Opioids have modest effects on average but large effects for some patients. A one year trial suggests aggressive opioid escalation was not superior to conservative therapy
Long term data is from follow up after
official trials have ended

journals.lww.com/pain/fulltex...

4/In our podcast, Saul Weiner and I ask how the medical profession became "addicted" to discussing opioids (mostly, not prescribing) and lost track of how to help someone with pain

"On Becoming a Healer" is on
Apple: podcasts.apple.com/us/podcast/o...
Spotify: open.spotify.com/episode/2mU6...

3/The ACP's "thumbs up" is 100% opposition to the CDC's current guidance. The CDC knows these measures harmed patients.
Please note ACP gave a big "red thumbs down" to measuring if patients experience their pain care as helpful.
A horrific message:
"The patient isn't your partner in pain care"

2/Example: American College of Physicians endorsed quality measures for pain care.
They gave a big "thumbs up" for profiling "use of opioids at high dose" (lower is better).
This has been tried, and led to patient harms as they were cut off of medication.
www.acpjournals.org/doi/10.7326/...

2/We interviewed Dr. Anne Walling, a physician of that generation who has published a book based on interviewing 37 of her peers, published by CRC Press

Find us (On Becoming a Healer) on Apple podcasts.apple.com/us/podcast/d...

Spotify open.spotify.com/episode/0qYH...

6/You can find our conversation with Dr. Iezzoni in the "On Becoming a Healer" podcast wherever you get your podcasts, including:
Apple podcasts.apple.com/us/podcast/o...
Spotify open.spotify.com/episode/59rc...
Youtube
youtu.be/y5aokUxvYBw?...

5/One very hard question to answer is "why are doctors and health systems not ready for disability?"

Is it just lack of equipment?
Fears about patients who "slow the clinic down"?
Or is there something in doctors, in US, that makes us fear disability?
We explore all of it in On Becoming a Healer

4/Dr. Lisa Iezzoni began research to capture disabled patients' experiences. She got even more attention when she asked questions of the doctors.
Doctors said patients with disability are a "disruption to clinic flow"
Just 56% "welcomed" disabled patients into their practices

3/Dr. Iezzoni's work focused on developing methods to measure health care quality. She was elected to the National Academy of Medicine.

But as she wheeled all over the country, people came up and talked to her about their terrible experiences in health care

2/While a med student in the 1980s, Harvard's admins & faculty discouraged Lisa Iezzoni from proceeding to clinical training.

This was before the Americans with Disabilities Act (ADA) passed (it passed in 1990)

So, after that rejection, Lisa became a leading health service researcher

This is a great paper and @maxjordan.bsky.social is a superb scholar

“under-prescribing—or more precisely, ignoring a patient’s pain treatment preferences—can also lead to harmful outcomes, especially when patients are dissatisfied with their care” - Dr Max Jordan Nguemi