In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on. I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the ...

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“There are three kinds of lies: lies, damned lies, and statistics.” There is much truth in this quotation of uncertain provenance. We see this phenomenon regularly in the medical profession. We see it in medical journals when statistics are presented in a manner that exaggerates the benefit of a treatment or a diagnostic test. Massaging numbers is raised to an art form by the pharmaceutical companies who will engage in numerical ...

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Polypharmacy was once the exception in psychiatry; now it seems to have become the rule. Patients frequently are taking 3, 4, even 5 psych meds at one time. And often it’s primary care doctors, not psychiatrists, who are doing the prescribing -- usually without adequate training in psychiatry. Some polypharmacy is rational -- e.g., a patient with bipolar disorder who receives the combination of antidepressant and mood stabilizer. But most polypharmacy is ...

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I don’t want to need it. That is a thought that has been all too familiar to me when I venture on the patient side of health care, an industry that I study as a scholar as well with the distance of one investigating a foreign land in which they do not intend to become entrenched. It is a thought that has been all too familiar as I see added to my ...

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Prince died of an opioid overdose. A tragic and avoidable fate but, even more tragically, one that is becoming increasingly common in the United States. Some people who overdose live on the edge of society–homeless and with no access to good medical care. Prince, by contrast, had several mansions and a number of physicians actively involved in his care, physicians aware of his problem with opiates. ...

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A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling ...

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“I need help with my colitis.” “Really? I thought we had things pretty well controlled.” I hadn’t seen her in the better part of a year. I remembered how hard it had been to get her ulcerative colitis into remission. How sick she had been, how miserable her life was. There was a bit of trial and error in the office, followed by a hospitalization for intravenous steroids, then a tapering dose ...

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Last week, when I stubbed my toe on our family room coffee table, a throbbing pain ensued. Over the next two to three days, as the bruise turned pink and then purple, the pain persisted. During the same time, I had a case of the blues. I am overstressed at work with several staff on vacation, my college-age children had come home and then left to start their internships, and my ...

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The opioid (painkiller) epidemic, with its seemingly indiscriminate reach, has embraced an alarming number of Americans. In the most recent statistics available, two million Americans either abuse or are dependent on prescription opioids. Even the death of internationally acclaimed artist, Prince Rogers Nelson, has now been attributed to fentanyl overdose, a strong prescription opioid whose illicit version has become ...

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“It’s an 8,” I heard him say from behind the curtain as I walked into the room. The nurse’s aide dutifully recorded the number while the automated blood pressure cuff searched for his pulse, and the plastic clip on the tip of his index finger measured his oxygen saturation. “What does an 8 mean?” I asked. “Oxycodone!” he chirped cheerfully, without a moment’s hesitation.  “An 8 means oxycodone.  Five milligrams!” “Ah, but you’re wrong,” ...

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