Yes, the Pain Is All in Your Head
Medscape / By F. Perry Wilson
Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I’m Dr F. Perry Wilson from the Yale School of Medicine.
I’ve been thinking about Dune a lot lately. I think I might be the only person in the world who prefers the bizarre and grotesque David Lynch movie version to the elegantly crafted Villeneuve oeuvre, including David Lynch himself. We lost a real artist with his passing, and a rewatch of Twin Peaks is very much on my to-do list for this winter.
But back to Dune, because one of the pivotal scenes in the novel and both movie versions is one where young Paul Atreides is tested by the Machiavellian Bene Gesserit. Atreides has to put his hand in a box. What is inside? Pain. Ever increasing pain. He must keep his hand in the box, despite all his instincts telling him to pull it out to prove his fundamental humanity — his ability to exercise control over his own instincts.
Because, as the Reverend Mother points out after the ordeal, his hand is unharmed. The pain is a fabrication — pain by nerve induction, she says. There is no physical damage. It’s all in his mind.
And, of course, that’s true of all pain, isn’t it? It’s not your toe that hurts when you stub it. Signals are sent from your toe, up a nerve to your spinal cord, up another nerve to your thalamus, and then onto the cortex to give it context, emotion, intensity, reality. If that chain is broken, pain simply does not occur. It’s all in your mind.
That’s what makes pain so difficult to treat. It is fundamentally subjective. I’ve had patients with wounds that would make me scream for my mother, yet they sat stoically silent while we worked on them. And I’ve had those who, well, seemed like they were hamming it up a bit…
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White House Rescinds Federal Funding Pause
Alliance Daily
On Monday evening, January 27, the Trump Administration’s Office of Management and Budget (OMB) issued guidance pausing Federal Financial Assistance until an appointee could review whether the spending was in-line with Administration priorities. Due to the wording of the memorandum, specifically a footnote specifying that Medicare and Social Security would not be impacted, some media outlets and policymakers raised concerns that Medicaid payments would, in fact, be subject to the payment pause. However, it is important to note that Medicaid, just like Medicare and Social Security, is an entitlement and not discretionary grant funding. The mandatory nature of the funding should prevent it from being paused.
On January 29, the White House Office of Management and Budget (OMB) rescinded its earlier memo that temporarily paused certain federal grants, loans, and financial assistance programs. The initial memo, issued earlier in the week, led to some confusion about its scope and impact. While OMB had clarified that entitlement programs like Medicare and Medicaid were not affected, uncertainties remained regarding which specific grants, loans, or programs would be subject to the freeze and how these determinations would be made.
See our Alliance Daily article for additional details about the pause. This funding pause was temporarily stayed by a federal court until at least February 3, pending further legal proceedings. The Alliance will continue to monitor for any further developments.
Despite the clarification that Medicaid is not subject to the funding freeze, several news outlets are reporting that State Medicaid Officials are unable to access the Medicaid “payment management system.” This could result in some delay in payments; however, it is likely that this is a short-term issue that is tied to the broader payment freeze and is likely to be resolved once the Administration is able to implement exceptions to the halt on disbursement. The Alliance will keep members informed as we learn more about the future of these funds.
The original OMB memo is available HERE. |
RFK Jr.'s First HHS Confirmation Hearing: 7 Healthcare Takeaways
Becker’s Hospital Review
President Donald Trump's HHS secretary pick Robert F. Kennedy Jr. faced more than three hours of questioning by the Senate Finance Committee Jan. 29, the first of two hearings this week in an effort to secure the nomination.
Wednesday's hearing covered a range of health topics, from vaccine mandates to rural hospital closures and plans for Medicare and Medicaid. Mr. Kennedy faces another hearing Jan. 30 with the Senate Committee on Health, Education, Labor and Pensions.
Here are seven takeaways and excerpts from the hearing. A recording of the hearing in full can be found here.
- Medicare and Medicaid: There were nearly 80 mentions of Medicaid, about 40 mentions of Medicare and only five mentions of Medicare Advantage throughout the Senate Finance Committee hearing.
The focus on Medicaid came one day after widespread disruptions to the program's portals and confusion about the program's inclusion in the Trump administration's plans to freeze an array of federal funds, grants and programs. This became a point of contention, with Sen. Ron Wyden, D-Ore., claiming the Trump budget office shut down the federal Medicaid payment portal, while Committee Chairman Sen. Mike Crapo, R-Idaho, countered that reports of disruptions were "proven false overnight," asserting that the portal was fully operational at the time of the hearing.
Sen. Bill Cassidy, MD, R-La., pressed Mr. Kennedy about his plans to reform Medicare and Medicaid, which collectively provide health coverage to more than 150 million Americans. At times, Mr. Kennedy's comments indicated confusion between the two programs. When asked about integrating Medicare and Medicaid for dual-eligible individuals, he inaccurately described Medicaid as being "fully paid for by the federal government," when in fact it is funded jointly by state and federal governments.
Mr. Kennedy suggested that most people are unhappy with federal health programs, and stated several times throughout the hearing that Medicaid premiums and deductibles are too high. A relatively small portion of Medicaid beneficiaries pay premiums and deductibles, however. He did not confirm whether he supports adding work requirements for Medicaid coverage or cuts to the program, though suggested improvements are needed. "I don't have a broad proposal for dismantling the program," Mr. Kennedy said.
A KFF poll conducted in 2023 found strong satisfaction with federal insurance programs, with 91% of Medicare beneficiaries and 83% of Medicaid enrollees rating their coverage positively.
Despite its prominence in previous policy discussions, Medicare Advantage received little attention during the hearing. One of its few mentions came when Mr. Kennedy disclosed that he is personally enrolled in a Medicare Advantage plan. "Most Americans like myself, I'm on Medicare Advantage and I'm very happy with it," he said during an exchange with Mr. Cassidy about Medicare and Medicaid…
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Trump’s Initial Orders Reverse Biden on Health Care Costs, Protections from Discrimination
Stat News / By Sarah Owermohle, John Wilkerson, Rachel Cohrs Zhang, and Lizzy Lawrence
WASHINGTON — President Trump began his second term Monday with a sweeping order aimed at reversing dozens of former President Biden’s top priorities, from regulations aimed at lowering health care costs, to coronavirus outreach, Affordable Care Act expansions, and protections against gender-based discrimination.
The “initial rescissions” order, signed in front of cheering crowds at the Capital One Arena, revokes dozens of Biden administration policies that the new White House called inflammatory, inflationary, and possibly illegal. They include an October 2022 order to test Medicare and Medicaid models that could lower health care costs, an extension, Biden said, of his administration’s signature achievement to negotiate drug prices in the Inflation Reduction Act.
Trump is also peeling back certain Biden administration efforts to expand access to Covid-19 treatments and vaccines, the 2021 formation of a Gender Policy Council, and multiple gender and sex discrimination protections. He ordered federal workers to return to their offices full time, and he froze federal hiring, with some exceptions.
Separately, Trump ordered the U.S. to begin the process of withdrawing from the World Health Organization, which he blames for mishandling the Covid-19 pandemic.
Trump’s broad proclamations, like any president’s executive orders, generally begin the process of regulations and rulemaking at federal agencies. The reversals could meet legal challenges or congressional intervention. Several of Biden’s orders were tied to laws
passed by Congress…
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