David Haddox

[101N]

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Who is David Haddox and what are his two big contributions to the field of pain medicine?

 

[Aether2000]

Oxycontin and pseudoaddiction?

 

[101N]

Oxycontin and pseudoaddiction?

1+

Who would have predicted - present company excluded - that the coiner of the term 'pseudoaddiction' (1) would subsequently go to work for Purdue Pharma and be given a patent for Oxycontin (2)? Moreover, how many here realize that Purdue Pharma pleaded guilty to 2007 to misleading the public about the abuse potential of Oxycontin and settled for for $600M (3).

Even more interesting, Haddox still works for Purdue, is a past president (4) - serving while employed by Purdue - of the AAPM, and still sits on the board of the ABPM (5). If these types of disclosures don't change disclosure rules and ethics charters then our pain professional societies might as well just shut down.

1. Opioid pseudoaddiction--an iatrogenic syndrome. Weissman DE, Haddox JD.
Pain. 1989 Mar;36(3):363-6.

2. http://www.uspto.gov/web/patents/patog/week32/OG/html/1381-1/US08236351-20120807.html

3. http://www.nytimes.com/2007/05/11/business/11drug-web.html?_r=1&hp

4. http://www.painmed.org/MemberCenter/Council_Past_Presidents.aspx

5. http://www.abpm.org/boardofdir

 

[facetguy]

1+

Who would have predicted - present company excluded - that the coiner of the term 'pseudoaddiction' (1) would subsequently go to work for Purdue Pharma and be given a patent for Oxycontin (2)? Moreover, how many here realize that Purdue Pharma pleaded guilty to 2007 to misleading the public about the abuse potential of Oxycontin and settled for for $600M (3).

Even more interesting, Haddox still works for Purdue, is a past president (4) - serving while employed by Purdue - of the AAPM, and still sits on the board of the ABPM (5). If these types of disclosures don't change disclosure rules and ethics charters then our pain professional societies might as well just shut down.

1. Opioid pseudoaddiction--an iatrogenic syndrome. Weissman DE, Haddox JD.
Pain. 1989 Mar;36(3):363-6.

2. http://www.uspto.gov/web/patents/patog/week32/OG/html/1381-1/US08236351-20120807.html

3. http://www.nytimes.com/2007/05/11/business/11drug-web.html?_r=1&hp

4. http://www.painmed.org/MemberCenter/Council_Past_Presidents.aspx

5. http://www.abpm.org/boardofdir

I read this earlier today. Related to your point about disclosures and ethics but in a broader context.
http://www.washingtonpost.com/busin...2-be82-c3411b7680a9_story.html?wpmk=MK0000205

 

[Aether2000]

I am in agreement that full disclosure is important. That is why it is disingenuous for the Propsters to not disclose fully all relationships they have had with government and industry when pontifcating about opioids. How many have served on task forces to limit opioid prescribing, hospital committees to restrict access, governmental agency advisory committees, work for plaintiffs lawyers in suing doctors for prescribing opioids, served as consultants to medical boards on opioids, are employees of a hospital system, have worked as consultants for the insurance industry, have rendered IME opinions on those taking opioids, are members of NADDI, have worked with police or other law enforcement agencies on drug diversion cases, have rendered opinions for or sat on the Washington Agency Directors Committees that defined opioid regulations, have written journal articles or opinion pieces regarding the malevolent effects of opioids, or have served on a board of directors for organizations that oppose the use of opioids. All of these pose potential conflicts of interest yet are not disclosed by propsters. I am all for full disclosure.

 

[101N]

I am in agreement that full disclosure is important. That is why it is disingenuous for the Propsters to not disclose fully all relationships they have had with government and industry when pontifcating about opioids. How many have served on task forces to limit opioid prescribing, hospital committees to restrict access, governmental agency advisory committees, work for plaintiffs lawyers in suing doctors for prescribing opioids, served as consultants to medical boards on opioids, are employees of a hospital system, have worked as consultants for the insurance industry, have rendered IME opinions on those taking opioids, are members of NADDI, have worked with police or other law enforcement agencies on drug diversion cases, have rendered opinions for or sat on the Washington Agency Directors Committees that defined opioid regulations, have written journal articles or opinion pieces regarding the malevolent effects of opioids, or have served on a board of directors for organizations that oppose the use of opioids. All of these pose potential conflicts of interest yet are not disclosed by propsters. I am all for full disclosure.

You are not describing conflicts of interests here, bias maybe. Bias exists on both sides and is difficult to prove. Conflicts of interest - being paid by an outside party to support their position - is proven and it's only occuring on the opioid avocacy side.

 

[Aether2000]

Any physician being paid as a consultant on opioids, whether it be by the state, a lawyer, an insurance company, or agency, etc has just as much conflict of interest as a person being paid to be a spokesman for a drug company. If the issue is not pay, but is bias, then I rest my case. Propsters, given their positions on the issue coupled with statements they have made in the literature, unquivocally demonstrate bias. Their hearts are in the right place but their methods and their bias make their proclamations a poor substitute for adopting governmental policy.

 

[101N]

Any physician being paid as a consultant on opioids, whether it be by the state, a lawyer, an insurance company, or agency, etc has just as much conflict of interest as a person being paid to be a spokesman for a drug company.

No, unlike bias, conflict of interest can be measured in dollar amounts from speakerships and honoraria.

 

[Aether2000]

Ok, then anyone paid as a consultant in dollars for any antiopioid position they postulate would have a conflict of interest that would be measurable.

 

[101N]

Ok, then anyone paid as a consultant in dollars for any antiopioid position they postulate would have a conflict of interest that would be measurable.

Only if there were an 'anti-opiod' industry that produced profits by selling 'anti-opioids' to someone🙂 Maybe there is a secret narcan industry connection with PROP🙂

 

[lobelsteve]

Only if there were an 'anti-opiod' industry that produced profits by selling 'anti-opioids' to someone🙂 Maybe there is a secret narcan industry connection with PROP🙂

It would be reasonable to have Kolodney, Ballantyne, Von Korff list all sources of income for the past 10 years.

And I'd like to know what Chou made and from who to write the nonsense he espouses.

 

[101N]

It would be reasonable to have Kolodney, Ballantyne, Von Korff list all sources of income for the past 10 years.

And I'd like to know what Chou made and from who to write the nonsense he espouses.

Agreed. I'll see if I can get that and publish it.

You get the same for the AAPM/APS/and ABPM boards and publish it as well🙂

 

[Aether2000]

Actually, there is not only an anti-opioid industry but there is an entire anti pain industry. ACOEM is dedicated to the eradication of pain treatments altogether. WC insurance companies pay their doctors for recommending crap like "lose weight, get rid of the cane, stop all narcotics, avoid all injections, stop expensive drugs like lyrica and cymbalta but it is ok to take a 200mg ibuprofen a day, think happy thoughts, etc". This is what we are really up against- malignant doctors making stupid recommendations employed by insurance companies. Of course with Obamacare, all pain treatments will be forbidden anyway (unless given by some hack CRNA) , so the whole argument becomes academic . 🙂

 

[Ducttape]

email him. kolodney posts his email addy on the website.

it is posted that they do not accept drug money...

 

[Aether2000]

Hmmm...it will be interesting to see if that is actually true once the sunshine numbers become publicly searchable. But how about taking money from Washington agencies to advocate against opioids? Or lawyers each has done work for and rendered opinions regarding opioids. Sunshine act will not pick up those numbers. Or any dinners they have attended with drug speakers, any sessions they have attended at national meetings sponsored by opioid manufacturers, or lunches provided for their office staff. And if they have not received any "drug money" then how much self funded research have they engaged in regarding opioids....if they haven't are they really experts?

 

[101N]

Hmmm...it will be interesting to see if that is actually true once the sunshine numbers become publicly searchable. But how about taking money from Washington agencies to advocate against opioids? Or lawyers each has done work for and rendered opinions regarding opioids. Sunshine act will not pick up those numbers. Or any dinners they have attended with drug speakers, any sessions they have attended at national meetings sponsored by opioid manufacturers, or lunches provided for their office staff. And if they have not received any "drug money" then how much self funded research have they engaged in regarding opioids....if they haven't are they really experts?

PROP are actually the the illuminati🙂 Lets all go hide in our bunkers.

 

[Aether2000]

lol not me: I prefer full disclosure. It is the propsters that have failed to disclose. It is disingenuous to critique one group of individuals for their disclosure while defending the contrarian view of those that refuse to disclose.

 

[Ducttape]

lol not me: I prefer full disclosure. It is the propsters that have failed to disclose. It is disingenuous to critique one group of individuals for their disclosure while defending the contrarian view of those that refuse to disclose.

1. unless they have nothing to disclose

2. what you are talking about, algos, the opioid favoring docs have not revealed - only "consulting fees". i dont see where speaking fees, lecture fees, etc that are not directly sponsored by pharmacology is delineated. and Fishman... isnt his lecture an integral part of the Harvard pain DVD?

3. clearly the drug companies have spent significant amounts of money "buying" off physicians. but there may be a difference between being given money to encourage sales of a product vs. being given money speaking, if there is no limitation on what can be talked about.

for example, if you were told to go in front of a national organization, say AAPMR, and talk about opioids - it is your choice and decision on what exactly you will talk about. Lets say you are allowed to talk about opioids and the prescription drug abuse crisis. You are still under no constraints, and you can get up in front of a national audience and say that such a crisis doesnt exist.

"consultation fees", i would argue, should be revealed. speaking fees? im not so sure of.

 

[lobelsteve]

I believe in full disclosure.

Politicians: All income and expenditures reported. Go to Walmart and buy paper towels, and the public should know about it. All gifts ned to be reported. Let the sunshine in.

Docs speaking or advocating or supporting laws etc: one step below the above.

 

[101N]

We need this type of disclosure in our field. And when we have it, those who hid their disclosures - or failed to recuse themselves - should be held accountable for the current prescription opioid epidemic.

1. http://www.washingtonpost.com/busin...64d596-1264-11e2-be82-c3411b7680a9_story.html

2. http://www.washingtonpost.com/busin...1d8e-36a1-11e2-9cfa-e41bac906cc9_graphic.html

 

[Aether2000]

On the national boards and committees on which I have served, it was required to disclose ALL potential conflicts, no matter how remote. Ownership of stock, bonds, any potential speaking fees, possible company ownership, product development reimbursement, future potential revenues from dividends or possible future ownership, any legal fees for consulting, expert witnessing, working for a medical board, speaking fees for anything even remotely medically related, etc. You should see the NASS disclosures.....very very exhaustive.

 

[101N]

On the national boards and committees on which I have served, it was required to disclose ALL potential conflicts, no matter how remote. Ownership of stock, bonds, any potential speaking fees, possible company ownership, product development reimbursement, future potential revenues from dividends or possible future ownership, any legal fees for consulting, expert witnessing, working for a medical board, speaking fees for anything even remotely medically related, etc. You should see the NASS disclosures.....very very exhaustive.

Carragee has done a good job at NASS. But unfortunately, we don't have anyone of his character - that I'm aware of - at the AAPM.


The Spine Journal Announces Editorial Changes to Protect Scientific Integrity and Public Trust

Four-Tiered Review Process and New Disclosure Requirements Are Among Changes



(Burr Ridge, IL) —After shining a critical light on the limitations of industry-sponsored, published research in its June focus issue on recombinant bone morphogenetic protein-2 (rhBMP-2), The Spine Journal has announced changes to its own editorial processes. The modifications are designed to protect the integrity of scientific publishing.

“Each year, millions of large and small medical decisions are influenced by the findings of clinical research published in journals such as The Spine Journal,” said Editor in Chief, Eugene J. Carragee, MD of the Stanford University School of Medicine, Redwood City, CA. “Therefore, it is absolutely critical to a patient’s well-being that the information published in medical journals be accurate and transparent.”

In keeping with this philosophy, The Spine Journal outlined changes in an editorial titled “Future directions for The Spine Journal: managing and reporting conflict of interest issues.” The paper’s authors are: Eugene J. Carragee, MD of the Stanford University School of Medicine, Redwood City, CA; Eric Hurwitz, DC, PhD of the University of Hawaii, Honolulu, HI; Bradley K. Weiner, MD of The Methodist Hospital, Houston, TX; and Christopher M. Bono, MD of Brigham & Women's Hospital, Boston, MA.

The Spine Journal will make the following modifications to its already-rigorous editorial and publication processes:


Manuscripts will be reviewed and vetted by four tiers of evaluators: peer review; review and comment by deputy editors by subject area; review and comment by the “Evidence and Methods” deputy editor; and a final review by the editor in chief. At all tiers, close attention will be paid to methodological rigor, the proper reporting of sources of error and potential bias, and appropriate interpretation of results in light of the study’s strengths and limitations.


Where appropriate in systematic reviews or evidence-based guidelines reports, appropriate adjustment for financial interest and industry sponsorship should be included in the analysis of strength of evidence.


Consolidated Standards of Reporting Trials (CONSORT) guidelines will be required for reporting results of randomized or controlled trials.


Complication rates in clinical studies will include an estimate of precision for safety analysis and should follow the CONSORT guidelines for reporting harms.


Strict rules for the entire editorial team have been implemented on the types of relationships they can have, from speakers’ bureau participation to royalties to fellowships. The disclosures will be published for public review, including dollar amounts in ranges.


Possibly the most innovative change is that funding sources (and the actual dollar amounts) and topic-specific conflict of interest (COI) of authors will be reported in the “Methods” section in clinical research studies.

“Conflicts and the role of potential biases are vital to evaluating the strength of a study and its evidence,” said Dr. Carragee. “They should be front and center with the study, where readers can readily view and consider them.”

The intention of this new direction is not to limit readers’ access to new information or to preclude investigators who have financial interests from publishing their work, but to provide transparency and a more balanced context. The reader of a clinical study now will be able to make an informed judgment about the article’s results and conclusions from the descriptions at hand, including the study’s design, conduct, data, analysis, strengths and limitations, including the sponsors’ and authors’ potential financial biases. Ultimately, these measures will enhance the quality and fairness of reviews and improve the quality of manuscripts published in The Spine Journal.

The Spine Journal is an international, multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. Published online continuously and printed monthly by Elsevier, Inc, The Spine Journal is the scientific publication of the North American Spine Society (NASS). NASS adheres to a policy of editorial independence for the journal’s editorial board, which follows guidelines of the International Committee of Medical Journal Editors, Committee on Publication Ethics and other best editorial practices. The Spine Journal recently earned an Impact Factor of 3.024, making it the top-rated spine publication in the world.