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Injury and Trauma

Dangerous Risks of Using Opioids to Treat Pain

by Angela Sams

Have you ever been prescribed a painkiller to help with surgery recovery or maybe for back pain that just won’t go away? Even if not, it is likely that you know someone who has been on a painkiller medication at some time or another. That likelihood rose steadily between 1999 and 2010, as doctors began turning to a “quick fix” that will treat their patients in an aggressive manner. But, as patients cooperatively swallow their prescribed pills, it is important to consider the downsides of opioids on an individual and societal level.

A recent opinion article in the New York Times indicates that while there has been a “steady increase in the mortality rate of middle-aged white Americans since 1999,” this is not the case in other age and ethnic groups, or even with people in the same age group who live in other countries. Consider this disturbing statistic: “In 2013 alone, opioids were involved in 37 percent of all fatal drug overdoses.” It is clear that opioid overdose is quickly becoming an epidemic, and a major shift in attitude is a key to the problem.

At one time, opioids were used mainly for pain caused by terminal illnesses or as a short-term fix for pain after surgery. However, during the 1990s, drug companies began marketing to doctors, encouraging them to “be proactive with pain and treat it aggressively.” Afraid of being seen as uncaring or reprimanded for not treating a patient’s pain to the best of their abilities, doctors fell for the marketing scheme and began prescribing powerful opioids such as OxyContin.

Though opioids may relieve pain and help a patient recover more comfortably, evidence suggests that they should only be used for short-term treatment, not long-term treatment of nonmalignant pain.  There are also many downsides to taking such a medication. This type of painkiller is extremely addictive, may affect mental health, lead to unemployment, and cause poor health in general, to name a few risks. Ironically, using these drugs can also make a patient more sensitive to pain.

So what is the solution to this problem? Should people suffer in pain, rather than take the risks associated with opioid drugs? Actually, the answer may be as simple as taking an over-the-counter medication. In one study, researchers found that when Motrin and Tylenol were combined, they were actually more effective than opioids, not to mention safer. While opioids are still very readily available to patients who are in pain, small steps towards a solution have been taken. For example, the Food and Drug Administration issued a Risk Evaluation and Mitigation Strategy, ensuring that opioids now contain warning labels. The makers of these drugs must also give training and education that will help doctors prescribe them safely. Certainly, patient awareness is helpful, but only time will tell if physicians can turn this shift in attitude back around, and work towards other, safer solutions for pain management.

Hospitals Are Getting Bigger (And Not Just In Texas)

by Jen Jenkins, Market Analyst

Parkland Hospital in Dallas, Texas is gaining exposure, and it isn’t due to its plush newness, updated equipment, sophisticated technology, or a tragic event of 1963 (for readers who are familiar with the name “Parkland Memorial.”). Instead, Parkland is getting attention because each room in the hospital has been specifically designed to more effectively treat overweight patients, or more accurately, “the bariatric population.” This population is made up of patients who typically have a body mass index of 40 or higher and as the need to accommodate these patients has grown, so has the trend to redesign hospital rooms across the country.

According to Nancy Connolly, a senior executive at a hospital consulting group, “Most hospitals we are building are providing an increasingly larger percentage of rooms that can accommodate the larger person.” These changes are necessary due to the unique challenges obese patients tend to face: beds, wheelchairs, and other equipment need to be larger and sturdier which also means that door frames and the rooms themselves need to designed differently. This is now routinely kept in mind as old hospitals are updated and new hospitals are built.

Regardless of what this new trend may indicate, the overall idea moving forward is for hospitals to be designed with the “universal patient” in mind so that every single person may feel comfortable and accounted for. Many arguments can and are being made about what this means about our society, food consumption, economic issues, etc. However, in this scenario hospitals are simply doing what is necessary to be in a better position to care for patients in every way possible – which is undoubtedly their most pertinent responsibility.  According to an article featured in The New York Times, although this trend is being seen across the country, Parkland has done an especially remarkable job in its new design, which will likely be replicated here on out.

 

Zion’s New Hands

By Jen Jenkins, Market Analyst

We are inundated by new technologies and on an almost daily basis learn of awe-inspiring events in the medical and scientific communities; nevertheless, it remains a momentous occasion when something happens that will so radically change a person’s life. Eight-year-old Zion Harvey, who lost his arms and legs to a life-threatening infection at the age of two, made his way home this week with a brand new pair of hands. Under the care of Dr. Scott Levin and a transplant team at the Children’s Hospital of Philadelphia, Zion became the first child to ever receive a double hand transplant.

The history of this extensive operation is a short one. The first single hand transplant to achieve prolonged success was performed in Louisville, Kentucky in 1999. Since that time there have been hand transplants performed on adults around the world; however, that list of completed surgeries is still relatively short.

Zion endured 11 hours of surgery and has had extensive physical and occupational therapy several times a day since the July surgery, but there are still many challenges he will continue to face. After not having use of these extremities for years, Zion will need to reengage his brain to use his hands to their full ability. Despite that, Dr. Levin shared with NBC News just how remarkable this boy is: “Today he was playing with his action figures and baking cookies with a whisk, doing all sorts of things with his hands we never dreamed he would be able to do within a few weeks of surgery.”  See the full story here.

 

Hyperbaric Chambers and Helmet Sensors: Effective Concussion Treatments?

Start-ups and doctors are in zealous pursuit of new and sometimes controversial ways to prevent, detect and treat concussions, as noted in this article.

A growing industry has developed around concussions, with entrepreneurs, academic institutions and doctors scrambling to find ways to detect, prevent and treat head injuries. An estimated 1.7 million Americans are treated every year after suffering concussions from falls, car accidents, sports injuries and other causes.

While the vast majority quickly recover with rest, a small percentage of patients experience lingering effects a year or longer afterward. Along with memory issues, symptoms can include headaches, dizziness and vision and balance problems.

Since 2007 research spending has increased dramatically. At that time Congress, facing criticism that the military had ignored the psychological and physical toll on soldiers of serving in the Afghanistan and Iraq conflicts, allocated $600 million for research and treatment on traumatic brain injury and post-traumatic stress disorder (PTSD), two major conditions faced by many returning soldiers. In turn much of the traumatic brain injury research has included a look at treating concussions. Many highly publicized cases in the NFL of concussed football players have added to the call for more research and treatment options.

The search for ways to treat and prevent concussions has spawned screening tools, helmet sensors, electronic mouthpieces, diagnostic blood tests and brain imaging devices. Start-ups are marketing their products to the military, schools, hospitals, sports teams and parents, and controversial therapies like hyperbaric oxygen are being promoted to patients. But as the industry booms, medical experts are raising concerns that it is a business where much of the science is sketchy, belief frequently outruns fact, and claims of technological breakthroughs evaporate soon after they are made. Read more…

Celebrating 60 Years of Polio Vaccinations!

Sunday April 12th marks 60 years since the polio vaccine, developed by Dr. Jonas Salk, was declared “safe, effective, and potent.” April 12th also marks 70th years since of the death of President Franklin D. Roosevelt, whose paralysis was generally believed to be caused by polio.

Prior to 1955 the dreaded disease afflicted 600,000 people around the world each year, including about 50,000 children in the U.S. There is still no known cure for the disease which could cause various degrees of paralysis and is sometimes fatal. The testing of the vaccine, known as the Francis Field Trial, was the largest medical experiment in history up at that point, involving more than 1.8 million children from Maine to California.

Polio was officially eradicated in the United States in 1979. However, worldwide there still remain occasional outbreaks. In fact, in 2014 the World Health Organization declared polio’s renewed spread a “world health emergency” and the civil in Syria has led to more than 90 cases reported in that country. There have also been at least 20 cases reported in Pakistan in 2015.

Given recent measles outbreaks in the U.S. — another preventable disease with an effective vaccination — a 2010 documentary on the polio vaccination is receiving extra attention these days. Carl Kurlander, CEO of the company which produced the film A Shot Felt ‘Round the World reports increased interest in the film from groups interested in promoting the importance of vaccination. The World Health Organization hopes to eradicate polio worldwide by 2018.

“There’s no technical reason why there should be cases anywhere in the world by the end of this year,” said Oliver Rosenbauer, communications officer for the World Health Organization’s Global Polio Eradication Initiative. “It’s a question of political will and societal will.”

Careers with the Highest Suicide Rates

In the US, suicide results in roughly 36,000 deaths per year. And since 2009 suicide has been the leading cause of injury-related deaths. A new study published in the American Journal of Preventive Medicine analyzes suicide trends in the workplace, identifying specific occupations with high incidents.

Occupations with the highest rates?

  • Law enforcement officers (5.3 per million)
  • Farming, fishing, and forestry occupations (5.1 per million)
  • Installation, maintenance, and repair (3.3 per million)

This study compared workplace versus non-workplace suicides in the U.S. between 2003 and 2010. During that time period there were 1700 workplace suicides (a rate of 1.5 per 1 million) with an overall US suicide rate of 144.1 per 1 million. The study used data from the Bureau of Labor Statistics’ (BLS) Census of Fatal Occupational Injury (CFOI) database.

  • The workplace suicide rate was 15 times higher for men than for women, and almost four times higher for workers aged 65-74 than for workers 16-24.

Why the high rates in these particular categories? One hypothesis suggests an increased risk based upon availability and access to lethal means. This would include access to pharmaceuticals for medical doctors and firearms for law enforcement officers.

This might help explain the higher rates of death among members of the second two categories noted (i.e. farmers and maintenance workers) who would routinely work with heavy, potentially dangerous equipment, and would also face workplace stressors such as social isolation, higher rates of chronic injuries and pain, a high risk of financial loss, and chronic exposure to toxic chemicals including many types of pesticides and solvents.

“This upward trend of suicides in the workplace underscores the need for additional research to understand occupation-specific risk factors and develop evidence-based programs that can be implemented in the workplace,” concluded Dr. Hope M. Tiesman, epidemiologist with the Division of Safety Research at the National Institute for Occupational Safety and Health (NIOSH) and lead investigatory for the study.

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A Disease of Time

Post Traumatic Stress Disorder is a psychiatric disorder, the fourth-most-common one in America.  Over a decade into the global war on terror, PTSD purportedly afflicts as many as 30 percent of the conflict’s veterans. And the disorder’s reach extends far beyond the armed forces.

David J. Morris, who served in Iraq from 2004 to 2007, provides us with a new understanding in his recently released The Evil Hours: A Biography of Post-Traumatic Stress Disorder. PTSD, he notes, is “in a manner of speaking, a way of institutionalizing moral outrage.”

From Morris’s website is a brief summary of The Evil Hours: Drawing on his own battles with post-traumatic stress, David J. Morris — a war correspondent and former Marine — has written a humane, unforgettable book…Through interviews with people living with PTSD; forays into the rich scientific, literary, and cultural history of the condition; and memoir, Morris crafts a moving work that will speak not only to those with PTSD and their loved ones, but to all of us struggling to make sense of an anxious and uncertain time.

David Morris notes:

I first got interested in PTSD when I read a newspaper article about how some Iraq veterans felt “poisoned” by the war, as if it had fundamentally altered their existential position in the world. I am fascinated by this moral component of survivorship—how events in life can freeze us in time, seeming to render us unfit for the everyday world. This is essentially the same question confronted by Ishmael at the end of Moby Dick, as he looks out on the vast sea from Queequeg’s coffin: How does one live in the aftermath of the impossible?

The Evil Hours has been widely and quite favorably reviewed, from “an eye-opening investigation of war’s casualties” (Kirkus Reviews)  to “Well-integrated autobiographical elements make this remarkable work highly instructive and readable. (Publishers Weekly) Read more…

Chronic Fatigue Syndrome Becomes Systemic Exertion Intolerance Disease

We have now seen another example of the medicalization of distress and the emergence of a new “disease” (as opposed to a group of symptoms) according to the linked article.

While we have not yet read the report and reserve full conclusions, the release suggests nothing new in terms of science, etiologic agents, or new findings that lend meaningful clarity and a path to recovery from the symptoms of Chronic Fatigue Syndrome (CFS). Rather, the deciding panel appears to have largely achieved a political goal of validating a syndrome of various symptoms that do not lean to any conclusions as to cause or cure. That those who claim to have CFS or whatever new name may be ascribed to it are suffering is not in question. What remains unknown is why, and whether this syndrome is caused by a lesion of some sort, a viral or bacterial pathogen. What is going on with this action?

Likely a number of things. One is that it addresses the anxiety and perceived stigma that often applies to experiences that are ill-defined and may be considered to have an emotional component, implying lack of validity for the sufferers. Noteworthy is that the panel is seeking responsive treatment and diagnostic codes. By validating a syndrome as a disease, the conversation changes to one of obligations and rights for the sufferers that they believe they lacked before.

And it implies and may create duties by others in the industry of treating diseases, including insurance carriers, employers, courts and the culture to increase the level of payment, support, acceptance and accommodation to those claiming the disease. And let’s not forget members of the medical profession, drug companies, hospitals and other parties who have a strong vested interest in adding to the list of issues for which they may/will receive payment.

The list of syndromes, new diagnoses or disorders with expanding numbers and those claiming them are many. In no particular order they include: Post-concussive syndrome, “Low-T,” erectile dysfunction (with a recent ad featuring a beautiful woman claiming that over 50% of men over 40 suffer from some form of it), Epstein Barr Virus, Autism, Post-traumatic stress disorder, Fibromyalgia, ADHD (attention deficit hyperactivity disorder), Lyme Disease, and others. Common to many are claims of financial, educational, occupational or legal entitlement, partial exculpation from responsibility, expensive and proprietary medications, strong advocacy groups and heated arguments in the media and professions.

In short, recent “clarification” on Chronic Fatigue Syndrome likely fits more into the realm of politics than science.

The Top 8 Jobs with the Highest Injury Rates

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Four of the top eight are medical workers: orderlies, nursing assistants, personal care aids, and registered nurses.

According to the Bureau of Labor Statistics, more than 35,000 nursing employees are injured each year severely enough that they miss work.

Some hospitals have report that they have reduced lifting injuries among nursing staff by up to 80 percent — using an approach often called “safe patient handling.” They use special machinery to lift patients, similar to motorized hoists that factory workers use to move heavy parts. The hospitals also conduct intensive training among the staff.

Yet the majority of the nation’s hospitals have not taken similar action. The injuries are often so severe that they’re career-ending, a problem compounded by the fact that many of those injured are relatively young. To help address the problem, on Jan. 1, 2012, the Hospital Patient and Health Care Worker Injury Protection Act went into effect in California. This NPR article follows several injured medical workers and their stories.

West Point Professor and Iraq War Veteran Weighs in on Disability Pay

Disability benefits, especially for veterans, can be a difficult, often emotional issue to discuss as is witnessed in this The New York Times article and accompanying comments. Lt. Col. Daniel Gade, a professor of public policy at the United States Military Academy, lost a leg while serving as a tank company commander in Iraq in 2005. He spends much of his spare time publishing essays and traveling the country pushing the idea that the Department of Veterans Affairs should move away from paying veterans for their wounds and instead create incentives for them to find work or create businesses.

“It’s a difficult issue to broach. People immediately think you are trying to shortchange veterans,” he said in an interview. “But I’m in a position to do it because I have skin in the game, literally.”

Colonel Gade wants to avoid a partisan fight over his ideas which says are first about helping veterans and second about saving money: “I think we can show we have a no-kidding better way to help veterans that is cheaper and more effective.”

One comment author summed many points up not just on veterans’ benefits but the disability system in general: “We can say that ‘disability status’ can become a disability in itself, without suggesting any sort of malingering or intent to defraud. This applies to vets and civilians alike. There are many cases of disability where the person really can’t work; gaining disability status is a godsend for them. It enables them to actually be more successfully productive in the community than continually failing in the workplace. BUT…Some people don’t do well being disabled. The status itself seems to undermine their ability to take charge of their lives.” Read more…