Could robots be the future?
The use of more interactive empathy dolls and pet-like robots is also gaining popularity.
While robots have been shown to be feasible and acceptable in dementia care, there remains some contention about their benefits.
While some studies have shown positive outcomes, including reduced agitation, others show no improvement in cognition, behaviour or quality of life among people with dementia.
Advances in artificial intelligence are also being used to help support people living with dementia and inform the community.
Viv and Friends, for example, are AI companions who appear on a screen and can interact with the person with dementia in real time. The AI character Viv has dementia and was co-created with women living with dementia using verbatim scripts of their words, insights and experiences. While Viv can share her experience of living with dementia, she can also be programmed to talk about common interests, such as gardening.
These companions are currently being trialled in some residential aged care facilities and to help educate people on the lived experience of dementia.
How should you respond to your loved one’s empathy doll?
While child representation can be a useful adjunct in dementia care, it requires sensitivity and appropriate consideration of the person’s needs.
People living with dementia may not perceive the social world the same way as a person without dementia. But a person living with dementia is not a child and should never be treated as one.
Ensure all family, friends and care workers are informed about the attachment to the empathy doll to help avoid unintentionally causing distress from inappropriate handling of the doll.
If using an interactive doll, ensure spare batteries are on hand.
Finally, it is important to reassess the attachment over time as the person’s response to the empathy doll may change.
Nikki-Anne Wilson, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response
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.
BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.
Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.
Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”
As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.
Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.
The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.
Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.
But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.
Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.
Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.
“If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”
From Pioneer to Lagger
California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.
The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.
Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.
In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.
When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.
Fall From Grace
Morrow’s troubles started long after the original California program had been shut down.
The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.
But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.
The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.
Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”
By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”
Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.
“I didn’t have to feel naked and judged,” she said.
Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.
Physician Privacy vs. Patient Protection
The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.
Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.
Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.
Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.
“To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.
Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.
The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.
People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.
“The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.
The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.
Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.
“I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”
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.
Subscribe to KFF Health News’ free Morning Briefing.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: