"I used to love "60 Minutes."
...Oh, how times have changed!
On February 24, 60 Minutes did a segment about a drug manufacturer who is calling out drug companies for "corrupt," "immoral," and "depraved" actions in marketing opioids.
Supposedly, the incentive for changing the labeling of opioids to allow for extended use is some sort of moral crime.
David Kessler, former Commissioner of the FDA said, "There are no studies on the safety or efficacy of opioids for long term use." (8:25 in the video)
David Kessler, former Commissioner of the FDA said, "There are no studies on the safety or efficacy of opioids for long term use." (8:25 in the video)
Case closed!
We need to restrict opioids to two or three days at most.
...while there may be no studies on extended use, those of us in medicine are painfully aware that while some patients do well without opioids, others require what Dr. Kessler would call "extended" use.
This is a result of the Bell curve, or "normal distribution" of response to drugs.
We need to restrict opioids to two or three days at most.
...while there may be no studies on extended use, those of us in medicine are painfully aware that while some patients do well without opioids, others require what Dr. Kessler would call "extended" use.
This is a result of the Bell curve, or "normal distribution" of response to drugs.
The person whose knee replacement requires zero opioids is on the left side of this curve, while the one who needs them for two weeks is on the right.
Most of us fall somewhere in the middle.
Every surgeon and every anesthesiologist lives with this curve every day.
Importantly, the difference between the left and right sides of the curve isn't two or three pain pills.
The range is from zero to a hundred or more.
And that leads to a key piece of information that 60 Minutes completely ignored.
Most of us fall somewhere in the middle.
Every surgeon and every anesthesiologist lives with this curve every day.
Importantly, the difference between the left and right sides of the curve isn't two or three pain pills.
The range is from zero to a hundred or more.
And that leads to a key piece of information that 60 Minutes completely ignored.
Most physicians routinely use medications in "off-label" ways.
To understand this, we have to point out one part of the Law of the Bureaucrat. Each FDA officer has been hired to "protect the public" from unsafe drugs.
This means that people are too stupid to use drugs properly
(Unfortunately, this is often all too true, even when explicit instructions are provided).
And it means that doctors are too stupid to prescribe them safely, leaving the bureaucrat charged with "protecting the public" as the smartest person in the room.
That then means that the bureaucrat must create iron-clad instructions for how medical personnel with more training and experience than him or her should prescribe the drugs..."
Read it all!
No comments:
Post a Comment