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Per the Civil rights law, racism is a civil rights violation… as is discrimination under the Americans with Disability Act. It becomes more and more obvious that the FEDS/DOJ are the driving force behind discrimination – or even favoritism – of certain segments of the populations.  Right now Gov Abbott has stated that he is going to arrest/jail illegal aliens coming into Texas – for trespassing on private property of numerous family farms that are on the Texas/Mexican border.

It has been reported that some 10%-20% of these illegal aliens test COVID-19 positive and abt 30% refuse a COVID-19 vaccination when offered. The Federal DOJ Attorney General Garland it has been reported that he is going to sue Gov Abbott if he starts arresting/jailing illegal aliens.

Reportedly, abt ONE MILLION + illegal aliens have been allowed into our country in the last SIX MONTHS.  While legal citizen have been encouraged to get COVID-19 vaccination and seemingly many businesses, academia and federal employees are in the process being mandated to get vaccination … if they wish to keep their job. Discrimination/Racism now seems to be a TWO WAY STREET.  What happened to all the EQUITY that has been a major battle cry since the beginning of the year?

Racism as a Chronic Disease: We Are All Affected

https://www.clinicaladvisor.com/home/the-waiting-room/racism-chronic-disease-we-are-all-affected/

Recent literature has increased the focus on health disparities related to racism, not race, as a major cause of illness.

Since the inception of Western medicine, however, there has been an effort to identify genes specific to certain races that would explain why minority populations, including Black, Indigenous, and people of color (BIPOC), have a higher disease burden than White populations.

I attended PA school from 1998 to 2000, and even then our lectures frequently discussed how certain populations are more likely to have certain diseases, including heart disease, diabetes, and hypertension. We know that it is true, but we also know that race is a non-scientific construct, widely based on racist beliefs. I recall a Black classmate who would mumble to those of us around him during lectures, “oh great, here’s something else that is wrong with me.” His comments were certainly reflective of the false and unscientific beliefs that race is a cause of illness.

The issue of how to view the impact of institutional and individual racism on the health of BIPOC has gained increased attention, including exploring new and novel ways to think about racism and health. A Baylor College of Medicine blog post from 2020 illustrates some new and creative thinking on this topic. Blogger Haley Jackson Manley, research assistant in the Center for Medical Ethics and Health Policy at Baylor College of Medicine, shared her insightful take in that post:

“It’s more than just semantics that irks me when people talk about racism as a pandemic. A pandemic implies an outbreak. A disease that is fleeting and may be new or has seasons, such as the flu. Racism is not that. Racism is not new. It’s unceasing with no treatment or vaccine in sight. A more appropriate diagnosis would be racism as a chronic disease, like cancer or diabetes. But this particular chronic disease does not destruct the body of the individual who is infected. Instead, in America, its effects are felt throughout the entire African American community and are not only physical but also emotional and social.”

This really got me thinking about the concept of racism as a chronic disease that affects the physical and mental health of BIPOC. But it also posed questions about how to view this perspective. For example, if we accept that racism is a chronic illness, it leads me to wonder who then has the illness. We know that BIPOC are most affected by racism. But are such populations the ones with the disease or is it those who have racially biased beliefs and actions?

Just because BIPOC bear the brunt of demonstrated negative health impacts from racism, does that really equal having the illness? For example, if an authoritarian parent berates and abuses their child, and causes the child harm, who has the disease in that case? It hardly seems reasonable to describe the harmed child as the diseased party. Instead, it’s the parent with the illness.

But racism can be more subtle. Certainly, explicit racist behavior would lead us to conclude that the source of the behavior is the root cause of the illness. But what about when implicit and unconscious bias and racism is the root of the problem? Research repeatedly demonstrates that implicit and unconscious biases are pervasive among all humans. It also tells us that it predictably affects the health of minority populations. So, does that mean that all humans who hold implicit biases should be viewed as having a disease? Or is implicit bias itself a disease?

I’m inclined to think that it is, depending on how we define disease. Part of being a human being is dealing with our own inevitable disease states, ranging from rhinitis to cancer, from COVID-19 to depression. A reasonable assertion would be that our implicit and explicit biases may need to be viewed as a disease state because of the known negative health impacts they have on others. 

Finally, what about society itself? Can a society with various cultures have a disease? It makes sense to me that societies can indeed be ill, with the illness caused by collective biases, hatred, ignorance, and racism. In the end, we know that the primary sufferers of racism are BIPOC. But asserting that they are the ones with the disease feels like a blaming-the-victim exercise, something that medicine knows much about. What really matters, however, is the chronic occurrence of ignorance, hatred, explicit and implicit bias, and historic prejudice within the medical community that dates back to its origins. This has resulted in premature death and unequal burden of illness and misery on BIPOC. Our job as PAs, nurse practitioners, and other health care providers is to understand how racism impacts us and our patients and establish ways to mitigate this impact. The job of medicine is to address how explicit, or even implicit biases, have made those of us with racial biases sick as well.

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https://youtu.be/pj1IpD7_aT8?t=586

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Congresswoman Kat Cammack website

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I just got a text from Paula and Joe suddenly passed away last night… Those Pharmacist that know Joe will remember him for “taking on” CVS Health over ADA, EEOC and Whistle blower lawsuit… and walked away a WINNER, that was abt 5 yrs ago.

I think that Joe was 69 y/o and regardless of him dealing with MS… was able to work as a Pharmacist for some 40 yrs.

Joe was one of those “good old time Pharmacists” that always tried to meet the pt’s needs.

RIP Gravestone

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Pfizer Vaccine Protection Wanes After 6 Months

https://www.medscape.com/viewarticle/955601

Pfizer’s COVID-19 vaccine continues to show strong protection against serious illness and hospitalization after 6 months, but overall protection against the virus appears to wane after a half a year, according to a new study.

The July 28 preprint report of the study, which has not been peer reviewed, suggests a gradual “declining trend in vaccine efficacy” over 6 months after a two-dose regimen of the Pfizer vaccine. The study included more than 45,000 people worldwide.

The study found that overall effectiveness fell from 96% to 84%.

A third booster dose of the Pfizer vaccine increases neutralizing antibody levels against the Delta variant by more than five times compared to levels after a second dose in people aged 18 to 55 years, new data from Pfizer show.

The immune response to the third dose appears even more robust ― more than 11 times higher than the response to second shot ― among people aged 65 to 85 years.

The company noted this could mean an estimated 100-fold increase in Delta variant protection after a third dose. These new findings are outlined in a Pfizer second quarter 2021 earnings report, which notes that the data are submitted for publication in a medical journal.

The data come from a relatively small number of people studied. There were 11 individuals in the 18- to 55-year-old group and 12 people in the 65- to 85-year-old cohort.

“These preliminary data are very encouraging as Delta continues to spread,” Mikael Dolsten, MD, chief scientific officer and president of the worldwide research, development and medical organization at Pfizer, said during prepared remarks on a company earnings call today, CNN reported.

Availability of a third dose of any of the current COVID-19 vaccines would require either amending the US Food and Drug Administration (FDA) emergency use authorization or granting full FDA approval status to the vaccine.

The possibility of a third-dose authorization or approval has not been without controversy. When Pfizer announced intentions to file for FDA authorization of a booster dose on July 8, the Centers for Disease Control and Prevention, the FDA, and the National Institutes of Health were quick to issue a joint statement saying that they would decide when the timing is right for Americans to have a third immunization. The agencies stated, in part, “We are prepared for booster doses if and when the science demonstrates that they are needed.”

In addition, the World Health Organization said at a media briefing on July 12 that rich countries should prioritize the sharing of COVID-19 vaccine supplies to other countries in need worldwide before allocating doses for a booster shot of its own residents.

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More Medical Device Deaths Than We Previously Thought?

https://www.medpagetoday.com/publichealthpolicy/fdageneral/93768

A significant number of medical device adverse events that resulted in patient deaths were miscategorized in the FDA’s Manufacturer and User Facility Device Experience (MAUDE) database, according to an analysis using a natural language processing algorithm.

Flagging terms commonly associated with death, the algorithm identified 290,141 reports in which a serious injury or death was reported; 52.1% of these events were reported as deaths, and 47.9% were classified as either malfunction, injury, or missing (the report was not put in any category), reported Christina Lalani, MD, of the University of California San Francisco, and colleagues.

From their overall sample, they found that 23% of reports with a death were not placed in the death category, amounting to roughly 31,552 reports filed from Dec. 31, 1991, to April 30, 2020, they noted in JAMA Internal Medicine.

The physicians and manufacturers who report adverse events with medical devices must choose whether to classify the event as a malfunction, injury, death, or “other.” Per FDA instructions, the reporter is required to categorize an adverse event as an official death if the cause of death is unknown, or if the device “may have caused or contributed to a death.”

In the current analysis, about 56% of reports involving patient deaths were for class III devices — the highest-risk medical devices — and 40.1% were for class II devices, Lalani and team wrote.

The three most common product codes among the adverse event reports were for ventricular assist bypass devices (38,708 reports), dialysate concentrate for hemodialysis (25,261 reports), and transcervical contraceptive tubal occlusion devices (14,387 reports).

The natural language processing algorithm used in this study was implemented to scan through reports and identify terms such as “patient died,” “patient expired,” “could not be resuscitated,” and “time of death.” Of the 70 natural language processing terms in total that were associated with a death, 62 (88.6%) were found among miscategorized adverse event reports involving a patient death. And, of all 62, there were 17 terms that had an estimated percentage of 100%, meaning that “every time that term was used, the patient had died, even though the reporter had not classified the report as death,” the team wrote.

Only 18 terms had sample sizes large enough for researchers to calculate confidence intervals; among them, the words “death” or “deaths” were linked to 12% of adverse event reports in which a patient died, but were classified as malfunction, other, or missing — the highest rate of all the analyzed terms.

Lalani and colleagues acknowledged that one of their study’s major limitations was that they only included reports that contained at least one term associated with death, as opposed to all the reports from the MAUDE database. This, they noted, will likely lead to the underestimation of the actual number of deaths that were improperly categorized.

“The classification chosen by the reporter is vital, as the FDA must review all adverse events reported as deaths, which is not the case for other reporting categories,” the authors wrote. Improving the accuracy of these reports is crucial, since the frequency of patient deaths is what can prompt the FDA to pursue investigations into the device’s safety, they added.

Notably, almost all of the reports analyzed in this study — 95.9% — were submitted by manufacturers, pointing to an inherent conflict of interest, the authors pointed out.

“It may not be in their interest to facilitate identification of serious problems with their own devices in a timely manner,” they wrote. “There have been multiple instances of delays by manufacturers in reporting serious malfunctions and deaths that were associated with medical devices, as well as complete failures to report.”

Therefore, it’s likely that a significant number of patients have been unknowingly treated with devices that were later revealed to be dangerous, Lalani and colleagues noted. For example, they referenced the reporting failures that occurred from 2002 to 2013, when 32,000 women reported adverse events associated with the permanent birth control device Essure; the FDA, however, only received 1,023 adverse event reports from the manufacturer during that 11-year period.

“For these reasons, physicians, hospitals, and patients should submit reports directly to the FDA instead of or in addition to reporting through the manufacturer,” they concluded.

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I often see letters that pts post on the web that they have received from various insurance/PBM companies.

ASSERTION: Opiates are ADDICTING                           

FACT: when prescribed to chronic pain pt, there is a POTENTIAL of addition but depending on what studies you read, various percentages are claimed but generally most will be < 2%

ASSERTION:  OTC meds (NASIDS, Aspirin (ASA, Tylenol (Acetaminophen (APAP)) are as effective as opiates

FACT:   everything is DOSE DEPENDENT… a high dose of NASIDS/ASA/APAP vs a low dose of opiates – in some incidents may be true

ASSERTION: OTC MEDS are SAFE

                                                              FACT: all meds are potentially dangerous, ASA/NASID can cause kidney damage and intestinal bleeds (est 15,000/yr die from bleed outs). APAP can cause liver damage Liver injury from acetaminophen at low doses linked to fasting, heavy drinking

Under/Untreated pain can have its serious health consequences to pts – see chart below –  things like high blood pressure/hypertensive crisis… which can cause stroke, kidney/eye damage, death for starters.  It can cause increased anxiety, depression, suicidal idealization and even suicide itself.

The pt might want to respond to such letters with asking the insurance company if they understand and are prepared to incur the cost of treating all the comorbidity issues that could be worsened or other health issues that the pt might develop because of their under/untreated pain.

The pt might also want to state that he/she is sharing their letter and this letter with my family … in case the pt dies prematurely from the actions of the insurer/PBM. So that they will have documentation to consult legal counsel for any rights that the pt had under various disability laws and what options they have to seek restitution.

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It would appear that according to this video poster,  during a pandemic/emergency situation… the Secretary of Health and Human Service pretty much is granted dictatorial powers and all those  other Federal/State laws are suspended during the emergency period.  Any adverse consequences to any person being affected by the mandates of HHS… the person has no legal recourse and all those entities involved in following HHS mandates are indemnified from any liability and/or defending any lawsuits. So it would appear that the FEDS can mandate that EVERYONE gets a COVID-19 vaccination and neither the individual nor any state could put any exemptions in place.

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It is claimed that of all the opiate OD’s,  a low percentage of people  OD by using their own Rx meds… our system declares their deaths Opiate related death, but in reality it is most likely a SUICIDE.  The chart below, explains the issues that a chronic pain pts has to deal with when their chronic pain is under/untreated. The pt may end up with a heart attack, stroke, death or even suicide… all a directly related to a pt having their meds involuntarily reduced/eliminated … but no one within the medical system is charged with any responsibility for the death.  If a person OD’s with any opiate/street drug that was at one time a pt of a prescriber…  the prescriber may be brought up on charges for that death.   Maybe surviving family of the pt who takes the final solution to end their torturous level of pain legally goes after the prescriber for assisting suicide, involuntary manslaughter or whatever charge can be filed against the prescriber and/or if the prescriber is an employee of a large healthcare corporation… and the prescriber is just following a corporate policy/edict. Could the surviving family go to the local prosecutor/district attorney to file charges against those entities.   The surviving family would not have hire any attorney, just let the judicial system take care of death/suicide.

The Final Solution – to end their pan – is a Major Component of the Opioid Crisis that Must Be Addressed

https://www.drugabuse.gov/about-nida/noras-blog/2019/09/final-solution-deaths-are-major-component-opioid-crisis-must-be-addressed

September is National Suicide Prevention Awareness Month. In observance, our two institutes, the National Institute on Drug Abuse (NIDA) and National Institute of Mental Health (NIMH), are taking this opportunity to highlight a dimension of the opioid crisis that receives too little attention—the links between opioid use, opioid use disorder (OUD), and suicide.

We’ve heard a lot about the opioid epidemic, and the rising toll it is taking on our communities. In 2017, 47,600 people died from overdoses involving prescription or illicit opioids. But the opioid overdose epidemic is not limited to people with opioid addiction who accidentally take too much of a pain reliever or unknowingly inject a tainted heroin product. Concealed in the alarming number of overdose deaths is a significant number of people who have decided to take their own life.

It can be challenging to discover the true relationship between suicide and drug use. In the absence of a suicide note, it is difficult to assess the intentions of an individual who has died of an overdose, other than circumstantially. Also, the intentions of someone with OUD who overdoses may not always be clear-cut. In a study last year of current and past overdose experiences among patients seeking treatment in a Flint, Michigan emergency department

(link is external), 39% of those whose worst overdose had involved an opioid or sedative reported wanting to die or not caring about the risks; another 15% reported they were unsure of their intentions.

While we don’t know exactly how many opioid overdoses deaths are actually suicides, some experts estimate that up to 30% of opioid overdoses may fit this description. The connection between opioid overdose and suicide has appeared to increase over time, with one 2017 analysis of National Vital Statistics data showing significant increases in suicides involving opioids among all age groups except teens and young adults between 1999 and 2014; in those aged 55-64, the rate quadrupled.

Research seeking to understand the link between suicide and opioid use suggests the two may be entangled in multiple ways and for many reasons. A 2017 study using national survey data showed that people who misused prescription opioids were 40-60% more likely to have thoughts of suicide, even after controlling for other health and psychiatric conditions. People with a prescription opioid use disorder were also twice as likely to attempt suicide as individuals who did not misuse prescription opioids.  

People with substance use disorders also frequently have other psychiatric disorders—for example, they are twice as likely to have mood and anxiety disorders, which are independently associated with increased suicide risk. The reverse is also true. Half of all individuals with a mental illness will—at some point in their life—have a substance use disorder. Moreover, mental illnesses are also associated with accidental overdoses of medications and illicit drugs.

Pain is another important factor when considering the complex relationships between opioids, overdose (both suicidal and accidental), and mental illnesses. Individuals suffering from chronic pain conditions—the primary reason people are prescribed opioids—may also have comorbid depression or other mental illnesses, and they may be at increased risk of suicide simply because of their pain. Individuals who take higher quantities of prescribed opioids for pain are also at an increased risk of accidental overdose death. With current initiatives to reduce opioid prescribing, many pain patients find themselves either unable to get treatment they need or stigmatized as “addicts” by the healthcare system, compounding their difficulties.

Our Institutes are engaged in research initiatives that address the suicide component of the opioid crisis. NIDA funds research aimed at understanding the complexities of addiction, including co-occurring mental health problems and shared environmental and genetic risk factors for addiction and mental illness. NIMH funds research aimed at understanding the causes of suicide and suicidal ideation and seeks to develop new prevention and treatment interventions specifically targeting suicide.

The opioid crisis and the deaths of despair associated with it demand addressing the larger mental health context of opioid use and misuse. We must fully utilize the effective OUD medications at our disposal in addition to addressing the many risk factors for suicide, particularly co-occurring mental illness and pain, in those who use opioids. This is why the NIH HEAL (Helping to End Addiction Long-term^SM) Initiative is so important. The initiative builds upon well-established NIH research to improve prevention and treatment for opioid misuse and addiction. It also aims to enhance pain management by developing effective but safer substitutes for opioids.

As part of this initiative, participating NIH institutes will be funding clinical trials of collaborative care models to treat people with opioid use disorder and co-occurring mental disorders. Collaborative care models, which involve mental health professionals, care managers, and primary care physicians all working together, are already recommended for depression and post-traumatic stress disorder. Recent evidence suggests they could be effective for substance use disorders and for reducing suicide risk. These new grants aim to demonstrate this efficacy definitively and to show how collaborative care can be implemented in community health centers in the areas hardest hit by the twin epidemics of opioid overdose and suicide deaths.

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