Employee shot and killed at Walgreens in Madera identified

MADERA, Calif. (KFSN) — The employee who was shot and killed at a Walgreens in Madera on Monday has been identified as Erick Velasquez.

Police say the shooting happened at the location on Cleveland and Schnoor just after 9:30 pm.

EDITOR’S NOTE: The video above is from a previous broadcast and will be updated.

When police arrived, they found Velasquez inside the store, where he was pronounced dead.

Police say the suspect, Narciso Gallardo Fernandez, went to Madera from Pixley and went inside the store with a handgun.

After the shooting, police say Fernandez fired at other employees as they were leaving the store. No one else was hit.

He was taken into custody in the parking lot.

Customers were also inside the store at the time of the shooting.

Police do not believe that Velasquez and Fernandez knew each other.

Walgreens released a statement on the incident, saying, “We are deeply saddened by last night’s tragic event, which resulted in the death of one of our team members. Our thoughts and prayers are with their loved ones during this difficult time. The safety of our customers and team members is our top priority, and we are working with local authorities in their investigation.”

Anyone with more information is asked to contact police.

When are disabled people going to get a DAY OF VISIBILITY? Where is the equity?

Today is

Transgender Day of Visibility: Honoring Trans Heroes and Sharing Stories of Resilience

https://www.hrc.org/press-releases/transgender-day-of-visibility-honoring-trans-heroes-and-sharing-stories-of-resilience

According to this:

Approximately 1.6 million people in the United States identify as transgender, representing around 0.6% of the population aged 13 and older. This includes about 1.3 million adults (0.5% of the adult population) and 300,000 adolescents aged 13 to 17 (1.4% of that age group)136.

While estimates vary slightly depending on the methodology and data source, this figure is consistent across multiple studies and surveys, including those conducted by the Williams Institute and other research organizations159.

Citations:

  1. https://www.newsweek.com/how-many-transgender-people-athletes-living-united-states-2030241
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC5227946/
  3. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Trans-Pop-Update-Jun-2022.pdf
  4. https://apnews.com/article/how-many-transgender-intersex-laws-0218b75a197f07d8c51620bb73495d55
  5. https://www.nbcmiami.com/news/local/politifact-how-many-trans-people-are-there-in-the-u-s-and-why-do-we-overestimate-it/3074621/
  6. https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/
  7. https://usafacts.org/articles/what-percentage-of-the-us-population-is-transgender/
  8. https://www.pewresearch.org/short-reads/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/
  9. https://www.reuters.com/world/us/new-study-estimates-16-million-us-identify-transgender-2022-06-10/

Answer from Perplexity: pplx.ai/share

According to www.perplexity.ai:

The number of people in the United States considered disabled varies depending on the criteria and data source:

  1. Adults with Disabilities: Over 70 million adults in the U.S., or more than 1 in 4 (28.7%), reported having a disability in 2022, according to the CDC’s Behavioral Risk Factor Surveillance System17.

  2. All Ages (Non-Institutionalized Population): Approximately 42.5 million Americans, or 13% of the civilian noninstitutionalized population, had a disability in 2021, based on U.S. Census Bureau data310.

  3. Survey of Income and Program Participation (SIPP): This survey estimates that around 54 million Americans have a disability, though it uses broader definitions and methodologies4.

  4. Working-Age Population (18–64): About 22 million working-age Americans (11% of this demographic) reported having a disability in 2022, according to the American Community Survey5.

These figures highlight differences in how disabilities are defined and measured across various surveys and contexts.

Citations:

  1. https://www.cdc.gov/media/releases/2024/s0716-Adult-disability.html
  2. https://www.ssa.gov/policy/docs/statcomps/di_asr/2021/sect01.html
  3. https://www.pewresearch.org/short-reads/2023/07/24/8-facts-about-americans-with-disabilities/
  4. https://adata.org/faq/how-many-people-united-states-have-disability
  5. https://askearn.org/page/statistics-on-disability
  6. https://www.researchondisability.org/sites/default/files/media/2024-03/2024-annual-report-a11y-1.pdf
  7. https://www.cdc.gov/disability-and-health/articles-documents/disability-impacts-all-of-us-infographic.html
  8. https://www.census.gov/newsroom/facts-for-features/2024/disabilities-act.html
  9. https://miusa.globaldisabilityrightsnow.org/infographic/disability-usa/
  10. https://www.census.gov/library/stories/2023/06/disability-rates-higher-in-rural-areas-than-urban-areas.html

Answer from Perplexity: pplx.ai/share

Did you know that the primary FDA medication that is used by females who wish to transition to being a male? TESTOSTERONE – A C-3 CONTROLLED SUBSTANCE. The DEA – to date – has not imposed any pharma production limitations. Apparently, the only reason that it is classified as a C-3 is to try to prevent/limit athletes and bodybuilders from using it. 

There is nothing that ever suggested that politicians and bureaucrats function with logic and common sense.

Have you ever been ASKED?

Have you ever been asked by your practitioners and/or a staff member?

Have you ever considered harming yourself?

In all the years that I have been doing my blog, I now notice that the number of ESTIMATED suicide and attempted suicides published by the CDC has remained unchanged. 2012 when I started my blog, and today the USA population abt 9%. Mental health issues tend to be a rather fixed percentage of a population.

It is also interesting that around 2010-2012 is when the Rx opioids peaked, and today, the number of Rx opioids has been reduced abt 50%.

We know that many chronic pain patients have committed suicide because their pain meds have been involuntarily reduced, and an untold number of PREMATURE DEATHS from various reasons caused by under/untreated pain. While those numbers may or may not be documented, I have not seen a number being published.

Does this STRONGLY SUGGEST that there is a COVERT GENOCIDE going on?

Maybe chronic pain pts should take a copy of the graphic below with them to their doctor’s appointment?

When ASKED THE QUESTION… Suicide ideation can be caused by increased anxiety and depression, which can be caused by chronic pain pt’s pain management being forcibly reduced.

Should the chronic pain pt’s answer to THE QUESTION BE?

It may all depend on how much my pain management is reduced! Point to the bottom line on the chart! Might say something about the fact that aren’t doctors/practitioners supposed to be HEALERS?  As my pain management is reduced, I can expect the average intensity of my pain to increase, and my QOL is going to be compromised. I don’t look forward to being under “house arrest” because my pain will confine me to my house, chair, or bed. The CP pt might also express their concerns about all the other comorbidity issues that may be made worse and/or cause the pt to experience NEW COMORBITIY ISSUES not top of all the comorbidity issues they are already dealing with.

Right now, I can answer the questions with a NO, but suicide is generally somewhat impulsive. As my QOL deteriorates in line with my pain management being reduced, I can’t say what tomorrow brings.

Read this and weep – AGs and National Opioid Agreement – nicely put CPs OUT IN THE COLD

If the opioid settlement agreements result in shortages of prescription opioids for patients with legitimate medical needs, those patients may face significant challenges in pursuing legal recourse against the participants in the agreement. Here are key considerations:

1. Legal Protections for Settlement Participants

  • The settlement agreements were designed to resolve litigation and include provisions that shield participating companies from future lawsuits related to their role in the opioid crisis. These protections likely extend to claims stemming from the terms of the settlement itself, such as restrictions on opioid distribution17.

  • The agreements include measures like enhanced monitoring of opioid distribution and stricter controls on suspicious orders to prevent diversion, which could indirectly contribute to shortages12.

2. Challenges for Patients Seeking Recourse

  • Causation: Patients would need to prove that the settlement terms directly caused their inability to access necessary opioids, rather than other factors like supply chain issues or prescribing practices.

  • Intent and Liability: The agreements aim to address public health concerns by reducing opioid misuse and diversion. Courts may view these measures as reasonable efforts to combat a public health crisis, making it difficult for patients to argue negligence or harm by the participants.

3. Potential Public Health Concerns

  • Shortages of prescription opioids could push some patients toward illicit alternatives, increasing risks of overdose and other harms3. This underscores the need for careful implementation of settlement terms to balance public health goals with legitimate patient needs.

4. Alternative Avenues for Patients

  • Patients facing shortages may be able to advocate through healthcare providers, pharmacists, or policymakers for adjustments in distribution practices or exceptions for certain cases.

  • Healthcare providers can explore alternative pain management strategies or appeal to regulatory agencies if shortages become widespread and harmful3.

In summary, while patients affected by shortages might face difficulties in holding settlement participants legally accountable, they can advocate for improved policies or seek alternative solutions within the healthcare system.

Citations:

  1. https://www.naag.org/issues/opioids/
  2. https://www.texasattorneygeneral.gov/globalopioidsettlement
  3. https://www.pharmacytimes.com/view/opioid-drug-shortages-affect-patients-health-systems
  4. https://www.naccho.org/uploads/downloadable-resources/OpioidSettlementsPDFFinal.pdf
  5. https://www.texasattorneygeneral.gov/news/releases/opioids-maker-teva-agrees-425-billion-settlement-preliminary-agreement-will-provide-cash-and
  6. https://www.ncbi.nlm.nih.gov/books/NBK458653/
  7. https://www.casscountymi.org/1574/Opioid-Settlement-Funds
  8. https://ncdoj.gov/attorney-general-josh-stein-announces-26-billion-agreement-with-opioid-distributors-manufacturer/
  9. https://www.congress.gov/bill/115th-congress/house-bill/6
  10. https://nationalopioidsettlement.com/executive-summary/
  11. https://www.justice.gov/archives/opa/pr/justice-department-issues-guidance-protections-people-opioid-use-disorder-under-americans
  12. https://journalofethics.ama-assn.org/article/how-should-physician-respond-patients-pain-when-new-opioid-prescribing-laws-limit-shared-decision/2019-10
  13. https://micounties.org/opioid-settlement-resource-center/
  14. https://www.jnj.com/media-center/press-releases/johnson-johnson-statement-on-nationwide-opioid-settlement-agreement-
  15. https://www.michigan.gov/opioids/nel/laws
  16. https://nationalopioidsettlement.com
  17. https://ag.ny.gov/press-release/2022/attorney-general-james-secures-585-million-top-opioid-manufacturer-mallinckrodt
  18. https://www.ashp.org/drug-shortages/shortage-resources/injectable-opioid-shortages-faq
  19. https://www.in.gov/attorneygeneral/about-the-office/complex-litigation/opioid-settlement/
  20. https://oag.ca.gov/fentanyl/opioidslitigation

Answer from Perplexity: pplx.ai/share

US Government Sues Pharmacy Chains CVS and Walgreens for Their Alleged Role in the Opioid Epidemic AGAIN

I find it interesting that in this article this statement As for Walgreens, recent litigation revealed that the pharmacy used an “honor system” rather than conducting regular audits of pharmacists’ prescribing patterns

Pharmacists do not have prescriptive authority and has neither the training nor facilities to do an in-person exam, but make some sort of  the appropriateness of the prescription for the pt.

And it seems that they are working with some on data that was over a decade old. It is claimed that the USA gets 17 million new chronic painers every year. Is the trouble with proper treatment of chronic pain pts going to get worse or is the “powers to be” trying to use covert genocide to reduce the number of existing chronic painers we now have?

US Government Sues Pharmacy Chains CVS and Walgreens for Their Alleged Role in the Opioid Epidemic

https://www.doximity.com/collections/43b4c0fa-83e6-4c62-989d-f157d619bc81

In the span of 30 days, the US Department of Justice (DOJ) sued both CVS and Walgreens, along with dozens of their state subsidiaries. The country’s largest pharmacy chains—which collectively operate more than 17 000 storefronts—aided and abetted the opioid epidemic, the federal lawsuits—filed last December and this January, respectively—allege.

The civil lawsuits by the DOJ rest on the allegation that the pharmacy chains violated both the Controlled Substances Act (CSA) and the False Claims Act (FCA).

The CSA states that narcotics can only be used for “a useful and legitimate medical purpose.” By filling prescriptions that were invalid, the pharmacies “made choices that caused these millions of violations of federal law,” the DOJ alleged in the Walgreens lawsuit. The FCA, for its part, states that entities cannot knowingly present a “false or fraudulent claim” for government payment—either due to “deliberate ignorance” or “reckless disregard” of the claim’s falsehood. The DOJ alleged that by requesting reimbursement from Medicare and Medicaid for illegitimate prescriptions, the pharmacies broke the law. They unlawfully dispensed “massive quantities of opioids and other controlled substances to fuel its own profits at the expense of public health and safety,” the lawsuit against CVS stated.

To substantiate its claims, the government unsealed more than 800 pages associated with the civil complaints that included thousands of “false or fraudulent” prescriptions filed by the pharmacy giants between 2012 and 2024, including hundreds written by clinicians known to operate so-called “pill mills.”

In doing so, the pharmacies not only defrauded taxpayers under the FCA but also helped exacerbate the country’s ongoing fatal overdose crisis by routinely dispensing “extremely high doses and excessive quantities of potent opioids that fed dependence and addiction,” the DOJ alleged in its CVS complaint.

Pharmacists’ Evolving Role in Pain Management

The assertion that pharmacies played a role in stoking the opioid epidemic is not new, according to Dorie Apollonio, PhD, MPP, a professor in the Department of Clinical Pharmacy at the University of California, San Francisco (UCSF).

Pharmacists have an independent legal responsibility under federal law to properly fill prescriptions for controlled substances, but rather than being seen as the critical “backstop of appropriateness of the prescription,” Apollonio said, people tend to think of pharmacists as being limited to “‘lick, stick, count, and pour.’” From the beginning, opioid manufacturers “were not ignorant of the role of pharmacists” in selling their products, she added, and “made a lot of effort to try to convince pharmacists to fill prescriptions they might not have formerly believed that they should.”

The opioid manufacturing industry adopted tactics including offering pharmacists financial incentives and bonuses for filling more and more prescriptions, Apollonio said. But there were also more insidious strategies, like sponsoring continuing medical education sessions for Walgreens’ pharmacists that were led by drug company liaisons. This achieved the dual goal of helping the pharmacist understand the supposed need for high dosage levels and securing exclusive product promotion rights, including “‘guaranteed’ stocking of future products at specific key stores,” according to an email exchange between corporate leaders at Walgreens and opioid manufacturer Purdue Pharma, which was cited in the study about improper opioid dispensing practices that Apollonio coauthored. (Purdue has separately paid out billions of dollars in settlements for its role in stoking the opioid epidemic, as have individual members of the Sackler family, who owned a controlling interest in Purdue.)

Academic scholars, such as Marie Chisholm-Burns, PharmD, PhD, MPH, and her former team at University of Tennessee’s Health Science Center College of Pharmacy, have previously pointed to pharmacists’ complicity with the pharmaceutical industry’s “widespread, aggressive marketing campaign advocating long-term use of opioids…which minimized the risks of addiction and overexaggerated benefits.”

Most notably, experts reference the American Pain Society’s 1995 guidelines for acute pain treatment, which encouraged physicians and pharmacists to provide “attentive analgesic care” to patients. The guidelines would later prompt the society’s campaign to treat pain as the “fifth vital sign.” By late 2000, toolkits like one authored by the Veterans Health Administration specifically identified pharmacists as “critical to the development of a reliable and comprehensive understanding of the patient’s pain and associated problems.”

Looking to Past Settlements

The lawsuits against CVS and Walgreens are not the first for the pharmacy giants. In 2022, 2426 municipalities across all 50 states and 6 additional US territories reached a more than $4.2 billion settlement with CVS for its failure to properly monitor suspicious orders of opiates. Walgreens has made similar settlements, as has Walmart, which operates more than 5000 retail pharmacies.

In contrast to the federal lawsuits—which invoke federal legislation—the state complaints varied in accordance with differences in state legislation.

Many of the state lawsuits cited statutes aimed at preventing consumer fraud. For example, Rhode Island alleged that the pharmacies violated the state’s Deceptive Trade Practices Act by “deceiv[ing] and mislead[ing] prescribers into prescribing and consumers into seeking and taking medically unnecessary and…harmful quantities and strengths of opioids.” In Maryland, Walgreens violated the state’s Consumer Protection Act, for “falsely represent[ing] that the opioids it sold were safe and effective” and failing to undertake “adequate steps to ensure customer safety,” Attorney General Anthony Brown alleged.

Some complaints included additional charges, depending on the particular state law and applicability of additional legislation. For instance, the Rhode Island suit alleged that the pharmacies violated the state’s public nuisance law by “failing to provide effective controls and procedures to guard against diversion of opioids.” The Washington state suit also claimed that several pharmacies violated public nuisance law by contributing to the opiate crisis in a manner “unreasonable and harmful to the health of Washingtonians” that “interferes with the comfortable enjoyment of life.”

The settlements have had some positive impact, largely by obtaining funds for state efforts to address the opioid crisis. These public health initiatives include providing youth education about the risks of opioid abuse, purchasing and distributing naloxone for overdose prevention, and establishing residential detoxification centers, according to an opioid settlement spending tracker maintained by the National Academy for State Health Policy.

The settlement money has also contributed to building out infrastructure for public health surveillance related to opioid misuse. For example, according to the Federation of State Medical Boards, every state now maintains a prescription drug monitoring program (PDMP) designed to deter opioid abuse and diversion. However, as it stands, studies show that the breadth—and enforcement—of PDMPs varies considerably state-to-state in ways that can lead to unintended consequences, like inappropriately “dumping” patients who depend on long-term opioids for pain relief.

Putting Settlement Funds to Work

If the DOJ is successful in its lawsuits—what Peter Neronha, JD, attorney general of Rhode Island, calls an attempt to “get their pound of financial flesh”—the funds may serve to supplement these inconsistently effective efforts. Although Neronha said he was unsure how it could work, he suggested fashioning the settlements “in some way to reach Americans directly” as opposed to allowing that money to flow back to federal agencies without earmarking for specific or regional initiatives.

Scholars like Joshua Sharfstein, MD, and Sara Whaley, MPH, MSW, both at Johns Hopkins University’s Bloomberg School of Public Health, have raised other concerns related to ineffective use of opioid settlement money.

Often, funds are spent right away, “squandering the chance to invest in programs for the long-term,” or they are spent on ineffective or unproven programs, Sharfstein and a coauthor wrote in a 2020 article in JAMA. Similarly, they noted, authorities responsible for spending these funds frequently fail to develop systems that can evaluate on an ongoing basis whether the programs are actually working.

What the settlements do stand to provide is better public knowledge of pharmacies’ role in the crisis. A West Virginia lawsuit, for example, uncovered considerable flaws in CVS’s ability to effectively monitor suspicious orders: an algorithm purported to reduce human error in prescription surveillance was ultimately determined to render analyses that were “for the most part, irrelevant and pointless.”

As for Walgreens, recent litigation revealed that the pharmacy used an “honor system” rather than conducting regular audits of pharmacists’ prescribing patterns—even as there was a “general sense that Walgreens pharmacies may be lacking in some compliance areas.” The lawsuit further identified numerous examples in which patients died of overdoses shortly after filling their prescriptions at Walgreens—and whose autopsies noted intoxication with the very medications they’d been dispensed just a few days prior.

Depending on how federal lawyers choose to pursue the cases, a variety of documents—from emails to board minutes to memos—could further “shed light on what the business practices were” at US pharmacy giants, Neronha said. Those kinds of details could prompt new approaches to monitoring, regulation, enforcement, and future litigation. (The Opioid Industry Documents Archive, a collaboration between Johns Hopkins and UCSF, contains more than 22 million pages from 4 million internal corporate documents obtained in part through litigation.)

But transparency related to historic practices alongside a well-spent national financial settlement may not necessarily mean substantive, or durable, change in the opioid crisis when day-to-day operations of individual pharmacies are not standardized. For instance, research by Apollonio’s team suggests that such procedures as those surrounding “red flag” prescriptions vary immensely between stores, even when owned by the same parent chain.

Furthermore, states have had a limited ability to enact injunctions against harmful actions, beyond garnering financial payments for damages. Studies on other forms of litigation of large-scale public health concerns—including tobacco, asbestos, and lead paint—have likewise demonstrated that efforts to prohibit illegal and detrimental practices have historically taken a back seat to financial remuneration.

And, according to investigations by organizations like the Ohio Board of Pharmacy (OBP), the conditions that led to regularly filling problematic and dangerous prescriptions are deeply ingrained in large chain pharmacies like CVS and Walgreens.

In 2021, data published by the OBP found that 49% of more than 2900 CVS pharmacists across the state disagreed that they had “adequate time to complete [their] job in a safe and effective manner,” and 88% agreed that they “feel pressure” by their employer or supervisor to “meet standards or metrics that may interfere with safe patient care.” Insufficient staffing was also common at chain pharmacies and negatively affected patient care, according to nearly half of respondents.

“Company focus on metrics makes the current practice of pharmacy unsafe and results in high risk of errors,” one respondent wrote. “We are constantly expected to ‘do more’ with less.”

In February 2024, OBP took steps to address these patterns through a settlement with CVS that placed 8 of the pharmacy’s storefronts in the state on probation and, among other provisions, required the chain to address understaffing and reduce the use of quotas to incentivize pharmacist behavior.

Still, according to Cameron McNamee, OBP’s policy and communications director, these actions alone are not enough. The real question, he said, is whether the federal litigation can lead to widespread systematic changes at pharmacies, including changes that state agencies themselves lack the jurisdiction or authority to make.

“The pharmacists are the gatekeepers—they have the keys to the kingdom, and they’re that last stop for the patient,” McNamee said. “They have that obligation [to protect patients] under the law, but whether they follow it is a

As the Trump Admin close more and more of our borders restricting the flow of illegal Fentanyl Consequences?

The Deadly Cost of Drug Busts: How Law Enforcement Fuels the Overdose Crisis

https://www.cato.org/blog/deadly-cost-drug-busts-how-law-enforcement-fuels-overdose-crisis

Two years ago, I reported on a study published in the American Journal of Public Health that examined data from Marion County, Indiana, covering the period from January 1, 2020, to December 31, 2021, to determine whether changes in the number and types of overdose deaths were associated with areas that experienced increases in drug seizures by law enforcement.

The researchers found, “Within 7, 14, and 21 days, opioid-related law enforcement drug seizures were significantly associated with increased spatiotemporal clustering of overdoses within radii of 100, 250, and 500 meters.” They concluded: “Supply-side enforcement interventions and drug policies should be further explored to determine whether they exacerbate an ongoing overdose epidemic and negatively affect the nation’s life expectancy.”

Today, the Journal of the American Medical Association released a study reinforcing the evidence that police drug seizures lead to increases in overdose deaths. The study, funded by the National Institute on Drug Abuse and the Centers for Disease Control and Prevention, sought to assess whether patterns of law enforcement drug seizures are geographically linked to opioid-related overdose deaths in San Francisco.

The researchers examined records of overdose deaths, including their locations and times, from the Office of the Chief Medical Examiner, along with crime data from the San Francisco Police Department. They investigated whether drug seizures by law enforcement, based on when and where they occurred between 2020 and 2023, were linked to later opioid overdose deaths. Their analysis covered data from January 2020 through September 2023. The study included 2,653 drug seizure events.

The researchers found:

Within the surrounding 100, 250, and 500 meters, drug seizures were associated with a statistically significant increase in the relative risk for fatal opioid overdoses 1, 2, 3, and 7 days following law enforcement drug seizure events.

They concluded:

The findings of this cross-sectional study suggest that the enforcement of drug distribution laws to increase public safety for residents in San Francisco may be having an unintended negative consequence of increasing opioid overdose mortality. To reduce overdose mortality, it may be better to focus on evidence-based health policies and interventions.

As I speculated about the earlier study of Indiana residents, one potential reason is that after law enforcement conducted drug busts, people who use drugs in those neighborhoods had to turn to unfamiliar and potentially less trustworthy suppliers. Without an established relationship, they couldn’t be certain about the strength or purity of the drugs they purchased. In addition, disruptions caused by the seizures may have compelled dealers to alter their supply chains, leading them to change formulations or adjust doses. Both factors could contribute to an increase in overdoses following drug enforcement actions.

I have written many times about how law enforcement pressure pushes drug trafficking organizations to develop and distribute increasingly potent and dangerous drugs—a pattern drug policy analysts refer to as the “iron law of prohibition.” This places people who use drugs at greater risk of overdose. Now we have new evidence of another way in which law enforcement increases the risk of overdose.

This new evidence raises an unavoidable question: how many more lives must be lost before we abandon enforcement-based approaches that fuel the crisis they claim to fight?

Not Even Regulations The CDC’s guidelines alone created increasingly harsh con

Not Even Regulations: The CDC’s guidelines alone created increasingly harsh conditions for Americans with chronic and severe pain.

https://substack.com/home/post/p-159290287

President Trump’s first week in office included an order effective til at least February 1st, suspending all CDC, HHS and NIH communications: regulations, announcements, reports, advisories, updates and online posts. This aligns with pruning federal bureaucracy. But silencing these 3, of hundreds of agencies, is interesting.

Covid was, for many Americans, their first personal experience of vast, unregulated power imposed by federal agencies. Without enforcing laws or interpreting regulations, just publishing claims and data have unrestrained power.

For many Americans, it was shocking and novel seeing suggestions rapidly morph into mandates, while mainstream and social media stripped contradictory evidence and contrary opinions from public discourse. Some citizens were inspired to push others to wear masks.

But covid wasn’t the first time government actions that were neither laws nor regulations, imposed dire consequences on ordinary, law-abiding Americans.

One agency muzzled by Trump, CDC, exemplifies far-reaching federal influence. One example of the profound impact of CDC publications is the 2016 CDC guidelines for pain treatment with opioids. These guidelines — not regulations, not laws — initiated drastic, ongoing reductions in pain care nationwide.

The guidelines discussed pain patients who had never been prescribed opioids. CDC recommended for these patients’ doses below 90MME per day. The guidelines didn’t discuss established patients with severe and chronic pain, or the wide genetic variability of sensitivity to pain and sensitivity to opioids. Although pain is often described as a subjective experience, it’s observable in animals and people unable to verbalize, including infants, coma patients and dementia patients. Four the top ten reasons for US ER visits are pain (abdomen, chest, head and general). Another, back problems, entail pain. Only for Spock, a fictional alien, is pain merely “a thing of the mind.”

Caution introducing new medication sounds reasonable. However, variability in pain and opioid sensitivity makes a one-size dosing, even for one subset of patients, or medical condition, unworkable. Chronic and severe pain often requires much more than 90 MME per day. Individual morphine tablets of 200mg are legally manufactured and prescribed.

Between 2011 and 2021, US opioid prescriptions were down 40%. According to JAMA, from 2016 to 2018, prescriptions were down sharply. This trend began years before the guidelines.

After 2016, many insurers and medical groups, and state governments, drastically reduced prescribing, even for long established, successfully treated patients. The 90 MME limit is currently enshrined in laws in 40 states, often applying to all pain patients. Inpatient palliative care, especially for economically disadvantaged patients, has been significantly reduced.

In 2014, approximately 39.4 million Americans suffered chronic and severe pain. As of 2024, that number was over 60 million. In 2016, 1 in 10 US veterans had chronic pain, and after the guidelines were published veterans complained of insufficient pain treatment, and rising veteran suicides.

Facing widespread criticism, CDC expressed surprise the guidelines had been applied widely and swiftly. In a 2019 paper the guidelines’ authors claimed recommendations were implemented incorrectly and pain patients were deprived of necessary medications. Revised guidelines published in 2022 softened some recommendations, with no effect on post-2016 legislation.

The 2016 guidelines didn’t arise in a vacuum. Years of prior CDC publications featured flawed data. There was a detectable inference that legally-manufactured opioids prescribed by professionals present a uniquely serious threat not only to patients, but to society.

To illustrate how prescription opioid deaths were supposedly under-reported, a 2017 CDC report

discussed Minnesota patients with pneumonia and opioid prescriptions who died between 2006 and 2015. CDC argued these should be counted as opioid deaths, not pneumonia, as they had been.

A 2021 report in the medical journal “Cureus,” examined a decade of CDC publications about opioid-linked deaths. From 2006 to 2016, CDC’s opioid prescription death totals were inflated by counting deaths linked to illicit fentanyl and methadone dispensed for substance abuse treatment. Methadone prescriptions for pain started declining prior to 2016. “What is clear from the authors’ inquiry is that, even today, the CDC has no way of determining the actual number of prescription opioid overdose deaths each year. For more than a decade, the CDC’s erroneous reports went unchallenged while being used by Congress and the Executive Branch as the basis for public policy.”

A 2021 Pain Therapy report shows death attributed to opioids were over-reported by 20-30% — virtually the same percentage by which the CDC claimed opioid deaths were increasing. Almost 90% of deaths attributed to opioids included 1-4 other drugs on the death certificate, most frequently benzodiazepines. A 2021 CDC publication bluntly states that agency efforts to quantify overdose deaths are “falling short.” As of 2021, CDC hadn’t complied with Congress’ mandate to improve its methods for tabulating OD deaths. While one CDC publication reported opioid deaths were up in 2020, another, in 2023, stated they were up for the first time since 2018.

Considering the influence wrought by one publication on one subset of patients, data on that subset might be pertinent. A 2018 study in the BJM studied over two million opioid-naive patients receiving surgery between 2008 and 2016. Their subsequent opioid misuse rate was 0.6%.

In 2016, JAMA published data for 641,941 subjects, with no opioid prescriptions for at least a year, receiving major surgery between 2001 and 2013. The reference sample of 18 million, received no surgery. Depending on the surgery, rates of subsequent misuse ranged from 0.119% following C-sections, to 1.141% for total knee replacement. For the no-surgery control group, the rate was 0.136%.

Despite revised guidelines, and documented flaws in their opioid data, CDC continues to publish flawed data. The influence of the 2016 guidelines continues to spread. We now have a return of opioid-free surgery, as well as the opioid-free emergency room.

Many medical professionals fear prescribing appropriate opioids from misguided belief that opioid prescriptions are uniquely lethally dangerous, or fear facing legal battles like the plaintiffs in the Supreme Court Ruan case.

The influence the CDC exerted via publications alone cannot be undone with publications.

At this point, CDC officials could appear in sackcloth and ashes, on social media blast, vigorously repenting the 2016 guidelines, without affecting the sequela of their work in 2016. For reasonable pain care, we’d need: 1. legislatures in 40 states to repeal post 2016 laws, 2. professional medical education to cease depicting prescribed opioids as uniquely dangerous to patients and society, 3. the White House to stop financial rewards for Hollywood productions pushing narratives crafted by government drug warriors.

Even if all effects of the 2016 guidelines were entirely reversed, it will do nothing for patients and who died by suicide following the sudden withdrawal or forced tapering of their prescriptions. How many there have been has not be the subject of any federal research.

Originally Published by American Thinker February 8, 2025 under the title “The CDC’s Big Mistake”

Of course, Congress cares about your healthcare and its cost – NOT!

Continuing resolution keeps government funded, skips health care, PBM reform

https://ncpa.org/newsroom/qam/2025/03/17/continuing-resolution-keeps-government-funded-skips-health-care-pbm-reform

Last week, the House of Representatives passed the slimmed-down government funding legislation without PBM reform. On Friday, the Senate took up consideration of the funding bill. Senate Democrats threatened to shut down the government, attempting to negotiate potential amendments as well as introducing their own legislation that would fund the government for one month, giving time for additional negotiations regarding President Donald Trump’s spending power. Ultimately, they were unsuccessful. Friday evening, the Senate passed the slimmed-down bill, keeping the government funded, by a vote of 54-46.

While negotiations were occurring, Sens. Ron Wyden (D-Ore.) and Bernie Sanders (I-Vt.) attempted to pass the health care package agreed to in December, which included PBM reform, by unanimous consent, but Sen. Rick Scott (R-Fla.) raised an objection, causing the effort to fail.

The End of Compounded GLP-1s: What Physicians Need to Know

The End of Compounded GLP-1s: What Physicians Need to Know

https://www.medscape.com/viewarticle/end-compounded-glp-1s-what-physicians-need-know-2025a100063o

For the last 2 years, compounded versions of glucagon-like peptide 1 (GLP-1) medications have been big business. Nearly 137 million American adults are eligible to use these costly drugs to treat diabetes and obesity, or for secondary prevention of cardiovascular disease. That’s more than half of our adult population, so it’s no surprise the drugs have been in short supply. Compounding pharmacies stepped in to fill the gaps, as permitted by law during shortages, and millions of Americans turned to them for affordable, copycat drugs. But the US Food and Drug Administration (FDA) has now declared those shortages over.

Compounding pharmacies will soon have to stop selling their mass-produced versions — at least, in theory.

“There is so much money to be made,” Robert Califf, MD, FDA commissioner under former President Joe Biden, told Reuters.

“There’s just an endless number of tricks that compounders could use. So I don’t think it’s the end of it, but it certainly will bring us into a new era after the time period has passed and all the lawsuits are finished.”

Here’s what you should know.

Concerns About Compounded GLP-1s

As sales of these drugs boomed, problems emerged.

Compounding pharmacies are regulated by the FDA, but the individual drugs they make don’t need to meet the same evidentiary standards as their brand-name counterparts.

The brand-name drug has FDA approval, but the compounded version does not. Advertising for online vendors has walked a fine ethical line in terms of promises made, said Rena Conti, PhD, associate professor of markets, public policy, and law at Questrom School of Business at Boston University, Boston. She’s the co-author of a recent article in JAMA Health Forum that looked at marketing and safety concerns with compounded GLP-1s.

Questionable marketing isn’t the only issue.

“From a medical perspective, one challenge of dealing with the explosion of these products online is that it’s not clear whether your patients are using them,” she said. “Your medical record is not complete, and that creates challenges because these products have side effects and have interactions with other drugs and with the management of other conditions.”

There are risks specific to the way the drugs are dispensed, too. Brand-name GLP-1s generally come in prefilled injection pens. With compounded versions, patients must learn to fill an empty syringe from a vial. User error is common.

“All drugs have side effects, but what we’re documenting is that patient-reported problems with use of these products have exploded,”

Conti said. “We think it has to do with these compounding products being dispensed in a way that patients don’t completely understand how to take them.”

By November 30, 2024, the FDA had received more than 600 reports of adverse events with compounded GLP-1s.

Accessibility and Affordability

As popular as they are, GLP-1 medications aren’t cheap. Brand-name prescriptions cost upward of $1000 per month. According to Becker’s Hospital Review, skyrocketing demand has led several insurers to post operating losses. Coverage was restrictive before, but it’s even more so in 2025.

According to GoodRX, which tracks how insurance companies handle these drugs, almost 5 million people lost coverage for Zepbound this year. And for patients whose insurance does cover some GLP-1s, 83% now must meet some additional requirement, like prior authorization.

This double whammy of limited accessibility and hard-to-swallow pricing helped drive patients to compounding pharmacies, where they’ve been able to get the medications for much less — for instance, telehealth company Hims & Hers has been offering a month’s supply of compounded semaglutide for $165. That company is currently trying to find a legal workaround to the FDA’s deadline.

“Some compounders think maybe they’ll keep producing,” said Jeanne Varner Powell, JD, senior legal risk consultant for the Mutual Insurance Company of Arizona Risk Team.

“They may believe the FDA enforcement manpower is so weak that the FDA won’t be enforcing the prohibition that closely. Maybe they’ll keep producing. Physicians need to be aware of that. From a risk standpoint, I don’t think they’d want to be associated with a compounder that’s in violation of the law.”

Once the ban on large-scale compounding of GLP-1s takes effect, physicians should be on the lookout for — and warn their patients about — counterfeit versions that might fill the gap, Powell said. The FDA has already expressed concern about this.

Meanwhile, the drug companies behind brand-name GLP-1s are getting into the act, selling direct-to-consumers well below list price. Last summer, Eli Lilly began to offer a month’s supply of Zepbound for between $350 and $500 without insurance. The company told NPR that 100,000 people now buy direct each month. Recently, Novo Nordisk announced they’ll be dispensing Wegovy for $499 per month. Even at these lower prices, though, brand-name medications remain out of reach for many.

“It’s about managing expectations,” Powell said. “It’s important to tell patients, while these [compounded] drugs are still available, we expect there’s going to be an end. You have to consider if you can afford the cost of the name brand.”

How to Better Help Your Patients

So while the FDA may say shortages are over, compounded GLP-1s aren’t necessarily going away. They’ll still be permitted on an individual basis. For instance, to create a version of a drug that doesn’t contain a certain ingredient or in a dosage that isn’t readily available.

“That determination is made by the physician who has to write a prescription for a patient-specific drug that, in their opinion, will make a clinical difference for the patient,” Powell said. So if you have patients who need access to a specific kind of compounded GLP-1, you can still prescribe it. Advise your patient on how to find a trustworthy compounding pharmacy, and if necessary, show them how to administer the drugs to themselves.

But use this option judiciously, she cautioned. “I’d hope they wouldn’t get into a routine of copy-pasting, using the same rationale for each patient. If something happens — if an adverse outcome happens — they’re opening themselves to risk.”

Communication is key, Conti said. “If physicians are seeing patients drop weight over time that looks to be in the range of what’s possible with GLP-1s and they haven’t prescribed [the medication], they should educate their patients on the use of these products found online in a compounding format. Ask directly and document it in their medical records.”

Part of that communication calls for empathy and paying attention to each patient’s situation.

“Physicians should anticipate their patients might try to get medications from alternative sources if they can’t get the physician to write an individual compounding prescription, and they can’t afford brand-name prices,” Powell said. “It’s very likely the physician’s duty, as part of their relationship with the patient, to warn them there may be counterfeit drugs out there. Compounded versions should not be available, so they should be very skeptical about anything they see online.”

Is the WHO a criminal organization?