Blame and illness

English: Massive left sided pleural effusion i...
English: Massive left sided pleural effusion in a patient presenting with lung cancer. (Photo credit: Wikipedia)

 

On blame and illness:

 

After Linnea Duff learned at age 45 that she had developed lung cancer, she practically encouraged people to ask if she had ever smoked. But in the eight years since, her feelings have soured considerably on the too-frequent question, and she’s developed an acute sense of solidarity with fellow patients: smokers, former smokers, and never-smokers alike.

“It’s just so inappropriate,” says Duff, who believes that people with other serious illnesses don’t field so many intrusive queries. “Would you ask someone, ‘Did you eat too much?’ or ‘Did you have too much sex?’ ”

 

 

 

Recovery coaches for chronic disease management

charles outreach accept

We’ve been talking about talking about peer supports and recovery coaches for more than a decade. The use of para-professionals in the field goes back several decades.

Now, a new study evaluates a similar role for enhancing management of other chronic diseases.

Disease Management Care Blog provides a little analysis:

There is increasing interest in incorporating lay-persons in the outpatient care of persons with chronic conditions.  That makes sense, because much of the educational “payload” may be deliverable using far cheaper and more engaging “peer” members of the community who – literally – speak the patients’ language.  This is a nicely done randomized clinical trial done in a real world setting that adds to our understanding of this care option. The bottom line is that this study showed that the care guides had a real impact.

 

 

Solving the prescription opioid problem

English: Drug overdose
English: Drug overdose (Photo credit: Wikipedia)

I’ve posted several times recently on the problem of opioid over-prescription and overdose.

Some might assume that I want some regulatory or statutory intervention to address the issue. Truth is, I’ve got more questions than answers and I would not support a response that forces us to choose between treating pain and preventing addiction and overdose.

It appears that opioids are a great solution to acute pain but a lousy treatment option for chronic pain. (Though,  they may be the least bad option.)

I’m not an expert on policy in this area, just an observer. But, my first thought is that The Joint Commission played a huge role in shifting pain treatment and that they may be a good way to change the behavior of prescribers and health systems.

The big difference this time is that PHARMA provided some wind at the back of those system changes. Other than medical cannabis, it would seem that the wind would be working against us this time. (Though, there is research being done on different delivery strategies for cannabis and its relative effectiveness.)

The current state of pain management is especially bad for addicts. It leads to bad care, neglect and stigma. Even addicts who really want non-opioid, but effective, pain management get brushed off as drug-seeking.

This feels like I’m stating the obvious, but it would seem that we need more education research on non-opioid treatment options, better access to the ones that already exist and better engagement strategies for the existing behavioral strategies.

Deconstructing “it works”

Healthcare, etc. has a great post deconstructing what it means to say a treatment works:

What exactly does it mean when we say that a treatment works? Do we mean the same thing for all treatments? Are there different ways of assessing whether and how well a treatment works? I am sure you’ve guessed that I wouldn’t be asking this question if the answer were simple. And indeed, the answer is “it depends.”

What I am talking about is examining outcomes. I did a post a couple of years ago here, where I use the following quote from a Pharma scientist:

“The vast majority of drugs – more than 90 per cent – only work in 30 or 50 per cent of the people,” Dr Roses said. “I wouldn’t say that most drugs don’t work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there on the market work, but they don’t work in everybody.”Here is that word “work” again. What does this mean? well, let’s take such common condition as heart disease. What does heart disease do to a person? Well, it can do many things, including give him/her such symptoms as a chest pain, shortness of breath, dizziness and palpitations, to name a few. These symptoms may have at least two sets of implications: 1) they are bothersome to the individual, and in this way may impair his/her enjoyment of life, and 2) they may signal either a present or a future risk of a heart attack. Why are heart attacks important? Well, they are important because one may kill the person who is having it, or one (or several) may weaken the heart to the point of a substantial disability and thus a deterioration in the quality of life. So, there certainly seems to be a good rationale to prevent heart disease either from happening in the first place or from at least worsening when it’s already established.

Now, what’s available to us to prevent heart disease? Well, some think that lowering one’s cholesterol is a good thing. OK, let’s go with that. What is the sign that the statins (cholesterol-lowering drugs) “work”? What would it look like if it was about lowering the cholesterol? Say, your total cholesterol is 240. You go on a statin and in 6 months your total cholesterol is 238. Your cholesterol was lowered, it worked! Well, yes, but if you are asking what this 2-point drop really accomplishes, you are beginning to understand the meaning of “work.” So, just intuitively we can say that there needs to be a certain, perhaps “clinically significant,” drop in the total cholesterol in order for us to say that the drug “worked.”

Great! Now we are sidling up to the real issue: What constitutes a “clinically significant” drop in cholesterol? Is it some arbitrary number that looks high enough? Probably not. How about some drop that correlates to a drop in the risk of the actual condition we are trying to impact, heart disease? Say, a 40-point drop, or getting to below 200, may be the right threshold for the “works” judgment. Ah, but there is yet another question to ask: How often does this type of a drop lead to a reduction in heart disease? Is it always (not likely), or is it the majority of the time (rarely) or at least some of the time (most likely in clinical medicine)? And what portion of that time do we consider satisfactory — 60%? 40%? 20%? 2%?

There’s more. Read the rest here.

 

What we spend on health

This infographic is from a report on obesity and it’s set off a debate its accuracy. But it gets at a point I’ve made before. And, the more I learn, the clearer it becomes that this general principle applies to medical problems, mental health problems and addiction.

To me, this doesn’t make a case for disengagement from the medical system. Rather it calls for finding some balance between care focused on delivering medications and devices and care that focuses on promoting and supporting health and wellness.

I think addiction recovery has a lot to offer, about maintaining healthy lifestyle changes in particular, but there’s still a lot to learn.

Sentences to ponder

Various pills
Various pills (Photo credit: Wikipedia)

What lessons does this have to offer addiction and psychiatric treatment?

Last year 41 million colds were erroneously treated with antibiotics because doctors were unwilling to confront patients who demanded drugs. Patients show up with a cold, don’t like to be told that their illness will just have to run its course, demand antibiotics, and get them—even though they won’t help. Why? Because the doctors can’t “just say no” to drugs.

Crucial Confrontations referring to “Colds uncommonly costly