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Two Leaders in Pain Treatment Have Long Ties to Drug Industry

American Pain Foundation board members Scott Fishman and Perry Fine, both physicians, have lectured and authored publications funded by makers of narcotic painkillers. They say the support doesn’t bias them.

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U.S. Surgeon General Dr. Regina Benjamin and Dr. Scott Fishman, of American Pain Foundation, after they participated in an expert panel in March 2011. (UC Davis Health System)

Google Dr. Scott Fishman, chairman and president of the American Pain Foundation, or Dr. Perry Fine, a prominent board member, and it's quickly clear that their ties to the world of pain are legion.

Here (and at right) is a photo of Fishman at a forum with U.S. Surgeon General Regina Benjamin. Here is his book about opioid prescribing that has been distributed to physicians in a couple of dozen states.

Multiple videos feature Fine delivering educational talks about the drugs. He appeared at the 2010 criminal trial of Anna Nicole Smith's boyfriend and two doctors accused of conspiracy in fostering the late celebrity's addiction to drugs. Fine testified that the 1,500 pills a month Smith was given did not make her an addict, according to news reports.

Fishman, chief of pain medicine at the University of California, Davis, and Fine, a professor of anesthesiology at the University of Utah School of Medicine, have authored articles on the foundation's website. They've testified in court cases and before state and federal committees, and each has been president of the American Academy of Pain Medicine, a doctors' group.

Last year, the pair and a third physician wrote a strongly worded column in The Seattle Times opposing a bill passed by Washington state lawmakers that required doctors and others to consult pain specialists before prescribing high doses of opioids to non-cancer patients. The governor signed it into law nonetheless.

Like the American Pain Foundation, both men have had longstanding ties to the pharmaceutical industry -- direct and indirect. The foundation received 88 percent of its $5 million income last year from drug and medical-device makers.

This fall, the physicians acknowledged they had failed to disclose all their potential conflicts of interest in a letter to the editor of the Journal of the American Medical Association, which had been published in July. The journal requires all authors, even of letters, to disclose commercial ties.

Dr. Perry Fine (American Pain Foundation)In his correction, Fine listed 12 more companies for which he consulted, gave legal advice, delivered promotional talks or provided medical education. Among other things, he listed a 5 percent stake in a medical education company whose programs are funded by drugmakers.

Fine also appears to have played a role in launching a painkiller in 2009, ProPublica found. A subsidiary of Johnson & Johnson quoted him in its media release touting its new opioid.

ProPublica also found discrepancies in Fine's disclosures to his employer, the University of Utah. For example, Fine told the university that he had received less than $5,000 in 2010 from Johnson & Johnson for providing "educational" services. On its website, however, the company says it paid Fine $32,017 for consulting, promotional talks, meals and travel that year. (The University requires doctors to disclose all ties to drug companies, even situations in which they are not compensated.)

In an interview, Fine said he tries to be fully transparent about his industry ties. After reviewing his tax records, Fine said in an email, he discovered he had made several errors on his university disclosure and would amend it.

Fine said his relationships with drug companies add to his knowledge about their products. "Does it bias me and cause me to be prejudiced?" he said. "I really don't believe so."

Fine said he is a prominent speaker and teacher on pain because it remains undertreated. "Chronic pain is sort of the modern day leprosy," he said. "It's been sort of hidden away. There are a lot of people affected."

In his initial JAMA disclosure, Fishman said he had written a book about responsible opioid prescribing but received no royalties. In his correction, he acknowledged receiving fees for teaching medical education courses, some of which were funded by drug-company grants.

Over time, Fishman has had relationships with at least eight companies, including OxyContin maker Purdue Pharma, for which he was a consultant, paid speaker and recipient of research support. In an email to ProPublica, Fishman said he had stopped taking money from drug companies in recent years to avoid the perception of a conflict of interest.

He does appear to maintain some ties. Last year, for example, he and Fine appeared in videos on a website sponsored by drugmaker Cephalon to educate patients about the safe use of prescription pain pills. [Fishman's video was removed from the site after this story was published.] Fishman's opioid book, written for the Federation of State Medical Boards, was financed in large part by drug companies. The federation would not provide specific dollar amounts.

Fishman, who is stepping down as chairman of the pain foundation this month, said he often receives honoraria for teaching medical education courses but doesn't discuss them with drug-company funders and completely controls the content.

Fishman also said his position on opioids has evolved. He now believes they are overused, often in cases in which the risks outweigh the benefits. "Opioids represent only a small part of the spectrum on options for mitigating pain, but they carry a disproportionate level of risk," he wrote to ProPublica.

Fine's defense of doctors who prescribe opioids was criticized last year by a top U.S. Drug Enforcement Administration official.

The agency's deputy administrator slammed Fine for his testimony in support of a Utah physician accused of doling out pain medication indiscriminately, several times after sexual activity with a patient.

In revoking the doctor's ability to prescribe narcotics, the official called Fine's testimony “patently disingenuous.”

Asked whether it would be outside the standard of practice for a doctor to "go to the home of his patient, have her take off her clothes, digitally penetrate her vagina and then issue her a controlled substance prescription," Fine initially said no, according to a revocation of registration for the accused physician, published in the Federal Register in August 2010.

Although Fine "eventually acknowledged" it was wrong, the administrative law judge in the case said Fine's testimony was "evasive" and "bias[ed] in favor of assuming the correctness of the actions of any doctor," according to the revocation notice in the Federal Register. The judge found a colleague of Fine's from the University of Utah, who had testified against the accused doctor, to be more believable.

Fine went on to testify at the doctor's criminal trial in federal court in Salt Lake City this year. The doctor was convicted of two counts of distributing a controlled substance resulting in death, as well as 38 other counts.

In an interview, Fine defended his participation in both cases, saying he did not believe the doctor's conduct was criminal. He said the prosecution had to attack him or its case would have fallen apart.

"They had to cast me in a bad light; of course they did," Fine said. "They were too deep into this." As for his colleague who testified for the other side, Fine said, "I believe he's wrong."

Margaret Wilde

Dec. 23, 2011, 3:22 p.m.

I eagerly await the day when corrupt charlatans like this receive their just deserts by way of punishment. What terrible damage they wreak on vulnerable lives!

Speaking for myself, I have had two major operations without use of morphine or other opioid painkillers. I regard coping with the pain as much the less harmful option than dealing with the harmful effects of the painkillers.And I never believe the claims of doctors about the efficacy of painkillers.

Doctors have always been the lowest form of scum on our planet.  When you look at the way German doctors ran concentration camps during WW II, hoped up soldiers on drugs, and even drugged up Adolph Hitler, you have to know they are the most dangerous entity in our society.  Why “Church Owned” businesses (hospitals) are allowed to receive Federal or State money is beyond me.  It is a violation of our first amendment.  Now were seeing what creeps really do run religious institutions and hospitals…

Being a well paid board member of one of these foundations is a cottage industry in the revolving door between prestigious government positions and the private sector.  Most of these people are hired guns and their reputations are for sale.  Two examples:  Nancy DeParle, now Obama’s chief healthcare advisor, is a former administrator of the Health care Financing Administration (now CMS), i.e., the Medicare and Medicaid programs (1995-1999).  When George W. Bush was elected, she moved back to the private sector and replaced HCFA’s new administrator under Bush, former hospital lobbyist Tom Scully (2000-2004), as a board member at DaVita, a huge dialysis corporation (Medicare pays for end stage renal disease patients, a $20 billion a year industry).  Scully had been on several of these foundation boards before his government job.  DeParle made money in the same manner before being re-hired by the current administration.

I’m sure there are doctors out there taking money + other things from drug companies.
But, as one in constant pain, I hope we see that such medications help some of us live a “normal” life.  Ah, to walk, if I could, in another man’s shoes…

Margaret Wilde

Today, 3:22 p.m.

I eagerly await the day when corrupt charlatans like this receive their just deserts by way of punishment. What terrible damage they wreak on vulnerable lives!

Speaking for myself, I have had two major operations without use of morphine or other opioid painkillers. I regard coping with the pain as much the less harmful option than dealing with the harmful effects of the painkillers.And I never believe the claims of doctors about the efficacy of painkillers.
______________________________________

Soooo…based on your personal attitude or experience you are willing to deny others real help, sometimes the ONLY refuge they may find from chronic and acute pain?  C’mon!  Who’s to say the attack on this foundation or these doctors isn’t inspired by those who wish to push more expensive drugs?  Did we consider that?

Margaret Wilde

Dec. 23, 2011, 7:18 p.m.

WillHarper

“Soooo…based on your personal attitude or experience you are willing to deny others real help, sometimes the ONLY refuge they may find from chronic and acute pain?”

You overlooked the fact that I wrote, “Speaking for myself”.  Your interpretation of what I write about my own experience and my choice not to use opioid painkillers, is that I would deny them to others. Your incorrect interpretation of my words is your invention. I would not deny others the drugs. I criticise the corrupt doctors, not the people in pain. I am in constant pain myself, but as with the post-operative pain, I choose to avoid opioid painkillers. That is my choice.

No one would argue that there are times when people are in such tremendous pain that an opioid is a humane solution.  So commenters who have had this experience need not be so defensive. 

What IS being made clear is that (1) this protocol is vastly overused; and (2) it occurs suspiciously because of BigPharma’s agenda and the mouthpieces it employs. 

As a clinical and holistic practitioner of almost 30 years, I can confirm that pain clinics rarely experiment with alternative approaches to pain control.  There are many choices for chronic pain that are being ignored in favor of the lazy and lucrative use of meds.  This is a red flag.

Whether legal or not, such physicians are unethical and self-serving.  They should be censured by their profession and if that won’t happen, the people need to step in and put a stop to this charade.

Christopher J. Ward

Dec. 23, 2011, 8:50 p.m.

How quickly a rational debate descends into mudslinging and trying to score points off one another.  Not being an American, I can’t comment on the relationship between drug companies and doctors and they’re not terribly different from here by all accounts.  I was diagnosed with chronic pain caused by injury some 30 years ago.  I have tried every treatment modality to little lasting effect.  The point about chronic pain is that is quite pointless trying to extrapolate from an individual condition.  At the moment I’m on fairly high doses of morphine patches and I hate what medication does to me.  I’ve tried cold turkey which took me to the edge of suicide because of pain.  The aspirin-based painkillers nearly tore out my guts.  I’ve tried self-hypnosis, hypnosis, meditation, herbal medication and nothing works.  Even using electrodes in the spine, based on the gateway theory of pain doesn’t work and I’m looking forward to the day when pain signals can be turned off by a computer chip inserted in the spinal cord. I can’t share my experiences with others because they can never have them in such depth.  Sometimes I think I would like any critic to have to spend 2 weeks with my body to gain some understanding of pain means to me and the effects it has on everyday life.  I exist and I endure and perhaps there is a reason for that.  At 70 years of age I would welcome euthanasia but my counselors spiritual and medical tell me there is purpose to my life and so I go on.  When you’re taking 41 pills every day along with patches life can be rather grim.  Sometimes I wonder what I have done to deserve the state I’m in but I’m told that is too destructive.  I’ve devoted my life to the service of my country and by extension, the US.  Please don’t bicker in these pages and have a Merry Christmas or happy holiday depending on your viewpoint.

Can you spell “Conflict of Interest?”

Christopher J. Ward

Dec. 23, 2011, 10:07 p.m.

If DG was aiming at me, I can assure you that conflict of interest is well and truly understood.  You might give me credit for some education but I didn’t bother to trot out my academic qualifications because the key point is chronic pain and its treatment.  The fact is that the sufferer is piggy in the middle between those who would provide care and those who promote medication and the latter bribe the medical profession to use their products.  I can speak with authority about the side effects of Vioxx and I certainly didn’t need indications of heart failure to add to my pre-existing condition.  I did not seek recompense for this drug treatment because I have neither the time nor the energy to engage in long distance litigation and once again, if I had, who would have gained the benefits?  Lawyers.  Enough said I think.

WHO ARE YOU? You know nothing unless this is a power-control grab. The doctors are NOT giving the pain meds they should. I’m deleting this page that supports communistic writers like YOU.

Christopher J. Ward

Dec. 25, 2011, 3:45 a.m.

If She is referring to me, I suggest a visit to a shrink. I fought against communists all my life - reading garbage makes me wonder why.

catherine martin

Dec. 25, 2011, 9:04 p.m.

I would walk the rest of my life in your shoes if it could help undo the damage those pills have done to my daughter recover relapse recover relapse.  AND MY PAIN CANNOT BE FIXED WITH A PILL Try being the parent of an addict, I would greatly trade my pain for yours.  My daughter is 24 and I am 51 Please no parent should have to bury their child because of drugs.

Christopher J Ward

Dec. 25, 2011, 11:29 p.m.

Catherine - at last common sense and Christian charity.  I have watched a daughter ravaged by arthritis since 16 months, affecting every limb and tried every treatment modality.  By 20, she had two artificial hips, then knees, a shoulder and both elbows. The medications she has taken would kill some, and others have been taken away because of side-effects.  My pain is service-related but includes chronic pain, PTSD, osteoarthritis. lung damage and so on.  But you are right in that no-one should have to bury a child, least of all ravaged by drugs.  Neither of us take anything beyond what is prescribed and still hate it.  To cry with a daughter for years because nothing can be done is my idea of living hell.

Christopher John Ward

Dec. 25, 2011, 11:35 p.m.

I have fought my pain and conniptions for over 25 years and the lack of research into drug interaction is frightening.  When my turn comes - no palliative care or life-extending treatments will be wanted or accepted. No more cheap shots thank you.

Please! These two docs are leading, highly respected leaders in their field. I would place my life in their hands if they were more geographically available to me. I have lived with severe, persistent pain for most of my adult life—over 30 years. Before I found a pain specialist who was knowledgeable and experienced, I was on a merry-go-round of practitioners from specialists to alternative medicine techniques and other therapies. I have severe spinal disease, and nothing else works to ease my pain besides opioid medicine and muscle relaxants and mild exercise. Believe me, I have tried everything.

IWithout caring, dedicated pain specialists like Drs. Fishman and Fine, I dare say thousands upon thousands of people would be living lives not worth living every year. Unfortunately, in this country, where medical research is not sufficiently funded by the government or university-based labs, researchers must look to private sources to develop novel approaches to pain care. We have not come far from the battlefield techniques of the Civil War. Why? Lack of funding. Lack of interest in pain—even though more than 50 million people in this country alone suffer with it. So, the pharmaceutical industry steps in with R&D where publicly funded research falls short.

I resent the attitude of attack in this article. These are fine docs, who have literally given their lives to finding sources of relief and hopefully, more safe interventions to cure the cause of chronic pain. I work in the medical industry and I can’t say I don’t know one professional who has not been reimbursed for travel or meals or their time to give a seminar or educate other professionals. That’s the way it goes. Come on: if they have to take two days away from their practice to deliver a paper at a conference, they deserve to be compensated, just as any other businessperson would expect. The days of golf retreats and ski trips are over. Many hospitals don’t even accept pens or Post-it Notes industry-sponsored educational seminars that are fair and balanced, and serve to update medical professionals as to new treatments and protocols. Without this informal education many would be out of date as to the latest available treatments and therapies.

Have some compassion and ease up on these dedicated doctors who give their all to their patients; and on the American Pain Foundation—the solid, non-biased patient-advocacy and education centered organization that helps thousands of people in pain find their way through a blizzard of confusion and uncertainty at a most vulnerable time in their lives. Their excellent publications, web-updates, online support and other services have helped me tremendously.

From a December 32, 2011 Washington Post article: 

“But the pills continue to have an influential champion in the American Pain Foundation, which describes itself as the nation’s largest advocacy group for pain patients. Its message: The risk of addiction is overblown, and the drugs are underused.

What the nonprofit organization doesn’t highlight is the money behind that message.

The foundation collected nearly 90 percent of its $5 million in funding last year from the drug and medical-device industry — and closely mirrors its positions, an examination by ProPublica found.”

The American Pain Foundation is an industry front.

Correcting a typo:  December 23, 2011 was the date of the Washington Post article.

Barry Schmittou

Dec. 27, 2011, 12:35 p.m.

This is another example of extreme and potentially deadly conflicts of interests that are seen in almost every area of big business and government in the U.S as evidenced at :

http://www.stopdeadlycorporatecrimes.blogspot.com

One of the unprosecuted crimes I will be adding to that website and Court filings include these quotes from ProPublica regarding Zyprexa :

According to ProPublica.org :

“Drugmaker Eli Lilly pleaded guilty to illegally marketing its blockbuster antipsychotic Zyprexa for elderly patients. Lilly paid $1.4 billion in criminal penalties”

(No one was prosecuted)

“A doctor named as a co-defendant in one suit - for allegedly taking kickbacks to prescribe the drug extensively at nursing homes - never was pursued.”

“Alpharma paid $42.5 million to settle fraud allegations that it paid kickbacks to doctors to prescribe its painkiller Kadian.”

“At least 15 drug and medical-device companies have paid $6.5 billion since 2008 to settle accusations of marketing fraud or kickbacks.”

(No one was prosecuted)

“None of the more than 75 doctors named as participants were sanctioned, despite allegations of fraud or of conduct that put patients at risk, a review by ProPublica found.”

(end of ProPublica quotes)

In this article Propublica wrote :

“Like the American Pain Foundation, both men have had longstanding ties to the pharmaceutical industry—direct and indirect. The foundation received 88 percent of its $5 million income last year [7] from drug and medical-device makers.”

I pray all those who need pain medication and every other type of medication will be able to receive the relief they need.

I pray the drug industries power and money will no longer be able to cause any doctors to overprescribe medications; I believe it will take a tremendous miracle for that to happen !!

To see more extreme conflicts of interest regarding doctors and insurance companies please view the quotes from numerous Judges I’ve posted at http://www.deadlyorganizedcrimes.blogspot.com

To see how the U.S. Government repeatedly fails to prosecute corporate crimes please go to :

http://www.stopdeadlycorporatecrimes.blogspot.com

O-look at that. The woman is pushing away the guilt of raising her child by the hair of it’s head and blaming everyone else for her death. Typical of wicked people. Read Scott Peck’s book about these parents who have NO HUMAN feelings about their children or anyone else. The woman here passing the buck of guilt is clearly one of the underground wicked ones! Don’t think you can hide anymore. You’re BUSTED.

There are levels of pain and there are levels of doctor ability to treat pain. Pain management is the way to go. There is still alot to be learned about pain and it’s treatment so find a doctor you trust to treat you in your best interest. To call doctors the scum on the earth is idiotic because some day you will be in pain for some reason and you will need a doctor. If you never have to deal with chronic pain you are the luckiest person on earth! I am currently on one of the breakthroughs in fibromyalgia treament and it seems to have changed my pain level and allowed me to sleep well for the first time in years. It is a serotonin and norepinephirine reuptake inhibitor that is thought to shut off the pain signals in the pain, allowing the signals to be modulated as they should be. For those of you whohave an attitude of attack towards doctors and drug comanies I highly suggest you educate yourselves on pain and latest theories. Also pray to your higher power every day you never have the problems of others that have severe chronic pain.

I spent three years in hell because my Md didn’t “believe” in opioids.  I lost track of the “trigger injections” which ruined my skin, teeth, integrity of my tendons (both Achilles ruptured simultaneously)and the steroids didn’t do a thing for pain. I took anti-inflammatories until I had blood coming out of both ends, and my stomach has never healed. Thank God when I fell on the pavement outside the ER, as I couldn’t walk another step, there was a pain specialist in that hospital.I had been diagnosed with poly-arithritides and I was living in a constant flair The pain Md put me on low dose opioids, sent me to physical therapy, a nutritionist, counseling (for the divorce caused by my inability to handle pain) That was 25 years ago and I was on the same low-dose of methadone for 11 years when I cut it down by 25%. I was able to go back to school for my masters and work for the past 12 years. I had tried everything, and nothing controlled the pain save for an opioid and a multi-modal approach to pain control. I know of the Md’s that this article took a cheap shot at. I know they are dedicated to helping people out of a living hell.Until you have watched your life fall apart, and no matter what you do, you know you will awake tomorrow in the same pain you went to sleep with. Nothing stops it, and it’s the ruin of your life, marriage, job, friendships, & everything that makes life worth living, you will never know how valuable Md’s like Fishman, Fine, Brookoff (RIP) ,Tennant and many more are. And you will never understand how agencies like APF help those who’s lives are turned upside down, and inside out by pain they can’t stop. Some people take too may drugs be they alcohol, tobacco, or opioids. Guns have killed more people than drugs ever will. But when people die of their involvement with guns, those drugs, or killing someone while driving drunk you don’t hear these journalists howling at the top of their keyboards to halt the use, and condemn the people who make guns, alcohol, or tobacco, because those laws would effect them.People have their lives back because of opioids and pain Md’s, I’m one of them, and I’m greatful.

Those of you who’ve been helped by various drugs, it’s worth remembering that nobody (to my reading) is saying that the drugs should never be prescribed.  Rather, it’s dangerous for someone with a vested interest in selling the drugs to be prescribing them.

Even where they’re technically right, there’s an ethical issue involved that makes all their decisions suspect.  And the bad apples need to be found and removed so we can get good healthcare, rather than a crapshoot covered up by the AMA.

I mean, Roberoo, for every case like yours, there’s someone addicted, overdosed, or dead from an allergic reaction where no drugs were advisable, because the doctor thought the pharm-rep had nice legs.

barbara molloy

Jan. 4, 2012, 1:48 a.m.

In 2007 my son nearly died of an overdose—- not of oxy, but of methadone which was all he could score at a time when he was so addicted at age 17, he’d pop or snort oxy right after vomiting blood. Since he cldn’t get oxy (not enough money) that night, he got methadone from heroin users selling their meds to oxy junkies.  Not getting the high he expected quickly enough, he downed enough methadone to, as the emergency doc said, “kill an elephant.”  They were “time release” and so by time he’d downed all, the methadone in his bloodstream was more than fatal.  It’s a miracle he lived.  He went into a coma due to respiratory distress. The hospital here saved him somehow.  They cldn’t promise he wldn’t suffer brain damage.  I believe he got his first oxy by stealing prescrip. from his dad and his stepmom, who were using a “boutique” doctor (paying for a doc on call 24 hours).  His dad had back troubles and his step mom, a teacher of pilates, had work related pain.  At this writing, they’re all ok.  But, the consequences of it all linger..  My son, a gifted student, had to get his G.E.D. and take comm. cllge courses.  His friends are all graduated, and he’s in his second year of college. He appears to have some minor brain development issues.  Hwvr, this is nothing compared to stories of others we know, some who didn’t make it.  My neighbor’s son, a friend of his, is still battling it, and a girl he “dealt
oxy with is in her 4th or 5th rehab—insurance has paid out all it can so her parents have gone broke, and it continues.  How this co. convicted of felony and wrapped only with a fine, continues to prescribe this last resort med. orig. meant only for terminally ill, to mainstream pain patients, is more than questionable.  It’s a crime of extenuating proportions.  Plse write .(JavaScript must be enabled to view this email address) w/ stories.  I’m compiling them for book on subject.  Thanks!

barbara, I am sorry to hear about your son and all of those who have had experience with loved ones destructive, addictive and even criminal behavior.  But I and many others have required or still require these drugs to live while in terrible pain.  We didn’t steal anything.  We weren’t looking for a high, or to act out or check out.  We have suffered and do suffer thru no fault of our own.  The fact that others are abusing pharmaceuticals should in no way reflect on or inhibit the lawful and necessary use of these drugs.  Instead, we should be examining why so many in our culture are driven toward self destructive behavior.

barbara molloy

Jan. 4, 2012, 3:50 a.m.

Hi Will,

Thanks for your comment.  You’ve hit on a big controversial and important point:  Oxychodone does relieve pain in sufferers of chronic and profound pain.  It’s too easy for persons like myself, who have experienced mostly the destruction by oxy, to say “But other pain relievers, far less addictive exist—why not use them?” ... In fact, my sister in Hospice for final stage breast cancer, was relieved of pain in her last months by way of “Oxy.”  My siblings and I administered it to her in her final days with the hospice team’s support.  I can see how this drug is not all bad when legally and responsibly given.  You “didn’t steal anything” and neither did my sis.  Who can argue with that?  But, devastation by way of oxy’s opiate-derived addictive propensity is well documented, and in my case, personally witnessed.  In the case of Oxy, it appears persons like yourself who wld use it responsibly for pain, and those like my sis in hospice, are innocent where others are vulnerable, if not easily exploited.  Addiction occurs where physical control ends.  I guess I’d say “self-destructive behavior” is just as difficult to ascertain scientifically as it is to “measure” pain objectively.

amy cavanaugh

Jan. 4, 2012, 8:22 a.m.

my husband died from legally prescribed pain pills, he was not destructive or addictive, he was prescribed this highly addictive poison and was off to the races.  I am concerned that pain has been criminalized, but I was also shocked and deeply saddened to see the lack of knowledge on the part of doctors as to this medication.

Sorry for those that say they cannot live without these opiate drugs, but what did ppl do before they were let out into the public? I wonder everyday if this is the night I get the phone to Identify my son’s body. He is 23 and has more of his peers die from these oxy’s then funerals I have gone to for my peers. He is going on his 5th yr of this bondage. People with chronic pain managed before “pain clinics” and these pills that were mean’t for dying patients, were allowed to statuate our country. I live in fl. so I know what these pain clinics do and the amt. of ppl we have die from these per day. It’s not our fault (those that are sick of seeing our youth/love ones die) that you feel pain is being criminalized…..no it is the corruption and greed that these pills have fostered. When a pain clinic racks a million dollars a day….No one needs opiates to Live…..there are other pain meds out there. I have seen what daily use of opiate does first hand and I find it hard to believe it is taken daily and one has a productive life…the longer it is taken the more is needed…our bodies built up a tolerance to pain meds. quickley. It’s all about the money or they never would have been given to drs. to perscribe for back pain, which i live with on a daily basis. ...

ann skolnick
Sorry for those that say they cannot live without these opiate drugs, but what did ppl do before they were let out into the public?  ....No one needs opiates to Live…
____________________________

Do you have any interest in this subject beyond making generalized and uninformed comments?  Opiates have been used to relieve pain for centuries.  Humans have been self treating with natural substances, broths, tinctures, chewing leaves etc for ages.  There is no God given commandment denying pain relief to any person simply because someone else abuses it or dies in the process.  People die due to all kinds of activity.  You aren’t responsible for them.  Neither am I.

Ann Skolnic wrote: “but what did ppl do before they[opioids] were let out into the public?” Ann
people have used opioids for 4000 years,perhaps 6000, and the vast majority of usage is/was a God-send. Just ask a wounded veteran.(see- http://opiates.net/ )  It is amazing how people are willing to transfer the blame for ‘their’ or their off-spring’s destructive behavior(s) to an inadamate object, and completely avoid placing the blame on the user/abuser/self-medicator/addict, someone willing to bring themselves to deaths door just to get high. There is a vast difference between the addict and the dependant. Addicts have allowed the urge to get high to control their lives, and they don’t need the medication, as it is designed to control pain, not to get high.The unintentional deaths from methadone or oxy are almost always drug cocktails (mixed drugs), be it alcohol, sleeping pills, anti-anxiety ect., the people who exceed the prescribed dose and/or take other opioids or schedule I, II, & III narcotics, are taking their lives in their own hands, and sometimes those decisions end up in a death or hospitalization. You can drive a car 120 mph and when stopped, look the officer in the eye and say” I couldn’t help it, that car just robs me of self-control.” But, you will get the ticket, not the car.
Ann S. also wrote:<“No one needs opiates to Live // these pills that were mean’t for dying patients” > *To rule out any means of controlling pain is to subject the person in pain to an increased potential for an early death, and a constant condition of a less than normal life.” Pain kills. see-( *  http://www.europeanjournalpain.com/article/S1090-3801(09)00155-4/abstract )  Because of your sad and unfortunate encounter with opioids,in your anger, you demand the government limit my right to use them (as prescribed) and you condemn me to a life in pain. So, why am I to be punished for your experiences. I have taken opioids for 25 years as prescribed, I have never mixed nor exceeded a prescription.Without pain control,I wouldn’t have a masters, nor a job.

This is such a touchy subject. I have a mother who has been on her death bed for the last 20 years. She suffers from chronic pain and her dr. have given her boat loads of Oxy’s. She functions until the pills run out. It is a sad existence living in a prescription bottle. It has robbed her of so much, but she has mastered the slurred speech pretty well.

On another note, I have watched this begin to take over my daughters world. She is around it, has experience and witnessed her friends being arrested. (Jail, rehab, meetings)  My daughter doesn’t suffer from chronic pain. She is a good and smart kid that knows better. So what is the connection? Is it just because it’s “available”..?

The pain clinics in South Florida are out of control.
Just watch the video The Oxycontin Express (http://www.youtube.com/watch?v=J7DHMqHFSB8)
Somewhere a line needs to be drawn. I think some form of control needs to be put upon opiates. The people that need it should have it and the people that are just in for the high shouldn’t be allowed. I think doctors that are handing it out like halloween candy need to be punished.

So a touchy subject. I can see both sides of it and the personal side is I am angry that this drug of choice has a grip on my family.

melissa

31 minutes ago

This is such a touchy subject.

...I can see both sides of it and the personal side is I am angry that this drug of choice has a grip on my family.
____________________________________

Huh?  I’m sorry, but no one, or thing, has a “grip” on your family unless they are being held at gunpoint.  Based on your comment, your mother is likely grateful to have some kind of relief from her pain.  And your daughter is no doubt a good kid.  We have become, as Americans, “addicted” to stress and finding something to stress about.  Terrorism, drugs, disease, marital infidelity, political rancor.  I believe our society could very well be classified as clinically neurotic.  I have a friend that is in the mid stages of liver failure, brought on by chronic alcohol abuse.  He is a decent, kind, if screwed up individual.  And he is still drinking, despite being hospitalized more than once, and despite the graphic and dire warnings of his physician.  Am I picketing outside of liquor stores?  No.  Why?  Because he is responsible for the choices he makes.  Not me.  Not the clerk taking the money.  My friend is not in the grip of anything but his own sad dysfunction.  This is and always has been a part of the human condition.  I am sympathetic and saddened by this, but it I didn’t make the rules.

Will Harper

That is right its the choice of the individual to use or abuse. I am saying that it needs to be controlled. It’s so available here in South Florida. People are making a crap ton of money of of people’s weakness points. This of course is also jeapordizing the chronically ill.

As for a substance having a grip upon my family - gunpoint or not .. It’s really paralyzingly to have to experience. Until you walk in my shoes and experience my journey - don’t judge.

I am not boycotting for opiates to disappear I am simply stating control And order are necessary.

Come on people this is about abuse of the meds.  My granddaughter has severe brain damage because they are not regulating this synthetic heroin and the doctors are handing them out like candy.  No one forced my daughter to take the pills and mix them with xanax but the weirdos who get them just to get young girls hooked for sex and to get them to steal and just basically control their lives are getting hold of the prescriptions way to easily. They are making a living from selling prescription drugs to our children. Another teen in our community just OD’ed a couple of weeks ago in his bedroom. So much for knowing where your kids are!  This is poison on our streets that is killing and maiming our children at an alarming rate.
If you can’t enforce it, get rid of it.  These meds need to be kept under
control with the tightest of regulations. It may be harder for those of you suffering chronic pain, but if you really are in such pain I would think that you would be glad for the extra steps you may have to go thru to get it so that it won’t be so available for abuse that is causing so much pain and grief to so so many families across the nation.  I live in Hawaii and it is a growing and horrific problem that must be stopped.

Gina M Carleo-Sniff

Jan. 4, 2012, 4:08 p.m.

I truly think the banning of Oxy has been thrown out of context. I would love more than anyone to see that the drug is not so easily found. I have lost one cousin of 23 years of age and my brother 30 years of age is seating in prison. People that do not understand the addiction is due to lacking the chemical makeup to become addicted. For one person who might be ADD, ADHD, Bi Poler, etc…. will be more likely to fall in the addiction pattern. Or just a person that has addictive personality. I happen to be ADD and have several siblings that are ADHD. Unfortunately, drugs and alcohol seems to be a self-soothing way to medicate some of them. The drug that you would take for such problems can be quite pricey without health insurances. Their body is craving for a correction and to them they feel better with self-medicating. I can say I am a lucky one I have sensitivity to opiates, so this has never been a weakness. I have seen in my lifetime being younger, when I was not taking the correct medication for the ADD, alcohol was an easy form for me to slow down.
People with ADHD sometimes try to self-medicate their symptoms by turning to pain medications such as vicodin, cocaine, percocets or any pain reliever with oxycodone. These are medications that have codeine, and all are narcotics that release opiates, the feel-good chemicals in the brain. These chemicals are often out of balance for some individuals with ADHD.
According to ADDers, Dr. Ned Hallowell and Dr. John Ratey, who co-wrote “Driven to Distraction,” estimate that of the 8 million to 15 million Americans who suffer from ADD and ADHD, as many as 30 percent to 50 percent of them use pain medication and alcohol to self-medicate their ADHD symptoms.
When oxycodone-based drugs such as OxyContin are used as prescribed by a physician it works as a time-release pill. Instead of having to take several pain medications over the course of a day, an individual need only take a single OxyContin. The problems began to arise when individuals realized that if they crushed the drug and snorted it (or injected it) that they would receive ALL of the active ingredients at once. This powerful high left many people addicted, and more than a few with fatal overdoses.  In addition, oxycodone is highly dangerous because as people grow addicted to the opiate, they develop a tolerance to the drug. That means it will take more and more oxycodone to achieve the desired euphoric effect. Taking so much of the drug leaves an individual highly susceptible to overdose.
The doctor in my brother’s situation was abusing the right. I think this is what gives them a bad name to the rest. Why would a doctor write a script for 80mg oxytocins, 180 for 3 months for a person with knee injury? Anyone taking such a high dose should have an opiate resentence or terminally ill. I do believe that a person that is in so much pain that they should be able to receive this type of drug.
But answer me, why is it that when I receive my prescription for Adderall which is considered a barbitchuate, that I cannot fill my script any earlier the 30 days. I cannot have the script called in. I have to go to my doctor’s office to pick it up. I have to go in every 3 months for a checkup, consolation and I have had blood work done before. Don’t you think if something along this line was enforced for oxy’s we could catch a lot of the problems that we have. You would think with all the rules they have for this med that it could be for the ones that people are dying from as we speak!!!!
What did people do before? look back in time humans have always found a way to alter the mind and feeling!!!Your loved ones that are dying yes, by god they deserve to be comfortable!
It’s the idiots that have no understanding of making sure that the drug is in a controlled environment! Checking yes or no on the paper at the doctor’s office is not the way to discuss how addicting that pain meds can be!! Counseling there patents and having them come in for a checkup. You don’t think the doctor couldn’t tell that there patent is hooked, when they come in gray to color, sores on their nose and face, deathly skinny???????? Hell yes, because we have all pointed one out before walking before. P.S. I will sign my name any day of the week!!!!

Apparently, It all depends on what camp you are in:  Those who think that banning or restricting access to items or substances is the best way to curb negative consequences or abuse, despite the fact that the items and substances are helpful to many; and those, like myself, who place the lion’s share of responsibility for use or misuse on the user. 

I can list item after item, substance after substance common to our society that may be dangerous if abused, carries risk, or that may lead to death.  Directly or indirectly.  Cars, alcohol, food, guns, motorcycles, cigarettes, diets, boating, pools, plastic surgery and sex after 60, etc.  And with enough prodding or media attention, we can get worked up about any one of them.  But could we please exercise some critical thought and proportionality in the process.

WTF else is new ??
It doesn’t suprise me that these people “got their hand caught in the cookie jar” when it comes to serving two masters. For some that’s just the American way of doin’ “bidness”, as “W” would allude to in his inital Connecticut bred, BS folksy Texas drawl.
Haven’t some of you people heard about a catagory of medical usage called appropriate medical dependency ? As recently as during WW I that was [given the specifics of the case] an inevitable outcome of some medical situations.
Never let it be said that if there’s some hysteria to be whipped the gov’t in the USA hasn’t been up to the task of fomenting this towards it’s zenith. Look at what Harry Ansingler did with/to marijuana, and the Harrison Narcotics Act of 1914.
Before all this modern hysteria about pain killers they were accepted for some as an inevitable way to deal with what life threw at them concerning physcial pain. Both medically and Independent of the medical “profession”.
Granted, ideally one wouldn’t want to have anything to do with these substances because of the possibility to probability of becomming dependent on them, but when the pain level gets to be an 8 out of 10, and you’ve exhausted other modalities to deal with it, then it’s time for something that’ll work.
Tell me, which one of you lives is anything approaching an ideal medical situation. If you raise your hand, you’re either a fool or a liar, maybe both given our western societies penchant for not dealing with difficult situations, none the less ....
To me this subject and it’s ancillaries/off shoots is no academic exercise. I deal with arthritis in my back, have lost part of the L2 disk, and as I write this am scheduled in for a complete left shoulder replacement because of osteoarthritis. And I suspect rheumatoid arthrisis, but don’t have a diagnosis as of yet.
I shouldn’t have the gov’t telling me what I can, or can’t take when it comes to alleviating gross amounts of pain appropriately.
Sorry, I’ve gone off on another tear and apologize for it, but I don’t want either the gov’t, drug companies getting between me and my MD by outright telling me or intimating, that I can’t have what we deem as appropriate therapy for that situation.

Raphaël Fischler

Feb. 6, 2012, 10:59 a.m.

January 23, 2012

To the Editors,

As a teacher of professional practice and professional communication in a graduate school, I found your article on Dr. Scott Fishman unprofessional and unfair (Weber & Ornstein, 23 December 2011).

Having met Dr. Fishman as the partner of one of his patients and having read some of his work, I was deeply impressed by his exceptional ability to listen to people, to learn from new information and from experience, and to frame his practice according to the highest intellectual and moral values.  He is, in my mind, an exemplary reflective practitioner, worthy of respect and emulation.  That is why I have dedicated a chapter entitled “Reflective Practice,” to appear in a forthcoming book published by the MIT Press, to the very person you criticize in a sly and underhanded manner.

I cannot believe that Pro Publica would attack a dedicated person like Dr. Fishman on such petty grounds as were alluded to in the Weber and Ornstein’s article.  Your provocative headline and negative message are in no way justified by the facts presented in the text and in related documents.  Had students of mine produced such a shoddy, dishonest piece of work as a course assignment, they would have received an “F” for their grade.  The problem is that Weber and Ornstein’s piece is not an academic exercise; it is a public declaration in which Pro Publica willfully tried to tarnish the reputation of a thoughtful public-health specialist, an excellent doctor and an exemplary human being.  Shame on you.

Raphaël Fischler
Director, School of Urban Planning
McGill University
Montreal, Canada
.(JavaScript must be enabled to view this email address)

To the Editors,

In two recent companion articles published on the same day in ProPublica, the first about two pain specialists, Dr. Scott Fishman and Dr. Perry Fine, and the second about the foremost pain patient advocacy group, The American Pain Foundation (December 23, 2011), reporters Charles Ornstein and Tracy Weber resort to techniques worthy of tabloid journalism to tarnish the hard-earned reputations of doctors who have devoted their careers to alleviating pain conditions that impact millions of Americans.  I can testify personally only about Dr. Fishman, having been a patient of his for over five years, and therefore limit my comments to claims made about him.

Dr. Fishman is a principled, hard-working, eminently qualified physician whose whole practice of medicine is centered on the well-being of his patients.  Unlike many of his colleagues in private practice who pick and choose those whom they treat, the patients of Dr. Fishman include children, adults, the elderly,  professionals, the well-to-do, the unemployed, veterans, athletes, the permanently disabled, police officers and prison inmates—the whole gamut of the California public he serves.  Ornstein and Weber’s portrait of a profit-driven doctor in the pocket of the pharmaceutical industry is a malicious invention.  If they had looked, as investigative reporters might be expected to do, for actual evidence to support their derogatory allegations, they would quickly have found those allegations contradicted by large numbers of witnesses—patients and physicians, colleagues and students, nurses and community advocates, scientists and health journalists.  In addition, no doctor could be more concerned with safety than Dr. Fishman.  “You know my motto,” he has said to me in reviewing treatment options, “If it’s safe, it’s in play.”  Moreover, he has worked tirelessly in university and medical settings and alongside the Federal Drug Enforcement Agency to promote the wise regulation of opioid medication.  Given my first-hand experience of Dr. Fishman’s integrity and commitment to patient well-being, I find the display of his name and photograph under an inflammatory and misleading headline disheartening in the extreme.  If he is to be singled out, it should be for his dedication to service without concern for monetary reward. 

No actual evidence cited in either of ProPublica’s two articles justifies Ornstein and Weber’s charges of illicit or nefarious ties to the pharmaceutical industry.  If one takes the time to look up the original sources cited in the articles, one learns that all that is being alleged is that Dr. Fishman had his airfare reimbursed to attend an (unpaid) meeting of a not-for-profit, public-interest patient advocacy organization that receives funding from manufacturers of key drugs for the treatment of pain.  One also learns that the reimbursement is for travel in coach class.  One learns, in addition, that Dr. Fishman refused to receive any profits from his book aimed at educating primary care physicians about the safe use of opioid medications in pain management.  Most importantly, one reads that, contrary to countless numbers of his colleagues, many of whom decline the extensive pro-bono work obligations he routinely takes on, Dr. Fishman has “not accepted any funds directly from any commercial sponsors” (JAMA 306(13): 1445).  So much for his “long ties” to the pharmaceutical industry!

Rather than contributing to intelligent debate on a complex public health issue, Ornstein and Weber’s two slapdash articles, larded with mistruths and hearsay, instead will help fuel hysteria and blaming-the-victim attitudes that already impede patients with persistent pain conditions from receiving effective treatment.  No one is immune to developing severe chronic pain—it can arise when a broken bone or amputated limb fails to heal properly; if a certain bout of shingles goes untreated; following a fall from a ledge; when a surgical operation damages nerves; or for reasons still mysterious to medical science—and no one who suffers from it should be denied adequate care.  According to the statistic Ornstein and Weber cite themselves, 116 million Americans suffer from chronic pain.  The decision of these two reporters to slander a physician who has selflessly devoted his teaching, research, pro-bono volunteer work and entire medical practice to safeguarding patients numbered among those 116 million contradicts the mission implied by your organization’s very name.  The public and Dr. Fishman deserve a retraction of Ornstein and Weber’s biased and misleading attack on a patient-advocacy group and on an superbly gifted physician who is on the front line of the war against pain, working every day to advance knowledge and care for patients: practicing medicine in the public interest.

Sincerely,
Eve Sanders

(excerpted from a more detailed letter submitted to the editors 24 January 2012)

Eve Sanders, I wouldn’t trust you as far as I could throw you and I’m guessing NOT able to pick you up. Complicated garble. How much did they pay you to LIE? I need pain pills and a doctor betta give’em or be BANNED from the medical field! They are putting their filthy hand’s in people’s personal panties. Get thee behind me satan and take ur damned doctors with ya!

She

0 minutes ago

Eve Sanders, I wouldn’t trust you as far as I could throw you and I’m guessing NOT able to pick you up. Complicated garble. How much did they pay you to LIE? I need pain pills and a doctor betta give’em or be BANNED from the medical field! They are putting their filthy hand’s in people’s personal panties. Get thee behind me satan and take ur damned doctors with ya!
__________________________________

Wow!  Proof once more that everything decent and reasonable quickly comes under attack by ugliness and derision; the opposite of intelligence.

This article is part of an ongoing investigation:
Dollars for Doctors

Dollars for Doctors: How Industry Money Reaches Physicians

ProPublica is tracking the financial ties between doctors and medical companies.

The Story So Far

ProPublica is investigating the financial ties between the medical community and the drug and device industry. In October 2010, ProPublica compiled the list of payments that drug companies make to physicians and built a publicly searchable database so that patients could look up their doctors.

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