Stephen Dahmer

Interests

Teaching

Integrative Medicine, Botanical Medicine, Ethnobotany, Medical Education Research, Healthcare Communication, Professionalism in Medicine, Evidence-Based Medicine, Quality Improvement in Healthcare, Patient Safety, Interprofessional Education, Narrative Medicine, Medical Ethics, Resident Wellness, Leadership Development, Clinical Decision-Making, Medical Informatics, Global Health Education, Mentorship in Medicine

Research

Integrative Medicine, Narrative Medicine, Patient-Centered Care, Medical Education Research, Quality Improvement in Healthcare, Integrative Medicine Outcomes, Botanical Medicine Research, Ethnobotany and Ethnomedicine, Clinical Decision-Making, Medical Informatics and Telemedicine, Global Health Education, Resident Wellness and Burnout, Leadership Development in Healthcare, Patient Engagement and Activation, Personalized Medicine and Genomics, Wellness and Integrative Therapies

Courses

Scholarly Contributions

Chapters

• Dahmer, S., & Kligler, B. (2018). HIV Disease and AIDS. In Integrative Medicine, 4th Edition. doi:10.1016/B978-0-323-35868-2.00019-0
• Dahmer, S., & Kligler, B. (2012). HIV Disease and AIDS. In Integrative Medicine, 3rd Edition. doi:10.1016/B978-1-4377-1793-8.00017-0
• Kligler, B., & Dahmer, S. (2007). HIV Disease and AIDS. In Integrative Medicine, 2nd Edition. doi:10.1016/B978-1-4160-2954-0.50025-9

Journals/Publications

• Bierman, S. F., Weil, A., & Dahmer, S. (2024). Placebo and the law of identification. Frontiers in psychiatry, 15, 1474558.
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  Thousands of essays and studies have been published on placebo and nocebo. Yet, despite this plethora of information, we are not much closer to a comprehensive understanding of the fundamental mechanism producing placebo and nocebo effects than we were in 1946, when participants in the Cornell Conferences on Therapy speculated on the roles of authority, belief and expectancy. In this paper, we examine the weaknesses in current placebo and nocebo definitions and theories. We also propose a more concise and comprehensive definition and theory of placebo and nocebo by introducing the Law of Identification and the Generic Placebo Instruction (GPI). The latter being the placebo/nocebo information expressed or implied in virtually every clinical encounter and trial; the former (i.e., the Law of Identification), being what drives the GPI to actualization. Further, we demonstrate the explanatory power of this new theory and suggest clinical studies that test predictions arising from it - studies whose results, if positive, would translate universally into clinical practice.
• Kirk, R., Uhley, O., Lehfeldtorcid, P., Shieldsorcid, C., Garretsonorcid, M., Collins, A., Wahbehorcid, H., & Dahmer, S. (2023). Willingness to participate in entheogen use research in naturalistic settings. Journal of Psychedelic Studies. doi:10.1556/2054.2022.00238
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  Background: Entheogen use is becoming increasingly popular and a potential option for treatment or adjuvant treatment for various medical conditions. Clinical studies are needed to determine the efficacy, safety, and possible role of these traditional medicines in the context of modern society and the Western medicine paradigm. The willingness of patients to participate in such studies is currently unknown. Materials and Methods: In September 2021 we implemented an anonymous, observational pilot survey to determine the general public's willingness to participate in future entheogen research. All participants were English-speaking adults and had participated in therapy or a retreat utilizing entheogens in a naturalistic setting in the last five (5) years. Participants were recruited through community outreach via email. Results: The response rate for this data set was estimated to be 48.3% (n = 84/174). Nearly all (95.5%) participants believed this research should be done and 86.9% said they would participate in entheogen research that lasted longer than one year. A greater proportion of participants were willing to participate in remote interviews (73.5%) rather than in-person surveys (64.7%). A majority of participants (78%) also noted the importance of financial compensation for their time influencing the willingness to participate in future entheogen studies. Conclusions: The willingness to participate in research involving traditional entheogens is not the limiting factor in facilitating further studies. Participants held overwhelmingly positive perceptions indicating that they believed this research should be done. Future longitudinal clinical studies with financial compensation and controlled set and settings will be necessary to expand the evidence base for naturalistic entheogen use.
• Lyu, X., Illamola, S. M., Marino, S. E., Leppik, I. E., Dahmer, S., Lehfeldt, P., Conway, J. M., Remmel, R. P., Kingsley, K., & Birnbaum, A. K. (2023). Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends. Current therapeutic research, clinical and experimental, 99, 100709.
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  Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to patients.
• Lyu, X., Illamola, S., Marino, S., Leppik, I., Dahmer, S., Lehfeldt, P., Conway, J., Remmel, R., Kingsley, K., & Birnbaum, A. (2023). Medical Cannabis Received by Patients According to Qualifying Condition in a US State Cannabis Program: Product Choice, Dosing, and Age-Related Trends. Curr Ther Res Clin Exp, 99. doi:10.1016/j.curtheres.2023.100709
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  Background: Little is known about the distribution of cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) to patients participating in state medical cannabis programs. The Minnesota cannabis program requires third-party testing of products with limited formulations of cannabis for distribution to patients. Objective: To characterize the distribution of cannabis products, their CBD/THC content, and dosing among patients with qualifying conditions. Methods: This is a retrospective analysis of ∼50% of registered users receiving medical cannabis in Minnesota (June 16, 2016, to November 15, 2019). Data included formulation, CBD/THC prescribed doses, and qualifying conditions. The primary end points were calculated using daily dose and duration of use. Comparisons were made for CBD and THC total daily dose dispensed, patient age, and approved product. Nonparametric statistical tests were used (significance was set at p < 0.05). Results: A total of 11,520 patients were listed with 1 qualifying condition. The most common condition was intractable pain (60.0%). Median dispensation duration varied from 53 days (cancer) to 322 days (muscle spasms). Most (≥62.8%) patients across all qualifying conditions received both CBD and THC. Median THC dose was lower in older (≥65 years) compared with younger adults with intractable pain (p < 0.0001) and cancer patients (p = 0.0152), and the same pattern was found CBD dose with seizure (p = 0.0498) patients. For commercial products with Food and Drug Administration indications, the median CBD total daily dose was 86.9% lower than the recommended doses for patients with seizures (Epidiolex: Jazz Pharmaceuticals, Palo Alto CA) and median THC total daily dose was 65.3% (Syndros: Benuvia Manufacturing, Round Rock, TX) or 79.3% lower (Marinol: Banner Pharmacaps, Inc., High Point, NC) for cancer patients. Conclusions: A majority of patients received products containing both CBD and THC. Dosages varied by age group and were lower than recommended for conditions with Food and Drug Administration-approved products. Complex pharmacokinetics of THC and CBD, possible age-related changes in physiology, unknown efficacy, and potential for drug interactions all increase the need for monitoring of patients receiving cannabis products. (Curr Ther Res Clin Exp. 2023; 84:XXX–XXX)
• Duarte, R. A., Dahmer, S., Sanguinetti, S. Y., Forde, G., Duarte, D. P., & Kobak, L. F. (2021). Medical Cannabis for Headache Pain: a Primer for Clinicians. Current pain and headache reports, 25(10), 64.
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  Public acceptance of Cannabis sativa L. (cannabis) as a therapeutic option grows despite lags in both research and clinician familiarity. Cannabis-whether as a medical, recreational, or illicit substance-is and has been commonly used by patients. With ongoing decriminalization efforts, decreased perception of harms, and increased use of cannabis in the treatment of symptoms and disease, it is critical for clinicians to understand the rationale for specific therapies and their medical and practical implications for patients. In view of the opioid crisis, overall patient dissatisfaction, and lack of adherence to current chronic pain and headache therapies, this review provides up-to-date knowledge on cannabis as a potential treatment option for headache pain.
• Loewy, J., Goldsmith, C., Deshpande, S., Sun, A., Harris, J., van Es, C., Zvi, Z. B., & Dahmer, S. (2021). Music therapy in pediatric asthma improves pulmonary function while reducing hospitalizations. The Journal of asthma : official journal of the Association for the Care of Asthma, 58(5), 674-682.
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  The aim of this study was to evaluate music therapy (MT), in conjunction with standard care, as a complementary option for asthma management in pediatric patients. 173 children were randomly assigned to one of three groups: 1) Music: a single individualized MT session along with a recorder and journal with instructions for home use; 2) Music Plus: weekly group MT sessions along with a recorder and journal for home use; or 3) Control: standard of care. Primary endpoints included pulmonary function tests (FEV1, FVC, FEF25-75, PEF), hospitalizations, ER visits, missed school days, and quality of life (Juniper). Significant intergroup differences relative to Controls were observed for FEV1/FVC (Music and Music Plus,  
• Loewy, J., Goldsmith, C., Deshpande, S., Sun, A., Harris, J., van Es, C., Zvi, Z., & Dahmer, S. (2021). Music therapy in pediatric asthma improves pulmonary function while reducing hospitalizations. J Asthma, 58(5). doi:10.1080/02770903.2020.1712725
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  Objective: The aim of this study was to evaluate music therapy (MT), in conjunction with standard care, as a complementary option for asthma management in pediatric patients. Methods: 173 children were randomly assigned to one of three groups: 1) Music: a single individualized MT session along with a recorder and journal with instructions for home use; 2) Music Plus: weekly group MT sessions along with a recorder and journal for home use; or 3) Control: standard of care. Primary endpoints included pulmonary function tests (FEV1, FVC, FEF25-75, PEF), hospitalizations, ER visits, missed school days, and quality of life (Juniper). Results: Significant intergroup differences relative to Controls were observed for FEV1/FVC (Music and Music Plus, p < 0.05) and FEF25-75 (Music Plus; p < 0.01). Music Plus participants experienced fewer hospitalizations compared to Controls (p < 0.001), corresponding to 1.16 fewer hospitalizations per patient-year. Caregivers’ perception of their children's QOL significantly increased in the Music (p = 0.011) and Music Plus (p < 0.001) groups compared to Controls. Conclusion: These results reflect MT’s potential to favorably impact pediatric asthma management as a child-friendly, low-risk intervention. Further research is needed to substantiate the possible benefits of incorporating MT into standard treatment regimens.
• Zylla, D. M., Eklund, J., Gilmore, G., Gavenda, A., Guggisberg, J., VazquezBenitez, G., Pawloski, P. A., Arneson, T., Richter, S., Birnbaum, A. K., Dahmer, S., Tracy, M., & Dudek, A. (2021). A randomized trial of medical cannabis in patients with stage IV cancers to assess feasibility, dose requirements, impact on pain and opioid use, safety, and overall patient satisfaction. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 29(12), 7471-7478.
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  The prevalence of medical cannabis (MC) use in patients with cancer is growing, but questions about safety, efficacy, and dosing remain. Conducting randomized, controlled trials (RCTs) using state-sponsored MC programs is novel and could provide data needed to guide patients and providers.
• Zylla, D., Eklund, J., Gilmore, G., Gavenda, A., Guggisberg, J., VazquezBenitez, G., Pawloski, P., Arneson, T., Richter, S., Birnbaum, A., Dahmer, S., Tracy, M., & Dudek, A. (2021). A randomized trial of medical cannabis in patients with stage IV cancers to assess feasibility, dose requirements, impact on pain and opioid use, safety, and overall patient satisfaction. Support Care Cancer, 29(12). doi:10.1007/s00520-021-06301-x
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  Purpose: The prevalence of medical cannabis (MC) use in patients with cancer is growing, but questions about safety, efficacy, and dosing remain. Conducting randomized, controlled trials (RCTs) using state-sponsored MC programs is novel and could provide data needed to guide patients and providers. Methods: A pilot RCT of patients with stage IV cancer requiring opioids was conducted. Thirty patients were randomized 1:1 to early cannabis (EC, n = 15) versus delayed start cannabis (DC, n = 15). The EC group obtained 3 months (3 M) of MC through a state program at no charge, while the DC group received standard oncology care without MC for the first 3 M. Patients met with licensed pharmacists at one of two MC dispensaries to determine a suggested MC dosing, formulation, and route. Patients completed surveys on pain levels, opioid/MC use, side effects, and overall satisfaction with the study. Results: Interest in the study was high as 36% of patients who met eligibility criteria ultimately enrolled. The estimated mean daily THC and CBD allotments at 3 M were 34 mg and 17 mg, respectively. A higher proportion of EC patients achieved a reduction in opioid use and improved pain control. No serious safety issues were reported, and patients reported high satisfaction. Conclusion: Conducting RCTs using a state cannabis program is feasible. The addition of MC to standard oncology care was well-tolerated and may lead to improved pain control and lower opioid requirements. Conducting larger RCTs with MC in state-sponsored programs may guide oncology providers on how to safely and effectively incorporate MC for interested patients.
• Dahmer, S., & Scott, E. (2010). Health effects of hawthorn. American family physician, 81(4), 465-8.
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  Hawthorn medicinal extract has long been a favored herbal remedy in Europe. The active components of this slow-acting cardiotonic agent are thought to be flavonoids and oligomeric procyanidins. The most studied hawthorn extracts are WS 1442 and LI 132. Reviews of placebo- controlled trials have reported both subjective and objective improvement in patients with mild forms of heart failure (New York Heart Association classes I through III). Other studies of hawthorn in patients with heart failure have revealed improvement in clinical symptoms, pressure-heart rate product, left ventricular ejection fraction, and patients' subjective sense of well-being. However, there is no evidence of a notable reduction in mortality or sudden death. Hawthorn is well tolerated; the most common adverse effects are vertigo and dizziness. Theoretic interactions exist with antiarrhythmics, antihypertensives, digoxin, and antihyperlipidemic agents. Proven conventional therapies for heart failure are still recommended until the safety and effectiveness of hawthorn has been proven in long-term studies.
• Teets, R. Y., Dahmer, S., & Scott, E. (2010). Integrative medicine approach to chronic pain. Primary care, 37(2), 407-21.
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  Chronic pain can be a frustrating condition for patient and clinician. The integrative medicine approach to pain can offer hope, adding safe complementary and alternative medical (CAM) therapies to mitigate pain and suffering. Such CAM therapies include nutrition, supplements and herbs, manual medicine, acupuncture, yoga, and mind-body approaches. The evidence is heterogeneous regarding these approaches, but some evidence suggests efficacy and confirms safety. The integrative medicine approach can be beneficial in a patient with chronic pain.
• Dahmer, S., & Schiller, R. M. (2008). Glucosamine. American family physician, 78(4), 471-6.
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  Glucosamine is one of the most popular dietary supplements sold in the United States. Most clinical trials have focused on its use in osteoarthritis of the knee. The reported adverse effects have been relatively well studied and are generally uncommon and minor. No significant supplement-drug interactions involving glucosamine have been reported. The National Institutes of Health-sponsored Glucosamine/chondroitin Arthritis Intervention Trial, the largest randomized, double-blind, placebo-controlled study involving the supplement, still has not confirmed whether glucosamine is effective in the treatment of osteoarthritis. Despite conflicting results in studies, there is no clear evidence to recommend against its use. If physicians have patients who wish to try glucosamine, it would be reasonable to support a 60-day trial of glucosamine sulfate, especially in those at high risk of secondary effects from other accepted treatments. The decision to continue therapy can then be left to patients on an individual basis, while the physician monitors for possible adverse effects. Glucosamine should be used with caution in patients who have shellfish allergies or asthma, and in those taking diabetes medications or warfarin.
• Dahmer, S. (2007). Ask the Experts. Explore, 3(5). doi:10.1016/j.explore.2007.07.013
• Dahmer, S. (2007). Do you have any advice on how to help with this problem of access to CAM therapies for patients without financial resources?. Explore (New York, N.Y.), 3(5), 546.