Sunday May 19, 2013
Overmedicated Patients and Lateral Moves into License Plate ManufacturingMarianne Skolek Salem-News.com Investigative Reporter
I encourage the Senate investigation of not only Dr. Fishman, and his guidebook- used as a model in the prescribing of opioids
(MYRTLE BEACH, SC) - "It is impossible to calculate the moral mischief, if I may so express it, that mental lying has produced in society. When a man has so far corrupted and prostituted the chastity of his mind as to subscribe his professional belief to things he does not believe he has prepared himself for the commission of every other crime." - Thomas Paine, The Age of Reason
On May 8, 2012 letters were sent by Senators Charles E. Grassley and Max Baucus regarding a U.S. Senate investigation being conducted on the pharmaceutical industry ties to certain individuals and organizations financially fed by pharma. Letters were sent to several pharmaceutical companies including the maker of OxyContin - Purdue Pharma and their pain societies The American Pain Foundation (which closed its doors when the Senate investigation was reported), The American Academy of Pain Medicine, The American Pain Society,The American Geriatric Society, The Wisconsin Pain and Policy Study Group, The Alliance of State Pain Initiatives, the Center for Practical Bioethics, Beth Israel Medical Center, Department of Pain Medicine and Palliative Care, The Joint Commission (and all related entities) and The Federation of State Medical Boards. In addition, individuals were also being investigated including Russell K. Portenoy, MD, Scott M. Fishman, MD and Lynn R. Webster, MD all whom I have written about for Salem-News.com.
A "Physician's Guide for Responsible Opioid Prescribing" written by Dr. Fishman is also being probed by the Senate.
I had written about Fishman's guidebook in a previous article for Salem-News.com after reading through the first half of the book. The second half of the book was as fascinating to me and lends itself to having some of the statements made by the good doctor questioned by the Senate. http://www.salem-news.com/
One of particular concern to me and I know others -- especially in the medical profession -- is:
"It is easy to mistake pseudoaddiction for the real thing. One way to discriminate between pseudoaddiction and addiction is that pseudroaddiction resolves when the patient obtains adequate analgesic; addictive behavior does not."
I encourage the Senate investigating not only Dr. Fishman, but also his guidebook which was used as a model in every state in the country in the prescribing of opioids and endorsed by the Federation of State Medical Boards (also under Senate investigation) to consider more from the guidebook.
"Some patients lie, but only sometimes does a lie represent a real threat to the therapeutic relationship and the effectiveness of a treatment regimen. .....it is again helpful to frame your role as that of a professional consultant with the patient in charge of ultimate decision-making. Your role is not to judge or punish but to present facts and find solutions."
I have lots of problems with this one Dr. Fishman -- "....only sometimes does a lie represent a real threat to the therapeutic relationship and the effectiveness of a treatment regimen." This is opioid therapy -- and highly addictive opioid therapy that we are talking about here Dr. Fishman. You know -- the opioids that are addicting and killing in the tens of thousands throughout the country. We are not talking about aspirin therapy.
"It can be difficult, but it is helpful to try to see lies as revealing important information about the patient Many of us react to being lied to with offense and hurt feelings. However, every clinician will probably be lied to from time to time. It's a "yellow light" signaling caution and in and of itself, does not require rejection or termination Your task is to try to find the truth without stigmatizing or harming the patient and without making yourself feel better at the expertise of the patient."
"Yellow light" Dr. Fishman? Thomas Paine has to be looking down and saying "I found my poster child." This statement alone should raise the eyebrows of every senator investigating the opioid epidemic in the country. But I guess if you say something over and over again to convince yourself and the medical profession that there is an "undertreatment of pain" in America and opioids should be pushed -- you may begin to believe it yourself -- especially when there are billions of dollars involved.
"To date, not all prescription monitoring program (pmp) have been created equal, however and some may have inadvertently erected barriers either overt or implicit, to the appropriate prescribing of opioids for legitimate medical purposes. Some programs may have sent unintended and subtle messages to physicians that encourage them to be stingy with or paranoid about prescribing strong pain medicines"
Subtle messages to physicians encouraging them to be stingy or paranoid about prescribing strong pain medicines? How about being a responsible health care provider determined first to do no harm to the patient?
"Look for signs of abuse but recognize the complexities of presentation and the possibilities of pseudoaddiction. Remember that not treating pain is often not a "safe" option."
There's that word again Dr. Fishman -- "pseudoaddiction". If a patient exhibits signs of addiction to an opioid, in all probability it is not "addiction" but rather "pseudoaddiction." Remember your cohort J. David Haddox, MD coined the word with one case study and is now gainfully employed by the maker of OxyContin, Purdue Pharma. You know the company under investigation by the U.S. Senate along with you and your guidebook. Hopefully the Senate will tie Haddox into this prescription drug epidemic and add his name to the investigation.
At the conclusion of the Senate probe, hopefully rather than vanity license plates on the vehicles of those who contributed to the soaring addiction, abuse and deaths in the use of opioids by their distortion of facts -- they will instead be learning "Making License Plates 101".
LP -- We can't move the mountain, but we can scale it to see what is on the other side. Hopefully it will be the peace, trust and love that was once the name of the mountain.
Salem-News.com Investigative Reporter Marianne Skolek, is an Activist for Victims of OxyContin and Purdue Pharma throughout the United States and Canada. In July 2007, she testified against Purdue Pharma in Federal Court in Virginia at the sentencing of their three CEO's - Michael Friedman, Howard Udell and Paul Goldenheim - who pleaded guilty to charges of marketing OxyContin as less likely to be addictive or abused to physicians and patients. She also testified against Purdue Pharma at a Judiciary Hearing of the U.S. Senate in July 2007. Marianne works with government agencies and private attorneys in having a voice for her daughter Jill, who died in 2002 after being prescribed OxyContin, as well as the voice for scores of victims of OxyContin. She has been involved in her work for the past 8-1/2 years and is currently working on a book that exposes Purdue Pharma for their continued criminal marketing of OxyContin.
Marianne is a nurse having graduated in 1991 as president of her graduating class. She also has a Paralegal certification. Marianne served on a Community Service Board for the Courier News, a Gannet newspaper in NJ writing articles predominantly regarding AIDS patients and their emotional issues. She was awarded a Community Service Award in 1993 by the Hunterdon County, NJ HIV/AIDS Task Force in recognition of and appreciation for the donated time, energy and love in facilitating a Support Group for persons with HIV/AIDS.
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