By Bill Scott

After reading recent media reports such as The Seattle Times series, “Methadone and the politics of pain,” I’ve been saddened to learn of the overwhelming number of Washington residents living in chronic pain and/or addicted to painkillers. Also, the near universal frustration of both patients and providers for solutions is alarming.

I’m sure that all caring persons agree that no one should ever be left in agonizing pain, but is increasing dependence on painkillers the only answer?

For instance, why is this largely an American problem? With less than 5% of the world’s population, Americans consume 80% of painkillers sold. A recent comment on the Times website noted, “I just worked in Cuba. There (are) NO narcotics except for a couple of doses after major surgery. Tylenol is over the counter and ibuprofen by prescription. Somehow they manage and they have a lot less pain. Consider that paradox? They have no pain medicines and have less pain?”

According to recent news reports, I’ve been encouraged to hear that some patients are managing to get off painkillers, including Cynthia Toussaint. From an ABC NEWS report last June, she “was confined to her bed, writhing in pain from muscle spasms, unable to walk or to live a meaningful life.”

Yet, ten years later, after turning to a variety of integrative medicine treatments, she resumed her singing career. Toussaint noted, “There’s a whole range of under-appreciated non-traditional treatment options that are low-cost, effective and with no side effects.”

A recent article in The St. Petersburg Times explains how addiction to prescription painkillers nearly killed ex-NFL star Randy Grimes. Yet, at a point that Grimes describes as “a spiritual moment,” he began to regain control of his life, found renewed purpose and now works to help others to overcome the same addiction. Throughout my entire life, I’ve taken a spiritual approach to my own health and have experienced consistent, positive results.

It’s also encouraging to read reports on therapeutic approaches that focus on thought and the mind in reducing pain. Studies at Stanford, Duke and Wake Forrest Universities have proven many mind-body approaches to be effective in clinical trials.

One reason alternative therapies are not more commonly used by the public appears to be the lack of insurance coverage. According to The Seattle Times, Rep. Jim Moeller believes it is “unfortunate” that Medicaid covers narcotic painkillers but not alternative treatments.

However, there are signs this may be changing. From a recent press release, starting in July of 2012 the 13,000 employees of Maricopa County, Arizona will soon have the option of an integrative approach “that embodies the philosophy and practice of healing oriented medicine, addressing mind, body and spirit.”

Specialists who work with patients dealing with pain have told me they support expanding health coverage to include alternative therapies that are less obtrusive and generally more affordable.

On Dec. 16, the Obama administration surprised many by declaring that each state will now be allowed to have greater freedom in what their respective health exchanges will include.

This may be a unique opportunity to include alternative treatments, especially the treatments that already qualify as medical expense deductions for federal income tax purposes. Including alternative therapies in health insurance will make them more accessible to patients who may be struggling to find better ways to manage their pain.

This article first appeared on Blogcritics.

A retired architect, Bill Scott writes about spirituality and health for Blogcritics.org and also serves as the Christian Science Committee on Publication for Washington State.

In the series, the Times reported that in order to save money the state steers Medicaid patients, workers’ compensation recipients and state employers toward methadone, a long acting drug that costs less than a dollar a dose.

The drug’s effects, however, are unpredictable, increasing the risk of overdose, and the Times investigators found that since 2003 at least 2,173 people in Washington had died from unintentional overdoses linked to the drug.

In today’s article, the Times writes:

The health advisory marks the first public acknowledgment by a powerful state committee that methadone can be more unpredictable than other pain drugs, or opioids. State officials had previously resisted attempts to single out methadone for special treatment, insisting the drug was as safe and effective as any other narcotic pain drug.

To learn more:

• Read today’s article in the Seattle Times: State plans emergency warning on risks of methadone.

Read the Seattle Times series:

Part 1: Silent deaths

State pushes drug that saves money, costs lives

Timeline: State defends methadone as deaths rise

How we did it: our analysis

Part 2: Politics of pain

New law leaves patients in pain

Source documents

Part 3: A troubled clinic

In pain clinic’s wake: doubts, chaos, deaths

Source documents

Graphics

More deaths from methadone than other drugs

Zocalo Public Square: How Doctors Die

Photo: Hanspeter Klasser

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. … He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible.

Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little (Dr. Ken Murray, 11/30).

Photo courtesy of Hanspeter Klasser

Health Affairs: An MS Patient Loses Trust When She Finds Out Her Doctor Is Paid By Drug Companies’

Last year, four years after showing initial symptoms of multiple sclerosis (MS), I walked out the door of one neurologist’s office and, after several months of searching, switched to a different doctor.

It was the final act in a series of events that had gradually eroded my trust in the first neurologist’s judgment, which I believe was colored by his financial relationships with drug companies who manufacture and market medicines for MS patients. … Given my background in medical ethics, I was familiar with the potential conflicts of interest that exist for physicians participating in clinical pharmaceutical trials.

Assuming that my neurologist was being compensated for running the trial, in addition to his earnings from seeing patients in his neurology practice, I’d asked him if that was the case, and he confirmed that it was (Maran Wolston, December 2011).

The New Republic: More Health Care Heresy From Newt

Newt Gingrich

Newt Gingrich’s past endorsement of an individual mandate has drawn fire from conservatives. But that’s not his only health care heresy.

In 2008, Gingrich made the case for another idea that became part of Obamacare and, in due time, the focus of right-wing attacks.

Worse still, at least from the standpoint of conservatives, he did so by writing an op-ed for The New York Times. Oh, and did I mention he had some help? Gingrich had a co-author: John Kerry, the Democratic senator and former presidential nominee. … they also acknowledged that ultimately the private sector couldn’t solve this problem on its own.

More action was necessary, they said, and that action had to come from government … That’s the problem for Gingrich when it comes to improving the delivery of health care. He isn’t crazy. But plenty of influential conservatives are (Jonathan Cohn, 12/13).

Photo by Gage Skidmore

Newsweek: Could This Be The End Of Cancer?

By all rights, Shari Baker should have said her final goodbyes years ago. In 2005, more than a year after three doctors dismissed a lump under her arm as a harmless cyst, she was diagnosed with stage IV (metastatic) breast cancer … In May 2006, she traveled to the University of Washington.

The (cancer) vaccine was injected into her upper arm; she got five more shots over the next five months. Today, with scans detecting no cancer anywhere, Baker seems to have beaten some extremely stiff odds. …

By “cancer vaccine,” scientists mean something that will stimulate the immune system to attack malignant cells (Sharon Begley, 12/12).

The Atlantic: The Top 10 Health Stories Of 2011

Photo by Jean Scheijen

Coffee is good for you. And coffee is bad for you. Cell phones cause cancer. And cell phones don’t cause cancer.

Like any other year in health, 2011 was one of conflicting studies. In the end, we’re not always sure how to act or what to drink or when to exercise, but we do know more about ourselves and the world we live in thanks to researchers everywhere and the work that they do.

However broad or specific their conclusions, however small or large their sample size, medical studies do contribute to our wellbeing simply by existing and, if nothing else, by making us think twice about the things we eat, say, and do on a daily basis (Nicholas Jackson, 12/14).

Photo courtesy of Jean Scheijen

The Daily Show: Ed Gillespie

Jon Stewart talks health care with Republican political strategist Ed Gillespie (12/8).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The paper argues drug is dangerously unpredictable and responsible for the deaths of hundreds, particularly among the poor.

At the same time, the state has adopted tough new prescription rules that are making it difficult for patients with chronic pain to find doctors willing to treat them, the paper reports.

The series is written by Seattle Times staff reporters Michael J. Berens and Ken Armstrong.

To learn more read the paper’s series: The Politics of Pain.

• State pushes drug that saves money, costs lives

To cut costs, Washington steers Medicaid patients to a narcotic painkiller that costs less than a dollar a dose. The state insists methadone is safe. But hundreds die each year — and more than anyone else, the poor pay the price.

• New state law leaves patients in pain

It was meant to curb rising overdose deaths. But Washington’s new pain-management law makes it so difficult for doctors to treat pain that many have stopped trying, leaving legions of patients without life-enabling medication.

By Jessica Marcy

A poll released Tuesday found that an overwhelming majority of doctors support palliative care, with 96 percent responding that they believe enhancing the quality of life for seriously ill patients is more important than extending life as long as possible.

Despite these sentiments, many physicians responded that they have some hesitations about palliative care and that there are barriers to its full adoption.

Notably, the poll, released by National Journal, also found a dramatic “generation gap” in physicians’ education and training on palliative care.

Seventy-three percent of physicians age 39 or younger report “a great deal” or “some” exposure to palliative care during medical school compared to 36 percent of those age 40-49, 23 percent of those age 50-59, and only 6 percent of those age 60 or older.

Ezekiel Emanuel

Speaking at a National Journal event Tuesday, oncologist and bioethicist Ezekiel Emanuel, who currently teaches at the University of Pennsylvania, called upon the medical community to push for even greater incorporation of palliative care into the health system.

Emanuel, the brother of Chicago Mayor Rahm Emanuel, said that his own career illustrates the major transformation in end-of-life care training. In 1984, during his third year of medical school, he decided to switch gears to pursue a PhD on end-of-life care issues, noting that his adviser told him, “That’s a career ender. Nobody wants to talk about end-of-life care.”

Despite such initial discouragement, he went on to incorporate palliative care in oncology treatment at the Dana-Farber Cancer Institute and later served as the founding chair of the Department of Bioethics at the NIH Clinical Center until last August and as a special health policy adviser at the White House, where he raised attention about ethical issues in end-of-life care.

Meanwhile, the poll found that 91 percent of physicians believe patients are not adequately informed about palliative care; other physician concerns include that patients are reluctant to accept it because it means they might not recover, health insurance companies and Medicare don’t reimburse adequately for consultations, there aren’t enough palliative care physicians and services and patients can’t afford the care.

Many physicians also reported that they received little training on operational and financial aspects of palliative care and that they would like more on those topics.

Shannon Brownlee, the New American Foundation’s acting health policy director, expressed concerns that the current reimbursement system inhibits the full use of palliative care, which would lead to the reduction of expensive treatment.

“This is the horrible dilemma that hospitals find themselves in,” Brownlee said. “When you reduce that volume, you’re punished.”

Emanuel said that at some point insurers and Medicare will have to “make a leap together” to better support paying for palliative care. Emanuel, recalling Republican charges that the 2010 health law would establish “death panels,” noted that such political tactics “completely backfired.” Instead, he said they reinvigorated physicians’ efforts to improve end-of-life care.

“My inbox was flooded with support from physicians and it renewed the recognition by physicians that we have to do something on this,” Emanuel said.

The poll, conducted by FTI Consulting and commissioned by National Journal, surveyed 500 board-certified physicians, 45 percent of whom were primary care providers and 55 percent specialists between Oct. 28-Nov. 2.  The poll has a margin of error of plus or minus 4 points.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.