SECOND comment posted to CDC opiate dosing guidelines

Posted on February 18, 2022 by Pharmaciststeve

I just realized that the CDC guidelines – both 2016 and the new proposed 2022 – do not follow how our healthcare systems works. A pt goes to the practitioner and they if they have obvious symptoms, the practitioner typically will run some lab test (blood/urine)… they get back the values of numerous of substances in those tests and if they are outside of what is considered an acceptable range. If one or more is out of the normal range… the pt ends up getting one or more medications to try and get those labs back into “normal range”.  The CDC with their opiate dosing guidelines, there is no reference as to the intensity of the pt’s pain… they focused on the amount of medications that the practitioner can prescribe.  No reference to getting the pt’s pain back to a “normal level”…  I am not sure if this mind set is UPSIDE DOWN – or – ASS BACKWARDS…  In many incidents, it prevents the practitioner from being a HEALER

I find it curious why the CDC has proposed both in the publish 2016 Opiate dosing guidelines and the 2022 proposed opiate dosing guidelines, that they are stating that chronic pain should be treated in an entirely different manner than what medical science does in treating just about any other chronic disease state. It doesn’t make any difference if the pt has been diagnosed with high blood pressure, diabetes, COPD, high lipid/cholesterol and on and on… Typically the diagnosis is done from some urine/blood lab test value that is outside of what has been a predetermined range that is safe. A good example is a pt being diagnosed with having diabetes, a type II diabetic will typically be initially prescribed Metformin with a starting dose of 500 mg BID. If the pt’s blood sugar does not come down to “normal range” the dose can be increased up to 2550mg/day in divided doses. If the pts blood sugar still does not reach “normal range” the practitioner could add a few other meds in combination up to three different meds. If the pt’s blood level doesn’t reach “normal level” the practitioner can add insulin. For decades the standard of care with insulin, insulin potency was standardized at 100 units/ml, but now there are also now 200 units/ml and 500 units/ml. There appears to be NO UPPER LIMITS OF UNITS/DAY for individual pts – dose is determined by their blood glucose or A1C readings returning to what is considered a “normal range” Same thing applies to pts diagnosed with hypertension, the final goal is to get the pt’s BP into normal range no matter the dose or the number of different meds are needed. The CDC previous opiate and proposed opiate dosing guidelines has turned what has been the traditional chronic disease treatment process ON ITS HEAD. First the MME equivalence process has ABSOLUTELY NO BASIS IN SCIENCE. It has been reported that these ratios were developed with opiate naive people with mechanically induced pain (Heat or Cold) and using a SINGLE DOSE. At a time when medical science had no knowledge of CYP-450 opiate metabolism rates and/or PGx opiate metabolism rate. As well as the ratio were determined on the “subjective opinion” of the people involved in this study and the results have no application to the use in treating chronic pain issues. Since studies have demonstrated that treating chronic pain pts with opiates will result in a 0.6% to 2.0% becoming addicted. So this proposed guidelines is prohibiting >98% of chronic pain pts getting treatment with opiates that will optimize their QOL, while there is no proof that those up to 2% will not be abusing some other substance(s). The LD50 of opiates is highly variable and will decrease on those pts who have taken opiates long term. I have had first hand experience with end stage CA pts being given 20mg to 30 mg/hr Morphine via IV without fatal respiratory suppression. In theory, that would be equivalent of 200mg to 300mg of Morphine PER HOUR. Every other chronic disease is treated to get the pt’s vitals into what is considered an acceptable range, The 2016 and 2022 proposed opiate dosing guidelines does not address getting the pt’s vitals to a acceptable range, only limits – in theory – a particular MME max dose and the pt is expected to live/exist in a intensity of pain that many could consider a torturous level of pain, and many other biological/physiological functions are outside of acceptable ranges because of under/untreated pain. The attached chart will demonstrate the possible complication of a pt’s comorbidity issues and/or cause the pt to develop additional comorbidity issues. Practitioners are suppose to be “healers”, but creating opiate dosing guidelines that does just the opposite is basically inhumane. I communicate regularly with pts whose practitioners have taken their pt’s opiate doses down to meet the arbitrary MME limits. Their blood pressure is in “stroke range” , typically north of 200/100 – even when taking four or more blood pressure meds, under/untreated pain has caused their adrenals to fail, in trying to compensate for the stress on their system, and the pt now is diagnosed with Addison’s disease. Pts are dying from premature deaths from all of these unnecessary biological stressors or and many more are committing suicide because they can no long tolerate the intensity of pain that they are being forced to live/exist in. The CDC, needs to rescind/revoke the 2016 guidelines and pull the proposed 2022 guidelines and turn the practice of medicine back to the FDA and the various state medical licensing boards. To do otherwise and proceed with these inappropriate opiate dosing guidelines, would strong suggest that the CDC is confirming that the CDC’s position that putting/leaving chronic pain pts in a torturous level of pain is acceptable and what should be considered “ a normal/acceptable range” for pt dealing with chronic pain.

Filed under: General Problems | 2 Comments »

Sometimes… the TRUTH… is the BEST JOKE

Posted on February 18, 2022 by Pharmaciststeve

Filed under: General Problems | Leave a Comment »

Mark Suckerberg has LOST some 40-50 billion in net worth because of the TUMBLING VALUE OF META (FB) FAKE BOOK STOCK

Posted on February 17, 2022 by Pharmaciststeve

This is the stock value of META (FB) “FAKEBOOK” as of abt 3:45 today… over the last six months the value of a share of FAKEBOOK is WORTH ALMOST HALF OF WHAT IT WAS AT ITS HIGHEST PRICE OVER THE LAST YEAR !  In fact Meta’s price hit a 52 WEEK LOW (207.16) TODAY.

52 week high is 384.33 and closed today at 207.16

I got a message from FAKE BOOK last night that they had deleted a number of posts linked to my blog on Feb 15th… and apparently … it took forever to get back to Feb 15th of last year… on my FAKE BOOK page and there was no posts on Feb 15th, 2021 and when I tried to click on the theoretical link like this message that I just got – “learn more about our decision and see what you can do” and it went NO WHERE… 

I know that one year ago Feb 13, 2021, I did not make 173 different posts or comments… so apparently anyone who did share a link from my blog a year ago… all those links have been deleted..

I guess we are back to Richard Mark and his harem/tribe of minions when they filed a untold number of complaints with FAKE BOOK that my blog was a spammer.

So far, it would appear that FAKE BOOK has deleted around 500 posts, comments or links to my blog that others shared a year ago.

 

Filed under: General Problems | 1 Comment »

We’re measuring opioid strength the wrong way

Posted on February 17, 2022 by Pharmaciststeve

I am not an attorney, but when someone robs a store and store employee is shot/killed … the person driving the get a way vehicle – gets charged with the same crime – just as if he/she had the gun and pulled the trigger. Should individual professionals, healthcare corporations, insurance/PBM’s that creates edicts, policy and procedures based on some study or such thing like the CDC opiate guidelines that are based on poorly designed studies ? For the harm to pts that happen because those entities who adopted such guidelines without doing their own evaluation of what those guidelines are based on ?

Here is a quote from the 211 pages of the 2022 proposed CDC opiate dosing guidelines

The update process uses multiple key sources of input.

The 2016 Guideline was developed using the best available scientific evidence and followed a rigorous scientific process. The update to the Guideline is following a similar process and includes several opportunities for community and partner engagement. CDC highly values public engagement and has ensured there are multiple opportunities to hear from and incorporate feedback from patients with pain, caregivers, clinicians, and partners.

If the same scientific evidence and similar processes is being used to develop these “new guidelines”… who believes that one could expect the 2022 revised guidelines that was considerably different than the guidelines that were published in 2016?

Does anyone seem that it is strange that both the 2016 & 2022 guidelines only talks about MME’s/day limits, which many consider the conversion ratios being highly inaccurate. There is no mention of the practitioner using CYP-450 opiate metabolism or PGx/Pharmacogenomics to help determine the opiate that the pt’s system utilizes the best, identify  a pt that is a fast/ultra fast metabolizer and would need larger or more frequent dosing and/or what intensity of pain should be ideal targeted to help optimize the pt’s QOL.

In reality, when a pt is diagnosed of being a chronic pain pt… the intensity of their pain will ALWAYS be under treated,  The probability of pt getting to “zero pain” is pretty much a unrealistic goal.  There is a chart on the first page of my blog that lists all the potential complications of pt’s existing comorbidity issues and/or could cause the pt to have developed more health issues.

Then there is the routine suggestions that pts use non-opiate meds ( NSAID’S & Acetaminophen ) which the first can cause kidney damage and the latter can cause liver damage. Focusing pain management/therapy on limiting MME’s/day can often cause a hypertensive crisis ( very high blood pressure), which can cause eye, heart & kidney damage,  heart attacks, strokes, not to mention elevated pain intensity levels .. forcing the pts to live/exist in a torturous level of pain, ending in some of these pts to commit suicide to take the final action to stop their unrelenting high intensity of pain.

Could any/all of the people/entities involved in creating/publishing/adopting these guidelines and the studies that the guidelines were based on, be held liable for the adverse health outcomes and/or damages to the pts  that are forced to conform to a plan of treatment that was derived from these guidelines?

We’re measuring opioid strength the wrong way

https://www.nydailynews.com/opinion/ny-oped-were-measuring-opioid-strength-the-wrong-way-20220217-tjmjeevofrdyvj443jvkakmlhe-story.html

Over the past several years, our government has taken control of doctors’ prescription pads. In an attempt to reduce opioid overdose deaths, lawmakers placed hard quantitative limits on the maximum daily dose of painkilling drugs doctors can prescribe. These dose limits were calculated from a conversion table that was the crux of the Centers for Disease Control. and Prevention (CDC) 2016 opioid prescribing guidelines. But a review of the scientific literature shows that the evidence upon which the table is based is either flimsy or non-existent. Even if the CDC recants its 2016 prescribing guidelines when it updates them later this year, the damage has already been done.

Oxycodone,Is,The,Generic,Name,For,A,Range,Of,Opoid
(Shutterstock)

The CDC conversion table was intended to help doctors calculate the appropriate dose of a given opioid by comparing its strength relative to morphine. Supposedly, the use of these “morphine milligram equivalents” (MME) would act as a quick reference for physicians. The CDC recommended 90 MME (90 milligrams of morphine) as the maximum daily dose and that the dose of other drugs be adjusted accordingly. For example, the maximum dose of oxycodone, a drug that is twice the strength of morphine, would be given at half the dose of morphine, or 45 milligrams per day.

Although some scientists voiced skepticism, the recommendations became gospel, and later, law. Indeed, by 2022 38 states enacted laws that restricted the number and dose of opioids doctors may prescribe. Many impose daily limits of 90 MME or less. Medicare requires pharmacists to “confirm the medical need” for patients prescribed doses exceeding 90 MME. Health plans impose restrictions on prescriptions exceeding 90 MME.

Although upon first inspection the conversion table appears authoritative, closer scrutiny reveals otherwise. To support it, the CDC cites only one paper — a 2008 study that is inadequate by any measure. This supposedly pivotal piece of research puts forth a conversion table that is cobbled together from a number of small, clinically insignificant studies dating back over 60 years.

But these studies never even compared the doses of the various opioids that cause respiratory depression and death. The types of trials that went into the table would never be conducted today. We call this junk science.

Never mind; this same deeply flawed science has become policy in many hospitals, health plans and pharmacies.

When junk science is enacted into law, innocent people become “guilty.” In many cases, innocent physicians have ended up in prison for exceeding the 90 MME law, even though this number was never properly determined. And innocent chronic pain patients fared even worse. Many of them who had been on long-term high-dose opioid therapy found themselves in unbearable pain after their pain meds were cut, sometimes sharply, because their doctors were afraid of the consequences of exceeding the 90 MME limit — even when medically appropriate. In desperation, an increasing number have turned to street drugs or worse, to suicide.

Realizing the mess it created, the CDC issued an advisory in 2019 stating their 2016 guidelines were “misapplied,” that it never meant the 90 MME benchmark to be a “hard limit.” The CDC admonished doctors for cutting off or abruptly tapering patients whose pain had been well-controlled with doses exceeding 90 MME, even though this practice continues. That same year the American Medical Association officially stated “no entity should use MME (morphine milligram equivalents) thresholds as anything more than guidance.”

Last June, the Food and Drug Administration requested comments from various experts for a workshop it held to investigate the science and “knowledge gaps” surrounding MME benchmarks. One of us commented, explaining why creating morphine equivalent conversion tables is pharmacological folly.

The last two years of the COVID-19 pandemic should have taught us that medical knowledge is constantly being revised and updated, that it is often based on questionable assumptions rather than evidence, and it is never “one size fits all.”

Writing dubious assumptions into law casts junk science in stone. And the junk science remains embedded in the public mindset long after a law is repealed.

As a result, current pain management policy is a house of cards resting on antiquated and unscientific assumptions with no foundation in evidence, just a collection of incorrect (or unproven) numbers. If the CDC seeks to establish meaningful guidelines, it must focus on modern, scientifically rigorous studies, not a patchwork of unreliable research from the past.

Singer practices general surgery in Phoenix and is a senior fellow at the Cato Institute; Bloom is director of chemical and pharmaceutical science at the American Council on Science and Health

Filed under: General Problems | Leave a Comment »

A law firm that is doing a lot of civil rights/discrimination lawsuits – could they assist chronic pain pts and being denied pain meds ?

Posted on February 16, 2022 by Pharmaciststeve

I am not sure if this article is just a bunch of hyperbole by a law firm trying to stir up some business.  This statement is rather confusing to me...The DEA is authorized to take administrative action against violating individuals and entities.. and then goes on to say… If criminal activity is suspected, the DEA will get the Department of Justice (DOJ) involved.  I am trying to figure out how a entity can violate the CSA and not be involved in criminal activity ?

This law firm has a webpage showing some 3000+ cases of discrimination, I did not review all the cases, but could this law firm be one that could possibly have the in house expertise to deal with discrimination of disable chronic pain pts, when their pain meds are involuntarily reduced or eliminated ?   https://www.jdsupra.com/topics/discrimination/

DOJ Opioid Enforcement Defense

https://www.jdsupra.com/legalnews/doj-opioid-enforcement-defense-2349310/

Introduction: The Controlled Substances Act (“CSA”)

The CSA (21 U.S.C. 801 et seq.) imposes a framework that regulates different categories of certain drugs that pose dependency and abuse risks to the public. The CSA applies only to those drugs that either administrative proceedings or Congress have designated as subject to control. The DEA is the main federal agency responsible for enforcing the CSA. The DEA is authorized to take administrative action against violating individuals and entities such as issuing warning letters, ordering suspensions, imposing fines, and demanding revocation of the entity´s license. If criminal activity is suspected, the DEA will get the Department of Justice (DOJ) involved.

In 2020, the Department of Justice (DOJ) announced that it would increase its enforcement efforts against pharmacies and pharmacists under the Controlled Substances Act (“CSA”) for violating their duty to ensure that opioids are only used for their intended purposes with intended persons. This article, drafted by the federal defense attorneys at Oberheiden, P.C., explains the DOJ´s position on opioid enforcement and recent federal investigations.

“The increase in federal investigations for opioid abuse has caused many pharmacies to receive federal subpoenas and/or civil investigative demands regarding their sales of opioids and controlled substances. To protect themselves, pharmacies should take care in ensuring that they have appropriate compliance procedures in place to prevent opioid diversion and that such compliance procedures are working effectively. Hiring experienced federal defense attorneys is the best defense against federal investigations.” – Dr. Nick Oberheiden, Founding Attorney of Oberheiden P.C.

DEA and DOJ Coordinated Efforts

The DEA generally investigates suspected violations of the CSA including the following:

  • Dispensing controlled substances to individuals without a prescription;
  • Lack of strong controls in place regarding the opioid distribution process;
  • Registration and reporting violations;
  • Failing to maintain detailed records on individuals and employees;
  • Failing to file suspicious reports with the government regarding certain orders;
  • Noncompliance with enhanced standards for security under the CSA; and
  • Other factors regarding dispensing opioids and controlled substances bearing on the pharmacist´s or pharmacy´s responsibilities.

While the above activities subject the individual or entity to DEA oversight, they are generally not criminal offenses. That said, if the DEA suspects that a violation was knowingly made, the DEA—in conjunction with the Department of Justice (DOJ)—may bring criminal charges.

With the DOJ, the DEA is focusing its efforts on the national opioid crisis. The DEA in late October 2021 announced the results of Operation “Dark HunTor,” a coordinated international effort to halt opioid trafficking on the Darknet. The operation resulted in 150 arrests worldwide and the seizure of over $31.6 million in cash and virtual currencies, including about 234 kilograms of drugs such as amphetamine, cocaine, opioids, ecstasy, fentanyl, oxycodone, hydrocodone, methamphetamine pills, and counterfeit medicine.

These agencies have broadened the scope of the CSA for pharmacies and pharmacists by establishing liability for failing to detect the warning signs of drug abuse or diversion. In the eyes of the DOJ, if the pharmacy or pharmacist fails to have procedures in place that detect opioid abuse or diversion or ignores obvious warning signs or red flags, then they may be liable for filling prescriptions that lack a legitimate purpose or that are written by prescribers not acting according to the standards of their professional practice.

DOJ Investigations to Combat Opioids

The DOJ´s Consumer Protection Branch is leading the effort in pursuing both criminal and civil actions against individuals and entities who are diverting or abusing opioids, taking advantage of the opioid crisis in the nation, or who are otherwise negligent or reckless in prescribing or delivering opioids. The DOJ has made it a priority to target various individuals and entities in the opioid supply chain, including distributors, manufacturers, pharmacies, pharmacists, and prescribers. Below are notable examples:

  • In early February 2020, a federal court ordered a pharmacy in North Carolina and a pharmacist to pay $600,000 in civil penalties and to permanently cease dispensing opioids and other controlled substances. The pharmacist was also ordered to surrender his license to practice. The order cites Defendant’s failure for years in responding to red flags of drug diversion when filling prescriptions for controlled substances.
  • In March 2020, a pharmacy from Georgia and its pharmacist agreed to settle charges with the DOJ for unlawfully dispensing thousands of illegitimate prescriptions for opioids and other controlled substances under the CSA. Defendants had allegedly ignored and failed to take action against numerous red flags, including prescriber and customer warning signs regarding opioid abuse, and therefore facilitated the opioid distribution process. The pharmacist and pharmacy agreed to a settlement of about $2.1 million in civil penalties.
  • At the end of October 2020, the DOJ announced the global resolution of criminal and civil investigations regarding opioid manufacturer Purdue Pharma LP and civil settlements. The charges involved the abuse and diversion of prescription opioids. The DOJ obtained guilty pleas, a settlement of over $8 billion, and the dissolution of the company’s assets.

The DOJ will continue its aggressive stance under the CSA with the help of the DEA. Another area of concern for prescribers in telemedicine has gathered increased federal scrutiny due to COVID-19. Telemedicine presents unique risks. Prescribers cannot see their patients and are unable to physically evaluate their condition. The lack of face-to-face meetings makes it easier for criminals to conceal their identities and true intentions. Further, identity verification procedures are often less intense with telemedicine and tele-visits. To avoid unnecessary federal attention, many prescribers and entities have implemented comprehensive compliance programs that are designed to detect, mitigate, and monitor an entity´s operations for red flags.

Conclusion

The Department of Justice (DOJ) is committed now more than ever to holding pharmacies and pharmacists accountable for their roles in allegedly failing to take action to prevent illicit uses of opioids or for further facilitating the nation’s opioid crisis. In conjunction with the DEA, the DOJ has pursued an aggressive, broadened stance for failing to take care that opioids and other controlled substances are not being diverted for illegal purposes. Violations regarding the mishandling of opioids or failing to take care in the opioid distribution process can lead to serious penalties and even imprisonment terms. We can expect more federal investigations and indictments under the CSA. To prevent this from happening to you, retaining experienced federal defense attorneys is your best defense.

Filed under: General Problems | 2 Comments »

Looking in the rear view mirror

Posted on February 16, 2022 by Pharmaciststeve

I found this graphic on my computer with a date from 2014


Then there is this graphic that shows ALL OVERDOSES – starting about the time that the Decade of Pain Law expired and was not renewed.. Opiate Rxs peaked in 2011 – again near the start of this graphic and projects the OD deaths thru the end of the decade. So if that prediction is correct, Overdose deaths will have INCREASED TEN FOLD in 15 yrs. If you notice in the graphic, there is a substantial uptick after the 2016 CDC guidelines were released and in 2021 when our SW Southern border was opened up. Reportedly a “flood” of illegal Fentanyl analog and other illegal abused substances started happening about one year ago. What is also interesting is the number of deaths contributed to use/abuse of alcohol and nicotine have not increased anywhere near those of involving legal/illegal controlled substances.  According to this article https://www.nbcnews.com/politics/immigration/fentanyl-seizures-u-s-southern-border-rise-dramatically-n1272676 in the first 9 months of 2021 federal fiscal year the seizures of just illegal fentanyl analogs was over THREE TIMES MORE than all of the entire 2020 fiscal year.

There is another graphic where the various illegal/legal drugs caused OD’s. What is not shown, and it is not known if the CDC did not track or did not disclose.. is the number of OD’s from Pharma opiates was relatively flat for the entire decade, were they from people who had a legal Rx for the opiate showing in the toxicology – which would suggest a SUICIDE or some pharma opiates that have been diverted from legal sources.

What I find interesting is that both pharma opiate production limits and the number of Rx opiate filled have been CUT IN HALF, since 2011.

One just have to wonder how anyone can claim that pharma opiates have any connection to all the OD’s involving illegal Fentanyl. In 2021, that number is reported as being 75,000.

Filed under: General Problems | Leave a Comment »

Clinical Trial Finds BP Elevation With Regular Acetaminophen Use

Posted on February 16, 2022 by Pharmaciststeve

So …. they CUT YOUR PAIN MEDS, YOUR BLOOD PRESSURE GOES UP… and they tell you to take a non-opiate pain med for your pain.. This study suggests that Acetaminophen ( Tylenol ) could cause your blood pressure to GO HIGHER !   The GOOD NEWS  is… you won’t harm your liver taking Acetaminophen, the BAD NEWS is, high blood pressure could harm your kidneys and so will most NSAIDS (Aspirin, Motrin, etc) – depending on how much you take. So what is worse … the frying pan or the fire ?

Clinical Trial Finds BP Elevation With Regular Acetaminophen Use

https://www.uspharmacist.com/article/clinical-trial-finds-bp-elevation-with-regular-acetaminophen-use

Edinburgh, UK—Regular use of acetaminophen might not be appropriate for patients with hypertension because the painkiller significantly raises blood pressure, according to a new study.

The University of Edinburgh study suggests that goes against conventional belief, adding that the drug “is widely used as first-line therapy for chronic pain because of its perceived safety and the assumption that, unlike nonsteroidal anti-inflammatory drugs, it has little or no effect on blood pressure (BP).”

Their study, published in Circulation, notes that observational studies suggest that acetaminophen may increase BP, but few clinical trials have tackled the question. That is why they conducted a clinical trial to access the effect of regular acetaminophen dosing on BP in hypertension.

For the double-blind, placebo-controlled, crossover study, researchers randomized 110 participants to receive 1 g of acetaminophen 4X daily or matched placebo for 2 weeks followed by a 2-week washout period before moving over to the alternate treatment. They measured ambulatory BPs at the beginning and end of each treatment period.

Defined as the primary outcome was a comparison of the change in mean daytime systolic BP from baseline to end of treatment between the placebo and acetaminophen arms.

With 103 patients completing both arms of the study, researchers report that regular acetaminophen, compared with placebo, was found to result in a significant increase in mean daytime systolic BP (132.8±10.5 to 136.5±10.1 mmHg [acetaminophen] vs. 133.9±10.3 to 132.5±9.9 mmHg [placebo] ;P <.0001) with a placebo-corrected increase of 4.7 mmHg (95% CI, 2.9-6.6) and mean daytime diastolic BP (81.2±8.0 to 82.1±7.8 mmHg [acetaminophen] vs. 81.7±7.9 to 80.9±7.8 mmHg [placebo]; P = .005) with a placebo-corrected increase of 1.6 mmHg (95% CI, 0.5-2.7).

They add that similar findings were identified for 24-hour ambulatory and clinic-measured BP.

“Regular daily intake of 4 g acetaminophen increases systolic BP in individuals with hypertension by ≈5 mm Hg when compared with placebo; this increases cardiovascular risk and calls into question the safety of regular acetaminophen use in this situation,” the authors conclude.

In an accompanying commentary, Steven M. Smith, PharmD, MPH, and Rhonda M. Cooper-DeHoff, PharmD, MS, of the Department of Pharmacotherapy and Translational Research, College of Pharmacy at the University of Florida, in Gainesville, point out, “An important but often underappreciated contributor to stagnant BP control rates is drug-induced hypertension. At least 40 to 50 drugs currently in use have been implicated in raising BP, through activation of sympathetic (e.g., pseudoephedrine, venlafaxine) or renin-angiotensin systems (estrogen-based oral contraceptives) promotion of sodium/volume retention (corticosteroids, calcineurin inhibitors) or other mechanisms.”

Drs. Smith and Cooper-DeHoff also advise that nonsteroidal anti-inflammatory drugs, to which acetaminophen often is used as an alternative, blunt the effectiveness of many first-line antihypertensives.

Calling the new study an “important addition” to the research, the commentators write that the BP-raising effects of acetaminophen have been known for more than half a century, but that few clinical trials have provided evidence of that.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

Filed under: General Problems | 1 Comment »

SUCKERBERG: Texas AG Paxton rips Meta for stealing user biometrics to ‘make more money’

Posted on February 15, 2022 by Pharmaciststeve

Texas AG Paxton rips Meta for stealing user biometrics to ‘make more money’

https://www.foxbusiness.com/technology/texas-ag-paxton-rips-meta-for-stealing-user-biometrics-to-make-more-money

AG Paxton says Meta’s privacy violations are ‘damaging’ to personal identity

Texas Attorney General Ken Paxton has filed a lawsuit against Meta for stealing users’ personal information and causing irreparable damages, he told “Mornings with Maria” Tuesday.

Paxton: There’s specific statutory damages for a deceptive trade practice up to 10,000 per violation and then 25,000 for actually capturing someone’s biometric identifier, whether that’s face, fingerprints, or anything without their knowledge. Because this is all personal information and this is information you can’t change. 

I mean, it’s not like you can go get a new Social Security number or a new driver’s license. This is your personal information and once it’s out, once they’ve shared it, once they’ve disclosed it, the genie is out of the bottle. You can’t get it back. So that’s damaging to you as an individual when you have not known about it, you didn’t consent to it as required by law. And now it’s been used by Facebook to make more money as they share it with other people without your knowledge or your consent…

TEXAS SUES META OVER FACEBOOK’S FACIAL-RECOGNITION PRACTICES

They actually implied or told us that they weren’t using facial geometry or capturing your face. And the reality was they’ve been doing it for well over a decade without our knowledge and actually misleading consumers and the state of Texas that they were actually capturing this information…

We filed this in East Texas in a state district court. I wouldn’t be surprised if we are in trial within a year or so. And in front of a jury, explain to the fellow Texans exactly what happened with Facebook. 

Filed under: General Problems | 1 Comment »

Why Try to Kill the Physician

Posted on February 15, 2022 by Pharmaciststeve

Why Try to Kill the Physician

https://www.daily-remedy.com/why-try-to-kill-the-physician/

The king is dead, long live the king.

The reign of the physician is over, replaced by a system of nudges, consultants, and care gap analyses. The lone physician is now gone. In its wake resides a nexus of data and decision prompts, all interacting to standardize healthcare for patients.

Clinical decisions are made in rapid succession. Each correlating data with a decision until the process achieves peak efficiency. In such a system, physicians become an unnecessary expense and a rate-limiting step.

So physicians are replaced. Sometimes they are replaced with mid-level healthcare providers. Sometimes they are replaced with outsourced consultants. But in nearly all circumstances, clinical decisions transfer from an individual physician to a system of decision-making.

It is justified as a cost-cutting measure, as a way to eliminate extraneous costs from healthcare. But the underlying assumption is that the clinical decisions made by a system are equal to that of a physician. Sometimes that is true, but sometimes not.

And in emphasizing the cost of care alone, we overlook a more fundamental balance – between the cost of care and the quality of decision-making. We seem to believe the two are on the same side of the figurative healthcare scale, moving in unison. When in reality, they are weighed against one another, in determined opposition.

There comes a point, in the push for healthcare efficiency, where additional cost cutting measures compromise the quality of care. There is a limit to the number of physicians we can eliminate through a cost-effective system of patient care. It is defined by the nature of the individual clinical decision.

Some clinical decisions are considered simple, nearly reflexive. We do not need a physician to tell us to lose a few pounds to stave off the effects of obesity. Yet many decisions are considered complex. These are the decisions that require physician input. So it would appear that the balance between cost and quality of clinical decision-making is defined by the complexity of the underlying decision.

But, when evaluated in its full context, every decision in healthcare is in reality complex. We merely choose which decisions to simplify and which to keep complex. When a patient repeatedly presents with elevated blood pressure, many would naturally assume that the patient is hypertensive and prescribe a medication. This appears to be a simple decision. These are the Best weight loss pills for women.

But elevated blood pressure is a complex phenomenon, influenced by psychological, behavioral, and physiologic processes. An anxious person can have elevated blood pressure, just like someone who loves to eat processed foods with an extra dash of salt. When physicians diagnose someone with essential hypertension, they essentially acknowledge that they do not know the primary cause of the elevated blood pressure, but recognize that medications may help.

In healthcare, complexity abounds every decision. But to pursue every aspect of every clinical decision would render healthcare obsolete. It would collapse under the weight of its own impractically. Simplification becomes a necessary aspect of modern healthcare.

But the trend towards simplification became a pursuit for the oversimplified as we vied for efficiency as a proxy for cost savings. We can only go so far in this direction because healthcare is not simple – we just need to pretend it is in order to navigate through it.

Systems can only replace physicians when we find an optimal balance between decisions that can be simplified and those that must remain complex. But the more we learn about healthcare, and barriers to optimal patient outcomes, the more complex healthcare proves to be.

And the more complex healthcare becomes, the less we can rely on systems for clinical decisions – the balance tilts away from the simple. Eventually we must revert back to physicians as primary decision-makers, incurring additional costs accordingly. Otherwise, healthcare will not advance further.

So perhaps the presumed demise of the physician has been greatly exaggerated.

I have stated many times that our healthcare system is nothing more … nothing less… that a FOR PROFIT BUSINESS. This article refers to corporations replacing physicians with “mid-levels”..  mid-levels are ARNP, NP, PA… and to the best of my knowledge, when a mid-level provides a product/service to a pt the corporation that they work for get reimbursed at 85% of what a MD would get reimbursed.  I doubt if mid-levels, get a salary that is 85% of what MD’s get paid…  So the corporation has a “larger spread” between what the practitioner gets paid and what the corporation gets reimbursed from insurance for the service provided. the times they are a changing !

 

Filed under: General Problems | 1 Comment »

You need to get Quality Control into that store: CVS #10548 @ 2600 W Michigan Kalamazoo MI location

Posted on February 15, 2022 by Pharmaciststeve

You need to get Quality Control into that store: CVS #10548 @ 2600 W Michigan Kalamazoo MI location

The CVS #10548 @ 2600 W Michigan Kalamazoo MI location has severe issues while dealing with people’s Rx.
#1 They have my middle name listed as my last name.
#2 They filled ALL RX INSTEAD of the one I called in. Before I had to resort to CVS Mail order bc this store NEVER FILLED my Rx in a timely manner. Today my son picked up the Rx I called for yesterday #272043 cost $0.00. Yet this store refilled #283434 cost $47.00 WHEN I NEVER ORDERED IT. Plus, they filled a 3rd Rx I NEVER ordered bc I don’t take it anymore. You need to get Quality Control into that store or soon they’ll give someone the wrong Rx that doesn’t belong to them and you’ll have a lawsuit on your hands. They are much too incompetent to be open to the public. Do something.

Filed under: General Problems | Leave a Comment »

« Previous Page — Next Page »