most societies/communities have 1 or more agitators, disruptors, false prophets, scammers, traitors, saboteurs and cult leaders

Some believe our country is on the verge of a Civil War, they may be right, but it won’t be a bilateral war like our last Civil War..  Our society has voluntarily divided itself in – for lack of a better description – TRIBES.

The chronic pain community is not all that different from our country of as a whole.

Recently a fellow chronic pain pt who had been advocating for end stage pediatric pts in a large hospital system that has a “no opiate” policy.  All of a sudden the advocated was told that he was no longer permitted to advocate for these end of life pediatric cancer pts.  I suppose that this major hospital system will return to treating these pediatric pts with NSAIDS and Acetaminophen and let them live the rest of their lives in a torturous level of pain.

There are rumors as to who said what and to whom… I am not going to elaborate. However, they know who they are and what was said to cause this to happen.  One can only imagine the deprived mental status of those who have been involved in this.

Some have told me that this tribe of malcontents have monetized chronic pain pts’- personal information  and several other covert processes. I started my blog in 2012 and have tried to motivate and educate chronic pain pts in some ways that they can navigate their way to getting their pain management back.  Some chronic painers have told me that I should charge for my advice.  My Pharmacy degree, license and career has provided for Barb and myself a comfortable retirement.

After this issue with these end of life pediatric pts,  Going forward… I am going to ASK of people that want my advice to make a contribution to one of the four national charities listed below, these are all about THE KIDS… and charities we support.  Maybe in some small way, my advice can help more than just one person/family. 

 

https://www.stjude.org/ St. Jude Children’s Research Hospital – deals with kids dealing with cancer and/or life threatening health issues

https://lovetotherescue.org/ Shriners Hospital – deals with kids, born with “broken bodies” and birth defects

https://rmhc-kentuckiana.org/ Ronald Mc Donald House – this is near us and just a few blocks from a very large regional pediatric hospital ,3 other major hospitals within blocks, one being a teaching hospital and having the only LEVEL ONE TRAUMA CENTERS for 100 miles and part of a medical university and  helps provide housing for families with kids in the hospital

https://t2t.org/ Tunnel to Towers Foundation – helps get handicapable housing for veterans, first responders with “broken bodies” , families with spouse/parent killed in the line of duty and Gold Star Families

 

 

TikTok Is Sued by State of Indiana, Accused of Targeting Young Teens With Adult Content

TikTok Is Sued by State of Indiana, Accused of Targeting Young Teens With Adult Content

https://www.wsj.com/articles/tiktok-is-sued-by-state-of-indiana-accused-of-targeting-young-teens-with-adult-content-11670445960

Suits come as states push back against the platform, citing worries over its influence on children and security concerns related to China

BeReal vs. TikTok: Can ‘Authentic’ Social Media Compete Without Ads?
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BeReal vs. TikTok: Can 'Authentic' Social Media Compete Without Ads?

BeReal vs. TikTok: Can ‘Authentic’ Social Media Compete Without Ads?Play video: BeReal vs. TikTok: Can ‘Authentic’ Social Media Compete Without Ads?
“Authentic” social-media apps like BeReal, Locket and LiveIn have the internet buzzing. WSJ’s Dalvin Brown takes a look at whether they can generate the profits to compete against more-established social media like Instagram, TikTok and Facebook. Illustration: Elizabeth Smelov

Indiana filed a pair of lawsuits against TikTok Wednesday, alleging the platform is deceiving consumers about its content and data security, the latest in a growing number of moves by state officials to push back against the platform’s influence on children and its connections to China.

The state said its lawsuits are the first of their kind against the popular app and its owner, Beijing-based ByteDance Ltd. In one of the complaints, Indiana alleged that TikTok’s algorithm is designed to addict young users and promotes harmful content that isn’t appropriate for them. The lawsuit cites studies and reports linking heavy use of the platform to mental disorders among teenagers, including eating disorders and depression.

“TikTok is actively exposing our children to drug use, alcohol abuse, profanity and sexually explicit material at a young age,” Indiana Attorney General Todd Rokita, a Republican, said. “TikTok is deceiving Indiana parents.”

The second lawsuit alleged that China has the ability to use TikTok’s data to spy on, blackmail and coerce users to serve the country’s national security and economic interests. Both lawsuits seek changes to TikTok’s practices, as well as civil penalties for each alleged violation.

Also Wednesday, Texas Gov. Greg Abbott banned the use of TikTok on government-issued devices, citing concerns that the platform could assist China in the surveillance of Americans and other intelligence work. Other states have started making similar moves in recent weeks.

“This TikTok ban extends to all state-issued cellphones, laptops, tablets, desktop computers, and other devices capable of internet connectivity, and it must be strictly enforced,” Mr. Abbott, a Republican, said in a letter to state agency leaders.

TikTok declined to comment on the litigation but said, “The safety, privacy and security of our community is our top priority. We build youth well-being into our policies, limit features by age, empower parents with tools and resources, and continue to invest in new ways to enjoy content based on age-appropriateness or family comfort. We are also confident that we’re on a path in our negotiations with the U.S. Government to fully satisfy all reasonable U.S. national security concerns.”

In regard to state bans, the company said, “We believe the concerns driving these decisions are largely fueled by misinformation about our company.”

Both Indiana lawsuits alleged that TikTok is violating the state’s consumer-protection laws by deceiving the public about its operations. In the complaint focused on children, the state alleged the app is misrepresenting that it is appropriate for users ages 12 and older. For example, to have a 12-plus rating on Apple‘s App Store, TikTok must represent that references to mature themes, alcohol, drugs and sexual content are “infrequent/mild,” according to the lawsuit.

The state alleged that such material is abundantly available, from videos about hallucinogenic drugs and how to make alcohol taste like candy, to clips about strippers and sexual kinks, including bondage and rape fantasies.

South Dakota is already implementing a partial ban on the service. Last week, Gov. Kristi Noem, a Republican, issued an executive order banning TikTok from state agencies because of national-security concerns. The state tourism department has since deleted its TikTok account, which had 60,000 followers. South Dakota’s public broadcaster did the same. The state’s six public universities are evaluating next steps.

South Dakota was the second state to take such action. Nebraska did so in 2020, when TikTok was less popular than it is today.

On Monday, South Carolina Republican Gov. Henry McMaster said he requested that the state’s department of administration remove TikTok from government devices and block the site. The same day, lawmakers in Arkansas filed legislation for the coming 2023 session that would ban access to TikTok from state-owned or state-leased devices.

Maryland Gov. Larry Hogan, also a Republican, issued on Tuesday what he called an emergency cybersecurity directive to prohibit the use of certain Chinese and Russian developed technology, including TikTok, in the state’s executive branch.

TikTok is accused of violating Indiana’s state consumer-protection laws by misrepresenting that its video-sharing platform is appropriate for users 12 and up.Photo: Jessica Pons for The Wall Street Journal

These measures stop short of prohibiting all citizens from using the app. State employees in these cases can still use TikTok on personal devices. But the state-level actions mirror growing bipartisan worries in Washington, D.C., where lawmakers are debating a national ban.

Leaders from both parties have ratcheted up concerns about the Chinese government’s potential to order TikTok to collect data on American users, and to influence public discourse by controlling what people watch on the app. TikTok has said it has never received such requests and wouldn’t comply if asked.

Former President Donald Trump during his administration threatened to ban TikTok if it wasn’t brought under U.S. ownership. President Biden dropped that after the action was successfully challenged in court. The Biden administration is now negotiating with TikTok over a deal aimed at alleviating national-security concerns.

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Meanwhile, Sen. Marco Rubio (R., Fla.) and other Republicans in Washington have come out publicly in support of a countrywide ban. Sen. Mark Warner (D., Va.) may support a ban too, but hasn’t decided, his spokeswoman said. Several leading lawmakers are threatening hearings over the matter in the Republican-held House next year.

In South Dakota, the ban has sown confusion and consternation. Some state employees say it is unclear if they can run state-affiliated TikTok accounts from personal devices.

The order bans the use of TikTok on “state-owned or state-leased equipment,” specifically prohibiting the app from being downloaded on such devices. It is less clear if the ban includes being able to access TikTok on personal phones through internet providers used in public spaces such as state-funded universities.

Ms. Noem didn’t respond to a request for comment. In issuing the executive order last Tuesday, she said the state had the duty to protect the private data of its citizens and hoped that other states would follow its lead.

The University of South Dakota’s TikTok account has about 24,000 followers, more than double its student population. A social-media analytics company, RivalIQ, ranked USD’s TikTok account as the second most-engaging university-run TikTok presence, behind No. 1 Central Michigan University. RivalIQ said USD stood out for engaging with students and creating whimsical moments around campus.

The South Dakota order inspired Rep. Mike Gallagher (R., Wis.) to ask Wisconsin Gov. Tony Evers to ban TikTok from the state’s government devices, Mr. Gallagher’s spokesman said. In a letter sent Tuesday and signed by other Wisconsin Republican congressmen, Mr. Gallagher urged the Democratic governor to delete his TikTok account, which he has used for campaigning.

Arkansas lawmakers drafted a bill on Monday for the 2023 legislative session to ban TikTok. And while the state’s GOP Gov. Asa Hutchinson hasn’t made any moves to ban the app, Governor-elect Sarah Huckabee Sanders, also a Republican, said she would work to address what she called the predatory actions of China.

“Everything is on the table,” she said. “Including going after TikTok.”

Appeared in the December 8, 2022, print edition as ‘Indiana Sues TikTok, Saying It Aims Adult Content at Teens’.

Looks like LAME DUCK HOUSE OF REPRESENTATIVES – are trying to expedite another 1.5 TRILLION spending

 Our country is now some 31+ Trillion dollars in debt.  When Obama came to office Jan, 2009, we were 9 trillion in debt, When Trump came to office we were abt 20 trillion in debt, when Biden came to office we were abt 25 trillion in debt and today< 2 yrs later we are 31+ trillion in debt. In 233 years since our founding we amassed 9 trillion in debt, paying for major wars, the civil war, WW-1, WW-2, Korea, Vietnam and numerous social wars like the war on poverty and the war on drugs. Nearly 20% of our ENTIRE NATIONAL DEBT has been amassed in < 2 yrs. Now Pelosi and the House is trying – in the dark of the night – to add almost another 5% to our national debt… in either BUM’S RUSH or a HAIL MARY PASS… while the House is a LAME DUCK… because the <D> will no longer be in the majority in the house in another EIGHT WEEKS.  The median age of the members of Congress is 60 y/o, 50% of the Congress probably won’t directly have to help pay all this debt down. It is going to be a financial albatross around the neck of our kids and Grand kids

Common Treatments for Knee Osteoarthritis May Be Harmful

Common Treatments for Knee Osteoarthritis May Be Harmful

— Steroids and NSAIDs reduced pain but not disease course, studies showed

https://www.medpagetoday.com/meetingcoverage/rsna/101987

CHICAGO — Common treatments for people living with osteoarthritis of the knee — such as steroid injections or anti-inflammatory agents — reduced pain, but were also associated with increasing damage to the joints, researchers suggested in a series of studies presented here at the Radiological Society of North America annual meeting.

In one study with 4 years of follow-up, regular users of non-steroidal anti-inflammatory drugs (NSAIDs) for moderate to severe osteoarthritis of the knee showed significantly greater 3T MRI signal intensities, indicating worsening osteoarthritis, compared with individuals who used NSAIDs episodically, reported Johanna Luitjens, MD, a postdoctoral scholar in radiology at the University of California San Francisco (UCSF).

In a second study, Azad Darbandi, MS, a medical student/researcher at the Chicago Medical School of Rosalind Franklin University of Medicine and Science, reported that when patients were randomized to receive steroid injections, injections of hyaluronic acid, or no treatment, after 2 years of observation a key marker of knee health — medial joint space narrowing — worsened significantly among those getting steroids compared with controls. There was no statistically significant difference in that marker between patients getting hyaluronic acid injections and controls.

And in a third study, which also compared steroids, hyaluronic acid injections, and matched control subjects who received no treatment, the results again showed worsening with steroids after 2 years of follow-up, reported Upasana Upadhyay Bharadwaj, MBBS, a postdoctoral scholar in the Department of Radiology and Biomedical Imaging at UCSF.

Luca Sconfienza, MD, PhD, head of the Unit of Diagnostic and Interventional Radiology at the University of Milan in Italy, told MedPage Today: “We have been aware of this situation in the medical literature — that steroids may have long-term harm, but these studies confirm this with higher evidence.”

“The reason for steroids to be potentially dangerous for the joint is twofold,” said Sconfienza, who was not involved with the study. “On the one hand, the steroids may directly damage the joint by weakening the bone which is under the cartilage. The second thing is that steroids are very powerful as painkillers, and therefore after an injection the patient doesn’t feel pain anymore and then can resume their activity even though the joint is not perfect. This can further progress the damage.”

He also noted that the formulations of the steroids used in injections can remain in the joint for long periods of time, and may attach to crystals and deposit them inside the cartilage. Sconfienza said that steroids may be useful in controlling pain in cases where patients are scheduled to undergo procedures for knee prostheses with a relatively short period of time.

“Hyaluronic acid injections don’t do this, because what the injections are doing is to supplement hyaluronic acid in the body. Hyaluronic acid improves the nutrition of the cartilage by hydrating the joint,” he explained. “The viscous fluid also helps to lubricate the joint, and it has a mechanical effect — it acts like a shock absorber, and it also induces the body to produce endogenous hyaluronic acid. Hyaluronic acid cannot heal damage to the joints, but it may be able to slow the damage and preserve what has not been damaged.”

NSAIDs

In the study presented by Luitjens, 277 participants from the Osteoarthritis Initiative (OAI) cohort taking NSAIDs were compared with 793 control participants who were not treated with NSAIDs. Both groups underwent 3T MRI of the knee initially and after 4 years. Images were scored for biomarkers of inflammation.

OAI is a multicenter, longitudinal, observational study of nearly 5,000 participants with knee osteoarthritis currently in its 14th year of follow-up.

The results showed no long-term benefit of NSAID use, Luitjens reported. Joint inflammation and cartilage quality were worse at baseline in the participants taking NSAIDs, compared with the control group, and worsened at 4-year follow-up, she said.

“On the one hand, the anti-inflammatory effect that normally comes from NSAIDs may not effectively prevent synovitis, with progressive degenerative change resulting in worsening of synovitis over time,” Luitjens noted in her presentation. “On the other hand, patients who have synovitis and are taking pain-relieving medications may be physically more active due to pain relief, which could potentially lead to worsening of synovitis, although we adjusted for physical activity in our model.”

Sconfienza noted that while NSAIDs do not have a direct effect on the joint, they do have the ability to relieve pain, so like with steroid injections, patients may continue activities and worsen their condition.

Steroid Injections

Darbandi and colleagues also selected patients from the OAI database, enrolling 50 patients who received corticosteroid injections, 50 who received hyaluronic acid injections, and 50 who were not injected over a 36-month time period. The groups were matched by sex, body mass index (BMI), and x-ray findings.

Patients underwent x-ray imaging of the knee at baseline and 2 years later. The researchers analyzed the images, including joint space narrowing, formation of bone spurs, and bone thickening around the knee cartilage.

“Even though imaging findings for all patients were similar at baseline, the imaging hallmarks of osteoarthritis were worse 2 years later in patients who received corticosteroid injections compared to patients who received hyaluronic acid injections or no treatment at all,” Darbandi said. “The results suggest that hyaluronic acid injections should be further explored for the management of knee osteoarthritis symptoms, and that steroid injections should be utilized with more caution.”

Upadhyay Bharadwaj also accessed patients from the OAI. Her team’s study included 210 patients; 44 were injected with corticosteroids, and 26 with hyaluronic acid. The treatment and control groups were matched by age, sex, BMI, pain and physical activity scores, and severity of disease.

MRI was performed on all patients at the time of the injection and 2 years before and after. Corticosteroid knee injections were significantly associated with the overall progression of osteoarthritis in the knee, specifically in the lateral meniscus, lateral cartilage, and medial cartilage, Upadhyay Bharadwaj reported.

Hyaluronic acid knee injections were not significantly associated with the progression of osteoarthritis in the knee, she added. Compared with the control group, the group who received hyaluronic injections showed a decreased progression of osteoarthritis, specifically in bone marrow lesions.

FBI, Big Tech, Big Media: Partners in collusion: Elon Musk appears to have the SMOKING GUN

FBI, Big Tech, Big Media: Partners in collusion

https://nypost.com/2022/12/03/fbi-big-tech-big-media-partners-in-collusion/

The bold release by Elon Musk of Twitter files on how and why employees blocked The Post’s 2020 bombshell on Hunter Biden’s laptop marks a defining moment in modern American history. The disturbing details of arrogance and ignorance revealed the so-called geniuses pulling the technology levers to be as supernatural as the man behind the curtain in “The Wizard of Oz.” 

The deflating reaction in both is the same: Is that all there is? 

In this case, no, not by a long shot. For Musk’s revelations must be the start of a national campaign to expose the entire picture of the unholy collusion between partisan government censors and Big Tech. 

Consider that Facebook’s Mark Zuckerberg recently admitted to podcaster Joe Rogan the FBI warned the company in the fall of 2020 to watch out for Russian disinformation schemes. 

“The FBI came to us, some folks on our team, and was like ‘hey, just so you know, you should be on high alert. We thought there was a lot of Russian propaganda in the 2016 election, we have it on notice that basically there’s about to be some kind of dump that’s similar to that.’” 

Zuckerberg said that by way of explaining why Facebook limited and in some cases blocked users from sharing The Post’s laptop report. 

Elon Musk has released files that revealed Twitter suppressed The Post’s reporting on Hunter Biden’s laptop.
Patrick Pleul/picture alliance via Getty Images
Musk appears determined to unveil collusion between partisan government censors and Big Tech.
SOPA Images/LightRocket via Getty Images

Twitter obviously got the same warning, which almost certainly involved James Baker, a former FBI general counsel who was involved in investigating the Trump campaign in 2016 and now holds a similar position at Twitter. Naturally, the released files show he was without remorse or doubt in urging repression of The Post’s story. 

Moreover, as Intercept reporter Lee Fang has detailed and as a former Twitter official confirmed, the FBI held weekly meetings in Silicon Valley with tech officials about policing disinformation. Of course, their definition of disinformation was so broad as to include virtually anything that made Joe Biden or Democrats look bad

But knowing all that, it still would be naive to think we know the whole story. For example, we don’t know who in the FBI was running the censoring operation, whether it was a rogue outfit or came from the top. Nor do we know if the operation continues now. 

We do know the FBI had Hunter Biden’s laptop for a year before The Post started to reveal the contents. You don’t have to be a cynic to wonder if the agents waved Facebook and Twitter off the story because they knew it was true. 


Catch up on Twitter’s censorship of the Post’s Hunter Biden laptop story


There is also a good chance the censorship effort involved other federal agencies. Fang and his Intercept colleague Ken Klippenstein reported in October that documents and court testimony show the Department of Homeland Security has “an expansive effort . . . to influence tech platforms.” 

Getting to the bottom of this collusion to thwart the First Amendment and mislead the public is a job custom-made for the hungry young Turks who will head the investigating committees of the new GOP House majority. 

But hold on — there remains another missing piece of the puzzle: the bell cows of the mainstream media. 

They, too, avoided touching the initial Hunter scoop — except to try to knock it down. Why? 

Mark Zuckerberg admitted the FBI warned Facebook to watch out for Russian disinformation schemes.
AP

The New York Times, for example, waited four days before printing a lazy article that tried to dermine the story by saying some Post newsroom employees were uncertain of its veracity. It’s shocking even now to realize Times reporters had access to Tony Bobulinski, Hunter Biden’s former partner, but refused to print that he confirmed the authenticity of the email naming Joe Biden as “the big guy” slated for a secret 10% cut in a joint venture with a Chinese conglomerate. 

There are two basic possibilities for explaining media complicity. First, perhaps the Times, Washington Post, CNN and others, all of whom are often favored with partisan leaks from the Justice Department, got misled by the FBI into thinking the story was bogus. 

Did Big Guy profit? 

Indeed, since then, they and other media laptop deniers have authenticated key contents, though in a scattered fashion that has left unexplored the central issue of Joe Biden’s role. 

Did the president of the United States profit from the selling of access to him, and is he compromised in dealing with foreign powers? No one in Big Media seems to care. 

The other possibility for media complicity is they might have gone along as a favor to their FBI minders because it fit their shared agenda to defeat Trump and elect Biden. 

After all, they were teammates in a similar effort in 2016, the Russia hoax to try to elect Hillary Clinton. That one failed and they were determined to succeed this time. So better not look too closely at Biden. 

The FBI had Hunter Biden’s laptop for a year before The Post started to reveal the contents.

Whatever the reason, we can say with absolute certainty the unholy collusion has three legs: the government, Big Tech and Big Media. 

Another unresolved piece of that alliance is the cabal of 51 former intelligence officers who signed a letter saying the laptop had “all the earmarks” of Russian disinformation. None had seen the laptop, but their letter became the story the media seized on and offered Joe Biden a lifeline in his next debate with Trump. Some signers still defend the letter, and not one has apologized for misleading the public. 

This is hardly a matter fit only for historians, especially not when most of the media covered Musk’s release the same way they covered the initial laptop story. They ignored it. 

That seems odd, until you consider they might have feared their role in suppressing the original story would be outed by the documents. I would call it a guilty conscience if these Dem handmaidens actually had a conscience, but that went overboard with all their standards the minute Trump came down the escalator. 

To make matters infinitely worse, the concentrated power of this collusion is unlike anything ever seen in our nation. 

The alliance leaders have become the purveyors of the only acceptable opinions and enforcers against dissenters. Their domain ranges from print to broadcast to social media and they aim to dictate what 300 million Americans can say and do on everything from COVID to race to the environment. Their criticism rattles board rooms, scholars and even athletes. 

When they take a united position on a matter, it can be difficult to find or hear an alternative. When they block news of an event or limit its spread, it is almost as if the event didn’t happen. 

And lest you forget their power, remember that Joe Biden was elected president because millions of voters were not allowed to learn The Post had unmasked his deep connections to his son’s corrupt schemes. 

The people who did that are not threats to democracy. They are its destroyers. 

This is a “golden oldie” from 7 years ago – now seven times the opioid OD/POISONINGS every year

This graphic is from 2014 and since 2016 CDC opiate dosing guidelines there is now ONLY ABOUT SEVEN TIMES OPIOID   OD/POISONING

Opinion: Medicare Advantage? More like Medicare Disadvantage

Opinion: Medicare Advantage? More like Medicare Disadvantage

https://www.washingtonpost.com/opinions/2022/11/30/medicare-advantage-seniors-health-care/

When the annual enrollment period for Medicare ends on Dec. 7, analysts expect that, for the first time, more seniors will receive their 2023 health-care coverage from Medicare Advantage than the traditional program.

That’s not a good thing for either elderly Americans or federal coffers. And while seniors are well advised to approach these plans with caution, we should all be paying attention to what’s going on.

Medicare Advantage plans, which are private insurance plans for seniors paid for with federal dollars, originated as a government savings strategy, on the theory that the private sector could improve on government performance at a lower cost. But over the past two decades, it has become clear that Medicare Advantage does not result in improved care for less money. Instead, it will come as no surprise to Americans familiar with the health insurance industry that insurers found a way to turn it into yet another profit center, while putting bureaucratic roadblocks in the way of patients.

The problems are so pronounced that Reps. Ro Khanna (D-Calif.) and Mark Pocan (D-Wis.) — both advocates of Medicare-for-all — recently introduced little-noticed legislation that would ban private insurers from using the word “Medicare” in their names or advertisements.

“Medicare implies universal coverage. You can go to any doctor, you can get your claims reimbursed,” Khanna told me. “You shouldn’t be able to appropriate the trust and faith people have in Medicare to sell a private product for personal profit that doesn’t have the same rules.”

Insurers in Medicare Advantage are paid a flat fee by the government, based on the enrollee’s health. These insurance companies often want their members to appear as ill as possible — at least as far as the Feds are concerned. They might “upcode,” in doctor speak, maximizing the amount of money they receive. (The federal government calls that practice “fraud” and has sued several of the largest insurers in federal court for it, including Anthem and Cigna, in cases still ongoing.)

As a result, multiple studies have found that seniors on Medicare Advantage cost the government more than those in the traditional program, exactly the opposite of what is intended. A government advisory panel recently estimated the overpayment was $12 billion in 2020.

This flood of money is fattening the bottom line of the health insurance giants even as they’re increasing pressure on the Medicare Hospital Insurance Trust Fund, which is projected to run out of funds in 2026. And Congress is loath to crack down, thanks to the combined power of health insurance lobbying and the program’s popularity with cash-strapped seniors.

Meanwhile, it’s not like seniors are getting better care for the money the federal government is spending — in fact, it can be worse. A research brief posted on the National Bureau of Economic Research website found picking the right plan could literally be a matter of life or death.

It’s “widespread” for Medicare Advantage plans to initially deny coverage for doctor-advised care, according to a report released this year by the Department of Health and Human Services. Plans erect roadblocks to treatment by demanding prior authorization for services traditional Medicare covers without questions. Plans can — and sometimes do — refuse to cover necessary prescription drugs. There are increasing complaints that private insurers rush patients out of skilled nursing and rehab facilities.

So why do people sign up? Traditional Medicare is not simple. It’s a complicated stew of different parts — for hospitalization, for doctors and for prescriptions. Seniors might feel they have to purchase supplemental coverage known as Medigap, which helps cover the co-pays and deductibles that Medicare does not cover.

Many Medicare Advantage plans eliminate or significantly reduce these out-of-pocket costs, as long as beneficiaries stay within their approved network. The private policies also frequently offer vision and dental coverage, not to mention gym memberships, something not on offer in Medicare itself.

These extras have an appeal. But a streamlined plan that can end up costing seniors more is no bargain — and Medicare Advantage sometimes relies on deceptive marketing to get them in the door. A report issued earlier this year by the Senate Finance Committee’s Democratic majority found that unscrupulous insurance agents — who are paid significantly more to sign up seniors for Medicare Advantage plans than for the traditional offering — will sometimes be misleading about networks and benefits, and even pursue seniors suffering from dementia. Ads featuring celebrities claim the plans will put more money in seniors’ pockets.

Medicare Advantage defenders are quick to point out that surveys show their enrollees are more likely to receive such preventive health and wellness services as monitoring of high blood pressure than those with the traditional program. But it’s usually when someone gets seriously ill that Medicare Advantage’s weaknesses become clear.

What would be best would be to fix Medicare, to make it more generous to enrollees and less generous to insurers. That’s unlikely to happen. But we can at least insist on calling it out for what it is: Try Medicare Disadvantage.

This is getting SERIOUS: State of New Jersey On Trial In India

State of New Jersey On Trial In India

As American corporations increasingly seek entry to India’s 1.4. billion-person market, an American state, that of the State of New Jersey, is being subjected to the jurisdiction and authority of an Indian Court, on charges of aiding and abetting policies of racial discrimination against successful Indian American physicians.

On April 23, 2022, Indian physician, Richard Arjun Kaul, did, through counsel, file suit (Kaul v Allstate/State of NJ/Christie – K11-5) against the Indian subsidiary of Allstate Insurance Company, the State of New Jersey and its ex-governor, Christopher J. Christie, in which Kaul claims, amongst other things:

“It is the case of the Plaintiff that the Defendants, led by the Defendant No. 1 (Allstate Solutions Private Limited) had lately adopted a practice of racial discrimination and conspiracy against Indian physicians, Doctors, Medical Professionals and Healthcare providers. The Defendants collude and conspire at international level and inter-alia use the internet and other media platforms to propagate adverse and negative narratives against successful Medical Professionals of Indian origin and cause excessive damage to their professional and social reputation … The Plaintiff has also expressed a reasonable threat to his life from the colluding Defendants.”

 

On October 12, 2022, the Indian Court advanced the case, as all Defendants had been officially served, and did schedule a court hearing on December 15, 2022.

The principal purpose of K11-5 is to expose the pernicious injustices perpetrated against Indian physicians in America, many of whom continue to languish in American jails, and to hold financially accountable those American corporations responsible for these crimes against humanity. These entities cannot expect to do business in India, while simultaneously executing programs of mass incarceration of Indians in America.

Hopefully this little girl will be able to have another Xmas with her family ?


We did well for this little lady today! ❤️ It’s not over yet and we still have a road ahead of us! Over a year ago this child was 7 years old and amazed us with her knowledge of Plato, Socrates, Warner, Twain, Hemingway, Orwell, and Dickson! She plays classic piano Beethoven, Chopin, Amadeus! Now she’s 9 a few days ago and even smarter! She also has terminal brain cancer and is in pain 24/7! In her short breaks of relief she still finds time to be brilliant! This little girl is on hospices and can’t see her 1/2 brother and sister because of her immune system is compromised. She’s smart enough to realize how screwed the system is for sure. She’s an amazing young lady who’s ready for what lies after this life is over. She also deserved to be treated appropriately and the medical system and the government have failed her miserably! We need to do better in America for these children! They shouldn’t need someone to fight and complain to a doctor no older than my kids to prescribe pain medication because cancer decided to pick on her! Sad and confused I bet most 9 year old don’t understand why they don’t get treated properly! Unfortunately she understands all to well. It’s hard not to want to wish this fate of terminal cancer on the ones who inflicted these awful laws and guidelines in the first place. Something tell me the same people making these laws get treated just fine. Senators and Congressman get treated just fine…. While a 9 year old suffers with a life ending illness she couldn’t have foreseen or prevented! Damn shame! Our Country best open their eyes soon! We have to stop torturing pain patients and especially kids! 😫

 

Walgreens seeks to dismiss state regulators’ complaints on closures, insurance billing

I am surprised that BOP did not drag the Pharmacy manager (PIC) into this, unless he/she had resigned, because technically they are responsible to the BOP for the legal operation of the Rx dept. Walgreens has a permit to have a Rx dept – as long as their is a pharmacist that is appointed to be PIC. I know that the Walgreens closest to us, that was a 8 AM to midnight hours of operation.  That store had 3 pharmacists and either they all walked out the same day or in the same week. They parked cars in the drive thru and my understanding is that the Rx dept would open when they could find a single pharmacist and technician to work – maybe as little as 5 hrs… and when their shift was over… the next time that the Rx dept would be staffed again… there was no/little certainty.  From what I was told this “white coat flu” was nearly epidemic in the greater Louisville, KY area in particularly in the major chain pharmacy stores. In the 20 yrs that we had our independent pharmacy, there one only ONE DAY that the pharmacy did not get opened. Having a 20 ” snow  ( year’s worth of snow in < 24 hrs) and 30-40 MPH winds caused a lot of roads to become impassible.  Out where we live in the county, they have to bring BULLDOZERS out to clear our roads.  There was a section of the road that we lived on, was drifted some 12′-15′ deep. My little ’73 Pinto station wagon was not up to the task.

Walgreens seeks to dismiss state regulators’ complaints on closures, insurance billing

https://www.benningtonbanner.com/local-news/walgreens-seeks-to-dismiss-state-regulators-complaints-on-closures-insurance-billing/article_7972cb54-24b3-11ed-be0f-ebeae1c5f7ed.html

MONTPELIER — Walgreens Co., in its response to a complaint by the state about the unplanned closures of pharmacies and the effects on customers, has asked the Vermont Board of Pharmacy to dismiss the complaint entirely.

It’s the first of what’s likely to be an avalanche of legal motions in what is now a quasi-judicial process. Until and unless the Vermont Office of Professional Regulation and Walgreens settle the allegations, the Board of Pharmacy must decide whether to discipline Walgreens for a laundry list of alleged violations at its 32 locations across the state, including in Brattleboro, Bellows Falls, Wilmington, Bennington and Manchester. That could include sanctions up to and including loss of license.

Walgreens, which had been given an additional month to respond to the allegations, replied with a motion to dismiss the complaint “with prejudice” — that is, preventing them from being refiled — and a motion to stay its deadline to respond. The pharmacy chain originally faced a July 20 deadline, which was pushed forward to Aug. 20 at Walgreens’ request.

In its motion to dismiss, Walgreens said the state had overreached in its assertion that many of the company’s stores had not met professional standards, that the statute governing the operation of pharmacies is vague, and that the allegations violate Walgreens’ due process rights. The motion was filed by White River Junction attorney P. Scott McGee on behalf of Washington, D.C.-based Quarles and Brady LLP.

“In the context of the uncertainty and instability caused by the pandemic, [Walgreens] provided reasonable care to its patients while grappling with contingencies that impacted pharmacists nationwide. Despite this, [the Vermont Office of Professional Regulation] is attempting to unfairly hold [Walgreens] to a nearly impossible standard of care under the circumstances and seeks to discipline [Walgreens] for unprecedented circumstances,” the motion said.

It further claims that the state “unilaterally — and without notice — determined that [Walgreens’] pharmacy closures are in violation of law.”

While the state acknowledges the closures were unexpected and temporary, “even though [Walgreens] pharmacies were mostly open and serving the public during a pandemic, [the Office of Professional Regulation] unreasonably seeks to penalize [Walgreens] for unexpected closures,” the motion argues.

The initial 40-page complaint alleges that the company unreasonably restricted consumer access to medication and hardship to customers by closing stores without notice; that it failed to comply with federal and state professional standards; and that it engaged in “conduct of a character likely to deceive, defraud or harm the public.”

The complaint further alleges Walgreens “failed to comply on an egregious scale” with state law by operating stores without a pharmacist-manager present, including locations in Bellows Falls and on Canal Street in Brattleboro, and did not identify or address working conditions that jeopardized patient care.

The state complaint also alleges that Walgreens’ computer system continued to order refills and charge customers’ insurance for medications they could not access because the store was closed. That led to customers scrambling to find another pharmacy that would fill the script — and in some cases, led to customers paying out of pocket at significant expense.

Incidents in Southern Vermont included unexpected closures in Brattleboro and Manchester that led to customers driving significant distance for prescriptions; insurance billing for medications that were not available because of the closures, meaning consumers had to pay out of pocket; and continued billing for prescriptions in Manchester, despite that pharmacy being closed after a fire.

The state’s response to the motion to dismiss is expected to be filed next week, according to S. Lauren Hibbert, director of the Office of Professional Regulation.

The state did respond to Walgreens’ motion for a stay on its response, saying it’s neither allowed by administrative rules nor warranted.

“Walgreens has already had additional time, almost eight weeks, to, in its own words, ‘determine the facts and provide a full and accurate response to each of the charges,’” attorney Jennifer B. Colin said on behalf of the Office of Professional Regulation. “The filing of Walgreens’ answer has already been delayed to allow respondents adequate time to gather facts and respond substantively to each of the specifications.”

Despite all the legal motions, the complaint is not before a civil or criminal court. Rather, it’s up to the Board of Pharmacy to act as jury in the matter, with a judge hired for the proceedings and administrative law officers appointed to assist the board. Retired Washington County Probate Judge George Belcher has been retained as the presiding officer in the matter.

The state Board of Pharmacy has eight members, who are appointed by the governor’s office.

This Couple Died by Suicide After the DEA Shut Down Their Pain Doctor

This Couple Died by Suicide After the DEA Shut Down Their Pain Doctor

https://www.vice.com/en/article/wxnyb9/dea-fentanyl-doctor-patient-suicide

“There are millions of chronic pain patients suffering just like me,” Danny Elliott wrote before ending his life. “Nobody cares.”
Danny and Gretchen Elliott, seen in an undated photograph.
Danny and Gretchen Elliott, seen in an undated photograph. Provided photo.

It was a Tuesday in early November when federal agents from the Drug Enforcement Administration paid a visit to the office of Dr. David Bockoff, a chronic pain specialist in Beverly Hills. It wasn’t a Hollywood-style raid—there were no shots fired or flash-bang grenades deployed—but the agents left behind a slip of paper that, according to those close to the doctor’s patients, had consequences just as deadly as any shootout.

On Nov. 1, the DEA suspended Bockoff’s ability to prescribe controlled substances, including powerful opioids such as fentanyl. While illicit fentanyl smuggled across the border by Mexican cartels has fueled a record surge in overdoses in recent years, doctors still use the pharmaceutical version during surgeries and for soothing the most severe types of pain. But amid efforts to shut down so-called “pill mills” and other illegal operations, advocates for pain patients say the DEA has gone too far, overcorrecting to the point that people with legitimate needs are blocked from obtaining the medication they need to live without suffering. 

One of Bockoff’s patients who relied on fentanyl was Danny Elliott, a 61-year-old native of Warner Robins, Georgia. In March 1991, Elliott was nearly electrocuted to death when a water pump he was using to drain a flooded basement malfunctioned, sending high-voltage shocks through his body for nearly 15 minutes until his father intervened to save his life. Elliott was never the same after the accident, which left him with debilitating, migraine-like headaches. Once a class president and basketball star in high school, he found himself spending days on end in a darkened bedroom, unable to bear sunlight or the sound of the outdoors. 

“I have these sensations like my brain is loose inside my skull,” Elliott told me in 2019, when I first interviewed him for the VICE News podcast series Painkiller. “If I turn my head too quickly, left or right, it feels like my brain sloshes around. Literally my eyes burn deep into my skull. My eyes hurt so bad that it hurts to blink.”

After years of trying alternative pain treatments such as acupuncture, along with other types of opioids, around 2002 Elliott found a doctor who prescribed fentanyl, which gave him some relief. But keeping a doctor proved nearly impossible amid the ongoing federal crackdown on opioids. Bockoff, Elliott said, was his third doctor to be shut down by the DEA since 2018. As Elliott described it, each transition meant weeks or months of desperate scrambling to find a replacement, plus excruciating withdrawals due to his physical dependence on opioids, followed by the return of that burning eyeball pit of despair.

After the DEA visited Bockoff on Nov. 1, Elliott posted on Twitter: “Even though I knew this would happen at some point, I’m stunned. Now I can’t get ANY pain relief as a #cpp [chronic pain patient.] So I’m officially done w/ the US HC [healthcare] system.”

Privately, Elliott and his wife Gretchen, 59, were frantically trying to find another doctor. He sent a text to his brother, Jim Elliott, saying he was “praying for help but not expecting it.” 

Jim, a former city attorney for Warner Robins who is now in private practice, was traveling when he received his brother’s message. They made plans to talk later in the week, after Danny had visited a local physician for a consultation. In subsequent messages, Danny told Jim that Gretchen had reached out to more than a dozen doctors. Each one had responded saying they would not take him as a patient.

Jim recalled sensing in Danny “a level of desperation I hadn’t seen before.” Then, on the morning of Nov. 8, he woke up to find what he called “a suicide email” from his brother. Jim called the local police department in Warner Robins to request a welfare check. The officers arrived a few minutes before 8:30 a.m. to find both Danny and Gretchen dead inside their home. 

A police report obtained by VICE News lists a handgun as the only weapon found at the scene. Warner Robins police said additional records could not be released because the case is “still active.” The department issued a press release calling the deaths a “dual suicide.” 

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Jim shared a portion of a note that Danny left behind: “I just can’t live with this severe pain anymore, and I don’t have any options left,” he wrote. “There are millions of chronic pain patients suffering just like me because of the DEA. Nobody cares. I haven’t lived without some sort of pain and pain relief meds since 1998, and I considered suicide back then. My wife called 17 doctors this past week looking for some kind of help. The only doctor who agreed to see me refused to help in any way. What am I supposed to do?”

At a joint funeral for Danny and Gretchen Elliott on Nov. 14 in Warner Robins, mourners filled a mortuary chapel to overflow capacity. Eulogies recalled a couple completely devoted to each other. They were doting cat owners, dedicated fans of Georgia Tech and Atlanta sports teams, and devout Christians, even as Danny’s chronic pain increasingly left him unable to attend church. In photos, the Elliotts radiate happiness with their smiles. But their lives were marred by pain: Gretchen was a breast cancer survivor. She married Danny in 1996, well after his accident, signing up to be his caregiver as part of their life partnership.

“It was a Romeo and Juliet story. They didn’t want to live without each other,” said Chuck Shaheen, Danny’s friend since childhood and Warner Robins’ former mayor. “I understand the DEA and other law enforcement, they investigate and then act. But what do they do with the patients that are no longer able to have treatment?”

Shaheen and Danny both worked in years past for Johnson & Johnson, which is among the companies sued for allegedly causing the opioid crisis. Shaheen was also previously a salesperson for Purdue Pharma, the maker of OxyContin, another company blamed for spreading addiction. But Shaheen said Danny was not among those chasing a high—he, like others with severe chronic pain, was just seeking a semblance of normalcy.

“They’re not doctor shopping,” Shaheen said. “They’re not trying to escalate their dose. They’re trying to function.”

Danny told me in 2019 that the relief he obtained from fentanyl didn’t make him feel euphoric or even completely pain free. He was using fentanyl patches and lozenges designed for people with terminal cancer pain, at extremely high doses that raised eyebrows whenever he was forced to switch doctors. But it was the only thing that worked for him.

“I call it turning the volume of my pain down from an eight or nine or even 10 sometimes to a six or a five,” he said. “The pain doesn’t get much lower than that, but for me, that’s almost pain free. It was the happiest thing I’ve ever experienced in my life.”

There are millions of chronic pain patients suffering just like me because of the DEA. Nobody cares

Gretchen’s brother, Eric Welde, choked up as he spoke with VICE News at the funeral about his perspective on the family’s loss: “In my mind, what the DEA is essentially doing is telling a diabetic who’s been on insulin for 20 years that they no longer need insulin and they should be cured. They just don’t understand what chronic pain is.”

So far, no criminal charges have been filed against Bockoff. In response to an inquiry from VICE News about the deaths of Danny and Gretchen Elliott, the doctor emailed a statement that said: “I am unable to participate in an interview except to say: Their blood is on the DEA’s hands.”

The DEA responded to a list of questions about Bockoff and the Elliotts’ suicides with an email saying Bockoff received what’s known as an “Immediate Suspension Order,” which according to public records is warranted in cases where the agency believes the prescriber poses “an imminent danger to public health or safety.” The DEA said local public health partners were notified in advance to coordinate under a federal program designed to mitigate overdose risks among patients who lose access to doctors. The agency offered no further comment.

Data on suicides by chronic pain patients is scarce, but experts who study these cases estimate that hundreds—perhaps thousands—of Americans have taken their own lives in the aftermath of losing access to prescription opioids and other medications. Some cases have occasionally made news, like a woman in Tennessee who was arrested for buying a gun to assist her husband’s suicide after his doctor abruptly cut down on his medication used to treat back pain.

Starting around 2016, a backlash to prescribing opioids began to spread across the U.S. healthcare system, sparked in part by guidance from the Centers for Disease Control and Prevention (CDC) that prompted scrutiny of patients on doses equivalent to over 90 milligrams of morphine per day.

The National Committee for Quality Assurance, which develops quality metrics for the healthcare industry, has implemented its own 90 milligram threshold, and patients over that baseline count as receiving “poor care,” regardless of their dose history. In practice that means doctors have strong incentives to reduce the dosage, even for someone like Elliott, who had been taking the same prescription for years, and even if it’s not necessarily in the best interests of the patient.

Since 2018, the CDC has developed an initiative called the Opioid Rapid Response Program, which is supposed to assist when doctors lose the ability to prescribe pain medication. Stephanie Rubel, a health scientist in CDC’s Injury Center who leads the program, said when the DEA visited Bockoff’s office, “a healthcare professional was onsite in case any patients arrived for their appointments.”

Rubel, in a statement sent via the CDC’s press office, said everyone from the county health department to Medicare providers were alerted about the DEA’s action against Bockoff. But Rubel also noted that the CDC program “does not provide direct assistance to patients affected by a disruption, including referrals or medical care.” In fact, the only help that patients like Elliott received was a flier with a list of local emergency rooms they could visit if—or when—they started experiencing withdrawal.

“Any loss of life due to suicide is one too many,” Rubel said. “This case is heartbreaking and emblematic of the trauma, pain and danger many patients face when these disruptions occur and is why ORRP [Opioid Rapid Resposne Program] has been developed to help prepare state and local jurisdictions to respond when disruptions in care occur.”

Dr. Stefan Kertesz, a professor at the University of Alabama at Birmingham Heersink School of Medicine, had been acquainted with Danny since 2018, meeting him in another moment of crisis. Danny’s doctor at the time had just been arrested by the DEA, and Kertesz, who conducts research and advocates on behalf of chronic pain patients, stepped in to help. It was difficult, Kertesz told VICE News, because “the doses he was on were orders of magnitude higher than most doctors are familiar with.”

What the DEA is essentially doing is telling a diabetic who’s been on insulin for 20 years that they no longer need insulin and they should be cured

Danny ultimately found another doctor but was forced to change once more before landing with Bockoff in Beverly Hills. Kertesz cautioned that he was not familiar with the details of Bockoff’s case, but said the doctor was known for treating “opioid refugees” who’d been turned away from other physicians. Danny and his wife would fly from Georgia to Los Angeles for appointments, and other patients with unique circumstances came from around the country.

Bockoff had practiced medicine in California for 53 years with no record of disciplinary action or complaints with the state medical board, according to the Pain News Network, which reported the DEA searched the doctor’s office about a year ago but did not take patient records. 

Asked about the DEA’s handling of the Bockoff case, Kertesz replied: “Honestly, it seemed to me like bombing a village. It could be they think they’re getting the bad guy, but it’s not a precision munition. Whoever is launching the bomb has to consider the collateral damage.” 

Clinical research on chronic pain patients is complicated, Kertesz said, but “a lengthy series of studies confirm that there is a strong association between opioid reduction or stoppage and suicide.” While reducing opioid intake can be helpful for some people, he said, Danny and other longtime users with medical needs should not be forced to go cold turkey.

“Even if you believe the doctors did something wrong, I can’t find somebody who believes all those patients should die,” Kertesz said. “And if we agree they shouldn’t all die, then why would we act in such a way that we know we’re going to massively increase their risk of death?”

Another former Bockoff patient was Kristen Ogden’s husband Louis. Much like Gretchen Elliott, Ogden has supported her husband for years as he’s battled chronic pain caused by a rare condition similar to fibromyalgia. And like the Elliotts, the Odgens have dealt with the fallout of DEA actions that triggered desperate searches for new doctors.

The Ogdens live in Virginia and had just landed in California for a doctor’s appointment when they got the news about the DEA’s visit to Bockoff’s office. They found the emergency room flier to be a slap in the face.

“They probably look at you as an addict and they recommend that you do whatever you can to get off these medications,” Ogden said. “They’re not there to help us at all.”

Ogden is the co-founder of an advocacy group called Families for Intractable Pain Relief, and she started reaching out to her network, including other patients. She spoke to Danny by phone and described him as sounding “consumed by this dread of what he fully expected was going to be the next step for his life—months of untreated pain.”

Honestly, it seemed to me like bombing a village

Ogden said she’s personally called at least 10 doctors seeking treatment for her husband but to no avail. Other Bockoff patients are in the same boat, she said, and nobody she knows has been able to find another specialist willing to continue with a similar course of care.

Dr. Thomas Sachy of Gray, Georgia, was the first doctor to prescribe Danny fentanyl and remained his physician until the DEA raided his practice in 2018. Federal authorities have alleged Sachy had his office set up like a “trap house” with firearms on the premises. Sachy is charged with “issuing prescriptions not for a legitimate medical purpose and not in the usual course of professional practice.” Two employees and Sachy’s 84-year-old mother, who worked at his clinic, were also initially charged but their cases have since been dropped.

Sachy agreed to plead guilty in the case to avoid a possible life sentence but later withdrew the plea. He maintains his innocence. His trial is scheduled to start in January in federal court in Georgia. Wearing an electronic ankle monitor to track his location while out on bond, Sachy attended the Elliotts’ funeral service in Warner Robins, where he sat for an interview with VICE News.

Federal prosecutors have accused Sachy of prescribing opioids that contributed to the deaths of patients. Sachy in turn blames the DEA for the suicides of two patients who took their lives in the aftermath of the raid.

“My patients weren’t young drug addicts off the street,” Sachy said. “They were middle-aged and older with health problems. And the thing about pain, chronic pain, and the anxiety and the suffering that comes with it, it wears you down.”

Similar to what happened with Bockoff, after the DEA visited Sachy’s office in Georgia, the only resource made available to patients was a list of local pain management facilities and resources for opioid withdrawal, including emergency rooms. Sachy scoffed at the idea of his patients visiting an ER for help: “They’d look at them like they were insane or criminals or both.”

“It’s absolutely frustrating,” Sachy said. “It’s absolutely heartbreaking. It sucks. It destroys everything you think a physician should do and be and should be able to accomplish. It’s all taken away. And it’s just utter helplessness.”

Among the Elliott family and other pain patients, helplessness and anger remain common sentiments. Ogden said her husband and other chronic pain patients have spoken with an attorney about the possibility of a lawsuit against the DEA.

As a lawyer who worked for years in public office, Jim Elliott knows civil litigation against the government can be an uphill battle. He said the family is still deciding how to move forward in response to the deaths of Danny and Gretchen.

Jim emphasized that “it wasn’t as if pain medication made Danny’s life great.”

Fentanyl just made the pain bearable. And when that was taken away, Danny saw no future.

“He was taking a high level of pain medication but he wasn’t an addict and he wasn’t trying to get high or anything,” Jim Elliott said. “He was just trying to live a life. And they closed every door for people like that.”

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.

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