Kevin, M.D. - Medical Weblog

Natalie Finn's article would have fallen into the realm of respectability - where it should have been - if she had avoided the innuendo that hearing loss comes from opioid use; to the dgree that it represents a relative contraindication to the use of opioids.

What Rush did was probably not a good thing. That does not mean that he did not have a legitimate pain condition. That does not mean that he didn't require these medications. Ms. Barbera is the LAST person on earth to qualify as an expert on the use of opioids and why this medication - OxyContin - is used with frequency.

By leaving doubt in the eyes of the reader, Natalie Finn has crossed the line between responsible, mature, reporting and the dissemination of hearsay and myth.

Newspaper reporters have an obligation to get to the truth. High dose opioid therapy is acceptable as a method of treatment when other therapies have failed to improve the lives of chronic pain patients. Rush Limbaugh had legitimate chronic pain as a result of a back condition.

Some patients hord medications for fear that doctors will abruptly stop prescribing. Many doctors HAVE stopped prescribing, over the past two years, as a result of law enforcement's 'criminalization' of opioid prescribing.

This is a serious public policy issue which needs to be addressed fairly.

Chronic pain is an illness. Society needs to jump off the bandwagon that vilifies doctors who prescribe, and patients who take, OxyContin and other opioids.

Unless we do this - we will disenfranchise a segment of patients who have an absolute right to expect the relief of pain - and not at the hands of doctors who have an entrepreneurial interest in providing physical therapy and injection after injection; while at the same time being unwilling to prescribe opioids.

William Mangino II, M.D.
 

"Five years ago Limbaugh underwent surgery to have an electronic device implanted in his skull to restore his hearing after announcing he had lost most of it due to an autoimmune inner-ear disease. Medical research has revealed another potential cause of hearing loss, however--abuse of opiate-based painkillers. Hmmm..."
The connection between opioids and hearing loss is something I first heard about last year, when the Rush story was breaking. How commonly do opioids cause hearing loss? Is there any contraindications to the use of opioids in those with hearing loss?
 

Did Rush have a legitimate need to employ his maid to go out on the streets to procure oxycontin? Please refer to this website to read the affidavit regarding Rush's case:
http://www.thesmokinggun.com/archive/rushsearch1.html

David Crosby, the singer, said going to prison after being arrested for heroin, saved his life.
http://www.alpha.nl/CSN/crozdrugs.html

When Rush needs that liver transplant I suppose he'll turn to the black market since it seems to be his usual pattern of obtaining what he "needs". Chris, RN
 

I thought Drs. had no use for patients who Doc shop for drugs? On another thought, I'm sick to death of people like Rush Limbaugh, giving this area of medicine such a bad name. It is ones like him that have the DEA at your doors, and keeping people who truly need pain medication from being able to obtain it.
 

Just happened to review these comments, which are well intended.

Nowhere do we advocate doctor shopping.

Pain specialists understand the issues. We are just trying to increase some public awareness as to what separates truth from fiction. I would not have written the letter to Kevin-MD had ms. Finn avoided blaming Limbaugh's deafness on opioids.

With all due respect - the DEA war on prescribing has little to do with doctor shopping.

Why don`t you log onto doctordeluca.com and emergingsolutionsinpain.com if you are interested in a balanced presentation of these issues.

I wish you well.If I can help giving some info. in the future, don't hesitate to ask. Thank you.

Dr. Mangino
 

The real problem here is that physicians can prescribe any amount of any drugs they wish to anybody who pays their fees. The solution is to recognize that physicians are technicians. They may well be highly competent, but they are still technicians and are not qualified to be decision makers.

Physicians should report possible diagnoses and treatment options to managers and executives who are educated in law, business, and economics and so are competent to make decisions about appropriate and cost-effective treatment. Physicians should then administer that treatment under appropriate supervision.

This model already is coming into practice in the United States, and the sooner it is fully implemented, the better. Good technicians need not be good managers or executives and it is insane to pretend that they are. The practice of medicine must be overseen and managed by the graduates of law and business schools. The line personnel (physicians) receive a technical education appropriate to their positions from medical schools and apprentice programs (internship, residency, etc.).

Technicians are not executives. Industrial concerns are not run by the personnel who man the assembly lines. Medicine must move into the modern world.
 

Dear Technician person,

You say that Doctors are technicians and "shouldn't be allowed to make decisions". You would prefer perhaps an accountant make the decision to operate on your wife's head bleed at 3AM? I suppose you fancy yourself an "executive" who would like to tell alot of doctors how to run things. The day that happens is the day that any intelligent doctor under your thumb or payroll keys your car and tells you to shove it.
 

He reminds me of a doctor trying to practice law.
 

That's really pushing things when they start talking about having Lawyers or accountants making the medical decisions. He's just pulling our leg, isn't he?
 

He is pulling his own "middle leg":>
 

He is just making a bitter joke.
 

No shit sherlock, but the ones with real medical issues shouldn't have to be treated with disrespect by doctors because one bad egg ruined it for the rest of us. I find this more and more with doctors. I get treated like a heroin junkie, even with my MRI, my disk desiccation, and bulging, its rude and all doctors need to be taught proper manners. Its offensive how i get treated at times. I hope you junkies out there are happy , you are ruining it for everyone, and maybe you should get a job and make your own money instead of sell drugs.
 

He's doing it again! Mr. Limbaugh is once again doctor shopping and the Republican Party is covering it up. Not only is it an embarressment to this country, it sends the wrong message to American troops, who are being brain washed on Armed Forces radio by this addict. Two investagations have been silenced by members of this administration that prove, he has found another way to get his drugs and until he gets medical help for his addiction, he will continue his dirty little secret. Get help Mr. Limbaugh!