Posts
Sunday, January 1, 2012
Dr. Truth Hurts on "Why we must repeal Obamacare"
http://actualgrit.wordpress.com/2011/12/31/dr-truth-hurts-why-we-must-repeal-obamacare/
Monday, December 26, 2011
Doctors Say Obamacare Is No Remedy for U.S. Health Woes
From Forbes Online, 12/26/11
America’s doctors have conducted a full examination of the president’s health reform law — and their diagnosis of its effects on our healthcare system isn’t good.
Nearly two-thirds of doctors expect the quality of care in this country to decline, according to a new survey from consulting giant Deloitte. Just 27 percent think that the law will lower costs. And nearly seven of every 10 doctors believe that medicine is no longer attractive to America’s “best and brightest.”
Few people know more about our healthcare system than doctors working on the frontlines. Policymakers should pay heed to their indictment of Obamacare and revisit the disastrous law.
President Obama promised that his reform package would begin to stymie the out-of-control growth in the cost of American health care. He pledged $2,500 in health insurance savings for the typical American family.
But doctors don’t buy it. Only one quarter feel that Obamacare will reduce health insurance costs for consumers. Nine out of ten posit that insurers will raise premiums for employers and individuals.
They have good reason to doubt Obamacare’s cost-cutting potential. Healthcare spending is expected to reach $2.7 trillion this year — or about $1 of every $6 spent in our economy. By 2020, health spending will account for a full fifth of America’s GDP.
That increase is in large part thanks to Obamacare. Instead of relieving high insurance premiums, the nonpartisan Congressional Budget Office estimates that American families in the non-group market will see their premiums rise $2,100.
They’re already trending higher. According to the Kaiser Family Foundation, average family premiums in 2011 topped $15,000 — a 9 percent increase from 2010. Prior to Obamacare’s passage — from 2009 to 2010 — premiums went up just 3 percent.
In April 2010, Richard Foster, the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS), concluded that American spending on health care through 2019 would be $311 billion higher than if the law had never passed.
Even with all that additional money flowing through the system, doctors don’t think that the quality of care will improve. Half of all doctors believe that access to care will diminish because of hospital closures prompted by health reform.
Further, nearly 70 percent of doctors believe that long wait times will plague emergency rooms. A full 83 percent of physicians foresee increased wait times for primary care appointments.
That’s in large part because Obamacare is expected to extend government-subsidized insurance coverage to many folks — even as the supply of providers remains relatively constant.
The United States already faces a shortage of primary-care doctors. Medical schools today produce one such physician for every two our country needs. By 2019, the American Academy of Family Physicians warns that the United States will be short 40,000 doctors.
Expanding insurance coverage to millions more Americans won’t do much good if they can’t get doctor’s appointments. Physicians believe that their ability to provide quality care will be further strained by the law’s attempt to change the way they’re paid — from a fee-for-service basis to a vaguely defined system of paying doctors based on patient health and outcomes.
Nine out of ten physicians fear they will receive inadequate payments and endure higher administrative costs. Fewer than a quarter of doctors expect their paperwork requirements to ease up. Time spent wading though paperwork is also time no longer available for actually practicing medicine.
American doctors’ negative view of Obamacare is telling. Proponents of the law may claim that their griping is misplaced, but as Paul Keckley, Ph.D., the lead author of the report explains, “Understanding the view of the physician is fundamental to any attempt to change the health care model.”
In other words, if physicians aren’t on board with Obamacare, it won’t work. A law that hinders the practice of medicine, obstructs access to care, and costs Americans more is clearly not the right remedy for what ails us.
Sally C. Pipes is President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her next book — The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare (Regnery) — will be released in January 2012.
America’s doctors have conducted a full examination of the president’s health reform law — and their diagnosis of its effects on our healthcare system isn’t good.
Nearly two-thirds of doctors expect the quality of care in this country to decline, according to a new survey from consulting giant Deloitte. Just 27 percent think that the law will lower costs. And nearly seven of every 10 doctors believe that medicine is no longer attractive to America’s “best and brightest.”
Few people know more about our healthcare system than doctors working on the frontlines. Policymakers should pay heed to their indictment of Obamacare and revisit the disastrous law.
President Obama promised that his reform package would begin to stymie the out-of-control growth in the cost of American health care. He pledged $2,500 in health insurance savings for the typical American family.
But doctors don’t buy it. Only one quarter feel that Obamacare will reduce health insurance costs for consumers. Nine out of ten posit that insurers will raise premiums for employers and individuals.
They have good reason to doubt Obamacare’s cost-cutting potential. Healthcare spending is expected to reach $2.7 trillion this year — or about $1 of every $6 spent in our economy. By 2020, health spending will account for a full fifth of America’s GDP.
That increase is in large part thanks to Obamacare. Instead of relieving high insurance premiums, the nonpartisan Congressional Budget Office estimates that American families in the non-group market will see their premiums rise $2,100.
They’re already trending higher. According to the Kaiser Family Foundation, average family premiums in 2011 topped $15,000 — a 9 percent increase from 2010. Prior to Obamacare’s passage — from 2009 to 2010 — premiums went up just 3 percent.
In April 2010, Richard Foster, the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS), concluded that American spending on health care through 2019 would be $311 billion higher than if the law had never passed.
Even with all that additional money flowing through the system, doctors don’t think that the quality of care will improve. Half of all doctors believe that access to care will diminish because of hospital closures prompted by health reform.
Further, nearly 70 percent of doctors believe that long wait times will plague emergency rooms. A full 83 percent of physicians foresee increased wait times for primary care appointments.
That’s in large part because Obamacare is expected to extend government-subsidized insurance coverage to many folks — even as the supply of providers remains relatively constant.
The United States already faces a shortage of primary-care doctors. Medical schools today produce one such physician for every two our country needs. By 2019, the American Academy of Family Physicians warns that the United States will be short 40,000 doctors.
Expanding insurance coverage to millions more Americans won’t do much good if they can’t get doctor’s appointments. Physicians believe that their ability to provide quality care will be further strained by the law’s attempt to change the way they’re paid — from a fee-for-service basis to a vaguely defined system of paying doctors based on patient health and outcomes.
Nine out of ten physicians fear they will receive inadequate payments and endure higher administrative costs. Fewer than a quarter of doctors expect their paperwork requirements to ease up. Time spent wading though paperwork is also time no longer available for actually practicing medicine.
American doctors’ negative view of Obamacare is telling. Proponents of the law may claim that their griping is misplaced, but as Paul Keckley, Ph.D., the lead author of the report explains, “Understanding the view of the physician is fundamental to any attempt to change the health care model.”
In other words, if physicians aren’t on board with Obamacare, it won’t work. A law that hinders the practice of medicine, obstructs access to care, and costs Americans more is clearly not the right remedy for what ails us.
Sally C. Pipes is President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her next book — The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare (Regnery) — will be released in January 2012.
Sunday, December 25, 2011
Can we really afford Obamacare?
Since Massachusetts instituted Romneycare, the cost, per patient, of healthcare has risen steadily to over $9400.00 per person compared to a national average of about $6800.00. Now, it doesn't take a rocket scientist, a doctor, or an healthcare economist to figure out that when you mandate everyone to have insurance, the incentive for personal responsibility is lost and people will seek and demand more as well as more expensive high tech care of which most is not needed.
Sadly, most people will read this and just shrug...
Share and repost if you believe we cannot afford Obamacare!
Sadly, most people will read this and just shrug...
Share and repost if you believe we cannot afford Obamacare!
CDC issues new alert for new R1P1 Virus
*****URGENT*****
The CDC has released an urgent advisory to physicians and other healthcare providers warning about a cluster of small epidemics of a serious viral infection that has traditionally been a virus with relatively low virulence and with small, but characteristic spikes every 4 years or so.
Scientists from the CDC are calling this virus the R1P1 virus which is a politico virus that is similar to the polio virus in that it primarily infects the nervous system. Unlike the polio virus which primarily affects the peripheral nerves, the politico virus causes widespread damage in the brain manifested as chronic encephalopathy.
Infection with this virus causes a very characteristic syndrome characterized by a sudden and permanent loss of ability to engage in higher cognitive functioning or reasoning and patients affected are characteristically delusional and paranoid and engage in curious behavior including echolalia (the repetition of words or phrases by a patient of words addressed to him), obsessive rumination (repetitive regurgitation of inane phrases ), persistent dwelling in conspiratorial and paranoid thinking, and an obsessive and compulsive need to a-paul-ogize to radical Islam for American neo-nazi-fascism and intervention. The clinical syndrome is often referred to as pauli-encephalopathy and commonly called Ronpaulitis. It is very similar to another chronic brain-wasting disease (Mad Cow Disease) caused by a slow-virus and because of this similarity is often called “Mad Paul Disease”.
Researchers from the CDC are concerned about the increased incidence and virulence of this otherwise relatively harmless virus that in past years has infected relatively few people (less than 2-3%). The RP viruses are relatively common viruses and arise from a family of viruses called the "cult viruses", included in this family are the BO (B. Obamagotcha) virus, the DK (D. Koreshiae) and the JJ (J. Jonesensei) virus. Researchers at the CDC say they are not sure if it is a mutation in the virus from a R1P2 virus which is the most common variety to a new R1P1 virus, or if instead it is a relative decrease in host defenses brought on by concurrent infection of a similar virus called the BO virus. One researcher believes that the evidence supports a mutation rather than a general decrease in immunity in the population because of areas of sporadic epidemics in the US, such as Iowa, New Mexico, and Texas. While there is no cure for these viruses, researchers do say that they are preventable by engaging in common sense behaviors such as
thinking and avoiding certain books (The Revolution: A Manifesto, End The Fed, etc), documentaries (Conspiracy Theory with Jesse Ventura), or movies such as George Orwell’s 1984 or JFK and the Manchurian Candidate. While, most people have a robust and natural defense against the negative and irrational cerebral influences of this genre of work, it is thought that exposure and infection to the R1N1 virus renders this natural defense weak or even non-existent.
Doctors at the CDC claim they are working on a vaccine for this virus, but do not expect to see a vaccine come to market until after November of 2012 at the soonest and caution that it may take several more decades before a cure or vaccine are found.
Doctors, healthcare workers, and the general public are asked to contact their local health departments and/or the CDC if they have become exposed to the virus or know of anyone that has. Since there is no cure, this would be strictly for demographic and research purposes. (From Neuter's Medical News Service)
The CDC has released an urgent advisory to physicians and other healthcare providers warning about a cluster of small epidemics of a serious viral infection that has traditionally been a virus with relatively low virulence and with small, but characteristic spikes every 4 years or so.
Scientists from the CDC are calling this virus the R1P1 virus which is a politico virus that is similar to the polio virus in that it primarily infects the nervous system. Unlike the polio virus which primarily affects the peripheral nerves, the politico virus causes widespread damage in the brain manifested as chronic encephalopathy.
Infection with this virus causes a very characteristic syndrome characterized by a sudden and permanent loss of ability to engage in higher cognitive functioning or reasoning and patients affected are characteristically delusional and paranoid and engage in curious behavior including echolalia (the repetition of words or phrases by a patient of words addressed to him), obsessive rumination (repetitive regurgitation of inane phrases ), persistent dwelling in conspiratorial and paranoid thinking, and an obsessive and compulsive need to a-paul-ogize to radical Islam for American neo-nazi-fascism and intervention. The clinical syndrome is often referred to as pauli-encephalopathy and commonly called Ronpaulitis. It is very similar to another chronic brain-wasting disease (Mad Cow Disease) caused by a slow-virus and because of this similarity is often called “Mad Paul Disease”.
Researchers from the CDC are concerned about the increased incidence and virulence of this otherwise relatively harmless virus that in past years has infected relatively few people (less than 2-3%). The RP viruses are relatively common viruses and arise from a family of viruses called the "cult viruses", included in this family are the BO (B. Obamagotcha) virus, the DK (D. Koreshiae) and the JJ (J. Jonesensei) virus. Researchers at the CDC say they are not sure if it is a mutation in the virus from a R1P2 virus which is the most common variety to a new R1P1 virus, or if instead it is a relative decrease in host defenses brought on by concurrent infection of a similar virus called the BO virus. One researcher believes that the evidence supports a mutation rather than a general decrease in immunity in the population because of areas of sporadic epidemics in the US, such as Iowa, New Mexico, and Texas. While there is no cure for these viruses, researchers do say that they are preventable by engaging in common sense behaviors such as
thinking and avoiding certain books (The Revolution: A Manifesto, End The Fed, etc), documentaries (Conspiracy Theory with Jesse Ventura), or movies such as George Orwell’s 1984 or JFK and the Manchurian Candidate. While, most people have a robust and natural defense against the negative and irrational cerebral influences of this genre of work, it is thought that exposure and infection to the R1N1 virus renders this natural defense weak or even non-existent.
Doctors at the CDC claim they are working on a vaccine for this virus, but do not expect to see a vaccine come to market until after November of 2012 at the soonest and caution that it may take several more decades before a cure or vaccine are found.
Doctors, healthcare workers, and the general public are asked to contact their local health departments and/or the CDC if they have become exposed to the virus or know of anyone that has. Since there is no cure, this would be strictly for demographic and research purposes. (From Neuter's Medical News Service)
Iowa Kool-Aid and How to Form a Cult
I was surprised to see the results of the Fox News Poll showing Ron Paul leading in who the pollsters thought would win the Iowa caucus vote. While, I consider myself a conservative and lean more towards libertarianism, I am nonetheless, quite frankly concerned about the possibility of Ron Paul winning the primaries and--God forbid--possibly becoming president of the United States. My concern comes as a fellow physician who believes that Dr. Paul suffers from a real psychological disorder characterized by megalomania, narcissism, delusional thinking, paranoia, antisocial characteristics, and (abnormal) feelings of persecution. Now, I am not a psychiatrist, but I did minor in psychology as an undergraduate and most physicians have been educated in the behavioral sciences and have been trained to diagnose common psychiatric disorders. Furthermore, it is estimated that the incidence of Narcissistic Personality Disorder occurs 34 times more often in medical doctors than in the general population.
Over the last several weeks, I have been studying Dr. Paul as well as his followers through his television appearances, his letters (and Newsletters), social media, and video clips from You-tube and have noted a very disturbing pattern of Dr. Paul showing all of the psycopathological characteristics of a genuine "cult leader" and his followers showing all of the characteristics of a cult.
I have studied cults and their leaders and have outlined the "five basic
rules" of being a cult leader. I have also indicated the psychopathology associated with cult leaders as they form their cults:
The number one rule of a cult leader is to polish and cultivate a persona that you--and only you--have been chosen, anointed, or have achieved spiritual, political, or intellectual enlightenment above all others. This shows features of megalomania, delusions of grandeur, as well as narcissism.
1. Dr. Paul has tried to cultivate this persona for over 30 years as the “outsider” and enlightened one within the “Washington establishment”.
2. Dr. Paul has publicly stated that while he believes in term limits, they do not apply to him because (paraphrasing) “there is no one good enough to bring in to replace him”.
3. In 2010, Dr. Paul commented to his wife that he would run for President in 2012 “if things were happening so quickly and fast in our country and we were in a crisis period…and needed somebody…with the knowledge he as, he would do it”.
4. Dr. Paul presents in interviews as haughty and stern and seems to be lecturing rather than engaging in conversation.
The next rule is to appeal to the disconnected, disenchanted, and disaffected in society who are often intellectually, politically, and emotionally immature (i.e., younger people)and convince them that while you have been “chosen” (or more likely self-selected) you are (almost) human just like them and can empathize with their disenchantment and discontent. This shows more tendencies of narcissism and ego-feeding by someone who sees them self as inherently better than others, but with a need to surround one’s self with those less fortunate or less “enlightened”—a “savior complex”, if you will. Often times, the empathy and compassion shown to the acolytes is not genuine (which is a feature of antisocial personality) and is only used for the ulterior motive of personal gain in sex, money, or power (or sense of superiority) or combination thereof.
1. Dr. Paul has always had a relatively small number of fanatical followers who have mostly been drawn from younger people in society. He routinely targets schools,
colleges, and other events where younger people tend to be.
2. His “populist” message today resonates with many, besides young people as social, geopolitical, and economic turmoil are perceived to be worsening and more and more people become disenfranchised, disenchanted, and discontent.
3. Dr. Paul’s ploy of not accepting Medicare payment for his Medicare services or a congressional pension—while on the surface seem like noble gestures—are really means to portray himself as “one of us” and morally higher than his colleagues.
The third step is through indoctrination, coercion, repetition, and/or isolation to exercise mind control over your flock of followers by relieving them of their ability to think rationally (usually by not allowing them to test your theories or have access to “the outside”)—but not emotionally—while simultaneously convincing them that your ideas—while plausible (but generally at the far fringes of mainstream thought) are the “light and the truth”. This shows more elements of antisocial ego-building in that the leader is now getting others to surrender their will and rational thought against deep seated norms of the self and/or society while they align their thinking towards that of the leader.
Furthermore, this shows the disordered or delusional thinking of the leader who generally has delusional thinking of the world and how it operates and he or she is the only one with the power to fix it.
1.Dr. Paul plays on the emotions of his followers by carefully crafting plausible—and easy to understand-- (but highly improbable and at the fringes of mainstream thought)scenarios out of complex geopolitical, political, social and economic issues
that are at “top of mind” of our society and that tug at some of our most basic
interests (individual freedom, economic freedom, nationalism, sanctity of life,
torture, and war) and evoke very basic human responses such as fear, anxiety,
anger, disgust, and etc.
2. Dr. Paul’s views on national defense, monetary policy, isolationism, and constitutionalism are considered by most to be outside of the mainstream of rational political, social, and governmental philosophy.
3. Dr. Paul has consistently repeated his messages over 30 years and as noted above, tends to target younger followers who are easier to indoctrinate.
The fourth rule is to proselytize not only your “enlightened philosophy or beliefs, but also to spread forth the word that while you and your followers are “the enlightened or chosen ones”, there will be naysayers and those that will persecute you and the movement. This clearly shows the elements of paranoia and persecution by the non-believers.
1. Dr. Paul and his followers are very defensive when challenged on the issues and their beliefs. Instead of engaging in earnest discourse, they tend to attack and accuse the “non-believer” as persecuting them for their beliefs or of being ignorant and unenlightened in their philosophy.
2. Dr. Paul and his followers display a common paranoia and decry a “conspiracy” of the right, the political elite, and the left against them and their “lofty ideas that will save America”.
3. Dr. Paul has consistently offered the explanation that others are simply “out to get him” by taking “tongue-in-cheek comments out of context” and things that were written in his newsletters (but purportedly not authorized or written by him).
4. Dr. Paul comes off as defensive and angry when challenged in interviews and becomes condescending.
The fifth and last rule is to convince your followers that it is only through blind faith and rigid adherence to your philosophy—no matter how foreign it may be to self or to society—that that blind adherence or “loyalty” is the only path to salvation, redemption, or the reparation of the “perceived” ills of society. This is more antisocial ego-building and the tightening of control over the flock.
1. Dr. Paul and his followers play the same monotonous drum beat about “smaller government”, defense of our borders,monetary reform and fiscal responsibility, “stop the wars”, and national isolationism over and over again like a Gregorian chant and mantra in a blind and stubborn adherence to their fringe philosophy that is the only path to saving America despite practical, rational, philosophical, and real world
evidence against and “common sense” opposition to their “zany” ideas, Messianic
messages, and Utopian philosophies.
Some authors would add another step which is to construct a “doomsday scenario” for your followers, such as “the end of the world, World War III, or economic collapse as the great incentive to motivate the followers to adhere to and spread your
teachings. This, again, would show delusional thinking as well as narcissistic thinking, especially if the leader and his or her followers will be the only ones saved from the impending calamity.
1. Of course we are all aware of the “doomsday” prophecies of Dr. Paul considering our economy and its impending collapse with hyperinflation if we don’t get rid of the Fed.
After considering this, and seeing Dr. Paul’s rise in the Iowa polls, it makes me
wonder what they are doing out there in Iowa. It seems to me that maybe they are mixing a little Ron Paul Kool-Aid with some fermented corn!
Over the last several weeks, I have been studying Dr. Paul as well as his followers through his television appearances, his letters (and Newsletters), social media, and video clips from You-tube and have noted a very disturbing pattern of Dr. Paul showing all of the psycopathological characteristics of a genuine "cult leader" and his followers showing all of the characteristics of a cult.
I have studied cults and their leaders and have outlined the "five basic
rules" of being a cult leader. I have also indicated the psychopathology associated with cult leaders as they form their cults:
The number one rule of a cult leader is to polish and cultivate a persona that you--and only you--have been chosen, anointed, or have achieved spiritual, political, or intellectual enlightenment above all others. This shows features of megalomania, delusions of grandeur, as well as narcissism.
1. Dr. Paul has tried to cultivate this persona for over 30 years as the “outsider” and enlightened one within the “Washington establishment”.
2. Dr. Paul has publicly stated that while he believes in term limits, they do not apply to him because (paraphrasing) “there is no one good enough to bring in to replace him”.
3. In 2010, Dr. Paul commented to his wife that he would run for President in 2012 “if things were happening so quickly and fast in our country and we were in a crisis period…and needed somebody…with the knowledge he as, he would do it”.
4. Dr. Paul presents in interviews as haughty and stern and seems to be lecturing rather than engaging in conversation.
The next rule is to appeal to the disconnected, disenchanted, and disaffected in society who are often intellectually, politically, and emotionally immature (i.e., younger people)and convince them that while you have been “chosen” (or more likely self-selected) you are (almost) human just like them and can empathize with their disenchantment and discontent. This shows more tendencies of narcissism and ego-feeding by someone who sees them self as inherently better than others, but with a need to surround one’s self with those less fortunate or less “enlightened”—a “savior complex”, if you will. Often times, the empathy and compassion shown to the acolytes is not genuine (which is a feature of antisocial personality) and is only used for the ulterior motive of personal gain in sex, money, or power (or sense of superiority) or combination thereof.
1. Dr. Paul has always had a relatively small number of fanatical followers who have mostly been drawn from younger people in society. He routinely targets schools,
colleges, and other events where younger people tend to be.
2. His “populist” message today resonates with many, besides young people as social, geopolitical, and economic turmoil are perceived to be worsening and more and more people become disenfranchised, disenchanted, and discontent.
3. Dr. Paul’s ploy of not accepting Medicare payment for his Medicare services or a congressional pension—while on the surface seem like noble gestures—are really means to portray himself as “one of us” and morally higher than his colleagues.
The third step is through indoctrination, coercion, repetition, and/or isolation to exercise mind control over your flock of followers by relieving them of their ability to think rationally (usually by not allowing them to test your theories or have access to “the outside”)—but not emotionally—while simultaneously convincing them that your ideas—while plausible (but generally at the far fringes of mainstream thought) are the “light and the truth”. This shows more elements of antisocial ego-building in that the leader is now getting others to surrender their will and rational thought against deep seated norms of the self and/or society while they align their thinking towards that of the leader.
Furthermore, this shows the disordered or delusional thinking of the leader who generally has delusional thinking of the world and how it operates and he or she is the only one with the power to fix it.
1.Dr. Paul plays on the emotions of his followers by carefully crafting plausible—and easy to understand-- (but highly improbable and at the fringes of mainstream thought)scenarios out of complex geopolitical, political, social and economic issues
that are at “top of mind” of our society and that tug at some of our most basic
interests (individual freedom, economic freedom, nationalism, sanctity of life,
torture, and war) and evoke very basic human responses such as fear, anxiety,
anger, disgust, and etc.
2. Dr. Paul’s views on national defense, monetary policy, isolationism, and constitutionalism are considered by most to be outside of the mainstream of rational political, social, and governmental philosophy.
3. Dr. Paul has consistently repeated his messages over 30 years and as noted above, tends to target younger followers who are easier to indoctrinate.
The fourth rule is to proselytize not only your “enlightened philosophy or beliefs, but also to spread forth the word that while you and your followers are “the enlightened or chosen ones”, there will be naysayers and those that will persecute you and the movement. This clearly shows the elements of paranoia and persecution by the non-believers.
1. Dr. Paul and his followers are very defensive when challenged on the issues and their beliefs. Instead of engaging in earnest discourse, they tend to attack and accuse the “non-believer” as persecuting them for their beliefs or of being ignorant and unenlightened in their philosophy.
2. Dr. Paul and his followers display a common paranoia and decry a “conspiracy” of the right, the political elite, and the left against them and their “lofty ideas that will save America”.
3. Dr. Paul has consistently offered the explanation that others are simply “out to get him” by taking “tongue-in-cheek comments out of context” and things that were written in his newsletters (but purportedly not authorized or written by him).
4. Dr. Paul comes off as defensive and angry when challenged in interviews and becomes condescending.
The fifth and last rule is to convince your followers that it is only through blind faith and rigid adherence to your philosophy—no matter how foreign it may be to self or to society—that that blind adherence or “loyalty” is the only path to salvation, redemption, or the reparation of the “perceived” ills of society. This is more antisocial ego-building and the tightening of control over the flock.
1. Dr. Paul and his followers play the same monotonous drum beat about “smaller government”, defense of our borders,monetary reform and fiscal responsibility, “stop the wars”, and national isolationism over and over again like a Gregorian chant and mantra in a blind and stubborn adherence to their fringe philosophy that is the only path to saving America despite practical, rational, philosophical, and real world
evidence against and “common sense” opposition to their “zany” ideas, Messianic
messages, and Utopian philosophies.
Some authors would add another step which is to construct a “doomsday scenario” for your followers, such as “the end of the world, World War III, or economic collapse as the great incentive to motivate the followers to adhere to and spread your
teachings. This, again, would show delusional thinking as well as narcissistic thinking, especially if the leader and his or her followers will be the only ones saved from the impending calamity.
1. Of course we are all aware of the “doomsday” prophecies of Dr. Paul considering our economy and its impending collapse with hyperinflation if we don’t get rid of the Fed.
After considering this, and seeing Dr. Paul’s rise in the Iowa polls, it makes me
wonder what they are doing out there in Iowa. It seems to me that maybe they are mixing a little Ron Paul Kool-Aid with some fermented corn!
Saturday, December 17, 2011
"Arm chair economists" vs MD/MBA and Expert in Healthcare Economics
I have read with amusement the letters to the editor in today’s (12/17/2011) Albuquerque Journal criticizing Dr. J. Deane Waldman’s recent editorial regarding out of control health care costs and the government’s role in regulating and/or contributing to those costs. It is interesting that all three letters published were all critical of Dr. Waldman’s analysis with no counter opposing view(s) supporting his analysis. I don’t know if that means there were no letters to support Dr. Waldman or if the Journal simply chose not to include any letters that supported his views.
Regardless if there was any supportive letters sent to the editor, it is both interesting and amusing to see three non-medical (and assuming, non-health care economics) professionals—unless one counts “45 years experience as a health care advocate” as qualifying as a health care professional—trying to rebut the thoughtful analysis of not only a practicing physician who has practiced for more than 2 decades within our “sick system”,but is also an MBA who is a published author and expert in healthcare economics and reform.
It is obvious from the reading of all three letters that the basis of their rebuttal is not based on any real facts or data from scholarly journals in medicine or economics, but rather simply on personal political ideology and opinion. All three letter writers obviously espouse a more liberal “more government is better” philosophy towards healthcare—vis-à-vis “Obamacare”-- and two of the letter writers ignominiously attempt to discredit Dr. Waldman’s analysis as merely the musings or political ranting of just another ill-informed or unenlightened “conservative”.
Regarding the first letter by Mr. Richard Valdez, he somehow manages to shift the argument that more government regulation is more or less cost efficient based on the merits—or lack of—of governmental bureaucratic efficiency , instead arguing for the benefits of more government regulation in healthcare in order to improve patient safety. In other words, he is trying to compare apples to apples, but using oranges as an example. On top of that,he insinuates that Dr. Waldman just magically pulls his data (of 40% of healthcare expenditures not going to pay for direct patient care) out of the air if not from a “conservative think tank” while offering his own simple statistic from the CDC and Institute of Medicine (which by the way is a liberal think tank) of “100,000 to 135,000 deaths annually due to doctor and/or hospital error”. Now, did I miss something? I thought we were discussing money and bureaucratic efficiency/inefficiency here and not the number of potentially preventable patient deaths per year attributable to medical errors. What does one have to do with the other? I’m deeply sorry that he has lost two sons, but his argument that more government spending or regulations would have saved them may or may not be true, but have absolutely nothing to do with the argument that the government can or cannot be more efficient in managing healthcare!
Regardless if there was any supportive letters sent to the editor, it is both interesting and amusing to see three non-medical (and assuming, non-health care economics) professionals—unless one counts “45 years experience as a health care advocate” as qualifying as a health care professional—trying to rebut the thoughtful analysis of not only a practicing physician who has practiced for more than 2 decades within our “sick system”,but is also an MBA who is a published author and expert in healthcare economics and reform.
It is obvious from the reading of all three letters that the basis of their rebuttal is not based on any real facts or data from scholarly journals in medicine or economics, but rather simply on personal political ideology and opinion. All three letter writers obviously espouse a more liberal “more government is better” philosophy towards healthcare—vis-à-vis “Obamacare”-- and two of the letter writers ignominiously attempt to discredit Dr. Waldman’s analysis as merely the musings or political ranting of just another ill-informed or unenlightened “conservative”.
Regarding the first letter by Mr. Richard Valdez, he somehow manages to shift the argument that more government regulation is more or less cost efficient based on the merits—or lack of—of governmental bureaucratic efficiency , instead arguing for the benefits of more government regulation in healthcare in order to improve patient safety. In other words, he is trying to compare apples to apples, but using oranges as an example. On top of that,he insinuates that Dr. Waldman just magically pulls his data (of 40% of healthcare expenditures not going to pay for direct patient care) out of the air if not from a “conservative think tank” while offering his own simple statistic from the CDC and Institute of Medicine (which by the way is a liberal think tank) of “100,000 to 135,000 deaths annually due to doctor and/or hospital error”. Now, did I miss something? I thought we were discussing money and bureaucratic efficiency/inefficiency here and not the number of potentially preventable patient deaths per year attributable to medical errors. What does one have to do with the other? I’m deeply sorry that he has lost two sons, but his argument that more government spending or regulations would have saved them may or may not be true, but have absolutely nothing to do with the argument that the government can or cannot be more efficient in managing healthcare!
While this letter is meant to offer a critique of the letters criticizing Dr. Waldman’s analysis and not a separate analysis of how we can best prevent medical errors in healthcare or what the government’s best role is in preventing medical errors, I do want to point out—using Mr. Valdez’ own statistics—how easy it is to pick and choose random statistics disingenuously to support one side or another of an argument. While Mr. Valdez correctly contends that there are anywhere from 100,000 to 135,000 (actual range is 85,000 to 195,000)deaths annually attributable to doctor and/or hospital errors, he conveniently fails to indicate that number one, these are classified as “potentially preventable deaths” and number two, that these potentially preventable deaths represent an extremely small fraction (0.00005%--using the higher number of 200,000) of the nearly 1 billion (995 million) doctors visits, outpatient clinic visits, ER visits, and hospitalizations (CDC data) seen each year!
You don’t have to be a "Black Belt” in Six Sigma --an extremely rigorous business ideal advocating for near perfection or 99.99966% error free processes—to see that in medicine, we get pretty damn close! Now as a physician and a father-- and a healthcare consumer-- I understand that we are talking about human lives here and not the manufacturing of ball bearings and that even 1 preventable death due to medical error is tragic and regrettable, but from the dawn of civilization, we have never been, currently are not, and never will be perfect in medicine or in any other human endeavor!
Mr. Raymond Schall and Mr. Byers both just simply spout standard democratic party line demagoguery in their justification for and defense of “Obamacare” and increased government involvement in one of the most personal aspects of our lives without providing any real or objective data or logic to buttress their criticism of Dr. Waldmam’s analysis. Mr. Schall tries to
also pick and choose some “statistics” to bolster his support of “Obamacare” by citing that the “Health and Human Services recently released their long awaited rules requiring insurance companies to spend at least 80 to 85 percent of their revenue on actual patient care. What he failed to mention is that in the United States, most private insurance companies spend about 6 to 11percent of revenues on “administrative costs” and 89 to 94% on “patient care costs” (multiple sources). He also did not mention that from at least 2000 to 2010, Medicare consistently has spent 19 to 31% more on true “administrative costs” than private insurance companies. He also tries to tout the benefits of “Obamacare” by stating that “more than 100,000” New Mexicans have “received free preventative health care” and “more than 18,000 students have received primary and behavioral healthcare” because of “Obamacare”.
Now Mr. Schall obviously has never heard of or does not believe in the 1st principle of economics which basically states “there is no such thing as a free lunch”. He uses the word “free” as if “the free market tooth fairy”—to borrow a trite little phrase from Mr. Byers (the 3rd letter writer)—suddenly dropped the money into the government coffers to pay for the “free care”! Excuse me, but just because the patients received “free” or discounted health care doesn’t at all mean that it was “free”—somebody(you and I—and not the tooth fairy) in the form of increased taxes and or both increased premiums has to pay for that “free health care”! Beyond that, the medical providers providing the “free care” do so at a deeply discounted government mandated rate that often is below the amount required to sustain a viable practice!
Finally, Mr. Doug Byer’s letter is nothing more than old and tired progressive-socialist and “new” OWS dogma lamenting the evils of capitalism and free markets thinly—as well as feebly--disguised as an attempt in intellectual discourse.
I conclude my critique of the letters to the editor with some rather interesting “statistics” to ponder:
1. There are approximately 1800 pages each in both Harrison’s textbook of Medicine and the American College of Surgeons textbook of Surgery which could be considered the "bibles” of Western Medicine and Surgery and which represent the collection of
at least 3000 years of medical and surgical science and knowledge. This compares to 1000 pages in the Patient Protection and Affordable Act (aka “Obamacare”), 670 pages in the HIPPA regulations, and over 132, 000 pages of Medicare rules and regulations collected over the last few decades (this does not include the various state and local rules and regulations regarding the practice of medicine in States and local localities)!
2. There are approximately 650,000 practicing physicians and surgeons in the United States and it is estimated that for every physician, there is 2 to 5 or (1.2 to 3.25 million) “non-medical administrative” workers (most of them Federal and State employees) per doctor “administering healthcare”!
3. The Medicare Trustees have projected that Medicare (which administers to approximately 30.5 million Americans) will be bankrupt by 2024 at current spending projections and somehow we want to expand that government bureaucratic behemoth to cover 10 times that much? This is what a “real” doctor in health care economics has to say about that:
“Contrary to the claims of public plan advocates, moving millions of
Americans from private insurance to a Medicare-like program will result in
program administrative costs that are higher per person and higher, not lower,
for the nation as a whole.”
Robert A. Book, Ph.D., is Senior Research Fellow in Health Economics in the Center
for Data Analysis at The Heritage Foundation
Sincerely,
John R. Vigil, MD
Dr. Vigil has a blog titled “What’s Wrong With American Healthcare Today;
The Musings of a Working Doc” and has been a practicing physician and surgeon for over 20 years. His interests in medicine are healthcare economics, improving healthcare delivery, and history of medicine and surgery. He has completed 1 year towards his Master’s degree in Business Administration at the Anderson School of Management, University of New Mexico.
Wednesday, August 31, 2011
Opiates and Pain Management; Pandora's Box
Opiates and Pain Management: Pandora’s Box
Today is National Overdose Awareness Day and an appropriate time to discuss the terrible epidemic of opiate addiction that we are seeing, not only in our community, but nationally as well. The statistics are staggering as according to SAMHSA (Substance Abuse and Mental Health Services Administration) there were 1.9 million prescription opiate addicts and another 600,000 or more heroin addicts in 2009 and the numbers are increasing. Accidental overdose has overtaken car accidents as the number one killer of young people 18 to 44 who are not only in their prime of life, but also the primary producers in our economy and society. It is estimated that overall, 24 million people in the US have an addiction and only about 1-2% are receiving treatment for their addiction.
I could easily write an entire paper on the staggering cost of addiction, not only in loss of human lives but also in economic costs to this country; however this paper is about the people affected by this horrible epidemic and not about statistics. There have been a number of stories and citizen comments recently in our news and newspapers about young people tragically dying of heroin overdose and doctors over-prescribing narcotic medication. This paper is written to try to bring some insight to the community of the scope of this problem, how we got there, and some possible solutions.
Sometime in the middle of the last decade, several national and international organizations, including the WHO (World Health Organization) drafted and adopted a Patient’s Bill of Rights that dealt specifically with pain management. Specifically and amongst other things, it stated that all patients “have a right to proper, respectful, informed, and non-discriminatory pain management and care”. Prior to this shift change in medicine, opiates had more or less been reserved to manage chronic pain only for patients with advanced cancers or other end-stage painful conditions. Apart from these patients, the only other use for opiates was generally for the short term treatment of severe acute pain postoperatively or for severe acute trauma. Following the lead of the national and international organizations, most state medical boards and societies adopted the Pain Patient’s Bill of Rights and Pandora’s Box was opened.
Since then, millions of patients have been treated and are being treated with opiate pain medication for a variety of conditions including headaches, chronic back pain, arthritis, fibromyalgia, and just about any other disorder that causes pain. While the overwhelming majority of these patients are being treated for legitimate pain by well-meaning, well trained, and legitimate physicians and are not abusing their medication or addicted, many of them do become addicted and/or dependent and a few obtain their medication illegitimately, by ruse or illegally. Unfortunately, there have been—and remain--more than a few unscrupulous and unethical doctors who have been more than happy to provide some of the latter “patients” with prescriptions for narcotic medication.
The opening of Pandora’s Box has produced a schizophrenic medical community with doctors under pressure to respect and adhere to the “Patient Bill of Rights” by providing legitimate patients with adequate and compassionate pain management on the one hand while feeling threatened or intimidated by the DEA and other law enforcement agencies if they chose to treat such patients. Another problem arises when all physicians know and understand that while the majority (more than 80%) of patients treated with opiate pain management will never develop an abuse problem or addiction, about 10% will ultimately develop an addiction with its attendant negative consequences—including risk of accidental overdose-- on those patient’s lives. Unfortunately for us, patients do not carry a sign with them that warn us that a particular patient will become addicted. Furthermore, since pain is a subjective and individual experience and is modified by emotional, physical, and psychological states, it is impossible for any physician to be 100% certain 100% of the time, who is legitimately seeking pain management and who is not.
By some of the reports in the news as well as some of the citizen’s comments, it would appear that there is a perception that most physicians are just “willy nilly” handing out prescriptions for opiates to just anyone who requests them without consideration of the consequences. As I have mentioned earlier and which have been documented in news stories across the country, I acknowledge that there are unethical and unscrupulous physicians who are prescribing for profit, but like the minority of legitimate patients who become addicted and cause problems to themselves and society, they are in the vast minority! In fact, statistics from SAMHSA indicate that in most communities, most “illegitimate” prescriptions are coming from only 1 or 2 doctors. Most doctors take their responsibility to their profession and society seriously and understand the risks of prescribing opiate medication. We also understand that the majority of people prescribed such medication will also be responsible and never develop a problem with it and we are constantly weighing the risks versus the benefits of prescribing such medication to each and every patient. It is inevitable that some of us will be duped by some “patients” and it is also inevitable that some legitimate patients will develop an addiction and that is the risk we take while Pandora’s Box is open.
Another common misperception is that many teenagers and young people are becoming addicted to opiates obtained from doctors. There are very few indications to treat a young person with opiate medication and most physicians are hesitant to prescribe these medications to teens and young people except in cases of moderate to severe pain from orthopedic or operative trauma. Statistics from SAMSHA and from my personal experience as an addiction specialist, most teens and young people (55%) report that they are getting their opiates right from home (friends or family), 17% report getting them from one doctor, and the rest from the street. Of those that reported obtaining their medication from friends or family, 80% of the friends or family members reported getting their medication from only one doctor.
So what can we do about Pandora’s Box? According to legend, once it was open, there was no way of closing it and I do not believe that there is any way of closing our modern day version of the box. However, the one thing that remained in the box was hope and it with hope that we can possibly change things at a variety of levels including personally, professionally, and legislatively to effect positive change in our communities and society at large to combat this insidious and horrible epidemic that is claiming the lives of our youngest and most productive individuals. Every time one of our young people dies from an overdose, it robs us all and our society of a “what if”—what if that person was going to be the next doctor to cure cancer or addiction, a great actress or actor, singer or athlete, or the next CEO of a great company, or even the next President.
While I do not profess to have all of the answers to this complex and vexing problem, I do have some suggestions, some of which will undoubtedly bring much scorn and criticism upon me from colleagues and others. I will outline these suggestions from a personal to professional to a legislative order.
Personally, as individuals we must all become aware of this insidious epidemic and must educate ourselves—and our children-- about the risks and dangers of opiate addiction when given these medications, even for short term use. As parents, we must educate ourselves to the signs and symptoms of addiction so that we may intervene early and decisively should we suspect our children or loved ones of developing a problem or experimenting with opiates. If we are obtaining and using opiate medication we must take measures to safeguard our medication and keep them out of the reach of children and inquiring minds. We can become advocates in our schools and our communities, becoming involved in groups and organizations, such as the Heroin Action Committee, that spread the word about this problem. Lastly, we must learn and understand that addiction is a disease and should be treated like a disease without the stigmatization that surrounds it and which stands as a barrier to many of those who would otherwise seek treatment.
At a professional level, we must take our heads out of the sand and acknowledge the epidemic of opiate addiction that the opening of Pandora’s Box has caused. We must keep up to date on the standards of care for the treatment of chronic pain and we must also keep up to date on the advances that are being made in the non-opiate management of chronic pain as well as the advancements being made in addiction medicine. We too, must divest ourselves of the cloaks of superiority and ignorance and recognize addiction for the disease that it is and not the old stereotypes we might still believe. We must accept our part in this epidemic and be more diligent about truly doing risk analysis every single time we write a narcotic prescription, including opiates, benzodiazepines, and medication for ADD. We must recognize our educational and training limitations and refer those patients requiring complex psychological and concomitant pain management to appropriate specialists. It is our house where Pandora’s Box came from and we must clean our house or others will clean it for us and ultimately, the patients and society will suffer.
At a legislative level, which must occur at both the state and federal levels, there are several things that can be done. First of all, hydrocodone and tramadol should be made scheduled II narcotics and all scheduled II narcotics should be controlled and prescribed only by appropriate specialists or physicians who have demonstrated interest, experience, and proficiency through conferences, courses, and continuing medical education in pain management—as well as addiction-- to their respective state medical boards or licensing agencies. It is interesting that I must demonstrate proficiency to apply for a license to prescribe Suboxone which treats addiction, but I have no restrictions whatsoever to write for all the drugs that cause addiction! For those specialists that may often treat acute severe pain, such as surgeons, orthopedic surgeons, or ER/Urgent Care physicians, strict limits should be made with respect to amounts written for and duration of treatment for all scheduled II drugs. All states should be mandated to have a reporting mechanism through the pharmacy boards where all physicians should be mandated to access and report to before prescribing scheduled II medication. On a broader level, we must enact legislation that shifts the emphasis from punishment to prevention and treatment for those that struggle with addiction. We should encourage and expand dramatically the number of doctors and midlevel providers who wish to provide outpatient opiate addiction treatment with Suboxone. As a society, we too must understand that addiction is a neurobiological disease manifested by abnormal behavior, not abnormal people voluntarily engaging in harmful and bad behavior!
Pandora’s Box may be open, but by coming together as citizens, professionals, and policy makers, we can perhaps reopen the box and bring hope to our communities and to society.
John R. Vigil, MD
Today is National Overdose Awareness Day and an appropriate time to discuss the terrible epidemic of opiate addiction that we are seeing, not only in our community, but nationally as well. The statistics are staggering as according to SAMHSA (Substance Abuse and Mental Health Services Administration) there were 1.9 million prescription opiate addicts and another 600,000 or more heroin addicts in 2009 and the numbers are increasing. Accidental overdose has overtaken car accidents as the number one killer of young people 18 to 44 who are not only in their prime of life, but also the primary producers in our economy and society. It is estimated that overall, 24 million people in the US have an addiction and only about 1-2% are receiving treatment for their addiction.
I could easily write an entire paper on the staggering cost of addiction, not only in loss of human lives but also in economic costs to this country; however this paper is about the people affected by this horrible epidemic and not about statistics. There have been a number of stories and citizen comments recently in our news and newspapers about young people tragically dying of heroin overdose and doctors over-prescribing narcotic medication. This paper is written to try to bring some insight to the community of the scope of this problem, how we got there, and some possible solutions.
Sometime in the middle of the last decade, several national and international organizations, including the WHO (World Health Organization) drafted and adopted a Patient’s Bill of Rights that dealt specifically with pain management. Specifically and amongst other things, it stated that all patients “have a right to proper, respectful, informed, and non-discriminatory pain management and care”. Prior to this shift change in medicine, opiates had more or less been reserved to manage chronic pain only for patients with advanced cancers or other end-stage painful conditions. Apart from these patients, the only other use for opiates was generally for the short term treatment of severe acute pain postoperatively or for severe acute trauma. Following the lead of the national and international organizations, most state medical boards and societies adopted the Pain Patient’s Bill of Rights and Pandora’s Box was opened.
Since then, millions of patients have been treated and are being treated with opiate pain medication for a variety of conditions including headaches, chronic back pain, arthritis, fibromyalgia, and just about any other disorder that causes pain. While the overwhelming majority of these patients are being treated for legitimate pain by well-meaning, well trained, and legitimate physicians and are not abusing their medication or addicted, many of them do become addicted and/or dependent and a few obtain their medication illegitimately, by ruse or illegally. Unfortunately, there have been—and remain--more than a few unscrupulous and unethical doctors who have been more than happy to provide some of the latter “patients” with prescriptions for narcotic medication.
The opening of Pandora’s Box has produced a schizophrenic medical community with doctors under pressure to respect and adhere to the “Patient Bill of Rights” by providing legitimate patients with adequate and compassionate pain management on the one hand while feeling threatened or intimidated by the DEA and other law enforcement agencies if they chose to treat such patients. Another problem arises when all physicians know and understand that while the majority (more than 80%) of patients treated with opiate pain management will never develop an abuse problem or addiction, about 10% will ultimately develop an addiction with its attendant negative consequences—including risk of accidental overdose-- on those patient’s lives. Unfortunately for us, patients do not carry a sign with them that warn us that a particular patient will become addicted. Furthermore, since pain is a subjective and individual experience and is modified by emotional, physical, and psychological states, it is impossible for any physician to be 100% certain 100% of the time, who is legitimately seeking pain management and who is not.
By some of the reports in the news as well as some of the citizen’s comments, it would appear that there is a perception that most physicians are just “willy nilly” handing out prescriptions for opiates to just anyone who requests them without consideration of the consequences. As I have mentioned earlier and which have been documented in news stories across the country, I acknowledge that there are unethical and unscrupulous physicians who are prescribing for profit, but like the minority of legitimate patients who become addicted and cause problems to themselves and society, they are in the vast minority! In fact, statistics from SAMHSA indicate that in most communities, most “illegitimate” prescriptions are coming from only 1 or 2 doctors. Most doctors take their responsibility to their profession and society seriously and understand the risks of prescribing opiate medication. We also understand that the majority of people prescribed such medication will also be responsible and never develop a problem with it and we are constantly weighing the risks versus the benefits of prescribing such medication to each and every patient. It is inevitable that some of us will be duped by some “patients” and it is also inevitable that some legitimate patients will develop an addiction and that is the risk we take while Pandora’s Box is open.
Another common misperception is that many teenagers and young people are becoming addicted to opiates obtained from doctors. There are very few indications to treat a young person with opiate medication and most physicians are hesitant to prescribe these medications to teens and young people except in cases of moderate to severe pain from orthopedic or operative trauma. Statistics from SAMSHA and from my personal experience as an addiction specialist, most teens and young people (55%) report that they are getting their opiates right from home (friends or family), 17% report getting them from one doctor, and the rest from the street. Of those that reported obtaining their medication from friends or family, 80% of the friends or family members reported getting their medication from only one doctor.
So what can we do about Pandora’s Box? According to legend, once it was open, there was no way of closing it and I do not believe that there is any way of closing our modern day version of the box. However, the one thing that remained in the box was hope and it with hope that we can possibly change things at a variety of levels including personally, professionally, and legislatively to effect positive change in our communities and society at large to combat this insidious and horrible epidemic that is claiming the lives of our youngest and most productive individuals. Every time one of our young people dies from an overdose, it robs us all and our society of a “what if”—what if that person was going to be the next doctor to cure cancer or addiction, a great actress or actor, singer or athlete, or the next CEO of a great company, or even the next President.
While I do not profess to have all of the answers to this complex and vexing problem, I do have some suggestions, some of which will undoubtedly bring much scorn and criticism upon me from colleagues and others. I will outline these suggestions from a personal to professional to a legislative order.
Personally, as individuals we must all become aware of this insidious epidemic and must educate ourselves—and our children-- about the risks and dangers of opiate addiction when given these medications, even for short term use. As parents, we must educate ourselves to the signs and symptoms of addiction so that we may intervene early and decisively should we suspect our children or loved ones of developing a problem or experimenting with opiates. If we are obtaining and using opiate medication we must take measures to safeguard our medication and keep them out of the reach of children and inquiring minds. We can become advocates in our schools and our communities, becoming involved in groups and organizations, such as the Heroin Action Committee, that spread the word about this problem. Lastly, we must learn and understand that addiction is a disease and should be treated like a disease without the stigmatization that surrounds it and which stands as a barrier to many of those who would otherwise seek treatment.
At a professional level, we must take our heads out of the sand and acknowledge the epidemic of opiate addiction that the opening of Pandora’s Box has caused. We must keep up to date on the standards of care for the treatment of chronic pain and we must also keep up to date on the advances that are being made in the non-opiate management of chronic pain as well as the advancements being made in addiction medicine. We too, must divest ourselves of the cloaks of superiority and ignorance and recognize addiction for the disease that it is and not the old stereotypes we might still believe. We must accept our part in this epidemic and be more diligent about truly doing risk analysis every single time we write a narcotic prescription, including opiates, benzodiazepines, and medication for ADD. We must recognize our educational and training limitations and refer those patients requiring complex psychological and concomitant pain management to appropriate specialists. It is our house where Pandora’s Box came from and we must clean our house or others will clean it for us and ultimately, the patients and society will suffer.
At a legislative level, which must occur at both the state and federal levels, there are several things that can be done. First of all, hydrocodone and tramadol should be made scheduled II narcotics and all scheduled II narcotics should be controlled and prescribed only by appropriate specialists or physicians who have demonstrated interest, experience, and proficiency through conferences, courses, and continuing medical education in pain management—as well as addiction-- to their respective state medical boards or licensing agencies. It is interesting that I must demonstrate proficiency to apply for a license to prescribe Suboxone which treats addiction, but I have no restrictions whatsoever to write for all the drugs that cause addiction! For those specialists that may often treat acute severe pain, such as surgeons, orthopedic surgeons, or ER/Urgent Care physicians, strict limits should be made with respect to amounts written for and duration of treatment for all scheduled II drugs. All states should be mandated to have a reporting mechanism through the pharmacy boards where all physicians should be mandated to access and report to before prescribing scheduled II medication. On a broader level, we must enact legislation that shifts the emphasis from punishment to prevention and treatment for those that struggle with addiction. We should encourage and expand dramatically the number of doctors and midlevel providers who wish to provide outpatient opiate addiction treatment with Suboxone. As a society, we too must understand that addiction is a neurobiological disease manifested by abnormal behavior, not abnormal people voluntarily engaging in harmful and bad behavior!
Pandora’s Box may be open, but by coming together as citizens, professionals, and policy makers, we can perhaps reopen the box and bring hope to our communities and to society.
John R. Vigil, MD
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