Now, the NY Times...

[emd123]

http://www.nytimes.com/2012/10/12/h...utbreak-injections-tied-to-risks.html?hp&_r=0


The "Shots were tied to risk"? Every medical treatment is tied to risk. A huge part of Medicine involves appropriately managing risk.

Aspirin/NDAIDS - GI bleed which can be fatal.

Tylenol - Liver failure which can be fatal.

Physical Therapy - Some patients report worsening pain.

Cardiac Cath- 1% risk of death, coronary perf, bleeding, arterial psudoaneurysm, many of which are done in patients that turn out to have no significant coronary disease.

Spine surgery - risk of infection, bleeding, nerve damage, death.


They want us to treat everyone's pain ("fifth vital sign"), but they don't want us to use opiates. Now they don't want us to use procedures. Even conservative procedures have risk.

Doing nothing has risk (increased pain, depression, poor quality of life, patients have committed suicide due to pain).



What are we to do ??????????

---

Members don't see this ad.

 

[facetguy]

http://www.nytimes.com/2012/10/12/h...utbreak-injections-tied-to-risks.html?hp&_r=0


The "Shots were tied to risk"? Every medical treatment is tied to risk. A huge part of Medicine involves appropriately managing risk.

Aspirin/NDAIDS - GI bleed which can be fatal.

Tylenol - Liver failure which can be fatal.

Physical Therapy - Some patients report worsening pain.

Cardiac Cath- 1% risk of death, coronary perf, bleeding, arterial psudoaneurysm, many of which are done in patients that turn out to have no significant coronary disease.

Spine surgery - risk of infection, bleeding, nerve damage, death.


They want us to treat everyone's pain ("fifth vital sign"), but they don't want us to use opiates. Now they don't want us to use procedures. Even conservative procedures have risk.

Doing nothing has risk (increased pain, depression, poor quality of life, patients have committed suicide due to pain).



What are we to do ??????????

Cash out, open a pizza shop, and be done with it.

 

[mdvol]

We are going to revert to the old west with a shot of whiskey and a bullet to bite on and maybe a little weed.

 

[Aether2000]

We could simply quit pain medicine and leave them all to suffer. Or we could debunk extremist positions and educate the public and insurers that we treat and do not cure....

 

[painstop]

These last few months I feel like this field is being assaulted from twenty different angles (CRNAs, meningitis, Obamacare with IPAB and ACOs looming, etc.). PROP is a different matter which merits debate. Hope all this shakes out so this field can continue to provide appropriate care.

 

[specepic]

This is when I'm glad I'm a D.O., worse comes to worst, I open a cash only small OMT/acupuncture clinic. I'll make less money but life will be good.

 

[Aether2000]

PROP is an internal assault from within our profession on chronic pain patients. However, overprescribing, overdose deaths, morbidity from opioids, and engaging in appropriate studies to prove or disprove their risk/benefit ratio should solicit reasonable and measured deliberation involving multiple organizations and legislatures

 

[deleted185747]

These last few months I feel like this field is being assaulted from twenty different angles (CRNAs, meningitis, Obamacare with IPAB and ACOs looming, etc.). PROP is a different matter which merits debate. Hope all this shakes out so this field can continue to provide appropriate care.

:guntothehead:

 

[SIIMS]

"Not only were these people killed, but there was no ethical reason to give this treatment," said Dr. William Landau, a professor of neurology at Washington University in St. Louis, referring to those who died of meningitis.

How bout this guy shuts the f&*k up and opines on something within his own specialty.

Ethical reason?? I'm gonna take this guy back behind the woodshed. Somebody comes into my office with a disc or stenosis and has radicular pain but I do an epidural and there was no "ethical reason" for doing so. What a dip sh%t. I'm sure you know your stroke and movement disorders and I promise I will never critique you or question your ethics or decision making on Rx ASA vs plavix in your stroke patients but please do not comment out your ass to the NYTimes.

Link here. http://neuro.wustl.edu/aboutus/facultybiographies/landau

 

[Ducttape]

he went to medical school in the 1940s. give him a break. pain treatment in his days probably consisted of shot of whiskey and a bullet, like mentioned above...

 

[Aether2000]

Since the neurologists cannot seem to stick to their own specialty and publish studies showing ESI is worthless, it does not surprise me that their myopic mouthpieces would rally around the "ethics" card. We could make the same claim for EMG, sleep studies, etc. Perhaps we should.....

 

[ml2001]

“Not only were these people killed, but there was no ethical reason to give this treatment,” said Dr. William Landau, a professor of neurology at Washington University in St. Louis, referring to those who died of meningitis.

How bout this guy shuts the f&*k up and opines on something within his own specialty.

Ethical reason?? I'm gonna take this guy back behind the woodshed. Somebody comes into my office with a disc or stenosis and has radicular pain but I do an epidural and there was no "ethical reason" for doing so. What a dip sh%t. I'm sure you know your stroke and movement disorders and I promise I will never critique you or question your ethics or decision making on Rx ASA vs plavix in your stroke patients but please do not comment out your ass to the NYTimes.

Link here. http://neuro.wustl.edu/aboutus/facultybiographies/landau

I went to Wash U (not neurology) and attended several of the conferences where this physician was present. All I can say about his statement above is that this is not new for him. Anything that other specialties do other than Neurology is worth nothing per this physician. This is nothing new for him to critique what we non-neurologists do. I have even seen him critique some of emerging treatments in Neurology itself. So, I wouldn't take this personally and ignore his statement.

-ML

 

[emd123]

I agree, his comment is ridiculous.

Very few things in medicine definitively cure.

You could make the same argument that it's unethical to prescribe any of the various medications for Parkinson's, for example, because they don't cure, only are temporary, only treat symptoms and must be repeated, the next day, then the next day, ad infinitum, and that the doctor is profiting from the treatments.

I tell all of my patients prior to consent for ESIs and other injections, the risks and that the symptoms may improve for a few months, few weeks, few days or not at all. If they are responders, then future injections may benefit them. If not, then will adjust course and consider other treatments. How is that unethical?

I don't do a "series of three" and repeat an injection 3 times "just because" when they are not responding just to make more money, either.

Anytime someone trashes an entire specialty of professionals, it just makes them look bitter and stupid. I think it's unethical for him to make such a stupid statement, in my humble opinion.

 

[SIIMS]

I went to Wash U (not neurology) and attended several of the conferences where this physician was present. All I can say about his statement above is that this is not new for him. Anything that other specialties do other than Neurology is worth nothing per this physician. This is nothing new for him to critique what we non-neurologists do. I have even seen him critique some of emerging treatments in Neurology itself. So, I wouldn't take this personally and ignore his statement.

-ML

Not to sound elitist but sometimes the lay public tend to be a not so smart group and react quickly without analysis of the facts, especially as it pertains to healthcare.

So when this 90 year old douche talks out his ass in a national publication for the "lay public" to read........while I can ignore his statement, what worries me will my future patients ignore his statements. Will there be a follow up from the times explaining this physician opined outside his true scope of practice? How many patients at his sheltered academic practice did he treat for spine pain in the last 50 years? Blow-hard!

 

[emd123]

In my opinion, just poor reporting and yet another reason not to ever read the New York Times.

 

[deleted682700]

This is covert rationing in medicine. Read Rich fogoros, cardiologist and his blog.
The agenda is that we all keep working and paying into social security and Medicare. But when you are older and need some pain relief or treatment, make the system so difficult that the elderly would silently suffer and die off. That way they don't have to pay for Medicare expenses and save on paying out of SS Ponzi scheme

 

[Stim4me]

http://www.nytimes.com/2012/10/12/h...utbreak-injections-tied-to-risks.html?hp&_r=0


The "Shots were tied to risk"? Every medical treatment is tied to risk. A huge part of Medicine involves appropriately managing risk.

Aspirin/NDAIDS - GI bleed which can be fatal.

Tylenol - Liver failure which can be fatal.

Physical Therapy - Some patients report worsening pain.

Cardiac Cath- 1% risk of death, coronary perf, bleeding, arterial psudoaneurysm, many of which are done in patients that turn out to have no significant coronary disease.

Spine surgery - risk of infection, bleeding, nerve damage, death.


They want us to treat everyone's pain ("fifth vital sign"), but they don't want us to use opiates. Now they don't want us to use procedures. Even conservative procedures have risk.

Doing nothing has risk (increased pain, depression, poor quality of life, patients have committed suicide due to pain).



What are we to do ??????????

Neurontin and suffer...