The Grade Working Group: Grading the Graders

Welcome to the  Grade Working Group: From evidence to recommendations – transparent and sensible

The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) working group began in the year 2000 as an informal collaboration of people with an interest in addressing the shortcomings of grading systems in health care. 

The working group has developed a common, sensible and transparent approach to grading quality (or certainty) of evidence and strength of recommendations.

So this is a group that’s grading the graders? 

Maximum Opioid Doses are an Abomination

Maximum Opioid Doses: A Pharmacological Abomination – By Josh Bloom — June 22, 2020

Despite irrefutable pharmacological evidence of the wide range in individuals’ metabolism of opioid drugs, states continue to impose “one-size-fits-none” laws.

It’s safe to say that no one is really paying attention to the science. So, here it is. Again.

The American Medical Association was two years late to the party when it issued its first statement (1) about the inappropriate use of CDC Guidelines to establish, among other things, laws that define a dose and duration limits for opioid analgesics. No one was listening. Since then things have gotten worse, not better, for pain patients.  

N.H. Bill supports doctors treating pain with opioids

Here’s a very positive development in New Hampshire:

HOUSE BILL 1639-FN – AN ACT relative to healthcare.

Section 5
Requires that boards regulating practitioners prescribing, administering, and dispensing controlled substances adopt rules for management of chronic pain.

Section 6:
defines chronic pain for the purposes of the controlled drug prescription health and safety program.  

A virus walks into a bar…

Packed Bars Serve Up New Rounds Of COVID Contagion | Kaiser Health News – By Jordan Rau and Elizabeth Lawrence June 25, 2020

As states ease their lockdowns, bars are emerging as fertile breeding grounds for the coronavirus.

Public health authorities have identified bars as the locus of outbreaks in Louisiana, Florida, Wyoming and Idaho.

Bars are tailor-made for the spread of the virus, with loud music and a cacophony of conversations that require raised voices. The alcohol can impede judgment about diligently following rules meant to prevent contagion. 

AMA recommends specific changes to CDC guideline

The full AMA letter and each recommendation to revise the CDC guideline – (continued from yesterday’s post)

…the CDC Guideline could be substantially improved in three overarching ways.

1. First, by incorporating some fundamental revisions that acknowledge that many patients experience pain that is not well controlled, substantially impairs their quality of life and/or functional status, stigmatizes them, and could be managed with more compassionate patient care.
2. Second, by using the revised CDC Guideline as part of a coordinated federal strategy to help ensure patients with pain receive comprehensive care delivered in a patient-centric approach. And
3. Third, by urging state legislatures, payers, pharmacy chains, pharmacy benefit management companies, and all other stakeholders to immediately suspend use of the CDC Guideline as an arbitrary policy to limit, discontinue or taper a patient’s opioid therapy.

AMA urges CDC to revise opioid prescribing guideline

AMA urges CDC to revise opioid prescribing guideline | American Medical Association – Jun 18, 2020

Finally! I’m still outraged that the AMA stood by silently for 5 long years as more and more pain patients were deprived of legitimate medical opioid treatment.

They remained silent as law enforcement second-guessed doctors’ decisions and essentially dictated our treatment. I didn’t hear a peep of protest when appropriate medical care was decided by the DEA and enforced by SWAT teams.

So pardon me if I’m not giving the AMA adulation or kudos or praise for doing what they should have done 5 years ago. Their inaction led directly to the suicides of so many pain patients who were deprived of pain relief on the basis of these appallingly arbitrary and misapplied CDC guidelines. 

Guidelines Written and Manipulated by Insiders

Professional Societies Should Abstain From Authorship of Guidelines and Disease Definition Statements – John P.A. Ioannidis – Oct 2018

Guidelines and other statements from professional societies have become increasingly influential. These documents shape how disease should be prevented and treated and what should come within the remit of medical care.

Changes in definition of illness can easily increase overnight by millions the number of people who deserve specialist care. This has been seen repeatedly in conditions as diverse as hypertension, diabetes mellitus, composite cardiovascular risk, depression, rheumatoid arthritis, or gastroesophageal reflux.

Similarly, changes in prevention or treatment options may escalate overnight the required cost of care by billions of dollars.

For example, if we accept PROP’s argument that we’re all addicted to our “heroin pills”, we’d all suddenly need “addiction-recovery programs/clinics/residential treatment centers/resorts” for our  “substance abuse” instead of “chronic pain”. 

Flaws Found in Interventional Treatment Guidelines

Flaws Found in Interventional Treatment Guidelines – Pain Medicine News – by Harry Fortuna – Mar 2020

Assessors were unable to give full votes of confidence to any of the four recently evaluated interventional guidelines created by major North American pain medicine societies.

Of further concern,

• only half of the sample studied was found to be of high methodological quality, and
• none of the guidelines surveyed adeptly involved all stakeholders such as patients, providers and payors.

Inaccurate Opioid Information Used by Lawmakers

Damaging State Legislation Regarding Opioids: The Need To Scrutinize Sources Of Inaccurate Information Provided To Lawmakers – free full-text /PMC6857667/ – Michael E Schatman and Hannah Shapiro – 2019 Nov

On January 22, 2019, a Massachusetts State Representative introduced House Bill 3656, “An Act requiring practitioners to be held responsible for patient opioid addiction”.

Section 50 of this proposed legislation reads, “A practitioner, who issues a prescription … which contains an opiate, shall be liable to the patient … for the payment of the first 90 days of in-patient hospitalization costs if the patient becomes addicted and is subsequently hospitalized”.

When asked of the source of medical information on which he based his bill, the Representative mentioned the name of a nationally known addiction psychiatrist.

Though unmentioned, this is clearly referring to our nemesis, Mr. Kolodny, who has continued using cherry-picked data from years ago to make his claims that “opioids cause addiction”. 

Guidelines should allow for individual decisions

National Academies outlines new guidelines for opioid prescribing – By Andrew Joseph @DrewQJoseph – Dec 2019

 A new report issued Thursday by the National Academies of Sciences, Engineering, and Medicine outlines a framework for prescribers and others to develop their own plans for acute pain, without offering any direct recommendations itself. 

Here is finally a sensible “guideline” that essentially says to ignore specific “rules” and work with individual patients to find what works best for them.

But I expect the simplistic anti-opioid rules fabricated by non-medical “experts” will continue to override any thoughtful guidance from respected scientific groups like the National Academies of Sciences, Engineering, and Medicine.

After all, what could scientists possibly know that PROPagandists don’t?