geoffrey modest medical blogs

  A recent article appeared in the New York Times about the potential harms of the high potency marijuana currently widespread and well-distributed, refuting that this is nonaddictive and safe (see https://www.nytimes.com/2024/10/04/us/cannabis-marijuana-risks-addiction.html?smid=nytcore-ios-share&referringSource=articleShare&sgrp=c-cb  or https://www.nytimes.com/2024/10/04/us/cannabis-marijuana-risks-addiction.html  ).   A few general comments: -- there are many reports of patients being treated for extremely large amounts of marijuana intake daily, with the following problems associated with that:   “ cannabinoid hyperemesis syndrome ”, or CHS: severe vomiting, with patients “writhing around in pain” at times, and associated with severe dehydration, seizures, kidney failure, cardiac arrest, and at least eight attributable deaths     -- it is hard to get accurate data on CHS since it is not consistently recorded in the medical records             -- one concern

  A Swedish study found that following men with a high PSA with an MRI seemed to be a reasonable approach for risk-stratifying patients, decreasing false positive results and without leading to significant delays in diagnosis of significantprostate cancer, in the Gothenburg-2 trial, a large, population-based, screening trial (see psa MRI followup NEJM2024  in dropbox, or DOI:10.1056/NEJMoa2406050). Special thanks to Brittany Berk (a really smart urologist and, it just so happens, my daughter-in-law) for some comments and suggestions.....   Details: -- about 80,000 men who were 50 to 60 years of age in Gothenburg (aka “Goteborg”), Sweden were eligible for participation in the trial, from which 38,316 men were randomly selected and invited for screening, a population-based trial that started in 2015 -- those who accepted the invitation were assigned in a 1:1:1 manner to 1 of 3 groups:     -- those with low PSA levels of 1.8-3.0 ng/mL.  these men were followed but were not targeted in the