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New Report Recommends Public Health Focus on Harmful Drinking vs. Eliminating Consumption Tuesday, February 26, 2013 International Center for Alcohol Policies (ICAP)   Findings Run Counter to Current Public Health Approach, Discredit Traditional Perspectives WASHINGTON, DC--(Marketwire) - The traditional public health perspective on alcohol and noncommunicable diseases is indicted in a new report from the International Center for Alcohol Policies (ICAP). "Alcohol misuse and global health: The case for an inclusive approach to harmful drinking" discredits the traditional public health perspective that focuses on a narrow group of stakeholders and ignores individual factors and social norms. "Unfortunately, some widely-held public policy perspectives on reducing harmful drinking are based on questionable and misleading data," said ICAP President Marcus Grant. "This report draws on a wide pool of research to clarify misconceptions and propose a more effective mode...

New Studies Confirm – and Contradict – Conventional Wisdom on Chronic Pain by Ian McLoone - Chronic pain patients have long been told it’s all in their heads. Well, a team at McGill University just submitted more proof . The researchers, led by Prof. Laura Stone, found that injuries resulting in chronic pain are associated with epigenetic changes in the brains of mice which can be observed 6 months after the date of injury. These heritable changes, called DNA methylation, have far-reaching consequences across the entire genome and can impact behavior and well-being – but were also shown to be reversible. “ The implications of epigenetic involvement in chronic pain are wide reaching and may alter the way we think about pain diagnosis, research and treatment,” the authors say. Future considerations for treatment will likely include behavioral and pharmacological interventions that focus on reversing DNA methylation in brain. - Think all addicts make risky chron...

NIH Warns Of Major Drawbacks With Sequester Feb 20, 2013 BETHESDA, Md. (WUSA9) -- The looming sequester may dramatically slow medical research. Officials at the National Institutes of Health warn the budget cuts they face if the sequester is implemented will be devastating to new research. NIH faces a possible 1.5 billion dollar cut, which would mean a 5 percent cut across the board for every program. National Institutes of Health Director, Dr. Francis Collins, M.D., Ph.D. says, "Cuts will spell slower progress against our most common diseases, such as alzheimer's, cancer, AIDS, diabetes, and heart disease." Dr. Collins says cuts may also mean a delay in creating the next vaccine for influenza. Senator Barbara A. Mikulski (D-Md.) toured NIH Wednesday afternoon.  She warns of the direct impact the research cuts may have in her home state. Sen. Mikulski says, "It will be an impact on 15-thousand Marylanders, who work either at NIH or who benefit from the research fundi...

In a recent meta-analysis, Tan and Glanz compared rates of hospitalization and death due to cardiovascular disease, stroke and respiratory across communities with different levels of smoke-free laws ( Tan, C. E., & Glantz, S. A. (2012). Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases.  Circulation ,  126 (18), 2177-2183.)  They combined the results of 43 studies that examined rates a median of 30 months before enactment of the laws and then compared them to rates over a median of 24 months after enactment. The results are shown in the graph below. Relative risk refers to the likelihood of an event. A RR < 1 indicates that an event is less likely compared to baseline (before enactment.) As is evident from the graph, there is a consistent and significant reduction in hospitalization and death rates for these diseases as a result of smoke free laws, and the more extensive the restrictions (restaur...

Since Jane Brody quoted me in her column in the New York Times, I've been inundated with calls, emails and other inquiries. Here are some themes, impressions and stories that help illustrate the gaps and barriers to receiving up to date, consumer-friendly, addiction treatment. 1. "He's been through treatment program after treatment program. None of them worked! And we still don't really feel he's had a good evaluation or any continuity of treatment." This has been a very consistent experience reported by families of someone with an addictive disorder. There is a profound sense of being out there alone, in sharp contrast to having a relative with colon cancer. There is a great sense of fragmentation of care, as well as inconsistent opinions and recommendations. Because "programs" are arbitrarily time-limited, they have no ongoing responsibility of the care of their patients, unlike other medical specialities. How would you like it if your oncologist o...

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It will come as no surprise to regular readers of this blog that there is a need for new approaches to treating addictions. In particular, people with substance use disorders (SUDs) and their families need access to current, scientifically based practice and greater consumer choice of treatment modalities. Today, I've been receiving a resounding validation of this fact from the response to Jane Brody's column for the New York Times three days ago. In the last two days, I've received almost 30 calls from all parts of the US from people who are interested, if not desperate, for something new, either for themselves or for a relative who is suffering from this disease. One person called me from China! The main focus of Jane's column was a terrific new book by Anne Fletcher titled Inside Rehab.  It's already #1 on the Amazon best-seller list for alcoholism recovery books, and it's been receiving widespread coverage that is overwhelmingly positive. And this is before ...

In the latest issue of Health Affairs , Grace Lin et al. describe an effort to introduce decision-making aids to facilitate shared decision-making regarding back pain and colo-rectal cancer screening. Essentially, nothing changed, in spite of making the aids easily accessible, conducting training sessions, and so on. What's important is the authors' conclusion that " The results of focus groups, ethnographic field notes, and surveys suggest that major structural and cultural changes in health care practice and policy are necessary to achieve the levels of use of decision aids and shared decision making in routine practice envisioned in current policy." Their experience mirrors my own in trying for over 20 years to get substance use addressed in primary care. Most recently, I have two separate but relate experiences here in Minnesota where I essentially ran up against a brick wall. Why? First, primary care doctors are besieged by quality improvement initiatives aimed a...