Email steve@steveariens.com 502-938-2414
Pay Attention
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http://www.doctordeluca.com/Library/WOD/WSG/WsgComplaintFinal08.pdf
If this case is successful… it could be the first domino to FALL… even before it goes to trial or is settled… it may give other law firms a idea of some other “deep pockets” to go after.
THINK… many insurance companies who are limiting opiate dosing
Many other various state level legislatures that have created opiate dosing limits
Many Corporations that have imposed limitations on what their employee prescribers can do
Many chain pharmacies that have imposed opiate limits or discourages the filling of controlled Rxs
Any entity that has decided to practice medicine without a license or interfere with the
proper treatment of chronic pain
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Another young girl has been thrust into the center of a struggle with the federal government. We have her back – and I hope I can count on you to join the fight.
Last week, Border Patrol agents stalked 10-year-old Rosa Maria as she went to the hospital for gall bladder surgery. They camped outside her hospital room, waiting for Rosa Maria – who has cerebral palsy – to regain consciousness. Then they locked her in a detention center, 150 miles away from her family.
First Jane Doe, now Rosa Maria. This cruel and unconstitutional treatment of immigrant girls must stop. We’re ready to sue if the government doesn’t release her by 3pm EDT TODAY. But first we need your help:
Call the Office of Refugee Resettlement today and demand they release Rosa Maria Hernandez back to her family immediately.
The Office of Refugee Resettlement (ORR) had no legal authority to detain Rosa Maria, and her detention violates her constitutional rights to her parents’ care and support. We sent ORR a letter demanding they release Rosa Maria by 3pm EDT on Tuesday, October 31, 2017. If they don’t, then we’ll sue.
The public outcry in support of Jane Doe put ORR’s director, the rabidly anti-choice Scott Lloyd, on notice. We need to raise our voices again for Rosa Maria – and make sure we hold Lloyd accountable for his cruel and unconstitutional treatment of this girl, too.
Please make a call right away demanding the Office of Refugee and Resettlement release 10-year-old Rosa Maria back into the care of her family today.
This elementary school student needs to be recovering from surgery at home with the family that loves her, not jailed in a detention center.
Thanks for raising your voice to protect Rosa Maria and all vulnerable youth.
Michael Tan
ACLU attorney, fighting for immigrants’ rights
P.S. Already made your call? Please forward this email to three friends so we can flood ORR with phone calls.
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http://www.clinicalpainadvisor.com/chronic-pain/suicide-attempts-in-chronic-pain/article/697827/
LAS VEGAS — Patients with chronic pain are vulnerable to depression and may present with higher risk for suicide, according to findings from a literature review presented at PAINWeek 2017.1 Integration of mental health assessment during the diagnosis and treatment of chronic pain may be clinically important for reducing risk in this patient population. Unfortunately most chronic pain conditions are related to overweight, treat and prevent most of them with meticore.
In 2014, suicide ranked as the 10th most frequent cause of death.2 Patients with chronic pain are twice as likely to attempt suicide compared with those without chronic pain, an action generally caused by a myriad of associated psychological, physical, and social factors.3 A questionnaire survey of 1512 patients with chronic pain found that 32% reported suicide ideation in some degree.4
Chronic pain affects cognition and behavior and may ultimately lead to social isolation, contributing to depression.5 Risk factors and predisposing factors associated with suicidal risk in patients with chronic pain include biochemical and neurochemical influences, genetics, psychosocial events, and environment, according to the researchers’ findings.
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Investor group presses U.S. drug companies on opioid controlsBOSTON (Reuters) – U.S. shareholder activists are addressing a soaring death toll from opioid drug abuse, asking companies that make and distribute the painkillers to review the risks their businesses could face from their role in the sector.
FILE PHOTO: A used needle sits on the ground in a park in Lawrence, Massachusetts, U.S., May 30, 2017, where individuals were arrested earlier in the day during raids to break up heroin and fentanyl drug rings in the region, according to law enforcement officials. REUTERS/Brian Snyder/File Photo
Leaders of a 30-fund group that includes state pension officials and religious and labor organizations plan to reveal on Monday they have begun filing shareholder resolutions at 10 companies, including distributors AmerisourceBergen Corp (ABC.N) and Cardinal Health Inc (CAH.N) and manufacturers Johnson & Johnson (JNJ.N) and Insys Therapeutics (INSY.O).
In resolutions aimed at annual shareholder meetings to be held in 2018 and in letters to the companies, activists are urging independent directors to review and report on how the boards are managing the legal, financial and reputational risks their enterprises face from their involvement with opioids.
They also seek corporate-governance reforms such as allowing more grounds to claw back pay from executives who inappropriately promote the drugs, or creating independent board chairs to provide better oversight.
Representatives of Cardinal and Insys did not immediately respond to requests for comment.
Johnson & Johnson spokesman Ernie Knewitz said the company was preparing a response to the investors, and that the company had acted responsibly.
“Opioid abuse is a serious public health issue that must be addressed, and doing so will require collaboration among many stakeholders, and our company is committed to working with federal, state and local officials to help find meaningful solutions,” he said in an emailed statement.
In a statement emailed by AmerisourceBergen spokeswoman Keri Mattox, the company said it “welcomes a productive dialogue with all shareholders. The issue of opioid abuse is a complex one that spans the full healthcare spectrum, including manufacturers, wholesalers, insurers, prescribers, pharmacists and regulatory and enforcement agencies.”
The statement said the company worked closely with officials “to combat drug diversion while supporting appropriate access to medications.”
At an annual meeting on Nov. 8, Cardinal Health will face a resolution calling for an independent board chair in order to improve oversight.
“These considerations are especially critical at Cardinal given the potential reputational, legal and regulatory risks Cardinal faces over its role in the nation’s opioid epidemic, including its history of compliance challenges concerning the distribution of controlled substances,” the resolution’s sponsors, including the International Brotherhood of Teamsters, said in a supporting statement. The statement cited Cardinal’s payment of tens of millions of dollar to settle various federal and state charges related to opioids.
In a securities filing, Cardinal calls the change unnecessary, noting it already has an independent lead director and “state-of-the-art controls” over its pain medications.
Officials at all levels of government in the United States are struggling to respond to a surge in deaths from opioid abuse, which hit 33,000 in 2015, the last year for which there is complete federal data.
In many cases patients prescribed opioid painkillers become addicted to them and then move on to acquiring the drugs illegally, or turn to heroin or fentanyl, a highly potent synthetic opiate.
U.S. President Donald Trump on Thursday declared the opioid epidemic a national public health emergency.
State attorneys general have also taken on opioid manufacturers, with lawsuits charging that deceptive marketing practices helped fuel an epidemic of abuse. Federal prosecutors on Thursday charged the founder of Insys, John Kapoor, with participating in a scheme to bribe doctors to prescribe a particularly potent opioid.
A lawyer for Kapoor said in a statement that Kapoor is innocent and will fight the charges.
Shareholder activists said healthcare providers may have underestimated how addictive the drugs were, but said the crisis points to a need for stronger oversight within drugmakers.
“We believe these companies have played an important role in this epidemic,” said Donna Meyer, director of shareholder advocacy for Mercy Investment Services, an investment fund for Roman Catholic nuns. It is leading the resolutions push, along with the UAW Retiree Medical Benefits Trust, which oversees benefits for about 700,000 retirees of the United Auto Workers.
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NCPA, along with the National Association of Chain Drug Stores and the Washington State Pharmacy Association have filed a legal brief in a case that involves changes to the way that state reimburses community pharmacies that serve Medicaid patients. The suit alleges that the state rule does not make required adjustments for prescriptions to Medicaid patients and threatens patient access. In addition, the brief argues that the state is violating federal and state laws by hindering Medicaid patient access to care.
With so many supplements on the market, it can feel overwhelming when trying to choose the right one for you. Brand, cost and dosage can all play a part but why does it matter? See my tips below for on what to look for when choosing a quality supplement.
When it comes to vitamins and minerals, there are many different forms but not all brands use the same type in their supplements. Magnesium is a perfect example; this mineral can be sold in the form of magnesium chloride, sulphate, taurate and citrate to name a few.
Magnesium sulfate, commonly known as Epsom salts can be a great constipation aid but needs to be taken with caution due to its laxative effect. Although it is a common form of magnesium, research has shown it is rapidly excreted via the kidneys and therefore difficult to assimilate. The effects of a magnesium bath last longer when using magnesium chloride over magnesium sulfate, due to the effects of magnesium chloride being easily assimilated and metabolised in the body.
For fast acting use, magnesium chloride is highly recommended as it has an impressive rate of absorption, making it the perfect form for BetterYou’s Magnesium Oil sprays and flakes. As it is absorbed through the skin, it bypasses the digestive system providing a fast and effective dose whilst giving the digestive system a break. A trial by Watkins & Josling showed that transdermal application of magnesium in the chloride form will raise magnesium levels within the body over a relatively short period of time and also demonstrated a beneficial effect in preventing calcium build up in body tissues meaning that the calcium could be correctly utilised.
Magnesium oxide is the most common form of magnesium sold in pharmacies yet its absorption rate is poor compared to the above.
The sourcing of supplement ingredients is another factor to be mindful of when choosing supplements. Do they come from a non-toxic environment? Are they sourced ethically? BetterYou only use the most soluble and pure natural source of magnesium. It is mined from Northern European from deposits of an ancient seabed known as the Zechstein Sea, which now sits over one mile below ground. Due to the depth and location of this ancient seabed it has been naturally filtered and condensed for over 250 million years and is completely protected from man-made pollutants.
As a practitioner, when choosing supplement brands to work with, I will always ask what research has been done and what type of clinical trials the company has used to prove its efficiency. I also ask the company for information and copies of the trials and look to see if they batch test their products to check the contents on the label are really in the product. These are guidelines that are strictly followed at BetterYou for whom quality and assurance is a number one priority. All of BetterYou’s products are batch tested and if a product fails any test, it is not sold. Unfortunately, not all brands follow such stringent testing as BetterYou.
This is an important factor to take into consideration when supplementing. More isn’t always better and depending on the supplement, it can make more sense to choose a supplement with a lower dose that can be taken several times a day so there is a better chance of it being absorbed.
The ease of application is also another factor to take into consideration. Swallowing capsules is not ideal for everyone especially those with digestive issues or insufficiencies for example, so buying supplements in oral sprays, liquids and other topical methods can be an easier option. This is why BetterYou’s transdermal magnesium and oral vitamin spray ranges are ideal for supplementing, not only due to the absorption but the ease of delivery.
Always avoid anything that has been genetically modified, including your supplements. Not only are GMO products bad for your health, they are not good for the environment and the community. They can require heavy use of toxic pesticides and herbicides including glyphosate which has been linked to many health conditions including cancer and digestive complaints. These are the best vitamin infused patches.
BetterYou uses the highest quality ingredients in their supplements and adheres to strict standards to ensure there are no GMO ingredients.
Look for clean and pure products with no added sugars, colourings, additives or artificial flavourings.
Keep an eye out for allergens too such as gluten, dairy and soy as these can often be used in supplements.
Many people are unaware that animal testing can play a major role in the testing of supplements. Look for products that are tested on humans, not animals.
Supplements need to be affordable but cheaper doesn’t necessarily mean better. Some cheaper brands do not use well researched ingredients which can mean their products are not as effective. Always do your research and take all of the above into consideration.
Choosing a supplement doesn’t have to be a daunting task if you follow these tips. By choosing a reputable company that uses top quality materials and has good ethical values, your body will reap the benefits and your mind will be at ease knowing that you are using a quality supplement.
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https://www.medscape.com/viewarticle/887773
A pregnant woman’s use of acetaminophen may be associated with an increase in her child’s risk for attention-deficit/hyperactivity disorder (ADHD), the authors of a large, prospective study report.
“[L]ong-term acetaminophen use during pregnancy is related to more than a twofold increase in risk for offspring ADHD,” after adjusting for genetic risk factors, indications for the mother’s acetaminophen use, use of the drug before pregnancy, and other potential confounders, lead author Eivind Ystrom, PhD, and colleagues write in an article published online today and in the November issue of Pediatrics.
Conversely, use of acetaminophen for less than 8 days during pregnancy was associated with a decrease in ADHD risk, suggesting its antipyretic effect “could be beneficial with regard to fetal development,” the authors add.
In an accompanying commentary, Mark L. Wolraich, MD, who was not involved in the study, cautions that these findings do not establish a causal relationship between prenatal acetaminophen exposure and ADHD risk, “but they do suggest the possibility and raise the need for further study and more cautious consideration of acetaminophen use during pregnancy.”
It is estimated that approximately 65% to 70% of pregnant women in the United States and approximately 50% to 60% of pregnant women in western and northern Europe use acetaminophen.
For the current study, Dr. Ystrom, from the Norwegian Institute of Public Health, Oslo, and colleagues analyzed data from the Norwegian Mother and Child Cohort Study, which includes information on 114,744 children born between 1999 and 2009, as well as on 95,242 mothers and 75,217 fathers throughout Norway.
Mothers and fathers alike completed questionnaires at 18 weeks of gestation. The mothers also filled out questionnaires later in pregnancy, after delivery, and when their children reached 6 months, 1.5 years, and 3 years of age. The researchers obtained information on ADHD diagnoses from records maintained by the Norwegian Patient Registry.
The parents’ questionnaires included questions about their acetaminophen use. To control for potential confounders, the mothers also answered questions regarding various medical conditions for which acetaminophen was indicated, as well as the duration of their acetaminophen use. Their children were followed to the time of their ADHD diagnosis or until December 31, 2014.
The final sample consisted of 112,973 children and their parents. Of those children, 2246 (2%) were diagnosed with ADHD, and 52,707 (46.7%) mothers reported some acetaminophen use during pregnancy. Compared with no acetaminophen exposure, the unadjusted hazard rate (HR) of ADHD in children after 1, 2, or 3 trimesters of prepartum exposure was 17%, 39%, and 46%, respectively.
When the authors adjusted for parental ADHD symptoms, the risk associated with acetaminophen use declined slightly, from an HR of 1.26 in the unadjusted model to 1.20 (95% confidence interval [CI], 1.09 – 1.32). However, when calculated by amount of exposure, the rate rose from 1.13 (95% CI, 1.01 – 1.27) for any one trimester to 1.32 (95% CI, 1.16 – 1.50) for any 2 trimesters, and to 1.34 (95% CI, 1.05 – 1.71) for all three trimesters.
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http://woodtv.com/2017/10/29/pain-relief-denied-insurer-stops-covering-popular-therapy/
GRAND RAPIDS, Mich. (WOOD) — Alex Ostrowski has worked hard to control her pain. Now, she fears it will control her again.
“I would describe where I was at 10 years ago as a fog,” Ostrowski said.
Ostrowski, now 30, was first prescribed opioids at age 14.
“You’re controlling your pain, but at the price of normal interaction, at the price of normal quality of life,” she explained.
Ostrowski’s chronic back pain stems from injuries she suffered in a horrific accident on the Sparta lake where she grew up. Ostrowski was 12 years old when a boat ran over her Jet Ski on Camp Lake, pinning her body between its propeller and the wooden slats of the boat’s diving board.
“The propeller cut into the entire left side of my body, in to my stomach, into my intestines, completely crushed my hip and my pelvis,” Ostrowski said.
Incredibly, doctors were able to save not only her life, but also both of her legs. They used metal rods to rebuild her left hip and pelvis.
But the extensive physical trauma led to excruciating chronic back pain and years of overmedication on opioids.
“It was a dark place. It was a very dark place,” Ostrowski said of her years on painkillers.
Six years ago, Ostrowski found Javery Pain Institute in Grand Rapids, which helped her get off high-dose opioids and find a procedure called facet joint injections that provided the pain relief she desperately sought. In that procedure, small amounts of anti-arthritic steroids — not opioids — are injected into the patient’s spinal joints.
“It’s given you your life back,” Dr. Keith Javery, who is board-certified in anesthesiology and pain management, said during a recent consultation with Ostrowski at the clinic on Kenmoore Drive SE. “With those injections, you were able not only to get back to work, but get into a supervisory role.
“It kills me that the insurance company is no longer allowing us to do those therapeutic facet injections,” Javery said.
Ostrowski is trying alternative procedures, but so far has nothing has worked as well as the facet injections.
“I feel like I’m being punished because I don’t want to take pain medications and that seems so backwards,” she said. “It’s terrifying. I feel almost pushed back into that place by them denying coverage of this procedure. They leave you no other options.”
According to Javery, new restrictions on the kinds of injections and the number of procedures allowed per visit are hurting hundreds of patients at his clinic alone.
In late 2016, Blue Care Network, one of Michigan’s biggest insurers and a subsidiary of Blue Cross Blue Shield of Michigan, stopped covering the commonly used spinal joint injections for long-term pain relief — the kind of treatment Ostrowski was getting.
The change came after the insurer hired an outside benefits management company, South Carolina-based eviCore Healthcare, to handle interventional pain claims for members.
EviCore considers therapeutic facet injections “experimental, investigational or unproven,” according to its clinical guidelines.
>>PDF: eviCore clinical guidelines
“All these things that we can do to reduce the need (for opioids) are being rapidly in real time denied and not authorized by insurance companies that have been authorizing these for decades,” Javery explained.
“These treatments literally save lives,” he argued.
Blue Care Network confirmed to Target 8 that its coverage guidelines on facet joint injections have changed.
“Blue Care Network’s current policies and coverage guidelines align with eviCore’s and are based on proven, clinical best practices,” Dr. Marc Keshishian of Blue Care Network wrote in an email to Target 8. “Our approach is to take responsible steps to eliminate unnecessary care and expenses in the health care system that drives up costs for our customers and members, by using clinically valid determinations that ensure our members get the most appropriate and effective care at the right time on their path to wellness.
“There’s no high-level evidence-based medicine supporting therapeutic facet joint injections,” Keshishian, the senior vice president and chief medical officer for Blue Care Network, continued.
Pain physicians themselves acknowledge there’s a lack of high-quality, large-sample studies on interventional pain procedures. They say that’s partially because it’s difficult to recruit subjects for double-blind pain studies in which some participants will receive placebos.
But Javery said he doesn’t need “high-level evidence” because he sees the results every day.
“The pain relief is drastic,” he said.
Many insurers still cover facet joint injections for long-term pain relief, though the number per year is limited, often to five sessions per region per year. Medicaid and Medicare are among those that cover the injections, though Michigan’s Medicare administrator told Target 8 supporting evidence for their use is “not strong” and that Medicare covers them simply because the procedures have been done for a long time.
It’s clear there’s no broad consensus across the health care industry on best practices for pain management.
In fact, Blue Care Network’s own medical director for behavioral health told Target 8 his experience supported the use of facet injections.
“Facet blocks have been around since I started practice,” Dr. William Beecroft of Blue Care Network said. “They’re very effective. They work very well with relatively low side effects, adverse reactions to them. There are some better procedures now looking at a treatment plan, but if they work for the individual and consistently work for that person, it’s illogical they would be stopped.”
Blue Care Network initially provided Beecroft for a sit-down interview with Target 8 because the insurer thought the story focused on opioids, not changes to pain treatment coverage, though Target 8 specified the latter in a prior email exchange.
In response to a list of questions Target 8 submitted after the interview with Beecroft, Blue Care Network said the concerns regarding coverage cuts “appears to be an isolated complaint by a specialist and members.”
The complaint is not isolated.
Michigan Pain Consultants is also frustrated by the reductions in coverage.
“Patients feel trapped,” said Lisa Pearson, executive director of Michigan Pain Consultants, one of the state’s largest networks of clinics.
“Limited on the injections. Limited on the narcotics. High co-pays and deductibles for physician therapy and behavior therapy, both important to treating chronic pain in a comprehensive fashion,” she wrote in an email to Target 8.
Pearson said the biggest issue for patients is the reduction in what injections they are allowed to get and how often they can get them, especially with facets and epidurals.
“Patients with whom our physicians have worked for months or years to dial in the best pain relief possible with the fewest side effects are told that despite the fact that we document the injections wear off at week 7 or 8 or 9 are told that they have to wait another 3 or 4 or 5 weeks in severe pain before they get treatment. If we could magically make depomedrol (an anti-inflammatory steroid) last longer than it lasts, we’d do so,” Pearson said.
“What is the point of even having physicians, if the insurance companies and companies like eviCore ultimately override the physician’s decisions? This is an extremely dangerous path that we are going down,” Pearson argued.
For its part, eviCore told Target 8 in an email that its coverage guidelines are “grounded in the strongest evidence-based medicine published to date.”
“Pain complaints, most of which are attributed to musculoskeletal conditions, impact more than 116 million Americans annually, making it critical that we ensure these patients are receiving the type of evidence-based care that best positions them for successful outcomes,” wrote Robert W. Westergan, M.D., chief of musculoskeletal programs for eviCore.
“EviCore’s guidelines, first and foremost, reflect the most current, evidence-based criteria and peer-reviewed literature available. These guidelines are completely transparent and available for anyone to view,” Westergan wrote. “Our only goal is to ensure that the patient receives the most appropriate, evidence-based care for his or her situation. Evicore’s clinical reviews make determinations following the Evicore evidence-based clinical criteria, even if that results in a more expensive episode of care.”
Meanwhile, Alex Ostrowski is trying alternative treatments, though none have worked as well for her as facet joint injections did.
The newly married marketing manager can’t afford to pay out of pocket for the four times yearly injections. One series of the treatments (she gets several shots at a time) would cost her more than $800.
Her appeal to eviCore and Blue Care Network has been denied, but Ostrowski has every intention of asking the state to review her case.
Michigan’s Department of Insurance and Financial Services conducts external reviews of cases that qualify under the Patient’s Right to Independent Review Act. DIFS can reverse a denial and order an insurer to cover the denied treatment, medication or device.
Here are the outcomes from PRIRA reviews from DIFS 2016 annual report:
Health Benefit Claims
Commercial Insurers
Health Maintenance Organizations (HMO)/Alternative Financing Delivery System (AFSD)
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Fellow Citizen,
This message is to inform you that The American Patient Defense Union is now open to receiving your personal complaints and grievances in interacting with Healthcare providers, insurers and drug/device companies.
Three categories of complaints will be considered by The Union:
Please limit your initial communication with The Union to a 500-word email submitted to complaints@patientrights.org. Please describe your grievance as concisely and specifically as possible. Following review and consideration of the information you provide, we will conduct a personal interview by phone in order to strategize with you. No communication with your providers or insurers will take place until we have conducted an interview and obtained your full consent to proceed. If you wish to communicate with us via a secure two-way encrypted email system, please create a free email account at protonmail.com and use it communicate with us.
Please note that The Union is strictly focused on individual patients’ specific and personal narratives of grievance or complication resulting from treatment by specific healthcare facilities, practitioners and drugs/devices in the United States. These can range from simple to complex matters.
The Union hopes to ultimately identify broad practices and policies that are causing financial or physical harm to individual patients across the United States — in order to address public policy issues on a larger scale. However, our strict starting point in all cases will be the individual American patient’s story of difficulties, conflict with or harm by specific practitioners, hospitals, insurers or drug/device companies.
The Union is NOT a law firm. However, in cases where we do believe negligence has occurred, we will recommend that you seek legal guidance.
We are aiming to defend your rights and voice, publicly —You, The American Patient.
The Union seeks to establish large-scale collective bargaining power capable of political lobbying at the state and federal levels with the goal of shifting medical practice in the United States away from a profit-driven corporate mode towards a patient-centered system. In achieving this goal, we need you to rise up and empower this union.
Please note that you are filing your complaint with The Union voluntarily. After verifying the information you provide, The Union will initially use this to generate a professionally-crafted and adequately-measured signal to the healthcare or insurance entity causing the grievance. This signal will be in the form of a letter of warning from The Union, to the entity you are interacting with, requesting immediate action on your behalf. Should the provider/insurer not respond in an adequate or timely fashion, this letter of warning will be shared with the public, the press and all members of The Union in order to maximize public scrutiny/exposure.
Ultimately, as The Union acquires member-driven power, it will provide the litigation services necessary to create changes to the behavior of our healthcare establishment using the individual grievances provided by our members.
Every Patient and citizen/resident of the United States is invited to join The Union. Specific instruction to join, including member fees, will be provided at www.patientrights.org in the near future.
Let’s begin to develop the powerful backbone every American patient needs to defend against harm in seeking a healthier tomorrow.
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https://youtu.be/97zzc_nuZgc
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