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Psuedo-medicine approved for use in Oregon

Discussion in 'Pain Medicine' started by drusso, Jul 31, 2015.

  1. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Thank you to Lobelsteve for calling this to my attention.

    Every evidence-based pain physician should learn from the Oregon experience. Our State's failure to thwart pain quackery is largely attributable to politics, the influence-peddling of a former MD-Governor and his "pet project" of a state Medicaid system called OHP, and a lack of rigorous thinking among policy-makers. If you participate in ANY pain care policy-making activities (task forces, committees, etc) in your State, you have a duty to stand up and say "no" to moo-shu pork medicine, psuedo-science, and quackery. These are not "harmless" interventions that reduce risk. They drain real resources from real patients with real pain. Non-content experts, meta-anlyticians, and soft-headed policy-makers deserve ridicule and contempt for wasting money and perpetuating nonsense. These policy determinations have been facilitated by "thought leaders" like Roger Chou and Rick Deyo. Their activities should not be supported.

    Here is how it works : research changes policy, policy changes payment, payment changes practice.

    http://sfsbm.org/index.php?option=com_easyblog&view=entry&id=693&Itemid=649

    More Metastasis of Pseudo-Medicine
    Friday, 31 July 2015

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    Oregon has a problem with prescription pain pills. Oregon leads the nation in the abuse of such drugs, federal statistics show, with the state's rate of prescription drug abuse 39 percent higher than the national average.

    Why that is, I do not know. As an Infectious Disease doctor I prescribe a narcotic about once a year. There are a real problems with the treatment of chronic pain and while I am aware of the issues and the changes over the last 25 years, it does not impact my practice, so my knowledge of the issues is basic

    I am also well aware of the Oregon Health Plan, OHP.

    OHP was intended to make health care more available to the working poor, while rationing benefits.

    Given limited resources, part of the plan has always included a prioritization of treatments and diagnostics, paying for interventions that give the most bang for the buck. Not a perfect way to ration care and as is always the case, no good deed goes unpunished.

    Another effect of limiting care, according to the Bend Bullitin, may be that

    OHP members who suffer back pain have been left with no choice but to take drugs, and the policy could be contributing to Oregon's high rate of narcotic abuse

    since other interventions are not paid for.

    New guidelines were recently updated by the Health Evidence Review Board and as a result

    The new guidelines open the door to acupuncture, chiropractic, cognitive behavioral therapy, osteopathic manipulation and physical and occupational therapy.

    To be picky, they do not say chiropractic, but "spinal manipulation", although the codes suggest chiropractic manipulation.

    As best I can tell, they relied on two reviews Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society from 2007 and Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline from 2007.

    They evidently did not review the literature to show that acupuncture is a theatrical placebo, has no basis in reality-based medicine and that most positive effects are probably due to bias

    results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies.

    and that chiropractic is no better other therapies

    High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain.

    not as was mentioned in the newspaper that

    Large, randomized trials have shown that for chronic back pain, acupuncture and chiropractic therapy are equally helpful, said Dr. Richard Deyo, professor of evidence-based medicine at Oregon Health & Science University. He served on a task force that advised the Health Evidence Review Commission. "Different people respond to different things," he said. "The outcomes tend to be very similar, in the short term at least."

    Of course, short term improvement is just what one would expect from a placebo that does nothing to the underlying process. As noted many times here and at Science-Based Medicine, evidence based medicine is inadequate at evaluating interventions that are not based in reality

    And this also ignores the question of the state paying for practitioners of magical pseudo-medicines and all the associated useless interventions and beliefs espoused by chiropractors, naturopaths and traditional Chinese medicine practitioners.

    Hardly seems like a good use of Oregon resources.

    They suggest possible benefit

    The expense of a broader range of treatments could be offset by a decline in narcotics use,

    and I hope they do some epidemiologic studies to show benefit of adding pseudo-medicines to OHP.
     
    #1 drusso, Jul 31, 2015
    Last edited: Jul 31, 2015
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  3. 101N

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    Is the author a "content expert"? For that matter, what does the term mean?

    And look at the bright side, you can now offer some non-opioid options to all those OHP patients you see in your IPM practice.
     
    #2 101N, Jul 31, 2015
    Last edited: Jul 31, 2015
  4. lobelsteve

    lobelsteve SDN Lifetime Donor
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    The author is mark crislip. President of Society for Science Based Medicine.
     
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  5. drusso

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    Content experts (also called subject matter experts or sometimes expert practitioners) are people who are thoroughly familiar with skills and content that training must impart.

    Nikolai Bogduk would be an example of a content expert and authority on the topic of the limits of evidence based medicine for evaluating the effectiveness of spine interventions and their appropriate use. Chou and Deyo are hired guns paid to pump out GIGO/regurgitated science on the public's dime in order to advance politically-driven health policy agendas.

    Get it?
     
  6. drusso

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    Most Patients with Chronic Pain Use Alternative Therapies, but Many Don’t Tell Their Doctors
    Mary Sawyers
    [​IMG]
    PORTLAND, Ore., July, 20, 2015 — More than half of chronic pain patients in a managed care setting reported using chiropractic care or acupuncture or both, but many of these patients didn’t discuss this care with their primary care providers. These study results, published today in The American Journal of Managed Care, suggest that better care coordination is needed among patients and physicians.

    Researchers surveyed more than 6,000 patients in Oregon and Washington who were Kaiser Permanente members from 2009 - 2011 and had three or more outpatient visits for chronic pain within 18 months. They found that 58 percent of these patients had used chiropractic care or acupuncture or both.

    The majority of patients shared information about these alternative therapies with their primary care provider, however a good portion (35 percent of patients who had acupuncture only, and 42 percent of patients who had chiropractic care only) didn’t talk to their providers about this care. Almost all of these patients said they would be happy to share this information if their provider asked.

    “Our study confirms that most of our patients with chronic pain are seeking complementary treatments to supplement the care we provide in the primary care setting,” said Charles Elder, MD, MPH, lead author of the study and affiliate investigator at the Kaiser Permanente Center for Health Research. “The problem is that too often, doctors don’t ask about this treatment, and patients don’t volunteer the information.”

    Chronic pain affects approximately 100 million Americans each year and costs nearly $600 billion, according to a report from the Institute of Medicine.

    Dr. Elder, who is also the physician lead for Kaiser Permanente’s complementary and alternative medicine program, added, “We want our patients to get better, so we need to ask them about the alternative and complementary approaches they are using. If we know what’s working and what’s not working, we can do a better job advising patients, and we may be able to recommend an approach they haven’t tried.”

    To find out how patients accessed this care researchers examined the medical records of patients who received acupuncture or chiropractic care in 2011. The majority of patients (66 percent) who received acupuncture accessed the services through their health plan, using a clinician referral or self-referral benefit. About half (45 percent) of patients who received chiropractic care accessed that care through their health plan. The remainder of patients went outside the health plan to access these services, or used a combination of health plan and outside resources to access the services.

    The majority of the patients in the study (71 percent) were women, and the mean age was 61. Common complaints included back pain, joint pain, arthritis, extremity, neck and muscle pain, and headache.

    Patients completed the survey online or by mail. It included 17 questions about the type of pain patients experienced, and their use of acupuncture, chiropractic care, and other alternative and complementary therapies. This survey was administered as part of a study called RELIEF, which is comparing outcomes among chronic pain patients who receive chiropractic care and acupuncture, and those who don’t.

    It was funded by a grant from the National Center for Complementary and Integrative Health. (R01 AT005896)

    Additional authors include: Lynn DeBar, PhD, William Vollmer, PhD, John Dickerson, MS, PhD and Lindsay Kindler, PhD, from the Kaiser Permanente Center for Health Research; Cheryl Ritenbaugh, PhD, from the University of Arizona; and Richard A. Deyo, MD, from the Kaiser Permanente Center for Health Research and Oregon Health & Science University.
     
  7. 101N

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    No I don't. I think Bogduk is someone whose ship sailed in the 1990s. He hasn't produced any level one evidence for what he espouses since his SINGLE, UNREPRODUCED, NEJM ARTICLE IN 1996. Chou & Deyo, OTOH,
    No, I don't. This is going to get difficult for you.
     
  8. lobelsteve

    lobelsteve SDN Lifetime Donor
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    And debakey didn't know diddly about the heart.
     
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  9. emd123

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    I agree. You can summarize their pseudo-logic as such:

    "Because interventions don't work for everyone, we recommend treatments that don't do anything for anyone."

    I'd still disagree, but respect them more if they just said we do nothing for Pain patients rather than turn back technology centuries and recommend snake oil. That is snake oil that taxpayers have to foot the bill for, and make patients poorer.
     
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  10. emd123

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    No offense to these guys as I don't know them personally. I'm sure they're fantastic internists. But I'm not about to take as gospel so called "expert opinion" from people with no fellowship training, accredited or even non-accredited, and no board certification in Pain Medicine, claiming to tell me how best to practice my specialty, in which I have done the proper training and certifications. Maybe they've seen a lot of poorly and unethically practiced Pain Management around them and in their careers, but I'm not going to put much stock in how an Internist tells me to practice Pain. Nor am I going to tell them how to best manage diabetes, hypertension or dementia. Similarly, Urologist should not proselytising how OB/GYNs should practice. It would take an unhealthy and pathological amount of arrogance to even attempt to do so, and anyone doing so should be ignored.

    Are these guys, whom you follow and look up to as your mentors in Pain Medicine, even properly credentialed as Pain Physicians?


    ImageUploadedBySDN Mobile1438460716.118569.jpg ImageUploadedBySDN Mobile1438460732.543137.jpg

    Board Certification search: http://www.certificationmatters.org/default.aspx

    Again, no offense to their credentials as Internists, but from what I see they're not even subspecialists in anything in their own specialty, let alone Pain. Interestingly, their own specialty Internal Medicine, doesn't consider Pain Medicine as a current or even potential subspecialty of IM. I'm told they even turned down an offer to apply to co-sponsor Pain as a subspecialty in the past year.
     
    #9 emd123, Aug 1, 2015
    Last edited: Aug 1, 2015
  11. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Neither Chou nor Deyo count as content experts in Pain Medicine. But, their opinions are influential among policymakers because of who is paying them.
     
  12. emd123

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    Who is that?
     
  13. 101N

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    Does Bogduk receive income from ISIS, or whatever it's called now? And, digging a little deeper, how does ISIS make money? I would venture that Bogduk makes a lot of money directly and indirectly from cadaver courses that teach people to do procedures.
     
  14. pastafan

    pastafan Interventional Pain Physician
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  15. drusso

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    Interesting that Chou & Deyo's employer--Oregon Health Sciences University--don't report their employee compensation data...more good 'ol fashioned government unaccountability. State contractors getting paid unreported income from other state agencies to craft state policy! Never mind, I'm certain that the scope of work was well vetted, that all relevant stakeholder were included, and a critical evaluation of evidence by content experts was performed.

    :wtf:

    http://cascadepolicy.org/govdocs/
     
  16. drusso

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  17. Ligament

    Ligament Interventional Pain Management
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    Deyo is a Professor of Evidence Based Medicine???? Are you freaking kidding me??? I'd resign myself in shame if I was professor of that...
     
  18. DrCommonSense

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    Yup.

    A dude who has never done an epidural, RF, facets, stim, kypho, back surgery or even sees pain patients at all is now the "expert" on whats "evidence based".

    I would be surprised if he even knows how to place an I.V.

    Remember, a "meta analysis" can say anything you want by qualifying which studies are "high quality" or "low quality", which is in the eye of the beholder mostly.

    Thats why his joke "recommendations" that include Thai Chi, Reiki, etc are even more laughable considering his insistence on "high quality studies".
     
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