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@AnnieLennox 1/Annie Lennox- I am a professor of medicine who has spent much of the last 3 years trying to remediate emergent mistreatment of persons with chronic pain. I have published extensively on pain & opioids, given a @TEDxBirmingham talk and would like to ask you to follow me
@AnnieLennox @TEDxBirmingham 2/A pendulum swing in North American #opioid prescribing policy resulted in mistreatment and discounting of patients and families with chronic pain. I am sharing the press release for a peer reviewed article but will share full article if you wish uab.edu/news/health/it…
@AnnieLennox @TEDxBirmingham 3/I have been shocked by the willingness of health systems to discount not just pain, but also survival of patients with severe pain. My TEDx talk tries to explain the dynamics of how and why while making clear my anger. Please watch.
@AnnieLennox @TEDxBirmingham 4/I have a fair number of peer reviewed and lay articles concerning the policy dynamics, and research. Also, I confess that your albums played a big role in helping me survive high school and med school. Please follow or message me. I am glad to offer more statnews.com/2017/02/24/opi…
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Stefan Kertesz, MD
@StefanKertesz
1/“Due to the increasing demands and changing nature in primary care, we will no longer manage chronic pain” as Mass. patient is told he will “taper off” in 1-2 months: I don’t know the clinic. I know the trend lines reflect impact of making a liability (the patient) unbearable
2/The overprescribed opioids’ role in contributing to problems of diversion & overuse drew a controlling reaction in which the Rx itself was seen as the prime target for reduction, by nearly all parties that could- simultaneously- affect prescribers’ sense of safety to practice
3/Amidst #COVID19 - neither a urine drug test nor an in-person visit are strictly required by existing DEA rules, but DEA rules alone don’t determine the decision framework for prescribing clinicians deadiversion.usdoj.gov/GDP/(DEA-DC-02…
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Stefan Kertesz, MD
@StefanKertesz
1/great piece by @CarlynZwaren addresses how we misconstrue associations between substance use and homelessness. The stories we tell, often enough, are “my addiction made me homeless”
filtermag.org/drugs-homeless…
2/I have talked with patients who say, “I’m homeless because of cocaine”. Yes. Okay. When I ask when they last used, it was 4 months earlier. One bad day triggered a catastrophe. Quoting @KellyMDoran there is every reason to think these relationships go both ways.
3/Just to be clear, a some bad days of drug use can cause homelessness if, wait for it, you’re poor, and your family is poor, and no one has any space left in their overpriced apartments and your community has not invested in light-touch assistance like temporary cash support.
Read 8 tweets
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Stefan Kertesz, MD
@StefanKertesz
1/Hydroxychloroquine (HCQ) is looking worse&worse as an option for care of #COVID19 The best new study offers a *superb* example of a statistical approach to data where treatment wasn't randomly assigned. I'll summarize the finding and "propensity scores" nejm.org/doi/full/10.10…
2/In this NY hospital (March 7-April 8), docs were permitted to offer HCQ but didn’t have to. And, the 811 who got HC were sicker than 565 who didn’t. If we compare outcomes with vs without HCQ, it might make HCQ look bad, because of who got it (“confounding by indication”).
3/To address such imbalances, you can do 2 things. Either do a large randomized trial (hard to do fast!), or- as was done here- attempt to analyze in a way that corrects for imbalances. The latter is never as definitive as the former, but it’s faster.
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