Undisclosed Conflicts of Interest by Physicians Creating the CDC Opioid Prescribing Guidelines: Bad Faith or Incompetence?
We described above how changes in opioid policy aimed at reducing Washington State’s Medicaid and Workers Compensation costs contributed to an increase in methadone deaths between 2003 and late 2014 (23-25). Focusing on similar cost reductions, the Centers for Medicar e and Medicaid Services (CMS) proposed rules for 2019 including several directives intended to reduce " Opioid Overutilization, ” including adoption of the “90 morphine milligram equivalent (MME) threshold cited by the 2016 CDC Opioid Guideline (147, 148). Simply put, reduced prescribing reduces costs for prescribed medications.Chou received research fu...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 12, 2022 Category: Palliative Care Tags: health policy judy kollas opioids research schechtman Source Type: blogs

Celebrating Hospice and Palliative Medicine as the Fifth Largest Medical Subspecialty
by Christian Sinclair (@ctsinclair)We have entered a new age! Spread the word!Hospice and palliative medicine (HPM) is the fifth largest medical subspecialty!You may have sensed we have been climbing the ranks, but I bet you are still surprised. A close look at the fellowship match data from Dec 2021, shows that HPM has the fifth highest number of matched applicants, behind the big 4: Cardiovascular, Pulmonary and Critical Care, Hematology and Oncology, and Gastroenterology.When I share this good news with HPM colleagues, few put us anywhere near fifth.I did an informal poll on Twitter and less than half of respondents ran...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 11, 2022 Category: Palliative Care Tags: fellowship sinclair The profession Source Type: blogs

The Peril and Privilege of Exploration: A Review of Subnautica
by Matt Tyler (@PalliDad)In the survival game Subnautica, you play the role of a space voyager who has crash landed on an aquatic alien planet. You must find a way to escape while navigating the planet ’s beautiful but dangerous flora and fauna. Exploration makes the core of Subnautica, and because I am a palliative care doctor, I couldn’t help but draw a parallel to serious illness conversations. Whether exploring shipwrecks and underwater caverns or the emotions and stories of patients, both require curiosity, methodical skill development, and respect for boundaries.Any explorer must first and foremost be curious, ev...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 13, 2022 Category: Palliative Care Tags: games media tyler video games Source Type: blogs

Simplifying Opioid Conversions
by Drew Rosielle (@drosielle)A Satirical Monologue in One Act:“Ok, 3rd year resident, let’s talk about rotating opioids. What do I mean by ‘rotating’ opioids? It’s just therapeutically switching one opioid with another. It’s um, like, a turnstile, I guess? Anyway--first let’s look at this equianalgesic table. Do you know what equianalgesia means? No? It is the concept that different opioids have the same analgesic power but at different milligram doses due to different potencies. That is, the idea that, say, 50 mg of oral morphine has the same analgesic power as 10 mg of hydromorphone. So 50 mg of oral morphi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 2, 2022 Category: Palliative Care Tags: opioid rosielle Source Type: blogs

Opioid Equianalgesic Tables are Broken
by Drew Rosielle (@drosielle)I am proposing we do away with equianalgesic table (EAT) as a tool to inform clinical decisions about opioid rotations/conversions. Fundamentally, EATs create too many problems, and there are simpler and safer ways to teach clinicians how to convert between different opioids.Part 1: New Data Can ' t Fix the EATA couple HPM fellows every year ask me which table do I prefer to use —the old EAT or the new one? By the old one, they refer to the table most of us used or were at least deeply familiar with for the last 10-20 years. By the new one, they mean the one created by Dr. Mary Lynn McPherson...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 21, 2022 Category: Palliative Care Tags: opioid pain rosielle Source Type: blogs

The Annual Assembly and COVID
by Christian Sinclair (@ctsinclair)Last week, many hospice and palliative care clinicians and advocates received the unfortunate news that the 2022 Annual Assembly of Hospice and Palliative Care (#hapc22) was moving from hybrid (both in person and virtual) to virtual only. The board of directors of AAHPM and HPNA " considered the current strain on health care systems, personnel and their families " when making the decision. And then one week later, many presenters found out their presentations were not going to be in the virtual-only assembly. That is immensely disappointing. I received notice that my talks - on which coll...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 24, 2022 Category: Palliative Care Tags: AAHPM conference HPNA sinclair Source Type: blogs

Difficult Conversations About Racism
This article differs from other important work like the 2016 NEJM article Paul-Emelie, Smith, Lo and Fern ández, "Dealing with Racist Patients." Most articles focus on what to do about the care of the patient now and in the future if they ask to be reassigned. That is important to consider as well, but what I appreciate about McKillip and Moss ' work is that it focuses on the team, and the role we all must have in working towards a more caring and supportive community at work.COI: Peer-to-peer mentorship - Mckillip, Bazelak*Friday Chalk Talk is a great weekly resource. I need to write about that too!For morePallimed posts...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 17, 2022 Category: Palliative Care Tags: bias ethics JPSM race racism sinclair Source Type: blogs

Cloaked Suffering
by Lyle Fettig (@FettigLyle)The suffering in our hospital is cloaked by tinted windows and shiny new steel, a serene architectural specimen which betrays the internal chaos of each person who experiences illness behind each door.Even for people who work there, it is sometimes surreal to approach the building in its beauty with the dissonant knowledge of what can happen in all manner of disease in between the walls. It ’s the perfect place to hide the devastation of a pandemic.Were the death and agony in the streets for all to see, perhaps the choices that are obvious to you and me would be obvious to all. How could a per...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 3, 2022 Category: Palliative Care Tags: covid fettig Source Type: blogs

Say No! More - A Video Game Review
by Matthew Tyler (@pallidad)Consider the last time you said “Yes” to something when you would have preferred to have said “No.” Maybe you worried saying “No” would damage a relationship. Or maybe you didn’t want to put your job at risk. InStudio Fizbin ’sSay No! More you assume the role of a corporate intern on a quest to reclaim their lunch stolen by upper management. You go to battle with your manager, the C-suite, and beyond, wielding the power of a word never-before spoken within the walls of your office.Say No! More demonstrates in an over-the-top fashion how being able to say “No” can be a positiv...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 30, 2021 Category: Palliative Care Tags: game media tyler video games Source Type: blogs

The Limits of Advance Care Planning
by Michael Pottash (@mpottash)Several luminaries of palliative care – writing in the Journal of the American Medical Association– recently outlined a strong case against advance care planning, referring specifically to advance directives and the efforts to plan for a future illness state. Planning for the end of life and documenting preferences was meant to improve “goal-concordant care” by providing a road map of a pe rson’s wishes for the end of their life when they can no longer communicate for themselves.When the Unitde States Supreme Court ruled against the family of Nancy Cruzan, they effectively placed a l...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 22, 2021 Category: Palliative Care Tags: acp advance care planning pottash Source Type: blogs

Roger Chou s Undisclosed Conflicts of Interest: How the CDCs 2016 Guideline for Prescribing Opioids for Chronic Pain Lost Its Clinical and Professional Integrity
by Chad D. Kollas MD, Terri A. Lewis PhD, Beverly Schechtman and Carrie JudyI ' m present. Uh I do have a conflict. I receive funding to conduct reviews on opioids, and I ' ll be recusing myself after the um, director ' s, uh, um, um, uh update.- Dr. Roger Chou, Center for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control (NCIPC) Board of Scientific Counselors (BSC) Meeting Friday, July 16, 2021.IntroductionFor those familiar with the controversial relationship between the anti-opioid advocacy group, Physicians for Responsible Opioid Prescribing (PROP, recently renamed, Health Pro...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 17, 2021 Category: Palliative Care Tags: CDC judy kollas lewis opioid pain schechtman Source Type: blogs

Roger Chou ’s Undisclosed Conflicts of Interest: How the CDC’s 2016 Guideline for Prescribing Opioids for Chronic Pain Lost Its Clinical and Professional Integrity
by Chad D. Kollas MD, Terri A. Lewis PhD, Beverly Schechtman and Carrie Judy“I ' m present. Uh … I do have a conflict. I receive funding to conduct reviews on opioids, and I ' ll be recusing myself after the um, director ' s, uh, um, um, uh … update.”- Dr. Roger Chou, Center for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control (NCIPC) Board of Scientific Counselors (BSC) Meeting Friday, July 16, 2021.IntroductionFor those familiar with the controversial relationship between the anti-opioid advocacy group, Physicians for Responsible Opioid Prescribing (PROP, recently renamed, He...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 17, 2021 Category: Palliative Care Tags: CDC judy kollas lewis opioid pain schechtman Source Type: blogs

How Spiritfarer Helped Me Through the Pandemic
by Matthew Tyler (@PalliDad)During what can only be described as a challenging year, I found Thunderlotus ’s gameSpiritfarer just in the nick of time. In this “cozy management game about dying,” you assume the role of a young woman named Stella who is charged with shuttling spirits to the gates of the afterlife. Unexpectedly,Spiritfarer served as both an escape from and means of processing my experience as a healthcare worker during the pandemic.From top to bottom,Spiritfarer exudes tranquility. The animations are bright and vibrant, and the music is soothing yet melancholy, invoking nostalgia for younger innocent da...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 14, 2021 Category: Palliative Care Tags: covid grief palliative care pandemic Tyler video games Source Type: blogs

Two Ways to Share your Palliative Care and Hospice Stories
by Christian Sinclair (@ctsinclair)This past few days, I came across two great opportunities that I wanted to share with a wider audience of hospice and palliative care clinicians.First is the podcast and radio show, Radiolab. I ' ve always appreciated the nuance and simplicity the creators can bring to complex issues. They are looking for voice memos from people who work in end-of-life care. They are also looking for patients and families who have been impacted by this work. All you have to do is record a 60-seconds or less voice memo and email it to wnycradiolab@gmail.com. Make sure to include your name, city, and your p...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 14, 2021 Category: Palliative Care Tags: media sinclair The profession Source Type: blogs

PROP s Disproportionate Influence on U.S. Opioid Policy: The Harms of Intended Consequences
ConclusionDespite being turned back from an effort to bluntly reduce opioid prescribing by the FDA in 2013 based on a lack of scientific evidence for its position (17,18), PROP has had a disproportionate effect on opioid policy in the Untied States for almost a decade. PROP found a willing federal regulatory partner in the CDC, and while PROP may not have secretly written the 2016 CDC Pain Guidelines (75), they certainly enjoyed disproportionate representation on CDCs review panels and Core Expert Group (23-25) in a process that lacked transparency (22, 23, 26, 27). When the CDC admitted that its Pain Guideline had been...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 3, 2021 Category: Palliative Care Tags: CDC health policy kollas opioids pain prop Source Type: blogs