So, who else has read today's Page 1 story about alleged over-prescription of pain medication for workers who have suffered workplace injuries
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It may be. But stupidity doesn't fully account for the overall tone of the piece: its strong subtext is that measures various players are taking or proposing to address the supposed problem of Too Much Pain Medication are positive steps that we should all support. And it takes its fundamental premise that what's going on with pain medication is in fact that it's overprescribed and in most instances harmful in some mysterious way as, well, a premise: it never allows for any possibility that the pain medication is being prescribed because there are too many people who have a serious problem with pain instead. This, despite the acknowledgment that nobody can say that the pain medication causes any of the problems discussed, and that there isn't even some credible hypothesis out there about how it might.
It's selling the need for a solution to the problem it identifies, and it's selling it hard. And it's not subtle about telling us what the problem is. It just also tells us, right in the middle, that what it identifies isn't really the problem at all. So I go back and forth in my own mind: can any combination of reporter and editorial staff really be so purely stupid that they didn't even notice that they've contradicted the entire point of their article? Doesn't a certain amount of consciousness of agenda-pushing regardless of fact almost have to have entered into it somewhere? Or am I totally wrong, and people really are dumb enough to do this with a pure heart?
Now that I've read the article - I'm muddled by the data, especially the paragraph that begins with "Nationwide, data suggests that a vast majority of narcotic drugs..." The conclusion I'd draw is that far too many people suffer from pain caused by work-related injuries which might (or might not) have been less costly or less tenacious if other measures (e.g. therapy) had been taken in the beginning. The writer makes it sound as if the narcotics are responsible when it could be the lack of appropriate treatment. And one would have to see the studies to know what's meant by "those with similar injuries who took lower doses" and so forth.
It's selling it hard because the studies it cites have a particular agenda to push but perhaps the writer had a moment of lucidity in the middle of the article and had no idea what to do with it? I'm going to ask my brother for his take on it. This is his area of expertise.
I'd love to know what your brother makes of it. There's nothing like getting the views of an actual expert in the field. I can see what's wrong with the article in the abstract: the places where a chain of logic is missing, and where the author has consciously or unconsciously attempted to create the appearance of that logic where it doesn't exist. But it takes somebody who knows to tell whether the story is incompetent or dishonest. And it would be nice to know which it is, even if for my immediate purposes it doesn't matter too much -- any plea to the public editor to look into it would likely be better couched as a request that he investigate a shocking error, rather than as an accusation of deliberate wrongdoing.
Even, or perhaps especially, if deliberate wrongdoing is what's going on.
I didn't share your thoughts about it. I sent him the article and asked what he made of it. I expect we'll be discussing it further but this was his preliminary response:
"As the article doesn't address the possible 'why' of it, I can thus freely speculate!
Narcotics are very simple drugs to use, and they are very effective at managing pain. Doctors who believe in magic bullets would find them attractive. But what do these drugs actually do? They generally alter the perception of pain, not pain itself much less the underlying cause of the pain. So the patient doesn't experience the injury in such a way as to treat it appropriately. At the same time,the drug does absolutely nothing about the actual injury, which is left to repair on its own, with an unaware patient, and possibly no ancillary therapy - such as physio. Thus it seems possible the actual injury would not get better, or be injured further by a careless patient, and might well deteriorate, requiring ever increasing doses of opiods. Spiral ensues.
Although they appear to take longer to 'work', NSAIDS actually do effect the injury so as to lessen further damage and promote healing. At the same time, the patient will still be aware of the injury, and may be more easily encouraged to undergo physio or other therapies that actually help repair the damage. But this is so much more tedious than giving the patient a magic pill that takes away the pain.
It seems that an opioid is the quick fix - even if it isn't - that would be very attractive to docs tied to 7 mins per patient and having little to offer beyond a pill. It feeds the patient notion that they shouldn't have to do anything to get better other than take some pill.
It would be helpful if people used the term "pain relief" more carefully. Opioids treat the perception of pain, and can be quite dramatic in that regard. NSAIDS relieve some of the symptoms that lead to pain, such as swelling and inflammation. Corticosteroids do much the same thing, but much more dramatically (like opiods) but with those nasty side effects that make them unattractive except for the most serious things such as bone cancer.
Doctors work with what they have, and few things can be dealt with in the 7 minute window, so the pill that makes the patient happiest, fastest, tends to win out. Patients expect miracles, and doctors really don't have the time, patience, or skill (usually) to offer a slower, but possibly more effective therapy.
Just some 'off the top' reactions."
I would add that the '7 minutes' applies to our system rather than yours although I think that doctors' desire to please patients with an apparent quick fix is universal. The insurers, or government, are interested in (apparent) cost-effectiveness. The above suggests an answer to the how and why of narcotic pain-killers that the writer of the article seems unable or unwilling to address. It's like a great deal of what I see in the media these days - just enough information to arouse one's curiosity (or moral panic), not enough to give a complete picture or suggest alternative modes of dealing with the issue in question. If Bro has more to say, I'll let you know.
And he adds "the media frequently don't look very hard for an original "meaning" or insight in a story, but simply filter what they are given to fit a familiar trope."
And really, that's the root of what I'm complaining about here. It's not the underlying facts; it's that in effect, the facts aren't what's being reported.
I love your brother's hypothesis about how opioid use might indeed have a negative impact on long-term recovery, at least in some patients: it has an elegant simplicity to it. But even if it's right, it doesn't get the Times off this particular hook, because if its implicit conclusion is correct, it's by sheer accident. The line about not knowing how or even whether the meds are implicated in the bad results still shows that they ran a story pushing a specific conclusion that they knew or believed they knew was not founded in the facts, just as if the facts they knew were entirely on the side they were pushing. And relied on tone and flow to carry the message to their readers unquestioned, despite the warnings that we shouldn't accept it. It's not the way a newspaper should be behaving.
Not that I think that either you or your brother necessarily disagree with me on this one, but I find myself still filled with rantiness. Wisconsin really, really didn't help me feel better about the larger problem.
I'm sure we'd both agree with you. The story ought to have been something like 'if narcotic painkillers are (over-)prescribed in spite of poor results, why is that and what should we do about it?' Instead, the writer wants to place his story within the context of a larger story - the 'problem' of 'the excessive use' of narcotics - while suggesting that narcotics might cause the development of chronic pain, something for which he has no evidence. He knows there's a problem - and there is - but he's only able to grasp the reasons and convey them to the reader in a fitful way so that, as you say, tone and flow leave the unwary reader with -- well, nothing much at all.
If he'd taken the information in the story, removed speculation and phrases like 'in a sense', and had explored just how inept doctors are when it comes to medications (other brother is a pharmacist, so I have views on this subject), and how insurers/government/health authorities want to weasel out of paying for better and more appropriate treatment, and how doctors deal with patient demands, and why narcotics aren't evil but the right drug for certain conditions and certain people, then he'd have had something like the beginnings of a proper story.
The sad thing is that one could write precisely this article about any number of other medications - i.e. medication x is overused and is driving up costs in spite of the fact that it doesn't work, may be counter-productive, and results in a host of symptoms/consequences that require more treatment and other medications and... You can see where I'm going with this.
It's hard to persuade people that not prescribing the med they think they need (because they've seen it advertised on TV) isn't about cost effectiveness; it's about not giving them what they don't need. But this is where people start talking about the evils of Obamacare cost/benefit boards and we don't need to go there. :D
It's selling the need for a solution to the problem it identifies, and it's selling it hard. And it's not subtle about telling us what the problem is. It just also tells us, right in the middle, that what it identifies isn't really the problem at all. So I go back and forth in my own mind: can any combination of reporter and editorial staff really be so purely stupid that they didn't even notice that they've contradicted the entire point of their article? Doesn't a certain amount of consciousness of agenda-pushing regardless of fact almost have to have entered into it somewhere? Or am I totally wrong, and people really are dumb enough to do this with a pure heart?
Reply
It's selling it hard because the studies it cites have a particular agenda to push but perhaps the writer had a moment of lucidity in the middle of the article and had no idea what to do with it? I'm going to ask my brother for his take on it. This is his area of expertise.
Reply
Even, or perhaps especially, if deliberate wrongdoing is what's going on.
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"As the article doesn't address the possible 'why' of it, I can thus freely speculate!
Narcotics are very simple drugs to use, and they are very effective at managing pain. Doctors who believe in magic bullets would find them attractive. But what do these drugs actually do? They generally alter the perception of pain, not pain itself much less the underlying cause of the pain. So the patient doesn't experience the injury in such a way as to treat it appropriately. At the same time,the drug does absolutely nothing about the actual injury, which is left to repair on its own, with an unaware patient, and possibly no ancillary therapy - such as physio. Thus it seems possible the actual injury would not get better, or be injured further by a careless patient, and might well deteriorate, requiring ever increasing doses of opiods. Spiral ensues.
Although they appear to take longer to 'work', NSAIDS actually do effect the injury so as to lessen further damage and promote healing. At the same time, the patient will still be aware of the injury, and may be more easily encouraged to undergo physio or other therapies that actually help repair the damage. But this is so much more tedious than giving the patient a magic pill that takes away the pain.
It seems that an opioid is the quick fix - even if it isn't - that would be very attractive to docs tied to 7 mins per patient and having little to offer beyond a pill. It feeds the patient notion that they shouldn't have to do anything to get better other than take some pill.
It would be helpful if people used the term "pain relief" more carefully. Opioids treat the perception of pain, and can be quite dramatic in that regard. NSAIDS relieve some of the symptoms that lead to pain, such as swelling and inflammation. Corticosteroids do much the same thing, but much more dramatically (like opiods) but with those nasty side effects that make them unattractive except for the most serious things such as bone cancer.
Doctors work with what they have, and few things can be dealt with in the 7 minute window, so the pill that makes the patient happiest, fastest, tends to win out. Patients expect miracles, and doctors really don't have the time, patience, or skill (usually) to offer a slower, but possibly more effective therapy.
Just some 'off the top' reactions."
I would add that the '7 minutes' applies to our system rather than yours although I think that doctors' desire to please patients with an apparent quick fix is universal. The insurers, or government, are interested in (apparent) cost-effectiveness. The above suggests an answer to the how and why of narcotic pain-killers that the writer of the article seems unable or unwilling to address. It's like a great deal of what I see in the media these days - just enough information to arouse one's curiosity (or moral panic), not enough to give a complete picture or suggest alternative modes of dealing with the issue in question. If Bro has more to say, I'll let you know.
Reply
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I love your brother's hypothesis about how opioid use might indeed have a negative impact on long-term recovery, at least in some patients: it has an elegant simplicity to it. But even if it's right, it doesn't get the Times off this particular hook, because if its implicit conclusion is correct, it's by sheer accident. The line about not knowing how or even whether the meds are implicated in the bad results still shows that they ran a story pushing a specific conclusion that they knew or believed they knew was not founded in the facts, just as if the facts they knew were entirely on the side they were pushing. And relied on tone and flow to carry the message to their readers unquestioned, despite the warnings that we shouldn't accept it. It's not the way a newspaper should be behaving.
Not that I think that either you or your brother necessarily disagree with me on this one, but I find myself still filled with rantiness. Wisconsin really, really didn't help me feel better about the larger problem.
Reply
If he'd taken the information in the story, removed speculation and phrases like 'in a sense', and had explored just how inept doctors are when it comes to medications (other brother is a pharmacist, so I have views on this subject), and how insurers/government/health authorities want to weasel out of paying for better and more appropriate treatment, and how doctors deal with patient demands, and why narcotics aren't evil but the right drug for certain conditions and certain people, then he'd have had something like the beginnings of a proper story.
The sad thing is that one could write precisely this article about any number of other medications - i.e. medication x is overused and is driving up costs in spite of the fact that it doesn't work, may be counter-productive, and results in a host of symptoms/consequences that require more treatment and other medications and... You can see where I'm going with this.
It's hard to persuade people that not prescribing the med they think they need (because they've seen it advertised on TV) isn't about cost effectiveness; it's about not giving them what they don't need. But this is where people start talking about the evils of Obamacare cost/benefit boards and we don't need to go there. :D
Reply
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