It is accurately said that politics is downstream of culture. Similarly, is has become apparent that results published in the medical “literature” are downstream from opinions; opinions formed at the behest of politics. The maligning of ivermectin during covid (and continuing) is a clear example. Even advocating for it based on previous, unbiased studies, led to loss of jobs and licenses of physicians! This is the kind of thing we, not long ago, recognized for the corruption that it is. I had no idea, until now, just how pervasive this corruption is in how medicine is practiced. Having managed post op pain for 50 years, I’m in a position to be knowledgeable on this subject.
My wife is scheduled for surgery - a major laparotomy for cancer. It’s a big deal and the first risk on the consent form is bleeding. So, what postop pain medications are offered (actually OTC medications prescribed at 10X the cost): acetaminophen (harmless in correct doses) and ibuprofen. Not long ago, the vast majority of surgeons believed NSAIDS like ibuprofen should never by used post-op for many sound reasons. Leading the list was increase in risk of bleeding. This has drastically changed over a very few years. Why?
Answer: To create “optics”. To show that the medical system is fully “on board” with the state’s efforts to “protect us” from the"opioid crisis". Never mind intercepting fentanyl freely crossing the southern border; better to deny adequate opioids to post-surgical patients! I.e. - the usual ham-fisted “gun control” model of effective governance: punish the lawful users over which you have easy control; no need to actually find and arrest criminals who kill with guns every day. No need to incarcerate and/or treat actual addicts. That’s messy. As is typical of mass hysteria and/or religious fervor generally - no exceptions are allowed. This absurd scheme is designed to deny that very class of effective pain medications, time tested for postop pain more than a century. Suddenly, their use has been found politically inconvenient, so they’re dose is rationed, willy-nilly.
Again, typical of religious ecstasy, not dispassionate medical science, this is not deemed to be a matter of patient choice or consent. It is presented as “take it or leave it” to all patients alike. EVen the recent highly-slanted “peer reviewed” papers indicate caution in their use and that they are not appropriate for everyone - like my wife. Here’s why:
The greatest risk of surgery, generally, is post op bleeding. The bigger the surgery, the greater the risk of bleeding. My wife will have a maximum-exposure exploratory laparotomy, whose incision is maximal: from xiphoid process of the sternum to the pubis. It couldn’t be any longer. The essential aim of the surgery to to remove any visible tumor which is spread thinly over the thin lining of the abdomen and all the internal organs, like the entire gut. These are not the kind of tumors which can be easily cut out, so they are mostly coagulated with either electrocautery, laser or harmonic (ultrasound) scalpel. This will result in significant areas of damaged (burned) tissue, any of which may bleed post op.
Now, the risk of bleeding is increased in numerous circumstances, beginning with advanced age. My wife is 71 10/12. Next comes major surgery. Check. Another well known risk is NSAID use and it is dose related. The recommended maximum dose of ibuprofen OTC is 1200 mg./day. Prescribed here is 1800mg. Perhaps most significant is the concomitant use of anticoagulants. Check - my wife is ordered Lovenox injections daily for 28 days post op to prevent deep vein thrombosis. Finally, are increased risks due to existing diseases - and my wife has lupus erythematosus - known to increase bleeding risk due to chronic blood vessel damage from vasculitis.
BTW, the bleeding risk encompasses more than just the surgical site. Upper GI bleed is a dreaded complication of all major surgery and there are few medications more irritating to the gastric mucosa than NSAIDS. Usually, this may be reduced with acid-reducers like Pepcid or Protonix. However, because of a recent, life threatening C.diff infection, such acid reducers are forbidden my wife because that increases recurrence of C.diff. In sum, there are 5 independent - and likely synergistic - contraindications to the use of NSAIDS! And, all this risk is to be meekly accepted in order to reduce what would otherwise be a few more almost harmless doses of oxycodone - for the sake of politically-inspired optics. “We’re DOING SOMETHING”! “SEE”!
And that’s not all the risk of using NSAIDS in this setting, if you can believe it. Another dreaded risk of major surgery in the elderly, especially, is renal injury. Lots of things can happen perioperatively to cause that. NSAIDS are renal-toxic at high doses ( these are). Again, lupus erythematosus is pertinent in that one of its major complications is renal failure. Avoiding renal toxins in such patients is merely prudent. In my wife’s case, it is beyond mere prudence, however. She will have to be treated wit vancomycin perioperatively, in aneffort to prevent C. diff recurrence which would otherwise result from the prophylactic antibiotics she will be given during and after surgery. Guess what? Vancomycin interacts with NSAIDS to augment each other’s nephrotoxicity!
In sum, the medical system in general and surgeon in particular, are quite willing to sacrifice my wife on the altar of political medicine - not for improved care of actual patients - but to manipulate perceptions about the government’s total failure to mitigate the opioid crisis… I am beside myself, because this is so glaringly obvious. I literally can’t sleep for worry.
The plan is that my wife will, as is her right, decline to take any NSAIDS in the hospital when offered. At home - and we may leave early if maltreated over exercising her right to not consent to any med or treatment - I can prescribe whatever she may need (she generally has a very good tolerance for pain, based on past surgeries). I feel badly enough for us with knowledge and escape routes. I feel even worse for those - the vast majority - without knowledge. I can only imagine the breadth and depth of other corruptions in health “care”.
Here, I lack the time to address the means by which the medical literature propagandizes everyone, by ratifying leadership opinions as “science”. “Wrongthought” or “wrong results” never get published and what is published freely mixes science with opinion. Consider, when was the last time you saw a journal article whose results were counter to the manmade global warming narrative? Similarly, I don’t expect there will be reports of postop NSAID complications. This is clear CORRUPTION of what was once a noble profession, including its research arm. I am despondent.