Who cares about opiates?

There’s an opioid epidemic. Oops. Maybe that should be a question. There’s an opioid epidemic?

Even if there is, who cares?

Doctors care. Not because of patients but because addiction pays. I can say with complete certainty that without payment no physician would be offering addiction treatment. The newest rage is Suboxone for “medication assisted treatment (“MAT”).” Suboxone, like methadone before it, is not a cure for addiction- no matter what The American Society for Addiction Medicine may say. These addicts are not recovering they are exchanging one addictive narcotic drug for another one. A different drug for which they need a prescription which can only be obtained by a licensed provider (physician, physician-assistant, or nurse practitioner).  The idea behind MAT is substituting one addiction for another. To put it in perspective it’s like treating an alcoholic with limited supplies of prescription beer. It’s like treating crack addicts with methamphetamine.

Doctors also care because they make money from each and every visit at which they write prescriptions. The price for a “suboxone visit” may be as high $500 and some providers only take cash. The rise of “pill mills” has occurred, not because doctors altruistically want to ease the suffering of people but because it pays. In short, cutting back prescribing cuts into business. Medical boards are hesitant to intervene because they are frequently run by doctors- the same doctors who make money prescribing. For example, Mississippi, with great fanfare announced the “Governor’s task force” on opioids in December 2016. Eight months later the task force has 41 recommendations. The few recommendation that have been released so far are similar to what other jurisdictions already have in place. It’s worth noting that the Governor specifically indicated that “here have been 95 overdoses to date this year in Mississipp.”

“Pain doctors” frequently run cash-only businesses with waiting rooms and parking lots filled to capacity with “unsavory” individuals. Pill mills are enough of a problem that there are instructions for how to recognize them. It’s not hard. See here, here, here, and here.  Some of my favorites:

334baa96-d56c-47eb-b128-40c018db4f64-large16x9_Capturepillmills-splash

 

Recent occurrences may cause doctors to re-think whether the income from opiate prescriptions is really worth it. South Bend, IN now has “groups working together to fight the local opioid epidemic.” It remains to be seen what “working together” will actually mean. It is, after all, only the providers (mostly doctors) who can stop the flow of unnecessary prescriptions.

More on the “opioid epidemic” later.

 

Academic Corruption

Many patients are skeptical of their physician- you probably should be too.  contributed a piece over at the Diet Doctor. The Diet Doctor states this on the “About” page:

Regaining health in a sick world requires thinking and acting differently. It requires trusting not in corporate propaganda or old misinformation, but in nature. In the power of your own body to return to its natural state, given the right environment.

Our mission is to find the truth about health and supply tools for those who want to free themselves. Thus empowering people everywhere to revolutionize their health.

Dr Fung highlights some of the most egregious conflicts of interest many physicians labor under. Money is the cause. You doctor is swayed by payments. You can (and should) check your physician at https://projects.propublica.org/docdollars/.

Almost all doctors acknowledge that physicians can be swayed by payments. However, they limit that persuasive effect to other doctors. No physician admits that a few bucks, or a golf trip, or a free lunch might cause him/her to compromise a patient’s care.

But let’s look at a specific example- Charles “Sam”Fillingane, DO from Jackson, Mississippi (how appropriate that he hails from the state that is routinely number last in everything good).

Wall Street Journal article cited the case of one doctor, Charles “Sam” Fillingane, as “the most prolific test prescriber among 296 doctors who referred patients to HDL.” He may have earned as much as $23,000 in six months on P&H fees at one point. In 2010, according to the Journal, he received $3,000 a month for serving on HDL’s medical advisory board. By 2012, as the former HDL employee told me, Fillingane received $6,000 a month to serve on the advisory board. This was on top of the P&H fees and his fees for speaking on behalf of the company. Despite all these revenue streams, the company gave him $100,000 in unsecured loans “because he was struggling in his business.”

If you do a quick google search for “Dr. Fillingane” in addition to his distinction as one of the highest referrers to the operations of HDL he can be found on several websites. On his own website he notes this:

Dr. Sam Fillingane is a board certified family practitioner whose practice is totally dedicated to “Cardiovascular Risk Reduction.” Dr. Fillingane has had a passion for CV Risk Reduction for years which has led him to develop a treatment protocol for cardiovascular disease that has had great success in reducing cardiovascular events in a high risk patient population.

Dr. Fillingane has been teaching courses related to cardiovascular risk reduction all over the country for many years. Recently Dr. Fillingane has become the TV host of a national television show related to cardiovascular risk reduction, “Straight To The Heart,” which can be seen weekly on My Family TV Network. Dr. Fillingane utilizes his experience and knowledge of cardiovascular biomarkers to identify patients at risk for cardiovascular disease and how to remove that risk from each patient.

Dr. Fillingane has been a sought after speaker for multiple topics related to CV disease. He has also assisted in the training of multiple medical students and residents throughout the years. Dr. Fillingane was selected as the AOA Mentor of the Year in 2009.

Dr. Fillingane is a medical director for Jackson Sleep Laboratory, and assists with the care of numerous cardiovascular patients with sleep abnormalities. Dr. Fillingane has laser surgical training that includes many years of experience treating obstructive sleep apnea with LAUP (laser assisted uvulopalatopharyngoplasty) when conservative treatment with CPAP or BiPAP are not an option.

Dr. Fillingane is a graduate of Kansas City College of Osteopathic Medicine and Biosciences. Dr. Fillingane also did his rotating internship in Kansas City at Lakeside Hospital, which included cardiology training at St. Luke’s Hospital. Dr. Fillingane is the founder and CEO of Fillingane Medical Clinic in Jackson, Mississippi.

He also has another website here, which also make many of the same self-serving claims. Ironically, it also touts his relationship with the now defunct HDL.

All of the websites indicate Dr. Fillingane practices here:

Fillingane Medical Clinic
1021 North Flowood Drive
Jackson, Mississippi

Yet this location is closed. The bank has taken possession of the property. Dr. Fillingane has abandoned the building, his patients, and his practice. Yet he still has a Mississippi license and has acquired, miraculously, a Florida license as well.

The public is right to be skeptical of “academic” credentials. The public- you included- should carefully check out whether you doctor’s credentials are real or simply bogus “puffery.” Licensure doesn’t help as a screening tool (ask Mississippi and Florida). At least Alabama had the good sense to deny “Dr. Fillingane” a license.

What’s wrong with healthcare?

Basically, it’s not very good but it’s very expensive. Yet another round of studies confirms what we should probably know. But we’re not just worse than other industrialized countries, we’re worse than Cuba. Basically, we kinda suck.

Insurance is a racket basically redirecting the spending of money “donated” by healthy people for the care of less healthy. Its the only insurance system we have wherein the really good risks are forced to subsidize the really poor risks.

Imagine, if you will, what your insurance auto premium would look like if your premium depended on how well your alcoholic, multiply convicted, thrice bankrupt, wife-beater neighbor drives. Right, that’s what modern health insurance does. We’re all in the same pool. Your premiums are driven up specifically so that unhealthy patients can have lower premiums and third-party payers can still make a profit.

But that’s what happens when healthcare is primarily a business designed for the enrichment of providers rather than the maintenance of patient welfare. The problem isn’t insurance. The problem is healthcare.

 

The decline and fall of informed consent

Over at KevinMD there’s a great post by Richard Gunderman (Chancellor’s Professor, Indiana University) and James Lynch (Dean of Admissions, University of Florida College of Medicine). In the post they authors bemoan the fact that informed consent documents have become impenetrable aggregations of legalese in comprehensible to almost everyone.

However, the authors only hint at the most important point. Informed consent is the mutual understanding arrived at between two entities. Informed consent may be guided by the massive document to which the authors refer. The document may be used to memorialize the agreement. But, the document is not the agreement.

The authors refer to a 30+ page “informed consent” document for a cancer study. The average person would find the document entirely incomprehensible. But, the average person might actually sign the document because (s)he believes  that the study might offer improved opportunity for survival. The belief is frequently without merit.

Patient have a right to question the care they receive. In particular they should question experimental care. The most important thing any patient should realize-

The purpose of research is NOT to improve your health. The purpose of research is to advance medical knowledge and possibly the career of your physician.

Medical researchers have an irremediable conflict of interest and this conflict of interest will not be in the “informed consent” document. But this conflict of interest may well compromise your health and safety.