Recently, I offered 2 articles written by reporters about the opioid epidemic involving America. Well, here’s part 3 written by a “hooker’, Dr. Marty Makary, who is a professor of surgery and health policy at the Johns Hopkins School of Medicine in Baltimore and an adviser to Practicing Wisely. The article again appeared in the Asbury Park Press on Sunday, August 6, 2017.
“For most of my surgical career, I gave out opioids like candy.
My colleagues and I were unaware that about one in 16 patients became chronic users, according to new research by doctors at the University of Michigan.
Even more alarming, research shows that relapse rates after opioid addiction treatment could be as high as 91 percent.
In addition to expanding treatment, it’s time we address the root of the problem – overprescribing.
My own “aha!” moment came recently after my father had gallbladder surgery and recovered comfortably at home with a single ibuprofen tablet.
Wow! It directly contradicted my residency training 15 years ago, when I was taught to give every surgical patient a prescription for 30 to 90 opioid tablets upon discharge.
Some of my mentors told me that over prescribing prevents late night phone calls asking for more.
The medical community at that time ingrained in all of us that opioids were not addictive and urged liberal prescribing. So, that’s exactly what we did.
The hundreds of excessive opioid prescriptions I wrote in 2015 alone were a tiny part of the country’s 249 million opioid prescriptions filled that year, which was almost one for every American adult.
Last year, in 2016, America produced 14 billion opioid pills (40 for every U.S. citizen), mostly paid for by the American public in the form of tax dollars or increasing health insurance premiums.
Take C-section for example: one of the most common operations paid for by Medicaid tax dollars. Some doctors appropriately prescribe five to 10 opioid tablets after the procedure, in combination with non-opioid meds as recommended by the American Pain Society, while other doctors are still doing what I did for years – giving every patient a bottle of 30 to 60 highly addictive opioid tablets.
We need to take away the matches, not put out the fires.
My colleagues at Johns Hopkins and I have used data to identify the average number of opioids a doctor prescribes after a routine C-section, excluding patients with pre-existing opioid use or pain syndromes.
The range of doctors’ prescribing patterns is stunning. Some doctors fall within what our Johns Hopkins pain specialists call “best practices range,” averaging three to 10 opioid tablets after C-section, while other doctors still average 30 to 60 tablets.
We have repeated the analysis for many minor procedures, including operations that can be managed with non-opioid alternatives alone.
The doctor distribution graphs keep showing us the same thing: There is wide variation in opioid prescribing today.
By allowing the data to tell us which doctors are outliers, we can identify who we can help and offer them expert guidance on prescribing wisely.
Using physician-developed metrics of appropriateness, data should be harnessed to laser in on the root of the overprescribing problem.
Hospitals should be rewarded rather than penalized financially for adopting these data-driven peer benchmarking programs.
Second, we need to address the consumerist pain-rating system that has elevated pain as a leading quality measure and overshadowed true medical quality.
The question, “How often did the hospital staff do everything they could to help you with your pain?”, is a measuring stick by which all U.S. hospitals are rated, creating a perverse incentive to generously distribute opioids.
While many doctors reserve opioids for conditions such as terminal cancer, burns and major surgery, the classic indications for opioids have been broadened to now include things such as backaches and very minor procedures.
We need to change the quality metrics in health care so doctors can be free to practice sound medicine.
Third, we need to change several perverse financial incentives in the market. It is very difficult to find doctors interested in carefully managing a patient’s pain medications because doing so pays so little (a 30-minute visit can pay as little as $50).
Our reimbursement system should value expert advice and counseling on pain management. Moreover, pain specialists should be paid not just for doing procedures, but also for their time managing pain.
Ironically, acetaminophen and NSAIDS (non steroidal anti-inflammatory drugs) are over-the-counter medicines and thus rarely covered by insurance, yet opioids are. Those who think that the $10 to $30 cost for a bottle of NSAIDS is not a barrier to patients buying them should meet some of my poor patients from inner-city Baltimore.
All non-opioid pain meds should be fully covered after surgery with no co-pay or deductible.
Finally, payers should give surgeons and anesthesiologists more incentive to do nerve block procedures. It’s well established that when patients are injected in a surgical area or root nerves with anesthetics, they require fewer pain pills.
Using data to identify overprescribing patterns and changing incentives to reward pain management best practices is far less expensive than addiction rehabilitation. Engaging with rather than blaming doctors who routinely overprescribe, as I did, can have a broad impact.
While opioid treatment is an important priority, we should remember that the most effective treatment is still prevention.”
Oh boy! Do you get the impression that this doctor, like any other doctor, would sacrifice his business by informing any of his customers that the human form is specifically designed to eat plant-based foods and that they should adhere to as much organic fruits, vegetables, and whole grains as possible, avoid GMOs, never eat processed foods, totally avoid refined grains, and learn about organic sulfur crystals that was purposely taken away from them so they would remain sick and become a “trick” for the medical “hookers” and the pharmaceutical and large food company “pimps”?
F**k No! In God we trust. All others pay cash!
Aloha!
Sources:
Asbury Park Press article by Dr. Marty Makary
www.asanediet.com
Just to put things in perspective, after I graduated from Weequahic High School and before going to Seton Hall University, I had a part-time job working for a butcher. I was the delivery guy and occasionally had to go to the slaughterhouse to pick up products for the store. Needless to say, I had no consciousness nor awareness, as change never came then despite the horrors I witnessed on an almost daily basis.
After graduating with a degree in accounting from Seton Hall, I eventually got married and moved to a town called Livingston. Livingston was basically a yuppie community where everyone was judged by the neighborhood they lived in and their income. To say it was a "plastic" community would be an understatement.
Livingston and the shallowness finally got to me. I told my wife I was fed up and wanted to move. She made it clear she had to be near her friends and New York City. I finally got my act together and split for Colorado.
I was living with a lady in Aspen at the end of 1974, when one day she said, " let's become vegetarians". I have no idea what possessed me to say it, but I said, "okay"! At that point I went to the freezer and took out about $100 worth of frozen, dead body parts and gave them to a welfare mother who lived behind us. Well, everything was great for about a week or so, and then the chick split with another guy.
So here I was, a vegetarian for a couple weeks, not really knowing what to do, how to cook, or basically how to prepare anything. For about a month, I was getting by on carrot sticks, celery sticks, and yogurt. Fortunately, when I went vegan in 1990, it was a simple and natural progression. Anyway, as I walked around Aspen town, I noticed a little vegetarian restaurant called, "The Little Kitchen".
Let me back up just a little bit. It was April of 1975, the snow was melting and the runoff of Ajax Mountain filled the streets full of knee-deep mud. Now, Aspen was great to ski in, but was a bummer to walk in when the snow was melting.
I was ready to call it quits and I needed a warmer place. I'll elaborate on that in a minute.
But right now, back to "The Little Kitchen". Knowing that I was going to leave Aspen and basically a new vegetarian, I needed help. So, I cruised into the restaurant and told them my plight and asked them if they would teach me how to cook. I told them in return I would wash dishes and empty their trash. They then asked me what I did for a living and I told them I was an accountant.
The owner said to me, "Let's make a deal. You do our tax return and we'll feed you as well". So for the next couple of weeks I was doing their tax return, washing their dishes, emptying the trash, and learning as much as I could.
But, like I said, the mud was getting to me. So I picked up a travel book written by a guy named Foder. The name of the book was, "Hawaii". Looking through the book I noticed that in Lahaina, on Maui, there was a little vegetarian restaurant called," Mr. Natural's". I decided right then and there that I would go to Lahaina and work at "Mr. Natural's." To make a long story short, that's exactly what happened.
So, I'm working at "Mr. Natural's" and learning everything I can about my new dietary lifestyle - it was great. Every afternoon we would close for lunch at about 1 PM and go to the Sheraton Hotel in Ka'anapali and play volleyball, while somebody stayed behind to prepare dinner.
Since I was the new guy, and didn't really know how to cook, I never thought that I would be asked to stay behind to cook dinner. Well, one afternoon, that's exactly what happened; it was my turn. That posed a problem for me because I was at the point where I finally knew how to boil water.
I was desperate, clueless and basically up the creek without a paddle. Fortunately, there was a friend of mine sitting in the gazebo at the restaurant and I asked him if he knew how to cook. He said the only thing he knew how to cook was enchiladas. He said that his enchiladas were bean-less and dairy-less. I told him that I had no idea what an enchilada was or what he was talking about, but I needed him to show me because it was my turn to do the evening meal.
Well, the guys came back from playing volleyball and I'm asked what was for dinner. I told them enchiladas; the owner wasn't thrilled. I told him that mine were bean-less and dairy-less. When he tried the enchilada he said it was incredible. Being the humble guy that I was, I smiled and said, "You expected anything less"? It apparently was so good that it was the only item on the menu that we served twice a week. In fact, after about a week, we were selling five dozen every night we had them on the menu and people would walk around Lahaina broadcasting, 'enchilada's at "Natural's" tonight'. I never had to cook anything else.
A year later the restaurant closed, and somehow I gravitated to a little health food store in Wailuku. I never told anyone I was an accountant and basically relegated myself to being the truck driver. The guys who were running the health food store had friends in similar businesses and farms on many of the islands. I told them that if they could organize and form one company they could probably lock in the State. That's when they found out I was an accountant and "Down to Earth" was born. "Down to Earth" became the largest natural food store chain in the islands, and I was their Chief Financial Officer and co-manager of their biggest store for 13 years.
In 1981, I started to do a weekly radio show to try and expose people to a vegetarian diet and get them away from killing innocent creatures. I still do that show today. I pay for my own airtime and have no sponsors to not compromise my honesty. One bit of a hassle was the fact that I was forced to get a Masters Degree in Nutrition to shut up all the MD's that would call in asking for my credentials.
My doing this radio show enabled me, through endless research, to see the corruption that existed within the big food industries, the big pharmaceutical companies, the biotech industries and the government agencies. This information, unconscionable as it is, enabled me to realize how broken our health system is. This will be covered more in depth in the Introduction and throughout the book and when you finish the book you will see this clearly and it will hopefully inspire you to make changes.
I left Down to Earth in 1989, got nationally certified as a sports injury massage therapist and started traveling the world with a bunch of guys that were making a martial arts movie. After doing that for about four years I finally made it back to Honolulu and got a job as a massage therapist at the Honolulu Club, one of Hawaii's premier fitness clubs. It was there I met the love of my life who I have been with since 1998. She made me an offer I couldn't refuse. She said," If you want to be with me you've got to stop working on naked women". So, I went back into accounting and was the Chief Financial Officer of a large construction company for many years.
Going back to my Newark days when I was an infant, I had no idea what a "chicken" or "egg" or "fish" or "pig" or "cow" was. My dietary blueprint was thrust upon me by my parents as theirs was thrust upon them by their parents. It was by the grace of God that I was able to put things in their proper perspective and improve my health and elevate my consciousness.
The road that I started walking down in 1975 has finally led me to the point of writing my book, “A Sane Diet For An Insane World”. Hopefully, the information contained herein will be enlightening, motivating, and inspiring to encourage you to make different choices. Doing what we do out of conditioning is not always the best course to follow. I am hoping that by the grace of the many friends and personalities I have encountered along my path, you will have a better perspective of what road is the best road for you to travel on, not only for your health but your consciousness as well.
Last but not least: after being vaccinated as a kid I developed asthma, which plagued me all of my life. In 2007 I got exposed to the organic sulfur crystals, which got rid of my asthma in 3 days and has not come back in over 10 years. That, being the tip of the iceberg, has helped people reverse stage 4 cancers, autism, joint pain, blood pressure problems, migraine headaches, erectile dysfunction, gingivitis, and more. Also, because of the detoxification effects by the release of oxygen that permeates and heals all the cells in the body, it removes parasites, radiation, fluoride, free radicals, and all the other crap that is thrust upon us in the environment by Big Business.
For more, please view www.healthtalkhawaii.com and www.asanediet.com.
Namaste!
