Evidence-informed Person-Centered Healthcare Part I: Do ‘Cognitive Biases Plus’ at Organizational Levels Influence Quality of Evidence? – PubMed – Dec 2014
As our medical system tries to implement Evidence-Based Medicine, it’s becoming more and more clear that the “evidence” isn’t the factual unbiased truth we expect.
Introduction: There is increasing concern about the unreliability of much of health care evidence, especially in its application to individuals.
- Cognitive biases,
- financial and non-financial conflicts of interest, and
- ethical violations
at the levels of individuals and organizations involved in health care undermine the evidence that informs person-centred care. Continue reading
Pain Specialists Pile on CDC Opioid Guidelines | MedPage Today – by Elizabeth Hlavinka, Staff Writer – Sept 2019
It’s infuriating that three solid years of professional medical criticism, even from some of the people involved in the original writing, hasn’t resulted in the withdrawal or “rewriting” of the CDC guideline.
In the 3 years since the guidelines were published, at least 33 states have enacted legislation that limits opioid prescribing, and although half of these states specify that the new limits are intended for patients with acute pain, many physicians have stopped prescribing opioids to chronic pain patients as well, according to Gary Jay, MD, of the University of North Carolina in Chapel Hill.
In April, the authors of the guidelines stated that the recommendations were not intended to force hard limits of opioid doses, abruptly taper or stop opioid use, or be applied to patients outside the guidelines’ scope, such as patients undergoing active cancer treatment or, in some cases, patients with chronic pain. Continue reading
Defining Addicts and Pain Patients as One and the Same, A Moral and Ethical Failure in Policy • CERGM – By R Carter – Mar 2019
Morals and ethics are often used interchangeably, but there are small differences.
- Ethics refers to rules provided by an external source, e.g., codes of conduct in workplaces or principles in religions.
- Morals refer to an individual’s own principles regarding right and wrong
There are two great arbitrators of morality devised by mankind, the State and Religion. Each has a power they use to enforce ethical standards. Continue reading
Illegal drug classifications are based on politics not science – report | Global development | The Guardian –Karen McVeigh – @karenmcveigh – Jun 2019
Illegal drugs including cocaine, heroin and cannabis should be reclassified to reflect a scientific assessment of harm, according to a report by the Global Commission on Drug Policy
The commission, which includes 14 former heads of states from countries such as Colombia, Mexico, Portugal and New Zealand, said the international classification system underpinning drug control is “biased and inconsistent”.
A “deep-lying imbalance” between controlling substances and allowing access for medicinal purposes had caused “collateral damage”, it said. Continue reading
Scope of practice expansion: Patient safety is sacrificed for greater access – Suzanne M. Everhart, DO | POLICY | Jul 24, 2019
The job of a physician is to provide the highest quality care to patients, while fostering a relationship based on trust.
There are serious consequences for the health of our patients if that standard is eroded and compromised by well-intentioned, but misguided, interest groups and politicians.
“Misguided” is a nice word for “wrong” and I have my doubts about anything being “sell-intentioned” when it comes from interest groups and politicians”. Continue reading
How Did We Come to Abandon America’s Pain Patients? – Filter Magazine – by Alison Knopf – July 2019
This is an excellent article pointing out exactly how pain patients have been neglected and dismissed by the medical system. Kudos to Alison Knopf for her exemplary work.
Overdoses—not those involving prescription opioids, but of heroin and illicit fentanyl, often combined with benzodiazepines—continue to go up. But opioid prescribing continues to go down.
Lawmakers contend WHO pain treatment guidelines are really Purdue ‘marketing materials’ – By ED SILVERMAN @Pharmalot MAY 22, 2019 – (article at “https://www.statnews.com/pharmalot/2019/05/22/purdue-opioids-world-health-guidelines/” accessible only through subscription to StatPlus)
Just the two first paragraphs of visible preview are astonishing and so infuriating that I’ll just leave you with these two:
Two lawmakers are urging the World Health Organization to rescind guidelines issued nearly a decade ago for treating pain because they contain “dangerously misleading” and sometimes “outright false claims” about the safety and effectiveness that were orchestrated by Purdue Pharma.
In a new report, the lawmakers contend that the WHO guidelines, which were released in 2011 and 2012, are “serving as marketing materials for Purdue.” And they pointed to efforts by the company to create and fund front groups that participated in research that shaped WHO decision making – and dovetailed with corporate goals to boost use of opioids, such as its own OxyContin pill.
CDC Director Says Agency Will ‘Clarify’ Opioid Guideline – April 11, 2019 – By Pat Anson – Apr 2019
CDC Director Robert Redfield, MD, has for the first time suggested that his agency may be preparing to make changes to its controversial opioid prescribing guideline.
“The Guideline does not endorse mandated or abrupt dose reduction or discontinuation, as these actions can result in patient harm,” Redfield said in his letter, which was released a day after the FDA warning. “The Guideline includes recommendations for clinicians to work with patients to taper or reduce dosage only when patient harm outweighs patient benefit of opioid therapy.”
I cannot understand why the CDC remained silent so long (almost exactly 3 years). They knew about the harm and suicides of patients yanked off their opioid therapy, they knew it was being used to make laws, they knew many doctors were quitting pain management… yet they said not one word until now. Continue reading
Patient Care and Population Health: Goals, Roles and Costs – free full-text /PMC4207028/ – Aug 2014
We should welcome efforts that encourage clinicians to avoid tests and treatments that do not improve health and thereby waste valuable resources
But we should critically evaluate proposals that assign clinicians the direct double responsibility of
- meeting the medical needs of patients while
- simultaneously meeting the economic needs of populations.
Why should we be sceptical? For two reasons. Continue reading
Misuse of Hyperalgesia to Limit Care | Practical Pain Mgmt | By Donald C. Harper, MD, BSc – March 2011
John (not his real name) is a 51-year-old chronic pain patient that I have been seeing since 2003. I had begun carefully titrating him on oxycodone, Oxycontin® and Dilaudid®, which had been started by another doctor and, ultimately, settled on a dose of Oxycontin 640mg B.I.D., 32mg hydromorphone q 4 hrs prn breakthrough pain and Xanax® 1 to 1.5mg q.i.d. prn muscle spasms and anxiety. On these medicines, he was content and functional and denied any deficits or side-effects due to his medicine.
His insurance company was concerned about the expenses of his medicine and asked me to arrange for a second opinion. Given the complicating factor of his end-stage lung cancer, I arranged for an evaluation by the pain clinic of a major cancer center. Continue reading