Tag Archive for Medical Profession

The politics of pain

December 14, 2011 admin No comments

The Institute of Medicine stands outside the government, offering independent advice to both the decision-makers in government and the public. As a nonprofit, its mission is to improve the quality of the healthcare services by providing detailed policy suggestions based on the best available evidence. This July, it published a highly critical report on the continuing refusal of the medical profession to accept comparative effectiveness research. This is work to discover which treatments are the most effective. At present, we are left to guess which treatments offer the best outcomes for each illness or disorder with little effort made to collect evidence on safety and quality. Hence, at one end of the scale, we can go years without knowing a particular drug or surgical procedure is ineffective. Or we can find ourselves participating in unofficial trials where doctors talk patients into off-label experiments with drugs.

Unfortunately, this is all part of the general lack of accountability within the healthcare services. The present culture allows the pharmaceutical industry and the doctors to dictate the treatment standards based on what generates the most profit for them. The idea such people would actively seek evidence to show whether their cherished treatments were medically effective is a nonstarter. There’s no willingness to engineer a learning environment where everyone tries to improve. Rather everyone wants to avoid any liability for errors of judgement and mistakes. Imagine the litigation if it emerged that doctors had for years been advising we agree to ineffective treatments.

Until there’s a major change in the culture, we will have to look with envy at the approach of the Europeans in the pain management field. As a symptom of our problems, the words “pain management clinic” in Florida and certain other states usually indicates a borderline illegal operation to sell pills. We should modify all aspects of the current service. The first reforms should affect the health insurance industry and the public bodies like Medicaid and Medicare. At present, these administrators and business people simply pay out on the bills submitted by the hospitals, clinics and doctors. Since the taxpayers fund the entitlement systems and the rest of us with money pay ever higher premiums, there’s no pressure on insurers to demand value for money. They are not there to guarantee good quality care for their insured. All they do is pay out on the bills and pocket the rest as profit.

At present, it suits everyone concerned with pain management to do as little as possible. That means the shortest possible consultations followed by the prescription of one of the standard drugs, the most effective being Tramadol. This gives everyone in the healthcare services industry the maximum possible profit with the least possible effort. If they were to adopt the European model of one-to-one treatment by physical therapists, cognitive behavioral therapists, and so on, the labor costs would rocket and profit would decline. So there’s no chance of a team-based, patient-centric approach in our great nation. Further, any evidence that might show the European approach to be more effective in medical terms must be suppressed. Everything possible must be done to reinforce the current practice standards. That means you take another Tramadol and accept second best.

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The politics of the deficit

December 13, 2011 admin No comments

You have probably noticed Washing almost produced a default on “foreign” debt. The Republican party held the government hostage to force action on the deficit. Now don’t be misled here. There are real problems in owing too much money and, truth be told, we do owe too much as a nation. But there are a number of real problems if the only strategy government is allowed to discuss is where to make cuts because there comes a point when you stop cutting the waste and the redundant programs, and start cutting the socially useful programs. At some point, we need more revenue. That said, there’s a big issue to talk about here: the Affordable Care Act or Obamacare. In theory, this is a good idea. If you force everyone to pay for their care, the premiums for everyone will fall and we all benefit. But forcing everyone to pay may not be constitutional and it does nothing to control costs.

The government is the biggest buyer of drugs through Medicare and Medicaid. It has the power to negotiate with the pharmaceutical industry on the price for each drug. If it used this power, it could save the country billions of dollars and, as individuals within health plans, we would all see our premiums drop. All it takes is for the government to show a little concern for taxpayers. Except that would mean cutting the profits of the drug manufacturers and the President backed away from that during the first stages of trying to get the bill into law. He thought it was more important to get the votes for the law and worry about the costs later. Put another way he realized too many Democrats take lobby money from Big Pharma and would not vote for his law.

In other countries, governments direct the medical profession on what they are allowed to prescribe. So where there’s a choice, doctors are only allowed to prescribe generic drugs and not the brands. Even where branded drugs are still under patent protection, doctors in the public sector may not be allowed to prescribe the drugs if the regulators consider the prices too high. This leaves patients with the option of paying for the drugs out of their own pocket or, if they have private insurance, negotiating with the insurer to pay. Yes, this cuts into the profits of the drug companies, but which is more important? That a country should have an affordable healthcare service? Or that the profits of a few drug companies should be allowed to grow without limit?

A recent report on healthcare policy called for a revolution in the culture of American healthcare. It argued there should be a radical change in the attitude of both government and the insurers, forcing the pharmaceutical manufacturers and doctors to reduce their profits. Note the force of this article. It’s on a site encouraging you to use Tramadol as your drug of choice if you are in pain. This is the generic version of Ultram which is sold at significantly higher prices. This site is trying to be responsible in encouraging you to use the cheap Tramadol. As an approved generic, it’s exactly the same as the more expensive brand. There’s no need to pay more.

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Electric shocks produce better results than Viagra

June 23, 2010 admin No comments

The Victorians were right up with the trend started in Ancient Greece where arthritis was treated by the application of electricity – the Greeks used the Torpedo fish to deliver the shocks. Electrotherapy became the most popular form of treatment being used somewhat indiscriminately by both the medical profession and “quacks” to cure more or less any ailment. But its popularity was its downfall. Just as the indiscriminate use of steroids in the 20th Century was slowly recognized as harming more people than it cured, the power of electricity to heal was slowly seen as non-existent in most cases. The only real exception was in the mental health field where electricity was used as a therapy to treat depressive disorders that had not responded to any other forms of treatment. However, flying somewhat under the radar was a more interesting use of electricity – as an aversion therapy where shocks were administered to discourage people from finding pleasure in different activities. It became moderately popular among families as a treatment for alcoholism and drug addiction, but it attracted extreme controversy when used to treat homosexuality and other aspects of sexual behavior. On ethical and legal grounds, the use of electricity in an attempt to change human sexuality is banned in most countries.

It therefore comes as something of a surprise to see research from the Rambam Medical Center in Haifa. The clinical trial applied electric shocks to the penis, testicles and groin area generally as a treatment for erectile dysfunction. The results are claimed to show a high success rate, matching or exceeding the results achieved by taking pills of different colors, shapes and sizes. Unlike those who specialize in the use of electricity as torture, this team administered very low energy shock waves. Something the men were no doubt grateful for. So, after regular treatment with three hundred mini-shocks being applied within a three minute window, most of the men demonstrated a rapid rise to a hard erection the moment anyone approached them with electrodes or a cattle prod in hand. None of the participants complained of pain – either they were enjoying the experience or were frightened the voltage would be cranked up in the next session.

The claimed scientific effect of these shocks is to either stimulate the growth of new blood vessels or to encourage tired old blood vessels back into life. This has a significant advantage over the use of drugs. If new blood vessels are formed or the hardening of old vessels is reversed, this would represent a “cure”. All the drugs can do is produce a temporary dilation of the relevant arteries. They do not cure the underlying condition.

Ignoring the potential humor of threatening to attach electrodes to your gonads as a medical treatment, the skeptical Victorians were right. There never has been any convincing scientific evidence to show electricity is or can be an effective treatment for any condition. Which leaves the vast majority of men back where they started. Viagra is the best treatment for erectile dysfunction. No matter what the claims of the Israeli team to produce a long-term cure, the experience of taking one viagra gives more than enough time to enjoy a length period of sexual activity. To repeat the activity, take another pill. Anyone else should go to their local BDSM club.

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Buy Tramadol for effective pain relief

June 18, 2010 admin No comments

Of course, no one should blame the Boomers. They just happened to be the largest group to challenge the political and medical communities’ view that marijuana (aka cannabis) was a dangerous drug and its use should continue to be a crime. The establishment ignores the facts. In many countries around the world, marijuana is considered a medicine and routinely used both for inhaling and as an infusion for drinking. But what they do in other countries should have no bearing on what happens in the US. Libertarian arguments that all drug-taking is victimless has also never really taken off. The cost of lost production forces us to pay higher prices for goods and services. The cost of hospital treatment for drug abuse means every taxpayer is a victim. So the Republican “tough on crime” policies have always favored the use of the criminal law to penalize those who abuse drugs.

Yet, looking around the US today sees a different landscape. Fourteen states have passed laws allowing the use of marijuana for medicinal purposes. Leading the way, as always, California has a proposition in the November midterms to legalize marijuana outright. What has happened to produce such a revolution? There are two answers. The first has been a general toning down of the rhetoric in favor of scientific debate. When marijuana was first criminalized back in the 1930s, the medical profession stood together and denounced the drug as a tool of the Devil, tempting people into sin and depravity. Today sees a significant number of doctors singing a different tune. First, a gesture to the traditional group: there is no doubt that smoking marijuana can and does cause lung cancer and, over time, there is evidence suggesting loss of memory and some brain damage. But there is also an impressive body of international evidence proving marijuana highly effective in giving pain relief. The use has to build up over at least six months. Once a stable concentration is achieved in the blood stream, it relieves chronic pain from arthritis, fibromyalgia, multiple sclerosis and cancers.

The second justification is fiscal. The sale of medical marijuana already makes a significant contribution to state funds through the tax system. In a recession, all contributions are gratefully received. If the outright legalization goes through in California, it is estimated the annual tax take will rise from about $200 million to $1.5 billion. It will also lead to a better system of regulation so that, like alcohol, its distribution can be controlled. None of this changes the need for “conventional” drugs to relieve pain. Tramadol in its different forms will remain the first response to moderate to severe pain. But in chronic cases, the continuing use of any drug can lead to dependence and the debate shifts. Which of the drugs is better when use may be indicated for years? In the fourteen states with Illinois perhaps about to join them, you have the possibility to buy marijuana rather than to buy tramadol is there to be freely made. Legalization has undermined the criminal gangs and reduced prices. The quality of the product is also guaranteed whereas, on the street, marijuana can be cut with many strange and sometimes dangerous substances. This is the practical reality on the ground and there is no point in trying to turn the clock back. Pain management in these states now includes marijuana. For those who disapprove, tramadol and the other traditional drugs remain available.

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Tramadol is not a drug of abuse

April 20, 2010 admin No comments

Our healthcare system is often torn between conflicting forces. On a professional level, doctors are supposed to place the interests of their patients first. So, it is reasonable for the profession to respond to a shortage of proper pain management facilities in the hospital sector by establishing “pain clinics”. In theory, these clinics will provide short-term care with mixed teams of doctors, physical and psychological therapists, and nursing professionals able to counsel and advise people on how to manage their pain. Unfortunately, the medical profession is strongly for profit. It would be good if there was a major stream of altruism running through the modern ranks of healthcare professionals. Unfortunately, an increasing number of doctors are abandoning general practice in favor of employed status in clinics and hospitals. This gives stability of earning with the least possible work commitment. It also enables the management to run their facilities to generate the most income from the lowest cost base. Thus, the reality of many pain clinics is they are “pill mills”, i.e. their main function is to supply people with every possible painkiller with the least possible time spent in expensive face-to-face contact between doctors and the people. Such clinics are characterized by long queues of people waiting to see a doctor to collect prescriptions. Doctors are on a quota target to see a minimum number of patients every day. This maximizes the claims to the health insurers by the volume of people seen. For those not on a health plan, it is a cheap consult system since no treatment is involved.

This is not to deny that some clinics are attempts to offer a professional service to those in genuine need. But such beacons of light are few and far between. How do we know this? Because there is an explosion in the number of pain clinics opening across America. In some areas, the local government is trying to control the problem. At least, there are political calls for the profession to rein in these fast prescription services. At best, there are local bans on the approval of new clinics. Sadly, the lobbying power of the medical profession means there are very few state-wide limits either on the establishment of clinics or on the practice of writing prescriptions for hundreds of pills at a time. Some local politicians are proposing ordinances to prohibit clinics from prescribing pain medication except in emergency situations and then only offering a 72-hour refill, expecting the individuals to return to their regular doctors for proper care. Their chances of being able to control the problem are slim without the support of state governments and the medical profession.

This is a tragic situation. There is a real need for professional pain management services at both a local and county level. Unfortunately, the medical profession is exploiting the public and feeding their growing addiction to pain medications. People, being practical, take pain relief in whatever form is available. If that means endless supplies of drugs, they take it. The best practice standards in other countries with public healthcare services does provide mixed teams of pain management specialists who focus on training people to cope using only low level painkillers. For example, they are allowed to buy tramadol. Because the higher labor costs are absorbed by the taxpayers, a significantly better service results. Because tramadol is not habit-forming to the same degree as more powerful drugs, this is a safer system for pain management.

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