Monday, December 10, 2012
Wednesday, December 5, 2012
BONO - Co-founder of ONE and (RED)
Lead singer, U2 - Co-founder, ONE & (RED)The lead singer of Irish rock band U2, Bono was born Paul David Hewson in Ballymun, Dublin. He met the Edge, Larry Mullen and Adam Clayton at school, and in 1978 the band was formed. Acknowledged as one of the best live acts in the world, U2 have sold over 140 million albums and won numerous awards, including 22 Grammys. Bono is also a well-known activist in the fight against AIDS and extreme poverty in Africa. In 2002, he co-founded DATA (debt, AIDS, trade, Africa) to raise public awareness of the issues in its name and influence government policy on Africa. In 2004, DATA helped to create ONE: The Campaign to Make Poverty History, an advocacy and campaigning organization dedicated to fighting extreme poverty and preventable disease. In early 2008, DATA and ONE combined operations under the name ONE. As part of his work with ONE, Bono has lobbied U.S. Presidents and Congressional leaders, along with the heads of many other G8 nations.In 2006, Bono and Bobby Shriver launched Product (RED) to raise money from businesses to buy AIDS drugs for people in Africa unable to afford them. Product (RED) has an ongoing relationship with a number of iconic global brands that sell (RED) products and donate a percentage of the profits directly to the Global Fund to Fight AIDS, Tuberculosis and Malaria.Bono also helped launch EDUN, an ethically-sourced high fashion clothing company run by his wife Ali Hewson; EDUN produces clothing in developing areas of the world, particularly in Africa.Bono has received a number of awards for his music and activism, including the Legion D’Honneur from the French Government in 2003, TIME Magazine’s Person of the Year for 2005 (along with Bill and Melinda Gates), and an honorary British knighthood in 2007. Bono lives in Dublin with Ali and their four children.
The Fight Goes ON!
In recognition of this year’s World AIDS Day, U2 singer and global activist Bono is stepping up his fight against HIV/AIDS by personally lobbying American legislators to maintain funding for global AIDS initiatives and awareness. His plea comes at a moment when Washington is embroiled in tensebudget debates over how to avoid the so-called “fiscal cliff” which would trigger automatic spending cuts and tax hikes. Bono showed up in Washington a few weeks after the presidential election to make his case and he didn’t just bring star-appeal, he brought data. His international advocacy organization, The ONE Campaign, recently released a report, warning that despite scientific strides made in combating the pandemic, the United Nation’s goal to achieve the “beginning of the end of AIDS by 2015” will fail if funding is cut to AIDS programs. The report also says financial and political commitment to AIDS efforts from the usual donor countries are varied, with the U.S., U.K. and France leading efforts while Germany, Canada, Japan and Italy lag behind in funding. Bono pushed lawmakers to continue to make AIDS financing a priority. Given the current status, the beginning of the end ofAIDS—defined as when the number of new HIV infections each year is surpassed by the number of people receiving treatment—will not be reached until 2022.
American support is key to reaching the ambitious goals set by the United Nations. When Bono sat down with TIME’s managing editor, Rick Stengel last year, he shared his confidence in the Obama Administration’s financial commitment and praised the U.S’s role in leading efforts to fight the virus. “It is an extraordinary thing that the United States has done, which is in the war against this tiny little virus, which has caused so much destruction and heartache, American leadership has been the turning point,” said Bono in the interview. “Five million lives have been saved around the world because of American leadership.”
Despite the anxiety over whether lack of fiscal support will slow the momentum the movement has already achieved, Bono’s organization, The ONE Campaign and its fundraising division (RED), are continuing to spearhead awareness with a new pop culture initiative coinciding with World AIDS Day on December 1st.
ONE is launching a first-person YouTube video series called “It starts with me,” with video messages and stories from contributors like AIDS activist Cleve Jones and actor Colin Farrell. (RED) has teamed up with Tiesto, a leading electronic music DJ to release a compilation album, DANCE (RED), SAVE LIVES with fellow EDM musicians. The album corresponds with a global YouTube livestream from the Stereosonic Festival in Melbourne, Australia.
As Bono told TIME prior to last year’s World AIDS Day, the beginning of the end of AIDS is nearing with continued international political and financial support. “With some breakthroughs in science there is a chance to turn [this around]… As I say it to you, I can hardly believe the sound of it. For some people, this is a really emotional moment,” he said.
Opioids Abuse
Why Doctors Prescribe Opioids to Known Opioid Abusers
Anna Lembke, M.D.
Prescription opioid abuse is an epidemic in the United States. In 2010, there were reportedly as many as 2.4 million opioid abus- ers in this country, and the num- ber of new abusers had increased by 225% between 1992 and 2000.1 Sixty percent of the opioids that are abused are obtained directly or indirectly through a physician’s prescription. In many instances, doctors are fully aware that their patients are abusing these medi- cations or diverting them to others for nonmedical use, but they prescribe them anyway. Why? Recent changes in medicine’s phi- losophy of pain treatment, cultural trends in Americans’ attitudes to- ward suffering, and financial dis- incentives for treating addiction have contributed to this problem.
Throughout the 19th century, doctors spoke out against the use of pain remedies.2 Pain, they ar- gued, was a good thing, a sign of physical vitality and important to the healing process. Over the past 100 years, and especially as the availability of morphine deriva- tives such as oxycodone (Oxycon- tin) increased, a paradigm shift has occurred with regard to pain treatment. Today, treating pain is every doctor’s mandated responsi- bility. In 2001, the Medical Board of California passed a law requir- ing all California-licensed physi- cians (except pathologists and radiologists) to take a full-day course on “pain management.” It was an unprecedented injunction. Earlier this year, Pizzo and Clark urged health care providers as well as “family members, employ- ers, and friends” to “rely on a person’s ability to express his or her subjective experience of pain
Prescription opioid abuse is an epidemic in the United States. In 2010, there were reportedly as many as 2.4 million opioid abus- ers in this country, and the num- ber of new abusers had increased by 225% between 1992 and 2000.1 Sixty percent of the opioids that are abused are obtained directly or indirectly through a physician’s prescription. In many instances, doctors are fully aware that their patients are abusing these medi- cations or diverting them to others for nonmedical use, but they prescribe them anyway. Why? Recent changes in medicine’s phi- losophy of pain treatment, cultural trends in Americans’ attitudes to- ward suffering, and financial dis- incentives for treating addiction have contributed to this problem.
Throughout the 19th century, doctors spoke out against the use of pain remedies.2 Pain, they ar- gued, was a good thing, a sign of physical vitality and important to the healing process. Over the past 100 years, and especially as the availability of morphine deriva- tives such as oxycodone (Oxycon- tin) increased, a paradigm shift has occurred with regard to pain treatment. Today, treating pain is every doctor’s mandated responsi- bility. In 2001, the Medical Board of California passed a law requir- ing all California-licensed physi- cians (except pathologists and radiologists) to take a full-day course on “pain management.” It was an unprecedented injunction. Earlier this year, Pizzo and Clark urged health care providers as well as “family members, employ- ers, and friends” to “rely on a person’s ability to express his or her subjective experience of pain
and learn to trust that expres-
sion,” adding that the “medical
system must give these expres-
sions credence and endeavor to
respond to them honestly and ef-
fectively.”3 It seems that the pa-
tient’s subjective experience of
pain now takes precedence over
other, potentially competing, con-
siderations. In contemporary med-
ical culture, self-reports of pain
are above question, and the treat-
ment of pain is held up as the
holy grail of compassionate med-
ical care.
The prioritization of the sub- jective experience of pain has been reinforced by the modern practice of regularly assessing pa- tient satisfaction. Patients fill out surveys about the care they re- ceive, which commonly include questions about how adequately their providers have addressed their pain. Doctors’ clinical skills may also be evaluated on for- profit doctor-grading websites for the world to see. Doctors who re- fuse to prescribe opioids to cer- tain patients out of concern about abuse are likely to get a poor rating from those patients. In some institutions, patient-sur- vey ratings can affect physicians’ reimbursement and job security. When I asked a physician col- league who regularly treats pain how he deals with the problem of using opioids in patients who he knows are abusing them, he said, “Sometimes I just have to do the right thing and refuse to prescribe them, even if I know they’re going to go on Yelp and give me a bad rating.” His “some- times” seems to imply that at other times he knowingly pre- scribes opioids to abusers be-
The prioritization of the sub- jective experience of pain has been reinforced by the modern practice of regularly assessing pa- tient satisfaction. Patients fill out surveys about the care they re- ceive, which commonly include questions about how adequately their providers have addressed their pain. Doctors’ clinical skills may also be evaluated on for- profit doctor-grading websites for the world to see. Doctors who re- fuse to prescribe opioids to cer- tain patients out of concern about abuse are likely to get a poor rating from those patients. In some institutions, patient-sur- vey ratings can affect physicians’ reimbursement and job security. When I asked a physician col- league who regularly treats pain how he deals with the problem of using opioids in patients who he knows are abusing them, he said, “Sometimes I just have to do the right thing and refuse to prescribe them, even if I know they’re going to go on Yelp and give me a bad rating.” His “some- times” seems to imply that at other times he knowingly pre- scribes opioids to abusers be-
cause not doing so would ad-
versely affect his professional
standing. If that’s the case, he is
by no means alone.
A cultural change contribut- ing to physicians’ dilemma is the “all suffering is avoidable” ethos that pervades many aspects of modern life. Many Americans to- day believe that any kind of pain, physical or mental, is indicative of pathology and therefore ame- nable to treatment. (The recent campaign to label “grief” a men- tal disorder is just one small ex- ample of this phenomenon.) At least some segments of our soci- ety also believe that pain that’s left untreated can cause a psychic scar, leading to psychopathology in the form of post-traumatic stress; thus, doctors who deny opioids to patients who report feeling pain may be seen not only as withholding relief, but also as inf licting further harm through psychological trauma. Trauma today is seen not just as causing illness, but also as con- ferring a right to be compensat- ed.4 No one understands this be- lief better than addicted patients themselves, who use their aware- ness of cultural narratives of ill- ness and victimhood to get the prescriptions they want. One pa- tient summed it up in this way: “I know I’m addicted to (opioids), and it’s the doctors’ fault because they prescribed them. But I’ll sue them if they leave me in pain.”
Furthermore, for physicians, treating pain pays, whereas treat- ing addiction does not. The main- stays of treatment for addiction are education and effective coun- seling, both of which take time. Time spent with each individual
A cultural change contribut- ing to physicians’ dilemma is the “all suffering is avoidable” ethos that pervades many aspects of modern life. Many Americans to- day believe that any kind of pain, physical or mental, is indicative of pathology and therefore ame- nable to treatment. (The recent campaign to label “grief” a men- tal disorder is just one small ex- ample of this phenomenon.) At least some segments of our soci- ety also believe that pain that’s left untreated can cause a psychic scar, leading to psychopathology in the form of post-traumatic stress; thus, doctors who deny opioids to patients who report feeling pain may be seen not only as withholding relief, but also as inf licting further harm through psychological trauma. Trauma today is seen not just as causing illness, but also as con- ferring a right to be compensat- ed.4 No one understands this be- lief better than addicted patients themselves, who use their aware- ness of cultural narratives of ill- ness and victimhood to get the prescriptions they want. One pa- tient summed it up in this way: “I know I’m addicted to (opioids), and it’s the doctors’ fault because they prescribed them. But I’ll sue them if they leave me in pain.”
Furthermore, for physicians, treating pain pays, whereas treat- ing addiction does not. The main- stays of treatment for addiction are education and effective coun- seling, both of which take time. Time spent with each individual
1580
n engl j med 367;17 nejm.org october 25, 2012
The New England Journal of Medicine
Downloaded from nejm.org on December 5, 2012. For personal use only. No other uses without permission. Copyright © 2012 Massachusetts Medical Society. All rights reserved.
The New England Journal of Medicine
Downloaded from nejm.org on December 5, 2012. For personal use only. No other uses without permission. Copyright © 2012 Massachusetts Medical Society. All rights reserved.
PERSPECTIVE
Why Doctors Prescribe Opioids to Known Abusers
patient is medicine’s least valued
commodity, from a financial re-
imbursement perspective. That’s
especially true in emergency de-
partment settings, where physi-
cians are often evaluated on the
numbers of patients seen, rather
than the amount of time they
spend with each one. Clinicians
will not take time to educate and
counsel patients about addiction
— even if they know how — until
they are adequately reimbursed
for doing so. Currently, it is faster
and pays better to diagnose pain
and prescribe an opioid than to
diagnose and treat addiction. Busy
emergency physicians who would
like to refer patients with addic-
tion for appropriate treatment
have few resources to call on.
To be sure, the recent shift in medicine’s and society’s approach to pain represents a response to long-standing neglect of patients’ subjective experience of pain, as well as an increasing incidence of chronic pain syndromes in an aging population. Although this shift has no doubt benefited many persons with intractable pain that might previously have been undertreated, it has had devastating consequences for pa- tients with addiction and those who may become addicted owing to lax opioid prescribing.
Some short-term changes that can help address this problem in- clude mandating that all physi- cians complete a continuing
To be sure, the recent shift in medicine’s and society’s approach to pain represents a response to long-standing neglect of patients’ subjective experience of pain, as well as an increasing incidence of chronic pain syndromes in an aging population. Although this shift has no doubt benefited many persons with intractable pain that might previously have been undertreated, it has had devastating consequences for pa- tients with addiction and those who may become addicted owing to lax opioid prescribing.
Some short-term changes that can help address this problem in- clude mandating that all physi- cians complete a continuing
Disclosure forms provided by the author
are available with the full text of this article
at NEJM.org.
From the Department of Psychiatry, Stan- ford University, Stanford, CA.
1. Resultsfromthe2010NationalSurveyon Drug Use and Health: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011 (publication no. SMA 11-4658).
2. Meldrum ML. A capsule history of pain management. JAMA 2003;290:2470-5.
3. Pizzo PA, Clark NM. Alleviating suffering 101 — pain relief in the United States. N Engl J Med 2012;366:197-9.
4. Fassin D, Rechtman R. The empire of trauma: an inquiry into the condition of vic- timhood. Princeton, NJ: Princeton University Press, 2009.
DOI: 10.1056/NEJMp1208498
Copyright © 2012 Massachusetts Medical Society.
From the Department of Psychiatry, Stan- ford University, Stanford, CA.
1. Resultsfromthe2010NationalSurveyon Drug Use and Health: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011 (publication no. SMA 11-4658).
2. Meldrum ML. A capsule history of pain management. JAMA 2003;290:2470-5.
3. Pizzo PA, Clark NM. Alleviating suffering 101 — pain relief in the United States. N Engl J Med 2012;366:197-9.
4. Fassin D, Rechtman R. The empire of trauma: an inquiry into the condition of vic- timhood. Princeton, NJ: Princeton University Press, 2009.
DOI: 10.1056/NEJMp1208498
Copyright © 2012 Massachusetts Medical Society.
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