Is it addiction or dependency?

Addiction vs dependency5Dr. Michael J. O’Connell, Healthcare Consultant, New Hampshire commented that the distinction between addiction and dependency is constantly mangled by the press, lay people and even many professionals.  The difference between dependency and addiction is not withdrawal.  Withdrawal is a phenomenon common to both.

Addiction marks a transition into pathology; the chemical, activity or behavior to which one is dependent (oxycodone, heroin, alcohol, THC, sex, eating, extrovertism/introvertism) becomes harmful…physically, psychologically and/or functionally, to the individual.  Withdrawal or craving is not necessarily a pathology and therefore not necessarily an indication of addiction.

One would be hard pressed to declare a weekly snorter of heroin or cocaine an addict.  If a person dreams much about food, craves certain tastes or dishes, but lives a functional work and social life and is not obese, this can hardly be defined as an addict.  If another has elevated liver enzymes, presence of abdominal fat in an otherwise slender body, is thinking about drinking alcohol much of the day, has a couple DUIs, occasional blood in the stools, and yet persists in drinking alcohol, this is most likely an addict.

If a chronic back pain patient has had a laminectomy and then fusion, still requires pain meds but goes into intense withdrawal with sweating, shakes, diarrhea, and piloerection, when away on a trip forgetting meds at home, this is dependency, but unlikely addiction.

 

Gender inequality and income…

pay inequality 3Dr. Michael J. O’Connell, Healthcare Consultant, Barrington, New Hampshire commented that the media is once again exploding over the issue of gender inequality regarding income.  So no better way of making the case than parading out Jennifer Lawrence, the eminent female star of the Hunger Games series et al, who earns a paltry $14 million per film.  Apparently that’s not as much as what a star leading man commands.  Who knew?  What a damn shame.

Why is it, Liberals are so quick to aim their weapons at CEOs and Wall Street tycoons, and the perceived glass ceilings, and yet ignore the conspicuously wealthy in Hollywood?  Could it be that what really matters to them is the politics of the fat cats?  The horror of a stockbroker earning $200,000 a year…this deserves Liberal protests, chest pounding and screams of outrage.  But the fact that Oprah earns $200,000 a month does not cause them a stir.  Interesting.

Liberals have always given the entertainment industry a pass on its arrogance and innumerable individual misdeeds, and the industry rewards this nod by donating its celebrity (and celebrity dollars) to Liberal politicians.  If Hillary Clinton and Bernie Sanders are truly committed to reversing the earnings’ disparities, as they both claim in their debates, maybe they need to start including those glaring examples that are among their very donors.

 

Kudos to Papplebon!

PapplebonDr. Michael J. O’Connell, Healthcare Consultant, Barrington, New Hampshire commented that last October we witnessed on the professional baseball field something that doesn’t happen but once in a blood moon.  A ballplayer (Jonathon Papplebon) called out a teammate (Harper) for not hustling his run to first base on a routine fly ball.  The two argued briefly in the dugout, then scuffled with a few punches flying briefly, all caught on televised broadcast.

Such laziness and lack of hustle is commonplace in baseball in particular (showing late for practice is commonplace in football).  In decades past this behavior was met with fairly severe measures including counseling by the manager (on and off the field), fines imposed by the team, possible suspension.  This discipline never happens nowadays, partly due to the union influence, partly due to our politically correct society.

The real travesty though is not Harper’s lack of hustle, that’s expected, but the fact that Papplebon was suspended.  Not Harper… Papplebon.  Jonathon should be rewarded for having the balls to do what today’s coaches/managers/owners are scared to death of doing. For what the players are paid, for such incredibly narrow talents/skills, they should run out all fly balls – run like they mean it.

Open letter to the Republican Party….

Republican Party TwoDr. Michael J. O’Connell, Healthcare Consultant from Barrington, New Hampshire commented:

  1. I understand the need to pander to the religious right, especially during the primary season, but let’s make sure we have a solidly right/centrist candidate for the general election – Mitt Romney where are you? Let’s not embarrass ourselves with a cretin like Trump or Cruz.
  1. Can you please forget Obamacare? It’s here to stay and it makes all Republicans look petty and desperate with these efforts to repeal.  There is no way legislation would successfully override a presidential veto, so it’s all window dressing.
  1. Likewise window dressing is the stance on debt with this menace, the monthly debt crisis – get things squared away after a Republican is in the White House.
  1. Gun Control – Let’s pull away from the NRA finally and ensure that assault weapons are banned. Sure they are plenty fun to shoot, but remember the Ford Pinto was pulled off the market?  It was fun to drive but turned into an inferno when rear ended.
  1. Abortion – I’ts here to stay. It’s a protection afforded by the Supreme Court.  Let it go—see #2
  1. Fiscal Responsibility – Definitely, Liberal spending must stop.
  1. Defense – Absolutely necessary to have a strong mobile force.
  1. The country, nah the world, needs measures to control population growth – the poor in this country are often ill-prepared to have more babies – Planned parenthood is the best tool to assist them in more thoughtful family development. Stop efforts to defund Planned Parenthood – again makes the party look stupid and totally alienates the left.
  1. Climate Change – WAKE UP REPUBLICANS – it’s occurring – only a few loony bin pseudo scientists reject – let’s admit to global warming, regardless of the cause. To deny is to look like a Monkey’s Ass

 

Is it addiction or dependency?

Addiction vs dependency6Dr. Michael J. O’Connell, New Hampshire commented that the distinction between addiction and dependency is constantly mangled by the press, lay people and even many professionals.  The difference between dependency and addiction is not withdrawal.  Withdrawal is a phenomenon common to both.

Addiction marks a transition into pathology; the chemical, activity or behavior to which one is dependent (oxycodone, heroin, alcohol, THC, sex, eating, extrovertism/introvertism) becomes harmful…physically, psychologically and/or functionally, to the individual.  Withdrawal or craving is not necessarily a pathology and therefore not necessarily an indication of addiction.

One would be hard pressed to declare a weekly snorter of heroin or cocaine an addict.  If a person dreams much about food, craves certain tastes or dishes, but lives a functional work and social life and is not obese, this can hardly be defined as an addict.  If another has elevated liver enzymes, presence of abdominal fat in an otherwise slender body, is thinking about drinking alcohol much of the day, has a couple DUIs, occasional blood in theAddiction vs dependency3 stools, and yet persists in drinking alcohol, this is most likely an addict.

If a chronic back pain patient that had a laminectomy and then fusion, still requires pain meds but goes into intense withdrawal with sweating, shakes, diarrhea, and piloerection, when away on a trip forgetting meds at home, this is dependency, but unlikely addiction.

Professional sports…

Professional sports Dr. Michael J. O’Connell, New Hampshire recently noted how interesting it is that professional sports has come under very sudden intense scrutiny this past six months first with the exposure of white NBA owners making derogatory remarks about their own black players, and then the brewing scandal over NFL/NBA/collegiate black players beating their wives and kids and then all lying about it.  Now it appears the Commissioner of the NFL is wilting under growing pressure to resign over the chaos.

What outside observers are hoping is that these bad actions are not representative of the vast majority of those who participate in “big showtime” sports.  But why would anyone, except those with a personal financial interest in success of the “big showtime” games, believe or want to believe this to be true?  What evidence would suggest that most owners, commissioners, and players behave well, in public and private?  I would opine there is precious little.

Let’s face it, the glory bestowed those participants and owners who are successful in the game, should be reserved for gallant heroic soldiers on the battlefield in defense of our nation and its values. Instead of talking heads on TV and radio, “big showtime” marketers, and much of the gullible audience, willingly bow to the superstars as though this “game” were something more than that.  It’s not of course.  It is simply a “game.”  The homage paid in the form of TV viewing, gate receipts and purchase of memorabilia creates a playing field full of narcissists – self adoring, arrogant and totally out of touch with the audience that has eagerly created them.  Is it realistic to think that such narcissists behave well in their personal lives?  With no sense of the welfare of others, with grotesquely magnified self-importance and wildly inflated notions of power…is it any wonder that these individuals behave badly?Professional sports 8

My prediction is that there will be more deactivated players, more ousted owners and very possibly the downfall of a Commissioner or two as this story unfolds.  As Fran Tarkington recently pointed out, football (and a host of other sports) has not only succeeded in birthing a mega business, but also succeeded in a massive cover up.  From steroids and other performance enhancing drugs to concussions and traumatic brain injuries to shortened life spans to racist and violent behavior…big showtime sports has protected itself with a heretofore impenetrable shield and the resilience of an old Timex watch.  Eventually this shield will be broken, it’s only a matter of when.  But Tarkington’s call for a boycott of the games until its act is cleaned up, is a non starter.  Fan’s trip over themselves to ignore the fracas and just enjoy the games.  Shortsightedness certainly abounds.

Domestic abuse scandal…

Dr. MDomestic abuse 2ichael J. O’Connell, New Hampshire commented that black talking heads are scrambling to define their view of the wife and child abuse scandal currently blowing up the NFL.  While on the one hand they want to appear appropriately horrified at the beatings, whippings, and blows to the head, on the other they wish to set the context in which many black men are raised, one quite tolerant, even encouraging of violence toward family members as a means of ‘discipline.’  Their quandary is redoubled by needing to deliver the first view without totally castigating their black brothers, and the other view without appearing to offer excuses for such bad behavior.

Female talking heads of color have an even tougher path, as they must protect their gender first and foremost, protect their race as a secondary priority, and all the while protect the image of the black athletes.Domestic abuse 4

Clearly most black commentators are uncomfortable with this scandal since many know from personal experience that domestic violence is a characteristic of the black community. Many commentators have alluded to being disciplined by their parents in such fashion, leaving open the answer to the question ‘where does discipline leave off and abuse begin’?  This is a question that requires answering by all races, all societies, and all nations.

Taney Dragons…

The Taney Dragons 9 Dr. Michael J. O’Connell, New Hampshire, commented that recently he watched another segment about that amazing Philadelphia Little League baseball team, the Taney Dragons, who won yet another game.

The Dragons stars an equally amazing black female pitcher.  She can sling a 70+ mph fastball.  From 60 feet, that’s got to look like a blur to the batters.  She pitched an easy shut out recently. Accolades abound and are well deserved.  It is so refreshing to see such a reserved, intelligent, humble, yet hugely talented youth star.  On interview, she carefully, persistently diverts attention from herself to her team, like the true leader she is.  She attributes her team’s success not to her, but to the team, TEAM.  The Taney Dragons 4

How refreshing is this youngster?  How exemplary?  How different from her ‘professional’ counterparts; those largely self-centered, pampered, arrogant sports figures we admire but swallow hard to endure.  Don’t know about you, but I am so sick of the fist pumping, , and end zone spiking.  Let’s hope she never loses this humility.  I wish her all the success.  She is indeed an inspiration and a breath of fresh air.

“Comprehensive” chronic pain management…

Chronic pain management 7Dr. Michael J. O’Connell, New Hampshire, commented that many pain managers across the nation claim to provide “comprehensive” chronic pain management, yet this term has not been defined by any of the pain societies.  This is unfortunate since the pain patient should know before accessing services, or wasting a good deal of money on one type of ineffective treatment, and other potentially successful types not mentioned or offered.  Even the dictionary definition of “comprehensive” is uncertain, alluding to the inclusion of “many” or “all.”  Which is it?  Such vagueness is not helpful.

So it would seem that “comprehensive pain management” should include most, if not all services generally considered as useful treatment for pain.  Enter another problem…how is “useful” or “effective” measured or characterized?  Dr. O’Connell notes that historically this problem has been addressed by research, and scientific study.  Pain management as a discipline in itself, and is historically very “new” compared with other specialties such as general surgery, cardiology or neurologChronic pain management 10y.  Hence, chronic pain management has not been subjected to rigorous study, and therefore its underpinnings are fragile if not precarious.

For example, the use of opioids in chronic conditions has been advocated by icons in pain management such as Lyn Webster, MD, former president of the American Academy of Pain Medicine, and Russ Portenoy, MD of New York’s Beth Israel Medical Center and former president of the American Pain Society.  Both of these renowned figures have been tarnished if not disgraced by accepting immense pharmaceutical funding to advocate for opioids, and with precious little clinical support for effective long term outcomes.  Webster has come under scrutiny by the DEA for over 20 ODs among his patients and has left clinical practice (despite having developed an assessment tool to root out abusers, both men named in a recent suit brought by the city of Chicago and several counties of California against the pharma that funded these men in promoting opioid use for chronic pain).

Another tool of the chronic pain manager, targeted steroid and anesthetic injections, has been subjected to a huge volume of studies by Lax Maschikanti, MD of Kentucky.  Chronic pain management 11While he professes to be heavily involved with face to face treatment of patients in his private practice, he apparently had enough time to produce more than 100 studies over the past few years, looking at the effectiveness and safety of such injections, many printed in peer reviewed journals.  In addition, Dr. Maschikanti is reportedly heavily involved with the politics of pain and health care, the primary motivator behind a PAC advocating for the field of pain management.  All these activities makes one question whether he sleeps, and the quality and reliability of his innumerable research articles.

Other tools of the chronic pain manager include behavioral medicine, psychotherapy, non opioid medications, physiotherapy, neurostimulation, chiropractic and alternative care with massage therapy, herbs, etc.  Not one of these modalities has been subjected to rigorous scientific analysis of efficacy, not just short term, but long term.  Not one randomized controlled study with significant numbers of patients has been produced on any.

So you can see that to answer the question, what is comprehensive pain management?, is to question the answer. Until questionable research can address the efficacy of each modality, the definition of comprehensive care cannot be entirely articulated.

Opioid pharma and profits…

Opiod pharma 2Dr. Michael J. O’Connell, New Hampshire stated that the pharmaceutical industry has never been a sanctuary from greed and placing profits before caring.  The attached link is mind numbing.  Be sure to scroll through the lawsuit embedded in the middle of this NY Times article.  The allegations against opioid pharma are staggering even if only 1/10 is factual.  Once respected names in pain medicine willingly allowed themselves to be used as pawns in big pharma’s high pressure marketing techniques.  Opiod pharma 4

Drugs such as Fentora, Actiq, Subsys, and Oxycontin, never approved by the FDA for non-cancer pain, were hawked by Drs Lyn Webster, Russ Portenoy, and Scott Fishman, and in return they were rewarded with millions of dollars.  The American Academy of Pain Medicine, American Pain Society and the defunct American Pain Foundation all advocated for the safety and efficacy of opioids for benign chronic pain, yet with essentially no evidence supporting it.   

See the following link:

http://www.nytimes.com/2014/08/25/us/chicago-and-2-california-counties-sue-drug-companies-over-painkiller-marketing.html?ref=health&_r=0