The Bridge

“Sometimes, if you aren’t sure about something, you just have to jump off the bridge and grow your wings on the way down.”  Danielle Steel




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“The hardest thing in life to learn is which bridge to cross and which to burn.” David Russell

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(Photos taken October 7 and 9, 2015.)

Will doctors become obsolete?

MedPage Today is written and read by doctors, which is why I think it’s important for patients to have a voice in that forum. Unfortunately, the website wouldn’t allow me to post a comment to this article, so I’ve got to post it here.

“Nelson noted that most chronic pain does not respond optimally to opioids, and many patients can use better alternatives for chronic pain. ‘We have learned this the hard way over the past 20 years,’ he said.”

It appears that pain patients and doctors have learned completely different things over the past 20 years. With the experience of suffering from intractable pain for the last 30 years, I certainly don’t agree with this doctor’s opinion. (How many other pain patients would also disagree? And whose opinion is more important?)

In fact, I’d like to know which treatment options this doctor believes are “better” alternatives for the treatment of chronic pain. Better in what way? Better for each individual patient, insurance companies, the alternative medicine and addiction industries, or the DEA? (Breaking news: Walgreens and CVS employ addiction “counselors” at every pharmacy. Just $20 for an initial visit. Bupe prescriptions available. Thanks, President Obama!)

What does successful treatment for pain look like? If a pain patient doesn’t develop addiction, doctors consider that a success. Are doctors trying to treat pain or the mental illness of addiction? And how many pain patients really suffer from both?

Maybe I missed the research that proves any of these alternative treatments actually help a significant percentage of pain patients (like opioids do). But I haven’t missed the complaints by patients that show the amount of harm caused by the non-opioid treatments which are being forced upon them.

Which is more harmful, treatments like steroid injections and antidepressants or opioids? What about the pain patient who’s been spending an enormous amount of money on painful chiropractic adjustments for the last 5 years and hasn’t seen any improvement? There are many different levels of harm caused by non-opioid treatments (including financial), and yet doctors still use them because of the opioid war. When there are about 400,000 patients who die every year from medical mistakes, why should doctors (and law enforcement) decide which treatment options should be available to patients? Who are the experts here?

What pain patients have learned during the past few decades — while the drug war invaded their health care — is that trusting doctors and medical science is a big mistake. Research by survey is now considered evidence and used to shame and discriminate against patients. Long-term evidence doesn’t exist for most drugs, not just opioids, because no one wants to pay for it. Anecdotal evidence is the only thing left that doesn’t always include conflicts of interest.

“Study authors and the editorialists reported no relevant financial interests.”

Everyone knows that financial interests — whether deemed relevant or not — are not the only conflicts of interest that exist within these industries.

“‘There is virtually no data for safety or efficacy in chronic non-end-of-life pain, but patients are convinced that they need [opiate medications],’ Nelson added.”

Funny thing about medications that work — patients learn to ask for them. (And because of the drug war, drugs that work are worth more money in the underground market, so diversion will always happen.)

No one can deny that opioids work, and just like all other legal and illegal drugs, that means opioids come with side effects. Let’s see, which is more harmful in the long-term, chemotherapy or opioid therapy? Surgery or opioid therapy? Dulling chronic pain with alcohol or opioid therapy? Medical cannabis or opioid therapy? Instead of discriminating against one drug or another, why not utilize a combination so as to reduce the harm of a single one? C’mon, this isn’t rocket science.

With doctors like Lewis Nelson (practicing in New York, just like Kolodny from PFROP), who needs enemies? And when did patients become more knowledgeable than doctors? Within the last 20 years? I admit, I enjoy seeing doctors make fools of themselves because of the drug war. It allows me to imagine a day when doctors become obsolete, just like cars you have to drive yourself.

An ADA lawyer’s advice for chronic pain patients

Essentially, the doctors you speak of appear to be denying services based on your disability which necessitates that you be prescribed pain medication in accordance to medical evaluation and as consistent with any treatment deemed necessary by a given doctor or specialist. Whatever the reasons for these refusals to treat, doctors are liable under Title III of the ADA for failing to provide their services to patients based on any stigma or stereotype associated with anyone who has a condition that imposes chronic pain. Moreover, a doctor is likely violating ethical codes by refusing to treat a given patient when the doctor is licensed appropriately to treat as a general practitioner and/or specialist in a given area. Hence, they may decline to treat patients that require medical services from a different practice area. But they may not decline to treat patients inside their scope of practice and/or they may not decline to provide a helpful referral even if the condition is outside their area of practice.

I would recommend that you forward them this response and seek to obtain treatment so as to avoid filing complaints against these doctors under the ADA and other applicable laws…

I am available for questions.

Diego Demaya, J.D.
Southwest ADA Center
TIRR Memorial Hermann
1333 Moursund St.
Research Center 2nd Flr. Suite 212
Houston, Texas 77030
Toll Free: (800) 949-4232
Office: (713) 797-7114
Fax (713) 520-5785

Under comments:

Bob Schubring, on October 21, 2015 at 2:20 am said:

The Montana doctors who are being persecuted by the assistant AG, are powerless against him…but their patients have the right, under ADA, to sue his boss (the AG), and demand the right to be treated for pain. Moreover, they also have the right to demand payment from Montana, of their legal fees and costs, of asserting that right…

Yes, it’s true. The US Justice Department has an ADA office with the power, theoretically, to act. The difficulty anyone in that office will have, in bringing a case, is that the DEA constitutes a large percentage of the Justice Department’s payroll and budget. It’s going to be quite a trick, for the ADA lawyers to keep their jobs at the Justice Department, if they go up against the entrenched forces of the DEA and the Drug War lobby. This is a clear conflict of interest. Accordingly, anybody at the ADA office willing to help pain patients, needs all the help we patients can provide…

Seems to me that this advice would also work for medical cannabis patients. But what it will come down to is the question of which treatments have been proven effective — and approved by the FDA (and now the CDC). Of course, we all know about the flaws in allegedly evidence-based research, so I don’t know how either side will “prove” their beliefs. Considering the questionable ethics of the scientific and medical industries, perhaps we should start relying more on anecdotal evidence.

Another question will be who is considered a “legitimate” pain patient. Which painful medical conditions deserve treatment? Only cancer or terminal conditions?

Doctors will argue that evidence for treating long-term chronic pain with opioids (or cannabis) doesn’t exist, and will try to prove there’s more harm than benefit with these treatments (especially to the public). Doctors and parents will continue to tell stories of lives ruined by drug abuse and addiction, and shout, “It’s a crisis! It’s an epidemic! And it all started with (name any drug)!”

But there’s no evidence that other treatments for pain are successful, so as always, the question becomes:  What are the alternatives? There’s an abundance of evidence for the harms associated with all other treatment options besides opioids, so who’s going to dictate which treatments patients are allowed access to? It doesn’t make sense (and it won’t work) for government agencies, law enforcement, and the medical industry to make decisions for patients — we’re the ones suffering, not them.


Pharmacist Steve brings us a link to a very cool video about electronic health records (EHRs), created by:

Rapper and internist “ZDoggMD”, aka Zubin Damania, M.D., is looking to shake up health care. During his 10-year career as a hospitalist at Stanford and close to burnout, Zubin turned to stand-up comedy and rap to voice his concerns and frustrations about our dysfunctional health system…

Dr. Damania is the Director of Healthcare Development for Downtown Project Las Vegas, an urban revitalization movement spearheaded by CEO Tony Hsieh, where he’s currently developing an innovative model of health care delivery that promotes wellness at both the individual and community level. He recently founded Turntable Health, a primary care clinic within Las Vegas—which he describes as “a revolution in medicine.”

The video is part rap, with a mixture of lyrics sung to Empire State of Mind (New York). If you’ve never heard Alicia Keys sing this song, you should stop what you’re doing, right this very second, and click on this link:

Be prepared for goosebumps. 🙂

Arizona Sets 1-Year Lifetime Limit on Welfare

Arizona will become the first and only state to impose a one-year lifetime limit for impoverished households receiving federal benefits from the Temporary Assistance to Needy Families program – a move that will cut payments to about 1,600 families in July…

A spokesperson for the Arizona Department of of Economic Security, which also oversees foster care and child safety services, declined to be interviewed, but in an email said the state expects to save $325,000 per month and $3.9 million per year…