Finally, recognize that some politically correct issues will have the potential to create havoc even with a topic such as pain relief in older adults. One surrounds the issue of ageism. Although racism and sexism are taboo, ageism seems to get a pass in our society. Deprecating remarks about seniors are commonplace, and often seniors are the brunt of jokes. Rarely does anyone challenge such "humor." People will often target the older population unfairly simply because of age and the stereotypes that accompany aging. It will be important to staunchly defend pain management in seniors and to unmask age bias whenever it is presented.
Another antagonist in pain control discussions is negative public opinion about the pharmaceutical industry. Some newer and relatively expensive drugs have demonstrated superiority to some of the less-expensive drugs. There will be tremendous resistance to acknowledging such improvement because many will interpret such acknowledgment as "advertising." In such circumstances, there is truly a bias; it is a bias against the pharmaceutical industry and the potential for profits.
For example, a good academic physician publicly acknowledged that a particular nonsteroidal anti-inflammatory drug, classified as an agent specific for cyclooxygenase-2 (COX-2), is safer for the gastrointestinal tract than a traditional nonsteroidal anti-inflammatory drug. However, because of a bias against any data from any study involving funding
Tips for Health Care Professionals on Using the Media to Advance the Pain Message
Call talk shows when anything related to the topic of pain relief develops Use group e-mail and faxes to release relevant information to the press in a timely fashion
Get to know reporters and editors (they are good resources for advisory board recruitment) Stay focused and concise Do not use space fillers (see text)
from the pharmaceutical industry, there are some physicians who refuse to be swayed by the plethora of data and the US Food and Drug Administration's acknowledgement of increased safety and would not prescribe such a drug (10). In essence, there was a willingness to chance putting an elderly patient at increased risk for intestinal bleeding because of the increased short-term cost of the safer medication and a bias against industry.
When the American Geriatrics Society (AGS) published guidelines on the management of persistent pain in older adults, the committee members who authored them were accused by a few members of the AGS of being unduly influenced by big drug companies (11). As this illustrates, if even well-educated physicians are unduly affected by preconception, dealing with an uneducated public can be a daunting challenge. Whenever integrity warrants doing what is right, even when politically difficult, everyone would be wise to remember the advice of a pilot, who remarked: "When the flak is heaviest, you're usually right over the target."
Other perpetual hot buttons for the media include adverse drug events and abuse. For the media, an ideal target will be a popular drug that is expensive. After a study showed a decrease in myocardial infarction rates in users of naprosyn compared to rofecoxib and the publication of a theoretical concern about the COX-2 class, a previously well-controlled osteoarthritis patient hobbled into the office complaining of pain since stopping her rofecoxib, which had worked well and had been well tolerated for over a year. When asked why she had stopped the medication, the response was, "I read that it would give me a heart attack." After a longer visit than anticipated, she resumed her medication and her pain relief.
A few reports of OxyContin abuse in rural Virginia left a perfect opportunity for the media to create a story and run with it. It became so absurd that the media's distortion of reality (the media hype almost certainly led to far more abuse of this medication than would have ever occurred without the sensational press reports) itself became newsworthy (12).
The tragedy of such irresponsible "journalism" is the devastating consequences to members of society. This venture beyond covering a problem to causing one, by advertising to abusers the existence of a new drug and how to get and use it, forces health care professionals to divert valuable resources in an attempt to get accurate information to the public at large and patients in particular. Perhaps worse, the media-propagated panic makes doctors and legitimate users needlessly afraid of utilizing an important advance in the treatment of pain. It also damages the efforts to educate the public positively about the merits of such medications.
This same problem develops when advertisements from malpractice attorneys, hopeful of getting out-of-court settlements, who advertise to acquire any patient who has had the misfortune of having a medical problem while taking a medication. Opportunistic attorneys who then advertise state to state to recruit such patients also often produce great anxiety among patients taking medications needed for controlling pain and other symptoms or risk factors. In an open society in which free speech is the hallmark of freedom, the recourse is limited. Regardless of personal stand on such issues, it would be easy to debate the frequently high harm-to-benefit ratio that hurts patients and requires a diversion of valuable time and energy from health care professionals direction of pain control efforts.
To be most successful in managing pain, physicians and other health care professionals cannot be content with direct patient care alone. It is useful and necessary to place the "political" and "social" aspects of pain relief on the professional calendar because they constantly play into how we practice medicine and how successfully we manage pain.
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