Coronavirus “is like the angel of death for older individuals,” do not downplay or minimize


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Jerusalem Post, March 8, 2020:

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….Pence’s speech is a departure from the guidelines the CDC posted to their website on Friday, which told older adults and those with serious medical conditions such as a heart, lung or kidney disease – rather than just the elderly with a serious health condition – to “stay home as much as possible” and “take actions to reduce your risk of exposure.”

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Last week, Dr. Peter Hotez, dean of tropical medicine at Baylor College of Medicine, warned lawmakers not to downplay or minimize how severe the coronavirus risk is for vulnerable Americans. Speaking at a congressional hearing, Hotez explained that the coronavirus “is like the angel of death for older individuals,” AP reported.

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According to Vanderblit University infectious diseases expert Dr. William Schaffner, “The clear message to people who fit into those categories is:

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‘You ought to become a semi-hermit. You’ve got to really get serious in your personal life about social distancing, and in particular avoiding crowds of any kind….’”  

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The material on this site is

for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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CDC blasted for removing public data on tests for coronavirus


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Lawmaker blasts CDC for removing public data on number of Americans tested for virus

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The Centers for Disease Control and Prevention has abruptly stopped disclosing the number of Americans tested for the novel coronavirus, a move one lawmaker has called “unacceptable.”

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In recent days, the agency has posted statistics to its website detailing the impact of the virus as it spread across the United States. Figures include a breakdown of confirmed and presumed patients and the total number of deaths, cases and tests administered.

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But as Rep. Mark Pocan (D-Wis.) noted Monday, one of those numbers suddenly vanished from the site.

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“Americans are dying,” Pocan wrote in a letter to CDC director Robert R. Redfield. “We deserve to know how many people have been tested.”.His letter cited comments made Sunday by Scott Gottlieb, the former commissioner of the Food and Drug Administration, who said there could be “hundreds or low thousands” of coronavirus cases in the U.S.

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Given this possibility, Pocan said, “knowing that CDC testing is keeping pace with the likely number of cases is imperative to maintaining public trust.”

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  

Welcome to my Weblog on Pain Management!

Please ignore the ads below. They are not from me.

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Coronavirus: Expect people you know to die. Take it seriously. Stay calm


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“Coronavirus: an email to my family”

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by an infectious disease epidemiologist.

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“I wrote this originally to share with my family.”

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…”I graduated from the CDC’s Epidemic Intelligence Service and have over 17 years of experience in the field, most of that with CDC.”

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Who should you listen to?

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The CDC and your state health department are your best place for information about COVID-19. (Listen to them before you listen to me.) Be cautious about other sources of information – many of them will not be reliable or accurate.

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How bad is this going to be?

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It’s possible that COVID-19 will be similar to a bad flu year but there are a number of indications that it will be very much like the 1918 Flu Pandemic. To put that in perspective, the 1918 flu did not end civilization as we know it but it was the second-deadliest event of the last 200 years. Expect people you know to die.

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However, there is one critical difference between COVID-19 and the 1918 flu – the 1918 flu virus hit children and young adults particularly hard. COVID-19 seems to be most severe in older adults. Children and young adults generally have mild infections. We are grateful for this.

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What can we expect?

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This is not the zombie apocalypse. Core infrastructure (e.g., power, water, supermarkets, internet, government, etc.) will continue to work, perhaps with some minor disruptions. 

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There will be significant economic disruption: a global recession is very possible and there will probably be significant shortages of some products. The healthcare system will be hit the hardest. The number of people who are likely to get sick is higher than our healthcare systems can probably handle.  

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Daily life will be impacted in important ways. Travel is likely to be limited and public gatherings will probably be canceled. Schools will probably be closed. Expect health departments to start issuing these orders in the near future, especially on the West Coast.

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The acute pandemic will probably last at least for several months and quite possibly for a year or two.

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What can we do?

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We can’t keep COVID-19 from being a global pandemic but the more we can do to slow the spread of the disease, the less severe the impact will be. With that in mind, here are the things you can do:

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Stay calm but take it seriously. This will likely be bad but it’s not the apocalypse.

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Stay home if you’re sick or someone in your house is sick. 

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Leave medical supplies for healthcare workers. You shouldn’t be stockpiling masks or other medical supplies. They are needed in hospitals to keep our healthcare workers healthy.

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Wash your hands. Get in the habit of frequently washing your hands thoroughly and covering your cough.

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Minimize your exposure. Now that we’re starting to see community transmission in the U.S., it’s probably time to start cutting back on your exposure to other people. Depending on your circumstances, consider:

  • Canceling non-essential travel

  • Avoiding large-scale gatherings

  • Working from home if possible

  • Minimizing direct contact with others including hand shakes and hugs

  • Reducing your trips out of the house. If possible, shop for two weeks of groceries at once or consider having your groceries delivered. Stay home and cook instead of going to a restaurant.
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Remember, keep calm and prepare. This is likely to be bad but if we respond calmly and thoughtfully we can handle it.

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Others have added: no more fist bumps or hand shakes. Elbow bumps or, as they are doing in China, toe bumps.

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  

Welcome to my Weblog on Pain Management!

Please ignore the ads below. They are not from me.

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The advertising below is not mine.

In exchange, this blog is less expensive.

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Coronavirus Test Kits Alarming Impurities, Contaminated


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From AXIOS

Test Kits May Have Been Contaminated

 March 1, 2020

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Behind the scenes: The FDA official who visited the Atlanta lab, Timothy Stenzel, is the director of the Office of In Vitro Diagnostics and Radiological Health.

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  • About a week ago, when the Secretary of Health and Human Services Alex Azar was under extreme pressure over the delays in getting coronavirus testing kits to market, Stenzel traveled to Atlanta to help troubleshoot whatever technical problems might have been occurring with the tests.

  • Stenzel was alarmed by the procedures he witnessed in the Atlanta laboratory and raised concerns with multiple CDC officials, per a source familiar with the situation in Atlanta.

  • Stenzel is a highly-regarded scientist and diagnostics expert. He was on the ground in Atlanta to deal with technical issues and happened to stumble upon the inappropriate procedures and possible contaminants. He is not a laboratory inspector and thus was not charged with producing an inspection report on the lab conditions.

  • But he raised the concerns and they have been taken seriously and risen to the highest levels of the U.S. government.

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On Thursday afternoon, the concerns about the Atlanta laboratory were raised in a conference call that included senior government officials from multiple agencies including the Department of Health and Human Services, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health.

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  • The call’s purpose was to figure out ways to mass produce the testing kits and get them to market quickly.

  • The Trump administration says it’s now figured out how to get over those hurdles. An HHS spokesperson promised that by the end of this week, “we will have the capacity to test up to 75,000 individuals” for the coronavirus

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What’s next: The FDA’s manufacturing concerns — which include the possible contamination of testing kits — have also resulted in the Trump administration ordering an independent investigation of the CDC’s Atlanta laboratory, according to senior officials.
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  • “HHS has launched an investigation and is assembling a team of non-CDC scientists to better understand the nature and source of the manufacturing defect in the first batch of COVID-19 test kits that were distributed to state health departments and others,” said an HHS spokesperson.

  • “HHS/CDC have been transparent with the American people regarding the issue with the manufacturing of the diagnostic and will be transparent with the findings of this investigation.” (But the administration was not transparent about the senior FDA official’s concerns about the conditions and procedures in the Atlanta laboratory.)

  • A senior administration official added that the government also moved the manufacturing of the coronavirus tests out of the Atlanta laboratory of CDC.

  • The official said that the CDC engaged with a third party contractor on Feb. 20 to help manufacture the testing kits. The official added that the FDA regulator, Stenzel, visited the Atlanta laboratory on Feb. 22.

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Between the lines: Until Thursday, the CDC’s guidance was to only test Americans for the coronavirus if they’d recently traveled to China — or had close contact with someone known to have the virus — and were symptomatic.

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  • Under this policy, the CDC initially refused to test a California patient who didn’t fit this criteria but had the coronavirus, although the CDC disputes that it denied doctors’ testing request.

  • As of Friday, South Korea had tested 65,000 people for the coronavirus; the U.S. had tested only 459, per Science Magazine. China can reportedly conduct up to 1.6 million tests a week.

  • Although the World Health Organization has sent testing kits to 57 other countries, the U.S. decided to make its own.

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There have also been problems with the tests themselves. On Feb. 12, the FDA announced that health labs across the country were having problems validating the CDC’s diagnostic test, Science reports in an in-depth account of what went wrong with the tests.

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The FDA announced yesterday that public health labs can create their own diagnostic test. Scott Becker, the CEO of the Association of Public Health Laboratories, told Science that he expects that public health labs will be able to do 10,000 tests a day by the end of the week.

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A WHO expert explains how China did it. “It’s all about speed.”
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Wash your damn hands.

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“You’re probably doing it wrong.”
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“Wash instead of sanitizing whenever possible” – good idea to review this page:
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“As for hand sanitizer, Larson says it’s important to know that sanitizers are only active as long as they’re on your hands. So even if it makes your hands feel annoyingly wet, keep the sanitizer on for at least 10 seconds.”

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The good news is dear leader is telling his people there is no problem in his crowds. All others remember keep at least 6 feet distance from others, probably more. Ain’t gonna happen at the grocer but give it time.

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  

Welcome to my Weblog on Pain Management!

Please ignore the ads below. They are not from me.

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The advertising below is not mine.

In exchange, this blog is less expensive.

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U.S. badly bungled coronavirus testing


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Quoting March 1, 2020, from Science:

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As of Friday, South Korea had tested 65,000 people for the coronavirus; the U.S. had tested only 459, per Science Magazine. China can reportedly conduct up to 1.6 million tests a week. Although the World Health Organization has sent testing kits to 57 other countries, the U.S. decided to make its own.

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.There have also been problems with the tests themselves. On Feb. 12, the FDA announced that health labs across the country were having problems validating the CDC’s diagnostic test, Science reports in an in-depth account of what went wrong with the tests.

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The FDA announced yesterday that public health labs can create their own diagnostic test. Scott Becker, the CEO of the Association of Public Health Laboratories, told Science that he expects that public health labs will be able to do 10,000 tests a day by the end of the week.

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From Common Dreams, February 27, 2020:

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“Mike Pence literally does not believe in science,” tweeted Ocasio-Cortez, a New York Democrat. “It is utterly irresponsible to put him in charge of U.S. coronavirus response as the world sits on the cusp of a pandemic. This decision could cost people their lives. Pence’s past decisions already have.”

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Ocasio-Cortez pointed to Pence’s tenure as Indiana governor, where he she said his “science denial contributed to one of the worst HIV outbreaks in Indiana’s history.”

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“He is not a medical doctor. He is not a health expert,” Ocasio-Cortez wrote. “He is not qualified nor positioned in any way to protect our public health.”

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Gregg Gonsalves—a Yale epidemiologist who co-authored a 2018 paper connecting Pence’s policy decisions as governor to the 2014 HIV outbreak in Scott County, Indiana—denounced the president’s decision to allow Pence to coordinate the administration’s coronavirus response.

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“Over 200 people were infected with HIV in an outbreak, met with ignorance, bumbling, incompetence, and ideological intransigence. Two hundred needlessly infected, now on medication for life at great costs to themselves and the state,” Gonsalves tweeted Thursday morning. “Now Donald Trump has put Mike Pence in charge of coronavirus.”

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“It’s like putting an arsonist in charge of the fire department, a bank robber in charge of the U.S. Mint,” Gonsalves added. “Donald Trump made the choice of putting someone absolutely not up to the task to this crucial position. It endangers us all. This isn’t a Republican or Democratic issue—we have the potential for coronavirus outbreak in the U.S. and we needed to rise above the partisan fray.”

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  

Welcome to my Weblog on Pain Management!

Please ignore the ads below. They are not from me.

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The advertising below is not mine.

In exchange, this blog is less expensive.

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Revision in CDC Opioid Guidelines Demanded


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Revision in CDC Opioid Guidelines Demanded

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  • by Shannon Firth, Washington Correspondent, MedPage Today February 15, 2019 

WASHINGTON — Pain patients tell Congress the CDC’s opioid guidelines are hindering access to vital medications, and an FDA panel recommends approval of esketamine for treatment-resistant depression.

Pain Patients to Congress: CDC’s Opioid Guideline Is Hurting Us

Patients with chronic pain are suffering from ham-handed efforts to curb opioid overdoses, a series of witnesses told the Senate Health, Education, Labor and Pensions (HELP) Committee on Tuesday.

In particular, the CDC’s 2016 guidelines for opioid prescribing came under heavy fire, as even a self-described supporter of its recommendations admitted the evidence base was weak.

Cindy Steinberg, national director of policy and advocacy for the U.S. Pain Foundation, argued that well-intentioned efforts to address the epidemic — particularly strategies to tamp down overprescribing — have stoked a “climate of fear” among doctors.

Thousands of patients with chronic pain have been forcibly tapered off their medications or dropped from care by their physicians, said Steinberg. (Physicians in California, under threat of medical-board sanction if patients die from overdoses, have reported similar reactions.)

Such decisions are “inhumane and morally reprehensible,” she said.

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The material on this site is for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Pain Patients to Congress: CDC’s Opioid Guideline Is Hurting Us, 2% NIH budget for Pain


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Pain Patients to Congress: CDC’s Opioid Guidelines is Hurting Us. Has stoked “climate of fear” leading to inadequate treatment of chronic pain

CLIMATE OF FEAR

WASHINGTON — Patients with chronic pain are suffering from ham-handed efforts to curb opioid overdoses, a series of witnesses told the Senate Health, Education, Labor and Pensions (HELP) Committee on Tuesday.

  • by Shannon Firth, Washington Correspondent, MedPage Today February 13, 2019 

In particular, the CDC’s 2016 guidelines for opioid prescribing came under heavy fire, as even a self-described supporter of its recommendations admitted the evidence base was weak.

In 2018, Congress passed the SUPPORT for Patients and Communities Act, which included billions of dollars in funding aimed at curbing the overdose epidemic and expanding access to treatment for those with substance use disorders.

About 50 million Americans suffer from chronic pain and almost 20 million have high-impact chronic pain. At the same time, more than 70,000 people died from drug overdoses in 2018, often involving opioids, said HELP Committee Chairman Lamar Alexander (R-Tenn.) at the start of Monday’s hearing.

Even as Congress tries to dramatically curb the supply and the use of opioids, “we want to make sure … that we keep in mind those people who are hurting,” said Alexander.

Cindy Steinberg, national director of policy and advocacy for the U.S. Pain Foundation, argued that well-intentioned efforts to address the epidemic — particularly strategies to tamp down overprescribing — have stoked a “climate of fear” among doctors.

Thousands of patients with chronic pain have been forcibly tapered off their medications or dropped from care by their physicians, said Steinberg. (Physicians in California, under threat of medical-board sanction if patients die from overdoses, have reported similar reactions.)

Such decisions are “inhumane and morally reprehensible,” she said.

Steinberg, herself a pain patient, said she takes opioids in order to function. Eighteen years ago, Steinberg was injured when a set of cabinets fell on her. Since her accident, she experiences constant pain, she said, and throughout the hearing she took breaks from testifying to recline on a cot and pillow.

She was especially critical of the CDC’s opioid guidelines, which included recommendations regarding the number of days and dosage limits for certain pain patients.

“When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed,” notes a CDC fact sheet.

These recommendations have been “taken as law,” she said.

In 2016, Massachusetts set a 7-day limit on first-time opioid prescriptions, according to the National Conference of State Legislatures, which counted 33 states with laws limiting opioid scripts as of October 2018.

Steinberg said the guidelines should be rewritten.

Because of the CDC’s reputation, “people think that those [guidelines] are based on strong science and they’re not,” Steinberg said. Pain consultants were not involved in the development of the guidelines, she said.

(Voicing similar concerns in November, the American Medical Association passed a resolution opposing blanket limits on the amount and dosage of opioids that physicians can prescribe.)

Steinberg pointed instead to the Pain Management Best Practices Inter-Agency Task Force, a group appointed by Congress of which she is a member, which issued its own draft recommendations in December.

Alternatively, the NIH (which she noted has an office dedicated to pain policy) could be asked to make recommendations, she suggested.

Halena Gazelka, MD, chair of the Mayo Clinic Opioid Stewardship Program in Rochester, Minnesota, pointed out that the guidelines were “intended to advise primary care providers” and not to provide “hard and fast rules.”

“I actually like the CDC guidelines,” Gazelka said. Mayo’s own guidelines are based on the CDC’s. However, “the doses that are mentioned, probably are not scientifically-based, as we would prefer that they would be,” she acknowledged.

Another challenge for some pain patients are situations that pit prescribers against pharmacists, said Sen. Lisa Murkowski (R-Alaska).

“It’s the pharmacists that are refusing to fill the prescription the doctor has prescribed,” she said, blaming the CDC guidance. Pharmacists are following it out of “an abundance of caution,” including in cases where abuse is not suspected, she suggested.

Steinberg said, “I think we need public education about pain and the fact that pain is a disease itself. … Pharmacists are not getting proper training in that, I don’t think anyone is getting proper training in pain.” She asserted that veterinarians get nearly 10 times as many hours of pain management training as do medical students.

Andrew Coop, PhD, of the University of Maryland School of Pharmacy in Baltimore, returned to the CDC guideline. “I think those guidances on the quotas, I think they’ve been taken too far and that needs to be rolled back.”

Improving Care

In exploring other ways to improve care for patients with chronic pain, Gazelka recalled the pain clinics that existed 30 years ago, which included a physician, a psychologist, and a physical therapist.

“It would be ideal to return to a situation where people could have all of that care in one place,” Gazelka told MedPage Today after the hearing. But most small practices and even institutions may not have the same blend of clinicians, and the cost could be “prohibitive,” she said.

Access to specialists also poses a problem, noted witnesses as well as senators.

In her own pain group, it takes patients more than a year to get an appointment with pain specialists, Steinberg said. She encouraged Congress to “incentivize” pain management as a specialty.

Gazelka agreed and suggested leveraging telemedicine and electronic health records to extend the reach of existing specialists.

Telemedicine can allow primary care physicians to consult with pain management specialists, she said. Also, in Mayo’s own controlled substances advisory group, she and other specialists review cases submitted by primary care clinicians and provide advice directly into the patient’s medical record. However, Gazelka noted that privacy protections in some states might disallow that.

Gazelka noted that insurance coverage can be a barrier to non-opioid alternatives. For example, the Mayo Clinic has a Pain Rehabilitation Center staffed by specialists in pain medicine, physical therapy, occupational therapy, biofeedback, and nursing that aims to treat pain without opioids. But Medicaid won’t pay for it, she testified.

Witnesses also spoke of efforts to develop non-addictive painkillers, such as NIH’s Helping to End Addiction Long-term program.

Steinberg called these efforts “a great start” but noted that only 2% of the NIH’s budget is directed towards pain research. Funding should be “commensurate with the burden of pain,” she said.

Finally, Coop pressed the committee to take seriously the potential of medical marijuana.

Acknowledging that it’s a controversial area, he stressed the need for “good consistent, well-designed clinical studies with good consistent material,” referring to the type of marijuana used.

But speaking to reporters after the hearing, Alexander was cautious. “I’ve supported giving states the right to make decisions about medical marijuana. That’s about as far as I’m willing to go right now.”

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please ignore the ads below. They are not from me.

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