Debating Hot Button Health Issues

What do prescription drug costs, cigarette taxes, legalizing marijuana, and the Super Bowl have in common? All were topics on the agenda at the January board meeting of the San Francisco Medical Society (SFMS), a professional organization that represents our city’s physicians.

Here we summarize some of the hot button health policy issues up for debate at the January SFMS board meeting.

Debating Marijuana Legalization

SFMS meeting attendees discussed draft legislation aiming to legalize the recreational use of marijuana in California for those 21 and older.

The SFMS has played a large role in drafting a white paper by the California Medical Association on the issue.

The 2011 paper recommended that the Drug Enforcement Agency reclassify marijuana to allow its use in clinical research, and to tax and regulate recreational cannabis, similarly to alcohol and tobacco.

The majority at the SFMS board meeting was in favor of the draft bill. However, some members voiced concern about endorsing full legalization, favoring decriminalization.

Even if marijuana is not as harmful to health as cigarettes — an argument not definitively scientifically proven — it’s still unhealthy.

The American Academy of Pediatrics argued that legalizing marijuana may make it easier for children to obtain the substance. Some attendees wondered if endorsing recreational marijuana would be perceived as contradicting the Society’s harsh opinion of cigarettes. More on that later.

Supporters of the bill are collecting signatures to put the Control, Regulate, and Tax Adult Use of Marijuana Act onto the November 8, 2016 ballot, leaving plenty of time for opinions to be heard.

Bringing Cigarette Tax Up to Par

The California Medical Association, our state’s primary physician organization, is part of the coalition, Save Lives California, supporting legislation raising California state cigarette tax by $2.

Notably, the legislation places equal taxes on e-cigarettes and other plant-derived nicotine products.

Currently, California’s cigarette tax lags behind the national average. A report from the Campaign for Tobacco-Free Kids shows that the current 87-cent per-pack tax is only the 35th highest among all states, behind the average of $1.61 per pack.

A $2 tax hike would bring California up to ninth on the list.

Tax increase proponents note that an estimated $1 billion annual revenue will fund state healthcare programs like Medi-Cal, anti-smoking programs and medical research on tobacco-related diseases.

Cigarettes are a leading cause of preventable death in California, and the CDC estimates the nationwide cost at over $300 billion each year.

SFMS support at the meeting was unanimous, although attendees cited the power of the tobacco lobby as an important challenge to overcome.

Save Lives California issued a petition, which will soon be available on UCSF campuses, to get onto the next statewide ballot.

The SFMS invites students or physicians interested in serving as media spokespeople for the campaign to a media training session (email jkuo@sfms.org for details).

Confronting Big Pharma 

The California Drug Price Relief Act draft legislation on the agenda would require that prescription drugs costs to state programs like Medi-Cal equal the cost to the US Department of Veterans Affairs.

The Relief Act argues that discounts negotiated by Veterans Affairs could serve as benchmarks for the state trying to control spiraling costs of prescription drugs.

But many SFMS members said they worried about the law’s potential for unintended consequences. Drug manufacturers could balk at demanded discounts, and drop important drugs from formularies.

Drug manufacturers could also raise prices for Veterans Affairs to keep caps higher for Californians. Finally, prices for Veterans Affairs may not be the lowest California could negotiate.

SFMS members’ prevailing opinion was that the California Drug Price Relief Act lacks nuance to avoid unintended consequences. There was still consensus on a need to rein in drug prices, and frustration with the pharmaceutical industry lobby’s power to oppose new legislation.

Here are a few other health policy and public health updates from around town:

• Dr. Todd May, Chief Medical Officer at San Francisco General Hospital, said the hospital plans to integrate its electronic health record system with UCSF’s EPIC-based system.

• The Super Bowl and associated events could threaten the well being of homeless individuals in certain parts of the city. Mayor Ed Lee announced that the homeless must decamp from the Embarcadero.

• A public protest at the Embarcadero is planned for the afternoon of Wednesday, February 3.

• The City’s public health department said there’s been a marked improvement in the use of pre-exposure HIV prophylaxis (PrEP).

Fired up about these or other health policy issues?

• UCSF’s new Health Policy Interest Group serves as a student forum discussing healthcare policies and building careers influencing policy.

• Medical students can get involved with UCSF’s combined chapter of the San Francisco Medical Society, California Medical Association, and American Medical Association. Every year, students contribute proposals that get voted on at the city, state, or national level to become real-world policy. If you are interested, email manu.venkat@ucsf.edu or prihatha.narasimmaraj@ucsf.edu.