Saturday, August 27, 2005

Painful Medicine

We believe in our medical system as progressive, technologically advanced, always available and ready to relieve pain and danger. We may worry about the soaring costs, fat insurance company executive salaries, and unwillingness to provide the country with a health care safety net. But we still have faith that the doctors will still give us some "medicine" to cure the illness and take away the pain.

They used to come to your house to do it but we cannot hope for the moon. They used to give you some of their time and concentration rather than forming groups and seeing 3 people at a time: a few minutes with one, run out, a few minutes with another. It would be nice to feel special but we cannot hope for the stars either.

The fact is that American medicine is now being overseen and sometimes controlled by businessmen (HMOs) and cops. In an article on "Pain Management" from George Mason University,

The question is, what are the 10-20 million Americans who suffer chronic pain to do? The only non-narcotic painkiller left, aspirin, remains an option. However, long-term use of painkilling doses can lead to potentially fatal gastrointestinal bleeding. Some 16,000 people die each year from bleeding related to aspirin and other NSAIDs.

That is a lot of people, a lot of pain (which is difficult to quantify) and very few medications left for the average person. There are also people with an intense allergy to aspirin; even fewer alternatives for them. This present round of worries comes after the big loss in court suffered by Merck, the maker of Vioxx. The drug makers of COX-2 drugs like Vioxx and Celebrex have been linked to "an increased risk of heart attack and stroke". Later the NSAIDS (non-steroidal anti-inflammatory drugs) such as Advil and Ibuprofen were found to increase these risks were seen as part of the genre of medication to which belong the Vioxx and Celebrex meds. Since it is a tiny risk factor, we won't mention that people allergic to aspirin are usually allergic to NSAIDs.

So no Vioxx, no Advil, no aspirin. At least for the little aches and pains there is Tylenol (acetominophen). Nope.

And now, the last hold-out, Tylenol (acetominephen) has been linked with kidney problems and with a significantly increased risk for high blood pressure in women in an analysis of the Nurses’ Health Study.

The New York Times reported on the $253 million suit won against Merck but noted that Merck, Novartis, and GlaxoSmithKline continue to invest in these cox-2 drugs and hope to prove their safety. Click over to the David Nalle post on Blogcritics on The Vioxx Verdict. Mr. Nalle's article is less a polemic about the state of pain medication than a reasoned discussion of this high an award and the future for Merck as well as the drugs themselves.

See $253 Million for the New York Times Business section take on the Merck decision and the state of the industry.

Aspirin and Tylenol are not even strong enough painkellers to be classed for more than "mild" pain. What, then, is left? The answer is opoids. Opium derivatives.

"Unfortunately, the National Institute on Drug Abuse has recently gotten into the anti-opiate act, with director Nora Volkow claiming that medical education misleads doctors into believing that there is little risk of addiction when prescribing opoids for chronic pain because those who use them for acute pain treatment are not likely to become addicted.

In an interview with Psychiatric Times (7/05), Volkow said that "5-7%" of chronic pain patients given opioids become addicts. That means, of course, that over 93% do not, which many would see as a low risk. But other studies have found the risk to be lower than that claimed by Volkow. The risk for people without a prior history of drug problems, for example, has been found to be less than 1%. Furthermore, the risk of accidental addiction declines with age, which, given that many pain patients are middle aged or older, is an important consideration in considering any potential risk for accidental addiction. None of that, however, is mentioned in the Psychiatric Times piece."

Do note that the prescriptions of physicians are being controlled by an agency led by a Nora Volkow . She doesn't appear to have an M.D. or Dr. attached to her name but has the power or influence to help create painful medicine -- the present situation where "50% of dying patients in the U. S. are still under-treated for pain"-- at least according to the World Health Organization.

Note that quotations were from a release from George Mason University at Pain Management. I was led to this article by the excellent science site (similar to Blogcritics arts, culture and politics site), SciTechDaily

Other studies have shown that the vast majority of people who need pain medication for severe pain do NOT develop an addiction. If you are suffering a heart attack, believe me, morphine in huge doses is wonderful to stop the pain that is enough to kill by itself. But the morphine itself is unpleasant and nauseating and will forever remind me of the intense pain that caused me to take it. Addiction tends to require some pleasure associated with the subject -- morphine, nicotine, caffeine, fast food...

The fact is that opium derivatives do the job. A number of years ago when Jackie Kennedy Onassis was dying of painful cancer, the papers reported that she received enough painkillers to die without suffering. Essentially because she was rich, famous and an American icon. One should not have to be that rich nor famous to be kept from suffering needlessly.

It is time to reexamine our national priorities. We really cannot afford to have foreign wars and this artificial war on medications and recreational drugs at the same time. The nation's resources, veracity and safety are compromised by using valuable resources to watch physicians, cause recreational drugs to be so expensive that people kill for them, castigate older, sick people for looking for alleviation of suffering. Further, this "war" is totally non-productive. Billions have been spent and nothing has been produced except fear, pain and death. It is time to fight terrorists, if fight we must, and stop fighting the medical profession and the people it tries to serve.

Check the post with its comments at: Painful Medicine.