Revision Logs Assignment 2:
Task One: Clarify several noted examples of unclear phrasing. This includes making your final points at the end more direct and clear.
Task Two: Cite your sources more often and concretely – and remove pasted material.
Task Three: Add a sense of the implications of your research – what does all of this research give us the context to consider, in the larger picture.
(Tasks are completed on each paragraph basis)
Vicodin. The name might ring a bell, it’s the most prescribed medication in the US and Knoll Pharmaceuticals best-selling product. Vicodin was a no name until the 80’s when it first became available. Opioids were not always like this and initially did not pose the threat of an epidemic like we see today. The U.S. Department of Health and Human Services released a statement in 2017 regarding the Opioid Epidemic as a public health emergency and a 5-Point Strategy to combat and solve the problem. (HHS, 2019) Since 2017 most states have not seen a decline in overdoses and the public health emergency still stands as an active warning to the public. (CDC, 2019) Global use of opioids goes back centuries where ancient Egyptian hieroglyphics show praise to the poppy plant. The medical uses are apparent and have been apart of ancient and modern medicine for a long time. The scale at which we see opioid use today is drastically different from the crude and weak forms of opium used originally. Medicine and science advanced the weak opium into concentrated Vicodin and Oxycontin. In the late 70’s when medical ethics and patient advocates voiced a need to manage pain in the new and modernized world. Pain was undertreated for patients with terminal illness and cancer, the latest most promising drugs for pain were, opioids. The World Health Organization (WHO) released a handbook regarding the timely need to help relieve cancer and terminal illness pain. With diagrams and guilds that look at the procedures and plans of action on when to use Opioids and which strength. (Rummans, 345) There was a need to treat these pains as the new medicine was able to relieve the pain like never before. Today, cancer and terminal illness accounts for a fraction of the reasons doctors prescribe opioids instead the global leader, back pain, takes up the majority of the prescriptions filled in the US. The Center for Disease Control (CDC) who has been recording and reporting on the opioid crisis. The epidemic starts because 50 million people are reported to suffer from back pain and the leading medications for chronic back pain, are various Opioids. As reported by the CDC people who are addicted to prescription opioid painkillers are 40 times more likely to become addicted to heroin. This dependency shared in drugs of the opioid family are what can scale a minimal dose of a weak form to being given Morphine. These are not rare or possible cases but the real side effects; opioids develop dependency and addiction making them ineffective in chronic pains and long term treatments. Cases of users scaling into stronger doses and more extreme doses is not rare and are often what lead to using the illegal opioids. An article from USA Today highlights the road of dependency experienced by General David Fridovich who was given Motrin and Morphine initially, after a leg injury at the gym. After being released from the hospital after surgery Fridovich get prescribed Oxycontin and Roxicet which are weaker in intensity as opposed to morphine. As pain became chronic for Fridovich, his dependence on Opioids grew as time continued. The starter dose of OxyContin became obsolete and had pushed him to ingest five dozen Oxycontin pills in a 24 hour period. After this Fridovich pushed himself to taking less pills until again his pain was too much and he was prescribed a considerably stronger form of Opioids – Morphine. Doctors were left to operate on Fedorovich since stronger opiates are illegal and continuing opioid treatment is was not an option.(USA Today) Federovich was a general and one could say “tougher” than the average person from battle experience. The article and Fedrovich’s situation showed just how addictive and destructive his medicine had become. Opioid popularity still dominates the medical drug market, and statistical scare tactics don’t change the increased use amongst the population. Opioid treatment in turn becomes a dependency and a treatment that for many patients is not improving their pain but is compromising their lives and futures. The facile efficacy and widespread prescription of Opioids has caused an epidemic that continues to lead patients to be dependent on the treatment for years or life.
I [Minor word choice and sentence structure changes. Firstly, I added more background after I felt assignment 3 paved a strong road of understanding when describing how the problem came to be. Added concrete info about white house statement including the 5 step plan of action. Adding some info on why and how there was a push for more opioid use in the 70s from the WHO itself. Found a scanned copy showing the exact words which may be useful In future paragraphs.]
II [Paste free and added sources for researched information that is not “common” knowledge (not to oversaturate the paper with sources as though people wouldn’t know definitions of words or terms]
III [Added some voice and opinion to lead the reader a bit more. I really want to emphasize the example that big pharma made of the world. They really framed opioids to be wonder drugs with small side effects excluding likelihood of dependence and addiction. Doctors over prescribe for a few years before someone blows the whistle and files a lawsuit. However, the damage had been done and doctors are now working at prescribing less.]
Opioids bring in way more money than the poppy seeds on a bagel at breakfast. The opioid market has a strong economic grip in the medical community and is promoted by the pharmacies that create them. Despite the effectiveness of treatment the revenue is clear with the opioid market being priced at $8.4 billion dollars calculated by tracking the use of the medications. The economic grip and money involved gives control in various ways which were used to promote opioids. In the case of Oxycontin and most medicines the new products that enter the market like with most items need to get their name out there. When it comes to prescription medicines the product life cycle is similar to most everyday products and requires marketing to promote the product. Marketing in the pharmaceutical industry is done though journal advertisements and conferences regarding specific fields. This can be in form of seminars and expos that relate to back pain, or talks for doctors that specialize in the pain management field. Part of the money distribution in pharmaceutical companies is directed towards promoting the products said company produces and distributes. With current systems it is faster and pays better to diagnose pain and prescribe an opioid than to diagnose and treat addiction. Outnumbered emergency physicians who would like to refer patients with addiction for appropriate treatment have few resources to do so. Opioids were like a wonder drug for doctors who treated pain as it would decrease pain of all kinds which meant less time to find exact problem in the patient. The ratio of doctors to patients increases opioid prescription as it works to provide relief rather than permanent fixtures or adjustments. It’s difficult to move through so many patients and help each of them individually, but, Opioids helped make the patient leave and welcome the next one. This dominance in the market came from the product promotion that the pharmaceutical companies incorporated.
One instance comes from the start of OxyContin and Purdue Pharma. Like most products, prescription drugs use advertising and campaigns to spread the word. Pharmaceutical companies claimed that the drug safety and efficacy were, of course, safe. Opioid dominance came from heavy control by Opioid manufacturers in various medical media and medical societies. An article from the CBC included an old page from the Canadian Family Physician journal displaying an Oxycontin advertisement that included side effects listed as “similar to other opioid analgesics; the most frequent observed are constipation, nausea, and somnolence.” (CBC, 2018). No where is it stated that there is a high chance of dependence or addiction. Purdue’s ad shows the tactics that got doctors to favor opioids over prior medicines. As provided by the U.S. National Library of Medicine site MedlinePlus, Opioid painkillers carry a significant risk of addiction and overdose. Facts like this were not initially stated in advertisements for Oxycontin and other opioids. Medical societies such as the American Academy of Pain Medicine (AAPM) had given Opioid manufacturers “Premier Status” which gave them the ability to host sponsored meetings. Doctors and other medical professionals learn about new medicine and treatment from going to these conferences and seeing advertisements in medical journals. Companies like Purdue Pharma, Abbott Laboratories, and Endo Pharmaceuticals, the makers of OxyContin, Vicodin, and Percodan also appear as the Corporate Council Members of the American Pain Society. (Deyo, 55) Between 1996 and 2002, Purdue Pharma funded more than 20,000 educational programs through direct sponsorship or financial grants and launched a multifaceted campaign to encourage long-term use of Opioids for chronic non-cancer pain. (United States General Accounting Office, 2003) These sponsored meetings were sponsored by the pharmaceutical companies themselves in turn, this meant promotional campaigns for prescribing and introducing Oxycontin. This promotional campaign downplayed how addictive the drugs can be and all was accepted by the community because it was the AAPM that was connected to the info. The reputation of the AAMP gave the promotional campaign an easy medium that would build trust quickly and effectively for massive adoption of opioid treatment on the masses. Ohio Attorney General Mike DeWine stated that opioid companies spend millions of dollars on promotional activities and materials that falsely deny or trivialize the risks of opioids while overstating the benefits of using them for chronic pain.” arguing its “borrowing a page from Big Tobacco’s playbook.” (German Lopez) DeWine uses the big tobacco analogy to push a similar method of getting the nation hooked. Similarly to big tobacco, opioid manufacturers released claims in advertising that downplayed the addiction and dependence like tobacco had before studies showed clear damage and harm from smoking. Like the advertising in big tobacco it was effective enough to cause an epidemic in the US. The economic power of these pharmaceutical companies allowed them to campaign drugs like never before with their connections spread in medical societies and journals. Doctors learned what Purdue wanted to teach, that being that opioids are safe to prescribe liberally because they falsely do not pose the strong risk of dependency and addiction.
I [Some word choice changes and removal of lines. Trying to give added information to build on point of how “unregulated yet regulated” the opioid fiasco is. Trying to steer reader to see that Purdue used the trust and reputation AAPM as a leader in pain related treatments to campaign their pills. Added example of old ad used in Canadian journal that showed no mention of dependency avoiding problem at stake. Described big tobacco reference Removed the filler sentences that would turn arguments into circles of thoughts that repeat. ]
II [Added source checked for sources and plagiarism check done via smallseotools.com]
III [Sense of implication comes from focusing more on marketing tactics and better explain the material learned and researched. As not all people are as informed as I am I need to add the things I feel are redundant from developing an expertise. Final line emphasis on main point of how economic grip in medicine can change what we know as current medicine]
When undergoing surgery, we are commonly given morphine to numb the pain from operation. Opioids like morphine are effective at doing this because they bind to opioid receptors in the brain and around the body. This reduces the sending of pain messages to the brain making them effective for the pain feeling. Opioids are effective in scarce administration periods or in short term prescriptions like those after a surgical procedure. Repeated use of opioids is what causes dependence and the initial stages of the drug becoming ineffective. As noted by James White from the Department of Clinical and Experimental Pharmacology at the University of Adelaide, “Increases in drug concentration arising from administration serve only to reduce the degree of pain and mood disturbance. These aversive pain and mood states may contribute to the motivation for continued drug use and the dysfunction associated with drug dependence.”(White, 1) Given the clinical findings that opioids are ineffective in prolonged use such as it is today. Since opioids are commonly prescribed for chronic pains the efficacy is diminished as stated above since the user is not only dependent because the pain doesn’t secede but on top of that the withdrawal symptoms are opposite – inducing more pain from withdrawal. These include most importantly pain and as Fridovich described as “emotionally and physically draining”. If it’s not the patients that are trying to quit Opioids, those that are users experience a variety of side effects as well. Studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting and constipation compared with placebo. Comparisons of opioids with non-opioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.(Opioids for Chronic Noncancer Pain, Busse) Long-term use also can lead to sexual problems due to the decline in testosterone levels when Opioids are started. The levels do return to normal when medicine is stopped but for chronic patients it persists. In older patients prolonged use increases the likelihood of falls, fractures, and osteoporosis (Saunders, et al. ). The side effects and cycle of prolonging treatment. The scale and current science behind pain treatment is very crude. Hospital procedures that assess the patient’s condition and pain, may sound like a helpful tool. By this method doctors use pain documentation to continue prescribing opioids. [The origins of the ten point scale that doctors or nurses ask patients in hospitals is well intentioned. A quick and effective scale of how sever the patient is feeling the pain but, the simplicity means quickly moving onto the next patient. Doctors liberally come to the habit of prescribing opioids to give the patient relief and continue out of the hospital. (Moved)] As patients pile up in the growing population means doctors have less and less time to effectively prescribe the right medicines and when to stop. Pharmaceutical companies were able to market a solution to this slow system of prescribing pain medicine. The solution being a medicine that directly blocks the feeling of pain mixed with an anti-inflammatory medicine such as Acetaminophen (Advil). This was not a solution but rather a relief mechanism that would avoid treatment at the center of the chronic pain. The thing that Opioids will not achieve is permanent solutions like physical therapy or surgery can provide. Chronic pain requires treatments that adjust the body rather than blocking the receptors. Opioids have come to treat all kinds of body pain broadening the treatments from terminal illness and cancer to common chronic pains experienced by patients.
I [Some word choice changes, tense, and grammar. Had fewer clarifying notes than previous paragraphs but I did manage to remove a chunk of text to be moved into the next paragraph. Adding some extra information and clarity to better push my point on how ineffective the drug is the way we prescribe it today. Adding a new aspect into my argument that we should really be using the drug limited to post operation as there are alternatives for chronic pain in non-drug form. (TBD next paragraph)]
II [Introduction had added information to background addiction and ineffective chronic use. Aside from personal check 3rd party app used to check integrity of material.]
III [Again I added a new angle at the previous argument by noting that current guidelines and treatments are ineffective and systematic. Continuing to strengthen the final lines of each argument to push that finalized idea onto the reader. ]
Millions of Americans suffer from back pain annually and similarly millions of prescriptions are written for opioids to treat them. We quickly shun opioids today because of their addictive nature that wasn’t apparent initially and has brought us to an epidemic. Opioids were a solution in a sense, for many years, in which doctors had found a universal medication that cures all pain. Opioids made pain management easy for doctors because it moved the growing number of patients as hospital and medical practice spaces are limited and the number of patients seeming unlimited.
The origins of the ten point scale that doctors or nurses ask patients in hospitals is well intentioned. “on a scale from 1-10 how bad does it hurt?” A quick and effective scale of how sever the patient is feeling the pain but, the simplicity means quickly moving onto the next patient. Doctors liberally come to the habit of prescribing opioids to give the patient relief and continue out of the hospital. The time and energy needed by the patient and physician is what Opioids cut out of the practice. There is a variety of non Opioid treatments that work similarly in other drug treatments with lower addiction and similar if not identical in effectiveness. As Americans grow weary of opioid treatment for chronic pain the opportunity to give a chiropractic a go opens up. Despite the pseudoscience belief in the medical world, a chiropractic and the spinal adjustment does provide relief. However, the relief comes from having the patient work alongside the treatment and for some this is not possible. Above all chiropractic require human skill and a workforce unlike pharmaceutical companies who spread production over a supply chain system. Unlike drugs spinal manipulation is non addictive. Current guidelines by the CDC focus on warning people of the dangers in decay and addiction of opioids. They released an updated guideline in 2016 that stated a different method of opioid use that most people didn’t really come to think of initially. “If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate, to provide greater benefits to patients in improving pain and function,” (CDC, 2016) This can be things like a chiropractor or acupuncture which have shown an emerging focus of study on efficacy in chronic pain. In a 2011 paper by DeBar who studies behavioral health looked at acupuncture and chiropractic care for chronic pain in an integrated health plan. Finding that use of complementary and alternative (CAM) treatments like acupuncture and chiropractic solutions have promising results in effectively cutting costs of pain treatment. Stating, “ alarming increases in delivery of opioid treatment and surgical interventions for chronic pain–despite their high costs, potential adverse effects, and modest efficacy” (DeBar, et al., 2011) Opposingly, DeBar wants us to start embracing the non-pharmacological and non-surgical alternatives that are cheaper and pose less of a danger. As stated earlier with CDC guidelines it would be ideal to see pain treatment done this way as it would cut out some of the early pain of injury or surgery along with providing a permanent treatment. Current treatments don’t require a physical type of solution aside from opioids, which means like earlier stated, people just become dependent fighting withdrawal symptoms rather than pain symptoms. As spinal manipulation and physical therapy can bring results no drug can provide like relearning to walk and move. What pills and other medications can’t solve is a permanent solution. Spinal manipulation is the core treatment that all chiropractors use, though they prefer the term spinal “adjustment.” There are many techniques, varying in the force delivered and the amplitude of movement. It’s unclear how spinal manipulation works to relieve pain. Various theories focus on the small facet joints in the spine, on repositioning disc material, on reducing muscle tension or stiffness, and on other possibilities. Chiropractors also often recommend therapeutic exercise and sometimes make use of massage and acupressure in addition to spinal manipulation. The medical community was slow to get a grip on chiropractic studies and research because it was pseudo science initially. The man behind the practice D.D. Palmer first came to use his technique in the late 19th century where he supposedly cured a janitors back and his hearing. (Palmer, 1910) However, this was not easily accepted by the medical community and was like snake charming seeming like pseudo-medicine rather than a real solution. Chiropractic’s use spinal adjustment and acupressure which are performed on patients. These two take the form of specific techniques used to adjust spines and other joints to relieve pain and fix joint postures and positioning. (Deyo,78) This is the solution side of the pain treatment spectrum, where a pill falls short. As part of the treatment requires patient cooperation in the form of exercise, for some this is limiting and sometimes impossible. Ideally, many advocate that the system should rely less on exclusively pharmacological treatments and find that physical therapy and chiropractors are serious sciences. This in part has the scientific community to blame as these two practices are arguably pseudoscience that have gotten enough support to call themselves legitimate. For example, D. D. Palmer, was a magnetic healer practicing in the Midwest in the late 1800s. He claimed that he once cured a janitor’s deafness by manipulating his neck. This was what the earliest of chiropractics looked like, a snake charmer of sorts that without scientific proof and only results to show. As mentioned earlier, Palmer was not as successful in pushing the legitimacy of his new treatment. Comparatively, Opioids and OxyContin had millions of dollars and sponsored programs that integrated their pills into the medical procedure of today’s pain treatments. To doctors Opioids have almost become ingrained if they had been practicing during Purdue Pharma’s aggressive advertising of OxyContin. Other homeopathic remedies are not as familiar to al doctors and need careful diagnosis and referral to the many varieties and sorts of alternatives. Other non drug treatments include acupuncture, massages, cryotherapy and many more. The solutions to fix and manage pain without opioids are promising but take up effort and work from the patient themselves. Most importantly those practicing these various physical remedies don’t make a monopoly selling their services.
I [Removed and changed sentences to push a central idea of alternative treatment existing but not being utilized enough. Fixed commented on sentences or removed and replaced. Strengthened the evidence to better support the final sentences of paragraph. Utilized prior lines in different place, and added more research on alternative treatment top give better background. ]
II [Took indepth look at writing and removed material I had previously gone lazy with. Used 3rd party program to check for integrity. New sources added and cited.]
III [Similarly, I used a technique of stearing my argument towards the end goal sentences. Adding some voice to make argument flow better]
Like every human, pain is unique to each person, and it is not the simplest task to locate and fix. Millions of Americans are in constant pain and a fraction of that are doctors available to properly treat the pain to make it all go back to the way it was. This paradox of the rapid growing amount of patients and a small supply of doctors to help them asks for a solution. Historically we have never seen this much opioid abuse like we see today. With record numbers in overdose and crime statistics related to prescription opioids the numbers don’t seem to get any smaller. As the 21st century provides us with more medical advances we seemed to have hit a plateau in pain management progress. The nation had gone into a state of Epidemic. The solution was not just a simple trick that can cure all and make the world whole again. Marketing and sponsored conventions for medical professionals influenced a sense of hypo and relief around OxyContin. A seemingly low addicting and dependency drug that worked. Until, this was all found to be a lie, a generation of doctors reliant on moving through patients on opioid prescription at a time, and a nation addicted. Highest, in this chain of events sits, the manufacturers and their supply chains. Pharmaceutical companies had changed a part of medicine and we see it till this day. Where once, people sleeked homeopathic remedies or elevating legs during sleep to relieve pain, the medical industry changed this. Introducing potent opioids that had great potential in terms of efficacy but backfired as people became addicted. Treating pain had been seen as a simple task these past years but had brought light to a harder task, rehabilitation. As users face the impending doom of having to detoxify and underdog withdrawal symptoms if they were to stop using Opioids. The revenue from these medications gave pharmaceutical companies advantages that kept a tight grip at dominating the pain maintenance field. While alternatives exist, the tight grip of the market and efficiency at the cost of addiction give Opioids their number one spot in the US. Some would rather live dependent on opioids than face the extreme pain they have; from work related back pain to cancer related pain. Current medical resources make surgery or permanent solutions impossible financially or physically, their only option sometimes is Opioids. But it doesn’t have to be if we see medicine as something that doesn’t require pharmacology or surgery. For some people it is a wonder drug but also the start of a life reliant on Opioids.
I [Changed some word choice and sentence placement. Had only one comment but upon personal review needed extra removal and new ideas. ]
II [Concluding arguments based more on arguments created not researched. ]
III [Again, really trying to pack that final punch on the reader to help them see what I am seeing. Less for them to interpret and more for me to feed into the reader. ]