“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
In the midst of a legal battle, the Sioux Falls casino owner, accused of disability discrimination, defends its decision to deny employment to a woman who didn’t pass a drug screening. The owner argues that the testing agency overlooked the validity of her painkiller prescription, raising important questions about the intricacies of preparing for an employment law discrimination proceeding.
M.G. Oil counter-sued TestPoint Paramedical last week, saying its failure to follow-up is the reason for the federal lawsuit.
The Equal Opportunity Employment Commission sued M.G. Oil in September for withdrawing a job offer from an applicant to Happy Jack’s casino who tested positive for hydrocodone.
M.G. Oil stood firm in its denial even after she told the company about her prescription and her diagnosis of chronic back and neck pain.
Denying a job to a person who uses drugs to treat a legitimate medical condition constitutes illegal job discrimination, and M.G. Oil refused to offer an out-of-court settlement to the applicant, according to the EEOC lawsuit.
ARGUS LEADER
Happy Jack’s Casino sued for drug test discrimination
Last week, M.G. Oil formally responded to the EEOC complaint for the first time.
It admitted to denying the job offer, but denied discrimination, saying the applicant never claimed that her pain constituted a disability or serious job impairment.
The company’s response to the lawsuit says M.G. instructs “all its drug testing companies” to conduct further investigation on positive tests, which would include checking for a valid prescription.
That didn’t happen, M.G. Oil claims.
After the lawsuit was filed, the company says, it “received notice from the drug testing company that this policy was not followed in this case.”.
If the court finds the casino job denial broke discrimination law, M.G. Oil says, the testing company should bear some of the blame and pay some of the cost.
“TestPoint breached its contractual obligation to automatically send the non-negative drug test to a medical review officer for verification,” the counterclaim said.
TestPoint has yet to reply in court to the accusations, levied the day before Thanksgiving.
Patrick Heitkamp, TestPoint’s owner, denied the allegations and said no signed, legal contract with M.G. Oil exists, but otherwise declined to comment on the pending litigation.
M.G. Oil admitted that the EEOC had given the company a chance to settle, but said the terms were “onerous” and “unreasonable.”
ARGUS LEADER
Painkillers pose tough questions for employers
No proposed dollar amounts or other settlement terms were included in the filing.
M.G. Oil’s lawyer, Jeff Swett of Rapid City, declined to comment beyond the filings.
EEOC investigations of job discrimination are fairly common, but lawsuits initiated by the EEOC on behalf of individuals are rare.
The M.G. Oil lawsuit represents the third EEOC case filed in the past five years against a South Dakota company.
Online directories used to market Medicare Advantage plans often contained incorrect, confusing or outdated information about which hospitals and specialty institutes were included, according to a recent study by the Kaiser Family Foundation. Photo: iStockphoto/Getty Images
By
Lisa Ward
An increasing number of seniors are choosing to get their Medicare benefits through Medicare Advantage plans. But do they understand what they’re signing up for?
A recent report suggests they may not, especially when it comes to which hospitals are included in the plans’ networks.
An alternative to traditional Medicare and administered by private insurers, Medicare Advantage plans are typically health maintenance organizations or preferred provider organizations that offer seniors hospital and medical coverage (Medicare Part A and Part B), and sometimes prescription-drug coverage (Medicare Part D), dental care or benefits such as gym memberships.
These plans typically offer lower out-of-pocket costs than traditional government-run Medicare in exchange for members using in-network doctors and hospitals.
A Maryland couple first saw Salinas as an escape from the cold. Then it became home.
Despite John Buskin’s best efforts to look as hip as he used to, he finds himself looking just the opposite.
The problem, according to the report from the Henry J. Kaiser Family Foundation, is that the size and composition of hospital networks varies greatly among plans, yet that isn’t always apparent to those shopping for coverage. Plan directories contain incorrect, confusing or outdated information about which hospitals and specialty institutes are included in networks, the study found, and the directories can be difficult to navigate. One directory featured 600 pages without a table of contents or index, it said.
Using the directories to pick a plan is “like trying to do your taxes with an abacus; it can be done, but not easily,” says Gretchen Jacobson, associate director at the Kaiser Family Foundation and co-author of the report, adding that Medicare’s website doesn’t provide an easy way to compare plan networks side by side.
About 17 million beneficiaries, roughly 30% of the Medicare population, enrolled in a Medicare Advantage plan in 2015, according to the Congressional Budget Office, which expects private-plan enrollment to grow to about 29 million Americans, or about 40% of the Medicare population, in 2025.Many seniors like Advantage plans because in addition to added benefits such as dental coverage and gym memberships, they eliminate the need for additional insurance, such as Medigap, and some plans cover the gap in Medicare prescription-drug coverage known as the “Donut Hole.”
“These sorts of benefits can make a big difference to someone on a fixed income,” says Clare Krusing, a spokeswoman for America’s Health Insurance Plans, an industry group.
That said, some Advantage plan members can face significant expenses if they seek treatment out of the network, experts say, which is why having a clear understanding of the size and composition of each plan’s network is important.
Of the 409 plans studied by Kaiser, 23% offered what the report termed broad networks, meaning 70% or more of the hospitals in a county were included. About 61% had medium-size networks, meaning between 30% and 69% of all hospitals in a county were included; and about 16% had narrow networks, with less than 30%.
While some plans with narrow networks get good ratings from the Centers for Medicare and Medicaid based on metrics such as preventive care and customer service, the Kaiser study found that in general they are more likely to exclude institutions that specialize in treating rare or more complicated conditions.
According to the report, 75% of narrow networks excluded National Cancer Institute Cancer Centers, which have experience handling rare and complicated cancers and provide more access to clinical trials; 49% excluded academic medical centers; and 21% had no hospitals with an accredited cancer program.
In the worst case, by not including certain institutions, networks can be built to exclude the sickest, most expensive patients, says Karen Davis, a professor and director of Roger C. Lipitz Center for Integrated Health Care at Johns Hopkins Bloomberg School of Public Health.
The insurance industry’s Ms. Krusing says some plans may exclude brand-name hospitals from their networks if there is no evidence they provide better care than cheaper community or regional hospitals. Medicare Advantage plans are increasingly enrolling patients with chronic illnesses, focusing on preventive care and reducing avoidable hospitalizations, she says.
Whatever the merits of the various plans, experts say it’s easy for the details to get lost in the generally weak shopping experience they offer.
The Kaiser report found, among other things, that some plan directories mislabeled rehabilitation or post acute-care facilities as hospitals, while others included hospitals that had been closed for several years.
A separate analysis prepared for the Centers for Medicare and Medicaid Services and presented at a conference in Baltimore in September, found a 46% chance that an Advantage plan’s listing of a primary-care physician, oncologist, ophthalmologist or cardiologist contained some sort of inaccuracy, including where the provider was located or whether they were accepting new patients.
“You can’t shop around very well,” says Timothy Layton, an assistant professor of health-care policy at Harvard Medical School. Trying to anticipate what specialty care may be needed in the coming year, along with calculating deductibles, copays and other out-of-pocket costs makes the task even more difficult, he adds.
The Centers for Medicare and Medicaid Services (CMS) and insurers say they are beginning to address this problem.
“We are actively working with insurers and the provider community to further develop best practices and solutions,” says CMS spokesman Raymond Thorn.
In 2017, plans that apply to expand their networks will have to submit their entire network for review by CMS. Currently, CMS examines provider networks for accuracy of listings in new geographic areas to which a plan is expanding, or in response to triggers such as complaints, changes of ownership or termination of a large provider.
Meanwhile, “seniors may have to do some additional work to make sure they chose the best plan for them,” says James Cosgrove, director of health care at GAO. Ask questions about which providers are in which networks, Dr. Cosgrove says.
Robert A Berenson, a fellow at the Urban Institute, a Washington, D.C.-based think tank, recommends asking how frequently a plan refers patients out of its network. Medicare Advantage plans are often reimbursed at a rate close to that of traditional Medicare patients even if a provider is out of network, he says.
Dr. Jacobson recommends State Health Insurance Assistance Programs, or SHIPS, for help choosing a plan. These programs provide free insurance counseling to Medicare beneficiaries in all 50 states.
For years, they were among the most routine proceedings in criminal court in Portland, Oregon.
Defendants facing drug possession charges based on inexpensive test kits used by police to detect illegal substances would strike a quick guilty plea at a preliminary hearing. Guilty or just eager to get out of jail as quickly as possible, the defendants would be sent off to serve their time or enter into addiction treatment. The drug-kit results that had prompted their arrest would then never have to be confirmed by a lab.
Last July, shortly after ProPublica and The New York Times Magazine published an article detailing that the kits are prone to error and years earlier had helped account for roughly 300 wrongful convictions in Houston, the Multnomah County District Attorney’s Office in Portland decided to change the way it secured guilty pleas in drug possession cases. Today, when a defendant pleads guilty before the lab analysis is performed, prosecutors must still have the field test results double-checked.
J. Russell Ratto, the head of conviction integrity at the district attorney’s office, had asked his colleagues whether it might be wise to change the policy after the article’s publication.
“Our DDAs [deputy district attorneys] are always looking to make sure we’re using the very best practices,” said J.R. Ujifusa, the deputy district attorney who oversees drug prosecutions.
Drug field tests have been used for decades by police departments across the country. Officers drop suspicions material in a pouch of chemicals and look for changes in colors that might indicate the presence of illegal drugs. The tests were typically used to establish probable cause for an arrest. Courts across the country have routinely barred them from being used as evidence at trial, demanding results confirmed by certified labs.
But ProPublica’s reporting has shown that field tests have grown much more consequential; in a criminal justice system in which 90 percent or more of all criminal convictions come via a plea bargain, in tens of thousands of cases a year the tests are the critical “evidence” used to gain convictions. In many cases, to be sure, those arrested are guilty. But just as surely, some number of innocent people — jailed and desperate to get back to their families and jobs — have pleaded guilty.
That was certainly the case in Houston. In 2014, the Harris County District Attorney’s office realized that several hundred people who had pleaded guilty after field tests indicated they had drugs actually were innocent once samples were subjected to more formal testing by Houston’s crime lab. It took years to uncover the wrongful convictions, and two years later, prosecutors are still working to notify the innocent and correct the record.
The district attorney in Houston subsequently ordered that no guilty pleas would be accepted in cases involving field tests until the lab had confirmed the presence of illegal drugs. Since then, the number of drug convictions has fallen markedly, with dismissals soaring.
Prosecutors in Multnomah County wanted to make sure they were not allowing innocent people to be saddled with wrongful convictions, Ujifusa said, which is why the office has now mandated lab confirmation of field test results even after guilty pleas.
Ratto, the conviction integrity unit chief, also reviewed cases from 2009 to the present in which the Oregon State Police Forensic Laboratory determined suspected drugs were not drugs, to see if any of those cases had nonetheless resulted in drug possession convictions. He discovered five wrongful convictions based on inaccurate field test results. Ujifusa said the district attorney’s office has already had those convictions vacated.
Busted
Tens of thousands of people every year are sent to jail based on the results of a $2 roadside drug test. Widespread evidence shows that these tests routinely produce false positives. Why are police departments and prosecutors still using them? Read the story.
Ratto did not recheck field test results beyond those already analyzed by the state’s forensic scientists. The review “was not to prove or disprove the scientific validity” of the kits in use in Multnomah County, Ujifusa said. “Rather it was to identify cases where a defendant had resolved his case before a lab test could be obtained and the results later showed either a different or no controlled substance.”
Multnomah County courts produce roughly 2,000 drug possession convictions a year, with police test kits contributing to at least the initial arrest for many of these. Ujifusa said he was not certain how often defendants plead guilty to drug charges with only a field test result, nor what happens to the drug evidence in a majority of those convictions.
It is also not yet clear whether the state lab confirmed field test results in all Portland-area drug possession cases. If not, there could potentially be other wrongful convictions based upon the flawed kits.
The U.S. opioid epidemic has evolved so much in the last four years that current federal policy responses risk diminishing returns in saving human lives, according to a new peer-reviewed perspective by University of Alabama at Birmingham Associate Professor of Preventive Medicine Stefan Kertesz, M.D. His perspective was published online in the addiction journal Substance Abuse.
Kertesz says physicians and patients are caught in a complicated balancing act between the safe prescription and use of pain medications and the risk of opioid addiction.
“Patient care is increasingly compromised by doctors who fear being seen as fueling a tide of opioid deaths, even when those deaths are now mostly caused by heroin and illicit drugs, rather than the pills doctors prescribe for patients with pain,” Kertesz said. “Fear gets in the way of thinking of each patient as an individual.”
The Centers for Disease Control and Prevention reported that in 2014 there were 28,000 Americans who died from opioid overdose. The prescribing of opioid pills by physicians such as hydrocodone for pain rose rapidly from 2001 through 2011, and Kertesz endorsed the view that this increase in prescribing helped to spur today’s epidemic.
Kertesz calls attention to a distinction others have not made.
“What caused the epidemic and what sustains it today are not the same,” he wrote in the publication. “While opioid prescribing rose through 2011, prescribing leveled and then fell after 2012. In Alabama, prescriptions for hydrocodone fell 35 percent in just three years.”
Two separate federal surveys show recreational use of prescription pain relievers is now at historic lows.
Illustration by Lissa Mathis, as published in the journal Substance Abuse.“If doctors are prescribing far less, and people are using these pills far less than they were just a few years ago, and opioid deaths are rising even faster, that should be a shocking wake-up call to policymakers,” Kertesz said. “Common sense dictates that we’re making a mistake to continue to focus so very narrowly on what happens when pain patients go to see a doctor.”
What has replaced pills is what Kertesz describes as “a booming market for potent heroin, fentanyl and its analogs.” Using public data from the coroner for Jefferson County — which includes Birmingham, Alabama — Kertesz showed how heroin and fentanyl account for nearly all overdose deaths. Just 15 percent of overdoses involve pills that could have been obtained through a prescription, echoing recent findings from several other cities.
His commentary calls for renewed public attention to subsidized access to medication therapies for addiction.
“Congressional funds for addiction treatment have failed to keep up with inflation since 2009,” he said. “Although Congress passed a new law in response to the opioid epidemic earlier this year, it has declined to fully fund it.”
“What people sometimes fail to realize is that addiction continues to kill people even when you choke off the supply of one particular addictive substance.”
Kertesz endorses a recent CDC Guideline that encouraged a careful weighing of risks and benefits for each patient, but he believes its message was overwhelmed by more aggressive communications from federal and state leaders.
“At this point, the doctors are overwhelmed and scared of being caught in the crossfire,” Kertesz said. “The result is bad news for stable patients who are being taken off the pills that actually were helpful to them.”
Kertesz says this issue is more complicated than people realize, and he hopes this publication will lead to better education and legislation to help patients.
“It’s almost like we decided to fight diabetes by shutting down all the donut shops,” he said. “A few years into it, there are a lot less donuts being eaten, and we’re beginning to realize that diabetes is a lot more complicated than donuts.”
Over the counter homeopathic remedies sold in the US will now have to come with a warning that they are based on outdated theories ‘not accepted by most modern medical experts’ and that ‘there is no scientific evidence the product works’. Failure to do so will mean the makers of homeopathic remedies will risk running afoul of the US Federal Trade Commission (FTC).
The agency argues that unsupported health claims included in the marketing for some of these remedies are in breach of laws that prohibit deceptive advertising or labelling of over the counter drugs.
The body has released an enforcement policy statement clarifying that homeopathic drugs are not exempt from rules that apply to other health products when it comes to claims of efficacy and should not be treated differently. In order for any claims in adverts or on packaging not to be ‘misleading’ to consumers it should be clearly communicated that they are based on theories developed in the 1700s and that there is a lack of evidence to back them up, the statement says. Thanks to detailed and strict quality assurance procedures, regular quality control audits, and contract packaging systems that have been refined through years of experience, pharmaceutical packaging Australia delivers the highest standards to manufacturers and distributors.
It adds that the FTC will ‘carefully scrutinise the net impression of [over the counter] homeopathic advertising or other marketing … to ensure that it adequately conveys the extremely limited nature of the health claim being asserted’.
A number of people in chronic pain support the plight of those with addiction. Yet, over the past year and a half, I have read any number of derogatory statements and comments here on Pain News Network and on its corresponding Facebook page about people who are dealing and struggling with addiction.
Even a cursory review of the comment section on different articles will reveal rather quickly any number of folks who are dismissive of those dealing with addiction. Some express a real hatred.
One person actually suggested letting “all the druggies overdose, one by one.”
Another laments that “addicts can’t die quick enough for me.”
Some express a sort of jealousy over addicts getting better treatment than they: “It’s good to be an addict” and “Maybe I’d be better off being an addict.”
And then there are those who got all shook up over Prince’s overdose, not so much from his death, but because it was linked to an opioid and that it might make it harder for them to obtain their own opioid medications.
And to think these comments come from the same people who beg others to better understand and accept their own need for better pain care!
It wasn’t very long ago that the “drug addict” was scorned and forgotten: the druggie on the dark-lit street corner or the drunk in the back-alley. Pretty much neglected and left to fend for themselves.
But that started to change in the ’70s and ’80s, and nowadays the person suffering from addiction is recognized as someone who suffers from a very complex disease, is quite sick, and struggles to access the necessary care in order to recover. Societal attitudes towards those with an addiction now reflect empathy and a desire to help, as opposed to denunciation and dismissiveness.
We chronic pain patients are looking for the same acceptance and understanding that addicts were desperately seeking just a few short years ago. And that struggle took many, many decades, one might say centuries, to achieve. Our struggle is similar, and my guess is if we keep our eyes and focus on reasonable and rational argument, we too will achieve success in our struggle to obtain acceptable pain care and understanding.
But if some of us continue to see the enemy as the person who has an addiction, our fight for justice will suffer and be delayed.
Why? Because the addict is not very different from us. Irrespective of the reason why a drug or substance user becomes addicted, the addict just wants to feel better, just like us. The addict is sick, just like us. The addict wants relief from pain, just like us. Perhaps not from physical pain, but emotional and psychic pain. The addict wants proper medication, just like us. The addict needs help and assistance, just like us.
And sometimes the pain patient is the addict. Sometimes we are one in the same. A recent review of 38 research reports pegs the addiction rate among chronic pain patients at 10 percent. From a genetic predisposition standpoint, we must presume that some addicts have become addicted just because of their genes, just like some of us.
No one with an addiction started out wanting to become addicted, just like none of us wanted chronic pain. And while our government is trying to figure out how to minimize the spread of opioid addiction, it is not the addict’s fault as to how it has decided to that.
In many ways those suffering from addiction are not very different from us who suffer from chronic pain. We both struggle for acceptance, we both require empathy and understanding from the world around us, and we both require treatment and proper care to lead better and more productive lives.
But, I firmly believe that as long as there are those of us in chronic pain who feel compelled to ridicule and demean those who are addicted, that we will only delay our own quest to receive the empathy we so justly deserve in our journey towards adequate pain care.
Empathy breeds empathy, and if we expect it for ourselves, we must be willing to extend it to others. And that includes the addict.
About 21 million Americans have substance abuse disorders. They are addicted to drugs or alcohol, and their addiction is destroying their lives. Along the way, they drag down their families and place a tremendous burden on society.
U.S. Surgeon General Vivek Murthy recently issued a groundbreaking report on substance abuse in America that could change the conversation around addiction.
In some regards, the report contains little that is truly new. Horror stories of people whose lives and the lives of their families are ruined by addiction are common in the media. The need for evidence-based treatment is well established in the academic literature.
What makes the report so important is that brings together the data and a strategy for going forward into one readable report that contains information for researchers, lawmakers and the public.
The Centers for Disease Control and Prevention report that, in 2014, the most recent year for which data is available, California had 4,521 overdose deaths. The opioid epidemic has hit localities hard. Here in Sonoma County, the rate of overdose deaths and emergency room visits exceeds statewide rates.
Nor is it just hard drugs that are problematic. About one-fifth of Americans binge drink. Substance abuse costs the United States more than $420 billion per year.
A popular view of addiction, especially among people who have no firsthand experience with it, is that it is a personal failing. The addict chose to start taking drugs or drinking too much. Personal suffering is punishment.
The surgeon general, backed by overwhelming medical research, rejected that notion. “Research on alcohol and drug use, and addiction, has led to an increase of knowledge and to one clear conclusion: Addiction to alcohol or drugs is a chronic but treatable brain disease that requires medical intervention, not moral judgment,” the report states.
In some ways, this moment is like 1964. That year, the surgeon general issued the first comprehensive government report on the dangers of smoking. Like the current report, it offered a path forward to lead to a healthier America. Five decades later, smoking rates have plummeted.
Like other diseases, treatments exist for addiction. Access to them is the biggest challenge.
One key to better access is better health insurance. The Affordable Care Act requires that insurance companies that participate in the exchanges provide mental and behavioral health parity. In other words, health insurance may no longer just pay for diseases of the body but also for diseases of the mind. Addiction, depression, etc. would be covered just as well as diabetes and pneumonia.
Republicans in Congress and President-elect Donald Trump, should make sure that remains true. If they make good on their promise to repeal Obamacare, whatever replaces it should include a parity requirement. Often, people who suffer from addiction are among the least able to pay for help. Insurance they purchase should cover that expense to help them recover and return to a healthful, productive life.
Yet the outline of a Republican plan released by House Speaker Paul Ryan doesn’t even mention treating addiction and mental health.
When it comes to addiction, the real moral failing will be society’s if America disregards the surgeon general’s warning and fails to confront this public health crisis.
You might think Surgeon General Vivek Murthy, who acknowledges marijuana’s medical utility, has relatively enlightened views on drug policy. But a report he released yesterday reveals that Murthy is utterly conventional in his attitude toward drinking and other kinds of recreational drug use, which he views as a problem to be minimized by the government. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health claims “addiction is a chronic brain disease” caused by exposure to psychoactive substances, even while acknowledging that the vast majority of people who consume those substances do not become addicted to them. The report describes even low-risk, harmless, and beneficial drug use as “misuse,” giving the government broad license to meddle with personal choices through policies aimed at making drugs more expensive and less accessible. Murthy argues that driving down total consumption, rather than focusing on problematic use, is the most effective way to reduce the harm caused by alcohol and other drugs. As he sees it, every drinker and drug user, no matter how careful, controlled, or responsible, is a legitimate target of government intervention.
Murthy’s report eschews the term substance abuse, explaining that the phrase “is increasingly avoided by professionals because it can be shaming.” Instead the report talks about “substance misuse,” which “is now the preferred term.” But substance misuse is just as judgmental, vague, and arbitrary as substance abuse. In fact, Murthy cannot quite decide what it means. On page 5 of the introduction, he says misuse occurs when people use drugs “in a manner that causes harm to the user or those around them.” But elsewhere (including the very next page), the report uses a much broader definition. “Although misuse is not a diagnostic term,” Murthy says, “it generally suggests use in a manner that could cause harm to the user or those around them.” Could cause harm? That definition is wide enough to cover all drug use.
Murthy does seem to think drug use is problematic even when it causes no problems. As an example of drug misuse, Murthy repeatedly cites a 2015 survey in which 25 percent of the respondents, representing 66.7 million Americans, reported that they had engaged in “binge drinking” during the previous month. “By definition,” Murthy says, “those episodes have the potential for producing harm to the user and/or to those around them, through increases in motor vehicle crashes, violence, and alcohol poisonings.” But the government’s definition of a binge—five or more drinks “on an occasion” for a man, four or more for a woman—encompasses patterns of consumption that do not harm anything except the sensibilities of public health officials. If a man at a dinner party drinks a cocktail before the meal, a few glasses of wine during it, and a little bourbon afterward, he is drinking too much, according to Murthy, even if he takes a cab home. By that standard, at least 44 percent of past-month drinkers are misusing alcohol.
Murthy also counts all consumption of federally proscribed drugs as misuse, no matter the context or consequences. As far as he is concerned, all 36 million Americans who consumed cannabis last year misused it, even if they lived in states where the drug is legal for medical or recreational purposes (which is now most states). Unauthorized use of prescription drugs also counts as misuse, whether or not harm results. “In 2015,” Murthy says, “12.5 million individuals misused a pain reliever in the past year—setting the stage for a potential overdose.” That makes the risk sound much bigger than it is. According to the CDC, there were 18,893 deaths involving opioid analgesics in 2014, the most recent year for which data are available. That year, according to the National Survey on Drug Use and Health, 10.3 million Americans used prescription painkillers for nonmedical purposes. On average, they ran a 0.2 percent change of dying as a result. For those who avoided mixing narcotic painkillers with other depressants (a typical factor in opioid-related deaths), the risk was even smaller—on the order of 0.02 percent, judging from New York City data.
Murthy also seems confused when he talks about addiction. “We now know from solid data that substance abuse disorders don’t discriminate,” he recently told NPR. “They affect the rich and the poor, all socioeconomic groups and ethnic groups. They affect people in urban areas and rural ones.” But according to Murthy’s report, “Prevalence of substance misuse and substance use disorders differs by race and ethnicity and gender.” Furthermore, “genetic, social, and environmental risk factors” increase a person’s vulnerability to addiction, while “protective factors” reduce it. Risk factors include “low parental monitoring,” “high levels of family conflict or violence,” “current mental disorders,” “low involvement in school,” and “a history of abuse and neglect.” Protective factors include “involvement in school, engagement in healthy recreational and social activities, and good coping skills.” Pace Murthy, it sounds like substance abuse disorders do discriminate, since they are more common among troubled people in difficult circumstances.
The fact that everyone is not equally prone to addiction tells us that Murthy’s account, in which a “substance abuse disorder” is “a medical illness caused by repeated misuse of a substance or substances,” cannot be accurate. According to the report, “prolonged, repeated misuse of any of these substances can produce changes to the brain that can lead to a substance use disorder, an independent illness that significantly impairs health and function and may require specialty treatment” (emphasis added). Those cans are carrying a lot of weight. In fact, as Murthy concedes, drug use typically does not “lead to a substance use disorder”; controlled use is much more common. “For a wide range of reasons that remain only partially understood,” says the executive summary, “some individuals are able to use alcohol or drugs in moderation and not develop addiction or even milder substance use disorders, whereas others—between 4 and 23 percent depending on the substance—proceed readily from trying a substance to developing a substance use disorder.” By saying “some” and “others” instead of “most” and “a minority,” the report obfuscates the point that the vast majority of drinkers and drug users are not addicts.
Murthy’s equation of addiction with cancer and diabetes is also misleading. “Now we understand that these disorders actually change the circuitry in your brain,” he tells NPR. “They affect your ability to make decisions, and change your reward system and your stress response. That tells us that addiction is a chronic disease of the brain, and we need to treat it with the same urgency and compassion that we do with any other illness.” All experiences change the brain; that does not make them diseases. Although the medical terminology is supposed to reduce the stigma associated with drug addiction and encourage people to seek help, it is not clear that describing the problem as an illness rather than a habit makes it any easier to change. Arguably it does the opposite, by depicting harmful patterns of drug use as something that happens to people rather than something that they do.
Raritan Pharmaceuticals, a contract manufacturer for Homeolab USA, is voluntarily recalling homeopathic products containing belladonna extract (see products below) due to the potential for variation in the content of belladonna extract in the products. The U.S. FDA has tested some products and recovered varying levels of belladonna extract content from what is declared on the label. Raritan Pharmaceuticals is a contract manufacturer of these products for Homeolab USA that supplies the belladonna blends to Raritan Pharmaceuticals.
Image/The Global Dispatch
UPC: 050428424162 Product: CVS Homeopathic Infants’ Teething Tablet 135 tablets (Please note that CVS has already taken a market action on this product as of September 30, 2016) Lots: 41116 and 43436
The homeopathic products have a very small amount of belladonna, a substance that can cause harm at larger doses. The company is voluntarily recalling the product out of an abundance of caution.
These products were distributed Nationwide. Consumers with any product being recalled should stop using the product. Consumers with questions regarding this recall can contact Raritan Pharmaceuticals by phone at 1-866-467-2748 (Monday-Friday from 8am to 5:30pm EST).
No other Homeolab or Raritan products are affected.
Consumers should contact their physician or healthcare provider if they have experienced any problems that may be related to taking or using this drug product.
The Green Party’s candidate Jill Stein… got 0.36% of the national vote… yet she… and the GREEN PARTY.. are raising money to force a vote recount in 2-3 different states. The chronic pain community may need to pay attention… sending letters, making phone calls, putting forth petitions, and all those other things that has proven to be synonymous with a dog chasing its tail… It would appear that the only way to get things done within out system is using the laws within our system that are working against those who are suffering from subjective diseases and being denied appropriate therapy.. to raise money and hire a law firm(s) to challenge those decisions… if nothing else.. on a constitutionality basis… if not from the flat out denial of care and the intentional infliction of the “pain consequences” for denial of care.
Jill Stein, the Green party’s candidate in the US presidential election, formally filed a motion for a recount in Wisconsin on Friday as her funding effort for counting the votes again in three states passed $5m.
As more money flooded in for her effort – which aims to fund recounts in Michigan, Pennsylvania and Wisconsin, all states where Donald Trump narrowly beat Hillary Clinton – she admitted she had no hard evidence of fraud but said the systems were vulnerable.
Her campaign team said it would formally file in Wisconsin before the 5pm ET deadline to do so; the recount motion deadlines for the other two states are next week. Less than half an hour before the deadline, the Wisconsin elections commission confirmed it had received the recount petition.
Her move has split opinions, with some energized by the thought it has potential to show defeated Democrat Clinton is the rightful election winner, and those who see Stein’s intervention as an expensive gimmick to promote the Green party.
The fundraising site explained that Stein’s campaign “could not guarantee” any of these states would have a recount. “We can only pledge we will demand recounts in those states,” the site said.
Amid questions from some quarters about how the money would be used, the site said: “If we raise more than what’s needed, the surplus will also go toward election integrity efforts and to promote voting system reform.”
On Friday, Stein said she was acting due to “compelling evidence of voting anomalies” and that data analysis had indicated “significant discrepancies in vote totals” that were released by state authorities.
“We do not have a smoking gun,” Stein told CNN. “On the other hand, we have a system that invites hacking, tampering and malfeasance.”
She said her campaign had no direct evidence voting systems had been hacked – something independent experts have also been skeptical about. And Stein insisted the recount was not meant to block Donald Trump, the surprise election winner, from becoming president.
Stein has frequently expressed disappointment in Clinton, and the day before the election described the Democratic nominee as a “warmonger” and said a victory for the former secretary of state would be “a mushroom cloud waiting to happen”. Those comments led to Stein being condemned by elected members of the Green party in Europe.
“Both of the candidates were at the highest level of distrust and dislike in our history and in my view, we as voters deserve a voting system that we can believe in,” Stein said on Friday. “And to my mind, having a verified vote is just a first step”.
Stein launched the campaign amid wider calls to recount or audit election results. Groups of academics and activists were concerned that foreign hackers may have interfered with voting systems, though none have provided evidence such hacking occurred.
These groups have called on Clinton to intervene. She is leading in the popular vote by more than 2.1m votes, a lead which is expected to grow. But Trump won narrow victories against Clinton in Pennsylvania and Wisconsin earlier this month and was declared the victor in Michigan on Thursday – sealing his electoral college win.
Stein’s effort, launched on Wednesday afternoon, is directed at funding recounts in those three states. Stein quickly surpassed the initial $2m fundraising goal by early Thursday morning, prompting her campaign to raise the goal to $4.5m. After crossing that threshold, the campaign increased the goal to $7m.
These funds will be used to file recount requests and for attorney’s fees, according to Stein’s campaign manager, David Cobb. He said $1m was needed for Wisconsin, $600,000 for Michigan and $500,000 for Pennsylvania. The rest of the money is expected to go to legal fees associated with the recount.
Adam Parkhomenko, national field director for the Democratic national convention and a longtime Clinton aide, said he did not support Jill Stein and “never will”, but: “I support democracy and the right to count every vote. And kudos to her for leading on this.”
US elections are so dominated by Democratic and Republican candidates that third-party candidates like Stein are more often seen as representing protest votes than a person with a legitimate shot at the White House. But these votes can greatly affect the race. For instance, Stein’s total votes in Michigan and Wisconsin were greater than the gap between Clinton and Trump, as were votes for the other major third-party candidate, Libertarian Gary Johnson.
And while it cannot be assumed that Stein voters would have voted for Clinton if Stein had not been on the ballot, it is a sensitive issue in such a tight race.
“I really wish Jill Stein had not waited until after the election to be so concerned about a few thousand votes tipping the election to Trump,” said Dan Pfeiffer, a former senior policy adviser to Barack Obama.
He criticized the fundraising campaign as a “wasted” effort and said funds could be better used to help Democrats in smaller, local races.
There was more energy around third-party candidates in 2016 because of the unpopularity of the main party candidates. Yet in the past two days, Stein’s recount campaign has raised more money than she did in the entirety of the presidential campaign. As of 19 October, Stein had raised $3.5m for her presidential race, according to the Center for Responsive Politics. As of 10am ET on Friday, the recount campaign had raised $4.8m.
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