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AN URGENT PLEA TO END THE WAR AGAINST PHYSICIANS AND PATIENTS

UPDATE 12/5/17:  A revised (shorter)version of this blog has been posted in KevinMD, at the following location.  Thanks, KevinMD!

https://www.kevinmd.com/blog/2017/12/stop-opioid-crisis-war-physicians-must-end.html

 

 

Crimes against humanity are widespread on this planet, and too many to count.  Over the past decade diligent researchers (by diligent I mean those who verify sources and results) have uncovered the roots of some of our more persistent and frightening social problems, and published reputable accounts thereof.  Many such problems are actually the result of conspiracies set decades ago, like the rise of private prisons for the purpose of incarcerating a specific race of young people because of socioeconomic issues (read racism), and calling it a War Against Drugs.  But the drugs continued to take over our nation—not just because of those young people, but because of the greed for money and power in the pharmaceutical companies, insurance companies, and politicians that has grown exponentially, unchecked.  Nixon’s intended outcome—that of getting minorities off the streets and severely impacting their ability to live normal lives outside of prison—also suited well the baser needs of other groups in our society.

Other groups, in fact, began to see the financial success and knowledge of physicians to be a major threat to their own greedy plans.  They deduced that chronic pain patients, now acknowledged and receiving treatment for their pain, could be both blamed as a source of street drugs and used to help bring down honest physicians (and to support the pill mill “doctors” who supplied the patients with enough medicine  to both use and sell).  Eventually, we begin to see “statistical reports” that “prescription drugs” were the cause of abuse and overdose deaths in specific regions of our country.   For a short time, they may have been.  But when the deaths began to occur in White Middle-Class families, the outcry to increase the efforts of the War on Drugs became deafening.  There had to appear to be some effort to control the drugs, so we see draconian measures being set—in some states by law, in others by regulation—that were targeting the legitimate physicians who prescribed for pain patients, and ultimately the patients who were frequently cut off without warning from their pain treatment.  Despite the outcry against punishing patients and physicians, and the evidence showing the futility of this approach to the War on Drugs, this situation continues to threaten the lives of both patients and their physicians, every day.

Despite scientific proof that Substance Abuse Disorder (being addicted to a substance) is an illness of the brain and can usually be well managed by an addiction specialist, legislators and law enforcement officials alike still only see “drunks and addicts” and still, after DECADES of failure, claim that incarceration/punishment is the only way to fight the war on drugs.

Despite, also, the logic that if you are fighting a War against a crime, you go after the source rather than innocent bystanders.  If we don’t get rid of the sources:  drug cartels, the dealers, and the creators of the drug,  how much good is it going to do to punish the people who use them?  Sadly, these sources have never been the primary targets.  Just as now we see heroin and fentanyl actually being the greater cause of overdose deaths (because they are cheap and much more potent than earlier versions), we still hear and see stories about prescription drugs being the cause of these deaths.  We are still subjected to so-called charts describing dubious statistical proof that prescription drugs are the main cause of overdoses, when more reliable research shows that it is street heroin and fentanyl.

To that, I would ask the reader to please follow the hyperlink below.  The author of this piece has provided a thoughtful and well researched discussion of what is really causing overdose deaths, and why the propaganda we are getting is so dishonest:

https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

Having read this article, consider well the facts that every year more than 400 physicians commit suicide;  that thousands of chronic pain patients suddenly deprived of their medication have either committed suicide or gone to the streets to get their medication; and that many of these have also suffered unintended overdose deaths.

These measures that make practicing good medicine so difficult, and the law enforcement mentality that believes physicians are guilty until proven innocent,  are not the only reasons physicians are either opting out of practicing medicine, or opting out of life altogether.  The War on Physicians and on Patients is real, and it is devastating.  The pharmaceutical houses and insurance companies may actually believe that we can survive without trained doctors; Artificial Intelligence will be just as good if not better, they believe….but check out this article:

https://www.scientificamerican.com/article/the-social-life-of-opioids/.

We read here that there is well-researched, scientific proof that a caring and trusting relationship between patient and doctor is a necessary, (but not sufficient), ingredient for best medical practice—AND for healing!  As one incredible physician has noted:  “They (the patients) don’t care how much you know until they know how much you care.”  Artificial intelligence hasn’t managed the caring part, and even if it does I don’t see much healing effect to be expected from a robotic hug.

The crime against pain patients who are now not only being vilified in news media, in pharmacies, and in social media, is certainly heartbreaking.  If you happen to be one of those pain patients, it is also a return to the terrors of intractable pain, inability to function productively in society, and a potentially horrible death.

If you are a physician who has spent at least half the normal human life span studying and preparing to make life better for those who suffer, life may be  becoming a nightmare.  Insurance companies dictate what treatments are allowable, how often, and how long such treatments will be permitted.  They do not refer to medical societies for their information.  They refer to bottom line profit indexes.  Legislators who pass laws (when medical board regulations would more properly suffice) that limit what physicians can prescribe, and how often—arrange that physician’s offices and lives will be disrupted, the physicians in question treated as guilty before having a chance to be proven innocent.  As usual, those who are charged with the felonies that have been put in place as a weapon in the War on Drugs never quite regain their previous status of innocence, even when proven so.

Does it matter to the insurance companies or the legislators that these laws have only created chaos and confusion, betrayal and mistrust?  Does it matter that physicians are already reeling from finding themselves backed into corners where they have to “sign on” to corporate health care entities that are run by non-medical administrators who decree when and how often they work, how many patients they will see for how long, and determine bonuses based on computer-run quotas and outcomes?  Does it matter that medical students are so disillusioned that they drop out, and that some commit suicide?

And finally, adding to the fears of losing their practices, their licenses, and the meaning attached to their life work, physicians in increasing numbers are being attacked and/or killed by frustrated, angry patients or their relatives.

Why is this ethically, morally, and even logically wrong approach to our drug crisis—which MUST be separated in our minds from medical care for chronic pain patients—continuing to exist as a modus operandi?  Why are physicians who serve our communities targeted as criminals at worst, and problem employees who must be managed at best?  Sociologically, physicians have historically belonged to one of the highest prestige vocations in America.  Their demotion to the present state is not through fault of their own, but through others’ sociopathic greed for money and power, combined with the attitude that allows so many to hate anyone who differs from themselves, to create this totally inhumane situation.

It is not “liberal” or “progressive” to respect and care for others.  It is Christian, and Muslim, and Hindi, and Jewish—it is a basic precept of many world religions and predates organized religion itself by centuries.  Of course, being human and egocentric, we do not always succeed in living up to these standards.

It is my opinion that the proof of our own individual humanity is the maturity, intelligence and self-motivation to care for others as we care for ourselves.

I could go on for pages about why so many people have lost the human characteristic of empathy, but there are enough people who retain it who could help our country become human again.  Who still respect the dignity of other human life, and who realize that “together, we stand; divided, we fall.”

It is definitely in our best interests to respect and protect the lives and experience of our physicians; it is also in our best interests not to stand by and leave them or their patients to live and die in misery when it is all so unnecessary.  And inhuman.

And, a last plea……

 

 

RESOURCES:

Alexander, Michelle.  The New Jim Crow:  Mass Incarceration in the Age of Colorblindness.  2012.  The New Press, NY

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial.  1996. University of California Press.

Bateman, Dustin.  Neurobiological & Sociological Aspects of Addiction

Levinthal, Charles F.  Messengers of Paradise.  Opiates and the Brain.  The Struggle Over Pain, Rage, Uncertainty and Addiction. 

Meier, Barry.  A World of Hurt:  Fixing Pain Medicine’s Biggest Mistake.  2013.  New York Times Company.

Parsons, Talcott.  “Illness and the Role of the Physician:  A Sociological Perspective.”  American Journal of Orthopsychiatry 24 March 2010.  Copyright © 2010, John Wiley and Sons.

Quinones, Sam.  Dreamland:  The True Tale of America’s Opiate Epidemic.  2015.  Bloomsbury Publishing Plc.

Sternheimer, Karen.  Connecting Social Problems and Popular Culture:   Why Media is not the Answer. 2nd Ed.  2013.  Westview Press, Perseus Books Group.

Webster, Lynn R.  The Painful Truth:  What Chronic Pain is Really Like and What it Means to Each of Us.  2015.  Webster Media LLC, PO Box 581113, Salt Lake City UT 84158.

WEB ARTICLES, including peer reviewed

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain  http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….    http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide:  http://t.co/4vhF63eD6N

Physician Risks:

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict:  Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics?  http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians:

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …


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CAN I SAY–“I QUIT!”?

25.  And hearing, the Master was glad, and gave thanks and came down from the hilltop…when the crowd pressed him with its woes….[the Messiah] smiled upon the multitude and said pleasantly unto them,

“I QUIT”

-Richard Bach, in Illusions, The Adventures of A Reluctant Messiah.

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How does one begin to talk about our nation’s social, economic and political problems?  What are the words that have not already been said; where are the moral imperatives that have not been rendered impotent; the facts that have not become “alt-“ and the news that has not become mere opinion?  Who, and what, can be trusted and believed?

Overcome with sensory overload, one feels sorely inadequate to the task of sorting out fact from fiction, truth from propaganda.  As time goes by and the “evidence” piles up, pro and con, on so many vital issues;  as the threats and disasters mount,  like Bach’s Reluctant Messiah, we soon long to say, “I Quit!”

Granted, Bach’s Illusions was more about our own illusion that we can and should save everyone, than it is about our present situation that seems to lack “Messiahs.”  Our advocacy, our pleas for justice, our outcry against downright sinful oppression has, in fact, become a battle to save ourselves—or to find someone who will do that for us.  Sadly, the very people we look to for salvation from our medical, economic, and social woes—to say nothing of the potential nuclear holocaust threat, the daily terrorist threats from home and abroad (I include cyber threats), and our planet’s efforts to pay us back for all the harm we have done to it—are all too often the very people whose only goal in life seems to be to wipe us from the face of said planet while causing the worst kinds of misery imaginable. How do we find the stamina to keep working for change?

During my lifetime, I have been an advocate for many social issues.  I have also worked in the service sector, seeking to do my best to make life better for my family, for my community.  One day while I was working as the nurse in the county jail, a couple of prisoners said to me, “You believe that you are helping us by working here, and by treating us like real people.  But in fact, you are motivated by the need to feel good about yourself; you need to help people worse off than you, so you can feel good.”

I thought about that for quite a while, finally deciding that yes, it did make me feel good to be of service to others.  But what was the alternative?   Would I feel better watching them starve, or be beaten, or fail to escape whatever ill came their way?  Of course not.  I finally figured out (with the help of Gospel readings, a PhD in Sociology and a Master’s in Theology, and continuing to actively live my philosophy of doing what good I could do, where I could do it) that being happy about helping others is a necessary by-product of community building.  And community building is all about making sure that the community is protected from greed, murder, neglect, shaming, and other crimes against the human family.  Because I am part of the community, I do also benefit from whatever service or good I am able to provide.

Having followed this moral imperative, however, I presently find myself threatened by the magnitude of crimes against humanity that demand my righteous anger; that call for me to add my voice to those whose anger is also shouting out against an unfeeling and unheeding leadership.  But now we are a sharply divided nation, with no inhibitions against verbally abusing people who disagree with us.  While this perfectly suits the darker intentions of our leadership, it fractures families, communities, and organizations.  Which also suits said leadership.  Perhaps, in fact, I should not refer to “leadership” because that is certainly not what is occurring in our government—far from it.  Use of the term is simply habit, and one we should not use until we have corrected our past errors and placed men and women of good character, intelligence, integrity and moral excellence in places we could then refer to as “leadership.”

I hate living in a society where the death and destruction of entire ethnic and socio-economic groups can be celebrated by the rich and powerful, and ignored by too many others—some of whom have just said “I Quit” for all the wrong reasons.  In Richard Bach’s book, the “Messiah” quit because he was trying to save the world and he was tired.  Also, we learn, because that is not the way to build community and it feeds our own brains with all the wrong information about who we are.  For too many people today, their “I Quit” is the result of feeling overwhelmed, or from a sense of helplessness against the sheer magnitude of the problems, or even from the acquired nihilism brought on by the culture of fear generated by all the propaganda.

But “I Quit” can’t be the answer today.  Not for me, and not for anyone who once had a dream about participating in creating a wonderful future for our nation’s children and grandchildren.  Today, all I could do was write this blog.  Perhaps no one will read it, and if they do perhaps they will disregard it.  That isn’t the point.  The point is that I have not given up, and I won’t quit.  Not as long as there is at least one thing I can do to make even the least important situation a better one, in some small way.

It does make me happy to do that.  And with any luck, it may also make someone else’s day a better one.  And best of all, with enough people happily doing what they can do, we may see a ripple effect of concern and support for one another that is strong enough to defeat those who prefer destruction over construction; death over life (for others), and ivory tower solitude over community.

I know it is possible.  In the face of lack of funding and support in so many disasters of our immediate past I have seen countless men and women whose first thought was for the victims.  They headed into disaster areas with disregard for their own safety, the cost of being there, and the magnitude of the disaster.  They just did what they could do, then and there, because it was the right thing to do.  They are heroes, and nation builders.  They didn’t quit.

Dedicated with love, to the heroes who care, and who don’t quit.

hands, heart


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PERSPECTIVES ON PAIN CARE PROVIDERS DAY

As I write this post, the date is February 1st. When I noted the date this morning, my reaction was “Finally! February is here. What a relief!” I surprised myself. The first 28 years of my life were spent in western New York State, so I can assure you that this is not my normal reaction to the first day of February – or any other day in February, for that matter. February was always the month when Seasonal Affective Disorder (SAD) reached its peak: Gray days, dirty gray snow, cold days and colder nights, chapped skin, shoveling snow day after day – by the second month of the year the reality of winter was enough to send me into at least a minor depression.

…Until recently. Chronic pain has for years held an even greater power in my life for bringing on depression, especially after a few long months of winter weather. However, once I had become convinced that my thought patterns and beliefs could actually make my pain even worse, I decided to try an experiment. Last year, I decided that instead of suffering through the blues of February – or grays, if you prefer – I would welcome the month as a certain sign that we were on the downside of winter, and better days were ahead.

That was actually true for me in several ways last year. I did concentrate on thinking positive thoughts about February, which was no small achievement. I also met my pain management physician that month, and had two epidural procedures which alleviated my pain enough to allow me to manage several other medical problems over the following months. I didn’t think any more about my experiment until this morning, when I surprised myself by welcoming the thought of February. My perspective has certainly changed.

All this soon led me to thoughts of chronic pain, and the Pain Care Providers Day campaign. I thought how over this past year I have watched and read about chronic pain patients who have joined their voices and efforts to bringing about national awareness of the hundreds of thousands of people who exist with daily, even constant, severe chronic pain. I thought of those professionals and clinical personnel who have joined to champion the cause of those people that they care for, day in and day out. And I remembered the families, and friends, and neighbors who join in to assist people who cannot always manage on their own, and who have also supported this campaign.

As I looked back over the year, I realized that attitudes are changing. Perspectives are changing. Many people who have been victimized by both their own bodies and by unreasonable laws and regulations regarding their care have refused to be labeled victims. They have found their voices, and are speaking out, demanding to be heard and treated fairly. And they are being supported by the voices and efforts of their caretakers.

Physicians are pushing pharmaceutical companies to produce medication that will not harm their patients. Medical societies are pushing for multidisciplinary approaches to treatment for chronic pain patients that will be more effective. During the month of September 2014 we celebrated Pain Awareness Month, and more people joined the efforts to bring new resources to the treatment of chronic pain.

So now, on March 20th, 2015, we will celebrate Pain Care Providers Day (PCPD).

What is this day all about?

It is definitely NOT about drugs. It’s not even about chronic pain patients, per se. It is about celebrating the steadfast and selfless gift of presence and help by all those who have cared for us all these years when we have generally been thought of as malingerers, hypochondriacs, drug seekers, or worse.

Admittedly, we chronic pain patients are not always easy to deal with. Sometimes it is difficult to discover what has caused our pain. Sometimes we are cranky, angry, depressed, uncooperative, or downright mean. Sometimes we are hopelessly fatalistic. Sometimes we are suicidal, because the pain and isolation is winning out over any potential for loving life. Yet our caretakers and providers are still there.

But there is hope—which for many of us, is an entirely new perspective.   Awareness is happening throughout the nation, thanks to the campaigns, and more changes of perspective are taking place in unique places. Some people are actually changing their opinions about pain care providers and their patients. Of course, it takes longer for government agencies to adjust their perspectives, but with all our voices together, we can and will be heard. And those who have cared for us will still be right there, working alongside of us. And on March 20th, the first day of Spring—a day of hope—we want to celebrate their presence and work in our lives, and what it has meant for us.

 For our pain care providers, and for those who will join their ranks in future generations, I offer the following statement in support of these achievements, and these changes in perspective. It was written by Henri J. M. Nouwen, and I have borrowed it from his delightful book Bread for the Journey:

 Joy is hidden in compassion. The word compassion literally means “to suffer with.” It seems quite unlikely that suffering with another person would bring joy. Yet being with a person in pain, offering simple presence to someone in despair, sharing with a friend times of confusion and uncertainty…such experiences can bring us deep joy. Not happiness, not excitement, not great satisfaction, but the quiet joy of being there for someone else and living in deep solidarity with our brothers and sisters in this human family. Often this is a solidarity in weakness, in brokenness, in woundedness, but it leads us to the center of joy, which is sharing our humanity with others.

 

Please join us in celebrating Pain Care Providers Day on March 20th. Tell your friends and neighbors, and encourage leaders to proclaim the day. It is our day to share our humanity with others. It can be a day of joy.

justinhighrock