Portenoy's Complaint. Pharmageddon is upon us, and He did it.
Twenty years ago, Russell Portenoy, a prominent New York psychiatrist, pushed a movement to help people with chronic pain. Physicians had been educated to be cautious in use of narcotics to avoid addicting patients. Long-term use was limited to cancer patients. Dr. Portenoy's message was that patients with chronic pain had little risk of addiction or overdose. He claimed that less than one percent (1%) of opioid users became addicted. His influence kicked the narcotic door wide open. Vicodin, OxyContin, and Percocet became almost as available as chewing gum. In 1998 the Federation of State Medical Boards (FSMB) released new policy reassuring doctors they would not face regulatory action for prescribing large amounts of narcotics for pain patients. Incredibly the FSMB called on state medical boards to make under-treatment of pain punishable! The Joint Commission on Hospital Accreditation (JCAHO) jumped on the narcotic bandwagon with a guide stating, in treating pain “there is no evidence that addiction is a significant issue.” A scale from one to ten was introduced and patients were asked to rate their pain. People lost sight of the fact that these drugs are dangerous and highly addictive. Now Dr. Portenoy admits his error. His one percent (1%) figure was based on a single paragraph in a 1980 New England Journal of Medicine report describing hospitalized patients briefly given opioids. It was never intended as a benchmark for narcotic prescription. In the past decade opioid-related deaths and hospital admissions for opioid addiction both increased five-fold. Thanks, Doc.
Come on, Man. It's just One More Pill and it might Help Something.
A daily multi-vitamin may have benefits but protection from a cardiovascular crisis isn't one of them. A report in the Journal of the American Medical Association by an epidemiology team at Harvard University found no cardiovascular benefit from a multi-vitamin vs a placebo. The researchers evaluated a randomly assigned group of 14,000 men for risk of heart attack, death from a heart-episode, or stroke. The study extended over 11 years and the multi-vitamin was found no more effective than the placebo.
“Sponge Count is Ok, but has Anyone Seen my Glasses?”
A research team from Johns Hopkins University School of Medicine wanted to quantify “never events” that occur in operating rooms around the country. Such mistakes are things that should never happen, eg, wrong patient, wrong extremity, or wrong procedure. Collecting data from the National Practitioner Data Bank, the national repository of malpractice judgments and out-of-court settlements, the team identified 9,744 cases between 1990 and 2010. Reporting in the journal Surgery, they found 6% of patients died, 32.9% had permanent injury, and 59.2% suffered temporary injury. A foreign body left behind occurred in 49.8%, wrong procedure 25.1%, wrong site 24.8%, and wrong patient 0.3%. Typically, many problems are only discovered when a patient has a complication such as poor wound healing or infection. Total malpractice payments came to $1.3 billion with a mean payment of $133.055. The actual number of “never” events is almost surely higher since many patients never file claims after errors. Hospitals have been working on projects to reduce such events, including “time outs,” use of bar codes, and wand-like body scanners that can locate retained material. Nothing is foolproof because fools are so creative.
Smoking is One of the Leading Causes of Statistics.
Teen smoking is falling. The annual survey report from the National Institute of Drug Abuse (NIDA) conducted by the University of Michigan reported on teenagers who admitted smoking cigarettes in the preceding 30 days. In 2011 the number was 11.7%, and in 2012 it fell to 10.6%. This may appear minuscule, but represents a drop of 9% in a single year! The study tracks tobacco, alcohol, and other drug abuse among 45,000 students in 8th, 10th, and 12th grades. The downside of the report was marijuana use. Almost 23% of high school seniors confessed to using marijuana in the prior 30 days. Nora Volkow, director of NIDA, is worried that many teenagers no longer view pot as dangerous since it is now legalized for recreational use in Colorado and Washington.
I Read it on the Internet. It must be True.
Cardiologists have been lecturing about good and bad cholesterol for decades: high density lipoproteins (HDL) are good and low density lipoproteins (LDL) are bad. Hold on, doctor! Now an international team, reporting in Lancet, looked at medical data from thousands of people with or without a history of heart attacks. The collection included some with higher-than-average HDL. Data supports lowering LDL to reduce heart attack risk. HDL is not so clear. Researchers found that having naturally higher HDL imparted no added protection against heart attacks. Activities that increase HDL - exercising, losing weight and stopping smoking - also do their part to protect against heart attacks. It is hard to discern how much protection HDL actually provides on its own. These new findings raise the possibility that having high HDL might simply be a sign of something else that is going right in the body.
Why is my Brow Still Wrinkled, Doc?
The latest report from the US Food and Drug Administration (FDA) includes an alert regarding illicit Botox. Canada Drugs, a 10-year-old internet pharmacy headquartered in Winnipeg, has profited big time in selling cheaper, foreign knock-offs of popular medicines to American customers and doctors. FDA considers the activity illegal even when the drugs are authentic, because they aren't approved by the agency. Last year the FDA informed cancer doctors that they had bought a cornstarch-based imitation of Avastin. This time it's Botox. Recently the FDA informed 350 medical practices they may have purchased a potentially counterfeit version of the injectable paralytic.
Sex is the Great Amateur Art.
Rachel Jones and her team at Rutgers University produced a 12 part dramatic video series that promoted safer sexual decisions. The soap operas followed four heroines navigating through relationship dilemmas with men. Women who watched the series had 19% fewer risky sexual encounters - unprotected sex with drug users or men identified as promiscuous - than those who only received text messages about preventing HIV. “The women loved the videos. They watched most two or three times.” Moreover, this dramatizes an effective method for public education that should be expanded.
He Should have Made Noise Like a Hippo.
The Plymouth Herald reported the arrest of a 48 year-old man urinating against a wall. Prosecutor Jennie Cater said, “He was spraying urine to and fro over the flower beds while making noise like an elephant.” The court heard that a public toilet was open across the square. A “shocked and distressed” couple with their 5-year-old daughter, reported the man to police. The attorney for the man stated that he had a “raging alcohol problem” but seems to have turned the matter around. Better turning it around than being cut-off.
Addenda
Largest empire in human history: the British empire of the 19th century.
Four out of five migraine sufferers are female.
Last year airlines collected $3.4 billion in baggage fees.
My daughter is a vegetarian. She always leans toward sunlight.
You know “that look” when women want sex? Me neither.
I like Mexican food, but only from the waist up.
You never see a homeless guy with a bottle of Gatorade.
ALOHA AND KEEP THE FAITH rts
(Editorial comment is strictly that of the writer.)