https://cronkitenews.azpbs.org/hookedrx/

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VA cover-up is morally indefensible

http://www.washingtontimes.com/news/2017/jan/3/americas-veterans-affairs-cover-morally-indefensib/

The U.S. government is guilty of a cover-up reminiscent of the tobacco industry’s longstanding denial of a nexus between smoking and disease.

The government conceals from its soldiers the risk of suicide or self-destructive behavior connected with fighting in our nine ongoing presidential wars not in self-defense that entail grisly killings of women and children: Libya, Somalia, Yemen, Syria, Iraq, Afghanistan, Pakistan, al Qaeda and ISIS.

Statistics are a starting point. But they are misleading or worse when divorced from the human element.

Touring Vietnam early in his tenure, then-Secretary of Defense Robert McNamara cheerfully assured a reporter that “every quantitative measure we have shows that we are winning this war.” Echoes of McNamara are heard today from the Pentagon and the intelligence community testifying to Congress in effect that by every quantitative measure we have we are destroying ISIS.

According to estimates of the National Alliance to End Veteran Suicide and the Department of Veterans Affairs, 7,400-8,000 veterans are committing suicide annually. Their risk is said by the VA to be 21 percent higher than among the civilian population.

These naked statistics are given flesh and blood by studying the anatomy of the days of 20-year-old Sam Siatta during his service in the Marine Corps in Afghanistan as reported in The New York Times Magazine (Jan. 1, 2017, “The Fighter” by C.J. Chivers).

Soon after he was deployed, Mr. Siatta was shaken by the sight of a child in a wheelbarrow with a bullet that had penetrated above his left eyebrow and severed the back of his head. The young Marine told the NYT Magazine reporter, “During all of our work-up, shooting targets, throwing grenades, doing all that, you never once saw kids mangled.”

Mr. Siatta participated in a festival of killings in the ensuing weeks. He wrote in his diary in the manner of Anne Frank:

“I go to sleep every night knowing I have the blood of so many on my hands and no amount of soap could ever wash these stains away.”

At about the 100-day mark of his service in Afghanistan, Mr. Siatta continued in the same vein in a companion diary entry:

“Sitting on post and not in firefights is really starting to f*** with me. Its making me rethink all the [decisions] I’ve made here and making me question if they were the right ones to begin with. The men I’ve killed well 15-year-old boys with Guns is more like it but did I deserve to kill them did they deserve to die.

“I mean I’m 20 years old I know damn well the risks of [joining] the Marine Corps in time of war. But did these young boys, Boys that I’ve killed know what the f*** there were [doing] or even fighting for, these are questions I ask myself.”

When Mr. Siatta returned to civilian life, he turned to self-ruinous conduct— including drinking and a guilty plea to a charge of attempted home invasion.

He is the soldier’s Everyman.

No human can avoid traumas or nightmares caused by participation in gratuitous wars that turn children into orphans, wives into widows, and have fathers bury sons rather than sons bury fathers.

Every recruiting poster or presentation featuring Uncle Sam’s “I Want You For U.S. Army” or otherwise should thus be required to include a prominent warning: “Participation in wars not in self-defense will implicate you in the killings of women, children, and youths and heighten your risk of suicide or self-destructive behaviors.”

For the U.S. government to lure men and women into the armed forces without full disclosure of the hazards of service is morally indefensible.

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Gov. Walker calls special session on opioid bills: “This isn’t somebody else’s problem”

fox6now.com/2017/01/05/governor-scott-walker-calls-special-legislative-session-on-opioid-bills/

MADISON— Governor Scott Walker is calling a special legislative session to pass a package of bills designed to curb heroin and opioid abuse. Walker has a long list of plans, but one idea — drug testing high school athletes — isn’t on it.

As the Legislature returned to Madison, top Republicans couldn’t name what would become their top priority legislation.

With this executive order, Governor Walker is essentially saying “I’ve got some ideas for you.”

“There`s a lot of time for members in general to focus on a legislative agenda. This is a legislative agenda,” Governor Walker said.

Governor Walker’s 11 requests came from a new report from a task force.

The Governor’s Task Force on Opioid Abuse made a number of recommendations to lawmakers. The task force wants school nurses to be able to give the heroin-fighting drug Naloxone to students who are overdosing in school. The task force has called for more funding for “recovery coaches” in hospital emergency rooms. Walker would also require prescriptions for medicines containing codeine, and he backs limited immunity for people who overdose, to encourage friends and family to call 911.

Governor Walker said opiate prescriptions have fallen 10 percent in a year’s time — crediting lawmakers’ previous efforts to fight addiction.

“Treatment works. It’s not 100 percent, but it works,” Rep. John Nygren, R-Marinette said.

“This isn`t somebody else`s problem. This is an issue that at some point or another will affect all of us or the loved ones that we have in our own circle of friends or family,” Walker said.

Additionally, Walker said he wants the University of Wisconsin System starting a recovery school; to allocate money for the rural hospital graduate medical training program; more state drug agents; and a consultation service to connect medical professionals with addiction medicine specialists.

Walker said he expects people to wean themselves off painkillers. He said his adult son used Advil instead of prescription drugs after getting his wisdom teeth out recently.

“As patients, we need to take on some of the responsibility of that as well and not just put the pressure on health care professionals to prescribe, prescribe, prescribe,” Walker said.

The task force did not recommend high schools drug test their athletes as a Republican state lawmaker proposed before pulling back when Walker and Assembly Speaker Robin Vos said they didn’t support the idea.

The Legislature is already in session, but a special session order allows lawmakers to operate under different rules that make passing bills easier.

The governor also typically uses a special session call to draw attention to issues.

According to a spokesman, Vos expects to have Assembly committees taking up Walker’s bills by the end of January.

Below is a statement from Vos’ spokeswoman, Kit Beyer:

“A special session puts a priority on the proposed legislation by allowing for a more expeditious legislative process.  It also draws more attention to an important problem that has become a health crisis in the state.

The Speaker looks forward to continuing to pass legislation to fight the opioid epidemic and hopes to have bills taken up in committee by the end of the month.

As you may recall, the HOPE Agenda produced 17 bills in the past two sessions, which received widespread support and have made an impact.”

Top Assembly Democrat Peter Barca said the special session was “warranted” — issuing this statement to FOX6 News:

“The opioid epidemic in our state is a very serious issue that requires a very aggressive response. I hope the committees will collect input from those who know this issue firsthand—from law enforcement, to educators, to medical professionals—as this will help us address this crisis in the most comprehensive manner possible.

The urgency of this special session is warranted, and I hope Gov. Walker takes the same approach to other incredibly significant issues facing Wisconsin families right now, including rebuilding the most diminished middle class in the country. As elected officials, we need to do everything we can to address those who are hurting.”

Senate Majority Leader Scott Fitzgerald said it could take some time before they get voted on.

Below is a statement from Fitzgerald’s spokeswoman, Myranda Tanck:

“We look forward to working with the Governor to expand on the HOPE legislation passed over the last two legislative sessions to continue to fight to address Wisconsin’s growing heroin and opiate epidemic.

As far as timeline: we had a Senator call the Senate into special session today and adjourn until January 10 as the call began today at 11:00. The procedure will be relatively unchanged going forward; each of the enumerated bills appears to still be in LRB form and will need to be introduced, assigned bill numbers, circulated for cosponsors, and referred to committee. As that process continues we will have a better idea of when these bills will be on the floor. As of right now we have not scheduled any additional floor days but the special session does allow us to come in any business day until the special session is closed.”

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Memory pill maker sued on grounds no proof it works

http://www.reuters.com/article/us-quincybioscience-ftc-memorypills-idUSKBN14T1Y6

Quincy Bioscience LLC, which makes the memory supplement Prevagen, was hit with a lawsuit on Monday filed by the Federal Trade Commission and New York attorney general’s office, which alleged that there is no proof the supplement works.

The medicine, which costs $24 to $68 for 30 pills, is advertised on cable and broadcast television, according to the FTC, which is seeking refunds for customers who bought Prevagen.

The lawsuit, which was filed in the U.S. District Court for the Southern District of New York, said that Quincy Bioscience had sold some $165 million worth of Prevagen between 2007 and mid-2015, according to court filings.

The lawsuit says that Quincy Bioscience based much of its advertising for Prevagen on a single study, called the Madison Memory Study, which gave the drug or a placebo to 218 people and then had them perform certain tasks on a computer.

“The Madison Memory Study failed to show a statistically

significant improvement in the treatment group over the placebo group on any of the nine computerized cognitive tasks,” the lawsuit said.

Quincy Bioscience said that it vehemently disagreed with the complaint, which it called overreach. “Quincy Bioscience will vigorously defend ourselves,” the company said in a statement that called into question how the government analyzed data from its study.

The two Democrats on the FTC voted to approve the complaint. The single Republican did not participate and two of the five commission seats are vacant.

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Searching for Alternatives to Opioids -Way Too Late

http://acsh.org/news/2017/01/10/searching-alternatives-opioids-way-too-late-10676

Anyone who reads a newspaper these days has been exposed to the ongoing hysteria concerning a so-called (and largely fictitious) “epidemic” of deaths due to prescription opioid drugs.  Nine months after the issuance of a highly restrictive CDC guideline, we are learning that the CDC writers group for the most part ignored the input of expert pain management specialists as they developed their guidelines on opioid prescription for chronic pain.  Worse still, the consultants violated the CDC’s own research protocols, in what appears to have been an effort to bias the outcomes of their work against the use of prescription pain relievers – regardless of the reality that available medical evidence fails to justify such action [Ref 1]. 

In the meantime, tens of thousands of chronic pain patients have had proven and essential pain medications arbitrarily reduced or outright withdrawn by doctors afraid of being maliciously prosecuted by the US Drug Enforcement Administration for over-prescription.  Doctors are leaving pain management, often “dumping” hundreds of their patients without referral.  Some patients have committed suicide, unable to deal with the agony and disability that their own government has imposed on them. Others may follow.

An especially disturbing aspect of this policy debacle is that restrictions on prescription opioids have occurred in the absence of clearly effective alternatives for pain management or relief.  This is despite a program of research mounted by the US Government including the Agency for Healthcare Research and Quality (AHRQ, within the US Department of Health and Human Services).  Most recently, AHRQ has issued a public call for comment on a series of questions intended as a basis for analyzing available medical evidence pertaining to “noninvasive, non-pharmacological treatment” of five types of pain in adults:

• Chronic low back pain
• Chronic neck pain
• Osteoarthritis related pain
• Fibromyalgia
• Tension headache (excluding migraine)

The types of medical interventions discussed by AHRQ as potential treatments include “exercise (e.g. physical therapy (PT), supervised exercise, home exercise, group exercise), psychological therapies (e.g., cognitive behavioral therapy, acceptance and commitment therapy, biofeedback, relaxation training), physical modalities (e.g., traction, ultrasound, TENS, low level laser therapy, interferential therapy, superficial heat or cold, back or neck support, magnets) manual therapies (e.g., manipulation, massage) mindfulness and mind-body practices (e.g., meditation, mindfulness-based stress reduction, Yoga, Tai Chi, Qigong), acupuncture, and multidisciplinary/ interdisciplinary rehabilitation” [Ref 2].  For each type of pain, three “sub-questions” are addressed:

1. What are the benefits and harms of noninvasive non-pharmacological therapies compared with sham treatment, no treatment, waitlist, attention control or usual care?
2. What are the benefits and harms of noninvasive non-pharmacological therapies compared with pharmacological therapy?
3. What are the benefits and harms of noninvasive non-pharmacological therapies compared with exercise? (for tension headache, “exercise” is replaced by “biofeedback”)

These questions are supplemented by one other general inquiry: “Do estimates of benefits and harms differ by age, sex or presence of co-morbidities (e.g. emotional or mood disorders)?”  Overall observations are also solicited (note: public commentary will be closed on January 16, 2017).

I read these questions against a background of 20 years of active participation as the spouse and father of chronic pain patients.  I am also a technically trained information miner and research analyst who daily interacts with hundreds of pain patients via social media.  As a peer to peer support site moderator, healthcare writer and patient advocate, I have communicated with well over 15,000 people in pain, and heard their experience with just about all of the “noninvasive” techniques noted above.

Having myself commented at the AHRQ gateway, my fundamental question about this process is “Are you people SERIOUS?”  If you had been talking with chronic pain patients themselves instead of your presumably educated colleagues, you would already understand the status of these so-called alternative therapies.  Not to put too fine a point on this, but they seem to temporarily help fewer than half of those treated – and even smaller numbers when pain is sufficiently severe and sustained that opioid medication would even be considered as an option by a Board Certified specialist in pain management.  

The AHRQ Draft Analytical Framework contains a number of obvious non-starter assumptions that should prompt its being thrown out and done over from scratch. Primary among these assumptions is the notion that opioid treatment of chronic pain is only temporarily effective and entails a high risk of patient addiction.  I have read letters and postings from or talked with hundreds of patients who have used opioids at high stable doses for years, with strongly positive effect in maintaining the quality of their lives and no evidence of addiction behaviors.  Just about any pain management specialist that you bother to consult will confirm this observation.

Just as bad is a fallacy in the present analytical framework— the apparent assumption that emotional or mood disorders may comprise a cause of chronic pain.  While erudite papers are published by practitioners of so-called psychosomatic medicine, what I see is a much different picture from their optimism.  I have never talked with a chronic pain patient in whom any form of Rational Cognitive Therapy has been effective against medically diagnosed pain.

Psychiatric professionals have little to offer beyond assistance with anxiety and stress control – and much to answer for in their too-often casual assumption that “the pain is all in your head.” Appearance of a mental health diagnosis in a patient record can literally be the kiss of death for ongoing medical assessment and effective treatment.  Sometimes it is the kiss of death for the disregarded and isolated patient him/herself. [Ref 3]

Several other factors are of concern in this framework.  For instance, chronic neck pain and low back pain are not single medical entities.  They are symptoms of multiple underlying disorders, sometimes neurological, sometimes neuropathic and not infrequently caused by treatment itself, particularly surgery.  Medical treatment and patient response to treatment can vary significantly between individuals.  Moreover, it is common for chronic pain patients to deal with multiple medical disorders which include forms of neuropathic pain — which AHRQ has chosen to exclude from its studies.  Such complications will likely confound the extraction of convenient generalities concerning either primary therapies or alternative treatments.

My recommendation to the AHRQ is to withdraw the draft analytical framework and solicit the help of the American Academy of Pain Management in re-drafting it.  Then advertise widely for participation in review by pain patients themselves and their doctors.  As an old but often true cliché would have it, it can be very difficult to get where you want to go when you start out not knowing where you are.  And you folks clearly don’t.

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Marine Vet Suffering From Chronic Pain Writes Congress

nationalpainreport.com/marine-vet-suffering-from-chronic-pain-writes-congress-8832641.html

By Ed Coghlan

With the coming of a new President, comes a familiar promise – to do more for the country’s military veterans with an eye toward reforming the VA Medical System.

No disrespect to President-elect Trump, but there doesn’t seem to be much in his plan that screams change.

As Newsweek wrote: “So what’s his plan? On Trump’s website, there’s a 10-point V.A. reform “vision.” But that plan basically amounts to firing bad managers, hiring better ones and then taking some other unspecified steps that fall under the heading of “modernization” while maybe putting more money toward providers.”

While President Obama’s performance in reforming the VA has largely gone wanting, veteran groups actually asked Trump to keep VA Chief Robert McDonald, the former Proctor and Gamble CEO who has run things since 2014.

In addition to the normal VA shortcomings, National Pain Report readers know that veterans have been hit hard by the CDC Guideline for Prescribing Opioids for Chronic Pain.

We are publishing a story today – not to review VA shortcomings – but because we received the copy of an interesting and personal letter written by a former Marine to Congressional representatives and staffers and the media about what the guidelines have done to him.

Robert Rose

His name is Robert Rose and he lives in Gray, Tennessee and his letter, spawned by what he felt was an unfair news story. We asked him for permission to republish some of the letter which he tells his story in a way that may be familiar to some of his fellow vets.

“Personally these guidelines and the “opioid safety initiative” have had a devastating effect on my family and my quality of life. First, because my mother and sisters do not understand the true extent of the injuries to my body and the havoc they incite in my body and mind. Therefore it is impossible for them to comprehend why I would challenge the government or the Veterans Administration. Actually with their limited knowledge about my situation they consider me a “pill popper” and just another veteran addicted to drugs because of the VA’s ineptitude. What else are they supposed to think considering some of the shoddiest reporting since beginning of the technology age (in many aspects the old gumshoe reporter is preferred). The result of this nightmare, we are barely on speaking terms.

Robert Rose shopping

Closer to home, my wife and sons do understand the challenges I am faced with due to the chronic pain, blackouts and constant struggle to simply be a man. They do in fact support me for standing tall (metaphorically) in this struggle. Regrettably I am an old school Marine infantryman which makes me very hardheaded. I see a problem and I attack, attack, attack head on. My boys believe I need to be more politically correct such as omitting references to Jesus Christ my Lord and Savior. To me, this would be tantamount of denying my God (see below) and spending an eternity in the real Hell and not just the one the Veterans Administration has created for so many. This one ends, the other is for eternity.

Additionally, because the pain and sleep deprivation created by being denied pain medications due to the “opioid safety initiative,” there’s something within my mind or body which generates an anger deep inside. Sporadically this fury erupts on my wife (and sometimes my sons) sporadically. God has blessed with enough self-control to not employ physical violence but anyone who had been in an abusive relationship can tell, sometimes the anger and the words do more damage.

This woman has stood through thick and thin for thirty years. The Marines, rehabilitation after my medical discharge, severe bouts of depression because I was once again a “civilian,” a graveyard shift in a prison while I attended college during the day, and so much more. If anything this woman deserves a monument erected in her name because as many of you know, I can be and am an “obnoxious asshole.” As a consequence of this nightmare, and the suffering they see daily as I simply try to walk upright to the restroom, it is taking a severe toil on my beautiful wife. Worse considering I have been waiting five years for an appeal from the Veterans Administration so that I might finally be eligible for health insurance to care for her cancer (in remission), heart issues (her mitral valve was replaced with a St. Jude mechanical valve), all her medications, specialists needed on top of all her the anxieties of having been on death’s door three separate times (and still is according to her) because of these conditions. Prior to October, I was doing everything in my power to care and provide emotional support to her. Going to the store, cooking, whatever she needed I was there. Only now, it is a struggle for either one of us to care for the other. Now, I pray daily I will not snap or yell at her because of my own weaknesses.

One other casualty of this campaign of misinformation is Sparky, our Yorkie. This is my wife’s constant companion (I believe she loves him more than even me). Unfortunately Sparky is getting on in years and has been diagnosed with arthritis among other things that occur to his breed as they age. We ran out of his medication in early December 2016. We have been so debilitated by our respective conditions, we have been unable to schedule an appointment for him to alleviate his suffering. How many others are dealing with similar situations simply because someone is getting rich off our ordeal created by the CDC guidelines? 

As you can see, these are real life issues brought about faulty (and fraudulent) research by the CDC, the DEA and other interested parties. People are suffering and only you, our esteemed representatives and caring professionals, can put an end to this madness.”

We’ve asked Mr. Rose to keep us apprised of any response he get.

In the meantime, let us know your thoughts.

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“Hooked Rx: From Prescription to Addiction”

https://cronkite.asu.edu/news-and-events/events/featured-event/%E2%80%9Chooked-rx-prescription-addiction%E2%80%9D

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This is a section of the CDC opiate dosing guidelines…  Those prescribers and corporations that create policies and procedures based on portion of this guidelines and not the guideline in its entirety may be walking into a legal minefield.

This is just ONE PARAGRAPH from the CDC guidelines… but contains a lot of very important information that if a prescriber or prescriber group ignores or chooses to omit from the policies and procedures … could put them at legal/financial risk of malpractice, failing to meet a standard of care and best  practices, pt abuse for starters..

First of all the guidelines are based on “limited information” and are VOLUNTARY and primarily directed towards primary care clinicians.  Pts in need of palliative care – most/all chronic pain pts – has cancer and/or terminal are AUTOMATICALLY EXEMPT from dosing limits.

Primary focus of the guidelines The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.

The very act of arbitrarily reducing a pt’s dose/medication(s) causing the pt to endure increased pain levels, become house/chair/bed confined because of increased pain – that were previously being well/better managed.. would seem to be in direct conflict with the intent of the guidelines.

Finally, it is clearly stated in these guidelines that Clinicians should consider the circumstances and unique needs of each patient when providing care.  So once again, a prescriber that arbitrarily limits a pt’s medication therapy would seem to be in conflict with these guidelines.

Likewise, a prescriber practice and/or an employer entity – like a hospital – mandates these guidelines and dosing limits be followed… would appear to be “practicing medicine” … for which they don’t have the legal authority to do.

I am not an attorney, but large medical practices or corporate entities (hospitals) that implement only portions of these guidelines … while ignoring other portions of these guidelines… could be setting themselves up for some law firm that specializes in class action lawsuits… since the harm to pts could and should be consider INTENTIONAL by their actions… and intentionally harming another human being via a specific action(s) or lack of action(s) could have legal/financial consequences.

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

This guideline provides recommendations for the prescribing of opioid pain medication by primary care clinicians for chronic pain (i.e., pain conditions that typically last >3 months or past the time of normal tissue healing) in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care. Although the guideline does not focus broadly on pain management, appropriate use of long-term opioid therapy must be considered within the context of all pain management strategies (including nonopioid pain medications and nonpharmacologic treatments). CDC’s recommendations are made on the basis of a systematic review of the best available evidence, along with input from experts, and further review and deliberation by a federally chartered advisory committee. The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function, and reduce the number of persons who develop opioid use disorder, overdose, or experience other adverse events related to these drugs. Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context. The recommendations in the guideline are voluntary, rather than prescriptive standards. They are based on emerging evidence, including observational studies or randomized clinical trials with notable limitations. Clinicians should consider the circumstances and unique needs of each patient when providing care.

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https://www.consumeraffairs.com/rx/riteaid_rx.html

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Internal Server Error

The server encountered an internal error or misconfiguration and was unable to complete your request.

Please contact the server administrator, webmaster@pharmaciststeve.com and inform them of the time the error occurred, and anything you might have done that may have caused the error.

More information about this error may be available in the server error log.

Additionally, a 500 Internal Server Error error was encountered while trying to use an ErrorDocument to handle the request.

I have exchanged some emails with my ISP and because of increased traffic on my blog along with some issues with Word Press … there are some intermittent errors being thrown…

Fortunately, nearly 100% of the time when a post is being made and this error is thrown… the post is actually saved to the blog… if you just refresh the screen… things will come back to normal…

Technology that is outside of my doing anything about it… except asking everyone has some , patience while those providing services for my blog… make some adjustment to make this problem less frequent

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