PHARMACIST STEVE

https://www.medscape.com/viewarticle/891411

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www.nationalpainreport.com/study-patients-who-receive-prescription-opioids-are-more-satisfied-with-their-care-8835295.html

Patients with musculoskeletal conditions who receive prescription opioids are more satisfied with their care than comparable patients who do not receive opioids.

“In the current payment paradigm, reimbursement is partially based on patient satisfaction scores. We sought to understand the relationship between prescription opioid use and satisfaction with care among adults who have musculoskeletal conditions,” lead author, Brian D. Sites, MD, MS, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, wrote.

In a study of nationally representative data, 13 percent (2,564) of more than 19,000 patients with musculoskeletal conditions used prescription opioids. Among those who used opioids over time, moderate and heavy use was associated with greater likelihood (55 percent and 43 percent, respectively) of being most satisfied, compared to single or no use of opioids.

Although opioids may be expected to offer patients with musculoskeletal conditions improved pain control, patients taking opioids in this study had more pain and worse health and disability than those taking limited or no opioids, suggesting a more complex picture.

As clinician compensation is increasingly linked to patient satisfaction, and as the United States struggles with an epidemic in opioid use, the authors suggest it is imperative to determine whether improved satisfaction with care is associated with demonstrable health benefits.

Dr. Sites’ study, Prescription Opioid Use and Satisfaction With Care Among Adults With Musculoskeletal Conditions, is published in the American Academy of Family Physicians’ journal, Annals of Family Medicine.

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www.thejointblog.com/illinois-judge-orders-state-add-intractable-pain-qualifying-medical-cannabis-condition/

In a decision that will significantly expand the pool of people eligible to use medical cannabis in Illinois, a judge has ruled that the state must add intractable pain as a qualifying medical cannabis condition.

In 2016 the Illinois Department of Public Health rejected a petition to add intractable pain to the state’s medical cannabis program. Now, two years later, Cook County Judge Raymond Mitchell has ordered the agency to add the condition. Intractable pain is defined as pain that’s resistant to standard treatment options.

The ruling comes from a lawsuit brought forth by Ann Mednick, who often experiences extreme pain associated with osteoarthritis; Mednick uses prescription opioids, but says they fail to control the pain and result in numerous side effects.

“Illinois is years behind the times,” says Mednick. “The state needs to get [it] together.” Mednick previously petitioned the now-disbanded Medical Cannabis Advisory Board to recommend the state add intractable pain as a medical cannabis condition; if you want to learn more about marijuana click here for weed online. The board voted unanimously to approve the petition, 10 to 0. However, this didn’t stop Department of Public Health Director Dr. Nirav Shah from rejecting the recommendation in January of 2016.

In his ruling Judge Mitchell stated that Dr. Shah’s decision was  “clearly erroneous”. He pointed to the fact that Dr. Mednick said intractable pain is not a condition listed in the International Statistical Classification of Diseases and Related Health Problems as a recognized unique medical condition, despite that not being true. The judge also said that; “The record shows that individuals with intractable pain would benefit from the medical use of cannabis”.

Unsurprisingly, the Department of Public Health says it plans to appeal the judge’s ruling.

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Yesterday… about mid afternoon… my computer just decided to self destruct… This is only the second time in all my decades of using computers that I had to seek “professional help” to put my computer back together… Off to Best Buy today and Geek Squad to the rescue… According to them .. .they have seen a “rash” of “C drives” just self destructing – at least the OS on the drive…they suspect that a update from Windows or Dell… has been sent out.. and they are not saying anything about how their little “bug” has trashed computer’s OS.

The good and bad of it for me… my computer has a solid state C DRIVE and all my data was on a old reliable typical hard drive labeled as “D”… but all the programs had to be downloaded and reinstalled and change their default configurations to my liking… – the ones that I could remember was on the system… I will probably be finding “missing” programs for weeks going forward.. when I need to do something.

If my blog seems rather “silent” over the next few days or I don’t get to your email for a few days… I am not intentionally ignoring anyone…

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www.thecipherbrief.com/us-agents-can-change-story-court-legally

The United States owes its existence as an independent nation partly to objections over excessive searches by British colonial authorities. Yet today, it is possible for an individual to go to prison as a result of evidence the U.S. government has deliberately kept hidden and that it may have gathered illegally.

Human Rights Watch just published an investigative report documenting parallel construction, a practice in which government agents create an alternative explanation for how evidence in a criminal investigation was found. It does this to avoid disclosing the original sources or methods in open court.

The result is that defense attorneys are unable to discover how evidence was collected and challenge it, and judges are unable to evaluate investigative methods that may have violated fundamental rights. Evidence described in the report suggests that agents may be using this concealment technique regularly and nationwide.

Of immediate relevance, parallel construction could be preventing Congress and the public from understanding the ways Section 702 of the Foreign Intelligence Surveillance Act (FISA), a controversial surveillance law that is currently the subject of a pitched battle over its renewal, affects people in the United States.

The “fruit of the poisonous tree” doctrine generally requires judges to bar prosecutors from introducing evidence that was obtained illegally. However, the government apparently justifies parallel construction based on exceptions to this doctrine.

For example, the U.S. Supreme Court has found that prosecutors may still introduce such evidence if they had a “genuinely independent” source for it. Human Rights Watch found that the government may be secretly deciding for itself what constitutes an “independent” source—cutting judges, whose role it is to ensure the fairness of trials, out of the picture.

One method the federal government may use to conceal sources entails asking local police to find their own reasons to pull over and search a vehicle for evidence of a criminal offense. We cited numerous avowed instances of such traffic stops, which are known in law enforcement circles as “wall” or “whisper” stops. The report provides links to leaked “be on the lookout” orders that explicitly instruct officers to “develop [their] own probable cause” for stopping and searching vehicles.

We also pointed to the possibility that the government is using orders issued under FISA, or closed proceedings under the Classified Information Procedures Act, to prevent the disclosure of activities or programs. Defense attorneys have had little success in finding out whether these or other techniques were used to conceal investigative methods in their clients’ cases.

While we were able to offer the most thorough portrayal of parallel construction to date, the report should inspire further questions. For example, we provided details about the Drug Enforcement Administration’s (DEA’s) Special Operations Division, which facilitates the sharing of intelligence with law enforcement agents and at least part of which has been nicknamed “the Dark Side.”

But a pair of e-mails from the surveillance software vendor Hacking Team that were leaked to WikiLeaks in 2015 point to the possibility that the Federal Bureau of Investigation (FBI) also contains an entity known as the “Dark Side.” (In the e-mails to which links are provided here, “Phoebe” is Hacking Team’s code name for the FBI, and “Charlie” is apparently a reference to an individual with an FBI e-mail address.)

The report also identifies “wall stops” requested by agencies including the FBI, Immigration and Customs Enforcement, and the Bureau of Alcohol, Tobacco, Firearms and Explosives.

Congress should demand—and the executive branch should provide—complete information about which agencies are engaging in parallel construction, and how. The public needs to know what is being done in its name, and everyone needs to be able to have confidence that the U.S. criminal justice system is respecting rights.

Numerous questions also remain about the DEA Special Operations Division’s “Dark Side.” A former federal prosecutor told us, “The Dark Side does stuff that doesn’t come to the public’s attention.” Another former federal prosecutor who has worked in the division said that members “do everything legally,” but suggested that they are operating under laws that confer vast powers. Such statements suggest a need for much greater transparency about the division’s activities and how they affect rights.

One of the most troubling aspects of parallel construction is that government agents could use it to conceal virtually any behavior, from a potentially unconstitutional National Security Agency surveillance program to untested new biometric technologies, or even run-of-the-mill illegal searches of luggage.

Public, transparent, fair trials are essential to human rights and democracy, and the rights of criminal defendants lie at the heart of the U.S. Constitution. Our findings should inspire further investigations at both the national and local levels—and a ban on the practice of deliberately hiding the true sources of evidence from people facing the loss of their liberty.

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http://chronicle.augusta.com/opinion/editorials/2018-01-14/opioid-lawsuit-discovery-more-point-dollars

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https://www.usatoday.com/story/money/2018/01/14/health-care-deals-could-make-you-healthier-but-may-not-save-you-money/930635001/

The health care industry’s fever for consolidation has shot up with two major deals closing out 2017, but the big question is whether consumers should be feeling any better this year. 

DaVita Medical Group, which has nearly 300 medical clinics​ along with about 40 surgery centers and urgent care clinics, will become part of UnitedHealth’s prescription drug benefits division.

CVS Health’s own pharmacy benefit management (PBM) business and in-store clinics would be merged with Aetna. PBMs negotiate deals with drug makers that include rebates and other compensation to encourage certain drugs and come up with lists of drugs their insurance plans will cover.

The deals will move the industry closer to a model in which  doctors and insurers are part of the same company, in a “Kaiser Permanente-esque way,” says Craig Garthwaite, who leads the health enterprise management program at Northwestern University’s Kellogg School of Management.

Under that scenario, there would be no incentive for health care providers to perform more tests and procedures than necessary on people. Instead they would be pushed to make sure patients get the right care from the start and to keep them healthy.

Since it became law under President Obama, the Affordable Care Act’s concept of health care reform focused on “paying for better health rather than the utilization of health care services,” Garthwaite says.

Susan Hayes, founder of Pharmacy Outcomes Specialists, which audits PBM contracts for employers and unions, says the recent deals are just the first of many, and she’s worried about the effects. 

“More mergers of insurance companies, chain pharmacies and (health care) providers means less transparency and higher costs — bottom line,” she says.

PBMs are billed as a way to lower drug costs for employers and consumers, but they’ve increasingly come under fire in recent years as drug prices have soared.

PBMs’ slice of the costs and role as a middleman is little understood. 

Critics of PBMs say the companies sometimes agree to favor high-cost drugs on the lists of medicines your insurer agrees to pay for and that they agree they won’t place quantity limits — or prior authorization programs — on the drugs. That’s despite the fact doing so could help health plans save money and make medical sense, 

How these deals could affect you: 

• You might get healthier. The companies will have a strong incentive to make and keep you well. Right now, CVS’ Minute Clinics don’t have that incentive, as the more you show up there, the more money they make. Currently, Aetna, and the employers whose plans they administer, already have a strong profit motive to keep patients healthy. But without employing the doctors or owning the hospitals, they can’t truly control how many tests, prescriptions or visits you get. When the insurer and the health care provider are one and the same, you’re more likely to find things that encourage health to be covered. 

Linda Fish, who is the caregiver for her husband and brother near Albuquerque, is excited by the prospects of a CVS-Aetna deal. She has gotten good service at CVS and likes that she can get a flu shot and affordable vitamins there. She was also impressed the company took a stand against Mylan’s huge price boost on EpiPens about a year ago when it began offering a low-cost generic version of an EpiPen competitor. 

“I’m a strong supporter of wellness first,” she says.

Fish’s husband, Richard, is a retired professional chef and they “eat the right foods prepared the right way,” she says, as “you don’t have to cook things in lard and grease.” The couple also have free membership to gyms in Albuquerque, thanks to their Humana Medicare Managed Care plan, so they work out as much as possible.

Still, Fish hopes she and her family can switch to Aetna’s Medicare plan if the deal goes through. 

Dave deBronkart, a cancer survivor and patient safety advocate who blogs as e-Patient Dave, says he is “in favor of any evolution that makes it easier for people with health problems to get the care they need.” But whether that will happen, he acknowledges, is “hard to assess” at the time of a merger. 

More:

CVS buying Aetna in deal valued at $69 billion

UnitedHealth pays $4.9B for DaVita Medical Group clinics, health care services

Coordinated care with doctors and hospitals can improve health and save money

•Your care could come under one roof. Davita — best known for its dialysis centers — could help launch UnitedHealth into the movement away from high-priced hospital care. Emergency room (ER) visits are the costliest form of health care for insurers, in large part because of the higher costs involved in running a hospital and the fact that, under law, ERs have to at least stabilize all the patients who show up. With more of these clinics, and expanded versions of CVS’ clinics, these insurers will have a place to send patients where they can control most types of care. Within a few years, clinics in or outside of stores, including CVS, could consolidate vision and dental care, as well as primary and specialty care.

• You might save money — or not. If insurers save money on healthier patients, it’s far from clear whether they will pass it along as lower premiums, Garthwaite says. Even if they do, more competition will be needed among big companies such as CVS-Aetna for premiums to truly come down. If there is a worry there, he says it’s that this kind of consolidation means it will be that much harder for new entrants to enter, so prices may not come down. 

• Your insurer may still be able to game the system. Insurers have to spend a certain percentage of their premium dollars on claims and other expenses that improve the quality of the health care you receive. But Garthwaite says they still find ways to get around that, and it will be even easier if they own the health providers who treat you. If UnitedHealth is setting the price at the Davita clinics, they will have far less of incentive to make them lower than they would if they were truly negotiating. 

• You may not have as much choice. Teresa Stickler, an Arizona pharmacy owner, founded Pharmacists Unity for Truth and Transparency because of what she calls “abusive practices”  by PBMs, such as steering consumers to drugs with higher list prices. Now these insurance companies will be able to steer you to the doctors and drug stores they want you to go to, or at least make it even costlier to go elsewhere, Stickler says. 

•You may not know who’s profiting. Drugmakers have gotten the brunt of the criticism over soaring drug prices, but the pharmaceutical industry has successfully turned some of that negative attention onto PBMs due to their lack of transparency. These companies make their money on rebates and what’s known as “spread pricing,” or fees charged in addition to maintenance fees that boost drug prices. And they’re doing quite well at it if they’re buying insurance companies, as in the case of CVS’ Caremark.

“I think it is apparent that PBMs are generating so much money through rebates and spread pricing that they are now looking for ways to control the entire vertical,” Hayes says.

Hayes predicts that in the “very near future,” we will see a health care company that includes a drug manufacturer, wholesaler, retail drug chain, insurers, doctors and clinics.

“Then there will be no negotiation possible at arm’s length,” she says

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http://www.modernhealthcare.com/article/20180112/NEWS/180119942

The U.S. Food and Drug Administration plans to focus on reducing opioid misuse

and promoting drug competition as two of its top policy priorities for 2018.

In a list released Thursday, the agency also said it wants to strengthen its scientific workforce and use nutrition to reduce the burden of disease this year.

FDA Commissioner Dr. Scott Gottlieb said the priorities represent the agency’s collective efforts to address public health. “Each one of us has an important role to play in achieving this mission,” he said in a statement.

The opioid crisis was the driver behind another record-setting year for drug overdose deaths in 2016, climbing by 21% over 2015 to nearly 64,000, according to the Centers for Disease Control and Prevention.

One of the actions the FDA plans to take to combat the epidemic will be reassessing how the agency evaluates opioid products before and after they reach the market, including consideration of the risk for misuse. On Thursday, the agency placed new restrictions on the use of opioids in children’s cold and cough products. In June, FDA requested Endo Pharmaceuticals remove its opioid pain medication, Opana ER, from the market due to its potential risk for abuse.

FDA will also encourage drugmakers to develop new abuse-deterrent opioid formulas and medication-assisted treatments. The agency will finalize policies to allow pharmacies to sell the overdose-reversal drug naloxone over the counter, an idea the FDA previously proposed during the Obama administration.

In terms of generics, the FDA wants to streamline the regulatory approval process and bring the lower-priced drugs to the market quicker. FDA will launch a program to promote biosimilar drug development as well.

“By making sure that the barriers to generic entry are not unnecessarily inflated through outdated scientific standards or inefficiencies in the development process — while maintaining the FDA’s gold standard for quality, safety and effectiveness — the agency can help lower the barriers to generic entry, keep costs low for high-quality generic products, ensure an adequate supply of critical generic medicines and promote price competition,” the FDA roadmap said.

FDA also set a goal to reduce preventable disease caused by poor nutrition, which affects approximately half of all American adults and has led to a steady rise in cases of cancer, heart disease and diabetes over the past two decades. The agency will move forward with menu labeling regulations to take place after years of delays.

The rule, finalized in 2014 but not yet implemented, would require chain restaurants, grocery stores and convenience stores to include calorie counts of the food items they serve on menus.

But strong pushback by the restaurant industry led to delays in when the rule would to go into effect. In June, consumer health advocates sued the FDA over the rule’s implementation, and the agency ultimately issued draft guidance last November for industry on how to comply with the menu labeling requirements by May 2018.

Gottlieb said the plan was not intended to be an exhaustive list of items the agency plans to set its focus, but rather an effort to be more transparent on its major goals for the year.

“These goals — and the work we do together in achieving them — go to the heart of our mission of advancing and protecting public health, while maintaining our commitment to the scientific standards that make FDA a recognized global leader, and a gold standard for product review,” Gottlieb said

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