From my story at Academic Pharmacy Now:

https://www.aacp.org/article/medical-marijuana-goes-mainstream

Ninety years ago, marijuana was widely known as the “evil weed,” prompting the 1936 propaganda film “Reefer Madness” about its dangers. In the ensuing decades, study after study gradually backed off the hyperbole about marijuana, though it is still under a spotlight of continued research. In today’s world, marijuana is sometimes used to treat what ails us. Pharmacy is keeping pace as medical marijuana goes mainstream.

Pharmacy schools are offering programs to study medical marijuana not only for student pharmacists but others seeking to learn more about it for myriad reasons, including regulatory or business purposes as well as for improved patient care. As the industry expands, more colleges are adding cannabis or marijuana courses to their portfolio. Medical marijuana is gaining traction in America with more states legalizing its use and more dispensaries opening across the country. Some educators point to the increasing need for medical professionals—including physicians, nurses and pharmacists—to properly advise patients about medical marijuana.

At last count, 33 states as well as the District of Columbia, Guam and Puerto Rico have legalized medical marijuana. Three states are already requiring that pharmacists be part of the dispensing process, according to the National Community Pharmacists Association. For instance, New York State requires a pharmacist to be on the premises and supervising the activities within a marijuana dispensing facility.

The legalization movement is expected to broaden to more states. “The number is only expected to increase in the future, fueling a demand for an educated workforce that is well-trained in both the science and therapeutic effects associated with this medicinal plant,” said Dr. Natalie D. Eddington, dean and professor at the University of Maryland School of Pharmacy.

A 2019 study from the University of Pittsburgh School of Pharmacy found that 62 percent of U.S. pharmacy schools surveyed incorporated medical cannabis into their doctor of pharmacy programs and another 23 percent planned to include courses in their programs in the next 12 months.

The University of Maryland School of Pharmacy has launched a new master of science in medical cannabis science and therapeutics, one of the first in the country to do so. The two-year program is designed for an array of healthcare professionals, scientists, regulators, dispensary owners and staff and anyone interested in the field. The program was developed “because of a knowledge gap (in medical cannabis), particularly for healthcare professionals,” said Dr. Leah Sera, assistant professor in the Department of Pharmacy Practice and Science, director of the school’s new master’s program and a clinical pharmacist.

University of the Sciences in Philadelphia has launched a medical cannabis MBA program, specifically targeting the business of cannabis, said Dr. Andrew Peterson, John Wyeth Dean Emeritus and professor of clinical pharmacy and health policy at USciences. Peterson said that the “combination of healthcare, pharmaceutical and cannabis business knowledge and expertise will be incredibly valuable as graduates move forward in their careers.” The USciences courses are provided through the business department in conjunction with the Substance Disorders Institute at USciences and include partnerships with Philadelphia-area cannabis organizations, Peterson said.

Researching the Risks and Benefits

While much of the academic community is focusing on medical marijuana, many questions remain about the impact of the drug and where it fits into pharmaceutical treatment regimens. That’s where the University of Florida College of Pharmacy is jumping in. The university is leading a statewide consortium studying health outcomes related to medical marijuana by evaluating its benefits and risks.

The consortium will tackle safety and effectiveness outcomes but also specific intricacies of medical marijuana inherent in its dosing routes of administration and the effects of smoking versus other methods of consumption, according to Dr. Almut Winterstein, a professor and chair in pharmaceutical outcomes and policy at the University of Florida College of Pharmacy and director of the University of Florida Center for Drug Evaluation and Safety. As the demand grows in the emerging marijuana and cannabis market in Florida, she said there is an “urgent need” for evidence-based studies revolving around medical marijuana. Under the program, the consortium of academic institutions will create a statewide resource for health outcomes research related to medical marijuana, said Winterstein, who was appointed director of the consortium.

As Winterstein sees it, marijuana would be put to the test in the same way as any other drug in development. “As with any other medical treatment, providers, patients and regulators need the necessary information to evaluate its benefits and risks,” she said. “At the time of drug approval, we really don’t know much about side effects and how the new drug works in populations with multiple comorbidities” because that’s not the focus of clinical trials. That’s why post-marketing safety and effectiveness studies are pivotal, and the same applies to medical marijuana. “Really we know very little about what medical marijuana actually does, and for me this requires basically the same systematic evaluation as is in place for any other drug that is on the market.”

While there are similarities with other drugs in studying the impacts of medical marijuana, there is a major difference: for the most part, medical marijuana lacks Food and Drug Administration approval, she noted. As a result, the Florida research “is probably more important because we don’t have approval process on the front end. We really don’t know much about efficacy. And it’s being used by patients who have really serious problems.” If patients who have Parkinson’s disease or multiple sclerosis take medical marijuana, “we don’t know the degree medical cannabis interacts with other drugs necessary to control the disease,” she continued.

While the FDA has not approved marijuana as a safe and effective drug for any indication, it has approved a drug that contains purified cannabidiol, one of the more than 80 active chemicals in marijuana, for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome in patients two years or older. The FDA also has approved drugs containing a synthetic version of a substance in marijuana.

At least 20 marijuana research studies have been initiated in the past five years in Florida, where as many as 200,000 people have been registered to receive medical marijuana, including people suffering from severe and life-threatening health conditions. Researchers have been examining the health benefits and risks of medical marijuana from different perspectives and include outcomes research related to HIV infection, chronic pain in older adults and cannabinol treatment for children with drug-resistant epilepsy.

The university has been involved in a medical marijuana program since 2014. It has extensive research infrastructure and a broad faculty, Winterstein said, and is well positioned to lead the Consortium for Medical Marijuana Clinical Outcomes Research, which comprises public and private universities engaged in research on clinical outcomes of medical marijuana. It will receive $1.5 million in annual recurrent funding from the state to support the research. The university proposes to:

• Build a repository known as the Medical Marijuana Clinical Outcomes Repository or MEMORY that can track patient outcomes over time.
• Develop a Clinical Research Core that will provide infrastructure support for studies and establish a competitive grants program offering $600,000 annually from the state appropriation to participating institutions.

The core will assemble a group of physicians and clinical partners to recruit patients for medical marijuana research studies. In addition, the core plans to conduct a survey of medical marijuana providers in Florida, engage a scientific expert group and provide opportunities for the public and industry to help inform the most urgent clinical research priorities, according to the university. The repository will be available to researchers within the consortium and create a statewide resource for real-world health outcomes research related to medical marijuana.

While pharmacy schools are beginning to tap into coursework for medical marijuana, the University of Mississippi School of Pharmacy has been involved in researching the plant for more than 50 years. A 12-acre farm run by the university has been the sole domestic source of cannabis for government-funded and approved research. Through the National Institute on Drug Abuse (NIDA), the University of Mississippi provides marijuana to researchers across the U.S. under NIDA’s Drug Supply Program. After an open competition among institutions around the country, the University of Mississippi won the first contract in spring 1968 to be the government’s provider for marijuana for research purposes.

“During our 50 years of cannabis research we have been involved in a multitude of projects involving the botanical and chemical properties of the plant as well as ongoing development of candidates for new cannabis-based drugs and novel drug delivery systems,” said Don Stanford, assistant director, Research Institute of Pharmaceutical Sciences, which is part of the school of pharmacy. After some legal challenges, the government has now opened the door for more than 30 other organizations to grow cannabis for research, although the process has yet to begin, officials said.

A Complicated Substance

While medical marijuana presents many possibilities, the plant itself is extremely controversial with questions over its legality, overall addictiveness and effectiveness. Marijuana use is legal in some states but it’s still illegal from the federal government’s perspective. About 85 percent of Americans support legalizing medical marijuana.

Because the marijuana plant contains chemicals that scientists say could help a range of illnesses and symptoms, many people argue it should be legal for medical purposes. The major thrust of medical marijuana has been for pain control. Chronic pain impacts millions of Americans.

Marijuana has more than 100 active components. THC, which stands for tetrahyrocannabiniol, is the chemical that ignites the “high” that is linked to marijuana use. CBD, which stands for cannabidiol, is derived from the hemp plant, a “cousin” of the marijuana plant, according to Harvard Medical School. CBD has been used by patients for a variety of conditions, such as pain relief, or to combat anxiety or insomnia. CBD does not have intoxicating properties (although it is also present in the marijuana variety of Cannabis sativa).

The medical cannabis MBA program at University of the Sciences in Philadelphia offers a “combination of healthcare, pharmaceutical and cannabis business knowledge and expertise [that] will be incredibly valuable as graduates move forward in their careers.DR. ANDREW PETERSON

The marijuana plant remains classified as a Schedule I substance under the federal Controlled Substances Act. Schedule I substances are considered to have a high potential for dependency and no accepted medical use, making distribution of marijuana a federal offense. The law, however, is generally applied only when people possess, cultivate or distribute large quantities of cannabis, according to Americans for Safe Access, an organization that advances legal medical marijuana therapeutics and research. The Obama administration encouraged federal officials not to prosecute people who distribute marijuana for medical purposes. The Trump administration differs; it has allowed federal prosecutors to decide how to prioritize enforcement of federal marijuana laws.

Marijuana dispensaries have grown because federal law prohibits cannabis from being prescribed and filled at pharmacies for medical or recreational purposes. State-regulated dispensaries are designated under regulations for the growth and consumption of cannabis, noted Americans for Safe Access.

In Maryland, Strategic Advantage

As the marijuana industry began expanding, University of Maryland officials believed they needed to initiate a program to give students a “competitive advantage” in pursuing a career in the medical cannabis industry, whether working in healthcare or not. Indeed, the program is specifically designed for students with or without a background in science or medicine, said Sera.

The Maryland curriculum includes coursework in “policy and direct patient care,” with a “grounding in the basic science of pharmacology and the development of the formulation and chemistry of different cannabinoids and how we can treat different conditions,” Sera said. For students, the courses also provide a “grounding in the history of cannabis regulation in our country in order to participate in the development of well-informed medical cannabis policy moving forward.”

Faculty for the medical cannabis program include instructors from the pharmacy school immersed in the basic sciences, teaching pharmacology and chemistry, as well as clinicians. Besides those working in the medical field, adjunct professors who are knowledgeable in the study of cannabis will be engaged. Sera herself is a specialist in pain medicine and palliative care.

At least half of the 150 students who were accepted into the program’s first class, which began in August, have a background in science, chemistry, medicine or microbiology. Others include attorneys, educators and patient advocates, and even an art student. The classes are primarily online with an in-person symposium held once each semester.

Neil Leikach, president of a Catonsville-based pharmacy and a BSP graduate of the University of Maryland, is a student in the master’s program and is particularly interested in learning about evolving regulations around cannabis that are impacting pharmacies.

“This has been a Schedule I drug, and states are looking at this differently. There are many opportunities to help patients,” Leikach said. “States are really catching up on how to help patients with different disease states.” Leikach said he’s attended classes that have focused on regulations and drug interactions with cannabis. He’s pleased with the course offerings. “As pharmacists we need more information, and there is not enough good information out there.”

A Matter of Business in Philadelphia

As USciences officials began looking into the academic program for cannabis instruction, they believed that it should examine not only the science of the plants but also something that has not received enough focus: the business of medical marijuana, its marketing and sales. “There are many unique aspects to the medical cannabis and hemp industry,” noted Peterson.

As he examined the program and worked with experts in the field, Peterson said he was surprised by the complexity involved in the underlying business of marijuana and the horticulture process. “I learned so much about the science of growing plants,” he said. “The humidity, pest control, so many things.”

The legal aspect will also be explored. Students will be asked questions such as “what is the status of cannabis as a controlled substance in the U.S. under federal law as well as state to state?” Peterson said. USciences sought assistance in developing its program through a memorandum of understanding agreement with Franklin BioScience, a Colorado-based cannabis grower and retailer. Franklin BioScience assisted in developing educational programs about the cannabis plant and its medicinal value.

Four separate courses are being offered online as part of the Cannabis Industry Masters of Business Administration option under the pharmaceutical and healthcare business curriculum. While any student can take the courses, priority is given to MBA students, and there is no certificate for taking cannabis-related electives, school officials said.

The courses include introduction to the medical cannabis industry; finance and regulation in the medical cannabis industry; cannabis marketing and sales; and a project-based course where students will work to write a business plan or bring a product to market. Currently 14 people are enrolled; officials are still recruiting for the next cohort, all of them MBA students (some of whom are pharmacists). Like Maryland, USciences does not have an on-site cannabis lab.

Mississippi: Ahead of the Field

The University of Mississippi has not offered an advanced degree in medical marijuana despite its research on the substance, officials said. “We could not consider doing so due to our long-standing efforts to develop new cannabis-based therapies as (Food and Drug Administration) approved products, but we are now exploring the possibilities of a cannabis program here,” said Stanford.

From 2005 to 2015, the University of Mississippi was involved in discovering 43 new cannabinoids, which are generally considered the most pharmacologically active compounds in the plant, according to the university. “Our contributions to the understanding of the chemical makeup and biological properties of the Cannabis sativa plant has spanned several decades,” Stanford said. “The longtime use of cannabis for the treatment of glaucoma is another example of how we have been involved in the search for new cannabis therapies.”

The University of Maryland’s program provides a “grounding in the history of cannabis regulation in our country in order to participate in the development of well-informed medical cannabis policy moving forward.DR. LEAH SERA

In the early 1970s, studies in both humans and animals indicated that smoking marijuana might provide relief for the intraocular pressure in the eyes, according to Stanford. Taking that a step further, the University of Mississippi conducted studies and provided the standardized cigarettes used in the studies conducted in the U.S. This evidence “led to one of the earliest expanded access programs by the FDA that allow patients access to unapproved treatments,” he said. The university’s research efforts also explored cannabis-based therapies for dry eye, macular degeneration and diabetic retinopathy.

Although the University of Mississippi was the sole contractor with the government for all these years, other researchers are seeking to grow marijuana for contracts now that the process is going to open to more than 30 other organizations and academic institutions. “The University of Mississippi applies for the contract just like everyone else,” said Dr. Mahmoud ElSohly, director of the university’s Marijuana Project and professor of pharmaceutics. “Our research capability, our expertise, our knowledge in the areas of cannabis chemistry and production our personnel and facilities—everything is in place to make us very competitive.” The Drug Enforcement Administration said it “anticipates that registering additional qualified marijuana growers will increase the variety of marijuana available for these purposes.”

Joseph A. Cantlupe is a freelance writer based in Washington, D.C.BACK TO TOP

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From my story at athenaInsight https://www.athenahealth.com/insight/treating-broken-bones-without-racking-bad-deb

From the story:

Orthopedic surgery is quite literally a pain for the patient who’s having it, but there’s a major downside for surgeons as well: bad debt. Among all medical specialties, orthopedic surgeons are the most likely to be unable to collect payment from either patients or insurers, especially as deductibles skyrocket. 

In a 2019 report from Medical Group Management Association, data revealed that at least 30 percent of orthopedic surgery practices were in arrears for more than 120 days. The median bad debt is about $48,000 for orthopedic surgeons, compared to $35,000 for other single surgery practices.”  

Many orthopedic practices focused on improving bill collection practices are counting on technology to help them meet their goals. There are a variety of measures physician practices are touting, says Kumrah. Patient cost-estimators can be used based on insurance providers that physicians contract with; they’re helpful because they can seamlessly identify bills for individual patients.  

Process automation robots can take care of the mindless tasks like verifying insurance eligibility and sending out reminders for upfront payments based on schedule. “Healthcare generally is slower to adopt tools/automation as compared to other industries, so it helps to see what’s worked elsewhere from that process and perspective,” Kumrah says.  

“When you have a better-organized system, you are going to have less bad debt,” says Cristy Good, Senior Industry Advisor for Medical Group Management Associate. “You make sure all things are in place: staff training on how to do front-end collections, how to educate patients on their responsibilities, be transparent in your pricing.” 

Thwarting bad debt relies on staying on the cutting edge of health technology, but practices can’t discount the skills of people-to-people conversations. With a little automation and ingenuity, orthopedic surgery doesn’t have to be as painful for anyone involved. — Joe Cantlupe, HealthDataBuzz

Quid Pro Quo — I’ll do something for you, if you do something for me — isn’t restricted to, well, politics.

Ok, it’s not even restricted to humans or other primates.

Rats do it too.

In exchange for food, rats will “groom” another rat’s hair, sometimes repeatedly in what scientists say is a cooperative behavior similar to humans. Researchers at the University of St. Andrew in Scotland found that rats were more inclined to engage in grooming with a fellow rat when food was received from it than not, and vice versa.

While many different animals show reciprocity for like commodities, such as food for food, primates have been known to be capable of trading goods, i.e. food, for other services, such as sex, for instance, in the case of chimpanzees. Trading of different commodities is considered a fundamental component of human interactions, with quid pro quo a part of our being and how we get along.

The fact that rats do it too indicates that it may be more widespread in nature than originally believed, and the reciprocal trading may not be limited to large-brained species with advanced cognitive abilities.

“The prevalence of reciprocal cooperation in non-human animals is hotly debated,” said Dr. Manon Schweinfurth of the School of Psychology and Neuroscience at the University of St. Andrew in Scotland, co-author of a study on rat behavior. “Our study suggests that either rats have this concept or reciprocity is cognitively less demanding than previously thought.”

She and Professor Michael Taborsky of the Institute of Ecology and Evolution at the University of Bern published a paper ‘Reciprocal Trading of Different Commodities in Norway Rats. on the subject earlier this year in Current Biology.

Quid Pro Quo

For humans, giving something in exchange for something else is a part of interactions with others and starts at a young age. “A key feature of human interactions is the quid pro quo: you do something for me and in exchange I do something for you and in exchange I do something for you,” Jonaton D. Crystal, Department of Psychology and Brain Sciences, Indiana University wrote about the study as a Quid Pro Quo in the journal Current Biology.

“Children 3 years onward reliably reciprocate with each other,” Schweinfurth says. “Kids most likely don’t have to learn reciprocity either but their brain is not fully developed and they lack capabilities that enable them to reciprocate.” “

Quid pro quo has been in the news constantly the last few months — maybe more so than at any time in recent memory — as investigators examine President Trump’s actions in allegedly withholding funds for Ukraine unless that government investigated former Vice President Joe Biden’s son, who conducted business there. ( The Democrats began steering the party’s narrative away from quid pro quo but a more directed allegation of “bribery.”

While quid pro quo is especially the topic of debate for political humans, some scientists believe that the action of reciprocity is definitely human, but others say the practice is not unique to us.

“The prevalence of reciprocal cooperation in non-human animals is hotly debated,” Schweinfurth writes. “Part of this dispute rests on the assumption that reciprocity means paying like with like. However, exchanges between social partners may involve different commodities and services.”

Many animals help each other such as bees managing hives seeking other bees’ assistance. And several species, particularly among primates, such as monkeys, have been known to apply such rules when exchanging food for other actions, such as protection, Schweinfurth says. Primates have been known — through observational evidence — to trade different services, such as chimpanzees trading grooming for meat.

Rats Do It

But rodents, such as rats? Indeed. Her studies show that “rats seem to follow reciprocal rules like tit-for-tat to help each other,” Schweinfurth said. Of rats, “they likely don’t memorize exact donation rates or calculate that was received but form attitudes toward their partner…like partner A was nice to me,” she added.

Rats live in burrows and form mixed social groups that might involve as many as 200 individual rats, which frequently interact with each other. As highly social animals, they often huddle together to keep warm, share food and have been known to softly pat each other’s hair.

“Rats are good model organisms because you can keep them in the lab and they learn quickly how to use experimental setup. We worked not with the classical lab rat but with descendants of wild rats,” the species known as Norway rats, Schweinfurth said.

In a series of experiments, food — oat flakes — were put into a moveable platform and rats pulled it toward other “partner” rats. The rats, which were closely studied, known as focal rats, pulled a stick connected to the moveable platform in a cage and provided food to the partner, which then in turn softly patted or groomed them. Each cage held two rats, each in its own little compartment. By pulling the connected stick, the platform moved into the cage and provided food only to the partner rat.

In an examination of more than 30 rats, the so-called focal rat continually provided more food to grooming partners than not. Rats provided more food to “cooperative” partners in test conditions, which were not previously achieved, Schweinfurth said.

The grooming occurred after saltwater was applied to the neck of the focal rat to create a situation where help was needed. Each rat’s “propensity to help the partner remove the unpleasant saltwater is enhanced by the previously experienced food donations of the partner,” the researchers wrote. “Grooming is a widespread behavior and the results might hence be more generalized to other species,” Schweinfurth said. After the experiment, the researchers took rats out into a large container where they could groom each other.

“Hitherto there is no experimental evidence that animals other than primates exchange different commodities among conspecifics based on the rules of direct reciprocity,” the researchers added in the study. “Here we show that Norway rats apply direct reciprocity rules when exchanging two different social services: food provisioning and (grooming.)

Rats — Lots of Them

Schweinfurth said she has been studying rats since 2013, calling them “fascinating animals.”

“They are highly intelligent and billions live with us, but we really don’t know much about them,” she says. “We have a very different and interesting relationship with rats. They are very useful to us as lab rats. We hate them when we encounter them in the cities and we love them as pets.”

“There is some evidence (from another study) that rats anticipate reciprocity in the future,” she says. “If rats are hungry, they are more likely to invest in donating food to others, probably in the hope of getting more back.”

Despite the give and take, Schweinfurth said she has been restarted in her studies that she couldn’t find a “friendship” among rats.

“For the rats, they work on not an accumulative experience with a partner,” she says. “They respond to the last experience. Basically, they only consider “what have you done for me lately.”

In her recent work, Schweinfurth has moved beyond rats — to humans and other primates.

She said she wanted to “compare rats to understand how unique our form of reciprocity is and whether different species have found different ways to cooperate with each other.”

And much of that cooperation begins with the quid pro quo. – Joe Cantlupe, HealthDataBuzz

(Photo: Rats “grooming.”Courtesy of Dr. Manon Schweinfurth)

Intersections, intersections.

That’s where 65 percent of bicycle and motor vehicle collisions occur.

And too many cars try to overtake bicyclists on the roads — incidents responsible for least 25 percent of fatal crashes. In many of those cases, the motorists didn’t see the cyclists.

Those are among the findings cited in the National Transportation Safety Board‘s first examination of bicyclist safety in 47 years. The board said today “critical changes” are needed to address an increase of bicycle crashes involving motor vehicles.

Among the proposals:

Improve roadway design.

Enhance visibility of bicyclists

Tap into the latest technology

Increase helmet use.

Such plans “hold the most promise for reducing the number of fatal and serious crashes,” the NTSB said.

“If we do not improve roadway infrastructure for bicyclists, more preventable crashes will happen and more cyclists will die in those preventable crashes, ” said NTSB Chairman Robert L. Sumwalt. “If we do not enhance bicyclist conspicuity, more bicyclists will die in preventable crashes.  If we do not act to mitigate head injury for more bicyclists, additional bicyclists will die.”

Photo, taken Aug. 16, 2019, in Washington, a two-way separated bike lane with vertical barrier is shown. NTSB photo by Ivan Cheung.)

NTSB investigators said “25 percent of all fatal collisions involving bicyclists – the most frequent type – occurred while a motorist was overtaking a bicyclist in the stretches of roadway between intersections.”

At intersections, said fixes should include clearly denoted “right-of-way using color, signage, medians, signals and pavement markings would likely reduce the number of crashes in those environments,” the NTSB said.

Investigators said “about a third of the motorists involved in fatal crashes while overtaking a bicyclist did not see the bicyclist prior to the collision. “

The NTSB safety report will be available in several weeks, officials said. A text of the findings and safety recommendations, is available at https://go.usa.gov/xpTps. — Joe Cantlupe, HealthDataBuzz

It was a mess.

Police cars parked in all directions. Ambulances rushed over. Connecticut Avenue, a major thoroughfare heading into and out of Washington DC from Montgomery County MD, was cordoned off. A bicyclist was pinned against a utility pole as a pickup truck and two cars crashed, The Washington Post reported.

The bicyclist wasn’t even on the road at the time of the collision, according to media reports. The man was standing with his bike on the sidewalk.

Bicyclists don’t have to be moving on the road to get hit. Several years ago, my son was riding with other bicyclists cross country on a gleeful trip. The joy cascaded into horror as one of the young riders in a separate group, a 24-year old woman, was killed when struck by a pick-up truck while she was changing a flat tire on the side of a road. That tragedy happened on a rural byway in Kentucky. Yet wading through traffic in urban areas is one of the biggest challenges for bicyclists, and some roads don’t seem to be a good fit no matter how enthusiastic or safety conscious the biker.  In the Connecticut Avenue crash, a bicyclist is recovering from injuries and luckily there were no fatalities.

That’s not always the case. Bicycle accidents involving motor vehicles are increasingly leading to fatalities.  They come against the backdrop of the tremendous growth of biking, whether it for fun, exercise or commuting to work. It’s not just the nine-year-old steering his or her bike on a sidewalk going to a friend’s house. The bicyclist is more likely a middle-aged person navigating a street.

While state legislators scheduled a meeting today to look at the Connecticut Avenue crash and figure out the problems of the biking accident and others along that stretch of road, the National Transportation Safety Board will be meeting a few miles away this morning in Washington DC to consider findings and recommendations of a major report about bicycle safety, crashes with motor vehicles and what can be done about it.

Usually you think of NTSB and airplane accidents. It’s true. But the agency covers bicycle and pedestrian safety too. The bicycle report is the first NTSB analysis of bicyclist safety in 47 years, and none too late, with the board mentioning the “growing use of bicycles as a means of transportation and resulting safety issues.” It will be releasing findings and recommendations in its “Safety Research Report: Bicyclist Safety U.S. Roadways: Crash Risks and Counter Measures.” The board says it will “examine the prevalence and the risk factors of bicycle crashes involving motor vehicles and assessing the most applicable countermeasures.”

NTSB officials declined to specifically identify what will be discussed in the report, but Dr. Ivan Cheung, a lead investigator, and Dr. Jana Price noted generally the board will focus on a wide-range of issues, ranging from alcohol use to speed among motorists, helmet use among bicyclists, traffic regulations,road engineering improvements – adjusting traffic signals or building islands for exclusive bicycle or pedestrian lanes, or new sidewalk overpasses and underpasses, and technological changes such as collision avoidance systems that are becoming more of a mainstream in new vehicles.

In its last report – in 1972 — the board said the majority of deaths and injuries were among children 5 to 14 years old, surely, a different world of bicycling from today, where much older people frequent the bike lanes.

In 2018, while overall traffic fatalities were down, more pedestrians and bicyclists were killed on U.S. roads last year, accounting for nearly 20 percent of all traffic deaths, according to the National Highway Traffic Safety Administration, The Washington Post said.

According to the NHTSA’s Fatal Analysis Report System data, 6,283 pedestrians and 857 people on bikes or similar nonmotorized vehicles were killed in 2018, an increase of 3.4 percent and 6.3 percent respectively, mostly in urban areas, the paper reported.

Other figures in recent years foreshadowed growing problems.  In 2017, 783 bicyclists, considered “vulnerable road users as they are more vulnerable to injury or death in the event of a crash” died as a result of crashes with motor vehicles, the National Highway Transportation Safety Administration reported.

“Safety is a growing concern. Although bicyclists represent only about 2 percent of road fatalities, bicyclist deaths have increased 25 percent since reaching their lowest point in 2010,” according to the

Insurance Institute of Highway Safety.

“Crash avoidance features and other vehicle improvements may also make pedestrians and bicyclists safer,” according to the IIHS. “Modifying the front structures of vehicles may reduce the severity of pedestrian injuries. Regulators in Europe and elsewhere have been encouraging pedestrian protection in vehicle design through their vehicle testing programs.”

It’s not always easy, whatever changes are made. the IIHS adds: “Bike lanes separated from the roadway by physical barriers make cyclists feel safer and encourage more people to ride, but IIHS says protected bike lanes vary in terms of injury risk.”

For bicyclists there are mostly two types of crashes: falls or, the most serious, collision with cars. And the NTSB has a breakdown of when they most likely occur (between 6 p.m. 9 pm.) and of those who die on a bike – males were eight times as likely as females. Among a majority of bicyclists killed in crashes, head injuries are the most serious, but helmet use can drastically reduce them.

The NTSB says: “A large percentage of crashes can be avoided if motorists and cyclists follow the rules of the road and watch out for each other,” the board says.

It seems like a no-brainer.

Many complicated issues converge, however.

In 2016, a pickup truck driver plowed into nine cyclists  in Michigan who were properly riding single file along a paved road shoulder. Five were killed.

For the bicyclists, an NTSB official said: They wore reflective material, had reflectors, flashers, helmets high visibility clothing. “They were doing everything right, nevertheless they were all struck and killed or injured by a driver who was impaired by a variety of substances,” said T. Bella Dinh-Zarr, an NTSB member.