Are the medications we use a factor in Alzheimers and Parkinsons?

A few years ago, some very poorly publicized studies suggested that long term use of drugs and medications which alter the amounts of dopamine and serotonin in the brain, can injure the dopamine and serontonin receptors. This includes the use of medications in the often used SSRI group (selective serotonin re-uptake inhibitors) which prevent the brain from absorbing the feel good chemical serotonin. These are used to combat depression and other uses including losing weight.

A book called "PROZAC BACKLASH" by Dr Joseph Glenmullen brought out another little known but possibly noteworthy, complication of these meds - the brain, like other places in the body is a finely balanced system - flooding it with serotonin causes it to produce greater amounts of dopamine to counteract what it detects as a "problem" and in the long run, said Glenmullen, this can cause Parkinsonism.

He pointed out that any stimulant has a similar effect and thus can raise the risk for Parkinson's disease and this causes me to wonder about even those well accepted stimulants like the caffeine in coffee.

Parkinsons is very common these days - could something so mild as our coffee drinking habits be contributing?

The fact is, medications have side effects - so do drugs and caffeine is a drug albeit people don't think of it as that because it's so commonly consumed.

In the NY Times recently a study was reported on which suggests that party drugs which give a "high" like meth and cocaine can damage dopamine receptors.

The article naturally, in the media fashion, emphasized the ill effects of meth and cocaine - drugs which most readings of that periodical won't be using but I have not seen much in the media about the real dangers of the SSRI's - the so-called Prozac group of medications which are widely in use.

Perhaps the legal drugs won't bring folks to the "edge of personal ruin" like the extreme case the NY times talked about... unless a case of Parkinson's would be considered somewhat ruining - I would consider it so.

Today I heard about two people I know - one formerly scholarly, talented university professor and the other, a talented string player who had chaired a section in a symphony orchestra - both downed with Alzheimers.

Everyone has heard of the nuns study on Alzheimers which was supposed to give us the exact cause of the disease (nuns allowed their brains to be dissected after death). It was a long carefully run study according to the book by the head researcher and midway into the study, they had a theory... nuns with alzheimers seemed to have smaller brains than those who retained their mental prowess.

But then came a 94 year old who was extremely mentally sharp, up to her death, teaching others, caring for nuns in the elderly home etc. When they dissected her brain, they found it was much smaller than another nun who'd had Alzheimers for several years.

"Now we are back to first base again," wrote lead researcher, David Snowdon, in his book published in 2007, "Aging with Grace"

Although the study revealed a lot about how to stay healthier and more mentally alert in one's Autumn years, it apparently left researchers with more questions than answers about Alzheimer's.

I continue to wonder though, could the chemicals we consume be a factor in some of these brain disorders? I would bet it's a good possibility.

Health shorts...

Click the links to read the stories...

1 Unrestrained dogs in the car can endanger them and you by falling on you in an accident or distracting you from driving. If you want to travel with your dog, seat it in the back seat with a seat belt.

2. Is Cymbalta, originally sold as an anti depressant, safe and effective for pain? Lilly which manufactures it is seeking FDA approval for more uses than depression, fibromyalgia and diabetic nerve pain. Lilly would like approval for general pain. Cymbalta, besides a host of side effects including nausea, nightmares, insomnia, can also cause liver damage with long term usage. There are 14.6 million taking Cymbalta. Since Lilly stock dropped in value after a trial for a new Alzheimer's drug in which those not taking the drug did better than those taking it, perhaps, Lilly wants to make up the loss.

3. A new study found 3000 children from 12-18 with hearing loss. Loud music and blaring Ipods are a suspected factor.

4. Acai berries do not help you lose weight, say experts - but only work as a laxative. The FTC is going after a couple of internet places making claims for the product which the FTC expert says are false. Additionally, taking these herbs can cause damage on a longer term basis. Just because it's a herb doesn't mean it's safe.

Pillz pillz pillz - do they really offer hope for easy weight loss

A headline in the AZCentral website boasts that "Experimental diet pill has promise, little risk".

Apparently a large study in the New England Journal of Medicine stated that this medication,

Lorcaserin caused more people to lose at least 5 percent of their body weight over one year, more than twice the rate achieved by those on dummy pills.

So what is this wonder drug? Yet another flavor of an SSRI i.e. like Prozac etc. And in fact, according to the newsletter, Heartwire, Lorcasin isn't that much different from fenfluramine - one of the medications in Phen-Fen:

Lorcaserin is a selective serotonin 2C receptor agonist, and previous studies have shown that drugs targeting serotonin are beneficial in weight loss. The nonselective serotonin agonist fenfluramine, which, along with phentermine, made up the antiobesity medication fen-phen, for example, was approved by the Food and Drug Administration (FDA) in the early 1970s as an adjunct for the treatment of obesity. It was pulled from the market after reports it caused valve disease and pulmonary hypertension.

And what was this amazing weight loss the drug caused? Well, the average weight loss among the people in the study, was 12 lbs over a year which they apparently kept off mostly during the second year of the study. This compared to a weight loss of 4.8 lbs in those taking sugar pills (Placebos).

Adverse events according to the researchers on the study ( abstract is available,) were 'only' headache, nausea and dizziness.

Fact remains, to lose 12 lbs in a year, is easy even without their drug. For example something as small as a walk a day will do it. (That's about 1 lbs a month)In fact, a 2003 study (reported on in the JAMA) by Stanley Heshka found that people on Weight Watchers who attended most meetings, lost an average of 11 lbs in a year - without any drugs. (JAMA. 2003 Apr 9;289(14):1792-8.)

This isn't the only "wonder drug" coming out - there is another I recently read about called Qnexa which is really a combination of two already available medications, Phentermine (yes, the stimulant and part of Phen-Fen, the combination which caused Pulmonary hypertension in some people) and Topamax, the anti seizure drug. Vivus called the combination Phen/TPM in the FDA documents but obviously since that's uncomfortably close to the unsafe Phen-Fen, I'm sure it won't be marketed under that name.

According to the releases on this medication, the weight loss was better than the serotonin agonist above:

Qnexa showed the best weight loss results in clinical trials, with patients losing between 13 percent and 15 percent of their body weight. But the drug also had the highest rate of patient dropouts due to side effects, which include memory and concentration problems. Qnexa is a combination of two older drugs: the amphetamine phentermine and topiramate, an anticonvulsant drug sold by Johnson & Johnson as Topamax. According to the company, phentermine helps suppress appetite, while topiramate makes patients feel more satiated.

In other words, the Phentermine makes your heart beat faster (which can't be good for the heart) and the Topamax causes you to forget how hungry you are?

Kidding aside, there seems to be conflicting reports how much weight the cohort lost as well as what those side effects are. (Vivus, the manufacturer has not yet published their two 56 week long studies on the drug combo yet)

UPI reported a weight loss of 3-11 percent which is considerably less than reported in the Dallas news media:

Included in the review [for the FDA] are two randomized, double-blind, placebo-controlled 56-week trials conducted by Vivus and presented at medical meetings, but not yet published in peer-reviewed journals. Under the low dose, body weight losses were 3 percent or more, while the higher dose (including 100 mg of Topamax - enough to cause the adverse side effects) resulted in a body weight loss of about 11 percent.

I have a friend who was put on Topamax for seizures - she didn't lose any weight and she complained bitterly about the side effects of the drug. What she described which seems to have been missed in the news but was described in an FDA memo document was as follows:

When used at doses of 100 mg to 400 mg per day for migraine prophylaxis and the treatment of seizures, topiramate is associated, in a dose-related manner, with an increased incidence of cognitive-associated adverse events including confusion, psychomotor slowing, difficulty with concentration/attention, and difficulty with memory, speech or language problems, particularly word-finding difficulties.

Another adverse side effect reported on in the FDA memo was Metabolic acidosis in a percentage of the cohort on Qnexa - this could cause kidney stones as well as osteopenia:

A mild, sustained metabolic acidosis increases the probability of developing nephrolithiasis [kidney stones] and adversely affects bone structure and function. In the one-year clinical trials, there were twenty-two reported cases of nephrolithiasis [kidney stones] in the PHEN/TPM group compared with five in the placebo group.

(Having gotten a kidney stone once in my life, I would add- you so don't want to suffer that one - yes, it is true what people say, that the pain is exquisite and intense!)

Finally the FDA memo stated that although cardiac arrythmias and other cardiovascular events were of low incidence, there was no information available about the repercussions of using it for the long term treatment of obesity.

And according to the FDA Briefing document from the manufacturer, most of the year, those on in studies were told to change their lifestyles to one of regular exercise and calorie restriction, which will, of course, cause a weight loss without the drug.

One blog stated that the FDA had concerns about the drug combo:

FDA reports show that Qnexa has potentially bad side effects on the heart. Increased heart rate, depression, adverse effects on pregnant women and memory and language problems were noted during testing. Attention span also seems to decrease with usage.

Unfortunately, I could not find the affore mentioned FDA reports and the blogger did not give the cite however, since Phen-Fen caused serious heart problems, I would not be surprised if Phen-TPM did also. They will only find that out in the aftermarket studies after thousands of people have been the guinea pigs for the new drugs.

There is a dark side of stimulants also, (and the serotonin agonists also work as stimulants which is why they are often used to treat depression) according to "PROZAC BACKLASH" by Joseph Glenmullen, MD, is that on the long term, they can significantly raise the risk for Parkinson's disease, something which people are seldom warned about despite a body of research suggesting this. Serotonin agonists tend to cause a flood of the brain chemical serotonin, which causes the brain to react by producing more dopamine - this imbalance of an overage of dopamine is what is thought to raise the risk for Parkinsonism.

Additionally some "whole life" animal studies have suggested that longer term use of the serotonin agonists can also damage the serotonin receptors in the brain.

The only wonder about these two drugs in my book is that I would bet people will buy them, still looking for the elusive "easy way out" of counting calories and exercising to achieve and maintain weight loss.

Truth being that people do not have to lose weight to get healthy - they only have to make mostly healthy food choices and try to exercise (cardio) 4-5 times a week - this is called HAES and is well proven by clinical studies including the 2 year study at USC - researchers on this clinical study were Linda Bacon and Judith Stern and since Stern is a member of the Weight Watchers International Medical advisory committee, she would have undoubtedly, preferred a different finding than the finding of the HAES study i.e. that healthy lifestyle without a focus on weight loss trumped dieting as far as reducing health risks.

Take a look: Link for the HAES study

For more info, also see Dr Bacon's website.

Music - are we body and mind alone?

A friend who is a music teacher and I (another music teacher) were chatting this morning. He said that he believed we are mind, body and soul. And our schools do pretty well with the mind (academics) and the body (sports and phys ed). But the soul is often ignored and yet, might be one of the most important parts.

Specifically, when a financial crunch happens within the school system, what is it that is usually first deleted? The music program which apparently many feel is unnecessary.

In my some 50 years of being a violinist and teacher, I have met hundreds of folks who tell me that they studied a bit of violin or organ or piano or trumpet in their youth but gave it up and now are sorry that they didn't pursue the music because they so wished they could play now.

I have never met anyone who continued music and can play now who is sorry they continued music.

But music programs also enrich the mind - thus found several studies over the years. Typically children and adolescents involved in music tend to do better at not only academics but also at sports.

For example in a study reported in 2009, Laurel Trainor, director of the Institute for Music and the Mind at McMaster University in West Hamilton, Ontario, compared pre schoolers who had studied music with those who had not. She found the kids who had studied music had better responses on a test of brain development, suggesting music actually enhances the brain functions. She further noted:

Even a year or two of music training leads to enhanced levels of memory and attention when measured by the same type of tests that monitor electrical and magnetic impulses in the brain.

And

We therefore hypothesize that musical training (but not necessarily passive listening to music) affects attention and memory, which provides a mechanism whereby musical training might lead to better learning across a number of domains

Trainor said the reason for this might be:

"that the motor and listening skills needed to play an instrument in concert with other people appears to heavily involve attention, memory and the ability to inhibit actions. "

Harvard University researcher Gottfried Schlaug has also studied the cognitive effects of musical training. Schlaug and his colleagues found a correlation between early-childhood training in music and enhanced motor and auditory skills as well as improvements in verbal ability and nonverbal reasoning.

A study published in the magazine, "The New Scientist" suggested that music training can actually boast the IQ scores of children and adolescents!

Read the bios of the valedictorians of the High School classes and you will find that the overwhelming majority of them play a musical instrument.

So even if the happiness music brings us is not considered important, perhaps the powers that be will consider that encouraging music training will likely cause the participating students to get higher scores on the AIMS and/or Iowa tests also!

My friend and I talked about the recent Allstate festival in our state. This is where selected musicians and singers from all the schools are put together into a large chorus, band and orchestra and they practice and give a concert (or two). The result is simply amazing. My friend described it as "hearing the Chicago Symphony couldn't be better than this".

I totally agree with him because the thing I remember most vividly from High School in Chicago was the conference festivals (we had so many music schools and programs in the area that an "Allstate" orchestra might have been too large).

We rode on a bus to another school in our conference, we practiced in the afternoon, and then, the next evening went back to give the concert.

One has never lived until one has listened to (or better yet, participated in) these large orchestras, bands and choruses. A chorus of over 500 High Schoolers singing "The Seven Last Words of David"? I can still hear it, over 40 years later.

Or how about 25 trumpets playing on "The March from Ben Hur". After hearing this rendition, the movie version pales by comparison.

Not withstanding the rich experience of playing under famous conductors and meeting so many other High Schoolers and much more. We all looked forward to these festivals as the high point of the year!

Most people I've talked to, feel the music program in school gave them some of the best times in their lives, studies suggest that participation in music helps people for life and just talk to anyone you meet - everyone loved the music program and no one is sorry for having participated but many feel cheated that they gave up music too early in life!

So why are we always considering cutting the music program. Just consider this - the IPOD's are even more precious to the average teen than their cell phones (or they use their cell phones to listen to music).

We seem to have an inborn desire for music and all evidence suggests it not makes us happier and better adjusted people but actually makes us smarter too. Seems a win-win to me.

So let's consider cutting something OTHER than the music programs! Please! Trust me, your children will thank you for making sure these programs continue!

Tysabri for MS - re-visit

I received a comment from "Enjolez" who is listed as having a blog but when you click on the link, it's non existent. The comment used explictives and suggested I didn't know what I was talking about when I wrote about the Multiple Sclerosis "disease modifying" medications, particularly a cancer chemo therapy drug named Tysabri which can cross the blood-brain barrier and cause a deadly type of brain infection called "progressive multifocal leukoencepelopathy" which according to the manufacturer of the medication, causes death or "severe disability".

Enjolez didn't mince words - he or she called me a f-king idiot but didn't bring up any facts to refute my claims. Despite the type of comment, I want to answer his or her issues because it's important that he or she (probably having infusions of this medication) has informed consent.

At a recent MS meeting, I was given a colorful brochure produced by Biogen. Biogen didn't mince words about the possible risks however or the fact that Tysabri hasn't been studied for "use longer than 2 years" (that's on the first page of the booklet). Interestingly enough, the gentleman I talked to, representing the company, really believed in the medication - he told me his wife was on it.

However, when the risk of a medication appears greater than the risks of the disease it is used to treat, it may be a smart thing to consider another type of treatment. Treatment with a medication which even the lax FDA approved with difficulty for MS, a disease which if treated properly is mild in most folks for years, sounds a bit to me, like playing "Russian Roulette".

From the "Safety information" tab in the same brochure from biogen we are informed that

Tysabri is not recommended if you have a medical condition that can weaken your immune system.

MS is a condition that can weaken your immune system all by itself because it's an autoimmune disorder and/or autoimmune/lymphocyte B disorder (the jury is still out on this). In other words, by having this drug infused into you, you could be dealing yourself a double whammy so to speak!

Biogen also warns that Tysabri can cause liver damage.

What many people do not know is that the nature of studying the MS disease modifying medications is such that they are typically studied in people who display "white spots" on an MRI of their brains but have not been formally diagnosed with MS yet i.e. they have no symptoms of the disease. Some of those in the studies cohorts never come down with MS!

Also, the white spots on the brain appear long before serious symptoms appear - progressive or intermittent MS is a mild disorder which takes many years to disable.

Back in the old days, people were not diagnosed until they had the clinical symptoms but now with MRI's, we have many cases of folks being diagnosed with some fleeting mild symptoms (one lady I'm thinking of, had some "weakness in the legs" but not enough to stop her from being in college athletics) and the MRI "white spots" and they are told that the sooner they get "on the medications", the better and because they had no real symptoms in the first place, and they "believe in" the medications, they naturally attribute this good feeling to the medications or the fact that they have virtually no symptoms but perhaps this is only because if they DO have MS, it's an early enough case that they would not have symptoms anyway. (We won't even discuss here, the possible ramifications of a "too early" diagnosis, psychologically which by itself is questionable since the person may never come down with active disease!)

In contrast, those who have a lot of clinical symptoms often do not experience the "help" that the early cases experience. One lady I talked to who was on Tysabri because she'd tried the other medications with no help, said she was disgusted with her neurologist because she'd been on Tysabri a year and no change. However, when I told her it was a risky medication, she shrugged her shoulders and said "Who cares?"

This attitude of doom and lack of knowledge of the nature of MS is, I think, what causes many folks with MS to take unnecessary risks.

I'm back from the 1970's before all the new treatments. Back then, the MS society told us that 10 years after diagnosis (from clinical symptoms), most folks with MS were still walking and many were still working. They advocated a healthy lifestyle with moderate exercise and range of motion moves, healthy eating and "some walking, some sitting, some standing and some lying down".

In my own research, I noticed that folks with MS who did the highly experimental medical treatments even like large doses of steroids, tended to have more disability in the long run. In fact, there were even a couple of studies which suggested that!

With today's "disease modifying medications" for MS, they don't promise patients anything as far as less disability but only (perhaps) less MS flare-ups. In the studies of these medications, "flare ups" are decided totally upon "new white spots" showing up on an MRI since those in the cohort have not formally come down with MS yet.

Our son, the medical provider, tells me that the disease modifiers for rheumatoid arthritis work well. These are also, medications which are not without risks, however, none of them have the risk (however rare) of causing a deadly brain infection like Tysabri.

Perhaps the problem with the MS disease modifiers is that they really don't know that much about the cause of MS i.e. they may know more about rheumatoid arthritis than they do about MS.

A favorite internist told me "neurology really don't understand a lot of these things". Well said.

Informed choice is the only way but that includes looking at the research behind the medication or at least just reading the caveats from the manufacturer. I wonder if the person who called me an "idiot" ever did the latter.

If "Enjolez" will write me privately and give me an email address to write him/her at, I will furnish more information about myself.

Football and sports in general - the other side

We see it on TV all the time. Parents dreaming of their kids playing football and when this dream is fulfilled, they are standing there, watching their rising stars, with tears in their eyes.

High School football players, playing for a deceased brother or sister --- or loved one with a backdrop of stands filled with cheering people.

Sunday afternoon stopping while everyone gathers around the big tube watching the exciting finish to a professional football game.

We hear bits and pieces... football players making big bucks, 500 thousand a year or more. We see young athletes on TV smilingly saying how they are so happy to be a part of a professional football team. A young gymnast saying how her dream is to be a part of the Olympic team...

But over the years, I've heard some other small voices here and there. Things which are unsettling, like how a large percentage of kids who play High School football, sustain back and knee injuries which plague them for life.

A lone movie depicting football as an ultra rough game, injuring many players.

Joan Ryan's book "LITTLE GIRLS IN PRETTY BOXES" depicting the sports of gymnastics and figure skating as exploitive and taking a toll on the bodies of those who are barely teenagers. A gymnast, here and there dying of a head injury. Things none of us who love sports really want to hear.

I did not allow our son to participate in any sports besides swimming (which he did not like!). And I, myself, only did one swimming competition. But like everyone else, I love watching sports on TV.

What does happen to those who achieve the ultimate dream of playing professional football?

Finally one man is breaking the silence.

Former NFL star, David Pear, is speaking out. Pear played ball for Washington University and then, went on to play with the Tampa Bay Buccaneers and finally was with the Oakland Raiders when they won the Super Bowl.

And David told a Sports Illustrator writer in a phone interview, recently, that he's sorry he ever played football and sends a warning to parents to not allow their children to EVER play football.

David explained that at the age of 56, he's a physical train-wreck. He's had multiple surgeries and suffers from pain throughout his body:

His neck hurts. His hips hurt. His knees hurt. His feet hurt. When he wakes up in the morning, pain shoots through his body. When he goes to sleep at night, pain shoots through his body.

David also walks with a cane - when he walks which isn't that much. And he suffers from vertigo and memory loss, he says.

He pointed out several other former NFL players who are in wheelchairs or in other ways, very disabled and all from football.

Football isn't the only sport which creates a lot of permanent injury. In following gymnastics, I remember Olympian JC Phelps requiring joint replacements at the tender age of 18 and a medical provider remarking that many gymnasts have the bones of a 70 year old before they reach the age of 20. A member of the gold medal winning Olympic gymnastics team telling reporters she (at the age of 22) no longer does gymnastics because her "body is too broken".

Tara Lipinski who won the Olympic gold medal for figure skating in 1998, dropped out of skating soon after. After a few surgeries on her hip and a serious back injury, she had to hang up her skates for life.

We never hear about those people - only about the ones who survive like Dorothy Hamill who skated into her 50's but it's not clear whether any of today's skaters who are required to do several triple jumps just to compete will survive to their 50's still on the ice. And did anyone notice that most gymnasts retire from participation after 1 or 2 Olympics? Does anyone care?

Elite Sports in general are more and more demanding and more and more hard on the bodies of those who participate also.

And some sports are overly demanding on the athletes even in the non elite arena - like football. For example how many people who "dream" of running marathons realize that the ambulances waiting in the background ARE there for more than decoration and that often, at least one person dies during or after doing a marathon. That seems a side of the story we never hear.

Don't get me wrong - I think sports are great - and I do confess that although I do not watch football, I do enjoy watching figure skating and gymnastics. How do I calm my niggling conscience that those who are so enjoyable to watch are quite literally giving their lives and health for my entertainment? Like the typical sports fan, I guess - I remind myself that they volunteered. I wouldn't want to do it myself but ...

The NFL gave Dave Pear, a yearly disability pay but not before several years in court and his pay is not enough to compensate for the constant pain he suffers, he told the SI reporter.

Seems like a no brainer that the human body was not made to throw around as is done in football, doesn't it? And yet, so many kids continue to go through hoops to become a part of a football team as parents and friends watch proudly because this is a story no one really wants to hear.

We don't even give folks "informed consent" for elective medical procedures, many of which bite hard after a few years so why should we consider "informed consent" for sports like football? Unfortunately, football is such a part of the American entertainment picture and considering that "informed consent" might greatly cut down the numbers of those who wish to participate, I suspect we will not hear more than a few lone voices crying out about the reality of it, in the near future.

Most of the injured ones will hang around in the background, quietly suffering.

I am reminded of the movie "The Matrix" where people live in a glamorous virtual reality while they waste away in tanks, their very lives being sucked out by a large machine. Art often reflects reality. Perhaps we should pay more attention to it.

Re-thinking narcotic pain control for chronic pain sufferers

There is an ongoing discussion about pain control with the majority of medical providers taking the position of being very negative toward using narcotics.

For example, this news article quotes a committee on pain management:

Chronic pain, if not recognized and treated as a chronic illness, takes an enormous personal toll on millions of patients and their families, and leads to increased health care costs. Chronic pain can also compromise the productivity of the U.S. workforce.

The article answers:

"Maybe Portenoy and Foley and the other Committee Members contributing to this report would like to address the epidemic in this country of OxyContin deaths and addictions which has taken 'an enormous personal toll on millions of patients and their families'."

Oxycontin deaths? Are they talking about pain management or are they talking about drug abusers? I would bet they are talking about drug abusers and not folks WHO NEED good pain management. And in the case of drug abusers, have they considered the large number of people killed on the road by drivers inebriated by alcoholic beverages, a highly addictive drug to which no one, it seems, objects and which has little to no value, medicinally? Have they considered the large numbers of those addicted to alcohol? Somehow this does not deter folks from enjoying their occasional drinks... on the contrary.

And for kids suffering from connective joint disease (this has really increased, in our society), perhaps narcotic pain meds should be considered, as, young folks, if in serious pain, (which is not really helped that much by NSAIDS etc) tend to "bootleg" drugs if the docs do not prescribe them, an act which could endanger them much more than prescribed drugs.

Addictive people can get addicted on legal drugs like alcohol and cigarettes (cigarettes is one of the worst addictions to shake too with a very small percentage able to give it up without numerous tries) but no one even MENTIONS those addictions.

But somehow when it comes to chronic pain, people get very strange ideas.

Why is it, I wonder, better to cook your liver and burn holes in your stomach with the NSAIDS for limited relief than to use narcotics? Or better to endanger your heart with drugs in cox 2 inhibitor class?

An 80 year old friend of mine (R.I.P.) had a vioxx-related heart attack (and his heart was healthy before that - he exercised regularly etc etc) so after this happened, there was really no relief from his severe arthritis pain since he was not given narcotics. He suffered stoically but would have had a much better quality of life in his last 3 years of life, if he had been given even small doses of a medication like oxycontin.

Pain management providers point out that those who NEED narcotics do not get "hooked" anyway... they may get DEPENDENT but that's a different thing from addiction and yet, many do not make the distinction.

People should NOTE that 95 percent of Dr Kevorkian's "patients" who sought "assisted suicide" were NOT terminally ill - they were in CHRONIC PAIN and/or depressed - most of them told Kevorkian they just wanted to stop the pain. But it seems our society is actually more accepting of "assisted suicide" as a "treatment" for chronic pain than narcotics which are the only medications which are reasonably effective.

A study a few years ago found that 65 percent or more of the elderly did NOT have good pain management because of our society's non acceptance of narcotics for pain control.

And one of the doctors on a Discovery Health CME about "none small cell carcinoma" of the lungs commented that many medical providers will not give narcotics to terminal cancer patients for "fear of getting them hooked" and he asked if this wasn't more than a bit ridiculous.

In a society which considers personal privacy so precious that it does not protect the life of an unborn baby if the mother wants to terminate, why are we invading people's PRIVACY over their own bodies and the opportunity to get relief from chronic pain? This over zealousness about prescribed narcotics seems more than a contradiction of our beliefs about a "woman's right to do as she pleases with her body" (especially as medicine does not consider the unborn baby as a part of a woman's body but rather simply HOUSED there).

In our society which has a lot of aged folks due to modern innovations in medicine etc, we must realize that a LARGE percentage of the elderly suffer with ELDERLY diseases which DO cause chronic pain.

But interestingly enough I once asked a pain management specialist what type of patient are most of his patients who are on large amounts of narcotic pain medication and surprisingly he did not answer, the elderly... his answer? Pain caused by chronic disorders like fibromyalgia or ... surgery! i.e. joint replacements, back surgeries etc. A close friend who is an RN studying to be a nurse practitioner confirmed the thing about back surgery. She has several herniated discs in her back (she is 59 going on 60) but said she would not have surgery because she finds in many patients, the surgeries just worsen things. Many of the chronic pain sufferers I know, had gastric bypass (for weight loss) several years ago. Some of them get narcotics and some of them do not - many doctors balk at prescribing these for fear of repercussions from the Drug Administration and those who do not get pain meds suffer a huge amount of depression. A study on 10 year post op weight loss surgery patients found that there was a much larger percentage of suicide in this population than even in severely obese people.... (and obese people are basically shunned by society and medicine alike)

If we are really worried about addiction, why not go after the liquor lobby? Besides the huge number of people killed or maimed by drunk drivers, consider that every drink of an alcoholic beverage kills liver cells (and we wonder why in a society where liquor freely flows, we have a large percentage of liver failure?) Or the cigarette companies (especially when cigarettes and tobacco usage are a factor in 400,000 deaths a year in the USA and 95 percent of COPD and 90 percent of lung cancers)?

I think healthcare may be broken but not because of the 30 million uninsured (of which, some pundits tell us, the present "reforms" will only cover half of these, still leaving 15 million uninsured) but because of, for one, the prevalent strange attitudes on pain control.

As the committee mentioned in the article stated, chronic pain takes a toll on everyone, and most of all the sufferer, many of whom stay in and are not active due to poor pain management and worse yet, suffer reactive clinical depression due to very poor quality of life.

I would bet that none of the writers of the affore mentioned news article suffer chronic pain!