November 2006

JUDICIAL DEVELOPMENTS

  1. A lawsuit against Florida physician, Dr. Jaimy Bensimon, has ended in a mistrial, called so that the doctor could attend the funeral in Israel of his mother. The plaintiffs in the civil trial have alleged that he and a nursing home violated the wishes of a 92-year old woman when life-prolonging procedures were used on her at the nursing home and during transfer to a hospital.
  2. The Kentucky Supreme Court has ordered a new trial for Dr. Fortune J. Williams who was sentenced to twenty years in prison for unlawfully prescribing medications. The court ruled that detectives had conducted an unconstitutional search when they accompanied investigators from the Kentucky Board of Medical Licensure to Williams’ office. At the time of the search, Kentucky law allowed Board investigators to search medical offices without a warrant.

LEGISLATIVE/REGULATORY DEVELOPMENTS

  1. California Governor Arnold Schwarzenegger recently signed into law SB 1248. It will go into effect on July 1, 2007, and will require non-certified skilled nursing facilities and intermediate care facilities to comply with both federal and state residents’ rights regulations. The primary areas affected by the new law will be rights regarding notice, transfer, and discharge, treatment by facility staff, quality of life, and visitation.
  2. The Maine legislature has enacted a law that requires prepaid mailing envelopes to be made available to citizens at various locations so that unused prescription medication can be mailed or returned to a single collection point. It is hoped that this “take back” program will help prevent diversion.
  3. In May, Oklahoma Governor Brad Henry signed a new advanced directive law that provides Oklahoma citizens with more options for expressing their desires for end of life care. Under the new legislation, an advanced directive will apply to those with end-stage diseases, not just to those who have a terminal illness with only six months to live or those who were irreversibly unconscious. The new law also allows more detailed decisions about organ donations.
  4. On November 29, Pennsylvania Governor Edward Rendell signed SB 628, which provides a comprehensive statutory framework governing health care decision-making for incompetent patient,
  5. Utah has instituted an online death registry for use by doctors, funeral directors, and government officials. It allows doctors to sign a death certificate on-line, avoiding delays which often occurred, especially when there was a death on a weekend or a holiday.

PAIN MANAGEMENT

  1. The second issue of a new journal, The Science Creative Quarterly, featured an article on phantom limb pain and how studying the phenomena has led scientists to new insights into the organization of the human brain.
  2. The FDA issued a public health advisory regarding the use of methadone for pain control. It noted that the agency has received reports of death and life-threatening side effects in patients taking methadone and cautioned that health care professionals should carefully follow the prescribing information for the drug.
  3. The on-line “News 14 Carolina” carried an article, titled “Healing Chronic Pain” regarding approaches being used by the Brady Institute in Orlando, Florida, and the University of Iowa Hospitals in treating patients with chronic pain. The University of Iowa is using hypnosis to ease pain. Dr. Scott Brady of the Brady Institute has developed a program in which patients journal, meditate, and exercise to help manage their chronic pain.
  4. The article “Living with Pain,” published in the Indianapolis Star, cites a Stanford University survey that found that one in four people in the United States deals with chronic pain. The article notes that there is no one answer that will help every person who is dealing with chronic pain. Although some patients control their pain through opiates, others find other approaches helpful such as the program at Methodist Hospital which conducts an intensive six-week outpatient program for its chronic pain patients, .
  5. A letter to the editor of the on-line British Medical Journal opined that Vitamin D deficiency may have a role in chronic low back pain and advocating that all patients with such pain be screened for vitamin D levels.
  6. The Army Times featured an article about how medical advances are saving the lives of more troops than in past wars, but that many of these veterans then end up living in chronic pain. A November survey by the American Pain Foundation found that 64 percent said they suffered from chronic pain directly related to their military service.
  7. The San Francisco Chronicle is one of a number of papers that discussed the painkiller Actiq in November. The Chronicle’s article was written by 24-year old Alicia Parlette, a Chronicle copywriter, who has written a series of articles concerning her struggles with cancer. November’s articles dealt with her dealing with the realization that she had become addicted to Actiq and her continuing battle with overcoming that addiction.
  8. The results of a new study published in Neurology demonstrate that pregabalin, an oral medication, is effective in relieving central nerve pain. The research was conducted at the Pain Management Research Institute in Sydney, Australia.
  9. Drs. Steven Cohen and Srinivasa Raja wrote an article in the November issue of Nature Clinical Practice Neurology which discussed the steps a physician should take before prescribing opioids for chronic pain but stressing that opioid treatment should not be rejected for patients when other intervention have failed. The doctors noted that they rarely prescribe opioids to “treatment-naïve” patients on the first visit without first communicating with the primary care provider.
  10. Could advances in pain management be made through carbon nanotubes? According to an article in the November issue of Advanced Materials, that is indeed possible. The article reports on the efforts of researchers at Oklahoma State University and the University of Texas Medical Branch to develop single-walled nanotubes that may eventually act as artificial nerve cells, control severe pain, or allow paralyzed muscles to be moved.
  11. The American Pain Society has announced that it plans to honor the country’s outstanding pain care programs by naming Clinical Centers of Excellence in Pain Management. Winners will be announced by the end of March 2007.
  12. The October 18 issue of Journal of Neuroscience included an article reporting research indicating that the brain’s dopamine system is active when someone experiences pain. The dopamine reaction is an individual phenomena and may explain why some chronic pain patients may be prone to developing addictions to certain pain medications.
  13. An article in the November 21 issue of the Proceedings of the National Academy of Sciences reported research led by Catherine Rougeot at the Pasteur Institute in Paris. Her team found that human saliva yields a natural painkiller up to six times more powerful than morphine.
  14. A recent issue of the Behavioural Brain Research journal carried an article reporting that scientists have found that synthetic antioxidants nearly eradicated pain-like behavior in almost three-quarters of mice with inflamed hind paws. The research was conducted by Robert Stephens, a professor of physiology and cell biology at Ohio State University, and colleagues at Ohio State and from Ataturk University in Turkey.

PRESCRIPTION DRUG DIVERSION

  1. As a result of an investigation conducted by federal, state, and local law enforcement agencies, seventy people were recently arrested on charges of unlawful distribution of controlled substances from eleven eastern and southeastern Kentucky counties. Eastern Kentucky has a reputation for being a “hotspot” for controlled substance abuse.
  2. Officer.com posted the second part of its two-part series, titled “Pill Pushers on the ‘Net.” The article noted that investigations of online prescription drug diversion are resource intensive and stresses the importance of cross-agency and state and federal teamwork in investigating these cases.
  3. An article in the Canadian press noted that the number 1 street drug in five cities in Canada is prescription opioids. Another article in a Maine newspaper reported that prescription drug abuse is rising in Maine.
  4. The 2007 National Drug Threat Assessment was issued the end of October.

OTHER DEVELOPMENTS OF INTEREST

  1. A special supplement to Critical Care Medicine, dedicated entirely to end of life care in a critical care setting, evaluates improvements in end of life care in intensive care units. The supplement contains 20 articles including palliative care in the ICU, attitudes toward withholding and withdrawing life support, ethical and legal issues, quality indicators, communications between physicians and nurses, interventions for children at the end of life, and promising future directions. The supplement resulted from a conference in February 2006 that was funded by the Robert Wood Johnson Foundation and hosted by the Society of Critical Care Medicine.
  2. November was National Hospice Month. Newspapers throughout the country featured articles on hospice care and reported on programs that were conducted to educate people on end of life treatment in a hospice setting.
  3. A two-part series in Minnesota’s Pioneer Press explored end of life issues. The first article explored how doctors at Minnesota hospitals are assembling teams to help their dying patients explore end of life issues. The second article explores how even the clearest dying wishes of a patient can get muddied when families are torn by tensions and doctors fail to clearly communicate.
  4. The National Radio Project made a program available to its affiliates that examined how miscommunication, stereotyping, and racism influence end of life health care for people of color.
  5. Columbia News Service distributed an article that reports on the training of end-of-life doulas.
  6. The Louisville, Kentucky-based Center for Interfaith Relations conducted its Festival of Faiths in November. This year’s festival centered on how various religions respond to death and dying.
  7. The National Cancer Institute awarded a five million dollar grant to the national Palliative Care Research Center, Mount Sinai School of Medicine. The grant will evaluate palliative and look at what programs are effective.
  8. The Seattle Times November 5 issue carried an article titled, “How to Talk to the Dying.” The article notes how difficult it is for Americans to face their own mortality and talk about dying.
  9. There are two blogs being written and published on the Internet that advocates and others interested in palliative and end of life care will find informative. The first is written by Dr. Maurice Bernstein. The second is written by Drs. Drew Rosielle and Christian Sinclair.
  10. According to the CDC’s Morbidity and Mortality Weekly Report for November 17, falling is the 14th leading cause of death among the elderly. The death rate from falling has risen since the 1990s. Experts postulate the reason is that more people are living longer with chronic conditions.
  11. A report published by the United Kingdom’s Neuffield Council on Bioethics has created debate and controversy. The report states that premature babies born at 22 weeks or earlier should not be routinely resuscitated.
  12. The National Hospice and Palliative Care Organization used the occasion of Veterans Day to highlight the need to support our nation’s veterans throughout their entire lives, including at the end of the lives. More than 50,000 U.S. military veterans die each month, representing 28 percent of all deaths in the nation.

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