Tag Archives: surrogate-endpoints

Surgeons’ Estimates of Opioid Needs Highly Variable

Orthopedic Surgeons’ Estimates of Opioid Consumption Following Total Knee Arthroplasty Found Highly Variable – Pain Medicine News – Dec 2019

A survey has uncovered wide variability in how orthopedic surgeons interpret their patients’ postoperative opioid consumption after total knee arthroplasty (TKA).

I find it odd that the leading sentence of this article talks about the “interpretation” (not estimate) of their patients’ postoperative opioid “consumption” (not need).

the researchers surveyed 36 orthopedic surgery residents, fellows and attendings at the institution. Respondents were asked to estimate the percentage of patients using opioids in the month before undergoing their TKA, as well as one to three months postoperatively. Continue reading

Even Medical Lit Subject to Media Hype about “Opioid Crisis”

Are Prescription Opioids Driving the Opioid Crisis? Assumptions vs Facts | Pain Medicine | Oxford AcademicMark Edmund Rose, BS, MA – Dec 2017

Sharp increases in opioid prescriptions, and associated increases in overdose deaths in the 2000s, evoked widespread calls to change perceptions of opioid analgesics.  Medical literature discussions of opioid analgesics began emphasizing patient and public health hazards.

Repetitive exposure to this [mis-]information may influence physician assumptions.

This is a huge problem for us, and a sad commentary on the state of medicine in the U.S. when doctors are influenced more by media-hype and biased research than their patients’ lived experiences.  Continue reading

Opioids Prescriptions Rare before OUD or Overdose

Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional studyNov 2019

I’m not going to pretend to be impartial and scientific anymore – this obscene charade of drug-warriors fighting what they call an “opioid epidemic” has gone to such ridiculous extremes (no opioids after cutting open a woman’s abdomen to pull her baby out) that I can no longer restrain my outrage.

With governments’ increasing efforts to curb opioid prescription use and limit dose below the Centers for Disease Control and Prevention (CDC)-recommended threshold of 90 morphine milligram equivalents per day, little is known about prescription opioid patterns preceding opioid use disorder (OUD) or overdose.

Limiting opioid prescriptions never worked in the past, isn’t working now, and never will work. It cannot work because legitimate opioid prescriptions are not related to opioid overdoses. How long will it take these bureaucrats to figure this out?  Continue reading

The Problem with Surrogate Endpoints

The Problem with Surrogate Endpoints – Alex Gertner – Twitter stream from @setmoreoff – Feb 2019

Mr. Gertner shows why you cannot measure drug use by counting various “surrogate outcomes” like those listed below and expect to get a realistic number.  Measurements can be dramatically skewed and lead to wildly inaccurate results when invalid surrogate endpoints are chosen.

1/ If you’d like to research the effect of a policy or program on drug use rates then you need to measure drug use.

  • ED overdose visits,
  • drug related arrests, and
  • overdose deaths

are not good measures of drug use rates. Thoughts from >10 years working in drug policy & research   Continue reading

Measurement of Chronic Pain and Opioid Use Evaluation

Measurement of Chronic Pain and Opioid Use Evaluation in Community-Based Persons with Serious Illnesses | Journal of Palliative Medicine – by Kathleen Puntillo, and Ramana K. Naidu – Mar 2018

I had high hopes for this paper after reading the abstract and finding this conclusion, which feels so spot-on:


Accountability for high quality care for community-dwelling patients requires selection of metrics that will capture the

  • burden of chronic pain and
  • beneficial use or misuse of opioids.

Continue reading

Misconceptions about Evidence-Based Medicine

Evidence-Based Medicine: Common Misconceptions, Barriers, and Practical Solutions – JAY SIWEK, MD, Georgetown University Medical Center, Washington – Sep 2018

More than 25 years have passed since the term evidence-based medicine (EBM) was introduced into the medical literature. Its original definition has been expanded to include not only the quality of the evidence, but also the two key players applying the available evidence—namely the clinician and patient.

A current working definition is: the integration of the best available evidence with clinical expertise and the individual patient’s values, preferences, and unique circumstances.

EBM is not dogmatic, “cookbook ” medicine.

Oh really? But that’s exactly how it’s being used. Continue reading

Behind the AHRQ Review of Alt Therapies for Pain

Behind the AHRQ Report – By Richard A. Lawhern, PhD and Stephen E. Nadeau, MD – October 3, 2018

In the current restrictive regulatory climate that governs opioid analgesic therapy for chronic pain, there is much discussion of “alternative” therapies and “integrative medicine.”

Unfortunately for proponents of such measures, the state of medical evidence in trials literature is very weak, reflecting weaknesses of trial design, execution, and size.

This is perhaps unintentionally illustrated by a major systematic review released in June 2018 by the Agency for Healthcare Research and Quality (AHRQ), an agency of the US Health and Human Services Department.   Continue reading

Human gut study questions probiotic health benefits

Human gut study questions probiotic health benefits — ScienceDaily – Sept 2018

Probiotics are found in everything from chocolate and pickles to hand lotion and baby formula, and millions of people buy probiotic supplements to boost digestive health. But new research suggests they might not be as effective as we think.

Through a series of experiments looking inside the human gut, researchers show that many people’s digestive tracts prevent standard probiotics from successfully colonizing them.

Furthermore, taking probiotics to counterbalance antibiotics could delay the return of normal gut bacteria and gut gene expression to their naïve state.   Continue reading

Those 2-Minute Walk Breaks? They Add Up

Those 2-Minute Walk Breaks? They Add Up – By GRETCHEN REYNOLDS MARCH 28, 2018

I’m glad to read that freq2uent short bursts of exercise (or any movement, even if not vigorous) can be as beneficial as longer, more intense sessions of exercise.

This is how I get most of my exercise: getting up from my desk when my 30-minute timer goes off. I just take a minute-long break, walking around and swinging my arms around, maybe doing some stretches (mainly backward to “open my hips” after so much sitting), or doing a quick burst of “20-steps” running in place.

Walk for two minutes. Repeat 15 times. Or walk for 10 minutes, thrice.   Continue reading

Surrogate endpoints in global health research

Surrogate endpoints in global health research: still searching for killer apps and silver bullets?March 2018

In clinical research, there is widespread acceptance that surrogate endpoints may not translate to long-term benefits.

Clinical epidemiologists highlight the hazards of surrogate measures (eg, biomarkers, laboratory test results and short-term improvements in health) that substitute for outcomes which are important for patients (eg, avoiding premature death or severe disability).

For example, in cardiovascular research, improvements in parameters such as blood pressure or cholesterol may not improve outcomes such as deaths.   Continue reading