Tuesday, June 19, 2007
In reading the newspaper and news magazines, and watching evening news show or listening to talk radio or NPR, I enjoy finding the parallels between palliative medicine and the news I'm learning about. Sometimes it takes a little creativity, such as when I am reading a Wall Street Journal article about business strategies an try to apply it to how a hospice team functions or how we market our unique services to others. Other times it is very easy to connect the dots.
The first obvious one was a cover article early in June about new pain research in Newsweek. It led to me discover Ionsys, an new trandermal fentanyl delivery device utilizing self-contained ionopheresis. Apparently it is designed for post-op patients. The device, called a E-Trans, and developed by ALZA, looks like a spaceship (watch the video on the site to get more of the spaceship feel. They even make it glow!). I have not seen any cost statements on it, but I am all for more options when it comes to opioids, but more than a new device I would like to see more medication options. Other than that, the article basic point is that people are starting to recognize pain (especially chronic pain) as a big enough gorilla that addressing it proactively may be the best option. But I can't recommend you read this article, because it hit on some of my palliative medicine pet peeves in the media.
1) Overstating facts/Hyperbole
The author bashed the 10-point visual analog scale as "absurdly imprecise." Absurd? As in logically contradictory; nonsensical; ridiculous? I think that is a bit much. The VAS is not perfect but it does help track pain in one patient over time. It does not help you to say, "Ah you have a pain of 7, well 50 mcg of fentanyl for you!" The article did go on to state the flaws of the VAS, but some of these flaws are also strengths, such as "inability to compare" between patients (i.e. one person's 5 to another person's 5).
Here is another example:
Morphine, also given to Jackson and many others in the Civil War, is still the Army's most commonly used painkilling drug. It works, but compared with more-modern options, it's one step above chloroform and two above biting the bullet. (emphasis mine)
So what are the label for the axis for this particular scale? Comfort? Sedation potential? Historical? Reverse alphabetical? Is it really necessary to compare morphine and demonize and stigmatize it more? It is a powerful medication for sure, but one that can be used effectively and properly when respected and understood to provide effective pain relief without major side effects.
2) Using the word narcotics when referring to opioids
Others pack all the punch of narcotics with less of the specter of addiction.
Narcotic is primarily a legal term referring to controlled substances regulated by the DEA, thus the Narcotics division, the 'narc' informant, etc. Nacrotics, when using the original definition, really applies to a medications with a effect of sleepiness or stupor. Therefore it is way to broad of a definition to include just opioids. Say 'opioids' when you discuss it in medical terms, say 'narcotics' when you are discussing legal/regulatory issues.
3) Poor use of scientific language
Kadian was referred to a a 'morphine derivative' in the article. The active medication is morphine, and is encapsulated in a different type of delivery system. A good example of a derivative is that codeine (methylmorphine) is a derivative of morphine
The second article was in Time covering the growing (ha!) field of appetite research. And appeared to have a scientific editor review the article more precisely as I did not find as many flaws as in the Newsweek article. The article did not reveal to much in to the world of appetite, anorexia-cachexia in the palliative care population, except to let the public know that appetite is much more complex than:
Speaking of appetite, I was recently tipped off to a 4 day conference on cachexia, which will be held in Tampa this year in December. Check out the schedule, looks like some interesting talks. The logo is pretty clever. Decline, decline, then maybe an improvement! Also check out the font for cachexia. It gets skinnier. I am a sucker for good graphic design. I am really impressed that cachexia research can cover 4 days! Are you?
The last health in the media connection I made recently was 60 Minutes reviewing the use of propranolol in preventing or reducing the severity in post-traumatic stress disorder (transcript and video available). The article had good coverage of the ethical debate in trying to minimize stressful experiences that we may learn from versus traumatic memories preventing people from proper functioning. As I was watching it, I imagined a family member approaching me to ask for propranolol so they could cope better with losing a loved one. Maybe I will discuss this with my team this week and see what the chaplains and social workers say about this? What would you do?
Updated/Added Prognosis Links
I added some prognosis links. Check them out on the Prognosis Links page.
Update on New Orleans Euthanasia Accusation Case
CNN has information that the two nurses accused of euthanasia in post-Katrina New Orleans have received immunity in exchange for their testimony. This is leading to speculation that Dr. Pou will be the main target. But it could also mean that the two nurses now will feel safe to talk openly about the situation without risk of prosecution and it could swing either way.