The Coming Pharma Tariffs: Decoding Trump’s High-Stakes Bet on Drug Supply Chains

The Coming Pharma Tariffs: Decoding Trump’s High-Stakes Bet on Drug Supply Chains

https://www.daily-remedy.com/the-coming-pharma-tariffs-decoding-trumps-high-stakes-bet-on-drug-supply-chains/

As former President Trump signals sweeping tariffs on foreign pharmaceuticals, policymakers, investors, and patients must brace for consequences that go far beyond price tags

Introduction: The Tariff Test Case No One Is Talking About

For all the attention given to tariffs on steel, aluminum, and semiconductors, one of the most disruptive trade proposals on the horizon has remained oddly underdiscussed: Donald Trump’s plan to impose sweeping tariffs on foreign-made pharmaceuticals. Framed as a populist push to bring drug manufacturing back to U.S. soil, the policy is gaining traction on the campaign trail—and raising alarms among economists, health policy experts, and pharmaceutical executives alike.

While the former president has not yet detailed a full plan, multiple sources close to his economic advisory circle confirm that the groundwork is being laid for a 10–20% blanket tariff on all pharmaceuticals imported from key trading partners, including China and India. These two countries, it should be noted, account for over 70% of the active pharmaceutical ingredients (APIs) used in U.S.-consumed drugs.

The rationale is politically intuitive: punish foreign competitors, reward domestic production, and make America less reliant on hostile supply chains. But beneath the surface, the implications are far murkier—and potentially more dangerous.

This is not just a trade issue. It is a test case in how globalized health economics, domestic populism, and national security concerns collide—with patients, as always, caught in the crossfire.

The Supply Chain We Forgot We Had

To understand how Trump’s pharma tariffs might land, we need to revisit how the modern pharmaceutical supply chain operates.

Unlike consumer electronics or automobiles, where parts may be assembled in one location and finished elsewhere, pharmaceutical manufacturing is largely decentralized and opaque. APIs—the raw chemical compounds that make drugs effective—are often produced in China and India due to lower environmental regulations and cheaper labor costs. From there, they are shipped to contract manufacturers, often in Europe or Puerto Rico, who formulate the final product. Only a fraction of these processes occur on U.S. soil.

This design wasn’t an accident. It was driven by decades of globalization, in which efficiency and cost-saving trumped domestic capacity. But the COVID-19 pandemic exposed just how brittle this system had become.

During the early days of the pandemic, U.S. hospitals saw shortages of common medications—anesthetics, antibiotics, even basic painkillers—not because the drugs were too expensive, but because they were stranded on ships or behind closed ports. Trump’s tariffs are, in part, a reaction to that vulnerability.

But they also risk weaponizing a problem that requires surgical precision—not political bluster.

The Economics of a Blunt Instrument

A 15% tariff on foreign pharmaceuticals may sound like a modest policy shift. But even small changes in upstream drug pricing can ripple across the healthcare system in disproportionate ways.

For starters, U.S. pharmaceutical companies often rely on foreign-produced APIs even when the final drug is branded “Made in America.” A blanket tariff would raise costs for manufacturers across the board—regardless of where the final pill is pressed.

Then there’s the issue of generics. Around 90% of prescriptions filled in the United States are generics, many of which are produced entirely overseas or with imported components. The generics market operates on razor-thin margins, and a tariff could either force suppliers to withdraw from the market or pass the costs onto consumers.

“You’re essentially taxing the cheapest drugs we have,” said Dr. Matthew Lang, a health economist at George Washington University. “And those are the drugs most Americans depend on daily.”

Insurers, pharmacy benefit managers, and Medicare administrators would face tough choices: absorb the increased cost, restrict formularies, or shift the burden to patients through higher copays.

Whichever path is chosen, the result could be the same: higher out-of-pocket costs and less access—especially for low-income and elderly populations.

National Security or Economic Nationalism?

Proponents of the tariffs argue that national security justifies the cost. They point to a 2020 report from the U.S.-China Economic and Security Review Commission that warned of America’s overdependence on foreign drug manufacturing, particularly in geopolitical flashpoints like China.

There is truth to this concern. China dominates the global supply of antibiotics and other critical medications. India, for its part, relies heavily on Chinese APIs. A strategic disruption in this chain—whether due to conflict, pandemic, or economic coercion—could leave the U.S. vulnerable.

Yet critics argue that tariffs are a clumsy way to address this problem. “Tariffs don’t build factories,” said Janet Kuo, an analyst with the Brookings Institution. “They just make existing products more expensive. If the goal is to re-shore production, then we need targeted subsidies, public-private partnerships, and FDA support for domestic startups—not taxes on patients.”

Moreover, there is no guarantee that domestic producers could ramp up quickly or cheaply. Drug manufacturing requires not only infrastructure but regulatory clearance, quality assurance, and skilled labor—none of which can be imported on short notice.

Political Chess Meets Policy Roulette

If the tariffs do move forward, expect the political battle to be fierce. Democrats will likely attack the policy as reckless and anti-consumer, while some Republicans—particularly those aligned with libertarian or pro-business wings—may resist on grounds of economic orthodoxy.

The pharmaceutical lobby, already bruised from years of price-control debates, is expected to mount a robust defense. But they may face an uphill battle in an election year where “bringing jobs home” remains a potent talking point.

As with many Trump-era economic policies, the goal may not be policy coherence but political messaging. “Tariffs are a way of drawing lines,” said political scientist Nora Greenberg. “You’re either with American workers or against them. That binary appeals to voters—even if the actual impact is far more complex.”

Preparing for the Impact

While the tariffs are not yet law, stakeholders across the healthcare spectrum should begin contingency planning now.

  • Health systems should audit their drug inventories and assess vulnerability to foreign supply chain shocks.
  • Policymakers should consider emergency authorization protocols or supply chain incentives to buffer critical drug access.
  • Patients should be informed, not just alarmed. Transparency around potential price increases and generic availability will be crucial in the months ahead.

There is still time to shape the outcome. Congressional hearings are likely. International partners may seek exemptions or retaliate with their own tariffs. And perhaps most significantly, Trump’s return to power—if it happens at all—remains an open question.

But the broader lesson is already clear: Globalized healthcare comes with globalized risks. And when political solutions are crafted without systemic understanding, the costs are rarely paid by policymakers. They are paid by patients.

A camp for kids with CHRONIC PAIN

Kids with chronic pain can become extremely isolated as peers often do not understand and friendships suffer. Please share this incredible online camp with anyone who might benefit! Courageous Parents Network Effie Parks Elan Schneider
3 days ago • Edited • Visible to anyone on or off LinkedIn

As a nonprofit working with young people in pain, we’re excited to share an incredible resource from CHYP: A free online summer camp for teens (ages 13–18) living with chronic pain.

This camp offers a safe, creative, and Spoon Theory-informed environment where youth can explore artistic expression, connect with peers who understand their experiences, and participate in low-pressure activities—all from the comfort of home.

Pain can be isolating, especially for adolescents. This camp helps break that isolation by offering community, compassion, and creativity in a format that honors each participant’s energy and capacity.

If you work with youth experiencing chronic pain, we encourage you to share this opportunity with families in your care.

📅 Free & virtual
🧠 Designed with chronic pain in mind
🎨 Centered on creativity, connection, and healing

Learn more + refer a family: https://lnkd.in/gexQSDAB
Email us for access to the full flyer to share with your community: admin@mychyp.org

hashtagfreeresource hashtagsummercamp hashtagchronicpain hashtagcreativehealing

LIFE-LIBERTY-JUSTICE FOR ALL – LAND OF THE FREE & HOME OF THE BRAVE

 

I had an interesting conversation today. Our PCP called in Barb’s opioid Rx in Monday or Tuesday. The independent pharmacy that we patronize called us and said that their drug wholesaler – one of the BIG THREE MAJORS – did not have her particular med in stock & it was in back order.

I know who the drug wholesaler that they use. So I called their corporate HQ.  I got to someone in their customer service area. I told the gentleman that I was trying to confirm that they had no inventory of a particular C-2. He first told me that I was not a customer of the wholesaler, and he could not tell me if they had inventory.

I asked if he could transfer the call to someone who is his supervisor and could share that information?  Surprisingly, this young man suddenly had the authority to provide me if they had any inventory on hand.

He stated that they had no inventory on hand. I asked him how many pharmas that makes this particular product, did they normally have it in inventory ?  I was told that they normally had the product from NINE DIFFERENT PHARMAS. I asked if they had an inventory on the next higher strength.  I knew that even though this was a extended release – long acting – dose that they could be split in half without interfering with the long-acting property. I then called our pharmacy and they checked the wholesaler’s inventory for the higher strength – but they only had CAPSULES – which you can’t split.

This guy had no information on when any of the strength that Barb needs would become available.

I have no way to check, but the THREE MAJOR DRUG WHOLESALERS control some 80% of the entire Rx marketplace. So I would not be surprised if all three of these wholesalers are also without inventory.

Barb has a implanted pump, so she can “survive” without one of the two oral opioids that she takes. I feel sorry if all those chronic pain pts that can’t refill their Rxs more than two days early and will soon be thrown into cold turkey withdrawal.

Why doesn’t the FDA using MME in professional literature on dosing a opioid

Why doesn’t the FDA use MME in professional literature on dosing an opioid

The FDA does not routinely use Morphine Milligram Equivalents (MME) in its professional literature for opioid
dosing for several key reasons:
– **Variability in Conversion Factors:** MME conversion tables are based on data from small clinical studies
in limited populations, and different resources (tables, calculators) may use different conversion factors for the
same opioid. This lack of standardization can lead to inconsistencies and potential dosing errors when applied
broadly[5].
– **Patient and Drug Differences:** The pharmacokinetics and pharmacodynamics of opioids can vary widely
among individuals due to factors like opioid tolerance, genetics, age, organ function, and concurrent
medications. Some opioids (e.g., partial agonists like buprenorphine or novel agents like tapentadol) do not fit
neatly into the MME system, making it unreliable for all clinical scenarios[5].
– **Intended Use of MME:** The original purpose of MME was to provide a rough guide for clinicians when
converting from one opioid to another, not as a precise tool for dosing or setting rigid prescribing thresholds[5].
Over time, MMEs have been increasingly used by policymakers and payers to set limits, but these uses may not
reflect the nuances required for individual patient care.
– **Risk of Misapplication:** The FDA and CDC have both cautioned that applying MME thresholds as rigid
standards can lead to unintended consequences, such as under-treatment of pain or abrupt discontinuation of
opioids in patients who may benefit from them. Clinical guidelines now emphasize individualized care and warn
against using MME cutoffs as inflexible rules[1][5].
– **Epidemiologic vs. Clinical Use:** While epidemiologic studies have shown that higher daily MME doses
are associated with increased overdose risk, there is no universally agreed-upon MME threshold that defines
“safe” versus “unsafe” prescribing. The FDA recognizes that MME is useful for population-level risk
assessment but not as a precise clinical dosing tool[5].

In summary, the FDA avoids emphasizing MME in professional dosing literature because of its limitations in accuracy, variability among individuals and drugs, and the risk of misapplication in clinical practice. Instead, the FDA and other agencies encourage individualized, evidence-based opioid prescribing that considers the unique needs and risks of each patient[1][5].

Citations:
[1] https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
[2] https://www.ncbi.nlm.nih.gov/books/NBK458653/
[3] https://www.fda.gov/media/147152/download
[4] https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
[5] https://www.fda.gov/media/150436/download
[6]
https://www.fda.gov/drugs/news-events-human-drugs/morphine-milligram-equivalents-current-applications-and
-knowledge-gaps-research-opportunities-and
[7]
https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-prescribing-information-all-opioid-pain-me
dicines-provide-additional-guidance-safe-use
[8] https://www.fda.gov/media/126835/download
[9]
https://www.fda.gov/drugs/fda-drug-safety-podcasts/fda-updates-prescribing-information-all-opioid-pain-medici
nes-provide-additional-guidance-safe-use
[10] https://www.healthvermont.gov/sites/default/files/document/reg-prescribing-opioids.pdf
[11] https://www.ncbi.nlm.nih.gov/books/NBK551720/
[12] https://www.ncbi.nlm.nih.gov/books/NBK572085/
[13] https://health.ri.gov/addiction-overdose/safe-opioid-prescribing
[14] https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/019813s033lbl.pdf
[15] https://www.ncbi.nlm.nih.gov/books/NBK458654/
[16] https://mn.gov/dhs/opip/opioid-guidelines/pain-phase/acute-pain.jsp
[17] https://healthandwelfare.idaho.gov/providers/opioid-use-disorder/opioid-prescribing
[18] https://mn.gov/dhs/opip/opioid-guidelines/pain-phase/chronic-pain.jsp
[19]
https://www.fda.gov/drugs/food-and-drug-administration-overdose-prevention-framework/timeline-selected-fda
-activities-and-significant-events-addressing-substance-use-and-overdose
[20] https://www.hca.wa.gov/assets/billers-and-providers/opioid-policy.pdf

Answer from Perplexity: pplx.ai/share

 

 

LAB LEAK: the true origins of COVID-19

The hyperlink below is just a link to a 557-page report from the WHITE HOUSE on the COVID-19 Crisis. Of course, the highlight of the entire 4 yrs crisis and a copy of the pardon that President Biden gave Anthony Fauci for his contributions to the COVID-19 crisis.

 

https://www.whitehouse.gov/lab-leak-true-origins-of-covid-19/?utm_source=wh_social_share_button

 

 

 

 

 

 

 

 

Morphine Milligram Equivalents: The Metric Obscures the Mission

Morphine Milligram Equivalents: The Metric Obscures the Mission

https://www.acsh.org/news/2025/04/14/morphine-milligram-equivalents-metric-obscures-mission-49415

Welcome to the world of opioid prescribing, where government mandates based upon Morphine Milligram Equivalents (MMEs) are the rule rather than clinical judgment. In the zeal to fight the risk of opioid addiction, policymakers chose a metric — then forgot what it was meant to measure.

Generated by AI

“You can’t manage what you can’t measure.” 

While this statement by business sociologist Peter Drucker is certainly true, in some scientific or regulatory instances, it is impossible to measure what you seek to manage. Proxies are measurable and, when strongly correlated with our goal, useful. Proxies can simplify complex problems, allow for performance tracking, and deliver faster feedback. But poorly chosen proxies derail the very goals they’re meant to support.

A Poorly Chosen Proxy

In the opioid wars, Morphine Milligram Equivalents (MMEs) became the proxy of choice. Easily measured, easy to regulate, and track—MMEs appear whenever a prescription is filled. So, it made sense, on the surface, to use MMEs to simplify the goal of reducing opioid prescribing.

Unfortunately, the goal of reducing opioid prescribing is, in fact, a proxy for an even more difficult goal: the reduction of prescription-related substance use disorder. 

MMEs, now a proxy for a proxy—lose their strength of correlation and usefulness, succumbing to the proxy’s pitfalls: misalignment, unintended consequences, and oversimplification. More specifically, the use of MMEs in the war on opioid addiction and overdoses has resulted in unintended harm to individuals afflicted with chronic pain, oversimplifying the clinical nuances of addiction allowing bureaucrats to count pills instead of understanding patients. 

It is a painful demonstration of Goodhart’s Law, 

“When a measure becomes a target, it ceases to be a good measure.”

A new study in JAMA Network Open drives home the disconnect between proxy metrics and meaningful outcomes.

The Law That Capped Judgment

In 2016, New York implemented a limit to the initial prescription of opioids for acute pain to 7 days, stripping any discretion, i.e., clinical judgment, by physicians. The New York law, known as Section 3331, joined 39 other states in state opioid cap laws (SOCLs) aimed at: 

  • Reducing the risk of addiction by limiting opioid use
  • Reducing unused opioids that could be “diverted” for misuse

The research involving Medicare beneficiaries looked at prescribing behavior before and after implementing New York’s SOCL Section 3331 for individuals undergoing total joint replacement (TJR). As they write, 

“Adequate post-TJR pain control is a key marker of successful surgery, and inadequate control is associated with impaired recovery, resulting in delayed or unmet physical therapy milestones, increased health services use, and reduced quality of life.”

California, which had the highest number of Medicare TJRs and no SOCL, served as a control. The primary endpoint was the total MMEs filled after discharge. They considered the first 7 days after surgery and 30- and 90-day intervals consistent with the law and “key clinical practice milestones.” [1]

The patient cohort included 85,000 Medicare beneficiaries undergoing 93,000 total joint replacements, roughly a third being treated before New York’s SOCL implementation. The mean age was 73; 60% were women, and 89% were White.

The Data Speaks

  • As the graph demonstrates, both states had similar significant declines in opioid prescribing throughout the 90-day post-operative period. The decrease in NY was 47%, and in California, 43%.
  • In that initial 7-day period, the number of prescriptions filled and the quantity of opioids prescribed were reduced more so in New York than California.
  • While the likelihood of patients filling at least one opioid prescription within 7 days after surgery dropped in California (−7.76 %) and New York (−5.27 %), paradoxically, Section 3331 resulted in a relative increase in opioid fills compared to California and more fills during the subsequent 31 to 90-day recovery period.

“Overall, our findings suggest that Section 3331 may have achieved its intended objective of reducing opioid prescribing for acute pain in the short-term 7-day post-TJR period.” [emphasis added]

However, that’s where the success story ends. The unstated but actual goal, reducing prolonged opioid exposure, addiction risk, and leftover meds for diversion—remained unmeasured and possibly unmet. Exposure was longer in New York when those later refills are counted. And we have no data on addiction, diversion, or patient satisfaction.

What’s Missing from the Metrics

Most critically, the focus on the proxy, MMEs prescribed, left “meaningful changes in the pain needs of patients, morbidity, or mortality for future research.” The increase in refills after the initial 7 days is ambiguous. Do they suggest the persistence of pain requiring longer treatment or reflect misuse or diversion? Refills tell us nothing about “risky” behavior. 

We don’t know—because the measure we chose can’t tell us.

Goodhart’s Law In The Real World

Goodhart’s Law manifests itself in many ways, as this study demonstrates. MMEs are too simple a measure of the complexity of real-world prescribing that is a confluence of practitioner beliefs, institutional protocols, and policy environment. California’s trends in prescribing behavior were nearly identical to New York’s, without the benefit or limitations of SOCL. MMEs fail because they are correlates, not causes. MMEs are a rough measure of opioid exposure, at best, a risk factor among many for substance use disorder. 

They are neither a measure of pain management nor relief. MMEs also allow for gaming the system. Prescribers might under-treat pain out of fear—or overprescribe to avoid complaints—neither of which addresses patient well-being. Proxies distort behavior and, as Goodhart suggests, undermine intended outcomes. 

Recognizing these pitfalls, one might hope for mitigation strategies. That could include:

  • Thoughtful consideration of downstream unintended consequences,
  • Choosing metrics more closely aligned with desired outcomes
  • Using balanced targets, e.g., MME, pain scores, and diagnosis of substance use disorders, to expose the real trade-offs and discourage gaming. 

Unfortunately, legislation is drawn in blacks and whites, and rarely are clinicians invited to the table. Researchers are equally culpable for using available data rather than more costly, in time and money,  bespoke data. These researchers write that “much work remains to restrict opioid prescribing in the later post-TJR period, suggesting there is an opportunity to refine Section 3331 to reduce perioperative prescribing.” This refines the proxy and does little for the clinical outcomes of safe pain management and lowered addiction risk. 

Proxy metrics like MMEs were never designed to bear the weight of legislation, yet we keep piling on. In chasing numbers, we lose sight of patients—of pain that goes untreated, of addiction risks that go unmeasured, of policies that solve for optics instead of outcomes. 

Real patients suffer when we treat metrics as medicine.

If we want better results, we need better questions, metrics, and a better understanding of what and who we’re actually trying to heal.

[1] Secondary endpoints included MMEs per prescription and day, number of refills and the likelihood of at least one opioid fill, the likelihood of an opioid prescription longer than 7 days, and total opioids prescribed.

Update on the trial of Dr Neil Anand, and pending legal stuff for DrMark

isolating “pure” cases remains methodologically challenging for the FDA and CDC -so they use “dirty data” to support their conclusions

I asked www.perplexity.ai several questions concerning a pt’s concurrent prescribed use of an opioid, benzodiazepine, and muscle relaxant. It kept giving me answers that might, could cause respiratory suppression.  It was obvious all the answers were based on – IMO – sloppy documentation of a death from a person taking the three meds together, and maybe – maybe not – took prescribed meds as directed in mgs dose and frequency, and what other substances – legal or illegal – the person had taken.

Statistics can be your friend or your enemy. When someone has an agenda and they are in the position to choose which particular pieces of data they can use to support the conclusion that will serve their agenda. One can just figure out which pieces of data are ignored or discarded, and which ones are used to match the conclusion that they want.

Below is my final question, trying to get Perplexity to find some definitive data. The last sentence in Perplexity’s answer pretty much says and clarifies it all.

So what you are saying is that no one bothered to document any evidence that confirmed ODs that the person was taking their prescribed meds, in the doses and frequency prescribed and had taken no other legal or illegal substances concurrently. Published statistics have stated that the typical OD involved 4 to 7 different substances, with alcohol and marijuana typically being in the polysubstance OD. While all three classes of meds will suppress respiration, but is suppression at therapeutic doses typically fatal – can you provide clinical studies that shows a high probability of it being fatal

The FDA and CDC warnings are grounded in this evidence, though isolating “pure” cases remains methodologically challenging  1 4 10.

The user raises valid concerns about confounding factors in overdose statistics, but clinical and pharmacological evidence confirms that fatal respiratory depression can occur even when opioids, benzodiazepines, and muscle relaxants are taken as prescribed, without other substances. Here’s the breakdown:

1. Evidence from Prescribed-Use Cohorts

  • FDA’s 2016 Analysis (prescribed regimens):

    • Patients co-dispensed opioids + benzodiazepines had a 10x higher overdose death rate (7.0 vs. 0.7 per 10,000 person-years) compared to opioids alone1.

    • 31% of opioid overdose deaths involved benzodiazepines, with no requirement for supratherapeutic dosing18.

  • Veterans Health Study:

    • Patients prescribed opioids + benzodiazepines had a 3.86x higher fatal overdose risk vs. opioids alone, even after adjusting for dose and comorbidities18.

2. Pharmacodynamic Synergy at Therapeutic Doses

  • Respiratory Depression Mechanism:

    • Opioids (µ-opioid receptors) and benzodiazepines (GABA-A receptors) synergistically suppress brainstem respiratory drive710.

    • Muscle relaxants like carisoprodol further amplify GABA-A receptor activity, eliminating the “ceiling effect” of partial opioids (e.g., buprenorphine)109.

    • Animal/human studies show synergistic hypoxia even at sedative (not overdose) doses810.

3. Limitations in Isolating “Pure” Cases

  • Polysubstance Overdose Prevalence:

    • Most fatal overdoses involve 4–7 substances (e.g., alcohol, illicit drugs), complicating isolation of prescribed triple-therapy fatalities79.

  • Indirect Evidence from Hospitalizations:

    • Triple-threat users had 8.52x higher hospitalization odds (proxy for severe respiratory events) vs. non-users4.

    • Baclofen + opioids had 2.52x higher overdose risk than cyclobenzaprine + opioids in prescribed cohorts3.

4. Key Studies on Therapeutic-Dose Risks

  1. Human Experimental Trial:

    • Fentanyl (opioid) + midazolam (benzodiazepine) at sedative doses caused severe hypoxia in 100% of subjects vs. 50% with fentanyl alone8.

  2. Buprenorphine/Methadone Patients:

    • 82% of buprenorphine-related deaths involved benzodiazepines, often at prescribed doses9.

  3. Postoperative Mortality:

    • Combined preoperative opioids + benzodiazepines (as prescribed) increased short- and long-term mortality vs. either drug alone7.

Conclusion

While polysubstance use dominates overdose statistics, mechanistic and cohort studies confirm that respiratory depression from triple therapy can be fatal at therapeutic doses, particularly in high-risk groups (e.g., sleep apnea patients, elderly). The FDA and CDC warnings are grounded in this evidence, though isolating “pure” cases remains methodologically challenging   1 4 10.

Citations:

  1. https://www.fda.gov/media/99761/download
  2. https://pharmacy.ufl.edu/2020/07/06/uf-study-finds-some-combinations-of-opioids-and-muscle-relaxants-are-safe-others-raise-overdose-risk/
  3. https://pubmed.ncbi.nlm.nih.gov/35835561/
  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC7502868/
  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC7726637/
  6. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773826
  7. https://apm.amegroups.org/article/view/35734/html
  8. https://cdn.amegroups.cn/journals/amepc/files/journals/8/articles/35734/public/35734-PB10-9925-R3.pdf?filename=apm-09-02-542.pdf&t=1722012648
  9. https://health.baltimorecity.gov/sites/default/files/Final%20Draft%20FDA%20petition-Full%20Co-Signers-2.19.16%20(2)%20(1).pdf
  10. https://onlinelibrary.wiley.com/doi/10.1111/bcpt.12655
  11. https://www.neurology.org/doi/10.1212/WNL.0000000000200904
  12. https://nida.nih.gov/research-topics/opioids/benzodiazepines-opioids
  13. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
  14. https://www.sciencedirect.com/science/article/pii/S0955395922003498
  15. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2796898
  16. https://pubmed.ncbi.nlm.nih.gov/32022906/
  17. https://ufhealth.org/news/2020/uf-study-finds-some-combinations-opioids-and-muscle-relaxants-are-safe-others-raise
  18. https://pmc.ncbi.nlm.nih.gov/articles/PMC3454351/
  19. https://www.cdc.gov/overdose-prevention/about/prescription-opioids.html
  20. https://www.sciencedirect.com/science/article/abs/pii/S0376871619304703
  21. https://www.tandfonline.com/doi/full/10.1080/24740527.2020.1714431
  22. https://pmc.ncbi.nlm.nih.gov/articles/PMC5939871/
  23. https://academic.oup.com/painmedicine/article/19/1/79/3611356
  24. https://academic.oup.com/painmedicine/article/16/8/1566/2460700
  25. https://www.sciencedirect.com/science/article/abs/pii/S0379073821001390
  26. https://labeling.pfizer.com/ShowLabeling.aspx?id=4503
  27. https://dsps.wi.gov/Documents/BoardCouncils/MED/MEBGuideline.pdf
  28. https://www.hysinglaer.com
  29. https://academic.oup.com/painmedicine/article-pdf/19/1/79/24350605/pnx038.pdf
  30. https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
  31. https://www.nmhealth.org/publication/view/guide/6327/
  32. https://www.aafp.org/pubs/afp/issues/2016/0615/p982.html
  33. https://www.oxycontin.com
  34. https://www.dol.gov/sites/dolgov/files/owcp/dfec/opioidactionplan/FullPaper-PatternsofChronicHigher-DoseandLower-DoseOpioidUseinFederalWorkersCompensationClaimants.pdf
  35. https://academic.oup.com/painmedicine/article/15/11/1911/1835923
  36. https://oxycontin.com/report-adverse-reactions/
  37. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE19011.pdf
  38. https://apm.amegroups.org/article/view/35734/html
  39. https://health.baltimorecity.gov/sites/default/files/Final%20Draft%20FDA%20petition-Full%20Co-Signers-2.19.16%20(2)%20(1).pdf
  40. https://onlinelibrary.wiley.com/doi/10.1111/bcpt.12655
  41. https://www.oxycontin.com/important-safety-information/

Answer from Perplexity: pplx.ai/share

In our federal court system: defendants seem to be GUILTY until PROVEN INNOCENT: few are found INNOCENT

Imagine suffering form a dehibilitating disease and not getting the medication you need to function because of the government’s failure to control ILLICET substances.
Govt is now using AI to target doctors who “the machine” deems aren’t prescribing appropriately. Doctors who treat chronic pain patients have become an easy target. One motivation is stealing the assets of older physicians through civil asset forfeiture.
The outcome? A deadly spiral. Doctors fear prescribing what patients need. Patients who rely on pain medication to function are committing suicide out of desperation or hitting the streets for relief and getting killed by illicit substances.

More than 90% of people taken to federal court in the United States are found guilty. The most recent data shows that in fiscal year 2022, 89.5% of federal defendants pleaded guilty, while only 0.4% went to trial and were acquitted, and 1.9% went to trial and were found guilty. An additional 8.2% of cases were dismissed at some point in the judicial process

When combining those who plead guilty with those found guilty at trial, the overall conviction rate in federal court exceeds 90%—and is often cited as being around 93% or higher in recent years

. This high rate is largely due to the prevalence of plea bargains, which account for the vast majority of convictions in the federal system

In summary, the percentage of people taken to federal court who are found guilty is typically above 90%, with most convictions resulting from guilty pleas rather than trials


Synopsis of Charges Against Dr. Neil K. Anand:  by www.perplexity.ai

Overview:
Dr. Neil K. Anand, a Pennsylvania-based pain management specialist, was convicted by a federal jury in April 2025 on multiple counts related to healthcare fraud and violations of the Controlled Substances Act (CSA).

Key Charges and Findings:

  • Healthcare Fraud and Wire Fraud:
    Dr. Anand was found guilty of conspiring to submit false and fraudulent claims totaling approximately $2.3 million to Medicare, the U.S. Office of Personnel Management (OPM), Independence Blue Cross (IBC), and Anthem. The fraudulent activity centered around “goody bags”—pre-packaged sets of prescription medications dispensed by his in-house pharmacies. Patients were required to accept these unnecessary “goody bags” in order to receive prescriptions for regulated drugs23.

  • Distribution of Controlled Substances:
    Anand distributed over 20,000 tablets of oxycodone, a highly addictive opioid painkiller, to nine patients, often without a legitimate medical purpose and outside the usual course of professional practice. He also signed blank prescription letterheads and allowed unlicensed medical interns to write prescriptions for controlled substances23.

  • Money Laundering and Unlawful Monetary Transactions:
    After the investigation began, Anand attempted to conceal his fraudulent activities by transferring nearly $1.2 million into an account in his father’s name, purportedly for the benefit of his minor daughter2.

  • Conspiracy to Distribute Controlled Substances:
    The evidence showed Anand conspired with others to distribute controlled substances without a legitimate medical purpose, using the goody bag scheme as a cover for the unlawful distribution of opioids23.

Potential Penalty:
Dr. Anand faces a maximum statutory penalty of up to 130 years in prison. Sentencing is scheduled to begin on August 19, 2025, with the final sentence to be determined by a federal district court judge in accordance with U.S. Sentencing Guidelines and other statutory provisions2.

Summary Table of Charges

Charge Description
Healthcare Fraud & Wire Fraud False claims to Medicare, OPM, IBC, Anthem via unnecessary “goody bags”
Distribution of Controlled Substances Unlawful prescription and distribution of over 20,000 oxycodone tablets
Money Laundering & Unlawful Transactions Concealing proceeds by transferring $1.2 million to a family account
Conspiracy to Distribute Controlled Drugs Collaborating with others to distribute opioids without legitimate medical purpose

Dr. Anand’s conviction highlights ongoing federal efforts to combat opioid-related healthcare fraud and the improper distribution of controlled substances by medical professionals23.

Citations:

  1. https://youarewithinthenorms.com/2025/04/01/king-of-eotf/
  2. https://www.indiatoday.in/world/us-news/story/indian-origin-doctor-neil-anand-convicted-medical-fraud-us-goody-bags-scam-drugs-fraud-2710445-2025-04-17
  3. https://indianexpress.com/article/world/indian-origin-doctor-us-convicted-health-care-fraud-9949396/
  4. https://law.justia.com/cases/federal/appellate-courts/ca3/21-2679/21-2679-2022-06-29.html
  5. https://www.justice.gov/opa/pr/physician-convicted-trial-illegal-distribution-opioids-and-healthcare-fraud-conspiracies
  6. https://www.courtlistener.com/docket/16243689/united-states-v-anand/
  7. https://nagalandpost.com/index.php/2025/04/17/indian-descent-doctor-neil-anand-convicted-in-2-3-million-drug-and-healthcare-fraud-scheme/
  8. https://law.justia.com/cases/pennsylvania/commonwealth-court/2024/318-m-d-2023.html
  9. https://www.courtlistener.com/docket/16243689/united-states-v-anand/?page=3

Answer from Perplexity: pplx.ai/share


While according to asking three different AI programs what was in the “goody bag,” the only one that mentioned was Oxycodone

One of the people that I know told me that a plastic bag with some writing on the outside like “EVIDENCE” contained one or more tubes of Diclofenac Topical (Voltaren)- which is an OTC medication.

God bless those men and women who give their lives for us

My lead flight attendant came to me and said, “We have an H.R. on this flight.” (H.R. stands for human remains.)
“Are they military?” I asked.
‘Yes’, she said.
‘Is there an escort?’ I asked.
‘Yes, I’ve already assigned him a seat’.
‘Would you please tell him to come to the Flight Deck. You can board him early,” I said…
A short while later a young army sergeant entered the flight deck. He was the image of the perfectly dressed soldier. He introduced himself and I asked him about his soldier.
The escorts of these fallen soldiers talk about them as if they are still alive and still with us. ‘My soldier is on his way back to Virginia ,’ he said. He proceeded to answer my questions, but offered no words.
I asked him if there was anything I could do for him and he said no. I told him that he had the toughest job in the military, and that I appreciated the work that he does for the families of our fallen soldiers. The first officer and I got up out of our seats to shake his hand. He left the Flight Deck to find his seat.
We completed our preflight checks, pushed back and performed an uneventful departure. About 30 minutes into our flight, I received a call from the lead flight attendant in the cabin.
‘I just found out the family of the soldier we are carrying, is also on board’, she said. She then proceeded to tell me that the father, mother, wife and 2-year old daughter were escorting their son, husband, and father home. The family was upset because they were unable to see the container that the soldier was in before we left.
We were on our way to a major hub at which the family was going to wait four hours for the connecting flight home to Virginia . The father of the soldier told the flight attendant that knowing his son was below him in the cargo compartment and being unable to see him was too much for him and the family to bear. He had asked the flight attendant if there was anything that could be done to allow them to see him upon our arrival. The family wanted to be outside by the cargo door to watch the soldier being taken off the airplane.
I could hear the desperation in the flight attendants voice when she asked me if there was anything I could do. ‘I’m on it’, I said. I told her that I would get back to her.
Airborne communication with my company normally occurs in the form of e-mail like messages. I decided to bypass this system and contact my flight dispatcher directly on a secondary radio. There is a radio operator in the operations control center who connects you to the telephone of the dispatcher. I was in direct contact with the dispatcher. I explained the situation I had on board with the family and what it was the family wanted. He said he understood and that he would get back to me.
Two hours went by and I had not heard from the dispatcher. We were going to get busy soon and I needed to know what to tell the family. I sent a text message asking for an update. I saved the return message from the dispatcher and the following is the text:
‘Captain, sorry it has taken so long to get back to you. There is policy on this now, and I had to check on a few things. Upon your arrival a dedicated escort team will meet the aircraft. The team will escort the family to the ramp and plane side. A van will be used to load the remains with a secondary van for the family.
The family will be taken to their departure area and escorted into the terminal, where the remains can be seen on the ramp. It is a private area for the family only. When the connecting aircraft arrives, the family will be escorted onto the ramp and plane side to watch the remains being loaded for the final leg home.
Captain, most of us here in flight control are veterans. Please pass our condolences on to the family. Thanks.
I sent a message back, telling flight control thanks for a good job. I printed out the message and gave it to the lead flight attendant to pass on to the father. The lead flight attendant was very thankful and told me, ‘You have no idea how much this will mean to them.’
Things started getting busy for the descent, approach and landing. After landing, we cleared the runway and taxied to the ramp area. The ramp is huge with 15 gates on either side of the alleyway. It is always a busy area with aircraft maneuvering every which way to enter and exit. When we entered the ramp and checked in with the ramp controller, we were told that all traffic was being held for us.
‘There is a team in place to meet the aircraft’, we were told. It looked like it was all coming together, then I realized that once we turned the seat belt sign off, everyone would stand up at once and delay the family from getting off the airplane. As we approached our gate, I asked the copilot to tell the ramp controller, we were going to stop short of the gate to make an announcement to the passengers. He did that and the ramp controller said, ‘Take your time.’
I stopped the aircraft and set the parking brake. I pushed the public address button and said: ‘Ladies and gentleman, this is your Captain speaking: I have stopped short of our gate to make a special announcement. We have a passenger on board who deserves our honor and respect. His Name is Private XXXXXX, a soldier who recently lost his life. Private XXXXXX is under your feet in the cargo hold. Escorting him today is Army Sergeant XXXXXXX. Also, on board are his father, mother, wife, and daughter. Your entire flight crew is asking for all passengers to remain in their seats to allow the family to exit the aircraft first. Thank you.’
We continued the turn to the gate, came to a stop and started our shutdown procedures. A couple of minutes later I opened the cockpit door. I found the two forward flight attendants crying, something you just do not see. I was told that after we came to a stop, every passenger on the aircraft stayed in their seats, waiting for the family to exit the aircraft.
When the family got up and gathered their things, a passenger slowly started to clap his hands. Moments later, more passengers joined in and soon the entire aircraft was clapping. Words of ‘God Bless You’, I’m sorry, thank you, be proud, and other kind words were uttered to the family as they made their way down the aisle and out of the airplane. They were escorted down to the ramp to finally be with their loved one.
Many of the passengers disembarking thanked me for the announcement I had made. They were just words, I told them, I could say them over and over again, but nothing I say will bring back that brave soldier.
I respectfully ask that all of you reflect on this event and the sacrifices that millions of our men and women have made to ensure our freedom and safety in these United States of AMERICA.
Foot note:
I know everyone who reads this will have tears in their eyes, including me. Prayer chain for our Military… PLEASE SHARE THIS! Please send this on after a short prayer for our service men and women.
They die for me and mine and you and yours and deserve our honor and respect.