The Painful Truth Documentary

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On a separate note, I don't remember a Trolley Square mass shooting. That is a crazy story - all over in 6 minutes.

I love SLC.
 
Too, too funny:)

HEALTH
TV documentary on pain treatment funded by doctor with industry ties
DAVID ARMSTRONG @DavidArmstrongX

MARCH 24, 2017

PainfulTruthScreenCap-645x645.jpg

VIA YOUTUBE



P

ublic television stations across the country have begun airing a documentary about pain treatment produced by a doctor with significant financial ties to the manufacturers of opioid medications — a fact not disclosed in the program.

“The Painful Truth” chronicles the plight of several patients struggling to find effective treatment for chronic pain. Throughout the 57-minute-long program, politicians, federal agencies, and others are depicted as having overreacted to the epidemic of opioid-related overdoses; the documentary suggests pain specialists have been discouraged from prescribing opioids to patients who genuinely need them.

The program accuses the US Drug Enforcement Agency of unfairly targeting pain doctors and putting a “bounty” on pain clinics the agency aims to shut down.

“The political culture has declared war against opioids and those who prescribe them,” the narrator of the program says. “The DEA is the army. The pain patients are the civilians caught in the middle.”

The producer, Dr. Lynn Webster of Utah, and several of the experts he quotes in the program, have long-standing and extensive financial relationships with pain medicine makers. When asked why these relationships are not disclosed to viewers, Webster told STAT that he did not receive any drug industry funding for the documentary. He said it was funded entirely by himself and his wife.

“I am cognizant of that issue, but I think I dealt with it as carefully as I could,” he said in an interview. If viewers want to know whether any of the individual doctors associated with the documentary have financial relationships with pharmaceutical makers, Webster said they can search for that information on the web.
 
I have the book by Lynn Webster. Heard him give a talk on it and was giving them away for free. Still haven't opened it
 
101N said:
Too, too funny:)

HEALTH
TV documentary on pain treatment funded by doctor with industry ties
DAVID ARMSTRONG @DavidArmstrongX

MARCH 24, 2017

PainfulTruthScreenCap-645x645.jpg

VIA YOUTUBE



P

ublic television stations across the country have begun airing a documentary about pain treatment produced by a doctor with significant financial ties to the manufacturers of opioid medications — a fact not disclosed in the program.

“The Painful Truth” chronicles the plight of several patients struggling to find effective treatment for chronic pain. Throughout the 57-minute-long program, politicians, federal agencies, and others are depicted as having overreacted to the epidemic of opioid-related overdoses; the documentary suggests pain specialists have been discouraged from prescribing opioids to patients who genuinely need them.

The program accuses the US Drug Enforcement Agency of unfairly targeting pain doctors and putting a “bounty” on pain clinics the agency aims to shut down.

“The political culture has declared war against opioids and those who prescribe them,” the narrator of the program says. “The DEA is the army. The pain patients are the civilians caught in the middle.”

The producer, Dr. Lynn Webster of Utah, and several of the experts he quotes in the program, have long-standing and extensive financial relationships with pain medicine makers. When asked why these relationships are not disclosed to viewers, Webster told STAT that he did not receive any drug industry funding for the documentary. He said it was funded entirely by himself and his wife.

“I am cognizant of that issue, but I think I dealt with it as carefully as I could,” he said in an interview. If viewers want to know whether any of the individual doctors associated with the documentary have financial relationships with pharmaceutical makers, Webster said they can search for that information on the web.
Click to expand...

I think this is misleading.

Just because someone gets paid to speak about something, doesn't mean he looses all ability to make good, honest, appropriate judgements. I get that there is bias - but the implication is usually industry funded = no ability to do good science or think critically.

I personally feel that Lynn Webster - although maybe misguided - is trying his damndest to do what is right. He knows a lot about the subject at least.
 
No, Lynn isn't interested in doing what's right or he would have done it long ago. If you are such an unabashed proponent of a therapy that hasn't been studied - chronic opioids for chronic non-cancer pain - you
find a way to fund a powerful RCT of the drugs for a year or so and report the findings in a peer-reviewed journal. He never did that and he's still an advocate for the therapy in spite of 20 deaths due to it in his own
practice. It amazes me that he hasn't done jail time.
 
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101N said:
No, Lynn isn't interested in doing what's right or he would have done it long ago. If you are such an unabashed proponent of a therapy that hasn't been studied - chronic opioids for chronic non-cancer pain - you
find a way to fund a powerful RCT of the drugs for a year or so and report the findings in a peer-reviewed journal. He never did that and he's still an advocate for the therapy in spite of 20 deaths due to it in his own
practice. It amazes me that he hasn't done jail time.
Click to expand...

So let me make sure I understand what you are saying just so we are clear.

You are saying - if what you are doing hasn't been proven to by way of RCT with outcomes out to year to be affective, then you personally have the responsibility to do an RCT. Otherwise, if you personally, don't do then RCT, then you are not to be trusted.

Does that sum up your feelings well?
 
Are u actually defending someone who has had 20 overdose deaths and has had a 3 year investigation by the DEA as being "fair and unbiased"?

The guy who said that those deaths were probably from the staff (ie his NPs and PAs) and not his own personal scripts?

That many of these patients committed suicide?

That had Perry Fine be the one his attorney hired to review his opioid practice? Imagine a former AAPMed chair reviewing another one...

Who is supposedly sold his practice to do research, and has not produced any since doing so in 2013?

Whose practice was bought out and about 1/2 of his patients left within 2 years because the new guy reviewed and sometime reduced dose?

Deaths Trigger DEA Probe of Pain Specialist


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Ducttape said:
Are u actually defending someone who has had 20 overdose deaths and has had a 3 year investigation by the DEA as being "fair and unbiased"?

The guy who said that those deaths were probably from the staff (ie his NPs and PAs) and not his own personal scripts?

That many of these patients committed suicide?

That had Perry Fine be the one his attorney hired to review his opioid practice? Imagine a former AAPMed chair reviewing another one...

Who is supposedly sold his practice to do research, and has not produced any since doing so in 2013?

Whose practice was bought out and about 1/2 of his patients left within 2 years because the new guy reviewed and sometime reduced dose?

Deaths Trigger DEA Probe of Pain Specialist


Sent from my iPhone using SDN mobile
Click to expand...

Hold on DuctTape. Lets keep on tract with the argument at hand. No Red Hearings please.

There was one issue - but you have made it into two issues.

Issue one - do I agree with the way Lynn Webster practices medicine? By saying "are actually defending......" you imply that I do. I do not. Nowhere did I ever defend the way he practices. That was not the issue - nor my issue with 101N's comment.

101N's implication is that Lynn Webster practices is a bitch for the industry. I don't know if that is true - but I HIGHLY doubt it. My point was, that I would suspect that Dr Webster is doing it because he thinks it is best for his patients - that his heart goes out for these people in pain and he believes that the answer lies at the opioid receptor. Whether I believe that or not has nothing to do with the argument.

Now 101N needs to explain or discuss my question to him.
 
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Also, PBS tries to get the reader to - right off the bat - be on their guard about the content of this video because Lynn Webster has ties to the industry. I totally disagree with this - which actually is my main point.

That just because someone gets paid to speak for a company doesn't mean they can no longer think clearly or make good clinical decisions.

That is ridiculous idea. If I love the iPhone so much, and I talk non-stop about how great it is, and get people to buy it - then Apple comes and says - ya know what? We want to pay you to go around and talk about how great the iPhone is...so then I get paid. Does that make me an unreliable source because I am getting paid? But before I was getting paid, I was hugely credible source?

It makes no sense.
 
Webster's rai·son d'ê·tre has always been high dose opioids for that subset of patients - like those portrayed in his pro-opioid advertisement flick - who no one else will treat due to their psychiatric comorbidities, clear drug seeking behavior, and pain catastrophizing. He is the doctor that you think of when you think of
adverse risk selection. Some of this is narcissism - as with Hurwitz - as he clearly get's off on envisioning himself as Joan of Arc or Albert Schweitzer
for the sketchy pain patients who fawn over him. But, unlike Hurwitz Webster has been a paid consultant for opioid companies for years. Thus, his narcissism alone doesn't explain his opioid advocacy, he's a paid advocate (who$e). He is much worse than Hurwitz in that regard, and he should be in jail.

Webster's deep, deep involvement with opioid advocacy, Pharma, and the AAPM, have given him ample opportunity to talk about the need for, and then coax an opioid manufacturer into, a long term RCT to assess risk and benefit. But he not only never pursued that opportunity, he never mentions it. He doesn't because he knows that tolerance, dependence, and addiction would quickly emerge as adverse events and the trial would be abandoned early. He will be remembered as a pariah in pain medicine, a Pharma shill who never had the courage or insight to issue a mea culpa.
 
first, someone who is being paid by a company is not impartial and at the very least needs to represent that situation, or at least document potential conflicts of interest. Webster does not.

second, your example is not complete. in your example, Apple would have been paying you before you started talking about how great it is, with the inherent "threat" that they will no longer provide compensation to you if you do not say how good the product is. although i cannot currently find the links, Webster has been recieving drug money since the early 2000s, to the tune of >$100,000 per year.


the final point - my post was in response to this line: "I personally feel that Lynn Webster - although maybe misguided - is trying his damndest to do what is right. He knows a lot about the subject at least." i might have unfortunately put too much emphasis on the "maybe" and the "do what is right" part of the statement.
 
101N said:
Webster's rai·son d'ê·tre has always been high dose opioids for that subset of patients - like those portrayed in his pro-opioid advertisement flick - who no one else will treat due to their psychiatric comorbidities, clear drug seeking behavior, and pain catastrophizing. He is the doctor that you think of when you think of
adverse risk selection. Some of this is narcissism - as with Hurwitz - as he clearly get's off on envisioning himself as Joan of Arc or Albert Schweitzer
for the sketchy pain patients who fawn over him. But, unlike Hurwitz Webster has been a paid consultant for opioid companies for years. Thus, his narcissism alone doesn't explain his opioid advocacy, he's a paid advocate (who$e). He is much worse than Hurwitz in that regard, and he should be in jail.

Webster's deep, deep involvement with opioid advocacy, Pharma, and the AAPM, have given him ample opportunity to talk about the need for, and then coax an opioid manufacturer into, a long term RCT to assess risk and benefit. But he not only never pursued that opportunity, he never mentions it. He doesn't because he knows that tolerance, dependence, and addiction would quickly emerge as adverse events and the trial would be abandoned early. He will be remembered as a pariah in pain medicine, a Pharma shill who never had the courage or insight to issue a mea culpa.
Click to expand...

SO you are saying addiction emerges due to exposure? That is an interesting concept. The Neurobiology of Opioid Dependence: Implications for Treatment
The Science of Drug Abuse and Addiction: The Basics

But reality is such that:

The Genetic Basis of Addictive Disorders

Addictions, including substance use disorders (SUDs), are multistep conditions that, by definition, require exposure to an addictive agent. The wide variety of addictive agents encompasses drugs, foods, sex, video-gaming, and gambling. Any of these agents may lead to an “addicted state” through neurobiologic pathways partially overlapping with those involved in addiction to psychoactive substances.1 Millions of people are exposed to addictive agents each year, for instance, in the course of medical care for treatment of pain. The vast majority do not become addicted, even if temporary tolerance and dependence are elicited. The probability of initial use and the probability of progression toward a pathologic pattern of use are influenced by intrinsic factors (eg, genotype, sex, age, age at first use, preexisting addictive disorder, or other mental illness), extrinsic factors (eg, drug availability, peer influences social support, childhood adversity, parenting style, socioeconomic status), and the nature of the addictive agent (eg, psychoactive properties, pharmacokinetics, mode of use or administration). The relative importance of these factors varies across the lifespan and at different stages of addiction. For example, peer influences and family environment are most important for exposure and initial pattern of use, whereas genetic factors and psychopathology play a more salient role in the transition to problematic use.




It is not the drug, it is the person who receives the drug, when they receive the drug, who their parents were, who their friends and siblings are, and certainly a multitude of other factors that make an addict an addict. We need better screening tools, possibly genetic testing (if ever appropriate-making an argument to Rx is not a good argument- making an argument to not Rx is a good argument), and a national database, national guidelines that apply to all doctors and patients.
 
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fyi i did find one of the links. 2013.

Utah doctors paid $25.8 million by drug companies
In Utah, ProPublica's data also spotlight a multimillion dollar industry of contract research organizations, or CROs, private companies that drug makers pay to test their drugs.

Among them is CRI LifeTree Research, which has received at least $3.4 million in drug company payments since 2009, according to ProPublica.

Co-founder Lynn Webster, an anesthesiologist, is listed as having received the single largest payment in the state: $1,687,771 from Cephalon, a big maker of pain medications. Only three other doctors in the country received more from Cephalon.

Nationally, Webster is among the top 50 for single largest payments received, behind marquee hospitals, such as the Mayo Clinic, Cleveland Clinic and Duke and Harvard Universities.

A nationally recognized expert in pain management, Webster is under investigation by the U.S. Drug Enforcement Administration, which is looking into opioid overdose deaths of patients of his former pain clinic. A Senate Committee is probing his financial ties to Big Pharma.

Webster no longer sees patients, but serves as a medical director at LifeTree's South Salt Lake location. Research payments to him cover overhead and other costs, including his salary as a lead researcher, he said.
Click to expand...
(so he is actually supposed to be putting all that money to use with research on opioids. i see some articles on pubmed, but most seem to deal with abuse potential of a new drug/way of giving the drug.)
addendum i looked through 120 selected articles using Webster L and Webster LR. the majority are position papers or studies involving abuse potential or novel formulations of opioids comparing them to standard opioids.)
 
Last edited:
"It is not the drug"

That's denial and it's BS.
 
I haven't changed anything. You rationalize opioid Rx'ing for CNP because that's what Rob taught you. The fruit doesn't fall far from the tree.
BTW, where's mini me lately?
 
101N said:
I haven't changed anything. You rationalize opioid Rx'ing for CNP because that's what Rob taught you. The fruit doesn't fall far from the tree.
BTW, where's mini me lately?
Click to expand...

Rob taught me how to steer a needle, and he eas the best at that ever. Ad hominem after straw man. You are losing your touch.
 
lobelsteve said:
Long-Term Opioid Contract Use for Chronic Pain Management in Primary Care Practice. A Five Year Experience

Weak to moderate data, but still data.
Click to expand...
im not understanding the "benefit" of this study.

not to be negative, but it was a retrospective cohort study, so tenuous conclusions at best.

what i got out of the study - maybe this is what you are looking for? - was that it was pretty crappy.

- only people who volunteered were included in the study. apparently, you could still get your opioids if you did not volunteer.

- only 42% of patients (n=104) got UDS done, and of them, a whopping 38% among those tested had illicit drugs (53 patients) . 18% was cocaine, 24% marijuana, and 6% both. of these 42%, only 50% had their "contract" cancelled because of illicit substance use, meaning 50% of the time it was ignored/remediated.

specifically - of those patients that the physicians cancelled - 54 patients - only 27 was due to a + UTS. only 4 other patients were cancelled due to "rules violations". 14 were discontinued for "prescription drug abuse" which may represent overuse. hard to tell, not specifically stated.

- with that in mind, no documentation if pill counts were done, but apparently no patients were fired for negative UDS, but there is no documentation that there were any negative UDS.


im not sure how that forwards the argument that addiction rate is low.



perhaps maybe we should advance this position - irrespective of the addiction rate (high or low), there is a significant portion of patients without sufficient benefit and with concurrent significant risks/complications from COT that such treatment should not be offered to them.
 
Ducttape said:
im not understanding the "benefit" of this study.

not to be negative, but it was a retrospective cohort study, so tenuous conclusions at best.

what i got out of the study - maybe this is what you are looking for? - was that it was pretty crappy.

- only people who volunteered were included in the study. apparently, you could still get your opioids if you did not volunteer.

- only 42% of patients (n=104) got UDS done, and of them, a whopping 38% among those tested had illicit drugs (53 patients) . 18% was cocaine, 24% marijuana, and 6% both. of these 42%, only 50% had their "contract" cancelled because of illicit substance use, meaning 50% of the time it was ignored/remediated.

specifically - of those patients that the physicians cancelled - 54 patients - only 27 was due to a + UTS. only 4 other patients were cancelled due to "rules violations". 14 were discontinued for "prescription drug abuse" which may represent overuse. hard to tell, not specifically stated.

- with that in mind, no documentation if pill counts were done, but apparently no patients were fired for negative UDS, but there is no documentation that there were any negative UDS.


im not sure how that forwards the argument that addiction rate is low.



perhaps maybe we should advance this position - irrespective of the addiction rate (high or low), there is a significant portion of patients without sufficient benefit and with concurrent significant risks/complications from COT that such treatment should not be offered to them.
Click to expand...


This.....

Some here have vilified an inanimate object and make it sound like it is going to change everything for the better if the medicine didn't exist. There are clearly those patients who benefit with full-time gainful employment appropriate diagnosis and appropriate selection by a pain physician. I'm at the position that these people should not be cut off from care. I'm also of the position that patients who are poorly selected will always do poorly. This happens in any field of medicine from back surgery to diabetes and heart disease to pain management. They are throwing out these babies with the bathwater by trying to treat addiction with supply-side changes.

Oddly, the same people with this agenda are happy to declare anyone who takes medicine to an addict and treat them with the same medicines.
 
epidural man said:
On a separate note, I don't remember a Trolley Square mass shooting. That is a crazy story - all over in 6 minutes.

I love SLC.
Click to expand...

I was working in the trauma bay at the university of utah medical center when the shooting happened, we got two of the 4 victims that survived to the hospital, it was a horrible scene.
 
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