It’s likely no one will answer the phone, a former CDC employee says

https://www.medpagetoday.com/publichealthpolicy/washington-watch/117943

Thinking of calling CDC to report a potential disease outbreak? Don’t bother; no one will answer, a former CDC employee said Tuesday.

“If it’s an infection that is being seen in the hospital in four different patients, and the infection control nurse calls [the CDC] … You are working with the physicians, the nurses, the schools, the restaurants, to try and sort through, ‘What is going on and what can we do?'” said Karen Remley, MD, MPH, former director of the CDC’s National Center on Birth Defects and Developmental Disabilities. “Sometimes that help might be, ‘We’re going to send some people to you; we’re going to give you more boots on the ground to help you do this.’ Sometimes that might be talking to somebody who’s one of the only world experts on a specific type of infection or a specific type of exposure. But [now] there’s nobody to answer the phone.”

“Being prepared and able to respond to public health emergencies is a core function of CDC,” said John Brooks, MD, former chief medical officer of the CDC’s Division of HIV Prevention, who retired from the CDC in September 2024. “Eight out of every 10 taxpayer dollars that CDC receives from Congress goes directly to support state and local staff and programs to help keep your community safe. Much of the remaining money is used to maintain and grow CDC’s public health expertise and its laboratory capacity that support these funded activities.”

“Today, many experts, including myself, are concerned that we are no longer well prepared for the next big outbreak or disaster because of the Trump administration’s continued erosion of our nation’s ability to respond to public health emergencies,” he added.

The cuts won’t just affect immediate operations like outbreak response — they will also affect longer-range projects, such as the annual National Health and Nutrition Examination Survey (NHANES) that the CDC conducts, Brooks said.

“Many of these very large, annualized … regular surveillance projects take a lot of planning. As they’re collecting data one year, the planning for the next year is well underway — how they’re going to do the randomization, how they’re going to find people, how they’re going to bring the data together and then analyze [it] — all of that is being planned, sometimes years in advance,” he explained. “With these regular surveys that have been collected on behalf of the public for many years, any interruption is unwelcome, because you lose that visibility on what’s happening.”

Remley and Brooks spoke Tuesday at a press conference organized by the National Public Health Coalition following a weekend in which approximately 1,300 HHS employees were fired

; about 700 of those had their termination notices rescinded less than 24 hours later. The Trump administration said those whose terminations were rescinded had been terminated due to a coding error

Reporters at Tuesday morning’s press conference also heard from Aryn Melton Backus, MPH, an employee at the CDC’s Office on Smoking and Health, who has received three different termination notices in the last few months.

“My first termination came during the wave of probationary employee firings,” she said. “On February 14, I was told that I was being terminated for poor performance during my trial period, despite having been on my team for almost 2.5 years and having been recently converted from a contractor to a federal employee. A judge has since ruled that these terminations were illegal.”

“My second termination came on April 1 when my office was eliminated during the agency-wide reduction in force [RIF],” she continued. “At first, I had no way to know if I had received a second termination notice, because my access to the CDC network had been cut off … I was finally able to regain access to my work email, and there was a reduction-in-force notice sent to my work email on April 1.”

“Despite the two termination letters, I’ve remained on administrative leave since February of this year due to a court case challenging the legality of the [first] reduction in force,” Backus said. “When word started spreading about the new reduction force, on October 10, I figured I was safe; a lawsuit [involving] my office prevents us from being further reorganized or fully separated. But then late Friday evening, I started hearing our team had received another reduction in force — a third for me. Luckily, that notice was rescinded less than 24 hours later, but I still remain on administrative leave, unable to do my job. My situation just highlights the chaos and confusion that federal employees have experienced over the past year.”

The American Federation of Government Employees (AFGE), which represents some of the fired workers, is fighting back. “[We are] demanding that all [RIF] notices be rescinded immediately,” AFGE Local 2883 President Yolanda Jacobs said at a separate press conference on Tuesday afternoon. “These illegal firings of our union members during a federal government shutdown [are] a callous attack on hardworking Americans and puts the livelihoods, health, and safety of our members and communities at great risk.”

Jacobs said she didn’t believe the now-rescinded RIFs happened because of an error. “I believe it was intentional,” she noted. “The administration did a whole lead-up campaign before they actually sent the notices out, to the point of even having the [Office of Management and Budget] director go on to X and say that the RIFs have begun. So, to me, it was not an error, those areas where they did reverse.” Instead, she added, the reversals happened because there was a lot of pushback on some of the firings.

One employee who received an RIF notice who was given anonymity in order to speak freely said she asked whether she could take another job while on administrative leave and was told she needed approval from the ethics office to be sure there wasn’t a conflict of interest. When the employee asked who she needed to contact in the ethics office, they said, “Well, you can’t, because they all got RIF letters too.”

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My time that I am capable of dealing with my blog and pt’s issues may get restricted going forward. We were just told that the independent pharmacy that we have been patronizing for abt 10 yrs is not going to be in the Humana  Part D next year!  This guy owns the only two independents in our county. Open enrollment starts in a couple of days for Medicare.

Our PCP told us the first of this year, that he is retiring at the end of 2026. However, he has had a hip joint replacement.. which apparently got infected and the hip joint is DEFECTIVE and he is to put no weight on the defect hip joint for at least 12 weeks.

We have also been told that the practice that our PCP is in – it has 10-12 practitioners – is developing a consensus for the practice in how they are going to treat pain. In the real world if a number of business people agreed to do something the same way it would be referred to as a COLLUSION – NOT A CONSENSUS.

I talked to the office manager last week and I asked for a copy of this “consensus” and she said that they had not put it to writing… I suggested that might be a very good thing for them to do.

Going forward, I am going to focus my time on adding to the “ACTION” tab and putting pt education information there. 

I am not going to “share” on all the FB pages like a normally do with additions to the “ACTION” page.  Below is where you can put your email into a place on the left column on the first page of my blog and Word Press will send you a email that I had made a new entry and/or look for the last 4-5 new posts that are listed in the same column

Below is a picture of the desk in the room that I call “my office”, this is where all “the magic happens :-)”. We knew that we were most likely going to have to change practitioners at the end of 2026 – if we can find one, but maybe having to change pharmacies as well in a couple of months, and now not knowing if our PCP will be coming back to the practice.

I may end up spending a lot of time trying to ADVOCATE for Barb and myself. If my blog ends up going sort of quiet, everyone will understand why!

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These are several audio presentations about Narxcare

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Analysis turned up 200,000 unneeded procedures that cost Medicare $2 billion over 3 years

https://www.medpagetoday.com/surgery/orthopedics/117856

The Lown Institute called out dozens of hospitals for performing unnecessary surgeries on Medicare beneficiaries with low back pain, putting patients at risk of serious complications with no evidence of clinical benefit.

Its analysis focused on high-volume hospitals that performed at least 500 spinal fusion/laminectomy or vertebroplasty procedures over a 3-year period — finding more than 200,000 unnecessary procedures amounting to about $1.9 billion in wasted Medicare spending during that time.

“We’re not doing this just to draw attention to the fact that there is unnecessary surgery,” Lown president Vikas Saini, MD, told MedPage Today. “We’re doing it to track how much, so people who want to do something about it have a guideline.”

As for the doctors who are performing these unnecessary procedures, Saini said there are “true believer” surgeons who insist that the procedure can benefit their patients despite a lack of evidence, “and there are those who are more skeptical. … But let’s be magnanimous and say that all of this comes from a place of wanting to help, and hope that it will help.”

“But if we’re really going to have a reliable, effective, and affordable healthcare system, we can’t just base it all on hope and a prayer,” he said. “It has to be based on evidence. Hope is easy to have, but in the end, it doesn’t solve the problem.”

The report also noted the high rate of complications from these procedures. Some 18% of spinal fusion procedures result in infection, blood clots, stroke, pneumonia, heart and lung problems, and in some cases, death.

The Lown Institute’s list was taken from Medicare data. The hospitals with the highest rates of spinal fusion/laminectomy overuse are Mount Nittany Medical Center in Pennsylvania (57.2% of 505 procedures), Concord Hospital in New Hampshire (39.5% of 517 procedures), and Lutheran Hospital of Indiana (38.6% of 1,232 procedures).

The hospitals with the highest rates of vertebroplasty overuse included Kettering Health Miamisburg in Ohio (56.1% of 578 procedures), Shannon Medical Center in Texas (54.6% of 694 procedures), and St. Elizabeth Florence Hospital in Kentucky (50.1% of 668 procedures).

The report also applauded hospitals with the lowest rates of these procedures. Avala Hospital in Louisiana, Northwest Specialty Hospital in Idaho, and Baylor Surgical Hospital at Las Colinas in Texas all had spinal fusion/laminectomy overuse rates of 1.2% or lower. Metrohealth Medical Center in Ohio, Harborview Medical Center in Washington, and the Mayo Clinic Health System-La Crosse were among 11 hospitals with no vertebroplasty overuse.

The hospitals with high rates of overuse have not returned a request for comment from MedPage Today.

The report also highlighted enormous state variation in rates of overuse of these procedures. California, Florida, Texas, and Pennsylvania had the highest amount of overuse of spinal fusion procedures, with at least 5,000 unnecessary procedures in each state. Texas, Florida, and Ohio had the highest volume of vertebroplasty overuse with at least 6,000 unnecessary procedures in each of those states.

Spinal fusion/laminectomy procedures were considered overused when performed for low back pain, but excluded patients with radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain, or scoliosis.

Spinal fusion-only procedures were not considered overused when performed for stenosis with neural claudication and spondylolisthesis. Laminectomy-only interventions were not considered overused when performed in patients with stenosis who had neural claudication.

Vertebroplasty procedures were considered overused when performed in patients with spinal fractures caused by osteoporosis, but the list excluded patients with bone cancer, myeloma, or hemangioma.

The Medicare data included fee-for-service patients’ procedures from 2021 to 2023 and Medicare Advantage patients’ procedures from 2020 to 2022. Procedures performed on Medicare beneficiaries under age 65 were not included.

Saini said the report concentrated just on those hospitals that performed at least 500 of these procedures. For the spinal fusion/laminectomy analysis, 466 hospitals were evaluated, and for vertebroplasty, 625 hospitals were included.

He said these procedures are extremely expensive, costing $14,500 for spinal fusion and $4,200 for vertebroplasty.

Asked what efforts he thinks will reduce the number of these unnecessary back pain procedures, Saini suggested federal oversight, such as the WISeR (Wasteful and Inappropriate Service Reduction) model, could have a larger role, perhaps with more targeted prior authorization requirements or guidelines. Yet he acknowledged that pathway is extremely controversial.

“There’s no way we can replace clinical judgment of the physician in the exam room,” Saini said. “We can’t have the federal government practicing medicine.”

But a lot of clinicians “just aren’t with the program and some of them will argue with you until they’re blue in the face that the data just doesn’t refute the way they practice,” he said, noting the saying, “It’s hard to get somebody to understand something when their salary depends on them not understanding.”

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Risks of Tramadol Likely Outweigh Benefit for Chronic Pain

https://www.medpagetoday.com/neurology/painmanagement/117842

Drug didn’t meet efficacy threshold and doubled serious adverse event risk, analysis suggests

The opioid analgesic tramadol reduced chronic pain levels compared with placebo, but appeared to double the risk of harm, a review of 19 clinical trials suggested.

In a meta-analysis and trial sequential analysis, tramadol improved chronic pain on the numerical rating scale (NRS) with low certainty of evidence (mean NRS difference -0.93 points, 97.5% CI -1.26 to -0.60, P<0.0001), said Jehad Ahmad Barakji, MD, of the Centre for Clinical Intervention Research at Rigshospitalet in Copenhagen, Denmark, and co-authors.

The effect size was below the predefined minimal important difference of 1.0 point, Barakji and colleagues wrote in BMJ Evidence-Based Medicine. The NRS evaluates pain on a scale of 0 (no pain) to 10 (worst pain imaginable).

Tramadol also raised the risk of serious adverse events (OR 2.13, 97.5% CI 1.29-3.51, P=0.001) with moderate-certainty evidence, driven mainly by a higher proportion of cardiac events and neoplasms, the researchers reported. Non-serious adverse events like nausea, dizziness, constipation, and somnolence were higher with tramadol.

“Approximately 60 million individuals worldwide experience the addictive effects of opioids,” observed co-author Janus Christian Jakobsen, MD, PhD, also of the Centre for Clinical Intervention Research.

“Tramadol continues to be widely prescribed for the management of chronic pain and is often perceived as safer than other opioids, although this perception lacks supporting evidence,” Jakobsen told MedPage Today.

“The use of tramadol and other opioids should be minimized as much as possible,” he added. “Our study provides evidence in support of this recommendation.”

Tramadol selectively binds to various opiate receptors in the central nervous system, similar to other opioids. It was first approved as a non-controlled analgesic in 1995 under the brand name Ultram.

In 2014, the Drug Enforcement Administration classified tramadol as a schedule IV controlled substance, indicating it had a lower risk of abuse and dependence than schedule II opioids like oxycodone and hydrocodone.

Tramadol is approved to treat pain severe enough to require an opioid analgesic and carries a boxed warning for addiction and abuse, life-threatening respiratory depression, and other potential harms. Total prescriptions for tramadol-containing products in the U.S. totaled 27.1 million in 2024.

“Tramadol is an interesting drug because there is a sense among many clinicians that it isn’t really an opioid,” noted Molly Jeffery, PhD, of the Mayo Clinic in Rochester, Minnesota, who wasn’t involved with the analysis.

In 2019, Jeffery led a large U.S. insurance claims study that showed patients who used tramadol alone after surgery had a higher risk of prolonged opioid use than expected.

“If tramadol really is very different from other opioids we give people for acute pain, we might expect to see differences in long-term use of opioids in people who are prescribed tramadol versus other opioids after surgery,” Jeffery pointed out.

“We found the opposite was true; people who got tramadol rather than oxycodone or hydrocodone after their surgery were actually more likely to continue using opioids long-term,” she told MedPage Today.

Barakji and colleagues assessed data from 19 clinical trials involving 6,506 participants with chronic pain in their systematic review with meta-analysis and trial sequential analysis. Five trials evaluated tramadol for neuropathic pain, nine focused on osteoarthritis, four assessed chronic low back pain, and one involved fibromyalgia.

Participants were ages 47 to 69; their mean age was 58. All trials involved oral tramadol except one osteoarthritis trial that used topical administration.

Treatment duration ranged from 2 to 16 weeks, and follow-up spanned from 3 to 15 weeks. Eight trials assessed serious adverse events after follow-up periods that ranged from 7 to 16 weeks.

Serious adverse events in the tramadol groups included chest pain, coronary artery disease, congestive heart failure, prostate cancer, breast cancer, and thyroid neoplasm. The follow-up period for neoplasms was short, making a causal link between tramadol and new cancer disease “questionable at this point,” the researchers noted.

Five trials that evaluated tramadol’s effect on quality of life had mixed results; two found improvements, and three reported no significant differences between tramadol and placebo.

The study had several limitations, Barakji and co-authors acknowledged. “All included trials were at high risk of bias except two, which increases the likelihood that our findings overestimate the beneficial effects and underestimate the harmful effects of tramadol,” they wrote.

Several trials did not report the specific types of serious adverse events, and follow-up length varied across trials.

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1. https://www.drugtopics.com/view/major-drug-distributors-to-pay-300-million-in-opioid-epidemic-settlements
2. https://www.texasattorneygeneral.gov/globalopioidsettlement
3. https://www.reuters.com/legal/government/baltimore-take-drug-distributors-jj-trial-over-opioids-2024-09-16/
4. https://nationalopioidsettlement.com/executive-summary/
5. https://ncopioidsettlement.org/about/national-settlements/
6. https://www.lanierlawfirm.com/practice-areas/pharmaceutical-liability/opioid-lawsuits/
7. https://www.dea.gov/press-releases/2024/10/03/multiple-pharmaceutical-distributor-executives-sales-representatives-and
8. https://www.npr.org/2022/07/04/1109772095/a-federal-judge-sides-with-3-major-drug-distributors-in-a-landmark-opioid-lawsui
9. https://www.bmj.com/content/379/bmj.o2688
10. https://rhlawfl.com/drug-crimes/first-of-its-kind-feds-bring-criminal-charges-against-pharma-distributor-ceo-in-opioid-case/
11. https://attorneygenerallynnfitch.com/opioidsettlement/
12. https://www.hbsslaw.com/press-releases/pharmaceutical-average-wholesale-price-litigation-judge-certifies-class-action-case-against-nations-largest-pharmaceutical-distributor-in-alleged-pricing-scheme
13. https://ag.ny.gov/nys-opioid-settlement
14. https://www.cbsnews.com/baltimore/news/baltimore-city-152-million-jury-award-litigation-opioid-distributors/
15. https://www.farrellfuller.com/news/2021/july/drug-distributors-rest-their-case-in-west-virgin/
16. https://www.healthlawalliance.com/blog/sun-pharma-rico-lawsuit-exposes-bribery-conspiracy-involving-big-three-wholesalers
17. https://www.atg.wa.gov/news/news-releases/ag-ferguson-opioid-distributors-pay-518-million-washington
18. https://www.naag.org/issues/opioids/
19. https://www.hbsslaw.com/practices/pharmaceutical-fraud
20. https://www.classaction.com/opioids/settlement/

1. https://www.naag.org/issues/opioids/
2. https://www.congress.gov/crs-product/LSB11270
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC10713840/
4. https://www.motleyrice.com/public-client/opioid-litigation
5. https://www.opioidsettlementtracker.com
6. https://www.opioidsettlementtracker.com/globalsettlementtracker
7. https://www.in.gov/attorneygeneral/home/opioid-settlement/
8. https://www.naco.org/resource/osc-nlc-settlement-dollars
9. https://nationalopioidsettlement.com/executive-summary/
10. https://www.ncbi.nlm.nih.gov/books/NBK458653/
11. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776301
12. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm
13. https://www.sciencedirect.com/science/article/abs/pii/S0376871621002568
14. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819204
15. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805808
16. https://www.sciencedirect.com/science/article/pii/S2773065425001129
17. https://journalofethics.ama-assn.org/article/how-fda-failures-contributed-opioid-crisis/2020-08
18. https://www.atg.wa.gov/news/news-releases/ag-ferguson-files-lawsuits-against-three-national-pharmacy-chains-their-role
19. https://www.sciencedirect.com/science/article/pii/S2667193X21000235
20. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose

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I find myself typing the same answers to pt’s inability to get their pain meds and numerous other things that untold number of pain pts are experiencing in trying to get their pain properly managed.

I have added a new tab on the front page of my blog ACTIONS. I will be adding to the information under this tab going forward.

This tab will take pts to a new blog page that will basically be a index to numerous informational posts. 

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can you define in detail what is pt abandonment when a intractable chronic pain pt is the pt and it is well known that it is unlikely that the pt will be able to find a new practitioner and the pt has been a pt of the practitioners for a minimum of several years

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC9555806/
2. https://www.norcal-group.com/library/dismissing-a-patient-with-chronic-pain-and-opioid-dependency-leads-to-allegation-of-abandonment
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC7947064/
4. https://www.clinician.com/articles/46948-avoid-abandonment-when-it-8217-s-time-to-terminate-care
5. https://www.empoweremr.com/blog/what-is-patient-abandonment-definition-laws-and-consequences
6. https://www.usatoday.com/story/opinion/voices/2023/01/05/cdc-opioid-guidelines-leave-pain-patients-suffering/10962261002/
7. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2783468
8. https://academic.oup.com/painmedicine/article/10/4/722/1830714
9. https://academic.oup.com/painmedicine/article/14/3/323/1858677
10. https://www.spigalaw.com/what-you-need-to-know-about-patient-abandonment
11. https://www.consumershield.com/injuries-accidents/medical-malpractice/patient-abandonment
12. https://curapaindoctors.com/navigating-your-next-steps-what-to-do-if-discharged-from-pain-management/
13. https://trustandwill.com/learn/patient-abandonment
14. https://www.sciencedirect.com/science/article/pii/S1526590024006631
15. https://ascopost.com/issues/september-10-2019/how-to-terminate-a-treatment-relationship/
16. https://www.justia.com/injury/medical-malpractice/patient-abandonment-and-premature-discharge/
17. https://www.ncbi.nlm.nih.gov/books/NBK563285/
18. https://www.statnews.com/2021/11/22/her-husband-died-by-suicide-she-sued-his-pain-doctors-a-rare-challenge-over-an-opioid-dose-reduction/
19. https://servetheinjured.com/understanding-patient-abandonment-legal-implications-and-patient-rights/
20. https://www.expertinstitute.com/resources/insights/patient-abandonment-cases-what-you-need-to-know/

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