The Potential for Unintended Consequences from Public Policy Shifts in the Treatment of Pain

1998 ◽  
Vol 26 (4) ◽  
pp. 350-352 ◽  
Author(s):  
J. David Haddox ◽  
Gerald M. Aronoff
Keyword(s):  
Public Policy ◽  
Chronic Pain ◽  
Unintended Consequences ◽  
Pharmacy Education ◽  
Open Forum ◽  
Balanced Approach ◽  
Medical Licensing ◽  
State Medical Boards ◽  
Policy Shifts ◽  
Broad Consensus

Recently, due to a number of converging factors, there have been significant shifts in public policy regarding the legitimacy of treating chronic pain with opioids. Traditional tenets handed down in medical, dental, nursing, and pharmacy education created a distinct reluctance on the part of practitioners to prescribe opioids on a continual basis. Much has been written about the reasons for these attitudes. One of the barriers that is very consistently reported by prescribers is the fear of regulatory and legal repercussions to ongoing prescription of this class of medications. It is in this arena that sentinel changes have occurred, the most recent of which is the promulgation of a document prepared by the Federation of State Medical Boards (FSMB), which suggests a set of guidelines meant to be endorsed or adopted by individual medical licensing boards on how to approach this particular aspect of practice. These guidelines, representing a broad consensus from a wide constituency, were developed in a relatively open forum and detail a balanced approach to the prescription of opioids for chronic pain.

The Politics and Practices of Central Clearing in OTC Derivatives Markets

2018 ◽  
Author(s):  
Erin Lockwood
Keyword(s):  
Financial Markets ◽  
Unintended Consequences ◽  
Regulatory Change ◽  
Significant Shift ◽  
Risk Modeling ◽  
Risk Models ◽  
Over The Counter ◽  
Otc Derivatives ◽  
Derivatives Markets ◽  
Policy Shifts

This chapter focuses on the unintended consequences of the post-crisis mandate that over-the-counter (OTC) derivatives be cleared through centralized clearinghouses in an effort to reduce counterparty and systemic risk. Although central clearing has been widely implemented, it has reproduced many of the same characteristics of financial markets that contributed to the 2008 crisis: concentrated risk, moral hazard, and a reliance on faulty risk models. What accounts for the recalcitrance of the OTC derivatives market to a regulatory change? The chapter argues that focusing on the technologies and practices used to govern derivatives markets helps explain the absence of more radical regulatory policy shifts in derivatives regulation. Although there has been a significant shift in who regulates OTC markets, much less has changed at the level of the specific practices that govern these markets, and the chapter examines the continued reliance on netting, collateralization, and risk modeling within clearinghouses.

Summary and conclusions

2018 ◽  
Author(s):  
Thomas F. Babor ◽  
Jonathan Caulkins ◽  
Benedikt Fischer ◽  
David Foxcroft ◽  
Keith Humphreys ◽  
...  
Keyword(s):  
International Organizations ◽  
Drug Policy ◽  
Drug Users ◽  
Illicit Drug ◽  
Supply And Demand ◽  
Unintended Consequences ◽  
Public Health Approach ◽  
Drug Supply ◽  
The Public ◽  
Balanced Approach

Among the 47 options reviewed in this book, most show some evidence of effectiveness in at least one country, but the evidence is less than definitive for many others, either because the interventions are ineffective, or the research is inadequate. Unfortunately, policies that have shown little or no evidence of effectiveness continue to be the preferred options of many countries and international organizations. The evidence reviewed in this book supports two overarching conclusions. First, an integrated and balanced approach to evidence-informed drug policy is more likely to benefit the public good than uncoordinated efforts to reduce drug supply and demand. Second, by shifting the emphasis toward a public health approach, it may be possible to reduce the extent of illicit drug use, prevent the escalation of new epidemics, and avoid the unintended consequences arising from the marginalization of drug users through severe criminal penalties.

In Search of a New Ethic for Treating Patients with Chronic Pain: What Can Medical Boards Do?

1998 ◽  
Vol 26 (4) ◽  
pp. 332-349 ◽  
Author(s):  
Ann M. Martino
Keyword(s):  
Chronic Pain ◽  
Opioid Analgesics ◽  
Conventional Wisdom ◽  
High Profile ◽  
Medical Board ◽  
Medical Establishment ◽  
The Press ◽  
Substantial Risk ◽  
State Medical Boards ◽  
State Medical Board

A decade ago, conventional wisdom in the medical establishment was that physicians treating chronic pain with opioid analgesics were at a substantial risk of being sanctioned for overprescribing by state medical regulatory boards. Dozens of articles written since have alluded to this risk as an obstacle to effective pain re1ief. In the early 1990s, a number of high profile cases in which physicians were disciplined by regulatory boards for overprescribing to patients with chronic pain were reported in the press. Although the board actions in many of these cases were eventually overturned by state judiciaries, the publicity heightened practitioners’. sensitivity to the regulatory risks associated with prescribing opioids.A review of the available data on state medical board actions nationwide for the period from 1990 to 1996 reveals that the perception of regulatory risk far exceeds the reality. Indeed, relatively few (less than 5 percent) of the disciplinary actions taken for overprescribing by state medical boards in any given year directly concern the treatment of chronic pain—malignant or nonmalignant—in patients.

scholarly journals The Use of COMLEX-USA and USMLE for Residency Applicant Selection

2016 ◽  
Vol 8 (3) ◽  
pp. 358-363 ◽  
Author(s):  
Jeanne M. Sandella ◽  
John R. Gimpel ◽  
Larissa L. Smith ◽  
John R. Boulet
Keyword(s):  
United States ◽  
Strong Association ◽  
The United States ◽  
Medical Licensing ◽  
Usmle Step 1 ◽  
Licensing Examination ◽  
Usmle Step ◽  
Level 1 ◽  
State Medical Boards ◽  
Phi Coefficient

ABSTRACT  The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) and the United States Medical Licensing Examination (USMLE) are recognized by all state medical licensing boards in the United States, and the Federation of State Medical Boards has supported the validity of both examinations for medical licensure. Many osteopathic medical students take both examinations.Background  The purpose of this study was to investigate performance on COMLEX-USA Level 1 and USMLE Step 1 of students from colleges of osteopathic medicine where the majority of students took both examinations.Objective  Data were collected on the entering classes of 2010 and 2011. Relationships between the COMLEX-USA Level 1 and the USMLE Step 1 were quantified using Pearson correlations. The correlation between outcomes on the 2 examinations was evaluated using the phi coefficient. A contingency table was constructed to look at first-attempt outcomes (pass/fail).Methods  Data for 2010 and 2011 were collected from 3 osteopathic medical schools, with 795 of 914 students (87%) taking both examinations. The correlation between first-attempt COMLEX-USA Level 1 and USMLE Step 1 scores was statistically significant across and within all 3 schools. The overall correlation was r(795) = 0.84 (P < .001). Pass/fail status on the 2 examinations was moderately correlated (ϕ = 0.39, P < .01).Results  Our study found a strong association between COMLEX Level 1 and USMLE Step 1 performance. Additional studies to accurately compare scores on these examinations are warranted.Conclusions

scholarly journals A balanced approach to identifying, prioritising and evaluating all potential consequences of quality improvement: modified Delphi study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e023890 ◽  
Author(s):  
Madalina Toma ◽  
Tobias Dreischulte ◽  
Nicola M Gray ◽  
Bruce Guthrie
Keyword(s):  
Quality Improvement ◽  
Delphi Study ◽  
Qualitative Evaluation ◽  
Unintended Consequences ◽  
Consensus Methods ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
Balanced Approach ◽  
Trade Offs ◽  
Qualitative Work

ObjectivesHealthcare is a complex system, so quality improvement will commonly lead to unintended consequences which are rarely evaluated. In previous qualitative work, we proposed a framework for considering the range of these potential consequences, in terms of their desirability and the extent to which they were predictable or expected during planning. This paper elaborates on the previous findings, using consensus methods to examine what consequences should be identified, why and how to prioritise, evaluate and interpret all identified consequences, and what stakeholders should be involved throughout this process.DesignTwo-round modified Delphi consensus study.Setting and participantsBoth rounds were completed by 60 panellists from an academic, clinical or management background and experience in designing, implementing or evaluating quality improvement programmes.ResultsPanellists agreed that trade-offs (expected undesirable consequences) and unpleasant surprises (unexpected undesirable consequences) should be actively considered. Measurement of harmful consequences for patients, and those with high workload or financial impact was prioritised, and their evaluation could also involve the use of qualitative methods. Clinical teams were agreed as important to involve at all stages, from identifying potential consequences, prioritising which of those to systematically evaluate, undertaking appropriate evaluation and interpreting the findings. Patients were necessary in identifying consequences, managers in identifying and prioritising, and improvement advisors in interpreting the data.ConclusionThere was consensus that a balanced approach to considering all the consequences of improvement can be achieved by carefully considering predictable trade-offs from the outset and deliberately pausing after implementation to identify any unexpected surprises and make an informed decision as to whether quantitative or qualitative evaluation is needed and feasible. Stakeholders’ roles in in the process of identifying, prioritising, evaluating and interpreting potential consequences should be explicitly addressed within planning and revisited during and after implementation.

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