January 18th, 2010 by admin

Once formed, habits are difficult to break. It always just seems easier to go on as you have before. This can become a serious problem when science gets in the way of the habits. If you look at the world of adverts in print and the media, you will see opioids recommended as the sure-fire drugs to use as painkillers, no matter what the pain. It carries on in the venerable tradition of the slogan, “Beecham’s Pills cure all ills”. The idea of a panacea – one pill to rule them all, as The Dark Lord of Mordor might have said – has been around since the beginning of time. This is fair game for the marketers to use when talking to the public, but the same thinking has entered the training manuals for the medical profession. Sit in lectures for student doctors and you will hear the same story that opioids are the first line of defense when it comes to moderate to severe pain. Once you have the source of the prescriptions in on the group think, the habit is almost impossible to break.

The monitoring and review process put in place after a drug is released into the market is designed to catch any unexpected side effects. If evidence of problems emerges, the FDA can require the manufacturer to change the warnings on the label or, in the worst cases, withdraw the drug from the market. But this monitoring process is not designed to catch the drugs that are ineffective. If no-one has an adverse reaction when taking it, no report is filed with the FDA. It’s safe so who cares whether it works. All this brings us to the Cochrane Collaboration. This is a non-profit group where researchers sift through and analyze existing published medical research to see whether there are any consistent patterns – what might not be apparent in one clinical trial involving two hundred participants might be identified when you compile the results from fifteen different trials, each involving two hundred participants. Two recently published Cochrane Reports have concluded that opioids should not be routinely prescribed to patients even with severe pain from hip and knee osteoarthritis. Read the rest of this entry »