Regarding the CNN story entitled Pain Doctor Investigation, thereafter rehashed by Anderson Cooper, which aired last week and has variously appeared on the Internet, Dr. Sanjay Gupta should be ashamed for his misdirection and reprehensible approach to the story on a number of levels.
This eerily appeared almost a year to the day after a similar “pain doctor bashing” by the Wall Street Journal last year that also served to sensationalize “bad doctors” rather than tell the whole truth or advocate for those clinicians that are highly recognized for their dedication and contributions to pain patients, medicine, and science. Last year’s story attempted to lambaste another internationally well-respected clinician, Dr. Russell Portenoy and was covered on PainDr.com HERE.
In short, this year’s CNN’s coverage is of a woman that died while Dr. Lynn Webster, also an internationally well-respected clinician, was treating her chronic pain. She was presumably on opioid therapy, but that’s all that anybody knows without carefully combing through her medical records. In the CNN piece, Dr. Gupta spends most of his time interviewing the patient’s husband who is understandably distraught over his wife’s death. Gupta attempts an interview with Dr. Lynn Webster who refuses to grant an interview or discuss any personal patient issues.
With all due respect for [media sensationalist] Dr. Gupta’s credentials as a neurosurgeon, educator, and journalist; he has clearly abandoned the patient community at large by joining his correspondent colleagues to sensationalize opioid deaths. Dr. Gupta, have you considered that perhaps Dr. Webster did not grant an interview because he is protecting the family and abiding by HIPAA guidelines? Have you considered that perhaps Dr. Webster is taking the high road by not arguing publically with a patient and their family? In the face of your accusations, I’d say that these attributes are honorable and respectful to Mr. Bosley and his family; not indifferent or apathetic.
I would love to see Gupta do a story on the “Pharmacy Crawl” that is occurring daily in the states of Florida and Kentucky where legitimate pain patients are unable to find a pharmacy that is willing to fill their prescriptions, a problem that is occurring because previously, politicians and law-makers turned a blind eye to corruption in “pill mills” and now they want to look like the heroes by bringing down an ax all at once.
Gupta stated, “Someone dies every 19 minutes from a prescription drug overdose and most of these deaths involve painkillers”. How about telling the audience that more deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined? 1,2
Your followers might be interested in “Policy Impact: Prescription Painkiller Overdoses. About one-half of prescription painkiller deaths involve at least one other drug, including benzodiazepines, cocaine, and heroin. Alcohol is also involved in many overdose deaths.3 In 2010, 2 million people reported using prescription painkillers nonmedically for the first time within the last year—nearly 5,500 a day.4
Isolated Police State politics and narrow-minded, draconian policy changes, across more and more states, is not the answer, but nevertheless are fueled by stories like yours. Telling the whole truth is less sexy media, may be limited by space constraints, and calls less attention to your followers.
I would be delighted to interview with Dr. Gupta on behalf of PROMPT so that he could better understand the lack of education for safe opioid use among various prescribers and pharmacists. But, any of the available coverage has heretofore blocked any of my attempts at a posted comment…is this fair journalism? Again, shame on you! The problem with opioid deaths is not Dr. Webster or any particular clinician. It involves the lack of a single acceptable opioid-equivalence schematic (which is not possible due to patient variabilities and polymorphism); safe opioid conversions; use of several validated risk stratification tools prior to initiating chronic opioids; urine drug screens and knowing how to accurately interpret them; drug interactions; third party insurance providers refusal to pay for more expensive safer drugs and alternative therapy including behavior health; and many other factors.
Dr. Gupta playfully calls Dr. Lynn Webster, “Dr. Death” as coined by the decedent’s husband. Perhaps Dr. Gupta, you are “Dr. Death” since stories like these scare away good clinicians from treating legitimate pain patients, many of whom choose suicide over pain. If you want to speak about some of these issues, I invite you to contact me, as my attempts to reach you have been fruitless.
I encourage comments from equally enraged pain clinicians and patients that suffer in pain daily to comment herein. Unlike Dr. Gupta and CNN, I also encourage input from those that disagree with my blog comments herein.
To all pain sufferers that are watching this site, all of us from PROMPT wish you a safe, healthy, and happy holiday season, and good fortune for the New Year!
References
- Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report 2008;57(45):1226–8.
- McGinnis J, Foege WH. Actual Causes of Death in the United States. Journal of American Medical Association 1993;270:2207–12.
- CDC. Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999-2006.
- Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: volume 1: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2011.
Until these pain medication bashers live in constant 24/7 chronic pain,that destroys life as you once lived it,can they begin to understand how horribly we suffer!!My pain Doctor&I have a honest,respectful,relationship. We can’t control the people who fake pain&let their choices affect those who do suffer.SHAME ON THEM!When you’ve spent yrs. suffering,I can guarantee your uninformed opinion will change!
Shared. When will ever see news reports on how opioids keep patients functioning in their daily lives, walking, moving, socializing? “Patients use their opioids responsibly; they understand they are the treatment of last resort.” Will we ever see reporting on both sides of the coin? Choice of pain relief should be individual, without judgement, humanitarian.
I am tired of the Dr. Websters all across the nation being labelled the boogie man, and I am tired of this fake war on drugs covering up the real truth about who the real boogie men are and where the opium for the pain medications is really going. If you are lucky enough to even get any pain medications, they are so watered down that you would have to take a three month supply to even overdose. The media should stop everybody but the real culprits. Thank you Dr. Fudlin for standing up for Dr. Webster and for standing up for what is right and for being our voice!
If a patient comes to a doctor with a legitimate condition that causes chronic pain and is able to have the condition diagnosed by supporting test results, the government should leave the doctors alone and let them administer care to their patients without fear of interference and retribution. People who have conditions that cause chronic painstill have to maintain alife. What quality of life do they have when they aren’t able to work, participate in their kids lives, or have any kind of social life what so ever? I know that greed driven physicians have operated “pill mill clinics” and they should be stripped of their license for exploiting the needs of people for their own personal gain. However, Doctors that are doing their job diligently shouldn’t be told by the Government how to do their jobs. I think that the whole idea of pain clinics is ridiculous. Nobody knows you better than your family physician. These pain clinics are over crowded and therefore, the patient can’t possibly get the consideration from the doctors that they need. You go in, they rush you through the process, and rarely have time to do athorough examination of the patient because they have a hundred more patients in the lobby waiting to see them. It’s a joke!! I have spoken with many people that suffer from chronic pain and the general consensus seems to be that if people had access to appropriate medical care for their chronic pain, there would be far less drug trafficking. When people have mortgages and monthly bills and expenses for their family and so on and so forth, they don’t have the option of not going to work and are forced to seek relief of their pain from less than legal sources. It just seemed to me that when we had one doctor to treat everything, things ran much smoother. Family physicians are much more likely to see if tolerance or dependence is becoming an issue alot faster than a doctor that sees you once every month or two and has so many patients that he/she doesn’t even remember what you look like an hour after you leave their office. Family members who see a problem developing may also be able to relay this easier to afamily doctor rather than the answering machine they are gonnareach when they try to notify a pain clinic. It is time to take a look around and see that all the measures they have put in place to deter drug abuse aren’t working.Our law makers need to go back to the drawing board and keep going back to the drawing board until they get it right. It is so wrong to make decent, hard working families pay for the wrong doings of others. I bet if one of the people we elect to represent us had to go to work one day and hurt like us lowly people do, they would pray for adoctor to have mercy on them. Government doesn’t belong in medicine!!
Christy,
I agree with you completely about Pain Clinics being a joke! They are one of the worst places to seek help for pain relief because most the doctors do not care about the patient, like you said, they are just trying tor rush patients in and out because they are so overbooked it is ridiculous. I had one I seen for about 2 years and the doctor NEVER ONCE remembered my name, I always had to go through everything wrong with me on every visit….it was horrible! If they want to continue with the pain clinics then they need to Open More instead of Closing More, patients need somewhere to go where they don’t have to wait over 6 hours just to see the doctor and then they need to be treated like a real person when they do see them. I am sickened by the way Chronic Pain patients are treated anymore, they look at us as something less than human it seems and that our pain doesn’t matter. I am truly hoping for a change soon!
Oh Christy and Charity, we can hope and dream to see some changes or we can try to do something about it. Kudos to both of you for taking the time to express your feelings on this matter instead of sitting back and letting others do all the work. We are truly fighting for our rights and our quality of life. We are going to have to do it or accept things the way they are.
THAT is a hard pill to swallow, my friends.
Opposition to Kentucky House Bill 1 AKA the PILL MILL BILL:
https://m.facebook.com/profile.php?id=595049517218134&__user=100004736613852
Amen!!!!!
I suffer from chronic pain. I’ve said many times they treat animals better when it come to pain management. This became more evident to me recently when I was prescribed tramadol (which didn’t relieve my pain BTW).My neighbor’s 90# dog was prescribed twice my dose. When my neighbor went to his MD, he was told his records had been flagged for possible doctor shopping because he had gotten tramadol (for dog.) In the mean time my PCP sent my to a rheumatologist because she doesn’t want to deal with the inconvenience of compiling with the state & fed gov’t regulations. She did tell me to get a UV lamp & if I would smoke pot I wouldn’t need any meds! (Marijuana is not legal in KY!) Of course the rheumatologist won’t order any other controlled substances either, so I suffer. Maybe I need a vet!
Diane,
I understand your frustration. Having dealt with the situation in Kentucky since the advent on the “Pill Mill Bill” (as it’s known) you are certainly treated more like a criminal than a patient, and yes, even an animal might receive better care. I am guessing the implication with your neighbor was he was “faking his dog’s pain” to get the mild narcotic, Ultram (tramadol). Ludicrous, to say the least, especially considering he got flagged when the animal was clearly the drug seeker in this scenario. All kidding aside, there’s certainly nothing funny about any of this, but I was trying to point out the absurdity of this incident.
There’s a group on Facebook attempting to gather some people together to address the legislature in Frankfort, Kentucky this February. If you’re interested in letting lawmakers know how you feel in a forum where your side will be heard, unlike the treatment received by Dr. Fudin from CNN, visit the link below for more information:
https://m.facebook.com/permalink.php?id=595049517218134&story_fbid=620826931307059#!/profile.php?id=595049517218134&__user=100004736613852
Thank You.
Thanks, I’ll follow up
Twelve years ago I watched my dad die from complications of osteoporosis. He was only 46 years old. Now I am watching my mother suffer on a daily basis as a chronic pain patient who is severely undermedicated for DDD, carpel tunnel, pinched nerves, and several other issues I honestly can not think of right now. I only wish that they could actually see how these conditions affect her everyday life before they put labels on her or tell her she doesn’t really need that medication. We live in Kentucky and HB1 is killing people as surly as it is “saving” others. Although I personally don’t understand how that claim can be made seeing as how heroin use is skyrocketing. I have seen addiction to painkillers ravage my hometown, to the point there is now even a National Geographic show that features drug busts made on a regular basis, but I can not understand why so many are unwilling to accept that addiction and dependence are two different animals.
To make things even lovelier, I am showing symptoms of inheriting these conditions from my parents at the age of 32 years old. It saddens me to know my future and the pain and suffering that is sure to come with it. I look at it every time i see my mom’s hands curl into a claw and her arm draw up to resemble a T-rex. I watched it every day when I would see my dad sneeze hard enough to break the vertebrae in his neck. To be honest the thought is overwhelming and makes me not want to even see that future. Something has to be done. How many lives will have to be lost before they realize that this is not the way to fight the war on drugs? How many will have to suffer and be labeled an addict in order to want to live a semi normal life? Why is even one not considered too many? I’m afraid these questions will remain sadly unanswered.
Watching a loved one suffer each and every day with chronic pain and inadequate pain treatment is heartbreaking. These “one size fits all” policies do not work for the patients or to curb actual drug abuse. Politicians should not be able to dictate to doctors the plan of treatment for the patient.
Hello, I am a 42 yo make with full blown aids going on 23 years. i was given only 5 years to live and ye here I am still alive not doing so well but I am here. Due to the changes made in Kentucky with the House Bill 1 ( pill mill Bill) has effected me in the worst kind of way
I as forced to stop taking HIV meds in exchange for Opiods and a patch i have no other options but to die of AIDS. It hurts alot to know that my life has no value at all now.due to this new bill.
If anything I hope things get better for many and hope that all these stories somehow help someone live with chronic pain .I dont want to die however it seems I have no choice in it. I can go back on HIV meds but I will be in the worst kind of pain and I would rather just die and get it over with.
I wish everyone the best and hopefully changes will be made to help those in pain.
Most sincerely and always a Friend – Rain
Rain, my name is Christy Richardson and we are in the facebook group Kentucky Pain Care Action Netork together but I haven’t had the chance to speak with you yet. I was reading your post and I am just left dumb founded. I really don’t know all of the changes that HB1 ( or the pill mill bill) calls for except for changes of the schedules of some drugs into a higher classification and tighter monitoring of these drugs but if I am understanding what you said in your comment correctly, you are saying that you had to make a choice as to what was more important to you between living and living with no quality of life, correct ? I hope that I haven’t offended you because this in no way is an intention to do so, I just want to understand exactly how far this “Pill Mill Bill” goes. I would love for you to explain to people that there is MUCH MORE to this bill than most people probably even realize. I would love to know your story. Your case seems to embody what the people in chronic pain face. Supporters of this bill are counting on people to be uneducated to the facts of this bill, the are neglecting to let the whole truth out. That is why these groups are important, we can share our stories with one another and understand that every aspect of this bill will only serve to make things harder than the chronic pain patients and their families. Thanks and I’m so sorry that I talked so long, I will pray for you and your family.
Hello, I am a 42 yo male with full blown AIDS,Osteoporosis, cataracts,spine disease and alot more other health issues that cause pain such as my Liver due to the old HIV meds doing damage to my body..I shouldnt have to live with Osteoporosis in bad form at this age in my life.. so much that goes on with an AIDS patient that its hard to keep up with all the diagnosis, been having seizures so thats now added on to my health issues.. it just keeps getting bigger and bigger.. I hope this helps explain something. I had to use hosperus to help with the pain because of the new pain pill laws and I was forced off my HIV meds because Hosperus is about the end of life.. HIV will keep me living longer but how bad off do i have to be before one gets tired of the side effects from this disease and the toxity of the HIV meds..
Dr Fudin,
Thank you for this Blog, I too am a pain management pharmacist, and I have had the esteemed opportunity to work side by side with this man of great integrity, who had taught me more about compassion, empathy and great professionalism. Along the side of him was an exemplary multidisiplinary health care staff that shared these same traits. I realized upon entering his clinic that he had seen some tough patients with multiple comorbidities with every reason to be a patient in his clinic yet would be quickly turned away by others clinics because of the degree of managment difficulty. When I first joined him, I asked him why, he said…Keri, they have nowhere else to go. If we dont see these patients who will…. For those who critisize that his pain clinic was operating outside the standard of practice, please see Rauck et al J Pain Sympt Managment 2006 v 31(5)393-406. that characterizes the Severe Chronic Pain Patient from 39 centers across the UNitied States, the average number of non opioid medication these patients were on was 12, which comprised of antidepressants, anxiolytics, muscle relaxants, antipsychotics, sedative hypnotics, anticonvulsants to a great degree. The median intrathecal opioid OME was 1200 mg/day, the median oral 183 mg/day ( 1 to 2126 mg/day). Pain is a CNS disease and unfortunately CNS acting drugs (usually depresants) are the mainstay used to modulate the pain signal. Adjunctive medications are used in hopes to reduce the need for opioids. The loss of Mrs Bosley is very unfortunate. I did not know of her as a patient,but I do know Dr Webster and this story was just that a story told by a grieving angry husband, sensationalized by the media however any sensible individual could see the gapping holes in this story. . It did not in any way shape or form resemble Dr Webster as a physician or the clinic that I am proud to say I worked at. Absolutely! Spouses and family memebers are always in attendance, and encouraged to attend, we provided them the same instructions and cautions that we do the patient so they can be another set of eyes. Nobody said the medications we use to treat pain are benign.. it takes a health care provider team and the family members at home to help manage these patients.
Keri, Thank you for your kind comments that come first hand working with Dr. Webster. It is especially nice to hear from someone who worked with Dr. Webster and observed his caring nature first hand. Happy holidays.
Warning: This may be a lengthy response. The main problem here is that Opioids make a perfect fall guy for people, they are the perfect thing to blame when something horrible happens to a loved one. The issues are not with the drugs themselves, the issues are not even with the doctors who are prescribing the drugs (clearly was stated he was only prescribing 6 tablets in a day and the women took too many resulting in their death) No, those aren’t the real issues….. one of the real issues is Legislators now thinking they are medical professionals, pharmacists thinking they are doctors and angry families out to blame anyone but the real culprit. The people abusing the drugs are to blame but instead of the family blaming the person who took too many pain pills they choose to try and blame someone (or something) else for their loss. Understandably these men are in pain but doing a news report bashing the Doctor for trying to help those women is clearly not the answer, the only thing that accomplishes is more difficulties for those of us needing pain medication on a daily basis to have a somewhat normal existence. Both men stated their wives had stopped using prescription pain medication for a time but yet they chose to go back to the doctor, leading any normal person to believe that their pain wasn’t being managed by everyday over the counter medications and if it was being managed then why would their husbands agree for them to return to the doctor. Hind sight is 20/20 and I am sure it is easy for them to look back and say “I shouldn’t have” but the fact is….they did agree to it; so they must have known their wives pain wasn’t really being controlled by the OTC medications even though they hated to admit it. Throwing Doctors like him under the bus only adds to the chaos in the medical field right now, he seen his patients, determined a treatment plan and then let his NP take over for him and trusted them to keep him up to date on the what was happening with the patients; just because the Doctor didn’t look over their files daily doesn’t mean he didn’t care and it doesn’t mean he was negligent, it only means he was attending to other patients while trusting his staff to keep him informed. It boils down to the women being addicts, once they started taking more of the medications than prescribed and getting their refills too early then the family should of stepped in and done something. We can’t leave everything up to the Doctors or the Government, some personal responsibility must be taken in cases like these! If the husbands were that worried about their wives then why did they not do an intervention, why did they not take the medications and only give them what they were allowed to take in a day? They were supposedly counting them on a nightly basis, why not go a step further to save their lives? People needing pain medications for chronic illnesses have a hard enough time finding a Doctor who will listen to them without judgement without people adding insult to injury by trying to take another Doctor out of the field because they feel guilty and angry at themselves. With all the new regulations nowadays a person is treated like a criminal as soon as the staff finds out they need (or are taking) pain medications, it is an instant change in how we are treated! Why should everyone else suffer due to people becoming addicted to their medication? We didn’t have anything to do with them, we have taken our medications for years without problem, without incident, without worry but now because a few people became addicted and overdosed we have to be treated like liars, criminals and lowlifes! I feel for the families of these women but I wish they would open their eyes to see that the Doctor was merely doing what he thought was in the patients best interest. The men should of went to the appointments with them and talked to the Doctor personally once they felt their wives were in danger, but instead they didn’t and the ultimate price has been paid. I do not blame the men, I apologize if that is how it sounds….I blame the women but the men are the ones who now want someone to blame but they need to take a step back and realize how many people they are going to be hurting if they (and the media) keep running articles and interviews portraying good Doctors as villains. I could go on about personal experiences and my anger toward all the new legislation but I am hoping I have made clear my disdain for the involvement of anyone other than medical professionals in my private medical treatment.
Legislators, of course, have the right to dictate the practice of medicine and regulate substances. In addition, everyone else has a right to be heard on issues related to substance use and the practice of medicine. The need for government, as Madison indicated, stems from the fact that people are not Angels. Doctors aren’t Gods moral vice regents descended from heaven and neither are anyone else. As the saying goes the only thing worse than government is no government at all. And without regulating doctors education and practices and the use of substances there would certainly be a lot of unscrupulous practices and more people would suffer. Only the virtuous are capable of freedom and so whether you may believe your perfect and should be allowed to do whatever you want and your doctors should be allowed to do whatever they want- obviously that won’t be happening anytime soon. And anyone who has read the history of medicine would understand the need for regulations. Despite the work of Semmelweis and Lister- doctors still don’t like to wash their hands between seeing patients. Theres oversue of antibiotics which has resulted in MSRA amongst other problems. Doctors who do research often fudge results,. A doctor in NYS injected hundreds of people with the same needle- over 100 developed Hepatitis. Its selfish for people to demand their own freedom to do what they want If your unhappy with opioid regulations-needless to say you can petition government. But its more than a little off to claim government has no right to interfere with the so called sanctity of your relation with your doctor or to allow any person to use any substance in any way that they want.
The overreaching, poorly thought out, and downright cruel changes that have resulted from Kentucky House Bill 1, are an excellent example of fame-seeking politicians interfering with the doctor-patient relationship. Subsequent to its enactment, a massive number of general practitioners refused to prescribe any narcotics, even to long-standing patients in obvious need of strong medications. These patients, often older, feeble, and, well, in a great deal of pain, were turned loose to find a pain doctor. Since the state had systematically closed nearly all the pain clinics, it has been a good result for legislators, not so good for cancer patients, post-surgical patients, or any patients who suffer from moderate to severe unrelenting pain.
One example of the government run amuck. Ask Floridians how they feel about the government in their exam rooms with them.
Ken, You are exactly right. See Kentucky’s Pharmacy Crawl and Dancing to the Pharmacy Crawl for Opioids.
Yes! BOTH excellent blog posts, and sadly, even MORE accurate today. People also need to realize that this “anti-opioid” agenda, made worse by sensationalized stories like CNN’s, has infiltrated all aspects of pain care. More and more stories have come to light about patients trying to fill short-term opioid prescriptions after MAJOR surgery, or serious ACUTE injuries, only to be questioned and denied at pharmacies. Everyone is one incident, diagnosis, or surgery away from the torture of being denied adequate pain relief. This is also true of patients with cancer and end-of-life pain. if we don’t get some education and accurate information out there, this is going to become epidemic in ALL aspects of pain care. No one is immune to this ignorance….
Charity,
Your comment is spot on, I had a friend that got the same amount of medications as me each month.
Yet he could not control his intake of medication, he would call me asking me to help him out till the end of the month, to which my answer was no. He would call me back and say God is watching you make me suffer. And on and on it went till I finally changed my phone number. For some people no matter what they just cant control their intake of pain meds. This is when a family member should step in and dole out the medication as it is suppose to be prescribed.
And in the end look who pays the price in pain, us the truly suffer.
Thank you.
Charity,
Thank you for saying what I personally believe myself. Where is personal responsibility? I have been on the same dosage/medication for many years. I take them as prescribed and would not say it was the doctors fault if I didn’t. I read the documentation that comes with my medication and follow it. If politicians need to make laws, let them make laws putting the responsibility where it should be with individuals that abbuse the medications. I’m in chronic pain due to a medical mishap that occured to me. I never asked for this to happen to me but I too have been treated like like a criminal for needing pain medication so I can live some simbulance of a normal life. I too have had a horrible time finding a compassionate doctor to work with me so I keep looking and then I’m labeled “doctor shopping”. I also live in Florida and often have to drive from pharmacy to pharmacy because the companies NOW don’t carry the medications that I have been on for over seven years and that they have carried all that time.
In order for CNN to maintain a high number of viewers, it is apparent they, Sanjay Gupta, and Anderson Cooper must sensationalize stories, presenting the fiery side of things, not bother so much with those pesky details that don’t really serve to spice up the piece. It’s therefore consistent with their goals to talk about the evils of opioids, the doctor who was dolling out the poison, the grieving husband, of course, and they even brought in Dr. Kolodny (PROP’s leader). It’s obvious these drugs should be banned because they cause so much harm.
But, wait a minute here, haven’t these drugs been known to help some people? Between the DEA, PROP (Dr. Kolodny’s group), overzealous congressional leaders, and the one-sided stories pumped out by the media, patients with legitimate pain issues are finding it increasingly difficult to find physicians who will treat them for their conditions. IF a patient suffering from chronic pain finds a doctor willing to treat their issues, IF opioids are prescribed, there’s a chance the pharmacy will refuse to fill the prescription for any number of reasons. Literally adding insult to injury, pain patients must sign a pain contract agreeing to random drug screenings, random pill counts, an excessive number of visits to the doctor, only to be then be questioned by a pharmacy employee, because, by now, the patient (remember the patient?) hasn’t been through enough.
Another organization, PROMPT, the antithesis of PROP, was never sought out for an opinion on this story. No chronic pain patients were asked what their lives would be like without the assistance of pain medication. This, you see, is just not very exciting to watch on the likes of CNN, a once valued news channel that, more often than not, sinks to the level of “scare journalism” seen on other, less professional, less reliable stations. What a shame. Shame on you, CNN.
Dr. Fudin, looks to me like you’ve managed to find a place on the internet for people who haven’t yet figured out that long-term opioids are a bad idea.
I’m amazed by the comments here. I think CNN’s coverage was completely fair. The fact that 20 or more of Dr. Webster’s patients died of overdose is an important news story because he’s considered an expert on the topic of safe opioid prescribing. The quote in the CNN article ( http://www.cnn.com/2013/12/20/health/pain-pillar/ ) sums it up nicely: “But when you think about the fact that he’s had multiple deaths in his clinic from overdose, it suggests that the system he is teaching is seriously flawed.”
If even an expert can’t prescribe chronic opioid therapy without killing his patients, how are busy primary care doctors supposed to do this safely?
I’m also amazed by the hypocrisy and vitriol of the comments here. Dr. Gupta treated Dr. Webster in a fair and respectful manner. He gave Dr. Webster an opportunity to be interviewed. The suggestion that Dr. Webster turned down the offer to protect patient privacy doesn’t make sense- Dr. Webster could have easily participated without answering questions about specific patients.
The same folks who complain that Webster was treated unfairly are making vicious personal attacks on Dr. Gupta and on Mr. Boswell. Shame on you for you malignant hypocrisy.
Rick,
No one made these people who overdosed take more medication than they should have. Doctors cant watch their patients 24/7 . So you think people who haven’t yet figured out that long-term opioids are a bad idea. Tell me Rick have you ever suffered a day of chronic pain in your life, every day all day, all year long. These medications where prescribed correctly but taken incorrectly. This can cause death if you don’t follow the doctors orders.
Your amazed by the comments here because you never suffered day after day from chronic pain or maybe you have and just have not reached the severe state of chronic pain yet. The only thing flawed are people who cant follow their doctors orders.
“looks to me like you’ve managed to find a place on the Internet for people who haven’t yet figured out that long-term opioids are a bad idea” – Rick
Anyone who makes such an ignorant, blanketed statement like this is clueless about the kind of suffering that serious pain conditions cause, and the kind of relief that opioids can provide….even longterm. No one is saying these medications are right for everyone, but to deny them to patients who benefit from them is cruel, barbaric, and a human rights violation. Such views are completely out of touch with reality.
The story did NOT tell us how many other substances were found in the deceased, whether or not they even had an “active” prescription for opioids, and if they did, if it was being taken “as prescribed”, what their mental health status or history was, whether or not they were being honest with their providers, etc…
It is also quite obvious that we know nothing about how any of the other patients died, if they were current or past patients, if they had severe disease / pain progression that caused suicidal thoughts, Pain patients who overdose or commit suicide are often UNDER treated for their pain, simply cannot tolerate life any longer, and are seeking RELIEF. I imagine that the patients who were seen by Dr. Webster were ones that other providers gave up on, abandoned, and/ or refused to treat. THAT is a reality for many pain patients. Some of those may have died far sooner if they hadn’t been seen by Dr. Webster. Too many doctors are too afraid to treat patients with pain. Overzealous and uninformed lawmakers & regulatory agencies are causing both doctors and patients to suffer. If things continue on this path, there are more deaths and suicides to come.
The CNN story was biased, one sided, slanderous, and incomplete! Also, when there are doctor/ patient confidentiality issues and/ or litigation pending, doctors do NOT, and should NOT comment….period.
Your being silly to assume opioids to assume opioids are the only powerful pain treatment- i guess you never heard of ketamine,nerve block, radiofrequency denervation or noesitherapy-to name a few. Proponents of the opioid economy are often ignorant of alternatives to opioids and claim others who dont share their ignorance are either cruel or ignorant- i am neither. But I am not surprised at the comments here reflecting a lack of knowledge at the treatments for pain.
This is like saying….” too bad you’ve never heard on bananas, apples, and carrots! HA!” To ASS-ume people haven’t heard of these other treatments (especially old & tired, already tried, non-FDA approved, or completely inappropriate for certain types of pain, alternatives), is what is so “silly”. Someone who advocates for continued access to opioids is NOT promotiing them, or not advocating for changes in pain care. There seems to be a very basic reading comprehension issue going on with you. You are reading things that simply aren’t there, and responding in a way that is bizarrely irrelevant, and manic, and ineffective….. Literally using exact phrases, sentences, and words that have been repeated endlessly on other blogs. Some of which were originally authored by OTHER people!!! It is doing little for your “cause”, whatever it is… I truly feel sad for you & the compulsion that drives this “gibberish” as if it is new, ground-breaking information that even highly educated professionals who specialize in pain care are unaware of. FYI: You have not brought any new insights here.
I know very well of injections, implants, surgeries, cutting and cauterization of nerves. I also know there are risks involved and no guarantee the pain will be gone. I also know these procedures are expensive, overpriced even, whether I have insurance or not. I am genuinely concerned that Medicare is not gouged by doctors more aware of their bank account, than their patients needs.
In these dire economical times, I think legislators should concern themselves with costs and budgets. An office visit costs @ $100. With an injection using ultrasound the price @ $800, up to twice a month. The implant operation, NOT PRICELESS! Is anyone so ignorant to think these solutions would take away my need for pain medication? I could lose my ability to walk!! I treasure my ability to stand and walk. I love my legs, PRICELESS! After my accident, amputation of both were a possibility.
I saw a pain specialist, who gave me injections (that gave me no relief) for a year. He also prescribed Lortab, 3Xday. When I refused more shots (they are painful, sometimes bloody), he started pressuring me to have a surgical implant that would send a mild electric shock to my nerves. He wanted to put this in my thigh–the only part of both legs without a surgery or titanium plates, rods, screws or wires. Even though I was a patient for a year, and every visit I marked on a drawing all the places I hurt (my R ankle is worst) and I told him each time… my daughter came with me and voiced her concern about losing feeling, control or strength in my R leg, since my left leg never healed completely. He said to me with shock, ”You have a rod in your left femur?”
And, to add insult to injury, he began weaning me off pain meds, because I didn’t want to be poked, prodded, sliced, stitched, scarred or bullied by someone who shames the definition of doctor. Even though I stopped going there voluntarily, I am having trouble finding a new pain clinic to take me.
I am not asking for an unrealistic dosage. I pass all my urine tests (another $45-100 a month). I just want to walk without excruciating pain, play with my young grandchildren, and keep my house clean. I’ve been without a script since September…all I do is lie in bed. The lack of exercise effects my health, which was excellent. Now I have high blood pressure, high cholesterol, weight gain, depression and I am a burden on my family.
P.S. Thank you, Dr. Jeff, for the compassion and courage to be outspoken on the subject.
Dave,
Assuming that I or any CIP Patient has not explored all options available to us before we turn to Opioid therapy as part of our Pain Management Treatment shows a lack of research on your part. We are well aware of the alternatives. Most of us have been poked, prodded, injected, burned,pulled, pushed, stretched,you name it we’ve tried it in the hopes of finding relief without having to take narcotic medications. Sometimes they are the only therapy that will consistently allow to live a somewhat normal life in the face of unrelenting pain, which we will have for the rest of our lives.
Sonna F.
Kentucky Pain Care Action Network
You are exactly correct in that there are a wide range of non-opiod treatments to help many forms of chronic pain. I am a believer in the effectiveness of alternative methods of pain control. There are cases however, where other treatments are contraindicated. My point exactly of why this bill is a bad idea. There are no gray areas. People are all different in the way our bodies work. What is good for some isn’t necessarily good for others and still for others it would be disasterous. My point is, a law doesn’t comform to individuality. When we allow our government to tell our physicians how and when and where they may treat us, the patients and their families are the ones that suffer. Medicine has too many variables to be dictated by government.
Screw you….go and have your chest ripped open to clean out wide spread cancer and have a physician accidentally cut a cord that left me in a coma and 5 years of unimaginal pain. I’ve had those pain Dr.s try and put me on all those 10 thru 12 different pharmaceutical meds. Dear God do I HATE human beings as yourself because you want to lump everyone in the same pile. Thank God for now my Oncology Dr. prescribes my ONE pain medication….not all that shit you’re blabbering about….IDIOT. And just so you know I’m a former fitness center owner ( Fit For Women) and have always lived healthy and happy. I do my part still to live the best life I can even though I don’t want to live on a planet that I have to share the air I breathe with such idiots as yourself. Keep your energy focused on prescribing all those drugs on another site. Ugh, disgusting human beings!!! BTW…Most people can’t afford all the prescriptions you want everyone to swallow everyday which may work for some people but mostly it’s just a kickback for the crummy pain Dr.s that insist that all those so called prescriptions work but never mention that they mostly render humans to drool and become foggy and unable to socialize and drive a car and so forth. I know this post is old that I’m replying to but I sure do hope it’s read by his tiny brain.
Sorry I didn’t address the few names that my postings were aiming for but I’M sure most of you know one of those are for the IDIOT DAVE and R.
You must read my post on a reply from one of your messages. You really aren’t thinking the whole thing through and obviously not as smart as you think you are. I understand these post are a bit outdated and hopefully you’ve learned some things over the last few years…only possible in most cases when a human being has the capability to open his or her mind on a much broader range.
si Rick, sounds to me like you have no history of dealing with chronic pain yourself. I am a chronic pain suferrer who has been in opiate therapy for 9 years. Originally I was in pain management for chronic cyphalgia due to concussions I sufferrd as an adolescent and several I suffered as a college athlete. While in pain management at a pain clinic while living in St Louis and attending grad school, I was attacked after I exited the metrolink on my way home from school. Everyday after class I would walk to the metro (St Louis’ version of the subway) and when I got in my seat, I would take my pain medication on my way home at the same time every day. On that fateful day in March 2010, a man sitting behind me and across from me observed me taking my medicine. He then followed me off of the train, followed me as I walked to my car, then came up from behind, pistol whipped me in the back of my head, then as I turned around to face the man who accosted me, I was looking down the barrel of a .380. From out of that .380 barrel rang 3 shots. Two of those shots hit me in they neck. One missed my artery by 3 milimeters, the other missed my spine by 2 centimeters. The bullets are still in my body. One is lodged in a vertebrae and the neurosugeon said it was too risky to try and extract it. The other bullet rests in my upper chest between my left lung and spine. It doesn’t cause any problems for me, so again the neurosurgeon decided it wasn’t worth sawing my chest open to take it out since it doesn’t cause any pain or any other problems for me. However, the bullet lodged in the bne of my spine in my neck gives me many problems, of which one is obviously pain. Another is that it make my cyphalgia worse. Another is that it is a catalyst for debilitating migraines that are so severe they induce vomitting spells that often last anywhere from 24 to 72 hours. I am on very strong pain meds for these migraines, and when a bad one strikes, my medicine does not offer any relief. The one thing that does offer relief when one of that level of severity strikes is marijuana. I am a huge advocate for medical marijuana. But, I cannot smoke marijuana anymore because of the new laws that regulate opiate use. So I have no choice but to suffer and just e the headache out, however long it lasts. The only other thing that can stop a headache of that severity is an IV administering of zofran and dilaudid. But since I am prescribed pain meds regularly and due to these new laws ( which I do understand are in place to try and help curb a major problem) I cannot get any opiates fromthe ER because I get them regularly from my dr. So in closing Rick, long term opiates are not a bad idea. Providing long term opiates to high risk patients who are likely to abuse them are a bad idea. If you suffered chronic pain you would then subjectively understand that for those of us who suffer severe chronic pain and use our medicine correctly, it is a godsend. Objectively, you are in no position to tell chronic pain sufferers what is or isn’t good or bad for us. I don’t advise you on what type of healthcare to obtain because I DON’T KNOW YOU OR ANYTHING ABOUT YOU. So don’t tellbme what is or isn’t good OR bad for me. I think ignorance is the real problem here. And I don’t mean ignorance negatively, I mean it as its true definition, lack of knowledge. Best of luck to you.
Re: Sunday Gupta
The reputation of neurosurgeons as less than adequate pain managers is deserved. That Dr Gupta took so long to finally “get” medical marijuana suggests that he needs to reserve his comments for topics within his scope of expertise.
Dr. Jeff,,,,,,,,,,,,,,,,,,,,,”Sanja Gupta” < I doubt he would ever grant you an interview……….."GasBAGS", never do. "They can't WALK THE WALK, so, Can't Talk the Talk." That was an old Military quote. And he would never fit that bill………………EVER………God bless on this Christmas Morn,,,,,,,,and your daughter, God love her for backing up her father………….come on Dr. Gupta, throw down with Dr. Fudin!!!!! Herb "doc" Neeland
Thank you Herb. Merry Christmas to you and yours. My lovely daughter Sarah is on her way to Australia today to visit one of her best friends. Ah…summer in December! G-d Bless.
Just when I had breathed a sigh of relief, Dr. Gupta decides to wave the anti-opioid flag and put people like me in jeapordy once again. Dr. Fudin, I really hope he will give you the professional courtesy you deserve and show the other side of the coin. I live in Florida, and that’s not a state any pain patient should relish living in. Since the disease I have is rare and untreatable (I was turned down for stem cell therapy because I didn’t die in my ’30s like most with my disease), and now I have been told I have multiple genetic syndromes that neurontin and all the anti-depressants not only can’t touch but have proved to be riskier for me than opioids. So, I at least have a responsible, hospital-based pain specialist who gets me through the times when I scream like an end-stage cancer patient and then adjusts my meds accordingly when my symptoms abate. Having 3 major genetic, pain-causing diseases is no picnic, but I wish Dr. Gupta would at least consider US before he gets on the “bad opioid” bandwagon. Opioids have given me a better quality of life with this set of complex diseases.
VEDS Patient, I have reached the next level with regard to speaking with Dr. Gupta. The staff sent me his email to send a message which will first be reviewed [I suspect] by the producers. That you for your well-wishes and support. I’ll keep you posted.
I also feel like a guinea pig for pharmaceuticals. A few years ago, the new trend was to be health savvy, to do your research and come prepared with questions. I have found that most doctors take offense to suggestion and if you know too much about medications… you must be a ”drug seeker” When I cited medical journals, the doctor, I mentioned above, actually printed out 2 pages on addiction and drug tolerance… His source?? Wikipedia, lmao.
I was a leader of a chronic pain support group for several years, during which time I had the opportunity to meet many of spouse whom just could not understand the difference between tolerence and addiction when it comes to the chronic pain patient taking opiates. This seems to be the case with this spouse who also doesn’t want to admit that there was allot going on in his marriage other than just his wifes pain. Since he could not control that, he now only has the doctor to blame and Dr Gupta’s journalistic employment took over his researching .
If Dr Gupta wants to do a Great Story, I suggest since he is a Neursurgeon, he should stick to his field and go back, way back to the 1970’s though the early 1990’s and tell about how Eastman Kodak made a product called Panopaque. This product was used without “informed concent” to take Myleograms. If it was not removed from the spinal canal properly, this “oil-based dye” stayed in the dura forever and grew lesions. Surgeons such as himself knew then and know now that the end result of such an insult to a patient could be a very painful incurable disease called Adhesive Arachnoiditis, for which narcotics are given for the pain. Yet to this very day, many of his peers will say this irotrogenic disease never happened. But, they couldn’t hide the recent ISP’s with the bad serums that should have never been injected into the thecal space of the spine in the first place could they?
So Dr Gupta, until you can answer how a patient is to live with the pain that your speciality has brought to them, should you really have anything to say about a profession who sticks there necks out to save the lives of the messes you have marked as “failed”?
Dr. Jeff,
Thank you for all your help in helping those of us who seem to be ignored by so many of the medical professionals. Most I feel are uneducated in the treatment of pain, I think my primary doctor said that he spent hardly any time learning about this terrible disease that causes millions of patients to be ignored, labeled as “drug seeking behavior” and making the patient feel even worse than they already do. When I worked at the hospital in Quality and Performance Improvement I found a wonderful nurse who has been a Hospice Nurse for over thirty years and also helps doctors understand treating patients with chronic pain. Her first question was to the doctors was, “what is the number one mistake that most physicians make when they treat people with severe chronic pain?” Their answers were “we give them too many medications”, “we cause them to become addicted to pain medications and then they will never stop” “we don’t know what is the correct medicine to give them” etc. so she wrote on the white board that ” the number one problem is patients are being under medicated for their pain! . They were shocked! But I was proud of our doctors as they asked some great questions and I felt it was a step in helping them understand that no they don’t become addicted they become dependent but it is easy to tritate the medicine down when the patient no longer needs it and they will be fine. No one wants to take a bunch of pills. She also told the ED doctors as they seem to be the most prejudiced and even mark patients charts in red “drug seeking patient”. She said have you ever thought that this patient is not getting their pain managed properly and so they have no where else to turn. Why not set them up for an evaluation with a Pain Specialist. I was shocked at the things I saw and often wondered why these doctors ever wanted to be in this profession. I remember in my young years of working there I also worked in the ER department and the first thing the doctors looked at was their insurance type, not all but a huge amount of them did. We deserve the same respect and treatment as any other patient with any disease. I did not ask for this. I have always been into health, I am a vegetarian, I am not over weight, nor do I smoke cigarettes or drink alcohol. Until I had the surgery that my surgeon promised me I would be able to do all the things I loved I was still skiing (water and snow), hiking, biking, swimming, roller blading I was not a couch potatoe. My whole family was into fitness, one played professional sports, my daughter did competition gymnastics and both my girls managed a health club all through college, taught classes, were personal trainers. My one daughter can take a man down who weighs 60 lbs more than her because she is solid muscle. So not only did I lose my ability to do what I loved, I had to quit my job, sell a business I had just started, lost my independence. I ended up in a wheel chair for two years. I do not want pitty, but I have the right to at least live with some pain relief, I am never pain free, never. This is my life at 59 years young. I had so many plans when I retired but those are gone. I just live day to day and try to help others who are worse off than me. So bless all you pain warriors, and thank God for the doctors that are smart enough and care enough about human suffering to stand up for us! You are the true doctors who are willing to go out on a limb to help those in need. Thank you, thank you from the bottom of my heart.
Nancy, You are quite welcome. Thank you for your comments.
Dr. Gupta seems adamant in his concern for the proper use of opioid therapy. However there are more convincing and respected ways of addressing his concern. His predator demeanor on Dr. Webster’s clinical judgement in one patient case is hardly a justifiable argument against opioid use. Dr. Fudin has hit the nail on the head in explaining the appropriate causes to opioid deaths, including the lack of an accurate opioid equivalence schematic. A thorough evaluation of these causes would be my recommendation to Dr. Gupta to voice his concern to opioid death instead of using Dr. Webster and other pain management clinicians as his scapegoat.
Instead of offering slanted opinions and limited facts it would be very refreshing for a news organization such as CNN to put together a piece in which two sides can come together and offer opposing arguments regarding an issue. I think having an open debate regarding the use and prescribing of opioids in this country is long overdue and would provide insight regarding the issues patients, doctors, and our heath system face.
Ryan, Thank you for your support and comments. Yes, a debate or at least an open discussion could go a long way to help us understand why Dr. Gupta took the approach he did, and perhaps tell the story on a more global level to show that pain clinicians are not monsters.
Anonymous,
It seems the treatment of chronic pain has changed over the past 14 years.
All the negative reporting leads people to believe half truths. It makes compassionate
doctors that treat chronic pain look and sound bad. When all along their just trying to help
people that suffer from intractable pain. Pain that will never go away and can last a lifetime.
I don’t think regular people truly understand the consequences of bad reporting and how it leads to
making people suffer with chronic pain.
I’ve had intractable pain in my body that doctors cant do anything about. The only relief I get is from
aggressive pain management. I’ve dealt with this ongoing chronic pain for 24 years now.
Imagine that if you can waking up every morning to yet another day of never ending ongoing chronic pain. Its like living a nightmare each ad every day, somehow I’ve made it through this long and I’m only 58 years old. Can everyone that reports on TV please tell the story of those that truly suffer and what its like to live a life with ongoing pain. Thank you,
Dave B,
So you think Pain Specialists poisonous enthusiasm for profit and pharmaceuticals lead to the opioid epidemic , so what doctors profited. And you see no shame with the one sided view of Dr. Gupta, but you do see shame in recklessly prescribing of opioids in most Pain Specialists. You say for cancer pain there are treatments like TENS that have proven effective, when they don’t have long to live to begin with, why would you subject the tens unit to a already sick patient with cancer.
You say Opioids can spread cancer, how so.
Mark S Barletta
MArk- If you viewed the vise- youll see Dr. Gupta tried to get a comment from Dr. Webster. Even so, I think he knew, that under the circumstances, Dr Webster was better off not commenting.
With regard to cancer- as Paracelsus is wrong for a doctor to assume a person wont get better from a illness- and certainly there are numerous cancer survivors. And when it comes to opioids spreading cancer- maybe you need to do a little more research.
Shut up!!!! Go away. You’re not getting it. Leave everyone alone and stop trying to convince someone you’re right. LEAVE IT ALONE. YOU’RE NOT GOING TO WIN THIS DEBATE!!!!
Dr. Fudin:
I believe we all agree that regardless of which camp you reside in regarding your views on chronic opioid therapy, the CNN piece was less than objective. My greatest concern stemming from the battle being waged in the media is the lack of clear direction we receive from the DEA and state licensing boards regarding safe harbors of practice. Because of this many get their “education” on appropriate patient selection and prescribing norms from the media vs. practice guidelines or well-designed RCTs. Potentially what I observe is limited geographically to my area, but we have essentially created a system of passing the buck, and patients are caught in the middle, similar to children being told to “go ask mom / go ask dad.” Our patients are referred to pain specialists who, in turn, send the patient back with recommendations for opioid therapy to be prescribed and monitored by the primary care provider. I see this every day. The PCP is then left to decide who is a good candidate for chronic opioid therapy. The monitoring must then be done in the same 10 minute appointment that preventive care, diabetes, HTN, etc. are evaluated. I believe the reason the story on Dr. Webster has had such visceral response is he is not one of the hacks that we so often read about in the papers that are clearly peddling controlled substances for profit, but a well-respected clinician that many, myself included, attempt to learn from in order help ease suffering while at the same time keeping our patients safe. We do have a problem in this country of over-prescribing of opioids without clear goals in mind, however, stories like this one is not the solution.
Thank you for providing this forum.
Instead of wasting resources on media coverage that is misinforming the public and attempting to tarnish a well-respected and highly qualified provider’s reputation, CNN should consider interviewing Dr. Fudin. Not only could this turn into an amusing debate, but the public would be provided accurate, objective information.
It was pain specialists poisonous enthusiasm for profit and paharmaceuticals that lead to the opioid epidemic-and i can see that when it comes to pain care the pain specialists show no conscience. It reminds me of what Dr Fishman said about pain specialists becoming insensitive to the suffering of others. And dont we know that when the AMA and AAPM had a summit they agreed that the education of pain specialists is inadequate. And obviously pain specialists lack both technical and nontechnical skills when it comes to paion care. Ill be sure to share with Senator Grassley all the careless comments here which only reflect that the poisonous enthusiasm for suboptimal and dangerous treatments continues on in the hearts of poorly trained pain specialists.
I admit there were some greedy doctors and businessmen who only saw $$$. Well in Kentucky, part of the law passed, HB1, addressed that very problem. Clinics can no longer be just a business venture. They must be owned and operated by a Medical Proffessional. The clinics MUST take insurance, which prevents them from being a cash and carry business with no paper trail. And I believe, the prescriptions must be filled off-site.
Just these changes would have fixed the pill mill trade. All the other rhetoric is there to make an impression on the public and to keep the DEA plenty to do besides going after real drug lords, cartels, and gangs….someone might get hurt…or their feathers ruffled.
I 2nd this!
Thank you for your kind comments Sonya…looks like you learned well in the Pain Management Elective. It was great seeing you at the ASHP Midyear. I’m looking forward to your post with student peers very soon. 🙂
Mr. Bosley comes across as being very no-nonsense and straightforward. Dr. Gupta should have also asked him how and why did he allow his wife to return to this mode of treatment, if it was so obviously disabling and dangerous for her?
I see Dr. Sanjay Gupta of CNN has reversed his previous opposition to medical marijuana and has apologized for his past views (https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=38&cad=rja&ved=0CHYQFjAHOB4&url=http%3A%2F%2Fblog.seattlepi.com%2Fmarijuana%2F2013%2F08%2F08%2Fcnns-gupta-apologizes-for-anti-marijuana-stance-but-doesnt-say-legalize-it%2F&ei=Y8C4UrLeH8LekQeY0oG4Cg&usg=AFQjCNEQvCttnT61uEKw2XiFSsUiplVPZA&sig2=gCN697Itz2bUBsjw9PlFbw&bvm=bv.58187178,d.eW0).
Perhaps enough comments here will get him to change his views on treatment of chronic pain with opioids.
Thank you to Doc for the People who spends hours helping people with pain. I have the privilege of being on another private group with him. He has a heart of gold and years of knowledge on this topic. He although is retired his life work did not end, as he works for free trying to make sure we have access to current laws and tells us what they mean and who to write too.
He is loved by many! He is my idea of a true caring and sensitive physician. Thank you for caring enough to help us!
Thank you for your kind comments regarding “Doc for the People” here. He has been very active on these blogs as you know.
Chronic pain was once treated and patients had relief but not any more. That has been taken away from people and now they are suffering everyday. Negative media such as this article from CNN is what is causing so many legitimate pain patients to suffer beyond belief since 2011 and it’s not getting better. It’s much worse! What is the future for these people? I am a pain care advocate in Florida who has worked very hard to support and encourage patients who live in pain and with their caregivers to please start speaking out loudly about the horrendous damage all this negative media has caused. Our doctors are severely afraid to treat pain patients with adequate medications and proper doses that are needed to help allow relief of suffering and also allow them some kind of a functioning in life. It seems that many people with pain are being undertreated now. It is clear that pain medicine is going in reverse and not forward to take care of chronic pain patients anymore. Florida has been one of the worse states that patients have become the collateral damage from over- reacting government. The pharmacy crawl started here. Dr. Gupta has no idea what is really happening in America with people in pain. Maybe he should read some of these blogs to learn what is going on. Something needs to change and it needs to start quickly. America has pain and it’s not being treated anymore! The conversation needs to change before it’s too late for many people.
Shame on Dr. Gupta. I live with a responsible wonderful man that simply wants to live comfortably. He’s had chronic pain for 18 years due to an autoimmune disease. Unless you live with someone, and see the tortuous pain they endure everyday, you couldn’t possibly understand why a person would take so many medications to relieve pain. I would like to know the whole story of the patient who died. For me, I would never hold a doctor responsible for trying to give my loved one a chance at some pain relief. Dr. Gupta has no idea the harm he’s caused pain patients and their families.
I see no shame with Dr. Gupta- but I do see shame in recklessly prescribing opioids and i see shame in pain specialists not making intelligent use of all resources available to help people in pain.
Dave,
Do you suffer with chronic severe pain that caused you to leave a 25 year job making over 100k a year? Who would do that unless their was no other option. I tried everything, steroid injections, physical therapy acupuncture, meditation, numerous horrific surgeries where they took bone from my hip and placed in in my cervical spine, my neck has a huge scar, back surgery, I even tried to be healed by a famous Christian healer that is known world wide, I went to every length I could before I had to throw the towel in as I was hitting my head on my bed headboard to try and get my head to hurt so the pain in my legs and feet that felt like they were in vices and they kept making them tighter and tighter. I planned my suicide because I had lost 40 lbs, I could not walk, comb my hair, I was just a breathing piece of useless meat. My pain doctor is double boarded in neurology and anesthesiology do you know how long he went to school? He was 33 when he started his practice. He drives a car older than mine. He spent 2 hours with me my first appointment, gave me his home and cell number. How dare you say he does it for money. He sees medical patients and people with no insurance for 60.00! You do not know what you are talking about.
I believe i do know what i am talking about- not because i was a pain sufferer for 4 years- and now am pain free for 13 years- but I am a leading advocate for better pain care-and so i have no shame in calling for better treatments than opioids and for more coordinated care than the type you receive- not to mention helping hundreds of people directly to obtain better pain care. I thoink my dorsolateral prefrontal cortex, mediofrontal cortex and anterioir insula is methylated enough to debate anyone on pain care- whether it is Dr. Tabak,, Dr Landis, Dr. Portenoy- and i = know much more than their Cnidian biomedical antipathic medicine.
First, i have the flu and so I am quite sure my responses are not well thought out, but secondly, I am in severe pain, like I am just about every day (though seems to be more severe (fever, swelling?) )…anyway, my point being, I would really like to resort to name calling in response to this “Dave b” which sadly I have seen his ridiculous posts several places on the internet.
the thing is, I am sure I really don’t have to say what everyone else has already concluded about his personality, motives, or speculate at what else he does with his day (after the 18 hours a day finding posts to comment on with his “suggestions”, his “knowledge” and his “accomplishments” ..ha ha) ..
So if this post gets published, is just to assure or provide the rest of the chronic pain patients out there living in the real world with the REAL constraints on our own healthcare, we all know there is always one blowhard who thinks they know it all, knows what is best for everyone in every situation…guess that is free speech right?
Thank you Dr. Fudin for keeping our interest at heart by bringing this type of media bashing to our attention.
I’m sorry but I just have to say this…..Your use of long medical terminology is no indication of your actual comprehension of living with Chronic Pain for a Lifetime. You say you lived with pain for 4 years but you are now pain free, that is a wonderful for you but what of the millions of people who will NEVER be completely pain free? If you don’t mind me asking, why exactly were you in pain for those mere 4 years of your life? How was it ‘cured’? Would you mind indulging me those few questions?
I too was a victim of the regulatory excess, forced to retire because I just could not afford to fight anymore. And so I share the anguish that Dr, Webster is most likely enduring. And the ones who suffer are the patients. Time and again I see former patients who now must drive over 75 to 100 miles each way just to find a doctor willing to see them…and sometimes they have to drive through treacherous snow. AND I practiced in a major metroplitan northeast city. That is the harvest that the DEA has given to those who suffer chronic pain in my community. Essentially everyone who practiced medical, as opposed to interventional, chronic pain care was driven out of practice. Dr. Webster is another cog in the regulatory dragnet. I submit that the doctors are the surrogates for the patients who are in fact the real target. After all, according to Department of Justice “legal” standards, there is no difference between being “addicted” and “physically dependent”. That means that the Dept. of Justice and the DEA consider any patient who takes chronic opioids to be an addict, and in that setting the doctors who prescribe to these DEA/DOJ addicts are essentially drug dealers. That is the root of the problem that confronts Dr. Webster. It matters not if the patient improves with use of chronic opioids and shows no evidence of abberent behavior. From what I have learned, the very fact of chronic use of opioids means that in the eyes of the federal regulators the chronic user who is by definition “physically dependent” the chronic user is by their definition an “Addict.” My heart goes out to Dr. Webster, but my heart breaks for the patients who are currently being so abused by a seemingly uncaring regulatory bureaucracy!
Thank you, Doc! Both doctors and patients have been lumped into this category of drug dealer/user. It’s dehumanizing.
I do feel CNN and Dr. Gupta should give Dr. Fudin a chance to speak, all that Dr. Kolodny has to say
is refutable . Seems every time I see him speak he is talking bad about the treatment of chronic pain and has that negative look about him. We must hear both sides of the story and not just the negative side on the treatment of chronic pain in people that truly suffer here in the U.S.
It seems something is not being said in the CNN story entitled Pain Doctor Investigation, someone is not telling the full truth. CNN please give a certified Pain Specialist a chance to speak.
Dr. Webster cant speak for himself because of HIPPA , so give Dr. Fudin a chance to speak and lets hear a rebuttal to get the story straight about the advantages of the correct treatment for those that suffer from chronic pain.
when serious issues are washed with a broad stroke they never represent the big picture and holistic nature of the issue – also very dangerous/irresponsible when a public figure presents his story in this manner – we need clarity and honest discussion around the this topic.
I don’t know much about this topic, but based on the CNN interview and this blog post (by my Dad) I’m appalled that there could even be two stories so extremely different. I’m biased, but this makes me lose trust in the media. Would love to see CNN and Dr. Gupta address this here in the comments. Keep fighting the good fight Dad!
Thank you Sarah. The story must be appalling if it fired you up enough to post this. I for one would be more than delighted to grant Dr. Gupta a cordial, informative interview…it only seems fair since he engaged PROP chair Dr. Andrew Kolodny. I think a view from PROMPT is at least fair!
This story frustrates and saddens me beyond words. It has become so difficult for patients like me to find doctors who will prescribe adequate dosages of opioids to control debilitating pain, and this kind of sensationalized tale just adds to the discrimination that we (and the providers who treat us) already face. This “investigation” is filled with inconsistencies, lies, holes, and drama. It should never have been allowed to air, and is far from the balanced, factual, FAIR, complete, and professional report that should be required from a major media network. Not to mention the fact that it is completely slanderous!
I don’t know Dr. Webster, but I do know that he has dedicated much of his professional career to helping patients who endure immeasurable suffering. Patients who have been passed off or abandoned by other providers, spent years and heart-breaking amounts of time, money, and energy on “cures”, and are often at the end of their ropes from constant, severe, untreated pain. They are completely misunderstood and are usually seen as time consuming, emotional, needy, complainers. Their previous care has been one miserable failure after another, and is never cost-effective! So…… Given that description….. How many GREAT doctors are lining up to help us? From what I have learned, Dr. Webster IS one of those great doctors. He is competent, experienced, compassionate, knowledgable, and he has earned the respect of his peers in the medical community, and the gratitude of his many patients who have successfully managed their pain because of his care.
Whatever the full story is….we certainly didn’t get it, and Dr. Gupta is well aware of the fact that Dr. Webster CANNOT and should not comment on confidential medical records. For him to act as though Dr. Webster’s silence is an indicator of guilt, is just pathetic journalism. That scene reminded me of tabloid magazine reporters chasing people down on the street. I’m not making light of the seriousness and tragedy of a patient death, but I feel as though Dr. Gupta did by employing those tactics, and by exploiting a grieving husband who needs someone to blame. Shame on him and shame on CNN. Additionally, shame on Dr. Kolodny for taking yet another opportunity to vilify opioids, spread misinformation, and deny the fact that for many, these medications save us from living what would be tortured lives from unbearable pain.
Its unfortunate that many dont understand that even for cancer pain there are treatments like TENS that have prove effective. Opioids do have their place and can make a world of difference for some people- but so can Gabapentin or DMARD’s, stem cell therapy, SCS, scrambler therapy, Manaka acupuncture, noesitherapy, FODMAP diet, Rapamycin, Botulinism toxin, Normast, frequency specific microcurrent, EMDR- even LSD and inert gases. Pain specialists would be better off advocating a more balanced approach to pain care-and so would people in pain.
And who is going to pay for that? Medicare won’t pay for many of the treatments that have been proven to help patients like IVIG which because of the cost the last time I tried to see if I could get it I was told, NO. My granddaughter had Guillian Barree’ Polyneuropathy when she was five years old. She could not walk more than two feet without falling. Kaiser who has a wonderful pediatric neurologist knew right away what she had and started her on the 10,000 dollar per IV bag. She would be in ICU for a week then go home for three weeks then return for another week, this went on for six months when her spinal taps and other tests came back normal. She will be turning 16 and is a 4.0 student and she still dances. She is on track for a full academic scholarship and I think we owe it all to her doctor. Many people who get these terrible disease never recover or they die. Many are on respirators for months, followed by therapy. So their is a price tag as to who gets well and who doesn’t, unless you have great insurance or tons of cash you just get what ever they give you. With our new health plan we will be lucky to ever have a choice of what or who we want to treat us. So I am sure the unexpected death rate will increase significantly!
Dave,
I’m trying to be fair and allowing all pro and con views. Please sign “Dave B” as we have multiple Dave’s here and you have a propensity to rile responses.
Dr Fudin- kudos to your for allowing for freedom of speech on an important issue. Nonetheless, I cant be held responsible for how others respond to my opinion. I think, it is important to allow discussion that is uninhibited, robust, and wide open. I understand how you and pain specialists feeel strongly about some issues in pain care. Its is also important for you to know- layman also feel strongly about pain care and some are committed to improving pain care. Since I have gotten 26 legislators in NYS to sign on to legislation requiring education in pain care- something your colleagues in the IOM report on pain care, and the May Day report: A Call to Revolutionize Pain Care In America called for- obviously, I am for something that would benefit people in pain. There is room for a heterogeneity of opinion on pain care- including opioids. Furthermore, as you know, long term research studies on the effectiveness of opiods for noncancer pain- is even inadequate to this day. I have no shame in calling for better treatments and treatment regimens than the current treatments available today for pain.
David B; You and I can certainly agree that comprehensive pain education is sorely lacking in all healthcare colleges including medicine, pharmacy, nursing, NPs, PAS, and others. And it is also lacking post graduation. I am in favor of requiring a certain number of hours of education from multiple disciplines to teach pain, but not only with regard to opioid therapy, but all facets of pain management including non-traditional. That’s not to say that opioids don’t have an important place in therapy; they do for sure, but those that prescribe these drugs need to be educated. And for the record, Dr. Webster is very well-educated in this area. So, I need to believe the Dr. Gupta’s story was sensationalized for the sake of a “story”. I want to spend time interviewing with Gupta so we can work together to do things right and avoid panic amongst many caring physicians that are willing to learn a careful and thoughtful approach to treating pain.
Dr Fudin- I’m glad we agree on the necessity of multidisciplinary education on pharmacological and nonpharmacological treatments for health care providers. This year a bill in NYS requiring education in pain management passed the full Assembly and the NYS Senate Health Committee and was on 3rd Calendar. Im confident this same bill will
come up for a vote again and your support, and the support of the APS could make this bill a law.
People are mistaken to believe I am against the use of opioids for pain. My focus is to call for substantive improvement in pain care and not fall pray to super stare vias antiquarius. Given that Dr. Landis in 2008 called treatments for pain “woefully inadequate” there is a need to improve all facets of pain care. Anyone who has studied the research on pain care can see that both research and practice in pain care is inadequate for most pain conditions. Unless laymen and professionals call on government to do more to help pain we cannot expect them to improve the status quo in pain care. You can see that my own Congressman Engel is the chief sponsor of a palliative education care bill-just as my City Councilman Koppel has a resolution supporting legislation in NYS requiring education in pain care. Whether one person can make a difference or not is not as important as the willingness to do what is right and call for progress. in pain care. I wish you and the APS the best for 2014 and thanks for your patience.
People in pain-and those who care about them have to energetically call upon medicine, insurers and government to make more effective treatments and treatment regimens available for pain-for obviously parlous pain care is due to our current opinion leaders- who have not only failed people in pain, but society, as well. Unless we, who care about pain demand an inspiring vision and energetic plan to greatly improve pain care-the dried voices of people in pain will remain mute and meaningless and distant as fading stars. I live in the only distric in the NAtion-where all my legislators- city, state and federal have signed on on legislation to improve pain care- what a coincidence…………
It is laughable & pathetic to me, that there are people commenting who assume people who take opioids were given them as a “first line” of treatment, for conditions that are treatable or curable, and NOT as a PART of a comprehensive multimodal treatment of intractable pain. The outright ignorance and self-righteousness is not just alienating and bizarre, it is quite sad.
Perhaps there needs to be a piece of “friendly advice” about how this blog works. For example…. It is inappropriate for a commenter to assume the responsibility of critiquing, correcting, or challenging another person’s post (or EVERY other person’s post!). This is especially true when the person commenting about another’s post is giving incorrect, illegible (spell check?), and irrelevant information.
Also, the people here who are concerned about lack of access to their life saving medications, are not new to the concept of trying non-opioid treatments for pain! We are talking about people who have spent many years (some, decades) trying alternative modes, methods, and medications to treat their pain. People who use opioids responsibly & as a significant piece of the pain treatment puzzle, not the sole pieace of pain treament. There is also the OBVIOUS concept that pain requires BETTER treatment, from BETTER educated professionals, BETTER studies, BETTER funding & resources, and on a BETTER, broader scale. These are some of the previously understood concepts that preclude this discussion. They are things that we all agree on.
It’s like listening to someone from PROP talk about PT, OTC pain relievers, and accupuncture as as “alternatives” to opioids. Ideally, YES…. Wouldn’t those be wonderful for people….if they WORKED for everyone! OR, reading the suggestion of trying a TENS unit, as if i havent owned THREE of them over the last TEN years! People who are advocating for access to opioids here are living with MIND BLOWING, earth shattering, can’t catch your breath PAIN conditions that are severe, intractable, and haven’t responded to multiple alternative treatments. THESE are the people who are losing access to opioids. For anyone who hasn’t lived with such a condition, to make blanket statements about alternatives is simply ignorant about the kind of pain we’re talking about. Plus, my insurance company won’t cover LSD….
Nancy,
Thank you for that very honest, “down and dirty”, but clearly accurate, soliloquy that uniquely and succinctly captures the frustration of many pain sufferers that are following this blog.
Just so that you and our readers know, I do intend to keep my promise by allowing positive and negative comments. This allows for fair dialogue as you pointed out, but also allows the opportunity for all to see just how ignorant some people are on this subject. It also is intended for some of us to compromise and understand the unique perspectives of others.
The few comments I have not accepted were inappropriate or had too many profanities to publish. These guidelines o are poutlined on my blog section.
So that everyone knows, it is difficult to get to Dr. Sanjay Gupta, but I have reached the next level. Another email went out to his personal CNN account tonight, the address of which was provided by CNN staff. My understanding is that it will first be reviewed by supervising directors, but then hopefully it will get to Dr. Gupta. My plea is for CNN to air another story that specifically focuses on the problem of education to clinicians, patients, and community and helps to clarify some of the ignorance you nicely outlined in your post here.
Certainly there are people who try different modalities- without success- but that is no proof of the effectiveness of the use of opioids or justification for using them. It reflect the llongstanding laziness in medicine toward people in pain that has been documented for over 40 years. Furthermore opioids dont work for a lot of people- you ever hear of hyperalgesia of opioids? One would think after 5000 years of use modern medicine in the postgenomic era would come up with more effective treatments. And the truly regrettable thing is professionals continuing to promote opioids instead of call for better treatments. And for your information even Dr. Webster has called for better treatments than opioids. Lastly- i love it when professionals refer to grammar or spelling when talking about opioids- it means they’ve lost the argument.
Not really. If you can’t spell and properly punctuate, then why should anyone consider your arguments on more complex subjects like medicine? Can you please explain how pointing out your poor writing skills is equivalent to losing the argument about opioids? Thanks Troll B.
Nancy
Your observations and conclusions are of course correct but, sadly, lost completely on the one person that truly needs to understand the basic realities (that they profess to know so much of) of chronic pain patients.
I can say this, based on seeing this poster drone on and on, on other websites or articles, (most likely he does it for the sole purpose of getting attention, or perhaps he just likes to inflame, patronize, ridicule portions of society because he can ) anyway it is like the stray cat that comes around..if you give it food (responses), attention (responses) or even look in general direction (responses) of the stray cat, well, the cat for some reason thinks it has found a home…even though it is obvious this particular stray cat is not wanted, nor respected.
Obviously it is a stray cat for a reason, hence it moving on from one forum to another, all day, every day, and sadly, perhaps because it has never actually experienced acceptance or been welcomed with open arms, this stray consistently misinterprets any form of communication as a sign that they do belong. Sad, yes. I myself have been prone to either feeding or shooing a stray cat from time to time, but my experiece with this particular one reminds me it is just pointless and perhaps if ignored for long enough, it will find some other avenue to build its self esteem, i mean, get fed.
Take care
Agreed! I know there are many other blogs where his comments have been banned. It is exhausting seeing the same exact lines, phrases, and “buzz words” over & over again. Especially, when exact sentences are used that were originally authored by someone else & passed of as his own. Isn’t that called plagiarism? I realize too, that this is not someone playing with a full deck of cards. The “grandiosity” is particularly concerning, but in the spirit of the holiday, I’ll refrain from attempting a shot at a diagnosis. No more feeding the stray cats! Thank you for the reminder…..
Happy New Year!
How apropos; see HYDROCODONE AND DEAD CATS here on paindr.com. And did he suggest ketamine as a common alternative? Hmm, makes you wonder if he isn’t hallucinating from that very drug. I’m not opposed to ketamine, but it is a rare case when I’d suggest it, especially for an outpatient.
Speaking of cats –there is another growing problem many pain patients are running into (at least in Florida…and I will hopefully circle back here and make the connection between this problem and cats)…I myself have this problem as do many in our group Fight for Florida Pain Care Action Network (FFPCAN), the problem? I am not sick ENOUGH, or more importantly, we do not have enough “other” prescriptions (non narcotic) to satisfy our pharmacy rules/quotas/etc.
I do apologize if this subject has already been discussed or even acknowledged, just at a loss, again, of who to approach for yet another silly “rule” or “hoop” making chronic pain patients jump through. It is obvious after another YEAR, that our letter writing campaign to all those “officials” is falling on deaf ears/blind eyes.
With the ridiculous amount of arbitrary rules and policies dictated daily from the pharmacies, here is another one, taking a twist and adding to “well, if you transfer ALL of your immediate family’s scripts to our pharmacy….” Okay, those of us that could do that, we did that.
Now the problem that many of us are running into –“well you don’t have enough non-narcotic “pills” (count)…. I don’t have a heart, thyroid, blood pressure, whatever issue. Even though I transferred anything and everything I could to this pharmacy, many of us are still being told that we are just not “profitable”, basically.
This is why it is so damn funny to watch these ridiculous discussions on theories as to how Pain Mgmt SHOULD be practice in the UNITED STATES of all places—while everyone is arguing about the principles of pain mgmt etc etc…there are those of us that are just trying to live day to day–every single one of us have had our quality of life hacked into drastically over the last two to three years..IF we can FIND a dr, IF we can find a dr. that knows about our actual condition, bonus (news flash, in most states, the number of certified pain mgmt dr.s is woefully small to the number of actual pain mgmt patients, so specialist ?!?, that may want to spend time trying different modalities, (insurance, if lucky enough to have, modalities are usually like pie in the sky to them) ), ok so reality, we finally find a pain mgmt dr (won’t get into actual logistics for most of us that are disabled -getting to a dr/pharmacy/etc), so the pain dr.s are pressured into prescribing less medications (regardless of narcotic or not–I myself had four non-narcotic medications suddenly cut), so now, here I am, on the least amount of medications in over 7 years, NOPE, sorry–we really DON’T want you healthy, we want you PROFITABLE. (the result of the DEA limiting wholesalers to distribute at a ridiculous pill count ratio, making pharmacies equate patients as pill count ratio)
Okay, here comes the cat! After my sad conversation with my pharmacists, who did acknowledge that yes perhaps I would have to go to my primary and FEIGN some illnesses to get back to being a customer–well, my cat–my cat is sick, Has thyroid issues. I am transferring my damn cat’s prescriptions, and will STILL have to feign or exaggerate conditions, pay money for these additional, useless prescriptions. Yes, my cat does need this medication, but what is sad is, the compounded cream would be better for her, rather then trying to crush a pill in her food, but I NEED those to apply towards the “PILL COUNT”…..how did things get so ass backwards in this country ?!?
I am not overly intelligent, articulate or well versed in the academia behind the principle’s of pain mgmt…but I am in chronic pain, like so many others I know, and I would love for these TV doctor hot shots, or heck, would be thrilled if one, just ONE of our elected officials took an interest in discussing an actual real life solution for the madness that is actually occurring for so many of us.
Yes I know, a rant. It wasn’t my intention to steer this in that direction, but the more I think of just about every single member in just our group, we are each being jerked around one way or another–this has to stop. I will gladly make myself look like an ass on a thousand different levels if I thought it would get some actual attention. We have tried doing it the “right way” by writing, calling etc etc.. No one cares apparently, other the few, special angels like Dr. Jeffrey Fudin.
I am flabbergasted at your list of remedies…and for a terminal patient? What is your problem with opioids? Opium has been used for thousands of years to treat pain and other illnesses… Accupunture is an Eastern treatment, as is massage and essential oils (I assume that’s what you mean by methylated)…well they also grew pretty red flowers!
Neurontin (Gabapentin) is forced on almost every chronic pain patient I know. Have you done your research, dave b? It is well on its way off the shelf…at least it should not be prescribed for pain. The FDA approved it for epilepsy. Pfizer has been slapped with fines and lawsuit after lawsuit, because it is being prescribed off-label, at their own suggestion, and it is harmful.
I’ll take a tried and true remedy, if you don’t mind. We aren’t shoving it down your throat… 😛
True believers in opioids like yourself should be calling for better treatments for pain. INstead you try to support opioids- and dont we know they are not only abused by patientsd and doctors but cause endocrinopathies, heart problems, can spread cancer, cause neural tube defects-and guess what-they don’t cure pain. They aren’t platelet rich plasma or stem cell therapy, or botuliinsim. What they do for too many people is foster an unhealthy dependence on what is often a suboptimal and dangerous substance. It reflects moral and mental laziness in medicien to keep promoting suboptimal treatments like opioids for pain. To claim you know better than people who call for better treatments than opioids is rich- its medicines misuse and overuse of opioids that has lead to the opioid epidemic. And like most medical professional you dread controversy as you advocate error. Maybe professionals in medicine need to get over their unjustificable attachment to using opioids as they so pleas and erroneously claim its because people in pain can’t live without them.
Perhaps it’s a reading comprehension issue?
Hmm…..
“you dread controversy as you advocate error” -Dave. (completely out of context & makes no sense).
“controversy is only dreaded by the advocates of error”- Benjamin Rush (quote from original author & founding father).
No worries. Dave B will not be posting for a while. We need some cool off time and adherence to the rules as listed on paindr.com under ABOUT THIS BLOG.
Dr. Webster is a respected advocate for pain management, and has advocated caution with respect to opioids for chronic pain. He recognizes the need to closely monitor patients and adequately document for analgesic efficacy, and functional restoration, balanced by the potential concerns for aberrant drug taking behaviors, misuse, abuse or diversion. This report is biased against pain management, and will result in many legitimate chronic pain patients loosing access to an effective and safe treatment. Otherwise these patients may resort to more self destructive behaviors (ie suicide) or desparation surgery or interventional care which may be ineffective, not scientifically proven, expensive and even result in a greater likelihood for higher medications or permanent complications. There are numerous other medical conditions that have not yet been conclusively proven by studies, where the “art of medicine” and treatments are primarily based on expert opinion and consensus. Each patient with chronic pain needs to be comprehensively assessed with individualized multi-modal treatments including medications.
I agree about comprehensive assessment and multimodal management. But multimodal management means more than referring ” a catastrophizer” for cbt. Pain specialists- and other professionals who treat pain need to work closely as teams to help people in pain- and people in pain-and their families and friends need to hold up their end of things, as well. We all need to work together to improve pain care- there is too much Balkanization. And hhope pain specialists will make this part of their vision- to work with all stakeholders toward the common good of helping people in pain.
Thank you for your comments Howard. Yes, regarding your statement “There are numerous other medical conditions that have not yet been conclusively proven by studies, where the ‘art of medicine’ and treatments are primarily based on expert opinion and consensus”, oncology comes to mind. But still, pain management is unique because of the multifaceted issues with loss of work, family, friends, sadness, and other social/psychological issues.
i posted this on CNN, but really can not tell if it was accepted or posted by CNN.
I was a patient of Dr. Webster’s and the Lifetree staff for about 8 years. Unlike the stories told here, the treatment I received saved my life. Over the years, we tried numerous procedures, medicines, and life style changes. I attended the Mayo Pain Management Program for a month. For me, I felt watched-over by not just Webster, but several of the staff members who took remarkable steps to help me and my family. I am so very sorry about the patients and families here. Having chronic pain lets you in on the community of those who deal with this everyday day and every night. It can be a horrible existence. Mine was. I say that there is a voice or dialect for those who have chronic pain. We recognize those who also have it. I have come to believe that it is not possible for those without it to understand life with it. The debate over all forms of pain management is good. And, from my experience, we don’t have enough doctors trained in pain medicine and hence the national problem with opioid abuse. That was not my experience at Lifetree. Just the opposite. There are so many victims and losers in this struggle to manage pain. My personal experience is not that of those mentioned here. Dr. Webster is one of my personal heros
Sadly, having been a board certified surgeon (influenced by Dr Portenoy’s scientific studies) and, in addition, trained by The University of the Pacific, in Stockton, receiving a Certificate of Pain Studies, then becoming a diplomate of the American Academy of Pain Management, I was driven from practice. Now, I have suffered a severe injury after a fall from a deer stand that broke a weld. The L-2 vertebra exploded and the nerve complex called the cauda equina was damaged. I had to move, recently, so I am in the process of trying to get the medications that give me a life. Without gabapentin or the pain pills, I develop a severe tingling pain, called a paresthesia, in my left foot. If any of the medications are withheld (I tried) I am up for the time period, when the pain starts and it ceases whenI reintroduce the regimen that works.(Two days last time) Fortunately, I have continued to improve after my injury. The initial physical therapy got my right leg back to moving and I was up on my feet within six weeks. I have improved to the point that I am stable. Yet, the neurologist I saw last, did an EMG (don’t know why) and wants me to get an MRI. ( I did not stop to ask him if he had done an EMG on a cauda equina patient before). He thought there were signs of acute injury on the EMG. I had MRSA from the corrective surgery for the exploded L-2, so I don’t intend on having any more surgery or needles stuck into my back. Both he and the FP refuse to keep me on the regimen of one 10mg Valium at bedtime, two tramadol pills a day and four, 10mg hydrocodone tablets. The FP said I was on “a heavy dose of medication” and the neurologist said “I could count on one hand the number of patients I have on narcotics”. That did not impress me, as well as the fact that he checked my reflexes with my feet on the ground (I did not learn that in medical school). He did not check my upper extremity reflexes (hyperactive) for comparison either! It is obvious I am very unsatisfied with the situation and now in the position to suffer at the hands of ill informed doctors, unwilling to treat chronic pain patients. It is in the same state known to punish doctors for trying to treat chronic pain patients. Having done it, I know it is time consuming, and not very lucrative, if you don’t practice anesthesia and use epidural injections. And that is another subject, completely! As has been noted, suicide is sometimes the only way for people to control their pain. Sadly, i had one patient, I know of, who committed suicide the month before his son was to graduate high school. It was because he had been kept awake for six nights with pain, I had not treated adequately (afraid to). The insanity of being awake for six days would be enough to put many of us over the edge! I estimate that 95% of the chronic pain patients are honorable people. Yet, that group is being ignored. It is like throwing the baby out with the bathwater! Worst of all, having had graduate school education, in addition to my medical schooling five year residency and two year program in pain certification, I am too well educated to be a good patient for doctors that won’t admit when they have never encountered such a condition. It would appear that the interest was in getting Medicare to pay for useless tests, and not compassionate patient care. I am nt feeling very hopeful for compassionate pain care under the new guidelines doctors will be forced to follow with “government controllers” taking over health care. I don’t expect much compassion!!
Dr Pizzo also didnt receive much compassionate care from those who treated his pain- and if Dr. Pizzo can’t get good pain care- i don’t know who can.
Dr. Gupta is now a TV doctor who earns his living by giving his opinion on hot topic stories. The news is never going to do a story on the average pain patient who suffers from many different diseases and surgeries that went wrong! No one wants to hear the real truth, good news doesn’t sale! Well my pain doctor is also a neurologist and an anesthesiologist. He said while he was studying neurology he asked about what kind of pain did the patient feel because of this or that and his answer was oh they don’t feel any pain or minimal pain and he did not believe that was true. So he started studying pain and the effects it had on patients and how it seemed to be ignored by most physicians. When I had my neck fusion I was told in two months I would be back skiing on the slopes in Tahoe, no more pain I would be new again. Well what a fool I was to believe that not only have I never been able to ski again, my pain only got worse and it caused a spiral effect of weakening the rest of my spine causing it to rupture and having more pain than pre surgery. But the surgeon didn’t want anything to do with me, unless I would let him surgical fix my thorasic rupture. By then I knew I would never be well again, I was to live the rest of my life in pain. My only relief was finding my wonderful, kind and loving pain doctor. He helped me manage to work another 10 years until I became so sick and so broken I could barely walk. I worked in a hospital and I did the clinical data on every indicator you can think of and we had very few drug seeking patients and the ones we did also used alcohol, street drugs, anything they could use to get high they used, they were almost all chain smokers and their life was consumed by addiction. We did not see regular pain patients being treated by a pain doctor come in with a code. I can’t remember one in my 25 years of working there. But I saw so many alcoholics bleed out in front of me, a sight I will never forget! I have urine tests every two months and if I showed any medicine except what he gives me and if my levels were not within the limits of what he prescribed he would dismiss me. The patients at his office are all invited to come once a month for a support group and we have a large group that come for help and understanding from one another, my doctor also attends as he cares about the mental state of his patients as well as their pain. I wish we could move on, yes like stopping tobacco, or alcohol which is the worst drug in history. What about all the drugs that get pass the FDA like Aavandia which even after they knew it was killing thousands of people they continued to sell it. We have bath salts being sold that are killing our young teenagers at an alarming rate, but it is still being sold as legal. Being a pain patient is an awful life to live and now we live in fear of the government taking away the only thing available to help us survive and to have some relief from the horrors of daily pain. Isn’t it our right to live without suffering? I wish that these people could spend one day in my shoes….I think things would be very different! How can a doctor who swore to first do no harm think it is ok for humans to suffer in horrific pain every day of their life. I would much rather not be alive if that is my choice.
It is hard for me to believe that supposedly intelligent and medically educated people cannot see the multiple factors involved, cannot understand that treating patients requires critical thinking, forget that the same treatment/ limits for all is not good medicine, and, like any treatment, there are side effects with the benefits. If we applied the same ridiculous scrutiny to chemotherapy, for example, no one would be treated ever. Overall, the benefits to society by treating pain far outweighs the risks. I applaud all health professionals willing to treat pain; it is a thankless job, important, but thankless.
Dr. Fudin,
I have a very high tolerance for hypocrisy; however after reading this post and watching Dr. Sanjay Gupta’s interview on his blog, I could not fathom as to how a well respected doctor like Dr. Gupta could go so low for the sake of publicity. It is well known that before healthcare providers graduate, they take the Hippocratic oath to practice medicine honestly; however in my opinion, the moment Dr. Gupta crossed the line to favor journalist prowess over medical ethics was the day he broke his promise. Trying to play on the emotions of patients who have lost loved ones is inappropriate; and if not mistaken, this was the same trickery that was being utilized by PROP which ultimately was not successful. Moreover, I thought the manner in which the interview concluded was awful. From my understanding, Dr. Gupta essentially made the spouse of the victim feel guilty, which may complicate the spouse’s mental behavior and put him at risk of mental health problems, such as depression. I completely agree with Dr. Kral’s comments about not throwing stones when one does not have all the information, however this is not a fair fight. This is essentially David vs. Goliath and currently Goliath is winning since it has the media power and the big names like Dr. Gupta to back up their false claims. This is why I admire Dr. Fudin and all others, for having integrity and fighting the battle against the “dark side”. I hope all the mainstream media see this blog post so that it may grab their attention, as well as Dr. Gupta’s. Dr. Kral said it best, “WE as a healthcare community need to ENGAGE the media to help patients and the public understand the complexity of chronic pain and that there are no easy answers.” It truly upsets me to see a health care clinician such as Dr. Gupta sacrifice the health and wellbeing of many for the sake of sensationalazation.
I dont think im from the darkside and i dont think much of opioids for pain. Opioids can spread cancer , lead to endocrinopathies- and numerous heart problems. Opioids don’t cure pain-they foster an unhealthy dependencce on suboptimal treatment. Youd think that after 500 years of use they would be replaced with somethin more modern in this postgenomic era.
The whole story has me confused. As in it just doesn’t add up. If his wife was doing so well on Tylenol why go back to the pain clinic? If a patient is taking x number of pills everyday then they are most likely tolerant to that dose whether it is 120 or 1,ooo pills per month. This screams out to me non-compliance. One doesn’t just take x number of pills a day then one day they overdose that just doesn’t happen unless there are breaks of taking little to no medication then taking the full amount or above. Why is this man taking pictures of his wife if he fears overdose shouldn’t he be getting her to the ER or calling 911? I would like to get a closer look at that autopsy report for one to see if she had any illicit drugs, alcohol, or similar meds from another doctor in her system.
Where is the personal responsibility? When one listens to the story one could come away with the idea that the patient had no say in the matter. What pain management doctor calls his patients and tells them they need to come back after they have left he clinic and are doing fine? If this rather convoluted story WAS true could the patient not have said no thanks I’m doing great right now but if I encounter difficulties I will be sure to let you know. The story is presented as if the doctor were pouring pills down his patients mouth and nobody could stop him from doing so.
There is just more to this story than meets the eye. Why? Like many other ODs featured in the media, it just doesn’t add up. I’m no addiction or pain medicine expert, just a patient with two incurable, painful autoimmune diseases (mixed connective tissue disease [similar to lupus] and systemic sarcoidosis]. To me this looks like one more case of the deceased patient;s loved ones trying very hard to find someone to pin the blame on. With the negative undercurrents and general hysteria swirling around pain treatment and Dr Webster’s prominent position and influence in the pain management community it’s no wonder this peculiar case made it as far as CNN. The simple fact is that once those powerful medications go from pharmacy to pain patient; it is up to the patient to take them responsibly. If someone is hanging off the couch in a stupor like in Mr. Bosley’s pictures then they are NOT taking the meds as prescribed. Though not a betting man I’d be willing to wager that Mrs Bosely did NOT go to her appointments with Doctor Webster drooping, drooling, and dragging around like that. I can assure you she wouldn’t be getting any medication displaying that type of behavior. Her husband describes her as an addict, perhaps she was one of the few that do develop addiction to the medications prescribed for pain and anxiety, this is a sad but true scenario for a small number of patients HOWEVER, it should NOT be presented as the norm in the practice of pain management. I would like to see statistics showing how many patients of Dr Webster’s were either dropped for addictive behaviors or OD’d and the total number of patients he treated overall. My guess is this wasn’t done because it would have made clear how uncommon these cases occur but they sure could tell you how many pills the lady took w/out noting why they were taken, mostly as adjuvant medications like antidepressants, etc.
I have a host of problems caused by my autoimmune diseases. I take 19 prescriptions. One for GI motility, one for GERD, 1 for nausea, 3 endocrine hormone replacements (thyroid, testosterone, cortisol), one for tachycardia, 2 DMARDs, 2 inhalers, an antidepressant, 6 for pain management (methadone/hydrocodone/soma/gabapentin/EMLA topical/Pennsaid topical) etc.
All these come up to between 29-33 pill a day (12 for PM), right up there w/ Gupta’s 1,ooo pills, described rather ambiguously, and presented as if to ‘shock’ the viewer as an obscene amount. The 29-33 do not include the many times I am using additional meds like antibiotics for frequent infections and Medrol packs for acute flare ups, etc. So the sheer number of pills taken may seem like a lot but it is not obscene and many patients in my online support groups take similar amounts to battle systemic incurable disease. The pill numbers as they are presented could make a viewer unfamiliar with chronic conditions seem unconscionable. I would like to see the prescriptions broken down, and explained.(they only mentioned anxiety, pain, and antidepressants)
Funny how the only doctor interviewed is our good friend Kolodny who is seemingly trying to push the use of effective opioid medications back into the dark ages.
I find it particularly infuriating that at a time when two states have legalized marijuana for RECREATIONAL use some patients w/ chronic, documented diseases/injuries are unable to obtain
their needed medications and if they do they find it increasingly difficult to get their Rx filled.
Of the many issues I do have and body systems affected (pulmonary, endocrine, cardio, autonomic nervous system, etc. ) one thing that I do NOT worry about is pain. I can’t tell you how much of a relief it is knowing I DONT have to battle uncontrolled pain I fear if these zealots have their way I will be back to square one which is not only is being in pain but everything that comes w/ it including deep depression, much time spent in bed, and a general lack of will to carry on day to day activities.
KB
Well, Dr. Jeff, All, I can’t comment. Heck, it’s all been said above. Wonderful comments. Except one. I know, “keep it in perspective”. BUT, Dr. Jeff, no, no one needs to keep you inline. LOL, you have to be the mouthpiece for all of the pain sufferers. IMHO, you are not out of line.
I sit here, writing, thinking of Dr. Webster, Dr. Fudin, etc. and feel if we didn’t have spokespeople, we would be done for. Right now, I’m recovering from a fall. NO extra pain meds. NO alcohol, a combined medication that I would think could help, NO!!Just stay the course. Kinda afraid to move to much. BUT, God love all of you out there that fight the good fight. Gupta? Well, he must be a lonely, and disgusted type. And, he appears BORDERLINE. His comments aren’t even half truths. He lies, and get’s what he wants from the media. Sensationalism. Heck with him……………..Merry Christmas and a Happy New Year. God bless all my fellow pain sufferers. and Dr. Jeff,,,,,,,,,,,,Stay out of line, lol…….WE all love your FIGHT!!! Herb “doc” Neeland
It amazes me when a doctor is given T.V. time the things they will say to the media.
Dr.Sanjay Gupta said he apologizes because he didn’t look hard enough, until now about the legitimate patients whose symptoms improved on cannabis. This I found in a addition of CNN Health on line.
Maybe Dr. Gupta should take closer look at legitimate uses of opiates and how they improve the life of chronic pain sufferers, then apologize to Dr. Webster.
People who suffer from chronic pain didn’t ask for that type life, I didn’t ask for this life of ongoing chronic pain but I deal with it the best I can. If not for a long acting pain medication I would be miserable and paralyzed by chronic pain. No one needs to warn me not to drink alcohol with these medications its basically common sense. No one needs to tell me not to mix other medications not prescribed to me with this long lasting opioid that has given me my life back.
I think what we have here is a failure to communicate , Dr. Webster has given quality of life back to chronic pain sufferers. It amazes me that Dr. Gupta would call Dr. Webster, Dr. D—th , what gives Dr. Gupta the right to be calling a board certified doctor in anesthesiology and pain medicine who is also certified in addiction medicine damaging names.
Reason is Dr. Sanjay Gupta contributes to CNN.com and CNNHealth.com. But to put a excellent doctors carrier at risk is uncalled for, Dr. Gupta needs to apologize to Dr. Webster and talk about the good Dr. Webster has done.
Everyone have a nice Christmas and a better year come 2014,
Mark S Barletta
Well said, Jeff Fudin! I watched my father suffer through years of chronic pain. He was injured in 1961, had his first spine fusion in 1973, had 2 more back surgeries, including 1 additional fusion. He had just as much pain as a result of the surgeries as he had pre-surgery. He was also hit by a tractor trailer in 1998 while on his way home from acupuncture. He tried all means to help his pain, but the only thing that gave him any relief was opiods, in the form of fentanyl patches and hydromorphone for breakthrough pain. He had run the gamut of other opiods over the years. His pain doctor in Albany lost his practice, and my poor father was shunted around and almost could not get his pain prescriptions. He was seriously considering suicide and ended up in Four Winds for a stay due to his high pain levels. He then moved to be closer to me and I was able to find a physician that would take him as a patient and would prescribe the narcotics he needed to live. Thankfully a small town, local MD took pity on him so that he lived out his remaining years in pain, but not so that he wanted to die. He was in constant pain that he described as a 5 or 6 on a daily basis, but without opiods, it was a 10. The answer is not to demonize physicians that try to help patients in legitimate pain. Good luck, and keep up the good fight! Patricia McCauley, PharmD, RPh,
I will keep any comments or opinions about Dr. Webster and his practice to myself. Also, will not comment on Dr. Gupta (or Dr. Oz, or any other healthcare provider that takes on a role in the media). If one does not have all the information, one should not throw stones (even Dr. Fudin). I do find issue, once again, with the media as a whole. They are not in the business of being objective any more, and let’s face it. A big name (be it a politician or a physician or the police chief or the NSA) being publicly accused of wrongdoing defines “news”. That is how they make a living. What WE as a healthcare community need to do is ENGAGE the media to help patients and the public understand the complexity of chronic pain and that there are no easy answers.
Thank you for your important comments. Someone needs to keep me in line; it might as well be you. What you said is vet fair!
Well, Dr. Sanjay Gupta is a NEUROSURGEON and therefore, even when he was in practice he was definitely NOT taking care of a lot of CHRONIC pain patients. I am sure he has referred a lot of CHRONIC pain patients out for someone else to take care of. But a neurosurgeon who knows what CHRONIC pain is all about????….Give me and the rest of us a break. Indeed the climate that has eliminated doctors who were prescribing opioids for true chronic pain patients has scared others away from the prescription of opioids. That climate has been created in good part by overzealous regulatory sanctions. That climate has also fostered the rapid growth of the injection industry, and the uncontrolled growth of compounding pharmacies. That unbridaled injection growth has already resulted in a tally of 61 pain victims killed and 751 severely injured by contaminated drugs from just one company: New England Compounding Company. The actual numbers are probably higher. For example there are known cases of illness from NECC medications in California, but none of these are included in the official CDC numbers.
For the 13,000+ patients who received potentially contaminated steroids from NECC, the death and injury rates are significantly higher than the death and injury rate from opioid misuse in the general public! And yet Dr. Gupta and CNN ignore this aspect of a purely iatrogenic epidemic of patient harm and death!
Shame on Sanjay Gupta! Dr Gupta is going after the lowest common denominator instead of doing an intelligent and thoughtful analysis of the pain relieved and lives saved by proper pain management. I know the story isn’t as sexy as opioid users = drug addicts. The harm done by people like Gupta is nearly incalculable. I was just released from the hospital. I had emergency surgery to remove my gallbladder and also had severe pancreatitis. Previous ultrasounds revealed gallstones and a HIDA test showed the gallbladder was not opening normally. Still, the surgeon declined operating as unnecessary and denied the pain. I was taken down in another attack (I had 15-20 attacks total before getting my gallbladder removed.) i went to the ER and was forced to wait 2.5 hrs to see a doc and did not receive pain meds for 4.5 hrs after I arrived and the attack was over. I was treated horribly by an ER nurse who informed me that she had her gallbladder out and my symptoms weren’t consistent with gallbladder issues and they weren’t “that bad.” She said I should feel bad because I was taken before some people who waited longer and that I didn’t belong in the ER. Another ultrasound confirmed that the gallstones were still there, and my gallbladder and pancreas were badly inflamed even after the attack ended. I was admitted by the real doctor and finally offered surgery, but that young nurse has yet to be corrected! She was another misguided opiophobe like Gupta who only added to my suffering with her silly babble that was contradicted by the real doctor.
Opioid use doesnt mean proper pain management. Opioids- as Dr. Fudin and Dr Webster know arent for everyone- and even Dr. Argoff recently lectured on functional genomic testing for opioid responses. More targeted use of opioids and other therapies are needed. Studies show that in some instances medical marijuana or an anti-depressant used with opioids is more effective then opioids alone for pain. But, of course first and foremost is a thorough assessment of the pain -and most importantly of the needs and wants of the person with pain.
I know you seem to have the answer for everyone’s problems so you tell me this one – since you are tossing the antidepressant card around – my dr. wanted me to add Cymalta to my pain management regimen. I do not have insurance, and I’m unable to work. I was about to begin the 4 weeks worth of samples of this antidepressant, although I had bad prior experiences with antidepressants for use when I tried to stop smoking, but I was still willing to give this medication a try UNTIL I found out that it would cost me an ADDITIONAL $235.00 a month, and that was for one of the lowest doses available. My pharmacist told me IF this medication was to work for pain relief it would have to be at a much higher dose hence a much higher cost. I have COPD and I will not begin smoking again, certainly not marijuana either, I don’t like the “out of control feeling” and it would also violate my pain contract I have signed with my doctor. Besides telling me I could bake pot brownies, tell me now how marijuana and antidepressants are beneficial for my situation. Oh and save the TENS units, steroid injections – I have already done those when I could afford it, even a simple “trigger point” injection costs $400.00 per site at my dr’s office and they have proven to be ineffective for any length of time. I am already barely squeaking by with my pain management costs exceeding $350.00 a month, luckily I have family assistance; your solutions to opioid therapy which allows many people in similar situations to myself to be able to do a little more than lie around in bed all day are not even rational to many of us. And like most of us, I have already tried NSAIDs, Gabapentin, physical therapy, chiropractic, the list goes on, opioid therapy was not the first line of treatment I sought or obtained.
Cymbalta – correction on spelling of antidepressant in previous post.
Erika, Thank you for sharing your story! It helps to put perspective on this.
Erika, I’m sorry you were treated so poorly by ER nurse, during a very painful ordeal. It has become the same way here in KY… the emergency departments simply will not try to relieve one’s pain… and likely will break out the red marker.
The Gupta exposé on CNN, which was carried forth by Anderson Cooper via his program, are the epitome of “yellow journalism.” Rather than well-researched evidence, the reporters rely on hearsay, insinuation, and eye-catching headlines to boost their ratings via scandal-mongering sensationalism. They should be ashamed of themselves.
Among other things, Gupta conflates DEA inquiry with federal indictment for unspecified crimes. To date, as far as we know, there has been no probable cause found for criminal charges against Dr. Webster or his clinic staff, but the reporters fail to mention that and the viewing audience is left with a false impression that criminal acts had been committed.
The many accusations by patients’ family members are hearsay evidence at best, and the defamatory “Dr. Death” allegation is unconscionable — the man should be sued. Gupta never asks the interviewed family members what they were doing while their loved ones were allegedly overdosing on prescribed medications (if, indeed, they were all prescribed), other than taking photographs to document their cases (perhaps, to boost remuneration in future lawsuits). Where was the culpability of family members — their personal responsibility and accountability — in aiding their loved ones and helping to prevent their deaths?
We also must question the role PROP (Physicians for Responsible Opioid Prescribing) might have played in instigating the story. President of the group, Andrew Kolodny, was briefly interviewed on camera and one can only imagine the many accusations and questionable statements he made off-camera. Unable to make their case against opioid analgesics and the “epidemic” of abuse/misuse, etc. on solid evidentiary grounds, PROP may be pursuing sensationalism and innuendo for its ad hominem attacks against leaders in the pain field.
Dr. Webster was correct in not responding on camera to the accusations. Sound bites would not be adequate for dispelling the misinformation and revealing the truth, even if Webster was willing to unethically violate patient privacy by providing details of each patient’s case. Despicably, Gupta subtly equated Webster’s silence with guilt — a characteristic ploy of “yellow journalism” but certainly beneath the dignity of Gupta as a physician.
All around, slanderous stories like this obfuscate truth and disparage the value of scientific evidence in seeking solutions for better pain management for the many millions of patients in need. All of those participating in the CNN news story, and Cooper, should be taken to task for their biased accusations without any semblance of fair balance. It seems un-American, to say the least, and contrary to a society that reveres the alleviation of human suffering.
When you say “…stories like this obfuscate the truth and disparage the value of scientific evidence…”, which evidence are you referring to?
Thanks very much.
David Juurlink
David,
Doesn’t Canada have their own version of the FDA? Just wondering…..
Yes Nancy…I will ask Dr. Juurlink to comment, as he is far better equipped to answer this question than me. I believe he is a pharmacist and physician by training and he is of course a resident in Canada.
Hi. Yes, our regulator is Health Canada. They are less transparent than the FDA, and while they generally issue similar regulatory decisions around opioids and other drugs, this is not always the case.
Dave
Thank you for clarifying!
Dave, Thank you for clarifying this!
Another question for David Juurlink…. So, when you signed the PROP Petition to the FDA, were you signing it as a “global” citizen, or an American citizen? Also, would it be appropriate for US citizens to petition Health Canada to attempt to influence Federal policy there? Lastly, if the PROP recommendations had passed, which three months of a patient’s life would you suggest they take their opioids? Over the Holidays? During the summer months? During the months of their children’s birthdays? I’m so glad I don’t have to pick!
Thanks!
Hi Nancy,
I signed as a physician who treats chronic pain regularly, including sometimes with opioids. And I do see some patients whose quality of life is improved with the judicious use of opioids, usually at low to moderate doses. But I also see firsthand the ways in which these drugs ruin lives, and how this often starts with a well-intentioned prescription. And then another. And another. To be clear, I am not opposed to the use of opioids in patients with chronic pain, just not at the doses and durations I see every day in my practice. I am aware of no evidence that this is a treatment for which the benefits outweigh the harms, especially in the long term.
Educating physicians is part of the solution to the epidemic, but we have been wrongly taught how to use these drugs by ‘thought leaders’ who have received, in some instances, millions of dollars from opioid manufacturers to do research (most of which is never published) and “spread the gospel” of opioids. Fixing the problem requires education of course, but the genie is out of the bottle and education alone won’t work. (Education sounds like a great idea, but it doesn’t work as well as we’d like to think.) That is why I favour regulatory action that would, I hope, stem the tide of addiction and death (more than 100,000 deaths and counting), while allowing patients who do benefit from opioids to continue receiving them.
Happy Holidays and all the best in 2014.
Dave
I agree that CNN’s view of this was slanted and unfair. However, given the parlous pain care in the U.S., with doctors refusing to have any education in pain care i don’t think there is much compassion for people in pain. As Dr. Volkow indicated- veterinarians receive 75 hours of education in pain care, and Doctors receive only 7. Anyone interested in whether or not pain care is adequate- let them read patient authored texts or the IOM report on pain care-all testify to the lack of compassion for people in pain.
Stew, Thank you for your incredible response here. It is particularly bothersome to me that Dr. Gupta chose to interview Dr. Kolodny, of course how that actually came to be is a questionable issue as you point out. A fair journalistic approach would have at least reached out to PROMPT for an opinion, since clearly PROMPT and PROP have been very outspoken against each others views through various Internet, Social Media, and publications.
Under Dr. Webster’s leadership, ethics has become a central focus of AAPM. If the mainstream media knew of his efforts, they would laud him as the champion of pain that he is.
I just wish someone out there in the media would have the b/@$$ to print some of the stories about the good these Doctors do. Please someone show the other side of this the good side…I have had 6 good years with my Grandchildren my wife of 50 years and my son and daughter. This could never have happened without my Doctor and my pain meds. I would never go back to what I was before pain management. If I had to choose then I would have to pick death. But not before thanking all of the Doctors for 6 great years. I pray I don,t have to choose……. Terry
Amen Terry. 🙂
I just finished reading this story. I. Don,t normaly comment but this is just outrageous.I have been taking pain meds for over 6 years now. Before that all I did was try to think of ways to take my own life. Not wanting to leave my family helped keep me going.Had I not found my Doctor I am sure I wouldn’t,t be here now.unless you suffer from constant pain you could never know the hell we go through. My doctor tried many things until we found the right pain med. for the last 6 years I have been blessed with what most people take for granted every day. To be able to sleep. Get up in the morning and be able to do what ever you want not just lay there and suffer.If not for these Doctors like Dr Jeff Fudin we would all be looking for a way out of life.These Doctors deserve our praise and respect for giving us our lives back. So if anyone dies from taking pain meds PLEASE REMEMBER IT,S NOT YOUR DOCTORS FAULT. He never told you to drink booze on top of your meds. He never told you to take more then he prescribed. He never told you to give pills to your friends.Or to mix them with other meds.He can not watch you 24/7. It your responsiability to take them as prescribed and to keep them were no one else can get to them. Use your head and do the right thing. DON,T blame the doctor. He is the one saving your life.all of you out there need to reply to this B.S.story and protect the people who care for you. Thank You Dr Fudin you are a true Hero….. God Bless you And All the Doctors like you…. Terry Bonomo
If Sanjay Gupta still considers himself a physician (I’m not sure anymore), he has to know that treating chronic pain is incredibly challenging these days. His CNN story on DOCTOR Webster smacks of hypocrisy. It is anecdotal, unconvincing, sensational, and seemed like “gotcha” to me. I expect better from CNN and a physician correspondent.
DOCTOR Webster is a caring, expert, and passionate physician. I wish he could have given his candid opinions, but (again, you know) when there is a lawsuit the doctor is advised to keep silent.
Opioid therapy for chronic pain is not without risks. Dr. Webster has been part of the solution exponentially more than he has been part of the problem. One-sided
stories like Sanjay Gupta’s cause harm by keeping silently suffering pain patients in the shadows and by discouraging physicians (like DOCTOR Webster) from taking on the challenge of chronic pain care.
James Patrick Murphy, MD, MMM
Thank you James! I appreciate your comments as always, especially the rapid responses! Happy New Year to you and yours. Jeff