that we do promote medical cannabis it's we have a lot of believers here in medical cannabis scientifically and research wise it's really starting to pick up and there's a lot of information out there now and we hope to be able to provide that information in a concise manner. the keen interest in the medical use of cannabis is not restricted to colorado even though it remains illegal on the federal level in twenty sixteen more than half of the states in the us had already legalized its medical use dozens of countries worldwide have done the same such as canada israel or germany which has recently changed its legislation. but some countries refuse like poland greece and especially fronts. here no reevaluation for cannabis not even medical according to the french national academy of medicine this plant and its contents have no place in pharmacies. for a long time our academy of medicine has considered the problem of cannabis in general and of its therapeutic values in particular but. after assembling and analyzing all the information derived from the numerous reports and the results of variou

as you can imagine, these conditions require medication. when you are uninsured, like all of our patients are, and you don't have access to medication, getting monthly medications that you need to control these conditions is untenable for most of our patients. and left untreated, these chronic conditions can be debilitating. they are demoralizing and they can even be fatal. which you might imagine as well. so, when we learned about the organization that was matching access medication with patients in need, we thought it was a fantastic idea. we knew that not only would it be incredibly helpful for patients that could -- at our clinic, but for patients throughout san francisco. it will save lives. i want to especially thank a supervisor safai. you have been amazing. thank you supervisor stefani. i will hope you will hear from our doctor to, out our clinic, has been shepherding this legislation through as well. thank you and i hope we can get your support for this important legislation. >> chair mandelman: thank you. next speaker. >> good mor

the use of medical cannabis is hardly a new idea. different traditional medicine it's recognised it's virtually is a very long time ago. latina's us right up with the medical use of cannabis in traditional chinese medicine goes back to about the first century a.d. we're not and we have written fragments with drawings of this plant describing it sematic and psychic powers so much it's a few. in the past cannabis was usually chewed or taken as a teen. it was often smoked but not always for its therapeutic effects. and . in antiquity cannabis was mentioned in the film the copius of india the middle east and even greece. limits victoria queen victoria's doctor prescribed calibers to relieve the suffering and pain of her legendary painful. no it was that and victoria. but with the arrival of aspirin which was more effective and easier to produce cannabis could no longer compete. old fashioned in the eyes of doctors it became obsolete. the final blow came in the us in the thirty's when prohibition ended the head of the federal bureau of na

that it is her job to check whether she has medical knowledge is up to scratch a classic or medical student question asked what's the difference kiss up to the judge at the girl please are going to have a hard facts and distinction on the border whereas your subdural ones are marked as actually appear almost. a donor through up and honestly when you get a question wrong on someone that you. literally like there's a blinding apparent because if you really get to know him there's like this loco oh my gosh really. i'm so sorry i'm so sorry for my stupidity. and you submission to the pediatric intensive care unit is a very sick child. his future lies precariously between life and death. facing this level of responsibility is the true purpose behind these clinical placements. and the ensure that students lay in lessons that can't be found in books and we're going to have a multidisciplinary team meeting because this patient has multiple complications and the very poor prognosis and there's certain decisions that need to be made in his best interest so where ever best interest is being considered

often times it is fairly medical what they are doing, as well. they often administer painkillers and attend to the medical sides of birth. >> how are they trained? prof. kline: another good question. there are two different models of training, one is the certified nurse-midwife. it is almost always a she. they have a degree in nursing and a degree in midwifery. two different certificates. and then there is a certified professional midwife, who does not have nursing training. those educational differences result in different types of models. >> why then, based on your research, with so many similarities between the u.s. and u.k., is there such a difference in this area? prof. kline: it has everything to do with history. around the turn of the century, around 1900, the american medical association did everything they could to start regulating obstetrics, and medicine more generally, to weed out what they believed to be quacks, that they saw as -- or those that they saw as a form of competition or simply incompetent. they virtually eliminated the pr

when i compare what i knew the first day in medical school versus what i knew last in medical school versus what i know now i and myself know that those are exponentially different places that you know in a very short period of time i can amass huge amounts of knowledge and be able to make clinically relevant decisions based on that knowledge and that comes with time . even as a qualified doctor shivani has to continue her studies she has chosen internal medicine as her specialty which requires a compulsory postgraduate residency for a minimum of four years. the one thing but for me and a lot of people who graduate from mark is that i'm always going to have things i don't know and being ok with that and being ok with i guess the practice of researching and learning and constantly being on a track where you're educating yourself to keep yourself up to date that's something that everyone struggles with. this process of continuous study is never a major element of the. eighteen system responding to the need for doctors to keep up with the extraordinary speed with which care and treatmen

i'm with sutter pacific medical foundation. the three programs that have already transitioned, the breast center on august 5, the cardiac echo lab on august 5, and the st. luke's diabetes program transferred on august 19. so far, it is business as usual, and we have not had any contracting issues since the go live dates. and in any situation where we need to request continuity of care, or policy is for those patients that are impacted, we will try to get an agreement with the health plans. and if the health plans agree, we will continue their service. if the health plan does not agree, it is their responsibility to identify alternative areas of service. >> commissioner sanchez? >> yeah. we've all spent a lot of time together, many of us here from different segments of the community both internally, externally, etc. and the bottom line to me has always been astounding. it's not about the quality of care, because we had families come from all over the bay area who would come and visit their brother, uncle, cousin because they wer

for example, the bureau of medical services lacked authority for domestic medical evacuations to send individuals to the university of pennsylvania for evaluations and care. this issue was addressed just last week when state delegated full authority for domestic medevacs to med. as mentioned earlier, state had issues ensuring npri was in the loop as the incidents initially occurred. externally, state also experienced difficulties in communicating with other departments and agencies in responding to these incidents. as ambassador bodde noted, the arb has completed its work. the arb identified some of the same challenges i just mentioned and state has also established the health incidence task force in may to direct the multiagency response to the incident. both of these efforts are resulting in changes that may address some of these management challenges. as gao continues its broader review, we will be examining the arb's findings and state's ongoing response. chairman cook, ranking member, and members of the subcommittee, this concludes my statement. i look forward to your questions.

but all medications that we brought into. eventually end up in our and ultimately inside of us that al water could soon be clear and clean in. a romantic little river in southern germany. clarified water from a nearby sewage treatment plant feeds into it it seems clean but looks can be deceiving that water still contains residues from drugs like painkillers antibiotics and blood pressure medication many rivers in germany now contain heightened concentrations of the pain reliever di cliff and knock even though some sources of drinking water but that's not the only reason why water chemists at the regional environment office are concerned about drug residues. in the shooting being a stickler for not we can prove with our own studies that even at low concentrations of an ak has an effect on organisms in the water for trout for instance. because of changes in their gills and in the kidneys and we're also focusing on a former for example birth control pills which in extreme cases they can lead to the feminization of organisms so f

first, we need a nationwide standard for sharing medical data. it's shortsighted for additional digital health companies to each use their own standards. every new technology goes through this period, but it is also true at some point we need to come together, standardize how information is shared. i think this was proven in other sectors to be the means by which we unlock true value. it happened in the railroads, it happened with automobiles on roads, it happened with the internet more broadly and it has yet to happen with digital health, too. the federal government can play a key role. imagine if they tied one to all medicaid and medicare reimbursement. i bet we would see conformity pretty quickly. second, we need to sell privacy challenges. patients must control their own data as it enters and exits the health care system. but i think there is a benefit to sharing data, when patients agree to use the health care system, we think there should be some agreement to share their data for the good of everyone, so we can learn what works and what doe

of the medications you take are eliminated by urine. up to seventy percent of the dye clover knack you swallow is excrete again residue from creams and gels is also rinsed the way in the shower bath and ends up in the waste water. the bavarian researches have built a reactor that can break down stable drug residues in it wastewater is post with ozone the process is already used to kill germs but it also breaks down drug residues into their constituent parts. these samples of waste water that have been treated with ozone illustrate how well it works they're carefully analyzed by vanno right from the noise his colleagues at the regional environment office they conduct tests for example in a comparison untreated samples turned reddish orange samples treated with ozone remain clear. but in overall exhibit when it comes to hormones we're very satisfied after ozone nation there are practically undetectible but with other medications the situation isn't quite as well. we have some good rates of degradation over ninety percent for example with

has been on for years to another medication. at one time he had 10 doctors and 20 medications. i experience from others who -- i hear from others who experience these frustrations, too. it is hard to spend all day on the phone, particularly when you are juggling a job, caring for kids and all the activities that families have.

the association of medical colleges findings 75% of medical students are carrying debt with a median loan of $192,00 >> walking around with six figures of debt is scary. >> paying off that burden is sending new doctors into specialties like orthopedics instead of primary care, pediatrics and research where there's higher need but lower pay. home depot co-founder and billionaire hopes the program will change that. >> these kids will be able to pick a specialty or pick a field of medicine they want to go in because that's where their passion is and that's where they can do the most good. >> he donated $100 million of the $450 million that nyu has raised so far. >> we think we've given them a good start in life to leave here debt free. and we think it's the right thing to do. >> so will this new policy at nyu address the shortage of doctors in less lucrative fields joining us is the editor and chief of kaiser health news and the author of the book called an american sickness, how health care became big business and how you can take it back elizabeth, thanks for being here today. >> than

when i compare what i knew the first day in medical school versus what i knew last in medical school versus what i know now i and myself know that those are exponentially different places but you know in a very short period of time i can amass huge amounts of knowledge and be able to make clinically relevant decisions based on that knowledge and that comes with time . even as a qualified doctor shivani has to continue her studies she has chosen internal medicine as her specialty which requires a compulsory postgraduate residency for a minimum of four years. the one thing but for me and a lot of people who graduate from mark is that i'm always going to have things i don't know and being ok with that and being ok with i guess the practice of researching and learning and constantly being on a trial where you're educating yourself to keep yourself up to date that's something that everyone struggles with. this process of continuous study is never a major element of the key. eighteen system responding to the need for doctors to keep up with the extraordinary speed with which care and treat

no speculation from a medical standpoint. there is nothing in the old medical literature? again, so what we are seeing is a unique syndrome. it is a unique constellation of systems and findings but with no obvious cause. there is a lot of speculation in media. we would prefer not to speak about speculation. those working with the patients are doing everything they can to indicate whether injuries occurred, what part of the brain and what can cause this. thank you. >> chairman, i'm going to let ranking member of the foreign affairs committee. >> i'm going to apologize. i did not see the ranking member hiding out on there. >> thank you, mr. chairman. thank you, ranking member. participating in these western hemisphere subcommittee hearings always feels like coming home since i was the chair for number of years. about a decade ago. so it's a pleasure to be here. i wanted to raise a few important questions. last month, asked the congressional research service to prepare report from the impact of staff reductions at the u.s. embassy. i ask unanimous consent that this be inserte

no speculation from a medical standpoint? >> there is nothing in the old medical literature. we are seeing a unique syndrome. we can't even really call it a syndrome. it is a unique combination of symptoms and findings, but with no obvious cause. we prefer not to talk about speculation. experts that have examined the patients are doing everything they can to determine where the injuries occurred and in what part of the brain and what could possibly cause this. >> i will turn it over to the ranking member for his questions. >> chairman, i will let the ranking member of the foreign affairs committee go. i know he has things to do. >> i did not see the ranking member hiding out down there. >> thank you, mr. chairman. thank you for allowing me to participate in this western hemisphere subcommittee hearing. it always feels like coming home, since i was the chair for a number of years, about a decade ago. it is a pleasure to be here. i wanted to raise a few really important questions. last month, i asked the congressional research service to prepare a report on the impact of staff

we deal with clients with multiple medical problems, psych problems. we deal with clients with psycho social problems, so we have the whole gamut. in addition to homelessness, we start i.v.'s, we tell man downs, which are seizure precautions. we get clients in from the streets that get sent to us that may be having seizures, may be having multiple substance abuse, and we have to deal with them right on the spot. we do not have enough staff to cover these clients. we have clients that are suicidal, homicidal, and we have clients that have been, what you call held hostage? we have clients with sexual problems, female and meale problems, we have gender problems in a unit. we deal with all sorts of care that we have to give to the clients. we -- our clients' age group is from 18 to 65, so we're dealing with that group. one patient might be on 20 pills, in addition to being injections, in addition to being diabetics, in addition to being -- having no medical care at all, having no interaction with people that really can communicate with them, so we have to

the current medical office building had 12%. the st. lukes which just celebrated its grand opening had 21%, and all three projects combined is 16.4%, and as of july 2018, something like 22.5 million have been generated for local businesses. and specifically outside of construction, we also have opportunities to work on the operations of the hospital, so this is entry level positions. it could be medical, clerks, and working in the -- in the hospital's operations for the food industry, so a lot of those jobs are entry level, which our goal is 40%, and i'm happy to report that it's exceeded. and these are some of the target areas that we worked with, so western addition, chinatown, outer mission. and they currently were at 54%, so 35 of the 65 employees were hired through the workforce system. and in addition to the workforce hiring, there's also investment fund grants that was provided? cpmc paid over $3 million fund to workforce through san francisco administration and also in partnership with the office of economic and workforce develo

what about the interruption of medical care how dangerous is that? >> so, what we always do is work with our partners over at hhs and we forward deploy disaster medical assistance teams, there's hundreds of people out in the field and not only to support medical needs but also we are ready to support any evacuation transportation needs. the. >> dickerson: the interruption of medical care was responsible for 47% of fatalities in katrina is big part that have number that's been disputed about puerto rico the 3,000 number. the president said that 3,000 number didn't exist that they didn't die. how is it true that you're preparing for interruption of medical care in florence but the president says people who died as result of interruption in medical care in puerto rico are not worth counting? >> well, look, these studies are all over the place. the harvard study was done differently, studies different period of time versus the george washington study. big discrepancy whether it's direct deaths or indirect deat deaths. if you look at the root cause of any

indiana, recreational and medical marijuana have not come through but there is a debate about that. we take the position that medical marijuana is no different than recreational marijuana and we have outlined a pathway for the possibility of that aspect. oil approved by the fda through a process of clinical trials. that is the process that we utilize in this country to demonstrate whether a particular substance has a medical necessity or inability -- or an ability to help people. tocannabis is determined have an effective use and is safe and reliable and gets fda approval, that is one thing. that is far different than just taking a substance like marijuana and saying we think it is ok, therefore we are going to simply legalize it for medical purposes. i don't think it is appropriate to have marijuana grown in the backyard is some kind of a defined medical substance versus an fda process. host: one of the things of note that many states are dealing with heading to the november elections was election security and border security and how that works for voting was. what does indiana fac

the question i have is, from a medical standpoint, and maybe this is a medical question more than it is anything else, if you have any free to print this for who was responsible? we have even heard the llegations of russians might be involved. at least from my standpoint, hat happens? i am worried about the families and everyone else that can be innocent bystanders to something like this. we want to just figure out what is going on. does anyone want to address that? octor? >> i can speak from a medical perspective. we are frustrated as well. we know the accumulation of medical knowledge tends to be very deliberate. i can only speak to what we are trying to do to find out what caused the injuries. there were symptoms that people presented that were very common symptoms -- symptoms. t took some time to figure out they were connected. these are symptoms similar to a traumatic rain injury or concussion. we had to work backwards and find out what caused this. we identified the university of pennsylvania as a location where people could do a thorough evaluation, but there is no obvious mec

clare gerada is the medical director of the php.ppen is doctors do nothing and suffer in silence right to the bitter end. and doctors looking after doctors aren't good at looking after their own kind. they tend to be embarrassed. they treat the sick doctor not as the vulnerable patient, but as a fellow professional, actually missing the fact that this is a vulnerable doctor, a vulnerable patient. in the ten years since class, i took the php, it has seen over 5000 doctors. the service has treated more than double the amount of women to men. the average age of doctors has dropped from 51.6 years old in 2008 to 38.9 in 2018. about a quarter weren't working when they first presented to the php, but more than 900 of those doctors subsequently returned to work. i think the last taboo in the nhs is the acknowledgement that doctors also have mental health problems, that doctors themselves are not immune to all the pressures that are piled onto them, that doctors can somehow absorb all the stress and strain of everyday medical practices. wha

you apply and get in the hardest medical school, the harvard medical school.e you surprised you got in, and was that your first choice? dr. kim: i was really surprised to get in. it was not my first choice. i was trying to convince my father i was not going to go to medical school, but was going to study political science and philosophy. i came home from brown one summer and he said, what are you going to study? i said i think i will study political science and philosophy and get into politics. he pulled over the car to the side of the road, coming back from the airport, and he said, hey, when you finish your internship and residency, you can study anything you want. [laughter] dr. kim: and he used to talk like that. he said, for him it was very clear who we were in this country. we were in iowa. he said you are a china men. he said this to me. do think people will pay you to hear your ideas about political science and philosophy? get a skill. it turned out it was great advice. there are so many things that i learned and happen because i had this notion that i

simon's transformation started at mcmaster medical school.when it opened back in one thousand nine hundred sixty five it pioneered a radical teaching philosophy which is now used widely of around the world. five thousand applied to canada's most popular medical school but only two hundred ten. this is day one for the two thousand and fifteen and take good morning. your first priority will be to learn to be great physicians your work in small groups and teams exactly the way that most of medicine is practiced. four thousand nine hundred twenty doctors have trained at mcmaster over the last forty years feeding canada state funded health care system these students all got here through a unique selection process called the multiple mini interview. the applicants a challenge with a series of rote gleason ariel's when you do your first one or two stations it's still kind of a trainer you're very nervous your hands are shaking you don't know what to do with your water bottle there are various you pay for it but i liked it a lot more than traditional

ben has had about 10 doctors and 20 medications.nd i hear from granite starters who experience frustrations too. it's hard as a patient or family member to spend all day on the phone wondering if a prior authorization went through, particularly hard when you are juggling a job, caring for kids and all the other daily activities that families have. i will also note we have talked about the importance of integrating electronic medical records for purposes of administrative fees, but i can tell you how important it is to patient safety. at three clock in the morning when your hospital owns your physician practice tells you that they can't get access to your son's primary care health record, because they are on different electronic systems, and all of a sudden the doctor is saying do you remember 15 years ago when your son had that one pneumonia whether we used this or that antibiotic? it's pretty scary. so when we are talking about administrative burdens, i think we really -- what really would make a difference is to eliminate these bu

you have medical leave, which is sick leave or a family member is sick, and you want to take medical leave. the third is family leave here that is the caregiving of a child or a parent or someone else. there are three different elements and the question is how broadly do you write the bill, what are the costs? we have been looking at studies that were done recently by folks at brookings and other places. they have come back and say by far the most expensive of these is medical leave. that would have the largest take-up rate. people would participate in the most. as they point out in the study, it is the area where there is probably the biggest existing system of taking medical leave. some businesses have sick leave even small businesses have sick leave where as opposed to family leave, less so and parental leave less so. how do youe issue of structure this program whether it is all three, two of the three, one of them, and how would you administer? it is fairly complicated. host: some stats from the bipartisan policy center at one in four women returned 10 to 14 days after giving bir

the bureau of medical services lacks authority for domestic medical evacuations to send individuals to the university of pennsylvania to evaluate their care. the third and final management challenge i want to highlight the state communication with internal and external stakeholders. the state has had issues ensuring npr i was in the loop as the incident initially occurred. states also experienced difficulties in communicating with other departments and agencies in response to these incidents. the arb has completed its work. the arb identified some of the same challenges i just mentioned and the date has also established the health incidents response task force and made to direct a multiagency response to the incident. may of these efforts address some of these management challenges. reviewing, wees will examine the arb findings and these eight ongoing response. members, andking members of the subcommittee, i look forward to your questions. >> thank you. i think you are going to hear, at least for me, we are somewhat bewildered and frustrated. this goes back quite a while. hearings.e cl

hopefully swap out your opioids for use of medical marijuana. the program basically would mean that for the extent of your prescription for opioids, let's say if you have a six-month prescription, you would be able to get a six-month card for medical marijuana. i think it's a step in the right direction. i don't think it's certainly the end-all answer to the issue with opioid abuse and the problems that we have, but i think it's a step in the right direction that we're offering, i think, safe alternatives to people to deal with their pain and deal with the issues that they have while they're using opioids to use something that really doesn't have the problems that opioids do. i'm looking forward to seeing this program get implemented and change some of the issues we have with opioid abuse in the state of illinois. >> another issue, gun violence. there are plenty of rankings on this issue comparing various states. illinois ranked by the giffords law center as having the eighth strongest gun laws in america. what has that meant for gun violence in

you apply and get in the hardest medical school to get in, the harvard medical school.e you surprised you got in, and was that your first choice? dr. kim: i was really surprised to get in. in fact, it was not my first choice, because i was trying to convince my father i was not going to go to medical school, but i was going to go study political science and philosophy. i came home from brown one summer and he asked me, so what are you going to study? i said, dad, i think i will study political science and philosophy and i think i'm going to get into politics. he literally pulled the car over to the side of the road, coming back from the airport, and he said, hey, when you finish your internship and residency, you can study anything you want. [laughter] dr. kim: and he used to talk like that. he said, for him, it was very clear who we were in this country. we were in iowa. he said you are a chinaman. he said this to me. do think people will pay you to hear your ideas about political science and philosophy? get a skill. it turned out it was great advice. there are so many

think about you are medics medical school now what do you make of that. as you mentioned there are three point five million six people that go for honor with clinics to get medical care and also to cutting the spawns one people will be able to get their medical care. because of the lack of medications so for us as a dental office a dental specialist. specialist a lot of medications need a lot of to a lot of current expenses so offerings in its history to complete helping many other people's. let's call it so many tools would be able to pay off for so many people so yes this is going to be catastrophically. you could question i mean you know you run a medical student you go to a career you go to my head ahead of you where because you future long do you think you're doing the studying. well after graduation i'm thinking of charles i think outside england and how much must a degree it ended on six think back to like reading my knowledge and trying to help people hear well i'll go home but that's ok i'll get back there. so you know this is really tough some s