[Music] [Applause]
[Music]
[Music] if we want to solve a problem we first
if we want to solve a problem we first
if we want to solve a problem we first have to figure out what’s causing it
have to figure out what’s causing it
have to figure out what’s causing it especially if we’re talking about about
especially if we’re talking about about
especially if we’re talking about about a problem that’s happening over and over
a problem that’s happening over and over
a problem that’s happening over and over again just like if we wanted to fix a
again just like if we wanted to fix a
again just like if we wanted to fix a leaky dam we’d have to find the leaks
leaky dam we’d have to find the leaks
leaky dam we’d have to find the leaks first we are in the midst of the worst
first we are in the midst of the worst
first we are in the midst of the worst opioid epidemic in US history and this
opioid epidemic in US history and this
opioid epidemic in US history and this opioid epidemic is first and foremost an
opioid epidemic is first and foremost an
opioid epidemic is first and foremost an epidemic of over prescribing prior to
epidemic of over prescribing prior to
epidemic of over prescribing prior to 1980 doctors were very reluctant to
1980 doctors were very reluctant to
1980 doctors were very reluctant to prescribe opioids for their patients
prescribe opioids for their patients
prescribe opioids for their patients because they were worried about
because they were worried about
because they were worried about addiction by 1990 or the late 1990s
addiction by 1990 or the late 1990s
addiction by 1990 or the late 1990s doctors were dispensing opioids like
doctors were dispensing opioids like
doctors were dispensing opioids like vending machines to anybody that came in
vending machines to anybody that came in
vending machines to anybody that came in and said I have pain today doctors
and said I have pain today doctors
and said I have pain today doctors prescribed more than two hundred and
prescribed more than two hundred and
prescribed more than two hundred and thirty million prescriptions annually
thirty million prescriptions annually
thirty million prescriptions annually and just to put that in perspective the
and just to put that in perspective the
and just to put that in perspective the United States consumes over 80% of the
United States consumes over 80% of the
United States consumes over 80% of the world’s supply of opioid pain pills
world’s supply of opioid pain pills
world’s supply of opioid pain pills despite constituting less than 5% of the
despite constituting less than 5% of the
despite constituting less than 5% of the world’s population so the question is
world’s population so the question is
world’s population so the question is how did healers how do healers become
how did healers how do healers become
how did healers how do healers become dealers right and I’m sure you’ve heard
dealers right and I’m sure you’ve heard
dealers right and I’m sure you’ve heard about the role that Big Pharma’s played
about the role that Big Pharma’s played
about the role that Big Pharma’s played in this in this public health crisis
in this in this public health crisis
in this in this public health crisis that we’re facing and I’m sure you’ve
that we’re facing and I’m sure you’ve
that we’re facing and I’m sure you’ve heard about pill mill doctors these are
heard about pill mill doctors these are
heard about pill mill doctors these are willfully nefarious doctors exchanging
willfully nefarious doctors exchanging
willfully nefarious doctors exchanging prescriptions for cash and they both of
prescriptions for cash and they both of
prescriptions for cash and they both of those elements have played a huge role
those elements have played a huge role
those elements have played a huge role right Big Pharma really is to blame and
right Big Pharma really is to blame and
right Big Pharma really is to blame and there are really greedy doctors out
there are really greedy doctors out
there are really greedy doctors out there but the truth is that big pharma
there but the truth is that big pharma
there but the truth is that big pharma existed well before this public health
existed well before this public health
existed well before this public health crisis and frankly the term quack dates
crisis and frankly the term quack dates
crisis and frankly the term quack dates back to the 17th century so the question
back to the 17th century so the question
back to the 17th century so the question is why this drug and why now to really
is why this drug and why now to really
is why this drug and why now to really be able to understand this problem we
be able to understand this problem we
be able to understand this problem we have to recognize but this current
have to recognize but this current
have to recognize but this current opioid epidemic is a symptom of a
opioid epidemic is a symptom of a
opioid epidemic is a symptom of a faltering health care system and a
faltering health care system and a
faltering health care system and a culture that has demonized pain and it’s
culture that has demonized pain and it’s
culture that has demonized pain and it’s perpetrated not by a small subset of
perpetrated not by a small subset of
perpetrated not by a small subset of pill mill doctors but by doctors like me
pill mill doctors but by doctors like me
pill mill doctors but by doctors like me compassionate doctors meaning to do well
compassionate doctors meaning to do well
compassionate doctors meaning to do well caught in a system gone awry
caught in a system gone awry
caught in a system gone awry harming patients who are showing up who
harming patients who are showing up who
harming patients who are showing up who really want help so in order to
really want help so in order to
really want help so in order to understand what caused this epidemic we
understand what caused this epidemic we
understand what caused this epidemic we need to be aware of three invisible
need to be aware of three invisible
need to be aware of three invisible forces inside of the healthcare system
forces inside of the healthcare system
forces inside of the healthcare system that are driving this problem the first
that are driving this problem the first
that are driving this problem the first force is the industrialization of
force is the industrialization of
force is the industrialization of Medicine or what I call the Toyota
Medicine or what I call the Toyota
Medicine or what I call the Toyota ization of Medicine right over the last
ization of Medicine right over the last
ization of Medicine right over the last three decades there has been a huge
three decades there has been a huge
three decades there has been a huge migration of physicians outside of
migration of physicians outside of
migration of physicians outside of private practice and physician led
private practice and physician led
private practice and physician led practices into large integrated
practices into large integrated
practices into large integrated healthcare systems we are now salaried
healthcare systems we are now salaried
healthcare systems we are now salaried employees of health care factories and
employees of health care factories and
employees of health care factories and what this means is we practice
what this means is we practice
what this means is we practice assembly-line medicine the throughput of
assembly-line medicine the throughput of
assembly-line medicine the throughput of body parts is more important than whole
body parts is more important than whole
body parts is more important than whole patient health there’s tremendous
patient health there’s tremendous
patient health there’s tremendous pressure on doctors to palliate pain
pressure on doctors to palliate pain
pressure on doctors to palliate pain prescribe pills and perform procedures
prescribe pills and perform procedures
prescribe pills and perform procedures because that’s what pays and to please
because that’s what pays and to please
because that’s what pays and to please patients because patients have become
patients because patients have become
patients because patients have become customers guess what opioids are a
customers guess what opioids are a
customers guess what opioids are a pretty good solution to that problem we
pretty good solution to that problem we
pretty good solution to that problem we have primary care doctors who have to
have primary care doctors who have to
have primary care doctors who have to see more than 40 patients a day less
see more than 40 patients a day less
see more than 40 patients a day less than five minutes per patients a couple
than five minutes per patients a couple
than five minutes per patients a couple of years ago my then 11 year old son
of years ago my then 11 year old son
of years ago my then 11 year old son googled my name on the internet and he
googled my name on the internet and he
googled my name on the internet and he came up with one of these internet
came up with one of these internet
came up with one of these internet doctor rating sites and he called me
doctor rating sites and he called me
doctor rating sites and he called me over you said mom is this you and there
over you said mom is this you and there
over you said mom is this you and there I was I only had one rating on this site
I was I only had one rating on this site
I was I only had one rating on this site one out of four stars and there was a
one out of four stars and there was a
one out of four stars and there was a comment about me in the comments said
comment about me in the comments said
comment about me in the comments said seeing this doctor made me wish I had
seeing this doctor made me wish I had
seeing this doctor made me wish I had never sought help in the first place
never sought help in the first place
never sought help in the first place wrong diagnosis wrong medication seek
wrong diagnosis wrong medication seek
wrong diagnosis wrong medication seek help from someone else
help from someone else
help from someone else I very sheepishly had to admit to my son
I very sheepishly had to admit to my son
I very sheepishly had to admit to my son that that was me and I was filled with
that that was me and I was filled with
that that was me and I was filled with shame I go around the country and have
shame I go around the country and have
shame I go around the country and have done so for years now encouraging
done so for years now encouraging
done so for years now encouraging doctors to prescribe fewer opioids and
doctors to prescribe fewer opioids and
doctors to prescribe fewer opioids and what they say to me is I’ll prescribe
what they say to me is I’ll prescribe
what they say to me is I’ll prescribe fewer opioids when you can promise me
fewer opioids when you can promise me
fewer opioids when you can promise me that my patients will still give me a
that my patients will still give me a
that my patients will still give me a good rating on the satisfaction survey
good rating on the satisfaction survey
good rating on the satisfaction survey right so this is what we’re dealing with
right so this is what we’re dealing with
right so this is what we’re dealing with right now now the good news is my son
right now now the good news is my son
right now now the good news is my son came up to me about 10 minutes later and
came up to me about 10 minutes later and
came up to me about 10 minutes later and said mom don’t worry I gave you 4 out of
said mom don’t worry I gave you 4 out of
said mom don’t worry I gave you 4 out of 4 stars
4 stars
4 stars twice okay
twice okay
twice okay the second big invisible force driving
the second big invisible force driving
the second big invisible force driving this opioid epidemic is the
this opioid epidemic is the
this opioid epidemic is the medicalization of poverty over the last
medicalization of poverty over the last
medicalization of poverty over the last three decades
three decades
three decades doctors have increasingly been faced
doctors have increasingly been faced
doctors have increasingly been faced with having to cope with not just the
with having to cope with not just the
with having to cope with not just the biological illnesses that are afflicting
biological illnesses that are afflicting
biological illnesses that are afflicting their patients but also their
their patients but also their
their patients but also their socio-economic and psychosocial distress
socio-economic and psychosocial distress
socio-economic and psychosocial distress and yet they haven’t been given the
and yet they haven’t been given the
and yet they haven’t been given the tools or the resources to handle those
tools or the resources to handle those
tools or the resources to handle those problems so what do they do they have to
problems so what do they do they have to
problems so what do they do they have to biology’s problems that aren’t really
biology’s problems that aren’t really
biology’s problems that aren’t really biological shoehorn them into our
biological shoehorn them into our
biological shoehorn them into our diagnostic codes in order to get
diagnostic codes in order to get
diagnostic codes in order to get insurance companies to pay for it and in
insurance companies to pay for it and in
insurance companies to pay for it and in the face of those overwhelming problems
the face of those overwhelming problems
the face of those overwhelming problems unemployment multi-generational trauma
unemployment multi-generational trauma
unemployment multi-generational trauma homelessness right doctors are left
homelessness right doctors are left
homelessness right doctors are left feeling not only overwhelmed but feeling
feeling not only overwhelmed but feeling
feeling not only overwhelmed but feeling like well what can I do at least I can
like well what can I do at least I can
like well what can I do at least I can prescribe this pill right at least for
prescribe this pill right at least for
prescribe this pill right at least for the short term my patient will feel
the short term my patient will feel
the short term my patient will feel better and indeed patients do go home
better and indeed patients do go home
better and indeed patients do go home and take the pill the opioid and
and take the pill the opioid and
and take the pill the opioid and describe feeling like they’re being held
describe feeling like they’re being held
describe feeling like they’re being held or covered by a warm blanket they come
or covered by a warm blanket they come
or covered by a warm blanket they come back later and say thank you doctor you
back later and say thank you doctor you
back later and say thank you doctor you really helped me and the doctor gets to
really helped me and the doctor gets to
really helped me and the doctor gets to experience gratitude right why they went
experience gratitude right why they went
experience gratitude right why they went into medicine in the first place
into medicine in the first place
into medicine in the first place and yet this really is a false god so
and yet this really is a false god so
and yet this really is a false god so not only are doctors incentivized to
not only are doctors incentivized to
not only are doctors incentivized to prescribe pills in order to take care of
prescribe pills in order to take care of
prescribe pills in order to take care of non biological problems we now have
non biological problems we now have
non biological problems we now have patients who are incentivized to adopt
patients who are incentivized to adopt
patients who are incentivized to adopt the patient role in order to pay the
the patient role in order to pay the
the patient role in order to pay the bills
bills
bills we have over 13 million people in this
we have over 13 million people in this
we have over 13 million people in this country on disability the number two
country on disability the number two
country on disability the number two reasons for disability or chronic pain
reasons for disability or chronic pain
reasons for disability or chronic pain and mental health in the 1950s we had
and mental health in the 1950s we had
and mental health in the 1950s we had less than a million people in this
less than a million people in this
less than a million people in this country and disability and the number
country and disability and the number
country and disability and the number two reasons were heart disease and
two reasons were heart disease and
two reasons were heart disease and cancer why is that it’s not because
cancer why is that it’s not because
cancer why is that it’s not because we’re getting sicker it’s because
we’re getting sicker it’s because
we’re getting sicker it’s because patients have figured out or people have
patients have figured out or people have
patients have figured out or people have figured out that by adopting the stick
figured out that by adopting the stick
figured out that by adopting the stick roll and signing up for disability they
roll and signing up for disability they
roll and signing up for disability they can pay their bills and yet in order to
can pay their bills and yet in order to
can pay their bills and yet in order to validate their sick roll status they
validate their sick roll status they
validate their sick roll status they have to participate in the health care
have to participate in the health care
have to participate in the health care system which also means taking certain
system which also means taking certain
system which also means taking certain types of pills
types of pills
types of pills Karl Marx said religion is the opium of
Karl Marx said religion is the opium of
Karl Marx said religion is the opium of the masses we are at a point in our
the masses we are at a point in our
the masses we are at a point in our history where opium has become the
history where opium has become the
history where opium has become the religion of the masses
religion of the masses
religion of the masses the third invisible force driving the
the third invisible force driving the
the third invisible force driving the opioid epidemic illness narratives in
opioid epidemic illness narratives in
opioid epidemic illness narratives in particular narratives about pain
particular narratives about pain
particular narratives about pain today we believe in the health care
today we believe in the health care
today we believe in the health care system that pain is dangerous so not
system that pain is dangerous so not
system that pain is dangerous so not only is pain painful in the moment but
only is pain painful in the moment but
only is pain painful in the moment but if we experience pain we are setting
if we experience pain we are setting
if we experience pain we are setting ourselves up for pain in the future how
ourselves up for pain in the future how
ourselves up for pain in the future how does that work because pain in the
does that work because pain in the
does that work because pain in the moment can leave a neurological scar
moment can leave a neurological scar
moment can leave a neurological scar which centralizes pain and makes us
which centralizes pain and makes us
which centralizes pain and makes us vulnerable to more pain in the form of a
vulnerable to more pain in the form of a
vulnerable to more pain in the form of a chronic pain condition this is a very
chronic pain condition this is a very
chronic pain condition this is a very modern concept and it’s essentially
modern concept and it’s essentially
modern concept and it’s essentially borrowed from the mental health field
borrowed from the mental health field
borrowed from the mental health field right this idea that if we experience
right this idea that if we experience
right this idea that if we experience psychological pain we might develop
psychological pain we might develop
psychological pain we might develop post-traumatic stress disorder in the
post-traumatic stress disorder in the
post-traumatic stress disorder in the future all sort of stemming from Freud’s
future all sort of stemming from Freud’s
future all sort of stemming from Freud’s original conception that what happens to
original conception that what happens to
original conception that what happens to us in childhood sets us up for neuroses
us in childhood sets us up for neuroses
us in childhood sets us up for neuroses as adults but 150 years ago doctors
as adults but 150 years ago doctors
as adults but 150 years ago doctors didn’t think this way about pain they in
didn’t think this way about pain they in
didn’t think this way about pain they in fact thought that pain was salutary that
fact thought that pain was salutary that
fact thought that pain was salutary that pain could boost the immune response
pain could boost the immune response
pain could boost the immune response that it could boost your cardiovascular
that it could boost your cardiovascular
that it could boost your cardiovascular system that what doesn’t kill you makes
system that what doesn’t kill you makes
system that what doesn’t kill you makes you stronger and in fact now we’re
you stronger and in fact now we’re
you stronger and in fact now we’re finding that people who take opioids
finding that people who take opioids
finding that people who take opioids heal more slowly than people who don’t
heal more slowly than people who don’t
heal more slowly than people who don’t people who get surgery with minimal
people who get surgery with minimal
people who get surgery with minimal opioids heal faster than people who
opioids heal faster than people who
opioids heal faster than people who receive a lot of opioids doing stirring
receive a lot of opioids doing stirring
receive a lot of opioids doing stirring surgery these three invisible forces are
surgery these three invisible forces are
surgery these three invisible forces are what is driving this opioid epidemic so
what is driving this opioid epidemic so
what is driving this opioid epidemic so the real question is how can we do
the real question is how can we do
the real question is how can we do better how can we fix this problem
better how can we fix this problem
better how can we fix this problem number one the Toyota ization of
number one the Toyota ization of
number one the Toyota ization of Medicine assembly-line care works great
Medicine assembly-line care works great
Medicine assembly-line care works great for some medical problems a knee
for some medical problems a knee
for some medical problems a knee replacement a heart attack
replacement a heart attack
replacement a heart attack a cataract surgery but it’s terrible for
a cataract surgery but it’s terrible for
a cataract surgery but it’s terrible for chronic relapsing and remitting
chronic relapsing and remitting
chronic relapsing and remitting illnesses like chronic pain and like
illnesses like chronic pain and like
illnesses like chronic pain and like addiction so what’s the solution we need
addiction so what’s the solution we need
addiction so what’s the solution we need to build an infrastructure inside the
to build an infrastructure inside the
to build an infrastructure inside the house of medicine that can take care of
house of medicine that can take care of
house of medicine that can take care of chronic illnesses and we have to
chronic illnesses and we have to
chronic illnesses and we have to reprioritize the doctor
reprioritize the doctor
reprioritize the doctor patient relationship we have to
patient relationship we have to
patient relationship we have to incentive i incentivize doctors to spend
incentive i incentivize doctors to spend
incentive i incentivize doctors to spend time with their patients to discuss
time with their patients to discuss
time with their patients to discuss these complex issues we need there to be
these complex issues we need there to be
these complex issues we need there to be a relationship through time so that
a relationship through time so that
a relationship through time so that opioids don’t have to be a proxy for a
opioids don’t have to be a proxy for a
opioids don’t have to be a proxy for a doctor-patient relationship that means
doctor-patient relationship that means
doctor-patient relationship that means we have to build an infrastructure
we have to build an infrastructure
we have to build an infrastructure inside medicine to provide care to
inside medicine to provide care to
inside medicine to provide care to patients for chronic pain that doesn’t
patients for chronic pain that doesn’t
patients for chronic pain that doesn’t just involve opioids right we need to
just involve opioids right we need to
just involve opioids right we need to build an infrastructure to take care of
build an infrastructure to take care of
build an infrastructure to take care of addiction and embrace it as a disease
addiction and embrace it as a disease
addiction and embrace it as a disease and insist that insurance companies pay
and insist that insurance companies pay
and insist that insurance companies pay to treat it the medicalization of
to treat it the medicalization of
to treat it the medicalization of poverty how do we fix that problem if we
poverty how do we fix that problem if we
poverty how do we fix that problem if we have decided as a society that medicine
have decided as a society that medicine
have decided as a society that medicine is our social safety net then we need to
is our social safety net then we need to
is our social safety net then we need to give doctors the resources to take care
give doctors the resources to take care
give doctors the resources to take care of the problems that patients really
of the problems that patients really
of the problems that patients really have and not biologies problems that
have and not biologies problems that
have and not biologies problems that aren’t really biological how about
aren’t really biological how about
aren’t really biological how about narratives can we bring back some of the
narratives can we bring back some of the
narratives can we bring back some of the narratives from 150 years ago is it time
narratives from 150 years ago is it time
narratives from 150 years ago is it time to do that how about people are
to do that how about people are
to do that how about people are resilient how about the body can heal
resilient how about the body can heal
resilient how about the body can heal itself
itself
itself how about pain is inevitable and there
how about pain is inevitable and there
how about pain is inevitable and there may even be some times when some sorts
may even be some times when some sorts
may even be some times when some sorts of pain can serve a useful purpose in
of pain can serve a useful purpose in
of pain can serve a useful purpose in our lives if only to remind us what joy
our lives if only to remind us what joy
our lives if only to remind us what joy looks like and possibly most importantly
looks like and possibly most importantly
looks like and possibly most importantly that doctors are limited in what they
that doctors are limited in what they
that doctors are limited in what they can fix once it’s broken the future of
can fix once it’s broken the future of
can fix once it’s broken the future of health care depends upon closing this
health care depends upon closing this
health care depends upon closing this gap between increasingly industrialized
gap between increasingly industrialized
gap between increasingly industrialized medicalised healthcare care delivery and
medicalised healthcare care delivery and
medicalised healthcare care delivery and the growing psychosocial psychosocial
the growing psychosocial psychosocial
the growing psychosocial psychosocial needs of our patients thank
needs of our patients thank
needs of our patients thank [Applause]
”
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