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
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.
Government efforts to curb opioid prescriptions may have backfired – Aug. 24, 2018
In the case of the DEA’s 2014 action to move opioid painkillers [hydrocodone, Vicodin] to a more restricted class, this “may inadvertently motivate surgeons to prescribe greater amounts to ensure adequate pain treatment,” said Dr. Jennifer Waljee, lead author of one of the studies.
Her team believes that once prescription refills became tougher under the new DEA rules, surgeons who worried about a patient’s longer-term pain control simply ordered a larger number of pills so the patient had a “stockpile” of opioids to use at home.
This seems like a perfectly appropriate medical response to such arbitrary limits. Continue reading
Opioid Prescriptions Plunge to 15-year Low – Pain News Network – August 29, 2018 – By Pat Anson, Editor
Prescriptions down. Deaths up. Hmmmm. Do you think this means the policy might be wrong? [from Twitter: https://t.co/tU6J0DpvlK)
The volume of opioid prescriptions in the United States has fallen sharply and now stand at their lowest levels since 2003, according to data released by the Food and Drug Administration.
Over 74 million metric tons of opioid analgesics were dispensed in the first six months of 2018, down more than 16 percent from the first half of 2017. Continue reading
Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention’s 2016 Opioid Guideline – Amy S.B. Bohnert, PhD, MHS; Gery P. Guy Jr., PhD, MPH; Jan L. Losby, PhD, MSW
This data doesn’t mention that opioid prescriptions have been declining since 2012, 4 years before the guideline was issued.
Background: In response to adverse outcomes from prescription opioids, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain in March 2016. Continue reading
Bait and switch in Oregon: Substituting quackery for opioids for Medicaid patients – sciencebasedmedicine.org – Aug 2018
My thinking on this issue first started to gel a couple of years ago, when the National Center for Complementary and Integrative Health (NCCIH) published its five year strategic plan for 2016-2021.
In this plan, NCCIH prominently featured researching and promoting the “nonpharmacologic treatment of pain” as one of its most pressing goals.
Later that year, it published a really bad review article, one based on horrible studies and huge extrapolations from weak data, that basically claimed all nonpharmacological treatment of pain as part of “complementary and alternative medicine” (CAM, now known as “integrative medicine”). Continue reading
Heroin-Fentanyl Mix Led to Drug Exposure Concerns at Prison | Maryland News | US News – Aug. 30, 2018 – By LISA CORNWELL, Associated Press
A substance that led to nearly 30 people at an Ohio prison being treated for drug exposure or suspected exposure was a mixture of heroin and fentanyl, the State Highway Patrol said.
Prison guards, nurses and inmates at Ross Correctional Institution in Chillicothe were treated Wednesday with the anti-overdose drug naloxone after an inmate showed signs of a drug overdose, and some people experienced symptoms consistent with exposure to the opioid fentanyl.
Because illicit fentanyl must be injected (like heroin), “snorted” (like cocaine), or swallowed in counterfeit pills, there is no way anyone would be affected by another person’s fentanyl. Lab technicians can handle it without protection (even the liquid) because it can’t be absorbed through the skin. Continue reading
OHA’s Allen defends controversial opioid tapering proposal – By Elizabeth Hayes – Staff Reporter, Portland Business Journal – Aug 30, 2018
In a letter to the Wall Street Journal, Oregon Health Authority Director Patrick Allen defended a controversial proposal to taper Medicaid patients off opioids, setting off a Twitter firestorm.
Allen’s letter, published Tuesday, came in response to an op-ed piece attacking the proposal policy penned by Sally Satel, a resident scholar at the American Enterprise Institute and lecturer at the Yale School of Medicine, and Dr. Stefan Kertesz, a professor of preventive medicine at the University of Alabama at Birmingham. Continue reading
Shades of Tuskegee – Oregon’s Monstrous Experiments On Poor Pain Patients – Aug 2018 – by Josh Bloom
But Oregon is about to take a giant regressive step – all the way back to 1932, when the “Tuskegee Study of Untreated Syphilis in the Negro Male,” one of the great shames in the history of the US, began in Alabama.
The study, which was initiated by the United States Public Health Service (now the United States Department of Health and Human Service) was designed to study how untreated syphilis impacted black men, who thought that they were receiving free healthcare from the government.
And then they wonder why minorities and poor people don’t trust our government. After what’s it’s doing to pain patients, I don’t trust it anymore either. Continue reading
Twitter discussion about Oregon Initiative by Sarah Blahovec @Sblahov – 13 August
This is typical of pain patients: keep trying other methods of pain relief and use opioids only as long as nothing else is effective,
Hi-pain patient here. And there are actually many of us who are experiencing losing access to pain medication that we NEED for quality of life.
Also, the statistics related to the opioid epidemic are seriously skewed. Continue reading