Michelle Mello and colleagues; Relationship Between State Malpractice Environment and Quality of Health Care in the United States

Jt Comm J Qual Patient Saf. 2017 May;43(5):241-250. doi: 10.1016/j.jcjq.2017.02.004. Epub 2017 Mar 27.

Relationship Between State Malpractice Environment and Quality of Health Care in the United States.

Bilimoria KY, Chung JW, Minami CA, Sohn MW, Pavey ES, Holl JL, Mello MM.

Abstract

BACKGROUND:

One major intent of the medical malpractice system in the United States is to deter negligent care and to create incentives for delivering high-quality health care. A study was conducted to assess whether state-level measures of malpractice risk were associated with hospital quality and patient safety.

METHODS:

In an observational study of short-term, acute-care general hospitals in the United States that publicly reported in the Centers for Medicaid & Medicare Services Hospital Compare in 2011, hierarchical regression models were used to estimate associations between state-specific malpractice environment measures (rates of paid claims, average Medicare Malpractice Geographic Practice Cost Index [MGPCI], absence of tort reform laws, and a composite measure) and measures of hospital quality (processes of care, imaging utilization, 30-day mortality and readmission, Agency for Healthcare Research and Quality Patient Safety Indicators, and patient experience from the Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]).

RESULTS:

No consistent association between malpractice environment and hospital process-of-care measures was found. Hospitals in areas with a higher MGPCI were associated with lower adjusted odds of magnetic resonance imaging overutilization for lower back pain but greater adjusted odds of overutilization of cardiac stress testing and brain/sinus computed tomography (CT) scans. The MGPCI was negatively associated with 30-day mortality measures but positively associated with 30-day readmission measures. Measures of malpractice risk were also negatively associated with HCAHPS measures of patient experience.

CONCLUSIONS:

Overall, little evidence was found that greater malpractice risk improves adherence to recommended clinical standards of care, but some evidence was found that malpractice risk may encourage defensive medicine.

Ending ObamaCare, Part One

House Republicans take a giant step toward better health care.

"The bill doesn’t repeal all of ObamaCare because it can’t without Democratic help under the Senate’s budget rules. But the bill marks a giant step away from the Democratic march to government-run health care, which is why the political and cultural left have been so vitriolic in their denunciations."

"But these nostalgic images are a shoddy replacement for any sophisticated understanding of history..."

Look back with danger

SIMON GOLDHILL

"Today’s constant talk of nostalgia – for old passport covers, old manners, old food, and above all that fantasy of a Britain before multiculturalism – is in part a response to rapid social change and feelings of insecurity. In part, it is what anyone who is growing older might feel, as their childhood becomes vividly distant. But these nostalgic images are a shoddy replacement for any sophisticated understanding of history – the complex story of the past, and the intricate forces that link the past and the present – and that is why we should be worried when politicians play the nostalgia card. When we forget that the questions “where have we come from?” and “where we going?” are integrally linked, we drastically reduce our chances of self-understanding or effective action. If we oversimplify history, we will live – as both Cicero and Kant predicted – with the shallow mindfulness of children."

Subst Abuse. 2017 Mar 23;11:1178221816685087. doi: 10.1177/1178221816685087. eCollection 2017.

"Don't Judge a Book Its Cover": A Qualitative Study of Methadone Patients' Experiences of Stigma.

Woo J1, Bhalerao A1, Bawor M2, Bhatt M3, Dennis B2, Mouravska N4, Zielinski L5, Samaan Z2,3,4,6.

Author information

1

Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

2

Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.

3

Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.

4

Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

5

MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.

6

Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada.

Abstract

INTRODUCTION:

Despite its efficacy and widespread use, methadone maintenance treatment (MMT) continues to be widely stigmatized. Reducing the stigma surrounding MMT will help improve the accessibility, retention, and treatment outcomes in MMT.

METHODS:

Semi-structured interviews were conducted with 18 adults undergoing MMT. Thematic content analysis was used to identify overarching themes.

RESULTS:

In total, 78% of participants reported having experienced stigma surrounding MMT. Common stereotypes associated with MMT patients included the following: methadone as a way to get high, incompetence, untrustworthiness, lack of willpower, and heroin junkies. Participants reported that stigma resulted in lower self-esteem; relationship conflicts; reluctance to initiate, access, or continue MMT; and distrust toward the health care system. Public awareness campaigns, education of health care workers, family therapy, and community meetings were cited as potential stigma-reduction strategies.

DISCUSSION AND CONCLUSION:

Stigma is a widespread and serious issue that adversely affects MMT patients' quality of life and treatment. More efforts are needed to combat MMT-related stigma.

Epidemiol Infect. 2017 May 2:1-10. doi: 10.1017/S0950268817000760. [Epub ahead of print]

Constructing Ebola transmission chains from West Africa and estimating model parameters using internet sources.

Pettey WBP1, Carter ME1, Toth DJA1, Samore MH1, Gundlapalli AV1.

Author information

1

University of Utah School of Medicine,Salt Lake City, Utah,USA.

Abstract

During the recent Ebola crisis in West Africa, individual person-level details of disease onset, transmissions, and outcomes such as survival or death were reported in online news media. We set out to document disease transmission chains for Ebola, with the goal of generating a timely account that could be used for surveillance, mathematical modeling, and public health decision-making. By accessing public web pages only, such as locally produced newspapers and blogs, we created a transmission chain involving two Ebola clusters in West Africa that compared favorably with other published transmission chains, and derived parameters for a mathematical model of Ebola disease transmission that were not statistically different from those derived from published sources. We present a protocol for responsibly gleaning epidemiological facts, transmission model parameters, and useful details from affected communities using mostly indigenously produced sources. After comparing our transmission parameters to published parameters, we discuss additional benefits of our method, such as gaining practical information about the affected community, its infrastructure, politics, and culture. We also briefly compare our method to similar efforts that used mostly non-indigenous online sources to generate epidemiological information.

Doctors urge more exercise for pregnant women

"About 45 percent of current mothers-to-be begin their pregnancy in an overweight or obese state, vs. 24 percent in 1983. In addition, nearly half of pregnant women now gain more weight in nine months than the amounts recommended by the Institute of Medicine. Those guidelines are ordered by body mass index of the woman -- normal, overweight or obese -- and stand at 25 to 35 pounds, 15 to 25 pounds, and 11 to 20 pounds."

From Tim Mackey and Bryan Liang: After Amarin v FDA: What Will the Future Hold for Off-label Promotion Regulation?

Mayo Clin Proc. 2016 Jun;91(6):701-6. doi: 10.1016/j.mayocp.2016.02.024. Epub 2016 Apr 12.

After Amarin v FDA: What Will the Future Hold for Off-label Promotion Regulation?

Mackey TK1, Liang BA2.

Author information

1

Department of Anesthesiology, Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA; Joint Masters Program in Health Policy and Law, University of California, San Diego School of Medicine and California Western School of Law, San Diego, CA; Global Health Policy Institute, La Jolla, CA. Electronic address: tmackey@ucsd.edu.

2

Global Health Policy Institute, La Jolla, CA.

"When manufacturers engage in promotion for any indication, dosage, or administration outside the FDA approval, they engage in illegal off-label promotion.4 However, the lines between illegal and permitted off-label promotion are now being blurred in the wake of the Amarin decision, which is likely to have a lasting impact on future drug promotion practices, regulatory and enforcement activities, and the role of the physician in patient care."

J Bioeth Inq. 2017 May 3. doi: 10.1007/s11673-017-9784-y. [Epub ahead of print]

Stigma and Self-Stigma in Addiction.

Matthews S1, Dwyer R2,3, Snoek A4.

Author information

1

Plunkett Centre for Ethics, Centre for Moral Philosophy and Applied Ethics, Australian Catholic University (ACU), Institute for Religion and Critical Inquiry (IRCI), 7 Ice Street, Darlinghurst, Sydney, NSW, 2010, Australia. stephen.matthews@acu.edu.au.

2

Social Studies of Addiction Concepts (SSAC) Research Program, National Drug Research Institute (Melbourne Office), Faculty of Health Sciences, Curtin University, Bentley, Australia.

3

Centre for Cultural Diversity and Wellbeing, College of Arts, Victoria University, Melbourne, Australia.

4

Faculty of Health, Medicine and Life Sciences, Maastricht University, Peter Debyeplein 1, 6229 HA, Maastricht, The Netherlands.

Abstract

Addictions are commonly accompanied by a sense of shame or self-stigmatization. Self-stigmatization results from public stigmatization in a process leading to the internalization of the social opprobrium attaching to the negative stereotypes associated with addiction. We offer an account of how this process works in terms of a range of looping effects, and this leads to our main claim that for a significant range of cases public stigma figures in the social construction of addiction. This rests on a social constructivist account in which those affected by public stigmatization internalize its norms. Stigma figures as part-constituent of the dynamic process in which addiction is formed. Our thesis is partly theoretical, partly empirical, as we source our claims about the process of internalization from interviews with people in treatment for substance use problems.

From Mari Mino-Kenudson: Programmed death-ligand 1 immunohistochemistry testing for non-small cell lung cancer in practice

Cancer. 2017 May 4. doi: 10.1002/cncy.21873. [Epub ahead of print]

Programmed death-ligand 1 immunohistochemistry testing for non-small cell lung cancer in practice.

Mino-Kenudson M1.

Author information

1

Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

"Given the recent approval by the US Food and Drug Administration of an anti-programmed cell death protein 1 agent as a first-line therapy for patients with advanced non-small cell lung cancer, programmed death-ligand 1 (PD-L1) immunohistochemistry (IHC) testing has become routine in pathology laboratories in the United States. Each pathology laboratory needs to select a PD-L1 IHC assay among the multiple assays available, conduct appropriate optimization and validation processes, and pay close attention to appropriate preanalytical tissue handling and the selection of optimal tissue samples."

We need to get active to help kids of the future

We need to get active to help kids of the future

"We must all model appropriate eating habits and exercise regimes ourselves if we are ever going to stop the increasing rates of childhood overweight and obesity."

Front Vet Sci. 2017 Apr 19;4:45. doi: 10.3389/fvets.2017.00045. eCollection 2017.

Veterinarians and Humane Endings: When Is It the Right Time to Euthanize a Companion Animal?

Knesl O1, Hart BL2, Fine AH3, Cooper L4, Patterson-Kane E5, Houlihan KE5, Anthony R6.

Author information

1

Zoetis Inc., Parsippany, NJ, USA.

2

Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, CA, USA.

3

College of Education and Integrative Studies, California State Polytechnic University, Pomona, CA, USA.

4

Davis, CA, USA.

5

Animal Welfare Division, American Veterinary Medical Association, Schaumburg, IL, USA.

6

Department of Philosophy, University of Alaska Anchorage, Anchorage, AK, USA.

Abstract

Current advances in technologies and treatments provide pet owners and veterinarians with more options for prolonging the life of beloved pets, but can simultaneously lead to ethical dilemmas relating to what is best for both animal and owner. Key tools for improving end-of-life outcomes include (1) sufficient training to understand the valid ethical approaches to determining when euthanasia is appropriate, (2) regular training in client communication skills, and (3) a standard end-of-life protocol that includes the use of quality of life assessment tools, euthanasia consent forms, and pet owner resources for coping with the loss of a pet. Using these tools will improve outcomes for animals and their owners and reduce the heavy burden of stress and burnout currently being experienced by the veterinary profession.

Did Net neutrality keep broadband out of low-income neighborhoods, as FCC claims?

"FCC Chairman Ajit Pai argues that the rules, which rely on utility-style authority based on Title II of The Communications Act of 1934, overburden Internet service providers (ISPs) and kept them from investing in low-income rural and urban areas. Democrats say that didn't happen. And they consider the current regulations as critical to protecting consumers from net providers blocking or slowing some content, while possibly favoring their own."

UK must get tough on childhood obesity, says top doctors

UK must get tough on childhood obesity, says top doctors

Obesity Health Alliance issues 10-point action plan in hope of influencing party manifestos for general election

"Britain must take much tougher action to tackle childhood obesity, including banning sponsorship of sports events by manufacturers of unhealthy food and drinks, leading doctors will warn. Without such robust measures, the NHS will come under “enormous and unsustainable strain” from a condition that already costs it £5bn a year, according to an action plan by the Obesity Health Alliance."

Does baby powder cause cancer? Another jury says yes.

WHAT RESEARCH SHOWS

The biggest studies have found no link between talcum powder applied to the genitals and ovarian cancer. But about two dozen smaller studies over three decades have mostly found a modest connection — a 20 percent to 40 percent increased risk among talc users.

However, that doesn’t mean talc causes cancer. Several factors make that unlikely, and there’s no proof talc, which doesn’t interact with chemicals or cells, can travel up the reproductive tract, enter the ovaries and then trigger cancer.

One large study published in June 2016 that followed 51,000 sisters of breast cancer patients found genital talc users had a reduced risk of ovarian cancer, 27 percent lower than in nonusers. An analysis of two huge, long-running U.S. studies, the Women’s Health Initiative and the Nurses’ Health Study, showed no increased risk of ovarian cancer in talc users.

WHAT EXPERTS SAY

If there were a true link, Dr. Hal C. Lawrence III says large studies that tracked women’s health for years would have verified results of the smaller ones.

“Lord knows, with the amount of powder that’s been applied to babies’ bottoms, we would’ve seen something,” if talc caused cancer, said Lawrence, vice president of the American College of Obstetrics and Gynecology.

The National Cancer Institute’s Dr. Nicolas Wentzensen says the federal agency’s position is that there’s not a clear connection.

“It is very hard to establish causal relationships,” he said, adding, “A lot of ovarian cancers occur in women who have never used talc, and many women have used talc and not gotten ovarian cancer.”

Research director Elizabeth Ward of the American Cancer Society says it is unusual to have so much discrepancy between studies. “The risk for any individual woman, if there is one, is probably very small,” Ward said.

Arch Pathol Lab Med. 2017 Apr 18. doi: 10.5858/arpa.2017-0105-SA. [Epub ahead of print]

Twenty-First Century Pathologists' Advocacy.

Allen TC.

Abstract

Pathologists' advocacy plays a central role in the establishment of continuously improving patient care quality and patient safety, and in the maintenance and progress of pathology as a profession. Pathology advocacy's primary goal is the betterment of patient safety and quality medical care; however, payment is a necessary and appropriate component to both, and has a central role in advocacy. Now is the time to become involved in pathology advocacy; the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) and the Protecting Access to Medicare Act of 2014 (PAMA) are two of the most consequential pieces of legislation impacting the pathology and laboratory industry in the last 20 years. Another current issue of far-reaching impact for pathologists is balance billing, and yet many pathologists have little or no understanding of balance billing. Pathologists at all stages of their careers, and in every professional setting, need to participate. Academic pathologists have a special obligation to, if not become directly involved in advocacy, at least have a broad and current understanding of those issues, as well as the need and responsibility of pathologists to actively engage in advocacy efforts to address them, in order to teach residents the place of advocacy, and its value, as an inseparable and indispensable component of their professional responsibilities.

Abandoned on Bataan: One Man's Story of Survival 

October, 2002

by Oliver Craig Allen  (Author), Mildred Faye Allen (Author)

"Back in the Philippines, there was no hero worship."

Battle of the Coral Sea and Corregidor: When America’s worst defeat gave way to victory

"As the Japanese tightened their grip on Bataan, President Franklin Roosevelt ordered MacArthur to leave Corregidor and proceed to Australia, ostensibly to take command of a relief expedition. His return to the Philippines would take years, but MacArthur’s dramatic escape by PT-boat propelled him into legend as the hero the American public desperately needed during the uncertain early months of the war.

Back in the Philippines, there was no hero worship. Faced with starvation, forces on Bataan surrendered early in April. Corregidor hung on until May 6. Where did this disastrous defeat leave America and its allies? As MacArthur hunkered down in Australia and mourned the fall of Corregidor, two aircraft carriers of the US Navy sailed into the Coral Sea to counter an invasion aimed at Port Moresby on New Guinea that threatened Australia itself."

Surviving veteran of Bataan Death March recalls horror 75 years later

Andrew J. Evans, Mohamed E. Salama, Walter H. Henricks, and Liron Pantanowitz (2017) Implementation of Whole Slide Imaging for Clinical Purposes: Issues to Consider From the Perspective of Early Adopters. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Implementation of Whole Slide Imaging for Clinical Purposes: Issues to Consider From the Perspective of Early Adopters

Andrew J. Evans, MD, PhD; Mohamed E. Salama, MD; Walter H. Henricks, MD; Liron Pantanowitz, MD

From the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Evans); the Department of Pathology, University of Utah and ARUP Laboratories, Reference Laboratory, Salt Lake City (Dr Salama); the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Henricks); and the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Pantanowitz).

Reprints: Andrew J. Evans, MD, PhD, Department of Pathology, University Health Network, Toronto General Hospital, 11-Eaton-223, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada (email: andrew.evans@uhn.ca).

Context.— There is growing interest in the use of digital pathology, especially whole slide imaging, for diagnostic purposes. Many issues need to be considered when incorporating this technology into a clinical laboratory. The College of American Pathologists established a Digital Pathology Committee to support the development of College programs related to digital pathology. One of its many initiatives was a panel discussion entitled “Implementing Whole-Slide Imaging for Clinical Use: What to Do and What to Avoid,” given for 3 years at the College's annual meetings starting in 2014.

Objectives.— To review major issues to consider when implementing whole slide imaging for clinical purposes as covered during the panel discussion.

Design.— The views expressed and recommendations given are based primarily on the personal experience of the authors as early adopters of this technology. It is not intended to be an exhaustive review of digital pathology.

Results.— Implementation is best approached in phases. Early efforts are directed toward identifying initial clinical applications and assembling an implementation team. Scanner selection should be based on intended use and budget. Recognizing pathologist concerns over the use of digital pathology for diagnostic purposes, ensuring adequate training, and performing appropriate validation studies will enhance adoption. Once implemented, the transition period from glass slide to image-based diagnostics will be associated with challenges, especially those related to a hybrid glass slide–digital slide workflow.

Conclusions.— With appropriate preparation, planning, and stepwise implementation, whole slide imaging can be used safely and reliably for frozen sections, consultation, quality assurance, and primary diagnosis.

30% of Americans have fatty liver disease

30% of Americans Have This Obesity-Related Disease

There are no drugs approved to treat fatty liver disease, although losing weight through diet and exercise can help reduce fat in the liver and related inflammation. Doctors can also help patients identify other obstacles to weight loss, like sleep problems or certain medications.

“For the majority of patients, lifestyle modification is way more effective than any drug,” says Behari. “All of these chronic disorders—fatty liver, diabetes, heart disease—share an underlying metabolic component, and the same common-sense healthy living principles apply for all of them.”

Transplant Proc. 2017 May;49(4):707-710. doi: 10.1016/j.transproceed.2017.02.013.

Ethical Issues in Uterine Transplantation: Psychological Implications and Informed Consent.

Petrini C1, Gainotti S2, Morresi A3, Nanni Costa A4.

Author information

1

Bioethics Unit, Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy. Electronic address: carlo.petrini@iss.it.

2

Bioethics Unit, Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy.

3

Dipartimento di Chimica, Biologia e Biotecnologie, Università degli Studi di Perugia, Perugia, Italy.

4

Centro Nazionale Trapianti (National Transplant Centre), Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy.

Abstract

Since 2000, 13 uterine transplantations (UTxs) have been performed in women with absolute uterine infertility factor (AUIF), from both living and deceased donors, in different transplantation centers worldwide. At present the birth of 4 children following UTx is documented by the literature, and a woman was having a second pregnancy in October 2015. Following these successes it is likely that the procedure will become part of normal healthcare practice, even though at the moment it is still experimental and, as such, requires careful attention. Because the emotional aspects that are tied to UTx may foster the "therapeutic misconception" of participants, which consists in an overestimation of the benefits and an underestimation of the risks, careful attention should be paid also to informed consent (IC), which must include the following: describing techniques, pointing out risks and possibility of failure, and informing about the treatments required after the intervention. Because the final aim of UTx is the birth of a healthy child, the IC document must include details not only of the transplantation itself, but also of the very particular pregnancy deriving from it, and the need to remove the uterus following delivery(ies) to avoid these risks. Here we suggest that the IC process includes counselling techniques, possibly involving the psychologist that is part of the transplantation team, to target the information and decision-making process to the specific situation of each couple.

Med Decis Making. 2017 Apr 1:272989X17696999. doi: 10.1177/0272989X17696999. [Epub ahead of print]

An Approach to Reconciling Competing Ethical Principles in Aggregating Heterogeneous Health Preferences.

Dewitt B1,2,3, Davis A1,2,3, Fischhoff B1,2,3, Hanmer J1,2,3.

Author information

1

Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA (BD, AD).

2

Department of Engineering and Public Policy and the Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, USA (BF).

3

Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA (JH).

Abstract

BACKGROUND:

Health-related quality of life (HRQL) scores are used extensively to quantify the effectiveness of medical interventions. Societal preference-based HRQL scores aim to produce societal valuations of health by aggregating valuations from individuals in the general population, where each aggregation procedure embodies different ethical principles, as explained in social choice theory.

METHODS:

Using the Health Utilities Index as an exemplar, we evaluate societal preference-based HRQL measures in the social choice theory framework.

RESULTS:

We find that current preference aggregation procedures are typically justified in terms of social choice theory. However, by convention, they use only one of many possible aggregation procedures (the mean). Central to the choice of aggregation procedure is how to treat preference heterogeneity, which can affect analyses that rely on HRQL scores, such as cost-effectiveness analyses. We propose an analytical-deliberative framework for choosing one (or a set of) aggregation procedure(s) in a socially credible way, which we believe to be analytically sound and empirically tractable, but leave open the institutional mechanism needed to implement it.

CONCLUSIONS:

Socially acceptable decisions about aggregating heterogeneous preferences require eliciting stakeholders' preferences among the set of analytically sound procedures, representing different ethical principles. We describe a framework for eliciting such preferences for the creation of HRQL scores, informed by social choice theory and behavioral decision research.

Alternate-day fasting not shown to increase weight loss: Study

"The researchers found at the end of the year that there was not a significant difference between the group that practiced alternate fasting and the group that cut calories."

Marijuana "...properly being considered a 'gateway drug'."

CNS Neurol Disord Drug Targets. 2017 Apr 13. doi: 10.2174/1871527316666170413113246. [Epub ahead of print]

Cannabis; epidemiological, neurobiological and psychopathological issues: an update.

De Luca MA1, Di Chiara G1, Cadoni C2, Lecca D1, Orsolini L3, Papanti D3, Corkery J3, Schifano F3.

Author information

1

Department of Biomedical Sciences, Neuropsychopharmacology Unit, University of Cagliari, Italy Cagliari. Italy.

2

Centre of Excellence "Neurobiology of Dependence", University of Cagliari-Cagliari, Italy Cagliari. Italy.

3

Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Hatfield, Herts, AL10 9AB, UK herts. United Kingdom.

Abstract

Cannabis is the illicit drug with both the largest current levels of consumption and the highest lifetime prevalence in the world. Across different countries, the prevalence of cannabis use varies according to the individual income, with the highest use reported in North America, Australia and Europe. Despite its 'soft drug' reputation, cannabis misuse may be associated with several acute and chronic adverse effects. The present article aims at reviewing several papers on epidemiological, neurobiological and psychopathological aspects of the use of cannabis. To this end, the PubMed database was examined in order to collect and discuss several papers. Cannabis intake usually starts during late adolescence/early adulthood (15-24 years) and drastically decreases in adulthood with the acquisition of working/familiar and social responsibilities. Clinical evidence supports the current socio-epidemiological alarm concerning the increased consumption among youngsters and the risks related to the onset of psychotic disorders. The mechanism of action of cannabis presents some analogies with other abused drugs, e.g. opiates. Furthermore, it has been well demonstrated that intake in adolescence may facilitate the transition to the use and/or abuse of other psychotropic drugs, hence properly being considered a 'gateway drug'. Some considerations on synthetic cannabimimetics are provided here as well. In conclusion, the highest prevalence of cannabis use and the social perception of a relatively low associated risk are in contrast with current knowledge based on biological and clinical evidence. Indeed, there are concerns relating to cannabis intake association with detrimental effects on both cognitive impairment and mental health.