Donna M. Olsen

A Controlled Trial of Multiphasic Screening

A clinical controlled trial was designed to determine the impact of Automated Multiphasic Health Testing on morbidity and attitudes. Three strata comprising 574 families (lower-income group enrolled in health maintenance organization, lower-income not enrolled in such a project, and a middle-income group employed by a utility company) were interviewed to obtain information on utilization, morbidity, health status, and attitudes. Sixty percent of adults in each stratum were then screened. All families were interviewed again one year later. The only significant difference found between screened and non-screened subjects was an increase in nights hospitalized for screened subjects. Physicians were interviewed to determine what abnormalities were found and what treatment was required for project and privately referred patients of these physicians. Previously unknown abnormalities prompted retesting for confirmation in only 28 per cent of the cases and even less often led to treatment.

The Influence of Cannabidiol and Δ9-Tetrahydrocannabinol on Cobalt Epilepsy in Rats

Summary: The mechanisms of the anticonvulsant activity of cannabidiol (CBD) and the central excitation of Δ9‐tetrahydrocannabinol (Δ9‐THC) were investigated electrophysiologically with conscious, unrestrained cobalt epileptic rats. The well‐known antiepileptics, trimethadione (TMO), ethosuximide (ESM), and phenytoin (PHT), were included as reference drugs. Direct measurements were made of spontaneously firing, epileptic potentials from a primary focus on the parietal cortex and convulsions were monitored visually. ESM and TMO decreased the frequency of focal potentials, but PHT and CBD exerted no such effect. Although CBD did not suppress the focal abnormality, it did abolish jaw and limb clonus; in contrast, Δ9‐THC markedly increased the frequency of focal potentials, evoked generalized bursts of polyspikes, and produced frank convulsions. 11‐OH‐Δ9‐THC, the major metabolite of Δ9‐THC, displayed only one of the excitatory properties of the parent compound: production of bursts of polyspikes. In contrast to Δ9‐THC and its 11‐OH metabolite, CBD, even in very high doses, did not induce any excitatory effects or convulsions. The present study provides the first evidence that CBD exerts anticonvulsant activity against the motor manifestations of a focal epilepsy, and that the mechanism of the effect may involve a depression of seizure generation or spread in the CNS.

An Electrophysiological Analysis of the Anticonvulsant Action of Cannabidiol on Limbic Seizures in Conscious Rats

Summary: The effects of cannabidiol (CBD) on electrically evoked kindled seizures were studied in conscious, unrestrained rats with chronically implanted cortical and limbic electrodes, and the results were compared with those of Δ9 ‐tetrahydrocannabinol (Δ9‐THC), phenytoin (PHT), and ethosuximide (ESM). All drugs were anticonvulsant, but there were marked differences in their effects on afterdischarge (AD) threshold, duration, and amplitude. CBD, like PHT and Δ9‐THC, elevated the AD threshold; in contrast, ESM decreased the threshold but suppressed AD spread. CBD, however, also resembled ESM inasmuch as both drugs decreased AD duration and amplitude. Electrophysiologically, the antiseizure effects of CBD were a combination of those of PHT and ESM. The combination of effects may account for the observation that CBD was the most efficacious of the drugs tested against limbic ADs and convulsions. Other properties of CBD were also noted: For example, compared with Δ9‐THC, it is a much more selective anticonvulsant vis‐à‐vis motor toxicity. CBD also lacks the CNS excitatory effects produced by Δ9‐THC, PHT, and ESM. These characteristics, combined with its apparently unique set of electrophysiological properties, support the suggestion that CBD has therapeutic potential as an antiepileptic.

Medical care as a commodity

A 10% household sample of high- and low-income census tracts was interviewed to assess the extent of doctor shopping. In 632 households studied, 53% of high socioeconomic status and 51% of low socioeconomic status families had shopped for or changed doctors of their own volition. During the previous year, 4% of each socioeconomic group had consulted more than one doctor without referral for the same episode of illness. Shoppers could be distinguished from non-shoppers—shoppers were younger, were better informed about medical specialties, were less self-reliant, more hypochondriacal, expressed less hostility toward physicians, and had less positive attitudes toward the medical care system. The differences between shoppers and non-shoppers were generally similar for both high and low socioeconomic status groups. In addition, 52% of the families studied had been forced to change doctors because of circumstances beyond their control, i.e., the patient moved or the doctor moved, retired, or died.

Effects of adding a Medex on practice costs and productivity

Archival data on ten rural practices employing a Medex and on ten matched controls were compared to determine changes in the volume of patients seen and changes in the practice finances before and after the employment of a Medex. There were no significant differences in the changes in patient volume; however, the practices that employed a Medex showed an increase in revenue and in net profit per physician. On the average, the net profit increased approximately

Changes in utilization patterns in a National Health Service Corps community.

11,000 (22%) for the physicians with Medex, compared with

Issues underlying prevalence of "doctor-shopping" behavior

9,000 (21%) for the control physicians.

MANIPULATING THE PATIENT A COMPARISON OF THE EFFECTIVENESS OF PHYSICIAN AND CHIROPRACTOR CARE

Utilization patterns in two adjacent rural Utah counties were compared over a span of five years (1971-1976). In one, a three-physician National Health Service Corps site was established during the interval; the other went from one family physician to two during the same period. The Corps site showed an increase in physician utilization while the “control” county utilization remained unchanged. However, despite the increased utilization of physicians in the Corps site, fewer respondents identified a family physician, especially one located within the county. This is consistent with an interpretation that county residents were content to use Corps physicians, but saw them as transitory figures with whom they could form no permanent attachment. A second brief follow-up study a year later suggests that the community had already begun to acknowledge the Corps doctors as their family physicians.