In most physician prosecutions for treating pain or addiction, there is never any actual evidence of criminal intent. Just the nebulous argument that a doctor “ignored the risk of overdose,” “ignored the risk of addiction,” or performed “an insufficient medical exam.” I have a big problem with these because the doctor didn’t ignore anything in about 80 percent of the cases I evaluated. Indeed, the DEA had to lie to …
A doctor in Virginia named Joel Smithers was serving a 40-year sentence in an Atlanta prison when he won his appeal to the 4th Circuit. No, he didn’t shoot someone. That’s probably 25 years. He treated patients in pain. Now, he will get a new trial where he will be bludgeoned again with false metrics and innuendo. To ensure that the benefit of the doubt prevails, a Reuters article starts …
Anyone reading health care news today must be aware that American medicine – particularly pain medicine – is in crisis. Doctors are experiencing high levels of burnout due to administrative burdens, prior authorization demands, and a health care system that often prioritizes efficiency over patient care. This burnout is leading to mental health issues and, in some cases, physician suicides.
Medicare payments to physicians have decreased by 26 …
According to some academics, in 2019, a ban on junk food advertising across London’s entire public transport network—foods and drinks high in fat and salt and ads for foods–resulted in the prevention of 100,000 obesity cases. Yet the U.S. love affair with the new semaglutide-based weight loss drugs like Ozempic gives junk food advertising and availability a huge pass.
Drug makers and Wall Street are pleased that instead of changing …
Today, I want to talk about how creative humans are. As physicians, we encounter patients with ideas that amaze us every day and make our lives interesting, to say the least. The best ones are often the elderly, who have years of experience and unique ways of getting things done that differ greatly from the current generation.
I came across an elderly patient in the office who had previously been diagnosed …
Have you ever heard of a drug called Ozempic? Just kidding. As we all know, this medicine and numerous related drugs are the rage. It is classified as a GLP-1 drug. The percentage of my patients who are taking these drugs is steadily rising. Of course, initially, Ozempic’s purpose was in diabetic management. Once it was discovered that weight loss was a “side-effect,” a new therapeutic mission was discovered. Indeed, …
On my outpatient clinical rotations last year, I saw ample management of heart disease and smoking cessation counseling. I also saw the annual physicals and checkups. But what surprised me was how many patients were on medications that were just now becoming more mainstream. I’m sure you’ve heard of one in particular—Ozempic. But it wasn’t just Ozempic. There was also Wegovy and Mounjaro. These medications, in the family of semaglutides, …
Since the United States Food and Drug Administration approved exenatide in 2005, it took decades for the American Society of Anesthesiologists (ASA) to identify and address perioperative safety concerns, if any, among patients using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as exenatide. This delay could be due to several factors: GLP-1 RAs were initially used only for managing diabetes and later for obesity, and now potentially for a wide …
This is a strange time in America. While tools for treating pain and addiction, unchanged essentially from the late 1800s to the early 2000s, are now being developed, daring to try to utilize these medications and the science we have learned about them can be a huge risk. Not for the patient but for the doctor. There is a stigma that has always been attached to these areas of medicine, …
The term “revolutionary” is used too often in health care. New imaging modalities, pharmaceutical breakthroughs, advanced medical devices, and artificial intelligence are all regularly proclaimed to be revolutionary to attract interest and attention. But those of us trained in medicine who work in these fields know that revolutions don’t happen—it takes 17 years for new research to reach the translational stage.
In reality, the best we can hope for is …
I have been writing for a while about how the DEA will run out of targets for opioid prosecutions because most doctors are too terrified to treat pain, and now it looks like it has happened. Three doctors in Tennessee were recently convicted of prescribing controlled medications “outside the usual practice of medicine” and “not for a legitimate medical purpose.” The interesting thing is that these doctors weren’t treating pain; …
Xylazine has been found to be adulterating pills in America, and doctors will need to understand this new threat. First, xylazine is not “krokodil,” although it produces somewhat similar-looking skin ulcers. Krokodil is a pseudonym for desomorphine, which is created from a precursor chemical called alpha-chlorocodide. Desomorphine is dihydrodesoxymorphine and was developed in Germany in 1932. It is a very fast but short-acting, semi-synthetic opioid used mainly in Russia. Xylazine …
Why bother going to work? If I didn’t work, I wouldn’t get paid, so there was that. But it seemed like a pointless exercise. I would stare at my monitor until it was time to go home. On some level I knew I should be, well, working, but I couldn’t collect my scattered thoughts enough to do it. I was also manic. Not the fun kind of mania where everything’s …
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If you are a fan of pharma, you might want to skip this article. Some pharma enthusiasts will call it a rant. By pharma, I mean avaricious pharmaceutical (a pleonasm) companies collectively. On the other hand, those of you who treat acute migraines will learn of a highly effective, innovative, inexpensive, and relatively safe way to help many of your migraineurs. Those of you who believe that pharma is interested …
When I heard about the new AvertD genetic test, pronounced like “averted,” I was compelled to contact the CEO of SOLVD Health, the maker of AvertD, and ask him to answer some of my questions. To my surprise, he was willing to do so, and here is what I learned from the training documents that will be mandatory for all prescribing MDs.
First, AvertD is not for use in patients receiving …
More Americans are seeking mental health care than ever before, but many people receiving treatment have never met their psychiatrist in person—or even at all.
Telemedicine has been growing in popularity for years, but the COVID-19 pandemic sent tele-health care utilization rates through the roof. Now, after sharp increases brought by COVID-19 lockdowns, American telehealth utilization has stabilized at levels a staggering 38 times higher than before the …
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Lizzie is a 13-year-old with a great sense of humor.
She tells it like it is, especially to her Mom, Jackie, who admits to being a bit of an Almond Mom (the parent who is stuck in a weight-focused diet culture). Jackie leads a very healthy lifestyle and has never had to deal with being overweight. Jackie is different from other Moms I work with because she isn’t telling me that …
A recent New York Times opinion piece detailed a lack of available pain medications. While the DEA claims that it is not purposefully restricting legitimate medication availability, even the names of its own operations belie this statement. On Halloween 2023, the DEA launched Operation “Bottleneck,” serving immediate suspension orders to six large pharmaceutical supply companies. These companies were accused of having failed to account for “a million doses” of …
A recent investigation in Quebec uncovered a concerning trend: benzodiazepines — medications commonly used for sleep or anxiety — are being overprescribed. This investigation has prompted the Quebec College of Physicians to closely examine the usage of these medications.
But this issue extends beyond Quebec’s borders; across Canada, these medications are being prescribed at alarming rates.
Benzodiazepines and other sedatives are often prescribed to older adults aged 65 and up for …
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According to a recent report by the Stanford-Lancet Commission on the North American Opioid Crisis, “more than 600,000 people in the USA and Canada have died from opioid overdose since 1999, and a staggering 1.2 million more are estimated to die due to overdose by 2029.”
The opioid crisis has reinforced hard lessons learned in earlier health crises. Chief among those is that we need multiple strategies if we are going …
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