Some of the most dangerous people in our society are people with a law degree who get elected to a powerful position, become a judge or prosecutor, or are given a badge, gun, and laws to enforce and sometimes is allowed to make their own interpretations of those laws.

The current Texas AG, apparently decided to use his personal opinion and ability to impose his will on a pregnant female who had been told by her OB/GYN that the fetus she was carrying was unviable and would complicate her pregnancy and threaten her health and future fertility. I have read in other articles about this that the Texas abortion law has provisions to allow abortions under such circumstances. However, it was reported that the TX AG stated that this woman and her fetus either did not check all the “boxes” or “enough boxes” for her to be entitled to any abortion under TX law. Anyone who wishes to “get into the weeds/details” of this case. Here is a link https://www.theguardian.com/world/2023/dec/12/kate-cox-texas-abortion-case-explained

I just wonder what the cost was for this couple to go to court and the tax dollars that the TX AG spent to justify him exercising his ideology on this case.

Politicians Must Stop Playing Doctor

https://www.medpagetoday.com/opinion/second-opinions/108291

Personal ideology should not guide medical care, even for abortion

Lately, I’ve found myself using the words “irrational” and “U.S. Court of Appeals for the Fifth Circuit” in the same sentence with increasing frequency. To that mix, I add, “dangerous.”

The latest misadventures from the Fifth Circuit include a ruling in favor of Attorney General Ken Paxton and anti-abortion groups that Texas hospitals receiving Medicare cannot be required to perform life-saving abortions to stabilize patients, despite federal guidance.

This grim beginning to 2024 in Texas comes on the heels of the Kate Cox case, one that I believe Paxton pursued without empathy or reason.

The same day that a lower court granted Cox the right to abortion for an unviable and complicated pregnancy that threatened her health and future fertility, Paxton fought the decision and intimidated physicians and hospitals with a threat that the ruling would not shield them from criminal charges for violating Texas’ abortion laws, should they be involved in Cox’s care. He was successful

In his argument, Paxton belittled the original ruling: “Judge Guerra Gamble is not medically qualified to make this determination,” ignoring his own lack of medical qualifications.

I see a couple of concerning themes here. The first is that the state of Texas has determined itself to be more qualified than trained physicians to practice medicine. Had Paxton been genuinely concerned with medical expertise, he would have respected the professional opinions of Cox’s physicians and would not need to threaten them with litigation.

The second is that Texas politicians’ “practice” of medicine is decidedly antithetical to the practice of medicine that I was taught. Our Hippocratic Oath is succinctly distilled into the phrase: “First, do no harm.” I do not see Paxton abiding by that credo either in his challenge to the federal guidelines on EMTALA and emergency abortions or in his efforts against Cox. Neither bullying patients by weaponizing the legal system against them nor prioritizing personal ideology over scientific evidence is considered good medical care. Furthermore, denying an emergency abortion to a medically unstable patient who needs one is the exact opposite of preserving life, especially when the fetus carries a deadly condition.

Ideology has governed the state of Texas’s “practice” of public health, as well as its “practice” of medicine. In November, the Supreme Court reviewed U.S. v. Rahimi the decision issued by the Fifth Circuit upending decades of federal law that had previously disarmed people subject to restraining orders for domestic violence.

The original Rahimi Fifth Circuit ruling ignores the facts: access to firearms is a highly significant predictor for intimate partner homicide, increasing the risk by 1,000% Furthermore, the children of abusive relationships are not exempt from abuse, and firearms are the leading cause of death among children in this country. The Fifth Circuit ruling disregards public health expertise and consequently endangers women and children.

The Fifth Circuit’s practice of medicine continues with further frivolous barriers to care. SCOTUS has agreed to review a decision by the court limiting access to mifepristone (Mifeprex) and imposing wholly unnecessary burdens and confusion 

for patients who need this medication. These restrictions do nothing to improve patient outcomes or experience with mifepristone.

As physicians, we can follow neither our ethics nor the appropriate standard of care if politicians flagrantly disrespect our training. If they can undermine our careful decision-making so easily, what is the point of our expertise?

The medical students I train are already considering the politicization of healthcare in their future career plans. Despite ob/gyn becoming more competitive, many medical students are reluctant to consider residency in states with rigid restrictions. “I would like to train at an institution that teaches family planning. And I don’t think I’ll apply to [ob/gyn residency] programs in states where there are restrictions or bans on abortion,” said one of my third-years, who is already a valuable asset to our medical team.

If you drive away physicians with the threat of criminal charges when they don’t practice according to your personal beliefs, they will not come to your state.

Another casualty of ideological extremism? Women’s access to comprehensive reproductive healthcare.

Anti-abortion advocates will inevitably challenge me on this, but the anti-abortion “murder” argument is an egregious misrepresentation and oversimplification of healthcare decisions in which abortion is determined to be the best option for the patient. This position suggests that hordes of callous and irresponsible women will casually line up to dispose of infant children, given the opportunity. That is not happening. Nor is Texas’s misrepresentation of federal guidance on emergency abortions and EMTALA happening: that the guidelines strive to turn emergency departments into abortion clinics.

What is happening is that a group of politicians are dictating medical care without medical training, and endangering women’s lives. These decisions are tantamount to enforcing decidedly inferior medical care that disproportionately harms women, prioritizing personal belief over evidence-based medicine, and in my view, effectively codifying misogyny into standard of care. This most recent decision by the Fifth Circuit, which allows the denial of an emergency abortion to a critically ill and unstable pregnant patient, highlights the chilling truth that the life of the mother is not, in fact, a priority in the eyes of the law.

For a group that professes to value life, the politicians and courts of Texas are certainly demonstrating otherwise, with unyielding dedication to preserving a black-and-white ideology and enforcing it without nuance or compassion, without firm grounding in scientific evidence, and even at the expense of women’s lives.

I would lose my job very quickly if I practiced medicine this way.

If politicians wish to play doctor, we should hold them to the same standard. The situation has become dire for too many innocent people.

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Over the 12+ yrs I have been working on my blog, I can’t count the total number of times that those in the chronic pain community have been told to contact their representatives in the Senate and House. Rep Goldman was way out of line demeaning this Angel Mom. It has also been reported that Mayorkas – who was the subject of this impeachment, was a no-show to the hearing.  Mayorkas is our Secretary of Homeland Security and who has repeatedly testified before Congress that our southern border is secure. Since the start of the Federal Fiscal Year 10/01/2021, we have documented abt EIGHT MILLION illegal immigrants coming into our country https://www.cbp.gov/newsroom/stats/nationwide-encounters

Dem Tells Mother Of Fentanyl Victim She Lacks Ability Speak On Mayorkas Impeachment

https://americanliberty.news/defense-news/dem-tells-mother-of-fentanyl-victim-she-lacks-ability-speak-on-mayorkas-impeachment/phouck/2024/01/

Rep. Dan Goldman (D-N.Y.) told a mother who lost her daughter to the fentanyl crisis that she lacked the background to speak at an impeachment hearing for Department of Homeland Security (DHS) Secretary Alejandro Mayorkas.

And that Republicans were using her.

From Fox News:

Goldman’s remarks to Josephine Dunn, whose 26-year-old daughter Ashley lost her life to fentanyl-laced pills, came during the committee’s hearing titled “Voices for the Victims: The Heartbreaking Reality of the Mayorkas Border Crisis.”

Dunn had been invited by Republicans to take part in the hearing and share the story of how she lost her daughter to fentanyl as Congress continues on with the impeachment proceedings against Department of Homeland Security Secretary Alejandro Mayorkas.

Expressing his “sincere condolences” to Dunn for the loss of her daughter, Goldman said that he wanted to “apologize in some ways” to Dunn because she was “being used as a fact witness for an impeachment investigation.”

“Obviously, given what your experience has been, you don’t have the background to understand what a high crime and misdemeanor is and how it relates to this,” he added in his remarks to Dunn.

Goldman’s attempt at diplomacy failed to impress Dunn. She told the Daily Caller that the Manhattan Democrat is “unaware about what my understanding, about what my education, what my experience is in any of those areas when it comes to misdemeanors or high crimes.”

“I have my opinions, and for him to assume that I want to just put more money into a system that has had plenty of money placed into it and is still broken is incorrect. Please don’t think for me. I have a brain, I can think and speak for myself,” she remarked.

As Goldman kept questioning Dunn, the pair became visibly frustrated.

“You would agree, would you not, that it would help to stop the fentanyl trade and fentanyl trafficking from coming into this country if we had more law enforcement officers at the border and more resources and technology to stop the fentanyl from coming in?” he pointedly asked Dunn. “Do you agree with that?”

Dunn snapped at the congressman, retorting “Border Patrol is now being used to make sandwiches and to screen people and let them into our country. So I disagree with you.”

“I would like the Border Patrol to be able to do the job that they were hired to do,” she continued. “Every Border Patrol officer that I have spoken to has told me that their hands are tied by this administration and Mr. Mayorkas. I’ve been to the border, sir, have you?”

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This news report was from – according to YouTube, TWO YEARS AGO. I wonder how many prescribers have been “taken out” by our DEA & judicial system in that time frame this video and that judge’s ruling has been out there. I vaguely remember the trial, I believe that it was in CALF and the “expert witness” for the prosecutor, stated that 25% of pts who took an opioid would become addicted. The judge corrected the witness – on the stand – that the percentage was only 5%. Depending on which study you wish to believe, the real rate is between 0.6% – 2%. In the end, our DEA/DOJ has been using the war on drugs to deny 98+% of pts that have a medical necessity for a controlled med, to ATTEMPT <2% of our population from becoming addicted.

The DEA started escalating the war on drugs after the Decade of Pain Law expired in 2010, when the CDC was reporting about 12,000 OD deaths from ALL DRUG OVERDOSES. I expect the OD/poisoning numbers to be > 100,000 for 2023. The vast majority are from illegal drugs from China and Mex cartels. Could that be considered an ABSOLUTE FAILURE by the DEA/DOJ?

That trial against J&J, was because J&J was the WHOLESALER to the entire pharma industry of RAW OPIOID PRODUCTS. They produced no patient-ready finished opioid product, nor marketed a finished opioid product to prescribers.

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42 USC 1395: Prohibition against any Federal interference

https://uscode.house.gov/view.xhtml?req=(title:42%20section:1395%20edition:prelim)

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I find it interesting the statements made by attorneys that CVS hires to defend lawsuits or actions against the chain. This case is just another example:  Kristina Dahmann, an attorney for CVS, she pointed out that the state requires no minimum level of staffing at pharmacies, and that weeks-long backups filling prescriptions don’t necessarily mean that patients are waiting that long for their medicine. “Numbers alone don’t tell the story,” she said.

She obviously did not make any claims about pts going without their medications, because of the number of days of unfilled Rxs in the queue where up to an average number of Rxs a store would fill.  I was at an FL BOP meeting in mid-June 2015, where they were discussing a new regulation that would mandate that pharmacists NOT start looking for a reason not to fill a controlled med, when handed a new Rx. Part of the new regulation was to mandate each FL-licensed pharmacist would have to have 2 continued education hrs every 2 hrs. At the end of the meeting, the BOP’s attorney was caught on a “hot mike” moment saying, “We are going to teach Pharmacists COMMON SENSE.”  Personally, I never figured that common sense was something that could be taught. Maybe pts who are patronizing CVS to have Rxs filled might want to consider their options. Here is a hyperlink https://ncpa.org/pharmacy-locator  to find an independent pharmacy, where pts will be dealing with the Pharmacist/Owner, who generally focuses on the pt’s health, rather than how many $$ they can get out of the pt,

Ohio Attorney General asks that CVS store be put on probation “for a period of years”

Understaffing found at Canton pharmacy appears to be widespread

https://ohiocapitaljournal.com/2024/01/16/ohio-attorney-general-asks-that-cvs-store-be-put-on-probation-for-a-period-of-years/

A deputy attorney general working for the Ohio Board of Pharmacy on Thursday recommended that the board fine CVS and place a store it operates in Canton on probation for “a period of years” after inspectors in 2021 found risks to patient safety due to understaffing.

Attorneys for CVS blamed the problems on the coronavirus pandemic. But the board of pharmacy inspectors found similar problems at a dozen other CVS stores in Ohio — some occurring as recently as last year. 

Problems have also been reported at CVS stores in other states. They raise questions about whether they’re due, as CVS contends, to a shrinking labor pool and increasing demands, or whether they’re the product of relentless cost cutting and consolidation by the company.

When Board of Pharmacy inspectors visited Canton store No. 2063 on Sept. 13, 2021, they found a pharmacy so understaffed that the inside counter was closed, the phone wasn’t working and the line of cars to the dive-through snaked around the side of the building. Stock — including controlled substances — hadn’t been shelved. The staff was so harried that it took inspectors 20 minutes to get somebody’s attention, according to the report, which CVS hasn’t disputed.

Inspectors found that it took almost two weeks for the overwhelmed pharmacy to fill many prescriptions. And on a follow-up call a month later, they were told the backlog for some was a full month.

During that period, the pharmacy also filled a prescription with the wrong medication. The patient was supposed to receive a statin to control cholesterol, but instead got the hypnotic sleep drug commonly known as ambien. Fortunately, the mistake was detected before that person took the medication and went for a drive.

Thursday’s hearing was a continuation of one that began in November, and the pharmacy board isn’t expected to make its decision until next month, when it will also take up allegations against another Ohio CVS store. But the penalties it can impose range from a small fine to revocation of the store’s license — and that decision could indicate how hard a line it will take in subsequent proceedings.

The hearings come after the pharmacy board in July released citations against eight CVS pharmacies in response to a records request from the Capital Journal. The board subsequently released citations against five others. They detailed problems similar to some of those alleged at the Canton store — and some revealed losses of controlled substances such as opioids.

On Thursday, lawyers for CVS put on testimony from Dennis McAllister, an expert witness who has worked as a pharmacist in many roles and who served for decades on the Arizona State Board of Pharmacy. 

He said that after viewing some of the earlier hearings and reviewing the inspection reports, he believed the problems suffered at the CVS store in Canton were severe, but they were emblematic of what was happening in the industry nationwide. 

The number of pharmacists and pharmacy technicians had been going down for a decade. Then COVID hit, making workers reluctant to work on the frontlines just as the workload spiked with pharmacies giving covid tests and administering vaccines, McAllister said.

“The industry in general wasn’t able to do stuff in time,” he said.

McAllister praised the hard work of the employees at the Canton store and credited it with quickly fixing problems inspectors found there. But CVS might have something to do with the diminishing pay and more-harried working conditions that have beset the industry, likely leading to the diminishing number of students entering pharmacy school. 

The chain increased the number of pharmacies it owns from 5,474 in 2005 to 9,939 in 2021, according to the German data-gathering firm Statista. Much of that has been from aggressive acquisition of competing pharmacies, closing them and moving their prescriptions to an existing CVS store.

In Thursday’s hearing, board member Tod J. Grimm pointed out that the Canton CVS absorbed the prescriptions of two other pharmacies, but only increased pharmacists’ hours there by two per week.

And at least after the worst of the pandemic, CVS employees said that understaffing CVS stores wasn’t due to a labor shortage, it was a choice.

“Understaffing is pretty deliberate from our upper and middle management,” Iggy Aleksick, a pharmacy technician at a CVS in Bowling Green told the Capital Journal in August, explaining that management wouldn’t OK additional hours even though workers were available.

And while McAllister made much of the burden created at the Canton store by giving covid and flu vaccines, CVS employees said the company relentlessly pushes the services because they’re a source of revenue. Simon Souhrada, a technician at the CVS in Mount Vernon until last June, said it was frustrating to be ordered to make phone calls as the prescription backlog there grew.

“It was all calling people, trying to sell them on vaccines and we would get daily emails demanding that we go faster and faster on these things while the queue (of unfilled prescriptions) was piling up and there was no one to fill it,” he said. “She just focused on all the wrong things and didn’t do anything to help.”

Kristina Dahmann, an attorney for CVS, has relentlessly tried to keep the focus in the hearing on the fact that the problems at the Canton store arose at the height of the pandemic.

In her closing statement, she pointed out that the state requires no minimum level of staffing at pharmacies, and that weeks-long backups filling prescriptions don’t necessarily mean that patients are waiting that long for their medicine.

“Numbers alone don’t tell the story,” she said.

But in their questioning of McAllister, the expert witness, members of the pharmacy board seemed skeptical of claims that the problems inspectors found at the Canton CVS were typical of pharmacies everywhere. All but one are pharmacists themselves, and independent pharmacists have said that while the pandemic was challenging, it didn’t lead to anything like the delays or chaos that the Board of Pharmacy found at numerous CVS stores.

It’s also unclear whether, as they assess the evidence of what happened at the Canton CVS in late 2021, the board will view it in isolation. While Dahmann insisted that problems there were due to the exigencies of the pandemic, board inspectors continue to allege dangerous conditions due to understaffing at Ohio CVS stores. 

In November, inspectors cited three stores for violations in 2023, including six-day backlogs filling prescriptions, dirty conditions and losses of hundreds of doses of the painkiller tramadol.

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CHIEF JUSTICE JOHN ROBERTS

AUSA WAYNE PRATT

DRUG ENFORCEMENT AGENCY (DEA) ARMED WITH BADGES, GUNS, AND PROFOUND STUPIDITY NEEDS CONGRESSIONAL REFORM OR BE DISBANDED (updated Repub, Part-1) :ETIOLOGY OF PAIN CARE TULSAFICATION

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The typical toxicology of a person who OD’d contained 4-7 different substances, one typically being the drug ALCOHOL. When was the last time an opioid was prescribed/filled by a particular person? And did that opioid show up in the OD’s toxicology? According to Wikipedia, there are over 1000 fentanyl analogs and it has been reported that China & Mex cartels are selling Fentanyl acetate on the street, not the Fentanyl citrate that is the FDA-approved analog. Using the descriptive OPIOID is a very broad brush to describe an OD or poisoning while obscuring the details of the OD/poisoning. In reading this article, I get the sense of a lot of “smoke & mirrors” or watching a magician make something appear or disappear. It is like we often see where a “study” is so designed to validate a preconceived conclusion.

Overdose Death Notices Plus Guidance Sink Opioid Prescribing

Doctors who were told about deaths and given planning prompts wrote fewer opioid scripts

https://www.medpagetoday.com/psychiatry/opioids/108282

Physicians who received a letter from a medical examiner about a patient’s fatal overdose — along with suggested guidance for future visits for pain — prescribed fewer opioids, according to a cluster randomized controlled trial.

Doctors who received the death notice plus guidance had a drop in weekly morphine milligram equivalents (MMEs) pre- to post-intervention (157.81 to 77.05), according to Jason Doctor, PhD, of the University of Southern California in Los Angeles, and colleagues.

While physicians who only got a death notice also saw a decline in weekly MMEs (157.70 to 103.16), those with the death notice plus guidance letter had a 12.85% greater decline in opioid prescribing (P<0.001), Doctor and colleagues reported in Nature Communicationsopens in a new tab or window.

“Providing physicians a simple plan that will guide them at a patient visit appears to help temper their use of these drugs,” Doctor said in a press release. “This represents a promising approach to reducing fatal drug overdoses, one that is both affordable and scalable.”

Doctor and colleagues noted that previous workopens in a new tab or window showed that notifying physicians by mail when a patient died of an opioid overdose helped diminish opioid prescribing. But they wanted to know whether adding “planning prompts” — concrete actions that can be triggered by a specific set of circumstances — could reduce this prescribing even further.

“For example, a physician might better use the information in the letter, if the letter guidance urges them to implement steps at the visit, such as discussing alternative pain management strategies or consulting with a pain management or addiction specialist for evaluation and care,” the researchers wrote.

To conduct the trial, Doctor and colleagues randomized 541 clinicians in Los Angeles County to receive either a standard letter about the patient’s death (n=284) or the letter with guidance (n=257).

Participants were included because they prescribed schedule II-IV drugs within the prior year to a patient who died of an overdose where opioids were a primary or contributing cause. Overall, 316 deaths from late October 2018 to late May 2020 were included.

Both physician groups received a letter signed by the examiner-coroner informing them of their patient’s opioid-related overdose death and information about judicious prescription practices. The intervention group additionally received an “if/when-then” plan that explained alternative ways to handle patients who needed pain treatment. The letters were sent monthly between April 4, 2019, and July 8, 2020.

In addition to greater declines in opioid prescribing, doctors who received the additional “if/when-then” plan also had greater declines in benzodiazepine prescribing, with an 8.32% reduction in weekly diazepam milligram equivalents (P<0.001).

The study was limited because it may not be generalizable outside of Los Angeles County, the largest county in the U.S., and by its small sample size. It examined a short-term effect and did not follow up to determine any effects on patient outcomes.

Also, the intervention reached only prescribers with a death in their practice, though the researchers emphasized those clinicians were likely most in need of the intervention.

They called for further research “to confirm the results, examine the long-term effects of the intervention, and explore its potential effects on patient outcomes.”

Doctor added that the study “is part of an evolution toward better understanding how to enact behavior change among physicians whose patients have suffered negative consequences from care by the medical community.”

The typical toxicology of a person who OD’d contained 4-7 different substances, one typically being the drug ALCOHOL. When was the last time a opioid prescribed/filled by the particular person? And did that opioid show up in the OD’s toxicology. According to wikipedia there is over 1000 fentanyl analogs and it has been reported that China & Mex cartels are selling Fentanyl acetate on the street, not the Fentanyl citrate that is the FDA approved analog. Using the descriptive OPIOID is a very broad brush to describe a OD or poisoning while obscuring the details of the OD/poisoning. In reading this article, I get the sense of a lot of “smoke & mirrors” or watching a magician make something appear or disappear. It is like we often see where a “study” is so designed to validate a preconceived conclusion.

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DEA DIRECTOR ANNE MILGRAM: The concept of “pre-crime,” once relegated to science fiction, has taken on a chilling reality in contemporary law enforcement practices. In a thought-provoking article titled “Pre-Crime” and the Danger of “Risk Assessments” authored by Paul J. Hetznecker, the issue of “pre-crime” and the utilization of “risk assessments” by law enforcement is brought to the forefront.

HOW THE DEA FABRICATED THEIR OPIOID PANDEMIC AND WAR ON PILL MILL SCAM: WHY DIRECTOR ANN MILGRAM MUST STEP DOWN

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