By Kurt W.G. Matthies, BSE, MSCS
As an engineer and computer scientist, a student of pain research, and as one who has lived most of his professional life with the chronic intractable pain of what has become an advanced case of degenerative spine disease over the past thirty-six years, I am therefore a highly experienced chronic pain patient. I would therefore like to comment on an article in the National Pain Report discussing a paper written by members of the staff at Stanford Pain that connects chronic opioid use with eleven different surgical procedures.
I admire Dr. Sean Mackey and Dr. Beth Darnall, two authors of this paper, for their commitment to a career dedicated to improving the lives of people living in pain. In my opinion, only someone who lives with chronic daily pain can appreciate such a commitment, and for this, I thank them.
I believe both Drs Mackey and Darnall to be well intended in their search for better treatments for those of us who suffer intractable pain. I understand that these learned people also recognize the hard fact that those who have lost control of their lives to opioid addiction also suffer, along with their families, friends, and communities. When abusers of these medications and their analogs succumb to hypoxia from opioid-induced respiratory arrest, i.e., the overdose episode, it is a great tragedy, but one that does not negate the clinical fact that opioid pain medication allows millions of Americans living with medical conditions that cause intractable pain to experience some degree of a functional life.
Last year we were told, by the nation’s highest medical authority, that approximately 40,000 Americans died from an opioid overdose. It was implied that many of these mortalities were unintentional, and therefore, preventable.
As many readers of the National Pain Report understand through the reporting of public health experts like Dr. Terri Lewis, these numbers are inflated through inaccuracies in the reporting requirements for death that vary from state to state, and county to county. In my county of Boulder, Colorado, our coroner is not a trained medical doctor, yet she is responsible for reporting mortality statistics to the CDC in Atlanta. These statistics are used in the CDC’s published mortality figures, found here.
Some of those 40,000 deaths from “opioid overdose” came from my county, yet how do we know the opioids responsible were from medically prescribed sources, or that the deaths were unintentional?
We are not even certain if the late pop-star, Prince, so famously died of an overdose of pharmaceutical fentanyl or one of the cheap fentanyl analogs flooding our communities from Mexico, Canada, and now, from an illegal drug manufacturer from a city near you. These counterfeit pills are marketed to opioid abusers disguised as popular prescription medications like the OxyContin 80mg tablet, for the recreational drug user.
I also fear that many of the thousands of Americans with chronic pain who have been recently abandoned by their doctors for reasons beyond all reason are also being fooled by these death pills, but that is another story – one about which the DEA and CDC seem to be surprisingly quiet.
As far as I know, we have still not heard from the DEA’s special laboratory setup in Carver County, which is reported to have the technology to analyze blood samples from Prince’s body to detect whether the metabolites of prescription fentanyl or those of an illegal fentanyl analog killed the popular singer.
Yet, Americans are largely ignorant of this latest assault on the body politic — counterfeit opioid pills disguised as medication. Instead, they believe the fault for this most famous death and the many anonymous victims of opioid overdose lies with American physicians and their overzealous prescriptive authority. This assault is being executed by small papers from the Salem News to the mighty New York Times, and has appeared on nationally respected television “news” programs, like 60 Minutes, and a so-called Town Meeting on the channel that brought you the Gulf Wars, live from Baghdad, CNN.
Now we have a study out of Stanford Pain that blames the opioid dependence of a small percentage of opioid-naive surgical recipients on their post-surgical pain management with opioid medication.
I say it’s poppycock.
Oh my ears and whiskers.
These are respected pain scientists.
Degrees in engineering and computer science require one to take a lot of math classes. In some dreary classroom many years ago I learned about a well-observed aspect of scientific research called “conformation bias,” also known as “Scientism.”
To understand Scientism, look to the old adage, often used in American politics that goes something like this:
“If it looks like a duck, and it walks like a duck, and it quacks like a duck — then it must be a duck.”
That old saw may be a great soundbite for Donald Trump or Hillary Clinton, but scientifically, it is pure nonsense.
Scientism is the foul practice that looks, walks, and quacks like science, but is in truth, a pseudo-science that leads the researcher directly toward his or her own bias. In other words, the researcher supports his or her hypothesis with a flurry of statistical hand-waving to find exactly what he or she was looking for — evidence confirming their brilliant hypothesis.
The proof in science comes only from following specific practices in doing the work of science, and is based solely upon the repeatability of an experiment. I read the Stanford study. In spite of impressive confidence levels in the thousandths, and minimal error bars, this paper is meaningless without repeatability by skilled, independent, and unbiased researchers. Personally, I would love to hear from BigPharma on this one.
The reason why scientists publish their theory, hypothesis, methods, data, analysis, and conclusions in a formally structured paper is so that other experts in their field can test their results, preferably on another data set, and demonstrate the repeatability of the original hypothesis.
If you are interested in how science is done to avoid conformational bias, there’s an interesting and readable article on the subject, written by a working scientist, Dr. Chris Lee, available here.
From repeatable experiments, hypothesis becomes theory. Maybe one day, a theory comes to be understood as truth, as it was for Galileo’s experiments, Newton’s theories with gravity, careful observations of the planetary motions by Tycho Brahe, and three theories on the motions of the planets around the Sun based on these observations by Johannes Kepler. Today, we navigate a spaceship to a tiny asteroid orbiting a larger asteroid hundreds of millions of miles from Earth based on the ideas, observations, and experiments of these men. That is how science works.
Today’s fearful medical establishment has turned against the safe and effective treatment of pain with opioid medications that have benefitted my quality of life for over thirty years, by using Scientism to stack the deck of evidence used in today’s practice of “evidence-based” medicine.
One paper proves nothing, no matter how large your statistical sample. This paper is not evidence. It is an idea. Let other researchers demonstrate whether or not this study has any validity in medical practice through repeatability.
I could go on, but that’s enough math for any story in this news source, and as a good friend once reminded me – everyone hates math.
Allow me to add a small plug for the value of a trained physician’s clinical experience to reenter the field of pain medicine, without fear of reprisal from state boards of medicine with their standards of care. I am sick, sore, and tired of being treated for pain based on Scientism absorbed into standards of care.
With so much left to do to fulfill the promise of the National Pain Initiative, with so many unanswered questions in the science of pain and its medical management, with 100 million Americans still suffering from intractable pain, I have to ask Stanford Pain, with all due respect:
Why do pain scientists from Stanford pursue research to support the existing popular bias that the medical use of opioids, for any purpose whatsoever, causes more harm than good within the bio-psycho-social milieu of the American who suffers from pain and consents to the informed risk of his or her opioid pain treatment?
What ever happened to standards of ethical medical treatment for the chronically ill human being who suffers from intractable pain?