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Covid19 pandemic and cannabinoid therapeutics

Much has been written about the short term and long term implications of the current pandemic on the science, legalization and business of developing therapeutics in general and Cannabinoid-based therapeutics specifically. Since this is my first blog post on my new “under construction” website, I will try to keep my comments brief and provocative in order to hopefully spur an active & lively discussion of what I think are the most important challeneed we face. I am a physician scientist first and foremost, so will concentrate on those aspects of the subject. In general, while there are some new lessons to be learned, mostly it seems like the pandemic has pulled the bandage off and we are seeing, perhaps for the first time, the immense and long existing problems in our society’s profit driven healthcare system The extreme political divisions that have been created by the Trump Presidency have only exacerbated those problems while making compromise solutions unfathomable. In my lifetime, beginning with the rise of private for profit hospitals and clinics, the relationships between doctor and patient have been eroded and new players- insurance companies and large healthcare systems- have entered into the examining room and distorted the mutual decision making process underlying that relationship. While we were told that the corporate model would bring competition, innovation and reduced costs to our healthcare system, it seems as if the exact opposite has happened. With consolidation of healthcare into large regional and even national “systems” and the increased role of corporate management there has been a dramatic increase in healthcare costs, most of it hidden and opaque since each insurance company or funding agency uses its size as leverage in striking a specific set of discounted rates for their members and this information is considered proprietary and not easily available to anybody wanting to understand the actual costs and competitive rates operating across systems. At the same time, prices for drugs, medical supplies and equipment have ballooned to unsustainable levels, driving a similar patchwork of discounts and “preferred“ products that is even more opaque then the service delivery market. Oftentimes the discounts and rebates given by drug manufacturers to distributors and large retail pharmacy chains are not even passed on to the consumer, further contributing to the increasing copay and deductible burden of patients, even those with comprehensive insurance coverage, must shoulder. It seems like every part of the corporate healthcare system profits except for the consumer! The lobbyists, the legislators they support and the agencies/systems that administrate care and collections have grown to consume an ever larger part of total healthcare expenditures, while focusing their own efforts on limiting service availability and worker salaries to further maximize their profits and executive salaries. Enough of this, as by now you know I am an strong advocate of Social Medicine, not socialized Medicine, but the concept that healthcare is a right not a privilege, and should seek to minimize and end health inequalities rather than contribute to them. Much has been made about the seemingly sudden realization that social, economic and healthcare access differences based on race, education, income and stays are cont to the the enormous differences in both Covid19 infection rates and severity of illness. But, as a survivor and active participant in the community and medical research responses to the HIV/AIDS pandemics, I can tell you that we in the frontlines of that crisis have know this since the beginning. In the 1980s I published an article showing that those subgroups of gay and bisexual men who had the highest risk for Hepatitis B and STI infection also had the lowest rates of vaccination and testing, and cited “Hart’s Law” (cite name, date pub) of inverse availability, namely “any new healthcare or preventive therapy will become available to those who need it the most, last!” I had largely forgotten about that piece of astute but depressing wisdom until yesterday’s Lancet featured an article about “Coronavirus pandemic and mental health: Time to re-evaluate the framework (cite Author, correct title, date etc) that quoted Hart’s Law in the second paragraph and then went on to describe how the patients already receiving the lowest level of care, the chronically mentally ill, were being further dehumanized by the Covid pandemic and the inability to provide safe isolation and social distancing in the institutions, group homes and SROs where they are living.

Similarly, I was appalled watching yesterday’s Senate hearings on our Federal pandemic response where both Democratic and Republican Senators tried to score political points to use in the upcoming elections, and the scientific experts had to do their very best to unpack their answers from whatever emotional responses that were feeling and, in measured calm tones, refute the misconstrued use of their responses without embarrassing either the Senator asking the question or angering the Presiden. Trump b for his part was conducting his own Twitter war against his Science leaders, the Chinese, the Press, even former President Obama and Democratic rival Joe Biden to deflect any criticism of his lack of effective leadership. And his continued encouraging of protests against Governors wanting to follow his own Task Force’s recommendations about slowly re-opening as conditions and testing-contract tracing systems are put into place contributed to a WI Supreme Court decision against a continued lock down in that State.

I shudder to think what a totally unbridled Trump (and his fellow dictators, like Vladimir Putin) will do when he sees how badly his Coronavirus pandemic response and the resulting massive economic and health decline has cost him heading into the Nov 3rd election. I take no pleasure in saying what I am about to write but have to be honest- If the Democratic Party and their Presidential candidate and Senate/House representatives up for election in 2020 can’t win on the basis of highlighting the massive corruption, abuse of power, totally chaotic response to the pandemic and now heartless push for premature opening of our businesses and the tens of thousands of additional lives it will needlessly cost, just to earn votes, then America must deserve four more years of dictatorial government, massive disenfranchisement of minorities, immigrants, the uninsured and poor, residents of “blue states” etc. and I’ll be heading out for good. Any suggestions? Must have democratic government, free and uncensored press and offer universal quality affordable healthcare. I think that narrows the possibilities...

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