Big Brother activities…

Big brother 2Dr. Michael J. O’Connell, PainCare, New Hampshire agrees that it is somewhat unsettling that the NSA and CIA have access to so much, perhaps most, of our internet and telephonic activities.  All in the name of fighting terrorism, and perhaps crime, in general.  It is also unsettling that on practically every city street corner, there is camera surveillance.  Again, in the name of public protection.

Many ideologues, such as Slavoj Zizek believe that such Big Brother activities are not simply invasive, but nefarious.  Interesting that Zizek, a well-known castigator of ideologues, should himself delve into fanciful speculation of the use of information for fomenting evil.  A perfect definition of an ideologue HE is.  In his recent documentary, “The Pervert’s Guide to Ideology,” he presents a couple instances in which citizens in this country were arrested and detained for something they had written in an email or text.  This activity certainly gives one pause, but is that reason to believe there are widespread incarcerations of totally innocent people?  Where’s the evidence of that, aside from his several examples, all of whom were released after questioning?

Regardless of whether history will prove this huge information harvest to be an overall public benefit, an evil trap, or just a general but tolerable nuisance, it should send a wakeup call to all users of social media.  As an employer of over 200 people, I am amazed at the comments made available on Facebook by many of them.  Maybe it’s time to think before posting.

 

Medical research…

Dr. Medical research 5Michael J. O’Connell, PainCare, New Hampshire commented that the recent 350.000 subject study in the American Journal of Clinical Nutrition demonstrating consumption of saturated fats to be no more the cause of cardiovascular disease than consumption of polyunsaturated fats is another blockbuster example of the rise and fall of yet another conventional wisdom.  For decades we have been fed garbage (pun intended) by media and by medical literature that the hydrogenation (saturation) of fatty acids (converts liquid fat to solid, as in margarine) is tantamount to chemical ‘perversion,’ and ingestion of such products is certain to lead to a premature death.  The recycling of age old “rock solid” advice from physicians is in my opinion analogous to the frequent ‘turning’ of my backyard compost pile.  Depending on how deeply I drive my pitchfork, the more likely I am to find intact wine corks, jar labels, oak leaves and other paraphernalia from years ago.

Scientific literature, the term itself meant to be synonymous to ‘truth,’ is hardly that.  Facts are destroyed then reinvented in a truly bewildering and dangerous process.  When is the public going to raise its intelligence quotient to the level at which it realizes that scientific literature is often no better than my compost pile, and occasionally far worse?

Now this is not to criticize the mountains of ‘applied research’ that has led to astounding technological advances.  Information retrieval, data storage, communications, robotics…all have been made possible through science, and many if not most, make our lives much easier and productive.  However, when science is applied to the human body, not a machine, not a flask of chemicals in the lab, science does not exactly shine.  Medical science more often than not fails us.  It usually does not get it right the first time, or even the second, third or umpteenth.  This does not reflect an evil underpinning to medical research, but rather the infinite complexity of humans, both the researcher and the researched.  The list of barely effective medications, medications that years later cause catastrophic health problems; surgeries that do not cure but rather maim if not immediately after, but years down the road, is staggering.Medical research 3

Which brings me to my favorite subject—Obamacare.  One of the primary tap roots of ACA is EBM (evidence based medicine).  The presumption is that the medical literature will guide doctors and other worthy practitioners in their treatment of various human pathologies, for the noble purpose of applying the ‘right treatment at the right time’ (whatever that means). This purpose has the effect of reducing providers of healthcare to automatons, who merely plug in patient’s complaints, physical findings and results of lab and radiological procedures and voilá, up pops the right and timely treatment on the computer screen.

If only it all worked so smoothly.

Suboxone and addiction…

Methadone detox 3Dr. Michael J. O’Connell, CEO/Owner of PainCare, New Hampshire, developed the  Suboxone NH clinic in 2006, an addiction treatment medical practice using buprenorphine (Suboxone) combined with group therapy.  Dr. O’Connell is delighted to announce the addition of Dr. Charles Dreibelbis to the North Conway PainCare office where he will extend the outreach of NH Suboxone.

“Addiction to opioid painkillers is a major and increasing cause of morbidity and mortality among our youth,” according to Dr. O’Connell.  “The great majority of young addicts start down the path using alcohol and pot, the cheapest available high.  Then the attraction to experimenting with a friend or relative’s drug cabinet begins.  Heroin can rapidly follow due to its availability, low price and more intense high; first snorting then injecting, each step more risky, and perhaps more exciting to the addict.  Soon the addict’s life is totally enwrapped to one purpose, finding the next high.  Not finding an opioid in timely fashion is a very potent motivator since severe withdrawal and craving follows.

Dr. Dreibelbis comes with almost 10 years of dedicated experience with addiction treatment using Suboxone (buprenorphine).  He also sees patients in the Somersworth PainCare location.  He will greatly assist addicts who truly desire to be done with opioids by prescribing buprenorphine, a drug which tightly binds with opioid receptors in the brain.  Very small amounts effectively shut down cravings, yet do not stimulate the receptors to produce but only mild sensorial effect.  Dr Michael O’Connell recognizes the North Conway area as a particularly needy area where opioids including heroin abound.  No inpatient drug rehab exists nearby, and access to excellent outpatient therapy such as with buprenorphine is very limited.

PainCare is the largest pain management practice in New Hampshire, serving 12 locations.  Since some chronic pain patients are referred already taking large doses of opioids, Dr O’Connell sees not just a usefulness of addiction treatment under one roof, but a profound need. “Addiction treatment is part and parcel of comprehensive pain management, anyone who thinks otherwise is not facing reality.”

 

Spine surgery…

Spine surgeryDr. Michael J. O’Connell, PainCare, New Hampshire noted that Spine surgery is gaining a lot of attention by Medicare and other health insurances as part of the push for evidence based medicine and treatment policy restrictions, and deservedly so.  Several large randomized controlled studies have been quite consistent in demonstrating the limited value (barely statistically significant) of spine surgery in general, to include dorsal decompression for stenosis, fusion for degenerative disc disease, discectomy/laminectomy for herniated and protruding discs, and sacroiliac fusion.  It is difficult to find a well performed study from the past decade that demonstrates anything more than modest advantages to surgery for almost all maladies of the spine; acute unstable fractures aside.  One recurring theme of all the available research on spine surgery outcomes is that the follow up of the patients is often six months or one year post op at most.  Many patients who underwent surgery are relatively happy with immediate gains.  However when queried after a year, reports of recurrent pain are typical.  This is not different pain; it is the same pain, same location, character, and exacerbating factors.  More alarming is the development of additional or new pain on top of the recurrent pain following surgical approaches.

Well, you might say that recurrent pain is the risk one takes, signs up for, when considering spine surgery.  While true, society needs to weigh in, particularly in this new age we live in where all medical treatments are scrutinized for cost effectiveness.  Spine surgery is extremely expensive, once the total costs are added up:  the surgeon’s fee, anesthesiologist’s fee, enormous hospital charges, and then rehabilitation/physical therapy required post op.  Sadly, for a significant portion of patients, this is not the end of the costs incurred.  Re-operation is relatively common, to treat recurring pain (e.g. Bill Walton), to treat pain that was never relieved even in the immediate post op period (e.g. Tiger Woods), to remove hardware (usually thought erroneously to be the cause of continued pain after fusion), to drain abscesses from operative infection, fusions required after multiple laminectomies for the resulting destabilization, the list goes on, and on, and on.

You might ask why we haven’t heard more about the vast failures of spine surgery.  The answer to that is multifactorial.  First and foremost, surgeons earn a great deal of money chasing down reasons to operate.  After all, they were trained not to medically treat spine related pain, but rather to cut.  So there are a tremendous amount of resources held by the astounding 6,000 spine surgeons (estimated, difficult to get hard numbers) we have in this country.  Second, hospitals make a pile of money supporting these surgeries through facility fees.  Third, a lot of peer reviewed spine surgery journals have “reviewed” and printed innumerable studies supporting the value of spine surgery for nearly anyone who walked on two legs and had axial pain.  These journals now have a vested interest and built in bias toward preserving spine surgery as a cash cow.  Needless to say, manufacturers of fusion devices are huge stakeholders.  Vast organizations that cater to conferences on spine surgery also have a hand in the pot.  In other words, money is at the root of the fact that the US performs vastly more spine fusion surgeries than any other industrialized country, and yet has vastly more disability from spine pathology.  Does this fact alone reveal a problem with the surgical approach?  Is much of spine surgery little more than wishful thinking?

 

Obama’s failure…

Barack7Dr. Michael J. O’Connell, PainCare, New Hampshire commented that every time Obama appears at press conferences or interviews, it becomes clearer that the presidency is not what he expected or was prepared for.  He started his first year in a very good strategic position, because the situation could hardly have been worse.  We were still in conflicts in both Afghanistan and Iraq, the economy was bordering on depression, and manufacturing jobs were fleeing overseas while our unemployment rate hovered at 10%.  Our relations with other developed nations was suffering from the ‘bravado approach’ of which Bush junior was accused.  Nothing could have been better for Obama, because only improvement on all fronts could be anticipated.

So what has Obama accomplished given this perfect set up for success?

  1. He has mandated a massive overhaul of healthcare that has disenfranchised many physicians and pushed many hospitals and healthcare systems to the brink of ruin. Patients are herded through provider offices like assembly line widgets, vocal interaction with the doctor is minimized, that frequently quoted “40 million Americans without insurance” has changed little, and those who are now covered have either catastrophic policies with huge deductibles they can’t afford, premiums that are out of sight, or they qualify for Medicaid that many providers will not accept due to dreadfully poor reimbursement for medical services.
  2. He has pulled troops out of Iraq and Afghanistan, with no deal with the existing government for maintaining air force bases in the desert, as had been an exit strategy by Bush. He must now rue that decision since our troops are slowly returning to Bagdad to “protect our interests” as ISIS extremists slowly bear down on the Iraqi capital, unraveling all that had been accomplished.
  3. Thanks to sloppy oversight, Edward Snowden has single handedly given our enemies and allies alike our blueprint for success in preventing further terrorism on our soil, in commerce and trade overseas, in competition with China, Europe et al. Our allies all now know that we spy on them, as they do on us, and more importantly, they now know how we do it.  Relations with our allies is arguably worse than at any time in the past two decades.
  4. Asleep at the wheel, and with our intelligence crippled by #3, Obama allows Russia to divide the Ukraine, and annex Crimea. A land grab.  Something no developed nation has done since WWII.  Again due to crippled intelligence, he has allowed moderate factions in Syria to whither, unaided and now disenfranchised.
  5. The economy limps along, gradual improvement in unemployment, some job creation…and it has taken nearly 7 years of Obama’s ‘laser beam’ concentration on this issue to accomplish a half-hearted recovery.
  6. Despite obvious need to trim back the government, return to fiscal responsibility, and stop stacking our massive debt on the backs of our youth, Obama continues to spend dollars we don’t have.
  7. Global warming, admirably part of the Democratic campaign platform, has been given lip service by this president

It must be shell shocking to the president that his famous campaign slogan of “yes we can” has clearly become “guess we can’t.”  His record is abysmal.  His extraordinary naiveté will be his legacy.  In some ways he seems to have learned few lessons from the oft criticized Bush administration.  In other ways he has fled so far from some of the controversies of that pervious president that he has run too far in the opposite direction, putting us in different but grievous risk.  “Change we can believe in”? Unfortunately, I can believe it.

More danger of EBM…

EBM danger 5
When like minded individuals think about the destruction or mutilation of the ‘art of medicine’ as the primary danger of Evidence Based Medicine (EBM), there is also a potentially far greater danger, a danger that Google tells me no one is looking at or critically thinking about.

Let’s assume EBM as part of the insistent Obamacare drumbeat, continues its progression and eventually infiltrates all of the payors, and worse, influences all their policies of treatment for which they will and will not pay.  In that situation doctors/providers would have little choice but to do what the policies dictate, again policies predicated on the best ‘randomized controlled’ studies available.  Is this going to be a good thing?  Does anyone see the likelihood of huge compounded mistakes, simply because EVERYONE’S attention will be directed toward the treatment ‘recipe’ as dictated by the insurance industry?

Let me give a hypothetical example to make my case.  Let’s look at the treatment of high cholesterol.  Currently, the literature is replete with fairly solid observational studies that demonstrate the correlation of high cholesterol with a higher incidence of heart EBM danger 6disease and death by same.  Other studies have refined this correlation somewhat to indicate that cholesterol held by high density lipoproteins (HDL) is more tolerable, more acceptable than that held by low density lipoproteins (LDL).  So called “statins,” drugs which have been in the planning stages since the 1970s, can, according to RCTs (randomized controlled trials) rather dependably reduce the ‘bad’ cholesterol.  Ergo, statins have become a standard of care for patients with high cholesterol, particularly for those with most of that cholesterol held by LDL.  So insurance policies have, or soon will include statins as mandated for most cases of ASYMPTOMATIC hypercholesterolemia.  What is the harm you say?

The problem is that the theory, upon which hundreds of billions of dollars is spent each year, that by blocking the body’s ability to make its own cholesterol a patient’s risk of cardiovascular disease leading to early demise, is a constantly shifting theory, and one that from 30,000 feet, doesn’t hold together.  As we all know, the cholesterol prEBM dangeroduced by our bodies is only a small portion of that which appears in the bloodstream of most Americans.  Dietary contribution swamps the manufactured portion.  However, by disregarding this fact, and diverting attention to a pill, an answer that most Americans jump at, Pharma makes a lot of profit, Americans lower their cholesterol by a small but dependable amount, and the elephant (and I DO mean elephant) in the room is ignored or seriously downplayed.  The single cause of high cholesterol is consumption of animal products, which lead to obesity and storage of excess cholesterol due to the inactivity obesity invites.

So can you see that EBM, which is thought to “illuminate” the value of thousands of treatments going forward, has a great chance of incentivizing treatments that are not in the macroeconomic sense cost effective, are of marginal (but statistically significant) value in changing a number, and promotes a pill rather than the all important counseling for lifestyle change (“you are obese, you must limit eating cholesterol laden meals, you must exercise daily, you must lose weight”)?

EBM will eventually place a chokehold on the decision making process of doctors!

Ideology…

Ideology 4
On the nightly news, yet another school shooting, another gang shootout in the streets of Chicago, and another giant yawn by mainstream America.  It seems the only folks to suffer are the victims and their friends and family.  How is it that we have grown to accept the status quo?  To accept the disturbingly trite and vastly ignorant “guns don’t shoot people, people do is absurd.”  No other industrialized country has anywhere near so much gun violence.  Yet every country severely limits or bans ownership of guns; they all have approximately the same incidence of mental illness; kids in all developed nations are exposed to the same violent videos; poor parents are ubiquitous in all nations.  The only feature that differentiates us from the other countries is the overwhelming availability of guns.

Yet, the tired arguments still exist:

1. “If innocent people disarm, only the criminals will have guns.” – Really?  The implication is that most gun violence is committed by criminals on innocents.  Not the case at all.  Home invasion and “stick ups” typically result without a shot being fired.  Gang shootings involve criminals vs. criminals, and most frequently drug related ‘turf battles.’  Domestic shooting (usually husband shooting wife) are committed by (previously) non criminals.  Mass murderers are typically quiet, unassuming, neighborly and expert at concealing their underlying mental illness.

2. “Better background checks will prevent guns from roaming into the wrong hands.” – This doesn’t even deserve acknowledgement as a rational argument.

3. “It is our constitutional right to bear arms.” – It has been about 250 years since these famous words were stroked on parchment.  Since that time, trains, cars, planes, personal computers, telephones and cell phones have all been invented and changed our society in hugely dramatic ways.  The right to bear arms by private citizens is arcane and totally out of context.

4. “We need to protect ourselves from our government.” – Listen, if our society were ever in a position to be worried about our government turning against its innocent citizenry, we would have far more to worry about than having a couple of assault rifles in the house.

5. “If not guns, criminals will use other weapons.” – Yep, knives or machetes perhaps?  One could certainly mow down a school room with those arms.

No matter how you analyze the issues, it all boils down to three main reasons why guns remain a part of our lives:Ideology 8

1. Gutless politicians, bought off by the NRA

2. Gutless politicians afraid of not being reelected

3. Americans’ love affair with guns (is it insecurity, naivete, fear?)

I have changed my stance on the issue of guns.  I have had enough of all of them.  Ban them all for private citizens, hand guns/rifles/assault weapons – put gun man
ufacturers out of business if that is the requirement.  And for God’s sake let’s decriminalize drug use, and eliminate the largest incentive to procure anillegalweapon in the U.S. today.