Does evidence-based medicine adversely affect clinical judgment? | The BMJ
For practical and theoretical reasons, says Michel Accad, evidence based medicine is flawed and leads to standardised rather than excellent individualised care, but
Darrel Francis argues that it protects patients from seemingly rational actions that cause more harm than good.
This is an interesting conflict arising when EBM, which is population-based, runs into individualized medicine, which is mostly based on a doctor’s judgment. Continue reading
Why genetics makes some people more vulnerable to opioid addiction – and protects others – 2018
From a scientific standpoint, addiction is a disease. And, as researchers who study opioid addiction, we’re hopeful about where epigenetics, the science of how DNA code is regulated, can lead us.
Just as genetics can affect a person’s risk for heart disease, cancer or diabetes, it can also make them more or less susceptible to addiction.
A great deal of research in the last decade has focused on tiny differences in a person’s DNA – termed single-nucleotide polymorphisms, or SNPs. These SNPs can indicate whether you have a higher or lower rick for addiction. Continue reading
Study Shows How Aspirin Fights Inflammation – National Pain Report
A daily low-dose aspirin has long been recommended by doctors for its cardiovascular benefits.
But only now are researchers getting a better understanding of how aspirin reduces the inflammation that can lead to heart disease and other chronic health conditions.
So, doctors were recommending something even though they didn’t know its mechanism of action. I always thought it worked because it thinned the blood. Continue reading
No wonder doctors don’t want to deal with prescribing opioids when they get these ridiculously time-consuming requests from insurance companies and pharmacy benefit managers, not to mention running the risk of losing their license and livelihood.
This diagram shows where the money flows after we pay for a prescription:
AI can spot the pain from a disease some doctors still think is fake – By Olivia Goldhill – August 9, 2018
In the 16 years since Liptan had her illness [fibromyalgia] so summarily dismissed in 2002, there are still those who believe fibromyalgia isn’t “real.”
There’s no tissue damage that explains the pain fibromyalgia patients experience all over their body, and contemporary medicine struggles to treat and even accept an illness where pain seems to be rooted in the mind or brain, rather than a bodily injury.
Artificial intelligence, though, has the potential to make a diagnosis in minutes. Last year, researchers used machine learning to distinguish the brain scans of those with fibromyalgia from those without—with 93% accuracy. Continue reading
FDA Investigating Misuse, Abuse of Gabapentinoids – by Joyce Frieden, News Editor, MedPage Today – Feb 2018
Here comes another round of addiction hysteria, this time about medications doctors are prescribing on the slim chance they could help suffering pain patients for whom they are no longer allowed to prescribe opioids.
The FDA is looking at whether gabapentinoids are an addiction threat, FDA Commissioner Scott Gottlieb, MD, said Thursday.
Gabapentinoids such as pregabalin (Lyrica) as well as the original agent gabapentin (Neurontin) are approved to treat a variety of conditions, including
- post-herpetic neuralgia,
- fibromyalgia, and
- neuropathic pain associated with diabetes,
Why a patient paid a $285 copay for a $40 drug | PBS NewsHour – By Megan Thompson – Aug 2018
Liu and her husband Z. Ming Ma, a retired physicist, are insured through an Anthem Medicare plan. Ma ordered the telmisartan [prescribed after transient ischemic attack]through Express Scripts, the company that manages pharmacy benefits for Anthem.
The copay for a 90-day supply was $285, which seemed high to Ma.
…during a trip to his local Costco, Ma asked the pharmacist how much it would cost if he got the prescription there and paid out of pocket.
The pharmacist told him it would cost about $40. Continue reading
Renewing Medicine’s basic concepts: on ambiguity | Philosophy, Ethics, and Humanities in Medicine | Full Text – April 2018
Edmund Pellegrino lamented that the cultural climate of the industrialized West had called the fundamental means and ends of medicine into question, leading him to propose a renewed reflection on medicine’s basic concepts, including health, disease, and illness.
My aim in this paper is take up Pellegrino’s call. I argue that in order to usher in this renewal, the concept of ambiguity should take on a guiding role in medical practice, both scientific and clinical.
Ambiguity = reality. Especially in humans, there are endless variations of the intricate machinery that guides our internal bodily processes, but these are obscured when studies look only at cumulative averages. (an “average” human has one breast and one testicle) Continue reading
A Brief Quackery Primer | American Council on Science and Health – Feb 2018 – by Josh Bloom
Many well-educated, skeptical people suffer from a failure of logic when it comes to matters of health. Some studies even suggest that the more educated the person, the more likely they are to fall for some form of quackery.
When a person who believes fervently in some idea is confronted by evidence that they are wrong they may react emotionally and consider the evidence to be a personal attack. They will then deny the evidence, no matter how strong it might be.
This is the problem we are having in the “opioid crisis” when charlatans like Kolodny ignite anti-opioid hysteria without data to back up his claims. When presented with contradictory facts, he ignores it or attacks the messenger. Continue reading