As of tomorrow (11/06/2019) I will not have to listen to the political ads of  the two candidates running for KY governor.  The current governor is a Republican and the Democrat running is the current state’s AG…  over the last 4 years I have seen the AG sue the Governor over some nonsense…  the content of these political ads… one could easily come to the conclusion that NEITHER ONE OF THEM…. is qualified to be governor of the state… but.. the two candidates belong to one of the two ingrained political parties in this country.  BUT.. one of the BUMS will get elected…

AND Dec 7th is the last day of Medicare open enrollment and I won’t have to listen to Joe Namath tells everyone HOW GREAT Medicare Advantage program is and if you call a certain number… they ( some insurance agent) will inform them how many new services and products that have been added to the Medicare Advantage program and often don’t have to pay any monthly premium.

Medicare Advantage is PRIVATE INSURANCE and when Congress allowed some new services/products to be made available to beneficiaries.. what they are not telling people is that when you give more and charge no more…something has to give..  I have heard some pts make comments that deductibles and copays in these programs in 2020 will INCREASE. People signing on to these programs may be limited to certain providers – not necessarily the providers that they have been using and/or ones that they are happy with and/or comfortable with their competency or demeanor.

Pts may see be forced to see mid-level practitioners ( ARNP, PA, NP) because they typically get paid at 85% of what a doctor get paid for from Medicare/Medicaid/Insurance. So pts may end up with a office practice with a single supervising physician and a large number of mid-level practitioners being the only and/or primary healthcare practitioner that they see.

But the Nov 2020 election is not that far off and there are a number of states that will have democratic primary voting starting in a few months.  Can hard wait 🙁

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RT America talked to Bill Tackett, a man who can’t live without hydrocodone and who has been prescribed opioids long term for his condition. Tackett, who was diagnosed with degenerative disc disease in his 20’s and is now 40, is concerned lawmakers out to limit opioid prescriptions will harm patients as they try to prevent addiction. Find RT America in your area: http://rt.com/where-to-watch/ Or watch us online: http://rt.com/on-air/rt-america-air/ Like us on Facebook http://www.facebook.com/RTAmerica Follow us on Twitter http://twitter.com/RT_America

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ACLU sues US gov calling for transparency over facial recognition tech

https://newatlas.com/computers/aclu-sues-us-gov-fbi-dea-doj-facial-recognition-technology/

The American Civil Liberties Union (ACLU) is taking several US government agencies to court claiming they have refused to comply with freedom of information requests related to the transparency of law enforcement usage of facial recognition technology.

The lawsuit claims in January 2019 the ACLU submitted a freedom of information (FOI) request to three US government agencies, the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), and the Drug Enforcement Administration (DEA). The FOI request pressed those agencies to supply all records outlining how, where and when facial recognition technologies had been utilized.

“Production of these records is important to assist the public in understanding the government’s use of highly invasive biometric identification and tracking technologies,” the ACLU states in the court lodgment. “These 2 technologies have the potential to enable undetectable, persistent, and suspicionless surveillance on an unprecedented scale. Such surveillance would permit the government to pervasively track people’s movements and associations in ways that threaten core constitutional values.”

As described in the complaint, the ACLU received acknowledgment of the FOI request from both the FBI and DEA within weeks of the initial submission. However, the last correspondence to the ACLU on the matter was a notification from the DEA on April 12, 2019, stating, “your request has been assigned and is being handled as expeditiously as possible.” Since then, the ACLU heard absolutely nothing from any of the agencies, suggesting they were not planning on responding to the legal request in violation of the Freedom of Information Act (FOIA).

In a statement accompanying the complaint, director of the Technology for Liberty Program at the ACLU of Massachusetts Kade Crockford says that what we already know about FBI uses of facial recognition technology, from public reporting and admissions to Congress, is already concerning.

“And when that agency stonewalls our requests for information about how its agents are tracking and monitoring our faces, we should all be concerned,” writes Crockford. “That’s why today we’re asking a federal court to intervene and order the FBI and related agencies to turn over all records concerning their use of face recognition technology.”

Concerns are growing globally over the increasing use of facial recognition technology. Several US cities and states have recently rolled out bans of the technology, while an ongoing battle in UK courts is challenging law enforcement uses of facial recognition in public spaces.

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Letter to the editor: Pain meds not to blame for opioid crisis

https://www.pressherald.com/2019/11/03/letter-to-the-editor-pain-meds-not-to-blame-for-opioid-crisis/

I strongly disagree that the opioid crisis was caused by legal over-prescribing by physicians, due to misleading marketing.

I am a soon-to-retire criminal attorney and have represented close to 100 heroin addicts. I can’t even think of one addict whose addiction began with a legal prescription. Most simply purchased Oxycontin on the street, and then switched to heroin. They took opioids because they wanted to feel good. I do feel addiction must be treated as a public health crisis, but the theory of liability is a big lie.

The problem with the theory that addiction begins with legal prescriptions is that now people who really have chronic pain, and sometimes depression, cannot get a legal prescription or they have to beg. It is no doubt convenient to blame a deep pocket to hopefully fund addiction programs. Politicians and many self-righteous physicians have no empathy for people, especially elderly people whose lives are made functional with opioids. They just want to go with the hysteria and cover their butt.

This same hysteria is now being directed also toward vaping. It is almost certain that people getting ill from vaping were using knockoffs with THC. Of course the physicians and politicians have little empathy for those who depend on vaping to stop smoking.

Thankfully Maine has not yet followed Massachusetts in banning the sale of all vaping devices. We’ll see.

In the meantime, elderly people who need opioids should not have to beg a provider for a prescription.

Larry Goodglass
Princeton

I think that “over prescribing” is a mis-label …. but I do believe that there was some careless prescribing.  There were some pts who were given an original opiate for a valid medical reason, but the pt kept request refills and the prescriber kept agreeing to them.. and then at some point in time.. the prescriber started paying attention and decided NO MORE OPIATES and of course the pt has become dependent and they go into cold turkey withdrawal.  Most likely, the pt came to the conclusion and confirmed by their friends and relatives that they were “addicted to opiates “

These are the pts that are put in a abstinence rehab and are able to “come clean”.. because they were never truly addicted and if the prescriber had taken the time to ween the pt off the opiates that had been carelessly prescribed… would never had been labeled as a addict nor had to go thru rehab. That is way only 5%-10% of people going thru abstinence rehab are successful in getting and staying “clean”.

Of course, there were a number of prescribers throughout the country – especially in Florida – that were writing opiate/controlled substance Rxs that they knew or should have known or suspected were being diverted.

They are now mostly gone and the fact that the DEA is no longer seeking out “dead bodies” from practices to be the reason that they should raid and shut down a practice. Now, more and more… they are making determinations of how many controlled Rxs a prescriber is writing over a several year period and claiming that millions of doses prescribed to thousands of pts… defines the appropriateness of the prescriber’s overall practice in treating pts who have a valid medical necessity for controlled medications.

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VA study uncovers critical link between pain intensity and suicide attempts

New study finds pain intensity is a telling risk factor for suicide

https://www.blogs.va.gov/VAntage/67708/va-study-uncovers-link-pain-intensity-suicide-attempts/

Many factors are associated with suicide risk. These factors range from PTSD, depression and anxiety disorder to financial and interpersonal concerns to access to opioids and other lethal means, like firearms. Even when we take these risk factors into consideration, moderate to severe pain intensity is associated with suicide risk.

Veterans are a particularly vulnerable group. The suicide rate among Veterans is 1.5 times that of the general population. Also, Veterans develop chronic pain conditions at higher rates and report greater pain severity than members of the general population.

VA’s Behavioral Health Autopsy Program: Executive Summary reports pain is the most common factor Veterans experience before they die by suicide. The VISN 2 Center of Excellence (CoE) for Suicide Prevention studied the link between reported pain intensity and suicide attempts. The results may uncover how effective pain treatment can be a critical suicide prevention tactic.

Managing pain in daily life

Veterans have several treatment options through VA to cope with pain and reduce pain intensity. Nonmedication interventions are considered first-line treatments. They include physical therapy, cognitive behavioral therapy for chronic pain and chiropractic care. Medication-based treatments include nonsteroidal anti-inflammatory medications and injections. Examples are cortisone for low back pain and botulinum toxin for migraines. Opioids may be used under close monitoring when they are taken appropriately and the benefits outweigh the risks.

Strategies

Strategies that improve psychological well-being can also help Veterans cope with pain in everyday life. Veterans can discuss the following tactics with care providers to see which may work best:

• Be honest about the pain you’re experiencing. An important step in managing chronic pain is accepting that it is part of your life. Accepting the presence of pain can help you move on and engage in enjoyable and everyday activities despite that pain.
• Pace your activities. Although you may not be able to do everything you did before the pain began, try to find ways to reintroduce some activities in a moderated way and create more balance in the activities you’re doing. For example, if you plan to go for a long walk in the morning, consider taking a break mid-day to give your body time to recover and to prevent a pain flare-up. Even if you start to feel better over time, avoid overdoing it to avoid a relapse or further injury.
• Explore mindfulness. Increasing awareness of the present moment can help relieve emotional and mental tension that can intensify physical pain. Meditation and other mindfulness practices help you become more comfortable in feeling the way you feel without judgement, helping to prevent pain from taking over your thoughts and acting on autopilot.

To learn more about pain management treatment provided by VA, explore VA’s pain management webpage for Veterans.

People with higher pain intensity had lower survival rates than those who had mild pain or no pain at all.

Study findings

A CoE study looked at Veterans’ average pain intensity scores in the year after they began receiving pain specialty services to determine whether pain intensity was associated with suicide attempts. Based on data from 2012–2014, moderate and severe pain over the course of a year increased the risk of a suicide attempt, even after considering other factors like a Veteran’s history of suicide attempts.

As the graph to the right shows, those with higher pain intensity had lower survival rates than those who had mild pain or no pain at all. This close correlation between pain intensity and suicide risk and death rates suggests that reducing pain, or the perception of that pain, can help prevent Veteran suicide.

Advice for Veterans’ family members and friends

Family members and friends are often the first to realize that a Veteran may be at risk for suicide. Warning signs include changes in mood or behaviors, outward comments about suicidal thoughts or increased interest in lethal means, such as firearms and opioids. If you see these signs in a Veteran in your life:

• Start the conversation. Topics of pain and suicide can be challenging to talk about. Still, don’t be afraid to begin the conversation with the Veteran you’re concerned about. Starting the conversation can help the Veteran realize the need to address pain. It also reassures the Veteran that you’re willing to help.
• #BeThere for the Veteran and engage in healthy activities. Invite your friend or loved one to a movie or dinner or for a walk around the neighborhood. Getting a Veteran out of the house can remind them of activities they can enjoy, despite their pain. Research suggests changing a Veteran’s mindset and engaging them in activities can improve overall wellness.

 

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Why Are Insurance Executives Treating Our Patients?

https://www.medpagetoday.com/resource-centers/meeting-challenge-multiple-sclerosis/early-imaging-ms-may-predict-long-term-outcomes/2612

In two recent surveys, physicians said that pre-authorizations are burdensome to their practice and that they could lead to adverse patient outcomes. Kevin Campbell, MD, agrees that the insurance companies shouldn’t be part of patient practice, and says that the peer-to-peer review process is even worse.

The opinions expressed in this commentary are those of the author. The following transcript has been edited for clarity.

Insurance companies have been granted far too much control over patient care over the last several decades. Nowhere is it more apparent than when physicians are asked to obtain “pre-approval” for guideline-based, medically necessary procedures. According to one survey from the Medical Group Management Association, 83% of those surveyed said prior authorizations are “very” or “extremely” burdensome to their practice and their staff. Another survey conducted of physicians found that nearly one-third of doctors believe that spending time obtaining pre-authorizations actually led to adverse patient outcomes.

Ninety percent of those practice managers have indicated that the amount of pre-authorizations have significantly increased over the last year. To illustrate the sheer volume of this work, there were 182 million pre-authorization transactions conducted last year alone.

While Congress has given lip service to this issue by hosting a hearing with doctors in September, no real changes have occurred. In fact, the insurance companies have lobbied Congress that these pre-authorizations are needed to reduce costs and prevent unneeded treatments.

I find this practice offensive. Who are insurance executives to decide who needs or does not need a procedure? Who are they to determine the appropriateness of a procedure? Did they go to medical school? Have they ever looked a patient in the eyes and told them they cannot have a life-saving procedure done because it costs too much?

Worse than the pre-authorization is the peer-to-peer consultations. As an electrophysiologist I spent nearly a decade training at Duke in order to become an expert in the implantation of pacemakers and ICDs and performing ablations. When I have a pre-auth denied, I have to get on the phone and argue my case for the procedure — which is based on ACC and HRS guidelines —

to someone who has NEVER even seen a pacemaker, and almost always does not even understand how a pacemaker functions! Often these are retired pathologists, pediatricians, or other non-specialists that are making decisions about MY clinical judgment.

In fact, an EP colleague of mine recently told me that he had to do a peer-to-peer consult to argue the appropriateness of an ICD implantation. When he began the consultation, the insurance company representative, who was supposedly an MD, said that he could not justify putting ACID into a patient. The trick here is that this guy did not even know that it was an AICD or a defibrillator and not ACID. This just illustrates the level of incompetence of the reviewing doctors that insurance companies hire to review the appropriateness of procedures.

We cannot stand for this any longer. Insurance companies are working around the clock to avoid paying for care. Our patients and our employers pay insurance companies for coverage. The physicians that care for patients every day — by and large — provide evidence-based care and do what is indicated for patients based on guidelines. It is insulting and frankly disgusting to have someone who has no knowledge of a particular specialty making a determination of care appropriateness on a patient that they have never evaluated and with no expert knowledge on the topic. Moreover, these reviewing MDs are actually compensated for NOT approving procedures.

Our patients are suffering. Our staff is becoming overworked with dealing with pre-authorizations. Our doctors are wasting valuable time on the phone arguing with ignorant MD reviewers employed and incentivized by insurance companies. Lets take medicine back — contact your congressman or congresswoman today.

Kevin Campbell, MD, is a cardiologist based in Raleigh, North Carolina, and Chief Innovation Officer at biocynetic. In addition to his weekly video analyses on MedPage Today, he is the official medical expert at WNCN in Raleigh and makes frequent guest appearances on other national media outlets such as Fox News and HLN.

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Fentanyl found in unregulated vape cartridges in other states. ‘Just a matter of time’ before it comes to Utah

https://fox13now.com/2019/11/01/fentanyl-found-in-unregulated-vape-cartridges-in-other-states-just-a-matter-of-time-before-it-comes-to-utah/

SALT LAKE CITY — Fentanyl is one of the deadliest drugs on the market. Just a small amount of the synthetic drug could cause someone to overdose and potentially die, said Brian Besser, the district agent in charge for the DEA in Utah.

“Fentanyl is the number one problem we are seeing with the cartels because they are putting that out in mass,” Besser said.

Friday, Besser read an alarming DEA intelligence report stating fentanyl had been found in unregulated vape cartridges in other areas of the nation. While there haven’t been any reported cases of this in Utah, Besser said it’s only a matter of time.

This is extremely concerning, Besser said.

“We are starting to see fentanyl make its way into the vaping industry, and we see that we are definitely going to see the death counts go up,” he said.

Vaping has been a heated topic in Utah. The latest numbers from the Utah Dept. of Health show more than 100 people have become sick from a vaping related illness and one person has died. Almost 90 percent of the patients have admitted to using unregulated THC cartridges.

The possibility of unregulated vape cartridges with fentanyl adds to the concerns of people using any sort of unregulated vape product, The C.O.O. of Odyssey House said.

“In terms of people buying illicit vape cartridges I think there needs to be a lot of caution there,” Christina Zidow said.

It is especially concerning with the youth population, Zidow said.

“That scares me a lot because I know many, many, many people vape,” she said.

Most people who come in contact with fentanyl, do so unknowingly, Besser said. Although there are people who seek out the strong drug.

“You are talking about a substance here that is over 100 times more potent, more powerful than street-level heroin,” he said.

Fentanyl is easy to disguise, Besser said, and has been found in a variety of drugs like marijuana, heroin, cocaine, pressed pills and other drugs.

“Synthetics are easy to make even though they are complex chemically, they are extremely volatile and very, very dangerous,” he said.

If you or someone you know is struggling with addiction, there are resources out there.

The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders. SAMHSA’s National Helpline can be reached by calling 1-800-662-HELP (4357) or on its website.

“Hope and help is possible and so is recovery,” Zidow said.

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RFK’s granddaughter Saoirse Kennedy Hill, 22, died from an accidental overdose, officials say

https://www.foxnews.com/us/rfk-granddaughter-cause-of-death-revealed

The 22-year-old granddaughter of Robert F. Kennedy who passed away after being found unresponsive at the family’s Cape Cod residence in August died from an accidental drug overdose, officials revealed Friday.

Saoirse Kennedy Hill had a mix of methadone, fluoxetine, norfluoxetine, diazepam, nordiazepam, and alcohol in her system at the time of her death on Aug. 1 in Hyannisport, Mass., the Boston Herald reported, citing toxicology testing.

Hill was the daughter of Courtney Kennedy Hill, the fifth of 11 children born to the late New York senator and wife Ethel. She had been attending Boston College and was expected to graduate in 2020.

“Our hearts are shattered by the loss of our beloved Saoirse,” the family had said in a statement following her death. “Her life was filled with hope, promise, and love. She cared deeply about friends and family, especially her mother Courtney, her father Paul, her stepmother Stephanie, and her grandmother Ethel.”

In a 2016 opinion piece for the Deerfield Scroll, the student newspaper for the Deerfield Academy boarding school in Massachusetts, Hill wrote about her bouts with depression.

“My depression took root in the beginning of my middle school years and will be with me for the rest of my life,” she wrote. “Although I was mostly a happy child, I suffered bouts of deep sadness that felt like a heavy boulder on my chest. These bouts would come and go, but they did not outwardly affect me until I was a new sophomore at Deerfield.”

She urged students and faculty to talk openly about mental illness in order to get rid of the stigma associated with depression.

“People talk about cancer freely; why is it so difficult to discuss the effects of depression, bipolar [sic], anxiety, or schizophrenic disorders?” Hill wrote. “Just because the illness may not be outwardly visible doesn’t mean the person suffering from it isn’t struggling.”

The compound where Hill was discovered has around six homes on Nantucket Sound in Hyannisport.

Multiple generations of the Kennedy family have lived at the compound, which famously served as President John F. Kennedy’s summer White House.

Saoirse Kennedy Hill had a mix of methadone, fluoxetine, norfluoxetine, diazepam, nordiazepam, and alcohol in her system at the time of her death on Aug. 1 in Hyannisport, Mass., the Boston Herald reported, citing toxicology testing.

NORFLUOXETINE – is a metabolite from a pt taking FLUOXETINE ( Prozac)

and  NORDIAZEPAM is a metabolite from a pt taking DIAZEPAM ( Valium)

So actually this young lady had really taken ONLY FOUR DIFFERENT SUBSTANCES  Prozac, Valium, Alcohol, Methadone – NOT THE FOUR SUBSTANCES AS WAS REPORTED.

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Oklahoma opioid law limits doctor prescription

https://www.kjrh.com/news/local-news/oklahoma-opioid-law-limits-doctor-prescription

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