Indoor transmission of COVID NOT likely

Indoor transmission of SARS-CoV-2 – from medRxiv preprint server – Apr 2020

Finally, they’ve studied and validated what has always seemed obvious and logical to me: of course, a disease will spread more easily in a confined indoor area than out in the open!

Yet, our officials cooped us up in crowded indoor spaces even though that’s where you’re most likely to get infected from the prolonged close contact. This practically guaranteed that everyone would get sick if any single household member got sick.

Still, I was in favor of the lockdown as a desperate measure to buy us time to start research, craft policies to mitigate harm, and prepare our healthcare infrastructure for the predicted surge of patients needing intensive care.

But that didn’t happen… 

Linking Excessive Drinking with Chronic Pain

Today I have documented my painful and failed search to find out what data or reasoning spawned this article further stigmatizing pain patients in a pain-related medical news site:

Excessive Drinking Seen in Some Patients With Chronic Pain – Clinical Pain Advisor – May 28, 2020

Among those reporting alcohol use, patients with certain common medical conditions are more likely to report excessive drinking, according to a study published online May 13 in JAMA Network Open.

There was no further reference to chronic pain as a “medical condition” in the article, only in the headline. This seemed like a completely gratuitous mention of pain, deliberately creating an association of chronic pain with alcohol and leaving the impression that pain patients are a bunch of drunks. So, I decided to investigate. 

CDC is blending counts for COVID cases

The CDC is lumping positive COVID-19 viral and antibody tests together. Here’s why that’s bad. | Live Science – By Nicoletta Lanese – Staff Writer – May 2020

The U.S. Centers for Disease Control and Prevention (CDC) and several state health departments have been reporting COVID-19 diagnostic tests and antibody tests as one grand tally, rather than keeping their results separate, The Atlantic reported. 

Reporting these numbers as a lump sum, rather than two distinct data points, presents several major issues. 

The CDC is doing with COVID cases exactly what they did to opioid overdose death counts: blending two very important separate counts. With overdoses it was counting prescription opioids along with illicit heroin and fentanyl into “opioid overdoses”, which made it look like everyone was overdosing on prescription medication. 

Biomarkers May (or may not) Indicate Chronic Pain

Biomarkers May Indicate Chronic Pain, Aid Personalized Treatment – Pain Medicine News – by Kaitlin Sullivan – Apr 2020

People who suffer from chronic pain may have abnormal levels of 11 biomarkers related to metabolites and nutrient deficiencies, according to a retrospective observational study published in Pain Physician (2020;23[1]:E41-E49).

Although the research is still in its early phase, these findings provide a snapshot of physiologic abnormalities found in a subset of patients with chronic pain.

“Subset” is the critical word here. If these “abnormalities” aren’t found in ALL patients with pain, how can they be used as “biomarkers” for pain?

10 Years of Missing Data for Clinical Trials

Clinical trial sponsors must publish 10 years of missing data, judge rules – By Lev Facher – Feb 2020

This shows how bad of a problem we have with scientific research, now that it’s been used and manipulated by financial interests. If a study can’t find the results the “payor” wants to “prove”, it simply disappears like it never happened.

For years, government research agencies have misinterpreted a law that requires them to collect and post clinical trial data, a federal judge ruled this week, leaving behind a 10-year gap in data that now must be made publicly available.

The ruling affects trials conducted for as-yet-unapproved drugs and devices in that 10-year stretch, according to a lawyer for the plaintiffs — meaning hundreds or even upwards of 1,000 noncompliant trials would be forced to post data. 

Review: opioid management for chronic noncancer pain

Long‐term opioid management for chronic noncancer pain – free full-text /PMC6494200/ – Cochrane Review: Jan 2010

I’ll start with these two key findings in the author’s conclusions from this extremely long Cochrane Review:

1. Many patients discontinue long‐term opioid therapy (especially oral opioids) due to adverse events or insufficient pain relief; however, weak evidence suggests that patients who are able to continue opioids long‐term experience clinically significant pain relief.

2. Whether quality of life or functioning improves is inconclusive. Many minor adverse events (like nausea and headache) occurred, but serious adverse events, including iatrogenic opioid addiction, were rare.

Conquering (or Not) Cancer Pain

Conquering Cancer Pain | Drug Topics – by Tzipora Lieder, RPh – Feb 2020

I think it’s a joke to talk about “conquering” any kind of pain. And if, like so many of us, you cannot conquer your pain, what does that say about you?

Military terms like “conquer” reformulate our suffering as a war, a battle we lose day after day, over and over again, and imply that we’re too weak (or stupid or lazy) to fight harder. The implication is that we’re too weak (or stupid or lazy) to fight hard and “conquer” the pain that plagues us.

But what does it mean to “win” this “battle with chronic pain” anyway?

In many articles like this, winning seems to be determined solely by whether or not we take opioid pain medication. All the other semi-effective semi-toxic medications used for chronic pain are seen as harmless, but if we take opioids, we are the “losers”. 

The medications that change who we are

The medications that change who we are – BBC Future – By Zaria Gorvett – Jan 2020

Over the years, Golomb has collected reports from patients across the United States – tales of broken marriages, destroyed careers, and a surprising number of men who have come unnervingly close to murdering their wives.

In almost every case, the symptoms began when they started taking statins, then promptly returned to normal when they stopped; one man repeated this cycle five times before he realised what was going on.

We’re all familiar with the mind-bending properties of psychedelic drugs – but it turns out ordinary medications can be just as potent.  

Chronic Pain After Cancer: The Role of Opioids – part 1

Chronic Pain Following Treatment for Cancer: The Role of Opioids – Ballantyne – 2003 – The Oncologist – Wiley Online Library – Jane C. Ballantyne –  Dec 2003

This study was done just months after Ballantyne had authored a study claiming hyperalgesia is a common problem with continued opioid use.

Ballantyne is one of the most adamant anti-opioid zealots who now insists that “opioids are bad” under all circumstances and shouldn’t be used for chronic pain, but in 2003 she was apparently still reasonable.

Opioids are the most effective analgesics for severe pain.

…opioid tolerance, if it develops, is relatively easy to overcome, and other problems of opioid use, including substance abuse, are unlikely to be problematic.

So, in 2003, she believed that opioid use is unlikely to be problematic, a view directly opposed to her current position. We never see references to these positive findings of opioid use anymore.

Truth About the Consequences of Opiophobia

A Dose of Truth about the Consequences of Opiophobia | HCPLive – 2010 – Joel S. Hochman, MD – Jan 2010

In this old article, the author picks apart a study from 2003 which became the backbone of the claims about hyperalgesia. It’s outrageous that a study from 17 years ago is determining our pain care (or lack thereof) today.

As this decade has progressed, some legal experts assumed that as a consequence of certain tort actions (cf. Bergman v. Chin), physicians would be compelled to treat pain effectively in compliance with the community standard of care.

The “community standard of care” no longer exists for pain control because opiophobia is preventing the use of the most effective medication just because some “street drugs” of the same chemical class, like heroin or illicit fentanyl, are being abused by people who then overdose.