by James Hubbard, M.D., M.P.H.

Like a lot of doctors, I have mixed feelings about narcotics.  They are great for severe, short-term pain and a must for some terminal cancer pain.   Some people abuse them for nothing more than the high they get.  And then there are all of the in-betweens.  We doctors are kind of caught in the middle, also.  We can lose our license if we prescribe too much or inappropriately.  We are told, by some groups, we prescribe too little to the patients that really need it.  But how do we know who really needs them?  If we are too gullible, we will be prescribing to a bunch of abusers, too strict and we are doing a disservice to those in need.

It is the long-term, chronic use that concerns us the most.  Narcotics are habit forming. They alter your mental state. If you take them long enough, you will have a physical withdrawal trying to get off of them.  Most people will become tolerant needing more and more to get the same effect.

So what to do?

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by  James Hubbard, M.D., M.P.H.

The FDA wants you to know that drugs not only interact with other drugs; they also interact with dietary supplements, food and beverages.  Always talk to your doctor and read any information available before starting new medicines.

To prove the point, the FDA has listed examples.

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by James Hubbard, M.D., M.P.H.

Heath Ledger is only one of many to die from an accidental overdose. The July 28, 2008 Archives of Internal Medicine found a 360 percent increase in “Fatal Medical Errors” (FME) between 1983 and 2004. The increased percentage was primarily in those that combine prescription medication with street drugs or alcohol. In 1984 there were 92 deaths reported of this nature. By 2004 the number was 3792.

With more emphasis on outpatient, non-hospital care in the past few years, there is less supervision and more powerful medications given than ever before. So what to do?

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By James Hubbard, M.D., M.P.H.

Interpretation bias means that the same data in a study can be interpreted, or parts emphasized over others to come to different conclusions.  It is not necessarily intentional, but it is still one of the things you should look for.   When you add the interpretation by news media, then it gets even more muddy, some might say agenda driven.

A good example is the data that came out of a Center for Disease Control (CDC) study on risky behavior in youth called the Youth Risk Behavior Surveillance System (YRBSS)   USA Today: http://snurl.com/2ds7j had the headline “Risky behavior declines among teens”.  The AP: http://tinyurl.com/52n3bo headlined “Hispanic teens try drugs, suicide at higher rates”.  The actual report from the cdc just gives out a lot of statistics.  You know the old saying, “There are lies, d… lies and statistics.”

So which interpretation is correct.  Well both, but read the reports for yourself.  A lot of risky behavior did decline in whites, blacks and hispanics such as risky sexual behavior, marijuana  and alcohol use.  However some types of drug intake and suicide did not change in hispanics.  As a reporter, which do you emphasize?

There are all sorts of biases in studies such as selection bias (who is included),  investigator bias (they can inadvertently change results by attitude toward subjects, or what they choose to measure), and on and on.  Researchers realize this and try to compensate in various ways (ie, random selection).  Now you throw in the reporting it can really get confusing.  Hopefully, James Hubbard’s My Family Doctor can help you through the haze.