If there is such thing as a safe haven for marijuana farmers it is Mendocino County, Calif., home to a flourishing green-leaf economy that emerged in the past decade to supply patients who are legally prescribed the weed for medical uses.

A marijuana bud on a plant grown by George and Jean Hanamoto in Mendocino County, Calif. Hanamoto, 74, uses marijuana to relieve glaucoma and back pain.(AP Photo/Rich Pedroncelli)

But now, amid concerns the local marijuana culture is cultivating big business in illegal markets and otherwise disrupting the region’s commerce, residents are pushing back, the New York Times reports. They voted on a proposition last week to restrict how much marijuana patients may keep in their possession. The move reflects action in other communities across the state, where voters have banned or put restrictions on the marijuana clubs that have sprouted up to fill pot prescriptions.

Medical marijuana was legalized in the state in 1996, but federal law continues to prohibit sales of the drug. Resulting busts and drug-agent seizures of plants grown outdoors have caused many growers to move operations to inside rooms and marijuana greenhouses, the Times reports. In Arcata, Calif., home of Humboldt State University, town officials estimate that one in five homes has set aside space to grow marijuana, contributing to a housing shortage for university students.

Local gendarmes have devoted plenty of time to enforcement actions too, as busts like one from a list of recent press releases from the Mendocino County Sheriff’s indicate. The Health Blog reported on the growing backlash against the growing California marijuana economy here.

Current laws in Mendocino County permit a person who has a prescription for marijuana to possess up to 25 mature plants and two pounds of dried pot, well above limits of state law, which allows six mature plants or 12 immature plans and eight ounces of dope, unless a doctor recommends a higher amount. Proposition B, on the ballot for a county election last week, would put the local statutes in compliance with state law.

So far, voters appear to support the restrictions, the Blog has determined. The preliminary count from 16,285 votes: 52%-48% in favor of Proposition B. But Katrina Bartolomie, the county’s assistant registrar of voters, tells the Blog that 11,000 absentee votes remain to be counted and final results may not be known for three weeks.

A virtual primary care practice started growing in Brooklyn last fall.

Jay Parkinson, a freshly minted internist, decided he had a better idea for caring for the under-40 crowd in neighborhoods not far from Health Blog HQ. He combined a pre-paid model (no insurance hassles, please) with housecalls and oodles of online support, which he told us about in an interview with us last September.

He’s still seeing patients the newfangled way. But he’s changed course a bit, joining Myca, a technology company in Canada, to produce what he calls a Facebook-like software platform for doctors to manage their practices. He’s also looking to take his care concept and the new technology to doctors nationally through a franchise branded as Hello Health. (You can watching the video for an overview.)

Parkinson has become something of an evangelist for bringing the power and coolness of the Internet to internal medicine. Today, he’s speaking on “The Healthcare Consumer Fallacy” to IT and health gurus at a meeting put on by the Healthcare Information and Management Systems Society.

We caught up with Parkinson by IM recently. Here’s the conversation, edited just a bit for length and clarity.

WSJ Health Blog: Jay, last we talked with you, you were just starting off on an experiment in delivering primary care. Can you tell us how it’s been going?
jayparkinsonmd: It’s been going better than I ever expected. Without having any sort of referral system in place except “hanging my shingle” as a website, I amassed about 300 patients in 3 months. Everything was going very well except one thing — all of the free pieces of technology I was using weren?t communicating and it was starting to become very frustrating and inefficient. I knew I needed a unified, seamless platform to make this scale.

WSJ Health Blog: So what changes are you making?
jayparkinsonmd: In mid-December, a video news story was on the front page of Yahoo for most of one day. I got about 200 emails an hour from people all over the nation either thanking me, providing encouragement, or asking if I could be their doctor. One of them was a gentleman from Quebec City — Nat Findlay. He basically just said, “We need to talk.”

He flew down the next day and we met for about three hours. Nat was in the process of retiring from Cardinal Health after selling a company he started to Cardinal about 5 years prior. He was looking to start a new company — one that focused on connecting doctors and patients.

During our first meeting, I told him of my vision to create a Facebook-like platform that connects doctors with their patients that also had some sort of EMR functionality to it to keep records. It’s evolved tremendously since then, and I’ve taken a position as Chief Medical Officer/Imagineer with Myca to build this technology and create and roll out Hello Health.

The third of three diabetes studies testing whether aggressively lowering blood sugar reduces risk of heart attacks and death from cardiovascular disease offers doctors and patients some clarity amid conflicting reports on the issue, the Los Angeles Times reports.

You don’t need a fourth leaf for good luck in managing heart risks of diabetes

The study, called the Veterans Affairs Diabetes Trial, was reported yesterday at the American Diabetes Association meeting underway in San Francisco. Put in perspective with results from the other reports–ACCORD from the National Institutes of Health and ADVANCE from Australia that were unveiled Friday–three broad messages for doctors and patients with Type 2 diabetes emerge, the LAT says.

First, the best way to reduce risk from cardiovascular disease is by lowering cholesterol and controlling blood pressure. Reducing blood sugar levels, as measured by hemoglobin A1c significantly below 7% appears to offer little additional benefit on heart risk.

Second, diabetics should strive to avoid hypoglycemic events — those caused by especially low blood sugar which lead to changes in consciousness including blackouts. In the VA study, patients with more than one such event during the 7-1/2-year study had double the risk of a heart-related death and three times the risk of death from any cause.

Third, aggressive control did provide an important benefit among patients who adopted the strategy early in the course of disease, but not if they waited until several years after they were diagnosed, when the approach appeared to turn harmful.

The ADA has its own blogger on the scene, and she quoted William Duckworth, co-chair of the study, like so: “If you treat patients intensively early in the disease, there is a benefit. If you wait 15 years (before starting), the benefit goes away, and may even be detrimental.”

None of this is to steer people away from achieving A1c targets of 7%, which helps prevent such diabetes complications as kidney and eye diseases, the paper reports.

Duckworth, from the Phoenix VA Health Care System, said researchers had expected 650 to 700 cardiovascular events or deaths among all participants over the course of the study, but only 494 occured–263 in the standard treatment group and 231 in the aggressive group. He attributed that finding to the “excellent blood pressure control, lipid control, improved diet and exercise and treatment with aspirin,” the Times said.

Three Leaf Clover by Miss Yellow via Flickr

How far would you go to land or keep affordable health insurance?

Some couples, straight and gay, are finagling wedding dates to quickly get both spouses on a company plan. Other married couples cruising for a breakup can at least agree on postponing divorce to keep both people on the existing health plan of one of them. And some self-employed people are hiring workers just to qualify for group insurance, Dow Jones Newswires’ Victoria E. Knight reports.

The rub is basic. Under federal law, insurers have charge the same for premiums for everybody in an employer-sponsored insurance plan–no matter their health. But try buying health insurance on the open market, and you may face high prices or rejection, depending on your medical history.

One planner told Knight about a client, a woman in her mid-50s, who moved up her wedding so that her fiance, would also become eligible for health benefits offered to workers and spouses as part of a corporate buyout package at her job.

A business owner in California, covered under a small group plan, put her husband on the payroll largely for insurance reasons. “I hired my husband to run my office and manage the IT,” the woman told Dow Jones, who asked not to be named for fear of drawing the attention of insurers.

Seven percent of Americans said that in the past year they or someone in their household decided to tie the knot mainly so one spouse would be eligible for the other?s health coverage, according to a survey by the Kaiser Family Foundation. We were a little skeptical about the figure, which by our calculation seemed a bit high, but have little doubt that insurance worries weigh heavily on millions, married or otherwise.

A controversial Harvard psychiatrist whose research and recommendations have paved the way for the wide use of antipsychotic drugs in kids has received more than $1.6 million in consulting fees from drugmakers since 2000, and he failed to properly disclose much of the funding, the New York Times reports.

Joseph Biederman (pictured) is a polarizing figure in psychiatry. As the Boston Globe put it in a profile last year: “No one has done more to convince Americans that even small children can suffer the dangerous mood swings of bipolar disorder than Dr. Joseph Biederman of Massachusetts General Hospital.” When asked in 2007 by the Globe about his drug company funding, he declined to provide it, but said Harvard Medical School and Mass General approved all his income.

Two colleagues of Biederman’s also earned at least $1 million in fees from drugmakers from 2000 to 2007 and may not have reported the funding properly. The discrepancies were found in documents provided to Congressional investigators. A NYT graphic here summarizes the issues and provides comments from the three psychiatrists.

The disclosure gaps could violate NIH rules on conflict of interest and could lead to sanctions. Policies at Harvard Mass General forbid researchers from conducting clinical tests with a drug if they receive payments greater than $20,000 from the company that makes it, according to a letter from Sen. Charles Grassley (R-Iowa).

Last fall Grassley asked Harvard and Mass General for the conflict-of-interest forms from the doctors as part of his look into financial ties between drugmakers and doctors. The forms were a “mess,” he said, and made it look as if the doctors had only taken a few hundred thousand dollars sums from industry over a seven-year period. After the doctors took another whack at disclosures and Congressional investigators compiled figures from drugmakers, the amounts involved soared to more than $1 million per doctor.

From the Senate floor last week, Grassley asked, “Why weren’t Harvard and Mass General
watching over these doctors? The answer is simple: They trusted these physicians to honestly report this money.” Grassley doesn’t and has introduced the Physician Payments Sunshine Act to require reporting of payments by makers of drugs, devices and medical supplies.

Bonus Reaction: Blogger Philip Dawdy at Furious Seasons writes, “What’s stunning to me is just how much money these researchers were pulling in.” He also provides a link to a rundown of current Biederman trials.

Photo from Massachusetts General Hospital

With questions about the safety of anti-smoking pill Chantix hurting sales, Pfizer’s head of R&D took to the opinion pages of the local paper in support of the medicine over the weekend.

Martin Mackay (pictured) wrote in the Day of New London, Conn., about his firsthand experience with the health toll of “cigarette addiction, having watched both of my parents smoke for most of their adult lives and my mother die of lung disease.”

His basic message was in keeping with points the company hit last week in a roundtable meeting with journalists. Quitting smoking is important, but hard. Chantix, despite some risks, remains a safe and effective option, in Pfizer’s view.

The drugmaker has upgraded the cautions on Chantix’s instructions to advise patients to stop taking Chantix in case of agitation, depression, or unusual behavior. Thoughts of suicide are a particular worry. A heightened concern about risk from Chantix led the FAA to ban the use of the drug by pilots and air-traffic controllers last month.

In his Chantix defense, Mackay couldn’t stop with data alone. He invoked some hometown pride in Chantix, one of Pfizer’s “homegrown” medicines.

The active ingredient in Chantix was invented by scientists in labs in Groton, Conn., on the eastern bank of the Thames River. On the opposite shore, in New London, other Pfizer workers designed and ran the clinical tests that led to the FDA’s approval of Chantix in May 2006. Pfizer employs 6,000 people in the area.

Photo from Pfizer

Microsoft and Kaiser Permanente are partnering to improve the exchange of patient information online, the WSJ reports.

In a pilot program, the giants of software and health care will tackle the transfer of Kaiser employees’ data between Kaiser’s personal health record — an online repository containing test results, prescriptions and immunizations — and Microsoft’s HealthVault, a Web-based service that allows patients to store, manage and share medical on the Web.

If all goes well during the test, expected to run through the fall, the service would be expanded to interested Kaiser patients.

Similar efforts to put personal medical records online are underway at companies such as Revolution Health Group and Google, which launched its online health-care service, Google Health earlier this year. But people have been slow to embrace the approach, the WSJ writes, in part because of privacy and security concerns.

Another big problem is the that only 14% of medical practices keep records electronically, the WSJ noted earlier this year.

Washington health-care lobbyists may be in for some déjà vu as a long-running partisan clash over Medicare Advantage, the controversial private health insurance option for seniors, bubbles up again in legislation to reform Medicare.

Sen. Max Baucus has a plan for Medicare reform (AP Photo)

Today, Senate Finance Committee Chairman Max Baucus, the Montana Democrat, introduced a Medicare bill aimed at avoiding a scheduled 10.6% dropoff in Medicare physician fees set to hit July 1. (You can read a summary of the bill by clicking on the PDF icon on the right.)

The bill hewed pretty closely to the expectations of the lobbyocracy, as well as to a partial outline floated to doctor groups earlier. Besides an increase in physician fees, there are some nice bon bons for others, including rural care providers, clinical labs and community health centers. The legislation would also cut beneficiaries’ co-payments on mental health services. And as we described earlier this week, there are also provisions encouraging doctors to prescribe medicines electronically.

But the bill would also trim the sails of some Medicare Advantage plans. It would phase out extra payments to Medicare Advantage plans for “indirect medical education” at teaching hospitals. It also dings the private fee-for-service plans by forcing them to create approved networks of health-care providers.

Medicare Advantage is a target for Democrats, who often focus on concerns that it costs the government more per beneficiary than traditional Medicare. Republicans, on the other hand, tend to defend the private plans. At the end of 2007, about 20% of Medicare beneficiaries were enrolled in Medicare Advantage plans.

As usual, the Medicare Advantage proposals are likely to be a rub with Republicans. The Baucus bill probably can’t get through the Senate in its current form, and the Bush Administration has already served notice of its intent to defend the Medicare Advantage plans through a veto if necessary. A Republican bill from Sen. Charles Grassley of Iowa is expected next week.

Two diabetes studies released this afternoon are just the latest evidence that lowering key risk factors isn’t enough to improve health. If patients (and their doctors) use the wrong strategies, they may lower risk factors but raise the chances of serious health problems.

That’s the argument from Harlan Krumholz, a Yale cardiologist whose Perspective piece accompanies the studies published today in the New England Journal of Medicine.

One of the studies, dubbed Accord, found that an unusually aggressive approach to lowering glycated hemoglobin, a key risk factor in diabetics, actually increased the risk of death.

The other, called Advance, found that an aggressive approach failed to lower the risk of heart attack or death compared with a more typical treatment approach (though researchers did see less kidney damage in the patients treated aggressively).

Krumholz cites other recent studies that showed that a strategy that should theoretically improve outcomes made no difference or made things worse.

With stents and anemia drugs under pressure, Johnson & Johnson is looking for growth wherever it can find it. Are your kids ready for contact lenses? J&J’s Vistakon division sure thinks so.

J&J thinks she’d look better in contacts (Getty Images)

A recent company-sponsored study showed that kids as young as 8 can wear and properly care for their contacts, said Michael Sneed, the head of J&J’s vision unit, during a J&J review of its medical devices, diagnostics and consumer health businesses yesterday in New Brunswick, N.J.

The typical bespectacled kid who switches to contacts does so around 15, Sneed said. “Our goal is to get contact lens wearers in earlier and staying longer,” he said. “In the future we believe contact lens wearers will range from 8 to 60 years of age. Dropping the entry-level age is integral to growing the category.”

Getting 8-year-olds and up to wear lenses wouldn’t just help the company. The kids would be better able to participate in sports and their self-esteem might also improve, Sneed said. “The belief from optometrists, and from parents, is they would like to put kids in contacts,” he told the Health Blog.

The company has been talking up the contact-lens study with eye doctors in hopes of making them more comfortable with prescribing contacts to youngsters. No further approval from FDA is necessary, and J&J already makes the right sizes.

But parents should use caution in deciding whether their child is ready for contacts because of the risk of infection, Assumpta Madu, an ophthalmologist at Montefiore Medical Center in New York, told the Health Blog. “There will always be some children who are extremely mature for their age who can handle it, but the fear is that there is always possibility of sight-threatening infection,” she said. Because of that risk, the average 8-year-old probably shouldn’t use them, she says.

J&J isn’t ignoring the other end of the age spectrum, either. For older adults who have to stop wearing contacts because they start to have a hard time seeing up close — usually after the age of 45 — the company has products in development to solve the problem. J&J remained mum on exactly what products were coming down the line to address the condition, called presbyopia, but says it has cutting-edge technology and the company is “optimizing it now,” according to Sneed.

Double Vision: You can hear Sneed’s presentation on J&J’s vision business by downloading this podcast from the company’s Web site.