Tag Archives: ethics

Industry-Funded Studies and the Skewing of America

I stumbled across this interesting publication that’s dedicated to reporting on the “cheating” that goes on as our country moves to privatize more and more services

Tarbell uncovers how powerful people and companies use their influence to shape a system that works for them, not you. We highlight solutions to pressing problems.

This puts our lives in the hands of corporations whose “moral imperative” is to make money for their shareholders, while all other goals and concerns (like patient outcomes) exist only in service of this “prime directive”.  Continue reading

60 Minutes Fails to Represent Pain Patient Perspective

60 Minutes Fails to Represent Pain Patient Perspective By Laura Mills, Kate M. Nicholson, and Lindsay Baran – Mar 2019

CBS heaved out another stigmatizing and inaccurate media “story” (didn’t qualify to be called a “report”) about opioids and those who must take them. Here is the response, which points out the “pain” side of opioids (instead of just the “addiction” side).

In a Feb. 24 segment, CBS’s 60 Minutes accused the Food and Drug Administration (FDA) of igniting the overdose epidemic in the United States with its “illegal approval of opioids for the treatment of chronic pain.”

While the program highlighted the adverse consequences of misleading pharmaceutical marketing and lax government oversight, this segment failed to consider the perspective of patients who legitimately use opioids for pain, stigmatized them as drug-seekers, and propagated misconceptions about the overdose crisis, such as the idea that opioid treatment for chronic pain is indisputably illegitimate and is driving overdose deaths in the US.   Continue reading

Anger is Destructive when Expressed on Social Media

Below is a Twitter stream regarding the expression of anger and its consequences. Two of our best advocates are warning that “letting it all hang out” on social media may be counter productive.

Kate Nicholson – @speakingabtpain – Mar 2019

More people in #pain who are being tapered down or off of medication are reaching out & speaking of suicide.

I am sympathetic to the difficulty of losing access to pain medicine, but I am not a mental health professional. Some helpful thoughts from @StefanKertesz follow:   Continue reading

What We Can and Cannot Control

Genes, Environment, and Luck: What We Can and Cannot Control – Quillettewritten by Michael Shermer – Jan 2019

I’m posting this article because it applies to chronic pain, which usually starts with an unlucky event, like injuries from a car accident, or from our genes, like sickle-cell disease or EDS, or develops as a natural consequence of living life, like chronic back pain from hard physical labor.

The deeper I looked into the matter of how lives turn out, in fact, the more I realized how much is out of our control.

Let’s begin with a question: Why do some people succeed in life while others fail?

Continue reading

Opioid Crisis: No Easy Fix to Social and Economic Causes

Opioid Crisis: No Easy Fix to Its Social and Economic Determinants – Feb 2018

The accepted wisdom about the US overdose crisis singles out prescribing as the causative vector.

I don’t see how this wrong idea can be called “accepted wisdom” when it is much more akin to “accepted nonsense” and “urban legend”.

Although drug supply is a key factor, we posit that the crisis is fundamentally fueled by economic and social upheaval, its etiology closely linked to the role of opioids as a refuge from physical and psychological trauma, concentrated disadvantage, isolation, and hopelessness.   Continue reading

Structural Iatrogenesis leading to “Opioid Misuse”

Structural Iatrogenesis — A 43-Year-Old Man with “Opioid Misuse” – Scott Stonington, M.D., Ph.D., and Diana Coffa, M.D. – February 21, 2019

Here’s a quick summary of a terrifying story:

“When he gets tangled in new restrictive policies on opioid prescribing, a factory worker with severe rheumatoid arthritis, whose pain must be managed for him to perform his job, ends up buying oxycodone from a friend.”

(I’ve quoted almost all the text of this case study because the NEJM is now behind a paywall with only 3 free articles a month, suddenly restricting our access to what our doctors are reading and upon which they base our treatments – just another screw being tightened on patients.) Continue reading

Ethical Dimensions of Using AI in Health Care

Ethical Dimensions of Using Artificial Intelligence in Health Care – Feb 2019

A necessary tool, but a slippery slope that could lead to healthcare automation.

An artificially intelligent computer program can now diagnose skin cancer more accurately than a board-certified dermatologist.

Better yet, the program can do it faster and more efficiently, requiring a training data set rather than a decade of expensive and labor-intensive medical education.

While it might appear that it is only a matter of time before physicians are rendered obsolete by this type of technology, a closer look at the role this technology can play in the delivery of health care is warranted to appreciate its current strengths, limitations, and ethical complexities.   Continue reading

A Crisis of Opioids and the Limits of Prescription Control

A Crisis of Opioids and the Limits of Prescription Control – by Stefan G. Kertesz and Adam J. Gordon – 23 July 2018

Here, again, is this seminal article by two high-profile pain/addiction doctors about the follies of current anti-opioid policies:

A rise in addiction and overdose deaths involving opioids in the United States has spurred a series of initiatives focused on reducing opioid risks, including several related to prescription of opioids in care of pain. Policy analytic scholarship provides a conceptual framework to assist in understanding this response.

Prior to 2011, a “policy monopoly” of regulators and pharmaceutical manufacturers allowed and encouraged high levels of opioid prescribing.

The authors then point out that the debate has been cornered by an “advocacy coalition” of anti-opioid fanatics.   Continue reading

Professional Pushback Against Anti-Opioid Policies

On the Importance of Using the Right Metrics for Patient Outcomes and Payment: Pain, Pain Interference, and Physical FunctionBeth D Darnall, PhD and Mark D Sullivan, MD, PhD – September 2018

I can only access the first few sentences of this article, but it is significant because its authors are two of the people who have championed the drive to reduce opioid prescriptions.

Now they are finally pushing back against the insanity of policies that have arisen in reaction to their vocal opposition to “excessive” opioid prescribing. These policies are focused only on reducing the milligrams of opioids prescribed and nothing else, resulting in mandated opioid dosage reductions in stable patients.

One of the authors, Beth Darnall, recently circulated a petition among medical professionals to reject such crude “solutions” to the “opioid crisis”. Continue reading

Patient drug use data at your fingertips

Patient drug use data at your fingertips – By Rachel Z. Arndt  | October 9, 2017

Every time Dr. Gina Huhnke writes a prescription for opioids, she first consults a number in the patient’s electronic health record.

That number, a risk score that providers can use to gauge a patient’s risk for a substance-use disorder, tells her whether she should prescribe the drug or instead have a conversation about drug addiction.

Sometimes even the patients themselves are surprised,” said Huhnke, director of medical affairs and emergency medicine at Deaconess Health System, based in Evansville, Ind.    Continue reading