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| Editorial on Adverse Events Reporting 
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More on Crisis and Opportunity |
Doctors:
I hope all of you are enjoying the holiday season, even with the growing economic concerns...
As I mentioned in my last message, these changes may open new doors and pathways for us all. We can easily see that a number of interventions provided by some of our painful colleagues are not only less than helpful, they are very expensive, often performed without scientific scrutiny, and serve to increase morbidity and mortality. They hurt people, and make us ALL look bad.
Do you know why? Are you aware of the science which allows me to make these bold assertions? Could you defend such statements at a deposition or in open court? Could your reports be enhanced by knowing and understanding these issues?
Does it make you angry to learn of Pain specialists billing $1,000,000 a month?????
Perhaps you should consider joining us or inviting a colleague for a few days in January in Orlando. Our voices can be heard by spreading the "Science of Pain Management" and dispelling the voodoo.....this must be stopped.
I would welcome your input...
Dave Randolph
AADEP 23rd Annual Meeting Program Chair
Click HERE to view the Annual Meeting brochure.
Click HERE to register online.
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Dec 9, 2009 2:00 PM
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These indeed are interesting times. My own biggest concerns centers around the concept of "semiotics" or "treating symptoms". No one knows what pain looks like, and yet we are piling billions of dollars into this pursuit. Where is the logic behind all this for something which cannot be proven. Benign pain complaints deserve a certain type of attention, but when there is little support from exams, and evidence of financial and legal interference, concerns regarding these practices need to be raised. There is never a substitute for talking to the patient and doing an exam, but all too often I see neither of these done. This industry needs closer scrutiny, and science needs to be much more cautiously applied
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Pain Management specialists are like any other specialists. You have both good and bad. My concerns noting some of the issues raised in this Blog include the lack of mention regarding function. Also, the risk of immobility is well documented in the literature as well. Much of what medicine does is considered a level 3 knowledge. Very few accepted traditional treatments are at a level one- most notably, repeated, reliable double blind cross over placebo studies showing statistical significant difference between control and experimental groups. So, does one advocate the application of statistics to individuals- a statistical error in itself- without acknowledging that the very nature of the bell curve has standard deviations? Or does one actually sit down with the patient and discuss the benefits, alternatives and risks of the proposed treatments proposed in order to help patient achieve their functional goals.
Much of the high prices associated with pain management boil down to a few key issues: 1) The regulatory issues regarding such management- staff time, lab costs 2) Implantable medical equipment 3) Drug costs
The first issue, regulatory, is legislatively determined. Gas chromatography confirmation tests can cost 800$ but if one practices in a state where it is either mandated or encouraged then a provider may have little say in the matter. Nevertheless, the lab usually bills the patient separately so it is not part of the practice income.
The second factor, implantable medical equipment, is costly due to many factors. Liability being a big one. Also, the approval of these devices is done in such a way that they are approved prior to completion of the study due to the need. Sometimes, when the study is completed or almost completed the device is modified which then necessitates another go round or approval.
Regarding the third point, drug costs, it is my opinion that the biggest problem we have is the fact that 5% of the world-the U.S. population- is basically funding research and development for the other 95%.
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1Mi. a month has to be fraud unless they are all celenbrities like Michael Jackson
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