Medscape - Understanding Opioids: Part 2

Medscape Psychiatry
Understanding Opioids: Part 2

Elinore F. McCance-Katz, MD, PhD, Jeffrey N. Baldwin, PharmD, Ann Marie Schreier, PhD, RN, William T. Kane, DDS, MBA

Jan 16, 2013

Editor's NotePart 1 of Medscape's 2-part Understanding Opioids series brought together a panel of pain specialists to discuss the increasing use of long-term opioid therapy, addressing the resulting risks and how best to prescribe these agents. Part 2 reflects the broad range of medical disciplines in which opioid therapies are used, bringing together a multidisciplinary panel of clinicians to discuss their respective approaches to opioid prescribing.

The widespread use of, and need for clinician education surrounding, opioid analgesic therapies is highlighted by 2 new programs led by the American Academy of Addiction Psychiatry (AAAP) in collaboration with the American Psychiatric Association and the American Osteopathic Academy of Addiction Medicine, and funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). Using online clinical education, the Physician's Clinical Support System-Buprenorphine (PCSS-B) trains clinicians in how to best use buprenorphine to treat opioid-addicted patients, while the Prescriber's Clinical Support System for Opioid Therapies (PCSS-O) is a national initiative led by AAAP in collaboration with the American Dental Association (ADA), American Medical Association, American Psychiatric Association, American Osteopathic Academy of Addiction Medicine, American Society of Pain Management Nursing, and the International Nurses Society on Addictions, helping ensure that clinicians prescribing opioid analgesic therapy are well versed in the nuances of appropriately using these agents, careful not to withhold potentially effective medications from patients who may benefit, and attentive to any potentially abusive and/or addictive behaviors or adverse events.

Elinore F. McCance-Katz, MD, PhD, is an addiction psychiatrist and Professor of Psychiatry at the University of California, San Francisco and serves as Medical Director for both projects. Medscape recently asked Dr. McCance-Katz to moderate Part 2 in this series, herself representing the field of addiction psychiatry, with the remainder of the panel including the following representatives from the PCSS-O Steering Committee: Jeffrey N. Baldwin, PharmD, addiction educator and Professor of Pharmacy Practice and Pediatrics at the University of Nebraska Medical Center; Ann Marie Schreier, PhD, RN, Associate Professor and Director of Alternate Entry MSN at East Carolina University College of Nursing in Greenville, North Carolina; and William T. Kane, DDS, MBA, general practitioner in dentistry in Dexter, Missouri. What follows is their discussion.

The Psychiatrist

Dr. McCance-Katz: Hello everyone, and welcome to this roundtable discussion focusing on how opioids are used by clinicians from different healthcare professions.

A main focus of my work in addiction psychiatry/addiction medicine has been in the treatment of opioid addiction -- including heroin addiction and prescription opioid pain medication addiction. The opioids approved for treatment of opioid addiction are methadone or buprenorphine (but the formulation encouraged by the Center for Substance Abuse Treatment (CSAT)/ SAMHSA for use in opioid addiction treatment is buprenorphine/naloxone). When used for treatment of opioid addiction, methadone can only be dispensed from methadone maintenance programs subject to federal and state regulation. Early in treatment, daily clinic attendance is required. Buprenorphine/naloxone can be prescribed by qualified physicians who have obtained a waiver from the Drug Enforcement Administration to allow them to prescribe this medication from outpatient settings for treatment of opioid addiction. There are several criteria by which physicians can qualify for this waiver, but most physicians will qualify by obtaining the required 8 hours of approved education in the treatment of opioid addiction and clinical use of buprenorphine. (More information is available at the PCSS-B Website.)

When thinking about what medication might be best suited to an individual patient, there are several considerations. These include a discussion of patient preference as well as other factors. For example, the structure provided by a methadone maintenance program may be beneficial to those with serious medical or mental illness because it allows for daily staff contact, which may be needed by some.

Similarly, those with polysubstance abuse or who may have difficulty safely handling opioids as outpatients can benefit from methadone maintenance programs that require daily attendance until there is evidence that progress is occurring in treatment and that opioid abuse has stopped or is substantially diminished. Buprenorphine/naloxone may be more helpful to opioid-dependent people who have concomitant medical or mental illnesses that could be treated by the same physician who is also treating the opioid addiction -- in my case, it is possible for me to offer treatment for mental disorders and opioid dependence.

The ability to treat medical or mental illness in addition to opioid addiction improves the care of those patients by simplifying treatment that can be provided by one clinician in one setting. Those who require medications for concomitant conditions may have fewer drug-drug interactions with buprenorphine than have been observed with methadone. For example, there is a larger number of drug interactions in which methadone concentrations are either increased or decreased with the potential for opioid toxicity or withdrawal, respectively, when administered with certain HIV medications than occurs with these medications and buprenorphine.

Other considerations include the amount of social support available, with those lacking social supports potentially benefitting from the structure of the methadone program. There is evidence that maintenance treatment is more effective than medical withdrawal (detoxification), so I discuss that option as part of a conversation about treatment options for opioid dependence. This is not to say that everyone should receive opioid maintenance therapy; rather, every patient should be evaluated for their needs as well as to obtain their input on which treatment they would like to receive (depending, of course, on what is available in their community).

Continue reading @ Medscape

The Psychiatrist
The Pharmacist
Useful Tips and Resources
The Nurse
Is the Prescription Appropriate?
And, Finally, Dentists

Big Pharma Wants to 'Friend' You

Direct-to-Consumer Advertising:

Big Pharma Wants to 'Friend' You

Drug makers are using social media to market products in ways that the brand affiliation is not always obvious

Adriana Barton
(The Globe and Mail, Toronto, July 25, 2011)

"According to a formal complaint submitted in November to the U.S. Federal Trade Commission [FTC]…by four separate watchdog groups…pharmaceutical marketing on the Web…'threatens consumer privacy and engages in unfair and deceptive practices'...the British Medical Journal cited the report in an article that suggests Big Pharma’s online marketing activities pose a threat to public health.

Direct-to-consumer advertising that includes the name of a prescription drug, health claim and contraindications is prohibited in Canada and highly regulated in the United States. But transparency has become murky on the Internet, says Jeff Chester, co-author of the complaint to the FTC and executive director of the Washington, D.C.-based Center for Digital Democracy…

The pharmaceutical industry’s growing presence online coincides with a pivotal shift in health care…As many as 80 per cent of Internet users go online to find health information, according to a 2011 report published by the non-profit Pew Research Center in Washington, D.C. And almost 20 per cent go online to find others with similar health problems. Big Pharma is gearing up to 'friend' and 'tweet' them…

According to a 2010 report in Pharma Marketing News, there may be hundreds of patients in social networks earning thousands of dollars from drug companies to provide 'real patient stories' as part of online branded drug or disease-awareness campaigns.

The article describes these 'online opinion leaders' as [the social media marketing]…'secret sauce' [for Big Pharma]…And unless drug companies comply with FTC regulations, consumers have no way of knowing which online 'friends' are on the payroll…Pharmaceutical companies…argue that social media provides an important channel…[With regard to one drug company’s social media forays]

The U.S. Federal Drug Administration [FDA] ruled the Facebook widget provided 'misleading' shared content because it failed to disclose serious risks associated with the drug…[overall] brand recognition plays a major role in doctors’ offices, points out Barbara Mintzes, a specialist in direct-to-consumer advertising at the University of British Columbia’s Centre for Health Services and Policy Research.

Her research and a 2005 study by Richard Kravitz at the University of California suggest that when patients ask for a medication by name, they have a 50- to 75-per-cent chance of walking out of the doctor’s office with a prescription for that drug -- often despite physicians’ ambivalence about the treatment choice."

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FDA finds U.S. drug research firm faked documents

Reuters) - Drug companies that had medicines tested by contractor Cetero Research might have to reevaluate results, U.S. regulators warned after the firm was found faking documents and manipulating samples.

The Food and Drug Administration said on Tuesday two 2010 inspections, an internal company investigation and a third-party audit uncovered "significant instances of misconduct and violations" at a Cetero facility in Houston.

The Cary, North Carolina-based firm does early-phase clinical research and bioanalytics for a number of drugmakers. The pharmaceutical companies can then use those studies as supporting evidence in drug approval applications to the FDA.

"The pattern of misconduct was serious enough to raise concerns about the integrity of the data Cetero generated during the five-year time frame," the FDA said, warning drugmakers they might have to repeat or confirm any studies Cetero did in support of their applications between April 2005 and June 2010.

It remains unclear which drugmakers have used Cetero's services to apply for regulatory approvals and the FDA is asking companies to identify such instances. The regulators said the measure is precautionary and the safety and efficacy of drugs already on the market are unlikely to be affected.

The FDA inspected Cetero in May and December last year and found falsified records about studies.

Specifically, in at least 1,900 instances between April 2005 and June 2009, laboratory technicians identified as conducting certain studies were not actually present at Cetero facilities at that time, the FDA said in its May report.

The FDA also said at the time that Cetero might have "fixed" studies to get the desired result, or did not include failed results in their report.

"Cetero's May 2010 and December 2010 responses are inadequate because the scope of their internal investigation was far too narrow to identify and adequately address the root cause of these systemic failures," the regulators said.

Cetero was not immediately available for comment.
(Reporting by Alina Selyukh and Anna Yukhananov; editing by Andre Grenon)

Buying ‘Legal Highs’ from the Internet Is a Risky Business

May 19, 2011

Buying ‘Legal Highs’ from the Internet Is a Risky Business

Many drugs sold as ‘legal highs’ on the internet do not contain the ingredients they claim. Some instead contain controlled substances and are illegal to sell over the internet. These are findings of Dr. Mark Baron, who bought a range of tablets from different websites to see what each contained. The study is published today in the journal Drug Testing and Analysis.

“It is clear that consumers are buying products that they think contain specific substances, but that in reality the labels are unreliable indicators of the actual contents,” says Dr. Baron, who works in the School of Natural and Applied Sciences at the University of Lincoln, UK.

Baron says that buyers need to be aware that they have no idea what they will be taking and that some of the products could contain illegal substances. “The product name cannot be used as an indication of what it contains as there is variation in the content of the same product name between different internet sites,” says Baron.

Recently there has been an explosion in the number of substances deemed ‘legal highs’ that can be found readily available on the internet . The UK and other governments have acted to control these products however, manufacturers and suppliers seem to be one step ahead as they attempt to offer new products outside of the restrictions of the current legislation.

Baron set out to determine the drug content of such products. Purchasing them was easy; numerous online legal-high retailers market a broad variety of products advertised as research chemicals, bath salts, or plant food although clearly marketed toward the recreational drug user . “No guidelines exist as to what is sold and in what purity and consumers are led to believe that purchased goods are entirely legal,” says Baron.

With just a few clicks Baron bought MDAI, 5-IAI, Benzo Fury and NRG-3 from http://www.benzofury.me.uk/ and two MDA-labelled samples from http://www.viplegals.com/ and http://www.wide-mouth-frog.com/. Six out of seven products did not contain the advertised active ingredient more disturbingly five samples contained the controlled substances benzylpiperazine and 1-[3-(trifluoromethyl)phenyl]piperazine combined with caffeine.

“These findings show that the legal high market is providing a route to supply banned substances,” says Baron. He hopes that this work will help consumers become more aware of the dangers of purchasing products from the internet.

At the same time, legislators need to think fast. “As legislation deals with the current crop of products we can expect to see new products appearing that try to find a route of supplying previously banned substances,” says Baron.

An analysis of legal highs—do they contain what it says on the tin?

1. Mark Baron,
2. Mathieu Elie,
3. Leonie Elie

Article first published online: 19 MAY 2011

DOI: 10.1002/dta.274

Copyright © 2011 John Wiley & Sons, Ltd.

Abstract

In recent years the availability of so-called legal highs over the Internet has hugely increased. Numerous online legal-high retailers market a broad variety of products which are advertised as research chemicals, bath salts, or plant food although clearly intended for human consumption as recreational drug replacements. No guidelines exist as to what is sold and in what purity. Consumers are led to believe that purchased goods are entirely legal.

In this study, several legal-high products were purchased and analyzed for their content. The powdered products were screened with attenuated total reflectance—Fourier Transform Infrared (ATR-FTIR) followed by gas chromatography-mass spectrometry (GC-MS) analysis of methanol extracts. Spectra were compared to reference standards and the NIST library.

Results showed that 6 out of 7 products did not contain the advertised active ingredient. Moreover, five samples contained the controlled substances benzylpiperazine and 1-[3-(trifluoromethyl)phenyl]piperazine combined with caffeine. Copyright © 2011 John Wiley & Sons, Ltd.

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Doctors won't always take their own advice: study

April 11, 2011

Doctors won't always take their own advice: study

NEW YORK (Reuters Health) - When doctors step into their patients' shoes, their treatment decisions don't always line up with the advice they give in their clinics, a U.S. survey suggests.

Faced with hypothetical treatment scenarios, when they imagined themselves as the sick person, they more often chose those that carried a higher risk of death but fewer crippling side effects.

"I don't think any patient would expect that," said Dr. Peter A. Ubel, who led the research. "If they found out, they would raise a lot of questions."

But he stressed his findings don't necessarily mean doctors are acting immorally, or against the best the best interests of their patients.

Instead, Ubel, of Duke University in Durham, North Carolina, and colleagues say that people may be acting more on emotion and irrational biases when their decisions regard themselves instead of someone else.

"It has nothing to do with moral," he told Reuters Health. "It has everything to do with human nature. The doctors don't even know they are behaving this way."

The new survey is based on two sets of questions sent to primary care physicians across the country. One set asked about different types of hypothetical colon cancer surgery and another about a treatment for bird flu.

The doctors received either a survey that asked them to assume they were the patient or one that asked them about their advice for patients.

Of 242 physicians who answered the colon cancer questionnaire, 38 percent went with the surgery that carried a higher risk of death but fewer side effects for themselves. By contrast, only a quarter said they would recommend that treatment to their patients.

For the bird flu treatment, the numbers were 63 percent versus 49 percent based on 1600 answers, respectively.

Although less than half the doctors receiving the questionnaire returned it, Ubel believes the findings represent most doctors in the U.S.

"Advice is not neutral," he said. "So make your values part of the discussion before you get advice, and find out why the doctor makes a given recommendation."

The new study was published in the Archives of Internal Medicine.

Alan Schwartz, a University of Illinois psychologist who studies medical decision making, said he wasn't surprised by the results.

"There is a problem whenever someone is trying to make a decision for someone else," said Schwartz, who wasn't involved in the study. "We know that physicians are not good at guessing what patients want."

A "healthy physician-patient relationship should allow the opportunity for the physician to explore the length-of-life and quality-of-life concerns of the patient regarding his or her condition, as well as which complications are acceptable to the patient and which are not," write Dr. Timothy Quill and colleagues from the University of Rochester in an accompanying editorial.

According to Schwartz, most doctors agree that patients should be the ultimate decision makers. The doctor's role then becomes laying out the evidence that allows patients to act according to their own values and goals.

"No one gets to decide whether your values are right or wrong," Schwartz told Reuters Health. "It is very important for patients to communicate to their physicians what is important to them to themselves in their lives."

On the other hand, he added, physicians aren't very good at finding out what patients want, so this survey should also serve as a wakeup call to doctors.

"Physicians should be attuned to their patients' values," Schwartz concluded.

SOURCE: http://bit.ly/7qXyI
 Archives of Internal Medicine, April 11, 2011.

The case of the disappearing liver disease ; "Stanford Medicine" magazine now online

The case of the disappearing liver disease
Uncovering an ordinary antibiotic’s secret power

It was the type of case that makes doctors feel helpless.

The 15-year-old boy’s lab tests indicated his liver function was badly impaired. He had a double whammy of two serious gastrointestinal diseases, both lacking cures. On top of it all, his colon was infected with an aggressive bacterial strain, Clostridium difficile.
Although pediatric gastroenterologist Kenneth Cox, MD, had little to offer for the teen’s other problems, he could at least treat the infection. He prescribed the antibiotic vancomycin....

Compelling, right? The article is available online in the new magazine; Standford Medicine.

You can read more about the magazine here;

New Stanford Medicine magazine explores bioethics
By Rosanne Spector

What's bioethics? It's a field that didn't exist 40 years ago but is central to today's world of medicine. It's a field that looks for answers to medicine's virtually unanswerable ethical quandaries. And it's the topic of the new issue of Stanford Medicine magazine, which just went online.....Continue Reading....

Top Hospitals and A Story

Healthgrades released the study today which identifies the hospitals that are in the top 5% of the nation; Distinguished Hospital Award for Clinical Excellence

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On (November 17, 2010) – HealthGrades made available to organ transplant patients a list of those hospitals with the best track record for survival and chances of receiving a donor organ. This information is available, free to the public, at HealthGrades.com and is intended to help patients in need of kidney, lung, heart or liver transplants.

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The Story

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If it's been awhile since you have been hospitalized you may have forgotten the frustration associated with a four or six day admission. Realistically the only patients that spend more then 24 hours in a hospital are usually in pretty serious condition. Now a days its an in and out process; in labor and delivery for instance a woman delivering a baby without any complications has 24 hours before they're shown the door.

Recently, when my mother was hospitalized, I witnessed her own entanglement with the day to day care she received. Yes, mistakes were made, but what really was disheartening was the passive approach taken by the staff towards this seventy eight year old woman.

My mother is not afraid to speak out as her own advocate. The attempt by a few staff members to silent her legitimate concerns were not going unnoticed by me, or by her. My mother is not new to maneuvering around a hospital or its staff, for 30 years she cared for her own child who suffered from an autoimmune disorder; we lost my sister at 36.

During this time my mother had numerous midnight runs to the U of M , with years upon years of hospital admissions. She knows how difficult it is for the patient and the staff. My mother has always practiced diplomacy when communicating her daughters needs and now her own. Our family is grateful to the many U of M doctors and nurses who kept my sister alive. We gravely respect the people who have chosen to work in the health care industry.

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Mom and Dad on the day of their engagement

This sure isn't like it used to be honey.

While my mother was in the hospital she was asked no less then ten times what her daily medication consisted of; a call to her doctor was unheard of, as was a quick check of her admission papers. I won't even mention the word "chart", everyone knows that's a no, no. However, my mother was equipped with a list of all her medication. I told ya, the woman knows her stuff.

At her age, the seemly innocent questions about her medication soon became alarming to her. With each bothersome question she remarked; "In the old days they never asked me about my medication, they knew what I was taking. Then after a deep breath she half yelled,"What the hell is wrong with these people?" As I looked at my mothers face I saw fear, she then started to cry as she said; " This sure isn't like it used to be honey ".

These people were scaring my mother, and I completely understood why. Another upsetting moment for my mother was when she learned her general practitioner would not be stopping by to check on her. In those "good old days" the general practitioner visited the patient, in my mothers case this didn't happen.

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What did happen?

Although what did happen was an attending office staff person, or nurse, maybe a medical liaison or whatever he was visited my mom. This nice person reported back to my mothers doctor through electronic medical updates, or email correspondence. I couldn't help but wonder if this is part of the new "medical reform" , you know cutting costs. Naw, the culprit is most likely the insurance companies, or is that now the same thing? Who knows ?

Anyhow, my momma wanted to see her doctor, with some personal assurance he was overseeing her care. Instead my mother started to assume she was on her own, with that came sleepless nights and worry, soon out came the sleep aids, I was not amused, I was upset. .

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An Error

The error that transpired was by a nurse as she dispensed the wrong dosage of medication, mom caught it. My mother quickly and nervously proclaimed to her nurse; That's not right honey, I don't take that color pill, you better check that out. The nurse quickly replied; "Now, now we can't go by the color of a pill Mrs. so and so. Enter me; "Oh yes we can miss so and so. The milligram is all wrong, unless its been changed. As for my mother she is aware that a "pill color" will change when the pill is offered as a generic ." I continued; "My mother also understands that the "pill color" will change according to the dose. However, what is transpiring right now is that my mother is asking you to double check that dosage before assuming this old woman doesn't know what shes talking about".

Whew, I embarrassed myself that time, I also lost my nurse. This is the deal, ya need to keep the nurse on your side, if they like ya, mom gets a midnight snack.

The truth is I love all nurses! My mothers nurse was great, it was me, not her. I had a few fears of my own; My fear was that my mother may not get out alive.

I lost my father two years earlier.

The Discharge

My Parents

Her discharge was handled by myself, I wanted everything written down clearly. The generic release form with follow up instructions was not going to be good enough.

This took a lot of running around but at my insistence we received clear instructions on how to proceed with the new medications (written out) and home care.

Including the time for all follow up appointments which included the invisible GP and the new heart specialist. By accomplishing this we intercepted a mistake before we left the hospital. The mistake was made by the hospital pharmacy no less. Which may have been the reason my mother was given the wrong dosage of medication a few days earlier.

The good news is my mom caught it at discharge and only because it was written down in front of her.

Go MOM!

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My Dad; The one in the middle

I lost my father a few years ago, the end of his life was not handled by hospice or the hospital, it was handled by my family.

They both dropped the ball, and he suffered more then he needed to.

I still can not re-visit those days, moments, of negligence.

When a child or elderly family member is hospitalized our family has always remained at bedside until they were discharged. In doing so we have clearly articulated their needs and have overseen their care.

I have great admiration for the physicians, nurses who have given expert care to myself and my family. It has been a rare occurrence that my family hasn't received top notch medical attention. If mistakes did occur during a hospital stay it was often during shift changes, or by first year medical staff.

This video from healthgrades is worth a view folks.

Video: Top Ten Tips for Avoiding Medical Errors (2:25)

This video below covers the "Top Ten Tips for Avoiding Medical Errors" Dr's. Samantha Collier and Rick May offer ten valuable tips to help you avoid dangerous and potentially costly medical errors.

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HCV, B.C. and Socialized Medicine

Q-What Is Socialized Medicine?.

A - The term is used to describe a system put in place by the government to publicly administered national health care. In England this system was first initiated in 1948; at that time the government was to provide free physician and hospital services. However, now they pay a small fee for doctors services but the concept is still in place.

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In Canada socialized medicine appears to exhibit a few drawbacks according to the report published online today entitled "Wait times for Canadians seeking medical treatment increases"

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Revealed in the report is the current wait time for Medical oncology and radiation oncology; The average is approximately 4.9 to 5.5 weeks.

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Also covered in the published report is the wait time to be seen by a specialist ; "Last year, from the time their GP referred them to a specialist to the time their treatment was actually started, Canadians had to wait approximately 16.1 weeks. That period has risen dramatically in just one year up to 18.2 weeks. The nationwide trend toward increased wait times is repeated through all 10 Canadian provinces".

The video link posted here today on the blog is a B.C. news report dated March 3, 2010 covering HCV and drug coverage. The CBC news reported on binge drinking by Hepatitis C Patients in order to raise enzyme levels and receive treatment.

According to CBC news ; "The provincial drug plans in B.C. and Ontario only pay for antiviral treatments if hepatitis C patients submit documented evidence of significant liver damage" .

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B.C./ Ontartio won't pay for antiviral drugs for those without liver damage, so some hepatitis C patients binge drink, Kathy Tomlinson reports.Hepatitis C patient Richard Levesque said he went on a three-day drinking binge to try to damage his liver enough to qualify for treatment in B.C. (CBC).

View Video

The same dire attempts are prevalent in Ontario, which have similar guidelines for drug coverage as those in B.C. The online news article accompanying the video mentioned Hepatitis C suffers in Ontario are also trying to inflame their livers in order to get the province to pay for HCV drugs. For anyone infected with HCV in B.C or Canada its apparent that "socialized medicine" is not working. Note* The 120 or so replies to the March online article were astounding..

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Private Reform In Canada?.

In July of 2010 written by DAVID GRATZER was the article Rethinking Socialized Medicine In Canada.

Mr Gratzer writes "Regina's health board (charged with providing health service to the city's population) recently started entertaining the idea of contracting out CT scans to the private sector. And with good reason: Regina has just three CT scanners, and they are running at full capacity, seven days a week. The reach-out to the private sector, then, is about practicality, not ideology — patients are simply waiting too long. Regina isn't the only place in Canada where health care officials are contemplating private reforms. In British Columbia, the government is moving hospitals to a pay-for-service model that would lead providers to compete with one another directly. In Quebec, the premier has openly endorsed the idea of co-pays for basic services, which no politician previously supported. And governments across the country are hiring private clinics to provide basic surgeries".

Socialized medicine can put patients at risk the author spoke of a woman who died in a Montreal ER ; "Why the appetite for change in a country that has long been held as a model of health care efficiency and equity? The system is beset by problems. According to the Canadian Medical Association, roughly 4 million to 5 million people don't have a family physician. Patients wait for practically any problem, sometimes with disastrous results. A Montreal woman died recently after waiting four days in a hospital ER, the last of a string of Quebec deaths that led the head of that province's College of Physicians to hope openly for a "miracle."

This my friends is socialized medicine.

In the United States socialized medicine is more of a term coined to provoke negative overtone for debate around the government involvement in our U.S. health care. According to wikipedia it may be defined as any system of medical care that is publicly financed, government administered, or both. In other words in the United States we will not be using the "term" socialized medicine , for socialized medicine.

I had an in depth conversation with my physician about the government involvement in our health care. His biggest concern as a patient is the new guidelines involving standard of care. Will there be limitations ? He wonders if a 75 year old needs a bypass will "Standard of Care" consider it feasible ? Maybe not. Why ? Well, because of life expectancy.

We discussed facing health care without specialized medicine. He elaborated starting with the doctor who now specializes in treating cancer, diabetes, children, pregnancy, arthritis, heart, they will no longer be in practice. He said highly advanced surgical procedures could also be a thing of the past.

The bottom Line

We may have one doctor to visit for all our medical needs. The horrifying reality is he will prescribe the same treatment as every other doctor based on the services for which the government has agreed to pay. We will no longer be treated as an individual patient/case, instead everyone will be treated the same.

Under the nationalized health-care program the goal is to standardize services and not to specialize them.

That is standardized care, this is "socialized medicine".

Thirteen Myths About Rheumatic Diseases

Rheumatology Mythbusters:

Thirteen Things About Rheumatic Diseases That Just Aren’t True

Released: 11/8/2010 9:00 AM EST
Source: American College of Rheumatology (ACR)

Newswise — A diagnosis of arthritis or another rheumatic disease can cause someone to feel anxious and even a little overwhelmed. Being a knowledgeable and empowered patient can help alleviate some of those feelings, and being able to navigate through the many misconceptions about arthritis and rheumatic diseases is vitally important.

Nearly 50 million U.S. adults—and 300,000 children—suffer from arthritis and other rheumatic diseases, and there are many myths surrounding how a person ‘gets’ arthritis, what can be done to treat it, and things to avoid to not exacerbate it.

Below are thirteen myths about arthritis and rheumatic disease:

Myth: Arthritis is one disease.
Myth: Arthritis is an older person’s disease. Kids don’t get arthritis.
Myth: Rheumatic diseases aren’t nearly as common as other diseases.
Myth: Wearing a copper bracelet can cure arthritis.
Myth: Any doctor can treat my rheumatic disease.
Myth: Smoking does not increase my risk for developing an autoimmune disorder.
Myth: Children outgrow arthritis.
Myth: Arthritis is brought on by weather changes.
Myth: Exercise should be avoided if you have arthritis or another rheumatic disease.
Myth: People with arthritis and other rheumatic diseases should seek herbal remedies and supplements for their treatment.
Myth: My weight has no impact on my arthritis.
Myth: Cracking your knuckles can cause arthritis.
Myth: Arthritis is an inevitable part of life, so you just have to deal with it.

And here are these myths, as busted by members of the American College of Rheumatology:

Myth: Arthritis is one disease.

Truth: Arthritis is an umbrella term used to describe over 100 medical conditions and diseases, known as rheumatic diseases, including rheumatoid arthritis, lupus, and gout.

Myth: Arthritis is an older person’s disease. Kids don’t get arthritis.

Truth: Arthritis and other rheumatic diseases do not discriminate based on age. Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting more than 1.3 million Americans (about 75 percent are women). RA most often begins between the 30s and 50s; however, RA can develop at any age.

Additionally, about one child in every 1,000 develops some type of juvenile arthritis. These disorders can affect children at any age, although rarely in the first six months of life.

Myth: Rheumatic diseases aren’t nearly as common as other diseases.

Truth: In the United States alone, there nearly 50 million adults and 300,000 children with arthritis and other rheumatic diseases. Rheumatic diseases are more frequently the cause of activity limitation than heart disease, cancer or diabetes. Forty percent of Americans have arthritis-related work limitations, and 60 percent of people with RA are unable to work 10 years after disease onset.

Myth: Wearing a copper bracelet can cure arthritis.

Truth: Copper bracelets have a reputation for helping with various health problems, including pain caused by physical conditions, such as arthritis. These benefits are passed along by word of mouth, and because of the popularity of these bracelets, many studies have been conducted to see whether their positive reputation is deserved.

There may indeed be benefits, although they appear to be based on the placebo effect rather than a true physical reaction.

Myth: Any doctor can treat my rheumatic disease.

Truth: While primary care physicians are an important part of a person’s health care team, you may need to see a rheumatologist, who is a physician who specializes in treating arthritis and other rheumatic diseases. If you had cancer, you would see an oncologist. If a child were to suffer from diabetes, he or she would be taken to an endocrinologist. Just as you would reach out to a specialist for these types of diseases, you should turn to a rheumatologist as your lead physician to treat rheumatic diseases.

Myth: Smoking does not increase my risk for developing an autoimmune disorder.

Truth: Smoking is well known to be associated with increased risk of emphysema, lung cancer, heart disease, stroke and other adverse health outcomes. It has now been recognized that smoking increases the risk for developing autoimmune diseases including rheumatoid arthritis and lupus. In addition, patients who smoke appear to have worse arthritis and other symptoms. The reasons for the association between smoking and autoimmune disease are not fully understood, but seem to relate to smoking-induced triggering of immune system, leading to these diseases.

Myth: Children outgrow arthritis.

Truth: In reality, over 50 percent of children with juvenile arthritis will enter adulthood with active arthritis, and even as adults, the characteristics (such as their rheumatoid factor status and suffering from other conditions such as uvetis) of their arthritis are more like JIA than RA.

Myth: Arthritis is brought on by weather changes.

Truth: While changes in the weather can exacerbate arthritis symptoms, such as joint pain, weather does not cause arthritis or other rheumatic diseases.

Myth: Exercise should be avoided if you have arthritis or another rheumatic disease.

Truth: Physically active individuals are healthier, happier and live longer than those who are inactive and unfit. This is especially true for people with arthritis and other rheumatic diseases. People with arthritis should work with their health care team to determine the best type of exercise for them (e.g., swimming, walking, tai chi, light weight lifting, etc.).

Myth: People with arthritis and other rheumatic diseases should seek herbal remedies and supplements for their treatment.

Truth: Despite new and more effective treatments, many arthritis patients live with chronic pain and disability. Some people turn to herbal medicines and other "natural" remedies in the belief that they are effective and safer than conventional medications. Unfortunately, most information available to the public about these remedies in the media and on the internet is misleading. Because the FDA is currently unable to regulate the quality of herbal remedies and supplements, or to verify their effectiveness or safety, the use of herbal remedies is not recommended.

Myth: My weight has no impact on my arthritis.

Truth: Some studies show that even a small amount of weight loss can help ease arthritis pain – particularly in the knees and hips. Treating rheumatic diseases is not a one-size-fits-all approach. Each condition requires a specific multidisciplinary treatment that may include diet, exercise, medication, and/or behavioral changes.

Myth: Cracking your knuckles can cause arthritis.

Truth: Some studies have shown that this habit can cause damage to the ligaments, but there is no evidence that knuckle cracking can lead to arthritis.

Myth: Arthritis is an inevitable part of life, so you just have to deal with it.

Truth: Aches and pains are an inevitable part of life. But, sometimes, pain in the joints, muscles or bones is severe or persists for more than a few days. At that point, you should see your physician to determine if a referral to a rheumatologist is appropriate.

Living your life with prolonged stiffness and pain isn’t something you should deal with on your own. Rheumatologists and rheumatology health professionals are trained to help you not only find a way to live with arthritis and other rheumatic diseases, but many treatments offered by rheumatologists can even stop certain diseases and conditions in their tracks.

Make sure you see your rheumatologist to determine which treatments are best for you.

Rheumatologists are devoted to the care of the whole person. With their comprehensive knowledge of the immune system, rheumatologists understand how rheumatic diseases affect the entire body from head to toe. And, because rheumatic diseases are not only complex but chronic, rheumatologists see their patients frequently over much of their lifetimes. They help them to understand and manage a variety of health issues – from medications to physical therapy to surgery needs to mental health to pregnancy to common infections. Rheumatologists serve as lifelong care leaders for their patients.

Learn more about living well with rheumatic disease as well as rheumatologists and the role they play in health care.

The American College of Rheumatology is an international professional medical society that represents more than 8,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology.