EFTA02565123.pdf

From: Ed < Sent: Friday, January 18, 2013 1A6 AM To: Epstein, Jeff Subject: Susana Duncan blog on opiate epidemic Hi Jeff Thanks for a great meeting. If you need any help to find a geisha =o train a robot, I have just the person in Tokyo. Below is Susana =uncan blog on how doctors, responding to the incentives in health =ystem, accelerate the opiate epidemic. BELOW Is Managed Care Pushing Addiction By Dr.Susana Duncan America's new addiction, which I wrote about in June in the Huffington =ost, is the epidemic of opiate pain killers, which, aptly named, last =ear resulted in over 16,000 overdose deaths. This is not the =tereotyped drug problem that can be solved by Miami Vice style drug =usts of traffickers and periodic round-up of street-addicts and =ushers. In this epidemic, the traffickers are our respected =harmaceutical companies acting entirely within the law seeking only to =ring legitimate pain relief to sufferers; the addicts are, for the =ost part, upstanding citizens seeking a medical solution to their =ain, and the "pushers" are, with few exceptions, dedicated doctors =ttempting to alleviate the suffering of their patients. So how can the =nteraction of decent people, pursuing well intentioned and legitimate =nds, result in a truly disastrous narcotics epidemic? The answer, as counter-intuitive as it may seems, is that in large part =he epidemic is an unanticipated consequence of "managed are"; which =wept the country in the 1980's to contain rising medical costs. Almost every week, I have received more calls from new patients =earching for a pain specialist willing to take on the prescribing of =heir drug. In each case the reason given for the need for a new doctor =as their previous doctor's retiring or otherwise no longer being =vailable for the task. In each case a brief interview revealed the =ature of the injury or physical problem to be either minor or at best =artially diagnosed. Further, there is a turn of phrase, an urgency, a =orn thin quality to their stories, which informs the practiced =istener that driving the call is addiction. The previous prescriber =ad created a demon and had withdrawn. As I reflect on why this wave of opiate addiction is so rapidly gaining =old in America, I realize that the answer lies in the new realities of =ow doctors must practice to earn their livelihood. Listening to Bill =linton, the only campaign speaker to try to get across the mechanics =f Obamacare, I learned for the first time where the funding ($617 =illion) for the proposed expansion of medical insurance coverage was =o come from: Hospitals, private insurers and doctors. A proposed 27% cut in Medicare payments to physicians, already so low =s to drive many physicians to refuse to see Medicare patients, is part =f the agreed legislation. It is not clear that private medical =ractice as we know it will survive at all under these cuts. In the =ast five years physicians have annually fought off a pending far =mailer cut, as the austere economics of managed care compels them to =ompromise and see increasing numbers of patients each hour. This =equisite for what government administrators might call =93efficiency", cuts deeply into a commodity precious to diagnosis =nd patient care, especially precious in pain management; adequate time =or listening, for which, under managed care, there is no commensurate =eimbursement. Pain has its own special, unfortunate place in this new =ut- costs at all cost system. Back and neck problems, vague complaints =f limb pain can be challenging at the best of times and may take long =nd repeated visits, interviewing and examining to fathom and correctly =reat. It takes not so much diligence as time to apply skill in getting =o the bottom of some of these complaints. And time is what is rationed =nder this new system. In this time-is-at-a-premium climate one =nderstands how for a harried physician, prescribing a pain killer =ecomes an expedient substitute for a lengthy diagnostic encounter. =ndeed, in the last decade, the use of opiates in general practice pain =anagement has become increasingly the norm. The sad truth is that =nder economic exigency prescribing in all fields, whether it be drugs =r expensive laboratory or imaging testing, is dramatically escalating; =oo EFTA_R1_01729284 EFTA02565123 often replacing appropriate, in-depth office encounters between =hysician and patient, such that a precious gem of spoken information, =hich might provide the key, is never heard. This pattern is only =rowing: Enough pain killers were prescribed in 2010 to medicate every =merican adult around-the-clock for a month. If one examines the whole story of opiate use more closely, one finds =hat (here too) there is another hidden and costly outcome: these =rescription drugs can readily reach those for whom they were never =ntended. A bottle of half finished opiates lying somewhere at home can =empt a teenager, and these drugs have the power to addict within three =ays of use. Further, less well intentioned callers at doctors' offices =ave learned to mimic pain, to see multiple doctors with the same =tory, and then sell the prescribed drugs for handsome profits. Looking ahead one sees that in a system where symptoms are treated, but =he source of pain remains, a growing number of patients will become =hronic pain sufferers. And as long as managed care continues to =anifest as "efficiencies" in medical practices; doctors' =emuneration for office visits progressively is whittled down, and =piate- based pills become faster acting and more powerful, the =nevitable outcome tragically is even greater opiate addiction in =merica. SLOG AT http://drsusanaduncan.blogspot.com/ Best regards Ed Epstein <?xml version=.0" encoding=TF-8"?> <IDOCTYPE plist PUBLIC "-//Apple//DTD PLIST 1.0//EN" "http://www.apple.com/DTDs/Propertylist-1.0.dtd"> <plist version=.0"> <dict> <key>conversation-id</key> <integer>242325</integer> <key>date-last-viewed</key> <integer>0</integer> <key>date-received</key> <integer>1358473565</integer> <key>flags</key> <integer>8623750145</integer> <key>gmail-label-ids</key> <array> <integer>6</integer> <integer>2</integer> </array> <key>remote-id</key> <string>269950</string> </diet> </plist> 2 EFTA_R1_01729285 EFTA02565124