The Drugs in Canada’s Drinking Water Are Affecting the Fish

The problems are that drugs are making it through water-treatment processes to be discharged in “clean” water and sent back into rivers and lakes, and that these drugs can affect aquatic life. The study found cocaine, amphetamines, MDMA, ephedrine, opioids, and more in various water samples from the Grand River watershed in Southern Ontario, “albeit in low concentration.”

When treated water was found to contain drugs, it was usually not in any amount that would affect humans, but fish are much smaller and more likely to be exposed to contaminated water (by dint of their living in water). While most prescription drugs have been tested for their effects on fish, many illegal drugs have not…

What It’s Like To Be The Girl Who Doesn’t Wear Makeup

When I stopped wearing daily makeup, I stopped feeling like I was wearing a mask. I show the real me to the world every day, with the knowledge that they see me the same way I see me. And you know what? Almost no one noticed, and absolutely no one complained…

Many people use makeup to “cover” or “fix” things they see as physical flaws. When you don’t wear makeup every day, it’s a big step toward making peace with yourself, and celebrating the beautiful characteristics that have been there all along. Sure, it made me feel vulnerable at first, but eventually I realized that any judgment or shame was actually coming from me, and not from others…

These Superhumans Are Real and Their DNA Could Be Worth Billions

Steven Pete can put his hand on a hot stove or step on a piece of glass and not feel a thing, all because of a quirk in his genes. Only a few dozen people in the world share Pete’s congenital insensitivity to pain. Drug companies see riches in his rare mutation. They also have their eye on people like Timothy Dreyer, 25, who has bones so dense he could walk away from accidents that would leave others with broken limbs. About 100 people have sclerosteosis, Dreyer’s condition…

What’s good for patients is also good for business. The painkiller market alone is worth $18 billion a year. The industry is pressing ahead with research into genetic irregularities. The U.S. Food and Drug Administration is expected to approve a cholesterol-lowering treatment on July 24 from Sanofi and Regeneron Pharmaceuticals based on the rare gene mutation of an aerobics instructor with astoundingly low cholesterol levels. Amgen has a similar cholesterol drug, based on the same discovery, and expects U.S. approval in August. The drugs can lower cholesterol when statins alone don’t work. They are expected to cost up to $12,000 per patient per year and bring in more than $1 billion annually...

The promise of the Nav 1.7 channel is to create an entirely new class of painkiller. Options on the market are all problematic. Opioids, such as morphine, are addictive, while nonsteroidal anti-inflammatory drugs, such as ibuprofen, are ineffective with severe pain and can cause gastrointestinal side effects including bleeding. Genentech is still in the earliest stage of clinical trials, and it could take more than five years before a drug is released…

Pitfalls of Point-of-Care Urinary Drug Screening for Pain Management

What are the clinical needs for drug testing in pain management clinics? Can these needs be met by POC urinary drug screen testing?

Drug testing in pain management clinics is used to determine: (1) whether the patient is taking the pain medication as prescribed versus diverting it; and (2) whether the patient is abusing other substances.

To address the above needs, a POC urinary drug screen test must be able to detect the pain medication of interest and accurately identify any drugs of abuse.

Unfortunately, POC urinary drug screen testing has a limited ability to do these things. It is a screening tool only, and can produce false-positive or false-negative results due to the testing methodology. The cutoff concentration may also be too high in some cases for pain management use. Thus, any screening result that does not match the patient’s prescribed medication must be confirmed by mass spectrometry before the patient can be accused of non-compliance. However, many providers do not understand the presumptive nature of these test results and want to act on them immediately.

In addition, the drug of interest may not be screened by the POC test. For example, most opiate screens on the market primarily detect morphine and codeine. Depending on the assay used, hydrocodone and oxycodone may or may not be included. Some opioids, such as fentanyl, buprenorphine, tapentadol, and tramadol, are also not routinely detected by POC urine tests. However, this is not common knowledge to most providers. To many, if the opiate screen is negative, it means the patient is not taking the pain medication. Sadly, I have encountered cases in which patients were wrongfully dismissed from pain management programs because a test result was misinterpreted…

AACC is a global scientific and medical professional organization dedicated to clinical laboratory science and its application to healthcare…

Pseudo-medical interventions and a doctor’s responsibility

As a doctor I have a responsibility to my patients. I have the responsibility to do my best to diagnose and treat any patient that comes my way. I also have the responsibility not to waste my patients time, money, hope and health by offering worthless therapies.

That can be hard at times. Because when I see someone who is ill, who is suffering, and who comes to me for advice, I want to help. I want to make them better. Being an infectious disease doctor I do not often see medical conditions for which I can offer nothing. Occasionally I see one of the chronic fatigue states and I hate it when I have to tell the patients that no, as best as I know, I have nothing to offer you.

And when patients ask me about various pseudo-medical interventions I usually feel obligated to give the same response. No, acupuncture or colloidal silver or those herbs or that homeopathic nostrum or [fill in the blank] will not help your illness. As much as I would like to be able to offer something, I can’t do it. I feel obligated to practice within the bounds of reality.

Other institutions have different standards.

As you are aware, acupuncture, chiropractic, rebirthing, regression therapy, guided imagery, and reiki are all pseudo-medical nonsense. As is Breath therapy, which I had never heard of…

I do not expect pseudo-medical providers to know any better. They have drunk the Kool-Aid. But I would not except a medical clinic to have on their website phrases like…

All examples of what the Cleveland Clinic is offering, and more, in their Integrative Medicine Center.

Really. Reiki. No homeopathy. Yet. But Reiki. Reiki!

My Dad always told me you can judge a person by the company they keep. You offer Reiki, no matter how potent your other high vibrational energies might be, I cannot help but suspect you and I have different concepts as to our responsibilities to our patients.

And now, according to a press release, they have added Chinese Herbal Therapy.

Such a collection of pseudo-medicines in one medical clinic. And I hope the picture is not from the Cleveland Clinic. That bare finger next to the needle gives me the infection control willies…

(March 2015) Acupuncture Provides Minimal Benefits After Study Design Bias Is Removed

“In our study, we enrolled participants who did not know the trial was examining acupuncture, whereas in other studies on acupuncture, subjects were aware that the focus was on this treatment,” said lead investigator Rana Hinman, PhD.

The researchers and experts are touting the study’s “Zelen design” (originally proposed by Harvard School of Public Health statistician Marvin Zelen) for overcoming a bias that previous trials on the topic have included by randomizing patients before consent to participate has been sought. Dr. Hinman said that individuals inclined to volunteer for an acupuncture study are also more likely to look favorably upon the approach. This increases the chances of a positive effect if they are administered either the treatment or a sham…

He said these results—like in some prior studies—show that on average, acupuncture is associated with slight and short-lived benefits. He noted that some individuals who were administered acupuncture and “other alternative and complementary modalities, or even treatments for pain described as placebos” have also reported improvement.

“These ‘responders’ should not be dismissed as gullible,” said Dr. Hadler. “There are certain individuals who, because of their worldview and beliefs, will find comfort in alternative and complementary treatments that have been proven to be no more effective than placebo.

“Whether it is ethical for clinicians to offer patients these ‘comforting’ treatments remains a topic of debate.”

What Homeopathy & Spine Surgery Have In Common

Should health insurance pay for placebo therapies?

Wednesday, 11 July 2012
Steroid injections for low back pain

The Cochrane review on injections for low back pain concludes: “There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain”. The injections contain corticosteroid (‘steroids’, ‘cortisone’) mixed with local anaesthetic and are injected into the epidural region or the facet joints of the lumbar spine. The injections have been compared to placebo injections and to other treatments and, without going in to all the detail, they basically don’t work…

But surely some studies show a benefit to these injections? Again, yes, but those studies are usually not ‘blinded’ and do not use a true placebo, so we are not allowing for the placebo effect and the other reasons why people get better without treatment…

How big is the problem? There are hundreds of thousands of back injections performed each year worldwide. It is routine practice for general practitioners and spine specialists, and it is big business for interventional radiologists. In the US, the rate of epidural injections in the Medicare population increased more than three-fold between 1994 and 2001 (here) and more than doubled in the 10 years leading up to 2006 (here). The increase in costs per injection means that the cost of spinal injections has increased several hundred percent (here)…  

We are witnessing an increasing divergence between the growing evidence that these injections do not work, and the growth in the number of these injections being performed. There are many likely explanations. Firstly, it is standard practice, so it is easy to justify; if everyone is doing it, then you cannot be criticised for doing it. Also, as I have said before, patients want some kind of treatment and at least the doctors feel as if they are “doing something”. Most doctors probably believe (from what they see, from tradition, and from wishful thinking) that the injections work. Like Bruce Willis in The Sixth Sense, doctors are ‘seeing what they want to see’. They give the injections and some patients feel better afterwards, and they impute cause-and-effect. Very human of them, but not very scientific. The science tells us that they were just as likely to get better with a placebo. Also, of course, a lot of people are making a lot of money from these injections.

(2009) Overtreating Chronic Back Pain: Time to Back Off?

Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain…

(July 2015) Physical Therapy, Surgery Yield Similar Results for Lumbar Spinal Stenosis

Expert: Nondrug Therapies May Be Most Effective Treatments for Fibro Pain

PALM SPRINGS, CALIF.—Given that fibromyalgia pain stems primarily from the central nervous system (CNS), nonpharmacologic therapies may provide greater benefits than opioids and narcotic analgesics, according to a presenter at the 2015 American Pain Society Annual Scientific Meeting…

The condition is believed to be associated with how the brain processes pain and other sensory information, so opioids and narcotic analgesics are usually not effective because they do not reduce the neurotransmitter activity in the brain, according to Dr. Clauw.

“These drugs have never been shown to be effective in fibromyalgia patients, and there is evidence that opioids might even worsen fibromyalgia and other centralized pain states,” he said.

Dr. Clauw recommended a combination of pharmacologic treatments (e.g., gabapentinoids, tricyclic antidepressants and selective serotonin reuptake inhibitors) and nonpharmacologic approaches (e.g., cognitive-behavioral therapy, exercise and stress reduction).

“Sometimes the magnitude of treatment response for simple and inexpensive nondrug therapies exceeds that for pharmaceuticals,” said Dr. Clauw. “The greatest benefit is improved function, which should be the main treatment goal for any chronic pain condition. The majority of patients with fibromyalgia can see improvement in their symptoms and lead normal lives with the right medications and extensive use of non drug therapies.”

The greatest benefit is improved function?  Shouldn’t the greatest benefit be a reduction in pain, which leads to improved function?

Opioids have never been show to effectively manage fibro?  Has it been shown that the “right” medications to treat fibro are antidepressants?  And this guy is supposed to be an “expert”?

No mention of cannabis?  So the only choices for fibro patients are antidepressants or nothing?

I support Planned Parenthood

I support women’s rights, but I just don’t have the mental energy to keep up with the abortion fight.  Keeping up with the war against pain patients and mental health care is about all I can handle.

But you can’t escape the news about the latest “attacks” against Planned Parenthood.

The link is to a graphic that shows connections between all the political and religious groups advocating against women’s (not men’s) reproductive rights.  It so reminds me of trying to figure out who is funding each anti-drug “expert” or group.  And you won’t be surprised to learn of all the religious groups that are funding the war against pain patients and drugs, or their connections to politicians, both in state and federal government.  And their connections to Big Pharma, law enforcement, and agencies like the DEA and FDA, along with very supportive, powerful and rich donors, like Sheldon Adelson.

Sometimes it seems like Republicans haven’t arrived in the internet age yet, where information is freely accessible online.  You can name your group “The Center for Medical Progress” and expect a few people to be misled by the generic (and anonymous) name, or too lazy to search for the intent of the group. But that you expect most people and the media to be fooled — and be so blatant about how dumb you think we are — makes me question the weak strategy behind such groups.

You can name your group “Physicians For Responsible Opioid Prescribing” and expect a few people to be fooled, but keep in mind that the addiction and pain management industries are really fooling no one. And no one is fooled by being unable to completely see into the dark corners of political machinations, where religious groups like to hide.

I suggest that religious groups come out of the closet.  Just like gay people who couldn’t and shouldn’t have to pretend to be heterosexual, religious groups should stop pretending and hiding behind generic labels, funding “anti” groups of every stripe and flavor — from the war against drugs to fighting against the rights of women, voters, immigrants, pain patients, the disabled, and poor people.

Just like pain patients who should have access to every available treatment option, women who require reproductive health care should have access to every service.  And that’s why I support Planned Parenthood.