Wilmont Kreis

Marketing: I have been asked if my portrayal of drug and implement representatives is overstated. It may be in some cases, but in others, I feel it is on the mark. Even though the pharmaceutical business is generally ethical and highly regulated, they are businesses and the goal of business is to sell its product. As in other industries, the salesmen are frequently compensated by the volume of the sales. As a young orthopedic resident, I remember a drug rep assuring me that Valium was in no way addictive. I have never had a rep caution me that their product was too dangerous. Although the regulators have tried to control it, incentives like, dinners, trips and gifts still abound for receptive physicians. If you have an opportunity to peruse a medical journal, especially one on pain management, look at the ads. Are they very different from those we saw ten years ago from the tobacco industry?  Read More 

Tolerance and addiction: As one consumes opiates, one develops some level of tolerance. That is to say they require more medicine to produce the same effect. At the same time an addiction occurs making it increasingly more difficult to lower the dose or discontinue the medicine altogether. In chronic pain situation it is very common to hear the plea uttered by Derrick Forton, “I need more!”  Read More 

Trends in opiate use: When I first practiced orthopedics, outpatient pain medicine generally included codeine, Darvon, Tylenol, and aspirin. In my opinion, patients did rather well with these medicines. As time went on, stronger (and more dangerous) drugs reached the market and names like Dilaudid, Demerol, Vicodin, Lortab, Oxycontin, and Fentanyl emerged and have seen increased use annually. As these medicines became more widely used they became more available via appropriate and inappropriate sources. Now I regularly see patients with relatively simple injuries who state, “I just took a couple of my wife’s Vicodin. This appalls me. Worse yet, they are becoming available to children. Teens often find a ready source of these dangerous narcotics in grandma’s medicine chest ready for their personal use, or sale on the streets.  Read More 

Opiates are a class of drugs used in medicine primarily to relieve pain. I do not pretend to be an expert in pharmacology, but over many years of medical study and treatment of patients with painful orthopedic conditions, I can certainly speak from experience. In addition to pain relief, opiates also cause drowsiness, and frequently euphoria. They are potentially dangerous and can be deadly. They certainly have an addictive potential in many people.  Read More 

The Pain Docfeatures four pain doctors three of whom have lost their way. The exception is Joe Brownstone who is content taking good care of patients for a comfortable living. Make no mistake, in my opinion he represents the vast majority of physicians today. The other three started this way but faltered. Terry Webb was lured to the sirens of money and social prominence. Luis Martinez was sidetracked by issues confronting foreign physicians, and Bernard Koplinger was seduced by the green fairy of opiates. More about opiates to come… Read More