Posts Tagged With: ethics

I am republishing these “Principles of Opioid Management of Pain“, by Dr. Joel Hochman, et al., because of the explosion of deeply flawed and misguided “Guidelines” for pain management in recent years. This document stands alone in meeting the (textbook, ‘responsible physician’) standard for pain management while not violating core ethical obligations of the doctor-patient relationship and is useful, I think, for comparison when studying promulgated Guidelines. [See also: The Distortion of Medicine and Confusion of Standards]

It seems to me an uncivilized and insane notion that just because someone in current moderate to severe pain had a history of an alcohol or drug problem, or even a current substance abuse problem, that you would deny them opioid therapy if that was the best medication to relieve their suffering. But this seems to be a point of confusion that increasingly comes up from patients, doctors, and regulators alike. So, in this post, let me make the medical standard of care in this situation perfectly clear. [...]

The nonprofit Pain Relief Network (PRN) says the guidelines for prescribing narcotics, written by the Washington state Department of Health and published in March 2007, have influenced pain treatment across the country and have made doctors afraid to give opiate prescriptions. Siobhan Reynolds, PRN president, says the group decided to target WA because the state has been a leader both in pain treatment and in restricting doctors’ prescriptions of pain relief medication. [...]

This Resource Is an article by Dr. Frank Fisher published in the Harvard Medical Alumni Bulletin. He recounts his tale of persecution for practicing excellent pain management – a quintessencial example of the War on Doctors and the Pain Crisis in America.

Talk given by Frank Fisher, M.D.; Drug Cops and Docs, Cato Institute Conference; 2005-09-09. Introduction — The undertreatment of chronic pain is an ongoing public health disaster. The means to reverse this disaster is a class of medications known as opioid analgesics. The pain crisis exists for just one reason. Physicians don’t prescribe enough of these medications. I’m going to explain why we don’t. — The war on drugs has become a war on legal drugs. This exposes physicians to the risk of unwarranted prosecution. In response to this threat, the academic pain establishment has developed a set of standards …

Excellent article by Dr. Forest Tennant explaining and demystifying chronic opioid therapy for chronic pain.

This Resource Is an article discusses the failure of the ‘barriers to pain care’ literature to analyze those barriers from an ethical POV. The author relates this to ‘the collective failure of the profession to recognize the ethical implications of undertreated pain.’

In this full text medical journal article, Joranson, in response to Paulozzi (below), describes a basic public health approach to the ‘drug abuse crisis.’ One wonders whether the combined brain power of the NIH, CDC and FDA would not have accomplished this, except for the imperatives of the drug war. Hurwitz 2005 (see below) is an example of the sort of creative analysis we should expect, but never get, from our academic and federal patriarchs.

Chronic pain patient experience of abuse and neglect from a medical system distorted by drug war law enforcement imperatives placed on physicians.

Purdue Pharma was coerced, under threat of destruction by the U.S. Department of Justice (DOJ), into pleading guilty to charges that their drug was “more addictive” than they had claimed, the government alleging that the company failed to inform both doctors and the public of this information when it came available. The problem for Americans in pain is that this private deal creates, if you will, a “fact” on the public record that is not factual, a “fact” that severely prejudices the interests of patients in pain. [...]

Blog entry about the distortion of medical ethics and of medical practice of pain management using opioid therapy by drug war imperatives on physicians to value catching drug abusers over providing compassionate and rational medical care to their patients.

This Resource Is the index or table of contents page for a collection entitled: THE PATHOLOGICAL DEA, which consists of several articles from the January issue of the peer-reviewed journal, Pain Medicine, by physicians, researchers and advocates most of whom worked with the DEA to produce the now infamous Amazing Vanishing DEA FAQ. The articles provide a glimpse into the feelings of personal hurt and professional betrayal experienced by these clinicians and academics of good will when the DEA abruptly disavowed the FAQ and wratcheded up attacks on pain doctors. Truly Fascinating articles by Heit, Fishman, Passik, and Rowe – …

Newspaper article focusing on Siobhan Reynolds, founder and President of the Pain Relief Network (PRN) and her life experience of trying to get decent medical care for a husband in chronic pain, while raising a child and founding a movement for social change – the Pain Relief advocacy movement.

TOC: Intro — Opiophobia and Opioignorance — Risk of Addiction in Chronic Opioid Therapy — Treatment and Outcomes — Undertreatment of Pain is a National Scourge — Footnootes

Excerpt: “You captured the absurdity of these trials beautifully. I remember when I watched my first one of these, the “trial” of Drs. Bordeaux, Allere, Jackson et al of the Comprehensive Care clinic in Myrtle Beach, South Carolina. There, the prosecution could make no allegations of high pill counts or “addicted” babies, so instead, they added little dramatic touches into the statements the doctors supposedly gave to the DEA agents. These touches gave the scene, as portrayed by prosecutors, what theater artists call the “feel of reality”… The stunning thing was, the topic at hand was pain care, so the …

First of a series of blog posts regarding the trial of pain doctor William Mangino. Excerpt: “The prosecution asked only one question on cross examination of defense expert Dr. Tennant. The prosecution brought forth no further expert testimony. The defense felt Tennant’s testimony was sufficiently strong and his credibility and professional stature so huge relative to the prosecution expert, and that the prosecution had failed to make it’s case. And so on 2007-07-03, the defense choose not to call it’s second defense expert (myself) and choose not to put Dr. Mangino on the stand, and rested.”

John Tierney (”A Taste of His Own Medicine,” column, May 6) hits the nail on the head when he suggests that drug war prosecutions, like those of Rush Limbaugh or Richard Paey, are more for show than for actual enforcement purposes. Unfortunately, these prosecutions also reinforce a medical culture that routinely hardens itself against the anguished pleas of people in serious pain. — An Internet study presented at the annual meeting of the American Pain Society last week in San Antonio, Tex., revealed that while 88 percent of those who visit emergency rooms do so because of out-of-control pain, only …

Blog item with embedded video, text of article Abstract, and link to full-text PDF about the EPIC survey which is the largest ever study of its kind to investigate the prevalence, impact and treatment of pain in cancer… The EPIC survey demonstrates that pain in patients with cancer is widespread, frequent and long-lasting, and is not always adequately managed.

Comment in response to a TierneyLab blag post by John Tierney of the NY Times. Dr. Volkman characterizes DEA as ‘a criminal organization’ with a primary interesting in cleaving pain patients from their legitimate physicians.Two months later the government charged him with federal drug crimes.

Excerpt: “Veterans in chronic pain average less than 4 Percosets a day from the compassionate care-givers of the Veterans Administration… [Such low-potency opioids] are indicated for mild to moderate acute pain, not chronic moderate to severe persistent pain… Oxycodone is a short acting opioid in this preparation, with an effective duration of action of about three hours. One pill every six hours of oxycodone/acetaminophen for chronic pain guarantees that the patient will be in unacceptable pain 50 percent of the time, at best. That’s not treatment, it’s under-treatment; it could not possibly be adequate.”