After being declared an official public health emergency in 2017, it is fair to ask, where are we today in regards to the opioid crisis that grips this country? I would venture to say not very far. A recent study shows that approximately a third of Americans live with chronic pain, and far too many of these sufferers continue to become dependent on the opioids prescribed to treat it. Meanwhile, a growing consensus among pain specialists says that a low-tech approach focused on lifestyle changes needs to be emphasized as a more effective solution.
Recently, Dr. Erin Krebs, a primary care physician and researcher at the Minneapolis VA Health Care System, published the first long-term randomized trial examining opioids as a treatment for chronic back pain and arthritis. As reported by NPR, for the majority of patients, the study found opioids to be no better than nonopioid medications in addressing the problem of chronic pain.
According to Dr. Krebs, “the gold standard for treatment … is a combination of things like exercise, rehabilitation therapies, yoga and cognitive behavioral therapies.” Unfortunately, because pain treatments such as these “are hands-on and time-intensive, it can be hard to find a clinic that offers them — and to get insurance to cover them.”
It is important to note that according to a 2016 review on the history of chronic pain management, difficulty finding non-drug-reliant treatment never used to be an issue. “Until the 1980s, the multidisciplinary approach was the go-to treatment for chronic pain,” NPR says. Its decline in popularity parallels the decline in reimbursement rates and hospitals shifting to more lucrative procedures. Opioid treatment gradually became the predominant pain treatment strategy.
“I did take an oath: First do no harm,” Dr. Dennis McManus, a neurologist who specializes in managing pain without drugs, tells NPR. “As a pain physician, I have a responsibility to use evidence-based medicine to manage my patients that have chronic pain.” For McManus, the choice is clear between an addictive medication that shows no evidence of benefit and low-tech therapies with some evidence of benefits.
On another medical front, in 2014, I wrote how the medical profession was facing both current and future shortages in a wide array of specialties. None was considered more critical than the field of immunology. At the time, though the demands for specialists in immunology were greatly increasing, a relatively small number of physicians were specializing in the field.
While I could not determine whether this shortage has been addressed, I did discover that on a listing of “The 5 Most in-Demand Life Science Jobs for 2017,” research technicians in immunology topped the list.
I also learned of a huge step forward in the field of immunotherapy. A study led by Dr. Leena Gandhi, director of the Thoracic Medical Oncology Program at New York University Langone Health’s Perlmutter Cancer Center, is now being hailed as a “sea change” in the way the medical community will think about treating lung cancer and immunology.
According to a New York Times report, this new study shows that “odds of survival can greatly improve for people with the most common type of lung cancer if they are given a new drug that activates the immune system along with chemotherapy.” The findings represent another major advance in immunotherapy, which has been making steady gains against a number of different cancers.
The Times says: “Lung cancer is the leading cause of cancer death globally, causing 1.7 million deaths a year. In the United States, it is expected to kill more than 154,000 people in 2018.”
“I’ve been treating lung cancer for 25 years now, and I’ve never seen such a big paradigm shift as we’re seeing with immunotherapy,” Dr. Roy Herbst, chief of medical oncology at the Yale Cancer Center, tells the Times.
This form of immunotherapy “is also already approved as a first-line treatment for this disease.” Given this approval, health insurers should cover it.
“Chemotherapy has limitations. Immunotherapy has the ability to cure,” Herbst says.
“Dr. Gandhi’s study included 616 patients with advanced lung cancer … from medical centers in 16 countries,” the Times says. “They were picked at random to receive either chemotherapy plus immunotherapy, or chemotherapy plus a placebo, with two thirds receiving the combination that included immunotherapy.
“After a median follow-up of 10.5 months, those in the immunotherapy group were half as likely to die. … Researchers are rushing to find ways to combine treatments to improve their effects and to determine which formulation is best for each patient.”
In another study published last year, scientists from the Research Institute of the McGill University Health Centre were on the brink of cracking the code to understanding the function of special cells that regulate the immune system and prevent excessive reactions.
The findings could have a major impact in the understanding and treatment of all autoimmune diseases and most chronic inflammatory diseases such as arthritis and Crohn’s disease, as well as broader conditions such as asthma, allergies and cancer.
Even back in 2014, immunology and immunotherapy was seen as exciting and game-changing, the hope of the future. There were 85 allergy and immunology programs in the country in 1994. Yet by 2007 the number had dropped to 71. The number of trainees has correspondingly declined. Attrition was projected to also play a large role in a future shortage. The Association of American Medical Colleges reports that 1 in 3 active doctors are likely to retire by 2020.
Let us hope that these recent breakthroughs will spark the interest and funding this field clearly deserves.
Write to Chuck Norris ([email protected]) with your questions about health and fitness.
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