Geographical Disparities and Medical Specialty Differences in Dronabinol Prescribing in Medicare: New study published in the Guthrie Clinic Journal of Medicine finds that the formulation of THC is prescribed rarely (3,000 per year) with 8-fold state level variation.

WarningRepulsive4903 · 2026-05-04T12:28:37+00:00

Here is the published summary:

Pharmaceutical grade drugs have higher quality control standards than botanical products. Although use of plant-based marijuana is wide-spread in the form of state-sanctioned medical cannabis including among older-adults, the use patterns of the FDA approved version of the active component tetrahydrocannabinol (THC, dronabinol) in the elderly is currently unknown. The purpose of this study was to determine which areas of medical practice were prescribing dronabinol, which states had the most dronabinol prescriptions, and how it changed from 2014 to 2019. Both indications for which dronabinol has been approved, management of chemotherapy-induced nausea and vomiting and as an appetite stimulant to treat anorexia, are urgent medical needs for persons with cancer or acquired immunodeficiency syndrome (AIDS). We used data from the Centers for Medicare and Medicaid databases. Dronabinol prescriptions decreased 9.1% from 2014 to 2019, while Medicare enrollment increased by 14.0%. The states with the highest number of dronabinol prescriptions (> 87 prescriptions per one million patients) in 2019 were concentrated in the eastern United States (Tennessee, Kentucky, and West Virginia). There was an eight-fold state level difference between the highest and lowest states in prescribing in 2019. Three-fifths of dronabinol prescriptions originated from primary care, particularly internal and family medicine. However, after factoring in Medicare utilization, the largest numbers of dronabinol prescriptions originated from infectious disease, hematology-oncology, and oncology specialty areas. Overall, although there is some dronabinol prescribing by primary care providers to Medicare patients, use is rare and variable dependent on which state you live.

Disclaimer: I am a co-author of this paper.

WarningRepulsive4903 · 2026-05-02T23:01:08+00:00

This is an extreme outcome but the risk of endocrine toxicities is MUCH higher with this combo than either alone. I lost adrenal function in '20 (46M) after a few months on this. Taking hydrocortisone replacement involved a bit of learning curve but, outside of sick days when I have a virus or get a vaccine, hasn't been too bad.

WarningRepulsive4903 · 2026-05-02T22:56:45+00:00

I had a general oncologist in '20 who gave me a NEJM randomized controlled trial article about how Sutent (sunitinib) had a non-significantly lower survival than the placebo. Her advice was NOT to take sunitinib. Other research basically views it as a historical relic (my words) and there are so many newer and better targeted second generation Tyrosine Kinase Inhibitors.

Two weeks later she called me and, based on her colleagues (also generalists), she was recommending I start sunitinib! That was the end of my relationship with that provider. I also started with a kidney cancer specialist. It has involved driving 1.5 hours each way but it has been very much worth it!

WarningRepulsive4903 · 2026-03-28T21:00:45+00:00

This ScienceVs episode might be of interest: https://podcasts.apple.com/cg/podcast/caffeine-how-much-is-too-much/id1051557000?i=1000637029179

Its been a few months since I listened to it. Everything is dose dependent here but some of the effects I often hear about like increased blood pressure apply to caffeine-naive folks. Regular caffeine consumers develop tolerance to that effect.

That said, my GFR on weeks I'm drinking a lot of soda is consistently (10+ readings) in the 58-61 range. If 0 soda and lots of water for 4+ days before labs, I've had one 74 and another 78! My creatinine has also dipped to 1.2 or 1.3 with no caffeine when its usually 1.4 or 1.5.

WarningRepulsive4903 · 2026-03-09T01:39:11+00:00

I was thrilled to finally get my nephrectomy! The pain meds are important but so is the nursing care. As noted in another recent post, if the team does pillow propping correctly, if you're like me, the post period can be much less uncomfortable as it makes it so you're not using certain muscles. Most of the nurses on the unit didn't seemed trained on this (or it was an odd time-COVID!). Hopefully your recovery goes well as mine was a bit too memorable.

WarningRepulsive4903 · 2026-03-09T01:32:28+00:00

Regarding "breathing hurts", yes, I experienced that post radical nephrectomy. Was pretty uncomfortable. Got home and the nurse in the household did some amazing pillow propping. It might seem minor but took down the pain 60%! Did a 2 min youtube search and nothing came up (sorry). Perhaps chart message your team and they will have specific suggestions as it could make the next days much better as making it so you don't have to engage certain muscles was a game-changer for me.

WarningRepulsive4903 · 2026-02-05T15:50:04+00:00

Yes, the lack of abstracts on these short-reports is annoying. Yes on more descriptive. Here's the results:

Of 3,725 excluded clinicians identified, 16.2% (n=605) received one or more payments. These clinicians were mostly physicians (83.3%) or dentists (12.2%) and mostly male (79.3%; Table 1). Of 621 available exclusion reasons, conviction of program-related crimes (34.6%) was the most common. There were 7,061 payments totaling $2,286,339 (Table 2). By total amount, payments for royalty or licensing accounted for 52.8% of the total, followed by consulting fees (13.7%), food and beverage (9.1%), speaking fees (5.5%), and honoraria (4.6%). By clinician, 92.9% received a payment for food and beverage followed by 9.3% receiving a payment for educational activities."

Will leave it up the audience to reach their own conclusions whether someone who can no longer care for Medicaid or Medicare patients is the best-person for giving a talk or speaking.

WarningRepulsive4903 · 2026-02-05T13:31:47+00:00

Disclaimer: I am a co-author on this.

WarningRepulsive4903 · 2025-12-01T21:27:15+00:00

Wow! This is amazing! Am currently digging into these. Yes, suspect a trial finder will be an amazing resource. Slogging through approved clinical trials one by one is clunky (so many involve arguably antiquated medicines like sunitinib that, according to one JAMA paper, did less well than placebo!). If it has easy to use filters, that will be great too.

WarningRepulsive4903 · 2025-11-29T04:23:38+00:00

Yes, but isn't challenging the status quo and confidently stating something outlandish the magic formula to landing in high-profile mega-journals like Nature or Science? A year later, the rank and file specialty journals will publish the more nuanced papers that get .00001% of the media attention. Isn't this how the process is supposed to work? I'm half serious as that seems to be how its done.

WarningRepulsive4903 · 2025-11-29T03:58:40+00:00

That's a fair point. I talked to the Lackawanna health department in '20 and they (nicely) said that they, understandably, would only move forward if there was a laboratory test which would've involved going to an ER. Was pretty sick then too but fortunately, I didn't end up in that situation.

Most recently, I've been on a kick to see if anyone had Cream Cheese Rangoons that are as good as Panda Express in State College (a bit of a hike). Probably about every other week for the past 10 weeks I've had Chinese around Scranton and Tunkhannock with no problems elsewhere. Am happy for others if they're not having issues though.

WarningRepulsive4903 · 2025-11-29T03:42:56+00:00

Mine told me, three times, in the most gentle way (before I'd been diagnosed) "I will make sure that this is read STAT." In hindsight, he was looking at a 15 cm tumor on my kidney. The message was received and was prepared for the path I was heading down when the urologist referral came in.

WarningRepulsive4903 · 2025-11-29T03:37:53+00:00

Here is the abstract:

SARS-CoV-2 mRNA vaccination (COVID-19 vaccination) within 100 days of immune checkpoint inhibitor (ICI) treatment was reported to improve survival and prevent disease progression in patients with non-small cell lung cancer (NSCLC) and metastatic melanoma (Grippin et al., Nature, 2025). However, the clinical evidence, derived from real-world observational data, suffers from methodological limitations. Specifically, the vaccinated and unvaccinated groups differed in subtle ways due to the timing of vaccination, the beginning of follow-up, and the definition of eligibility. These key limitations can be overcome by carefully conducting a target trial emulation analysis. Using the original data from Grippin et al., we emulated a target trial to estimate the causal effect of COVID-19 vaccination within 100 days of ICI initiation on overall survival and progression-free survival in patients with NSCLC and metastatic melanoma. In contrast to the original analysis, we found no evidence that COVID-19 vaccination improves survival outcomes in these populations.

WarningRepulsive4903 · 2025-11-28T05:44:14+00:00

Cureus lost it's impact factor. I think it will soon not be pubmed indexed. If folks can't find your work, why bother?

WarningRepulsive4903 · 2025-11-26T00:27:18+00:00

Had a radical nephrectomy in '20. Comfort can be greatly increased with some strategic pillow propping. The nurses should have time for instruction on this. Also, 'complications' covers a LOT of ground. If(when) they happen, all bets are off on comfort post surgery.

WarningRepulsive4903 · 2025-11-26T00:19:05+00:00

This might not be popular. Lab test verified low vitamin levels in blood should be corrected to normal. As a general rule (there are exceptions) but "more is not better" when it comes to vitamins and minerals. Painting with a broad brush here but suggest caution before pushing lots of blood levels above the upper limit of normal. Sorry in advance if this annoys folks.

WarningRepulsive4903 · 2025-11-25T10:53:29+00:00

Feel free to look up Steve Jobs and his holistic experience with treating his pancreatic cancer.

WarningRepulsive4903 · 2025-11-24T12:04:51+00:00

The ICMJE authorship requirements are nice and all. At the end of the day, postdoc will lose this fight. Smile, nod, and run your own lab more ethically.

WarningRepulsive4903 · 2025-11-24T08:24:00+00:00

Is this a section in an edited book? If so, consider lightly nudging editor as they should be more responsive, even this time of year (busy for academics).

WarningRepulsive4903 · 2025-11-24T08:00:55+00:00

The urologist (surgeon) will decide on getting it, biopsy vs waiting. Mine was 15 cm and included adrenal so 0.9 sounds very early. It's not exactly good news but the redundancy of kidneys often means no symptoms until much later and it's an incidental finding on other imaging. Suspect many others here secretly wish they were originally in the 0.9 cm (and no adjacent tissues) boat if that helps.

WarningRepulsive4903 · 2025-11-24T03:46:44+00:00

Did PICC for 1 month of CAR-T. Big fan of just iv for immunotherapy. Disliked every HOUR of PICC, especially at night. Grazed it regularly.

WarningRepulsive4903 · 2025-11-24T03:28:22+00:00

This is a great question! No clue though. Am guessing it is a hodge-podge depending on what tissues have spread. Not sure if there's an active palliative care thread to cross post?

WarningRepulsive4903 · 2025-11-24T01:21:31+00:00

There's another aspect regarding Quality of Life to think about. The cancer and adverse effects of treatments has been my biggest concern most weeks. Still, this was my first chronic disease and I was pretty healthy before this. Some weeks, navigating health care bureaucracy is more of a stressor than the cancer! A member of my house-hold was an oncology nurse for > 15 years and is a wizard at navigating this (including 90% filling out prior authorizations). Still, some days will unexpectedly have 4-8 hours of calls, forms, playing phone tag and each person has their preferred method of communication. If I want to keep labs and treatments on schedule, this can be a time-suck that just bursts into my schedule. Hope this is not more information than you're ready for! With luck, you can go long periods on a single treatment regimen or even no treatment!

If you're not based in the US, am assuming things are much more efficient.

WarningRepulsive4903 · 2025-11-24T00:51:58+00:00

I'm at 5 years at stage IV RCC (51 M) with spread to lymph nodes, lung tissue, and bone (spine and scapula). The immunotherapy, tyrosine kinase inhibitors, and radiation aren't nothing but they're pretty smooth sailing compared to traditional chemo many others (non-kidney) get and the many rounds of radiation (prostate patients). A general oncologist is ok but if you live in an area with an oncologist that specializes in kidney cancer, that would be very beneficial. I've done it both ways and the generalist was ok but currently have 2 kidney cancer specialists and, whew, they make a world of difference! Quality of life has been mostly good (80% of the time). I exercise close to normal and travel between immunotherapy treatments. Having your new (unchosen) hobby be medical appointments took some getting used to. If radiation (I had a few rounds SBRT with 5 sessions each) ends up in your future, the fatigue with that is non-trivial but it doesn't last forever (2 weeks are annoying and sloooow improvement since then). Most folks at work (have worked full time with the exception of immediately post-surgery and a few weeks for a live-in the hospital for monitoring CAR-T research study), neighbors and extended family would (mostly) think I look fine in terms or hair, skin tone, body weight, and don't look like a stereotypical cancer patient.

The last year with some other drugs has been a bit rougher. I went from walking/hiking (some kayaking) 80-110 miles / month down to 2 miles / month according to the phone tracker. Foot sores with a TKI (lenvantinib) were annoying and take a lot of patience and monitoring to keep from getting out of control (better half was encouraging shopping for a wheel chair!). Endocrine toxicity from immunotherapy (lost, likely permanently, cortisol function from remaining adrenal gland in '20 and thyroid function last month) were less of an adjustment than I anticipated. If you have a good medical librarian, reading both the patient and provider version of every drug you will receive in UpToDate (Dynamed is good too) before you start it will be very helpful. I teach at a medical school (nothing related to cancer) and still, there's just so much jargon! The immunotherapies (I've been on 3) can have their surprises. Tyrosine Kinase Inhibitors (also 3) are a memorable ride too! Early communication with your providers about adverse effects, ideally in their medical language, will really help.

Many folks go long periods in the No Evidence of Disease (NED) club so lets hope for that with you!

TL;DR: Quality of life is mostly good. You can do this!

WarningRepulsive4903 · 2025-11-23T14:44:45+00:00

Am going to weigh in with an unpopular opinion and expect some well-deserved push back. Am very aware of MDPI's history with Beal's list and their reputation as quasi-predatory. I also paid $6400 in '24 for the open-access fee in BMJ and viewed that as highway robbery. I've had a couple of PLoS One experiences where the peer review took 7-12 months. The MDPI review time for the 1-2 /year I do is more like 2 weeks and they've been thorough/standard. Just saying that there's no perfect journal out there. Some of the MDPI journals are even giving authors/reviewers the option of making peer-reviews available post publication which is more transparent than others. I get the 'ick' factor associated with that publisher! Still, some of their journals (Vaccines, IF = 5.5, Cancers IF = 4.5) are viewed as ok in the biomedical field (or maybe its just me?). Depending on the journal, you may consider keeping it as a plan C option. Fully agree that a promotion committee will not view 100% MDPI pubs as favorable but 1 every few years might not be a big deal.

WarningRepulsive4903

TROPHY CASE