Chronic Pain Fuels Boom in Opioids

By John Fauber

Milwaukee Journal Sentinel/MedPage Today

Originally published on February 19, 2012

Prescriptions for narcotic painkillers soared so much over the last decade that by 2010 enough were being dispensed to medicate every adult in the U.S. around-the-clock for a month.

Fueling that surge was a network of pain organizations, doctors, and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the very companies that made them, a Journal Sentinel/MedPage Today investigation found.

Last year, the Journal Sentinel/MedPage Today found that a University of Wisconsin-Madison-based organization had been a national force in helping liberalize the way opioids are prescribed and viewed. During a decade-long campaign that promoted expanded use of opioids -- an agenda that critics say was not supported by rigorous science -- the UW Pain & Policy Studies Group received $2.5 million from makers of opioid analgesics.

After that article was published last April, the UW Pain group said it had decided to stop taking money from the drug industry.

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The Pendulum Swings Back

Several of the pain industry's core beliefs about chronic pain and opioids are not supported by good science and contributed to the growing use of the drugs, a Journal Sentinel/MedPage Today review of records and interviews found.

Among the misconceptions:

• The risk of addiction is low in patients who obtain their narcotic painkillers legitimately.
• There is no maximum dose of the drugs that can't be safely prescribed.
• People who seek more frequent prescriptions or higher doses of the drugs aren't addicts, they are "pseudoaddicts" who just need more pain relief and more opioids.

Underlying those fallacies, critics say, is an even larger one: That the use of narcotic painkillers to treat non-cancer pain lasting many months or years is supported by rigorous science.

Even doctors who have financial relationships with companies that make narcotic painkillers concede that the practice of pain medicine got ahead of the science.

Lynn Webster, MD, a Utah pain specialist who has worked as a consultant and adviser to most of the companies in the opioid analgesic market, said the pain community got some of it wrong.

"We overshot our mark, all well-intended, I believe," Webster, an officer of the American Academy of Pain Medicine, said in an interview. "We certainly have a lot of reverse education that needs to occur."

Some chronic pain sufferers do benefit from the drugs, Webster said.

"The problem is pain is complex," he said. "There is a whole family of opioids and we have not figured out how to best identify the individuals who can benefit long term.

"I don't think industry was trying to harm anyone. I think industry was trying to fill a need that we as physicians saw."

Others say that Webster is too forgiving in his analysis: they claim that the pharmaceutical industry chose profits over patient safety.

The entire story is here.

Judge: Killer Faked Insanity for Decades

By Elaine Silverstrini
The Tampa Tribune

More than 30 years after Carlos Bello murdered a Tampa police detective and wounded another, a judge concluded he is faking mental illness and is competent to be resentenced.

As soon as Circuit Judge Ronald Ficarrotta announced his ruling Friday, several Tampa police officers in his courtroom took out phones and began sending text messages.

Among those present was Detective Greg Stout, president of the Tampa Police Benevolent Association, who immediately after the hearing said he was sure word had spread through the department. The reaction, he said, was "jubilation."

Bello, 58, was convicted and sentenced to death in 1987 for killing Detective Gerald Rauft and shooting Detective Robert Ulriksen during a drug raid at an Ybor City home in 1981. But his sentence was overturned by the Florida Supreme Court, and Bello began years of evaluations for mental competency.

"This defendant has played the system like no one has ever played the system before," Assistant State Attorney Darrell Dirks told Ficarrotta. "He had one judge tell him in 1987 he is going to be sentenced to death. This defendant has made it his purpose that that is never ever going to happen to him. … He has done a great job. I'll give him kudos. He is a great manipulator."

The entire story is here.

Prosecutors Allowed Access to Loughner Notes

By Michael Kiefer
The Arizona Republic

The judge in the Tucson mass shooting case has ruled that prosecutors can have access to notes made by Jared Loughner's prison psychologist over the course of her evaluations of his mental health.

The suspected shooter is undergoing restoration to competency at a federal prison hospital in Springfield, Mo., and his lawyer asked that federal prosecutors be denied access to the psychologist's notes because of self-incriminating statements Loughner made during sessions with psychologist Christina Pietz.

The entire story is here.

Law OKs Cross-State Counseling Services

By Joe Gould
Army Times

The recent passage of the National Defense Authorization Act in Congress will make it easier for active-duty personnel and veterans to get mental health care wherever they are, officials said.

A provision of the act, aimed at expanding federal exemptions for behavioral telehealth consultations across state lines, removes the requirement for health care providers to be licensed in the state in which their patients are being treated.

Gen. Peter Chiarelli, then-Army vice chief of staff and an advocate for providing behavioral health counseling to soldiers in their homes via telehealth, praised the new law as a “big victory.”

“It’s the biggest step forward we’ve seen in two years,” Chiarelli told Army Times. “For me, it is huge. We have just to take advantage of it.”

Chiarelli retired Jan. 31, and Gen. Lloyd Austin has since assumed the post as Army vice chief.

Nearly 20 percent of military personnel returning from Iraq and Afghanistan showed symptoms of post-traumatic stress disorder, according to a Rand Corp. survey.

Patients are plentiful, but the doctors who are needed to treat them are not. Chiarelli acknowledged a shortage of behavioral health specialists in the Army, as well as the challenge of attracting, hiring and retaining them to the rural areas that surround some posts.

“I find when I get closer to large metropolitan areas, I don’t have as many problems,” Chiarelli said. “But when I go to the Fort Stewarts, when I go to the Fort Braggs, when I go to the Fort Hoods, my ability to attract a shortage population in society is difficult. But we’re working very, very hard to get everything we possibly can to hire those folks.”

The hope is that connecting patients to care by video teleconference skirts this problem, allowing a provider in Seattle, for example, to speak with a patient across state lines in rural Montana.

The entire story is here.

UK: Phone and Email Records to be Stored in New Spy Plan

By David Barret

The Telegraph: Technology-Internet

Details of every phone call and text message, email traffic and websites visited online are to be stored in a series of vast databases under new Government anti-terror plans.

Landline and mobile phone companies and broadband providers will be ordered to store the data for a year and make it available to the security services under the scheme. 

The databases would not record the contents of calls, texts or emails but the numbers or email addresses of who they are sent and received by. 

For the first time, the security services will have widespread access to information about who has been communicating with each other on social networking sites such as Facebook. 

Direct messages between subscribers to websites such as Twitter would also be stored, as well as communications between players in online video games. 

The Home Office is understood to have begun negotiations with internet companies in the last two months over the plan, which could be officially announced as early as May. 

It is certain to cause controversy over civil liberties - but also raise concerns over the security of the records. 

Access to such information would be highly prized by hackers and could be exploited to send spam email and texts. Details of which websites people visit could also be exploited for commercial gain. 

The plan has been drawn up on the advice of MI5, the home security service, MI6, which operates abroad, and GCHQ, the Government’s “listening post” responsible for monitoring communications.

The entire story is here.

mHealth: Remote Patient Monitoring Is On The Rise, With Smartphones Leading The Way

By Rip Empson

Tech Crunch

Originally published February 8, 2012

Last month, we took a look at someof the ways mobile technology is transforming the health industry. While there are many factors affecting this transformation, like artificial intelligence, big data, 3-D printing, social health networks, and remote communications, to name a few (check out Josh’s post on this here), unsurprisingly, change is coming at the hands of the growing ubiquity of cell phones, smartphones, and mobile devices.

Early last year, PEW Researchwas already reporting that 17 percent of mobile phone users were using their devices to look up health and medical information, and Juniperrecently estimated that 44 million health apps were downloaded in 2011.

In turn, the amount and availability of health data is exploding in tandem with the growing adoption of health and medical apps and devices, thanks to the increasingly wearable and user-friendly devices that use smart sensors to capture and transmit a variety biometric data. Electronic medical records (EMRs) are being made available on mobile devices — even KaiserPermanente is getting in on the digital revolution.

The mHealth industry is growing fast. According to Research2guidance‘s calculations, the size of the mHealth app market will nearly double in 2012 to $1.3 billion, up from $718 million in 2011. (I discussed the volatility of these statistics, the still-changing definitions of mHealth and mHealth technology, and conflictingreporting on these numbers here.)

While these numbers can sometimes be misleading, the mHealth sector is not only going to continue to expand, its profitability is going to skyrocket. This is because, in juxtaposition with the $7 trillion global healthcare market, the mHealth market remains incipient. Healthcare companies, startups, and beyond are just beginning to tap into the potential of mobile technology, both in terms of quantified self devices, which bring healthcare in the clinic home, the mobility of data and communication channels. Companies are beginning to spend more and more on research and development, the big kahunas of the medical world are starting to release real, functional mobile apps, and consumer-facing medical devices are just starting to see real market penetration.

The entire information is here.

Termination of Supervision Requires Planning

Termination of Supervision Requires Planning

Suicidal Ideation and Self-Harm in LGBT Youth

Medical News Today
Originally published February 16, 2012

What protects lesbian, gay, bisexual and transgender (LGBT) youths from considering suicide and, conversely, what makes them most vulnerable to it?

The question is of paramount concern because these youths are at least twice as likely to attempt suicide than heterosexual youths, prompting the national "It Gets Better Project" with encouraging video messages from such public figures as Lady Gaga and President Barack Obama.

Now the first longitudinal study to look at suicide ideation and self-harm in this population shows support from friends and family offers the most protection in preventing youths from thinking about suicide. Adolescents who know they can talk to their parents about problems and know they have friends who care about them are less likely to consider ending their lives, according to new Northwestern Medicine research.

Adolescents most likely to consider killing themselves and engage in self-harm behaviors are those who feel victimized for being gay. About 94 percent of LGBT youths have had at least one experience in which people said cruel things to them, spit on them, destroyed their property and threatened or assaulted them - all related to them being gay, according to prior Northwestern research.

Suicidal thoughts are a key predictor of a suicide attempt. Cutting behaviors also are a risk factor.

Previous studies of LGBT adolescents looked at their risk of making suicide attempts, not predictors that make them vulnerable to it or protect them from it.

"Our research shows how critical it is for these young people to have social support and for schools to have programs to reduce bullying," said Brian Mustanski, associate professor of medical social sciences at Northwestern University Feinberg School of Medicine. "We believe this will help save young lives."

The entire story is here.

The research article is here.

The Unintended Consequences of Conflict of Interest Disclosure

By George Loewenstein, PhD, Sunita Sah, MD, PhD, & Daylian M. Cain, PhD.

The Journal of the American Medical Association

Conflicts of interest, both financial and nonfinancial, are ubiquitous in medicine, and the most commonly prescribed remedy is disclosure. The Medicare Payment Advisory Commission and the Accountable Care Act impose a range of disclosure requirements for physicians, and almost all medical journals now require authors to disclose conflicts of interest (although these requirements may be imperfectly heeded). Given that some relationships between physicians and industry are fruitful and some conflicts are unavoidable, can disclosure correct the problems that arise when economic interests prevent physicians from putting patients' interests first?

Given that some relationships between physicians and industry are fruitful and some conflicts are unavoidable, can disclosure correct the problems that arise when economic interests prevent physicians from putting patients' interests first?

Disclosure has appeal across the political spectrum because it acknowledges the problem of conflicts but involves minimal regulation and is less expensive to implement than more comprehensive remedies.

More importantly, even if disclosure is rarely seen as providing a complete solution to the problem, it is broadly perceived to have beneficial effects.

There are, however, reasons that disclosure can have adverse effects, exacerbating bias and hurting those it is ostensibly intended to help.

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ENHANCING THE EFFECTIVENESS OF DISCLOSURE

Despite its potential pitfalls, disclosure is almost certainly a good thing.

It should be a patient's right to know whether his or her physician is receiving financial benefits from prescribing a particular drug or will personally benefit if the patient accepts recommended tests or procedures.

The question for policy should not be whether to disclose but how to ensure that disclosure has its intended effects.

Research has revealed ways of making disclosure more effective.

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Even if disclosure is crafted in a fashion that increases effectiveness and minimizes potentially adverse consequences, it is no panacea.

Disclosure is simply not applicable to many serious conflicts of interest affecting medicine in the United States.

Although payments from pharmaceutical and device companies have received most of the attention in the literature on disclosure, other conflicts, such as financial arrangements that give physicians (and their institutions) incentives for providing high-cost services of dubious value, may be more consequential.

It is difficult to imagine how disclosure could even be applied to, let alone undo, those problems.

However, perhaps the most significant likely pitfall of disclosure is not its effects on the quality of advice received by individual patients or its inapplicability to many serious conflicts of interest, but the likelihood of a kind of moral licensing on the part of the profession as a whole--the rationalization that, with disclosure, the profession has dispensed with its obligation to deal with conflicts of interest.

Conflicts of interest, including fee-for-service arrangements, are at the heart of the astronomical increases in health care costs in the United States, and transparency is no substitute for more substantive reform.

The entire article is here.

Special thanks to Ken Pope for this information.