In bygone days, when social change and the evolution of medical care moved at a more leisurely pace, medical education did the same. Those days are over, but medical schools don’t seem to have acknowledged that fact. Training new doctors in today’s rapidly evolving social, political, and medical climates demands a faster rate of curricular change than ever before, and our medical schools are falling behind.

As medical students who study the social and political systems that affect health care, it is clear to us that medical school curricula tend to give short shrift to socially relevant topics that are vitally important to our futures as practicing physicians.

Take nutrition. In preclinical coursework, medical students learn in detail about obesity, diabetes, and the immense role diet plays in health and disease. But we receive little, if any, education on nutrition. A 2015 survey found that three-quarters of medical schools fail to provide the recommended minimum number of hours of nutrition education and less than half teach any nutrition at all in clinical practice.

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Gun violence is another example. In the wake of recent mass shootings, the medical community has repeatedly called for gun violence to be treated as a public health crisis. Medical students assemble in their white coats for protests and attend marches, purporting to represent the medical perspective on this pressing political issue. Yet our academic institutions rarely provide guidance to physicians-in-training about firearm safety or firearm injury prevention, resulting in missed opportunities to improve patient and population health.

How to properly assess and treat chronic pain is another essential skill that has become increasingly important over the past decade but is inadequately taught in U.S. medical schools. A separate but related issue, the use of medical marijuana, provides a good case study of medical schools failing to keep pace.

Eight states and the District of Columbia have legalized marijuana for recreational and medical use. Another 22 states allow residents to use medical marijuana under certain circumstances, and many require a medical recommendation from a physician. Yet the majority of physicians-in-training are not being prepared to have informed conversations with their patients about medical marijuana, let alone recommend it as a treatment. This mismatch is striking, reflecting a failure on the part of medical schools to adapt to changing laws and a changing culture around marijuana.

In a study published last fall, researchers found that fewer than 1 in 10 medical schools included medical marijuana in their curricula. Two-thirds of medical school deans reported that their graduates “were not at all prepared to prescribe medical marijuana,” and a quarter reported that their graduates “were not at all prepared to answer questions about medical marijuana.”

Even more worrisome, the survey demonstrated that almost 90 percent of physicians in the final stages of their training — residents and fellows — felt they weren’t at all prepared to prescribe medical marijuana, and more than one-third felt they were not able to accurately answer questions about it. Almost 85 percent reported receiving no education about medical marijuana during medical school or residency.

Medical schools may be wary about wading into such a controversial and politically charged issue. But they don’t need to take a stand on medical marijuana to communicate what is known about it. We realize that politics and the law may be outpacing medical consensus here, but we are preparing to take care of patients in the real world, where politics and the law affect medicine.

Given that medical marijuana is now a therapeutic option in many states, and that some of our patients will request it, we need to be informed enough to guide our patients in an evidence-based manner and discern which ones might benefit from medical marijuana.

Beyond the obligation to adequately prepare their students, medical schools should also include medical marijuana in the curriculum as a public health imperative. The provision of medical marijuana has been associated with fewer opioid prescriptions, less opioid-related substance abuse, and fewer opioid overdose deaths. While there are many ways to explain these findings, a key point is that relative to opioids, marijuana offers a lower risk of addiction and virtually no risk of overdose, but is still effective in treating pain. Medical marijuana may be an underutilized tool to fight the opioid crisis, and medical schools can help us apply it.

The most recent research showing that increased access to marijuana can reduce the use of opioid prescribing, and thereby reduce the risk of opioid use disorder, only adds to the urgency with which we need to be educated on this topic.

Ongoing controversy about the dangers of marijuana in certain populations, such as adolescents, makes education on the topic even more essential. We need to understand when medical marijuana and other cannabis-based treatment options are indicated and, in contrast, when the risks may outweigh the benefits.

Information about medical marijuana is especially important for students like us training in states where it is legal and the opioid epidemic is rampant. If we decide to stay in Massachusetts after medical school and practice medicine here, we would be better doctors for our patients if we were taught more about medical marijuana.

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If medical schools continue to lag behind on marijuana education, the physicians they graduate will be ill-prepared when their patients ask about using it. But if medical schools commit to supplementing preclinical and clinical coursework with lectures or discussions on medical marijuana — communicating what is known, what isn’t, and where we fit in as physicians — they will prepare us to seize often-missed opportunities to better serve our patients.

The same holds true for nutrition, firearm safety, chronic pain, and a host of other issues. Better coverage of these topics in medical schools’ curricula would improve budding doctors’ ability to care for our patients and improve the health of the communities in which we practice.

Months-long classes aren’t needed. As medical education increasingly embraces case-based learning, opportunities abound for teaching these topics in powerful ways. For instance, faculty members could hold interactive demonstrations of how a physician might navigate a situation in which a patient presents with chronic lower back pain and asks about medical marijuana, walking us through the evaluation, decision-making, and follow-up steps.

Medical education doesn’t always keep pace. But it’s never too late to catch up.

Suhas Gondi is a student at Harvard Medical School. Andreas Mitchell is a student at Harvard Medical School and a master’s candidate at the Harvard Kennedy School of Government.

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  • Because Dr Sanjay Dipstick of CNN pushes marijuana in the absence of data does not make it a good idea for medical care. Regarding THC vs Cannabidiol..they are different, with one an agonist and the other an antagonist. The balance of the two in an uncontrolled manner in whatever is growing in someone’s yard makes for poor scientific study. Animal studies using carefully processed versions of these substances show tremendous analgesia…which cannot be demonstrated in mirrored human studies. Analgesia only occurs with major CNS effects (i.e. being ‘drunk’ or ‘stoned’). Because some media-desperate doc wants to sell ad space by creating clickbait based on the reports of a bunch of users without the benefit of scientifically controlled data (gluten anyone? vaccinations and autism anyone? Ouija boards anyone?) doesn’t mean you need to be a sucker and buy into it. PubMed.com has the scientific literature…it’s a good resource.

  • CBD drastically ameliorate my systemic lupus. Thanks to my knowledge about supplements like this one and the ketogenic diet my SLE is essentially in remission. I wish doctors could help patients who don’t have a PhD to better understand how to use this information.

  • Great article. I often talk to people about this issue. Without knowledge, these new doctors can’t provide recommendations, which in turn, keeps patients from trying cannabis.

    Until we can evolve our education system (beginning in the secondary school health and education classes), we will continue to see sick people sitting on the outside looking in.

  • Joe Dent, Joe Dirt, Joe B and DrT… I’m a retired RN – 20 years of critical care and 20 years of clinical informatics. I don’t mean to be insulting but your education about the endocannabinoid system and it’s important role in all homeostatic processes, and how phytocannabinoids affect that system is severely limited. It absolutely should be taught in all medical and nursing schools. You can remedy your deficiency by going here: https://grannystormcrowslist.wordpress.com/the-list/the-endocannab/

    To say that there is no worthwhile evidence for benefits is obviously because you have your heads stuck in the sand, or elsewhere. If the Federal Government, in all it’s misguided wisdom, had not been blocking research into cannabis for the past 50 years maybe the picture would be much clearer. Supercilious drug warrior attitudes are just not very helpful when we have 90% of Americans in favor of medical cannabis and 61% in favor of legalization. You want evidence based science? It takes a dedicated person to collate ALL the studies and articles that have been published world-wide, pro and con. Go here and get yourself educated: https://grannystormcrowslist.wordpress.com/the-list/

    Or for those with limited time you may prefer a shorter listing of relevant articles and studies at the website of the Society of Cannabis Clinicians, who actually take seriously the medicinal effects of cannabis :
    http://cannabisclinicians.org/
    http://cannabisclinicians.org/search-articles-by-medical-condition/
    Do you know who Dr. Ralph Mechoulam is????

    You all may find this site interesting – O’Shaughnessy’s Online – with this history of the medical “marijuana” movement.
    http://www.beyondthc.com/osr-shop/

  • Medical education should reflect scientific data rather than myths. Unfortunately century old prejudices about marihuana prevented research, thus there is a dearth of good information. Unless the federal ban on marihuana is lifted, there is little chance that universities will do a lot of studies.

  • Also, I’m all for the legalization of marijuana. Smoke it if you got it. JUST DON’T drag the medical profession into this pseudoscience.

    Trust me, I’m a medical student. We’re lectured on this stuff. We objectively look at can marijuana help certain conditions. But the fact that those marijuana cards are given to people for conditions that are not rooted in “evidence based” medicine is absurd.

    Peace out. Stay in school. Don’t do drugs, kids if you’re reading this.

    • Sorry, but this is not a pseudoscience. There are many books by reputable authors you should check out. The anti inflammatory effects are very helpful/curative in many diseases.

  • This is stupid. You realize “medical marijuana” and medical cannabinoids are TWO totally different things, right? The only thing that’s been studied in the literature are medial cannabinoids (synthetic cannabinol) which DOESN’T get you high. The smoke shops which purport themselves as “medical” marijuana dispensaries are just drug dealers in suits. The ONLY proven benefit of smoked marijuana is in the treatment of glaucoma ocular pain; HOWEVER, the amount and frequency one needs to smoke marijuana to achieve adequate pain relief in glaucoma is about 1 joint/hr. Nonsense, no medication is dosed at that frequency and therefore it shouldn’t be a recommended medication for the treatment of glaucoma.

    I understand people have chronic pain and there are other medications for that. But call a spade a spade and all these hemp freaks just want to get high with their “doctor’s” permission.

    • So, Donald Abrams’ work and studies on smoked cannabis at UCSF were just my imagination? You do know all about the endocannabinoid system and how it’s the “master control panel for almost every physiological process in there human body?”

      Smoked cannabis may be required as often as every hour, but so what? If it’s efficacious and reduces the need for other pharmaceutical substances, why is that a problem?

      And, as someone who has experienced chronic pain for decades, the modest euphoria related to marijuana that is more-than-helpful in reducing suffering. Pain isn’t pain until it reaches the brain and that makes it an emotional experience. Smoked cannabis offers me a quality of life that Big Pharma can’t touch.

      I’ve taken CME credits on cannabis through UCSF and cannabis should be the first therapy considered. Well, that’s if you believe in the value of the Hippocratic’s oath: First Do No Harm.

      There’s a growing body-count associated with U.S. medical schools not teaching the endocannabinoid system. And it’s a mistake to conclude that ONLY single-moleucule cannabinoids are medicine.

      You seem to believe in the cult of the Randomized Clinical Trial, a land where case histories don’t exist. If you’re not an expert on the ECS, welcome to the land of DATED physicians.

    • I’ll have to check out Donald Abrams’ work, can’t say I’ve heard of him.

      It’s not a cult of RCTs, although I do find that funny. I do believe there are those rare case reports that are interesting. However, riddle me his: imagine we design a large randomized control trial studying the use of smoked cannabis and traditional therapies (PT exercises, mindfulness, etc) vs opioids and traditional therapies. I would like to see the difference in PROMs (patient reported outcome measures after initiating therapy) but also the rates of secondary outcomes like number of falls, episodes of delirium requiring hospital admission especially in elderly cohorts. Design me that trial and then I’ll support your damn smoked cannabis for medical purposes.

    • Yes I have heard of the endocannabinoid system. But modulating it for measurable clinical outcomes it is like trading penny stocks. It won’t matter.

    • Please read the many books available on the anti inflammatory effects. There are strains with very low THC AND HIGH CBD CONTENT. This allows the patient to have pain relief and they are able to go about their daily lives. Please research before having an opinion.

  • Too bad the authors blended areas where science has demonstrated what the result of intervention is and where it has not. Violence, obesity, pain, plenty of concrete research that says we know what is best and what one can expect from a course of action. Soros and friends brought us “medical marijuana”, no studies, no definitive proven results just lots of stories. That’s not medicine.

    • Please do your research. There are medical journals that have published studies on how there are fewer opiate related deaths in states where there is legal marijuana and how marijuana reduces the need for opiate medications. I have worked in the medical field for almost 2 years and I worked side by side with over 25 different physicians during that time. I have known many doctors who know absolutely nothing about marijuana. A lot of patients are honest and they say they are taking marijuana for a variety of ailments. As an aspiring medical student, I believe it is important to be informed about how medical marijuana can be used as a treatment option for pain, seizures, cancer etc. Marijuana is not going away. Instead of hiding out in the dark ages, we can start being more progessive when it comes to seeking out forms of alternative treatement instead of getting patients hooked on opiates. Jmo

    • Agree with the other comment. While concrete research has been done on violence, obesity and pain management, saying we know what is best is FAR from true! While pain management might be the furthest along, effective interventions for violence and obesity have been stubbornly out of reach regardless of research.

    • Spot on comment. We practice evidence based medicine. There is no worthwhile evidence to support medical marijuana use. American Society of Addiction medicine white paper on marijuana is an excellent review of credible science and decidedly anti marijuana. So tired of all the “Google PhDs” who come on here and tell real health professionals how wrong they are about their beloved wonder drug marijuana. Show me the evidence. The real evidence. The studies showing the harms right now are significantly more compelling. If Pfizer made a pill with 300 chemicals of mostly unknown physiologic effects, clear adverse cognitive effects, psychiatric side effects including association with anxiety, depression, bipolar and schizophrenia, possibly caused cancer and other adverse physical health consequences and had considerable abuse potential and had little to know evidence supporting any actual benefit no physician in their right mind would prescribe it. Yet we are being force fed that marijuana is medicine? It’s all about the money: please count me out!

    • Those commenting saying there is no research are wrong. Please research a subject before having an opinion. Educate yourself, your patients deserve this of their practitioner. If you do not care about improving the lives of your patients, I beg you to find another career. Medicine does not need persons like you treating patients!

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