I have been a student of our bureaucracy/bureaucrats for nearly 40 yrs and how they act can be highly predictable.

The CDC’s first published opiate dosing guidelines were at first attempted to be done with a great deal of it done in secret.  The meeting of the group was not published and they tried to keep the identity of all those participating in the meeting anonymous.

There was no period for the public to make comment on what was proposed… because there was NO PROPOSAL… the guidelines were created and published.

Immediately after they were published, the then head of the CDC Tom Frieden published a public statement to CLEARLY STATE that the guidelines DID NOT BEAR THE WEIGHT OF LAW… they were just GUIDELINES.

Many of us believe that the CDC did not have the statutory authority to generate these guidelines, thus besides not have the weigh of law they were basically UNCONSTITUTIONAL.

Our system is so designed that bills/laws/interpretation of laws  do not have to meet any constitutional verification before they are put on the books and they can be applied/enforced as long as they remain on the books or until they are challenged in our courts and declared unconstitutional.

Some believe that figuratively  the DEA and the VA were waiting outside of the meeting room door to get a copy of these new opiate dosing guidelines… they may have even been getting copies of the draft guidelines on a daily basis, because it would seem that those two agencies were ready to hit the ground running once the guidelines were officially published.

Again our medical system, once >50% of medical practitioners follow a particular process or policy and procedures it becomes a de-facto the standard of care and best practices. There seemed to be a coordinated push by the VA, DEA, insurance/PBM industry to influence these guidelines with practitioners go get them to adhere to these guidelines.  So once that >50% goal was reached either locally/regionally/nationally … the DEA could come in and accuse prescribers of not meeting the current standard of care and best practices and thus the DEA could draw the conclusion that the prescriber was prescribing controlled meds that were not medically necessary to many/most/all of their pts.

After a couple of years,  there was a growing number of statements that the CDC opiate dosing guidelines were being misapplied… and eventually the CDC agreed to reopen the guidelines for public comment to “revise” the guidelines.

This time the CDC followed the proper federal laws… they made a public announcement that they were revising the guidelines and had a public comment period..  Why shouldn’t they… they created the first set of opiate dosing guidelines without following any of the federal laws and they suffered no consequences and no one bothered to challenge the constitutionality of the original set of guidelines.

Historically, when laws/regulations are open for revision, they usually end up rougher/harder/stricter on those who they are to applied to.

It is no secret that PROP and FEDUP where making comments during the open comment period and those and other similar groups are in lock step with the DEA’s/VA’s agenda on treating pain with opiates and prescribing other controlled substances to people who have a medical need for treating their subjective diseases.

The community had better be prepared for new and tighter guidelines… maybe 50 MME/day limits – for all pts … acute, chronic , terminal.  Maybe limiting PCP’s to maybe 20 -30 MME/day for 7 days for acute pain – no additional pain meds. Expand the guidelines to make it illegal for a pt to be prescribed a opiate, benzo and muscle relaxant together – BY ANY PRESCRIBER(S).

If my suspicions are anywhere near close to where the revised guidelines will end up… the community had better stop all its in-fighting and start raising money to challenge these guidelines in our court system as to their constitutionality. If I am near correct, prescribers will start discharging chronic pain pts – IN MASS – with a 30 days of meds to wean down off their controls.  There is not enough pain clinics to accept or take appropriate care of all the chronic painers.

Suicides will increase dramatically, and street dealers will be more than happy to take care of all the chronic painers seeking relief from their relentless intractable chronic pain… and the street dealers won’t take insurance, won’t want you to pee in a bottle, no pain contracts nor care if you what more meds “early”.

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https://www.facebook.com/ghostsurgeries/

This FB page is about The Mayo Clinic, in Rochester, MN and this page was just created in the last week.  There is quite a bit of context on this page so I am not going to try and cut/paste … because there is probably a lot more to come on this page going forward.

This does suggest why medical errors are the THIRD LARGEST CAUSE OF DEATH… behind cancer and cardio.

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What to know about the Ga. anti-steering law

https://www.wtoc.com/2020/06/16/what-know-about-ga-anti-steering-law/

SAVANNAH, Ga. (WTOC) – It is likely that within the last year you have received a letter or a phone call from your insurance company stating that you can save money by using mail order prescriptions or that you must use a specific pharmacy suggested by your insurance company. What you may not know is that Georgia has just passed a law that may allow you to continue using whatever pharmacy you would like.

In the early months of 2020, the state of Georgia passed House Bill 323, also known as the Pharmacy Anti-Steering and Transparency Act. The laws prohibit PBM (or insurer-owned pharmacies) from profiting off prescriptions “steered” from their PBM and insurance affiliates. They also restrict PBM and insurer patient steering, strengthen anti-mandatory mail order, add additional audit protections, and restrict mining of patient data. The Pharmacy Transparency and Anti Steering Act attempts to meet three goals; increase transparency, allow patients to choose their pharmacy, and make sure patients receive quality care regarding pharmacy services.

So, how do you handle the situation if your insurance carrier tells you must use mail order pharmacy? You may be able to simply opt out by calling them. Telling patients they must use mail order takes away the patients right to healthcare professionals help them manage their medications. Approach the subject with your insurer by calling the phone number on the back of your insurance card. The good news is if you are persistent with your insurance company, they might comply and allow you to continue to use your local pharmacy.

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Association of American Physicians and Surgeons Sues FDA for “Irrational” Interference of Access to Life-Saving Hydroxychloroquine

https://www.thegatewaypundit.com/2020/06/association-american-physicians-surgeons-sues-fda-irrational-interference-access-life-saving-hydroxychloroquine/

The Association of American Physicians and Surgeons (https://aapsonline.org) filed a lawsuit against Department of Health and Human Services and the FDA for “irrational interference” by the FDA with timely access to hydroxychloroquine.

Never in history have we seen such a determined effort by the scientific community and pharmaceutical industry to downplay and lie about the use of a successful drug to treat a deadly disease.

Hydroxychloroquine is the first choice in a study of 6,000 doctors treating the coronavirus.
In the field and in independent testing hydroxychloroquine displayed amazing results in treating the COVID-19 virus.

But there was great pushback against hydroxychloroquine for two reasons. The first reason was because it was safe and very inexpensive. The second reason is because Donald Trump promoted its use.

It is not a stretch to say the Democrat establishment would rather see people die than see President Trump be proven right.

So the so-called experts went to great lengths to lie and smear the use of this drug as we have discussed previously.

I smell insurance industry interference in this issue… the medication hydroxychloroquine can still be prescribed by prescribers “off label”  What everyone may run into is that the insurance industry will not recognize it being prescribed off label but will most likely declare that it is an “experimental treatment” and refuse to pay for the therapy. There are some other things going on in the “background”, but this is the first time I have heard the FDA coming out with this sort of order

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I really am hoping I can reach out to you. I’m feeling embarrassed about my visit to cvs pharmacy . The pharmacist tore me down emotionally in public today. I don’t know who to ask for help. I see an addiction doc who’s also my primary. I Needed to get back on my medicines to stay healthy. I stopped my meds for a while to have my baby. I went to the cvs I had always went to in my past. The pharmacist denied my scripts @first! Finally she said she would fill only one of them. In the end she said that my doc & I needed to answer some questions before filling my other script & that she was entitled to surpass my HIPAA law being that she’s my pharmacist. My docs office needed to answer some questions before her considering filling it. My doc office said it’s a violation of my HIPAA rights. The problem is she said she’s looking out for my best interest as though it was her decision. She degraded me about taking my anti anxiety med. it’s still hasn’t been filled. Any advice? Also she didn’t refer me to another pharmacist In that location but did put stickers&numbers on the script if I wanted to take it elsewhere she wouldn’t fill either. I felt it was a personal attack & degrading. Please help

According to what this pt wrote… the pt got a unwarranted “second medical opinion” on the therapy the pt has been taking for four years.

The medications involved are both controlled substances but neither was a C-II

One thing that the Pharmacist was correct about is that pharmacists can have access to a pt’s medical records without violating the HIPAA rules.

Most will agree that one of the primary functions of the practice of medicine is the starting, changing, stopping a pt’s therapy.

IMO, it is also inappropriate for a pharmacist to decide not to fill a prescription and not call the prescriber to discuss their concerns. To put the pt in the middle of the issue it is grossly unprofessional.

Since this pt has been on this medication for abt 4 yrs.  The only reason that a pharmacist has the valid reason to refuse to fill a pt’s Rx is because the dose is perceived as too high, the pt’s health records indicates that the pt is allergic to a new Rx and/or there is a significant level one drug to drug interaction.

Who believes that this pharmacist  – if the pt and prescriber jumps thru all the hoops and over all the hurdles this time.. that the pharmacist would not create/fabricate some more hoops and hurdles the next month, when the pt needs for medications  and keep this up month after month until the pt and prescriber gets fed up and the pt takes the Rxs to another store.

Everyone needs to ask themselves the question … should I have to BEG ANYONE to allow me to spend my money in their business ?  Does anyone deserve your business if all they want to do is put unnecessary obstacles between you and your medically necessary medications ?

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Watchdog report slams DEA’s money-laundering operations

https://www.politico.com/amp/news/2020/06/17/watchdog-report-dea-money-laundering-325723

Findings that DEA-handled funds may have fueled crime echo the furor over Operation Fast & Furious.

The Drug Enforcement Administration laundered tens of millions of dollars in the course of drug trafficking investigations over the past decade without complying with laws governing such operations, according to a newly released review from the Justice Department’s in-house watchdog.

Justice’s Inspector General Michael Horowitz found that the DEA failed to move millions of dollars in profits from completed operations to the U.S. Treasury and did not report all such undercover operations to Congress as the law requires.

In some cases, the financial transactions handled by the DEA facilitated the purchase of aircraft by drug trafficking organizations, but the DEA apparently showed little interest in determining just how the aircraft were used until auditors asked about the issue.

Horowitz’s review echoed many of the findings that fueled a controversy almost a decade ago over a federal gunrunning investigation known as “Operation Fast and Furious,” that allowed suspected gun traffickers to purchase weapons in order to trace their flow.

As many as 2,000 of the weapons crossed the border into Mexico, investigators found, prompting a loud outcry against the Obama administration from Republicans in Congress.

Drug trafficking organizations “are not only involved in drug trafficking, but also participate in violent crimes and have been linked to terrorism,” the new IG report finds. “This elevates the risks that the DEA’s involvement in money laundering activity may inadvertently support particularly egregious criminal activity. Despite these risks, officials in the DEA and in the Department conveyed the idea that allowing money to ‘walk’ is not as inherently risky as letting drugs or guns ‘walk.’”

The report also indicates that DEA sometimes changed the focus or nature of the undercover operations without seeking the appropriate approvals from higher-ups at DOJ. In one instance, a narco-terrorist was added as a new, “atypical” target of a DEA money laundering effort, without high-level approval.

“Because of the sensitivity and additional risks involved in investigating narco-terrorists, we believe that the addition of this target should have immediately alerted [senior officials] that this target did not fall within the initial scope of approved activity,” the review said.

The new report spans three fiscal years, from 2015 to 2017, but some of the money-laundering operations date back to the 1990s and the report suggests neglect of the legal requirements for well over a decade.

DEA is supposed to report details of its undercover operations to Congress on an annual basis but has not done so since 2006 or earlier, the watchdog found.

DEA and Justice Department officials agreed with 19 recommendations Horowitz made to address shortcomings found during the audit.

DEA tightened some of its policies on the undercover operation issues in 2018, but didn’t take more significant action until April of this year, well after the inspector general’s team gave Justice and DEA officials the initial findings.

“While DEA acknowledges a need for improvement in the areas noted in the OIG’s report….significant progress has been made in recent years and that effort continues today,” DEA Chief Compliance Officer Mary Schaefer wrote in a response attached to the report.

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Coronavirus can still pass between face mask wearers — even when they’re 4 feet apart: study

COVID-19 can be transmitted between people who are standing more than four feet apart, even if they are wearing a mask, a new study has found.

The research, published in Physics of Fluids, notes that face coverings alone do not prevent droplets of fluid that are projected by a cough, a discovery the researchers called “alarming.” It adds to the importance to also maintain proper social distancing measures, they said.

The same researchers found previously that droplets of saliva can travel 18 feet in five seconds when an unmasked person coughs, so masks are important. However, repeated coughs are likely to reduce their effectiveness, the experts found in the new study, using computer models.

“The use of a mask will not provide complete protection,” study co-author and University of Nicosia professor Dimitris Drikakis said in a statement. “Therefore, social distancing remains essential.”

If a person has a coughing fit, “many droplets penetrate the mask shield and some saliva droplet disease-carrier particles can travel more than 1.2 meters (4 feet),” Drikakis added.

The calculations from the simulation also noted that droplet size could be affected due to hitting the mask, escaping and eventually, entering the environment.

“The droplet sizes change and fluctuate continuously during cough cycles as a result of several interactions with the mask and face,” Drikakis explained.

“Masks decrease the droplet accumulation during repeated cough cycles,” Dr. Talib Dbouk, the study’s co-author, added. “However, it remains unclear whether large droplets or small ones are more infectious.”

The study’s findings have implications for health care workers, who are often unable to maintain proper social distancing.

The researchers suggested wearing “much more complete personal protective equipment,” including helmets with built-in air filters, face shields, disposable gowns and two sets of gloves.

Earlier this month, the World Health Organization updated its guidance to recommend that governments around the world encourage the widespread use of fabric face masks while in public settings.

Initially, the WHO advised only those who are experiencing symptoms of COVID-19 or are caring for someone infected with the novel virus to wear a face mask. The WHO’s new recommendations also lag behind those from other top health agencies, such as the Centers for Disease Control and Prevention (CDC).

In April, the CDC updated its guidelines to recommend all Americans wear cloth face coverings while in public, “especially in areas of significant community-based transmission.”

As of Tuesday morning, more than 8 million coronavirus cases have been diagnosed worldwide, more than 2.1 million of which are in the U.S., the most impacted country on the planet.

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Finally: Common Drug Improves COVID-19 Survival in Trial

https://www.medpagetoday.com/infectiousdisease/covid19/87086

Dexamethasone, the familiar glucocorticoid, reduced deaths in hospitalized COVID-19 patients with severe disease by one-third compared to those receiving usual care, according to topline interim results from the RECOVERY trial released early Tuesday.

Deaths in the dexamethasone arm were reduced by one-third (RR 0.65, 95% CI 0.48-0.88, P=0.0003) among patients receiving mechanical ventilation, and by one-fifth (RR 0.80, 95% CI 0.67-0.96, P=0.0021) among patients requiring oxygen versus patients receiving usual care, according to a statement from the study’s authors.

But dexamethasone showed no benefit among patients who did not require respiratory support (RR 1.22, 95% CI 0.86-1.75).

RECOVERY is a U.K.-based pragmatic trial in which hospitalized patients are randomized to various open-label treatments: besides dexamethasone, these include tocilizumab (Actemra), convalescent plasma, azithromycin, and lopinavir/ritonavir (Kaletra); hydroxychloroquine was also being tested until enrollment in that arm was stopped earlier this month, after it failed to show any benefit.

“Dexamethasone is the first drug to be shown to improve survival in COVID-19,” said RECOVERY trial chief investigator Peter Horby, MD, PhD, of University of Oxford, in the group’s statement. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients.”

Horby described dexamethasone as “inexpensive, on the shelf and can be used immediately to save lives worldwide.”

Sir Patrick Vallance, the U.K.’s chief scientific adviser, characterized the news as a “ground-breaking development” in the fight against COVID-19.

In the trial thus far, 2,104 patients were randomized to receive 6 mg of dexamethasone via intravenous injection for 10 days compared to 4,321 patients receiving usual care. Among the usual care group, 28-day mortality was highest (41%) among patients requiring mechanical ventilation; mortality was 25% in those who required oxygen only and 13% among those not requiring any respiratory support.

The investigators estimated that treating 8 ventilated patients or 25 requiring supplemental oxygen would prevent one death.

Recruitment to the dexamethasone arm of the trial was stopped on June 8, as a sufficient number of patients were enrolled to determine if the drug had meaningful benefit.

They added that given the “public health importance of these results,” they are working to publish the full details soon.

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I am a member of this private group 

Shih Tzu Lovers

https://www.facebook.com/groups/shihtzuloverus/members

There is 57,000 members in this private group

Within the last week a woman made a post about having to euthanize her 16 y/o Shih Tzu after becoming suddenly ill…  Those of us who have had pets understand how she feels… we are currently on our third Shih Tzu,, having “adopted” our first Shih Tzu pup about 30 years ago…  and having to euthanize the first two over liver or kidneys failing…  when they were in their mid-teens

This SINGLE POST has received 451 comments and 778 emojis on this single post. Since this is a private FB page.. there cannot be any shares.

Maybe these Shih Tzu owners have so much activity ..because – unlike the chronic pain community – they don’t have hundreds or thousands of FB pages devoted to the Shih Tzu breed ?

And the chronic pain community questions about their lack of unity… seems like some people care more about their “fur babies” than chronic painers care about each other ?

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E07: Interview With Shasta Rayne Harner, Vice President of CIAAG 06/15/2020

https://www.podbean.com/ew/pb-3rs7a-dfd3c9

In this episode, we interview Shasta Rayne Harner of Chronic Illness Advocacy and Awareness Group, Inc. (CIAAG). Shasta is the Vice President and Dir

ector of CIAAG. She is also a chronic pain patient herself, suffering from Dermatomyositis. 

The Chronic Illness Advocacy & Awareness Group, Inc. (CIAAG) is a national non-profit organization that promotes both a common-sense, compassionate and research-based approach to palliative care along with the responsible prescribing of opioid medication to those experiencing chronic pain and illnesses, including: serious injuries, intractable pain, and those who suffer from painful chronic diseases.

CIAAG’s mission is to work collaboratively with legislators in crafting the policy changes and legislation enacted to combat opioid abuse (including heroin and illicit fentanyl) in a way that does not restrict patients’ access to their medication. Restricting access is not just a problem for the individual;

it negatively impacts the nation’s public and economic health, resulting in previously functioning members of society being forced into unemployment and disability in response to the relentless, inhumane and debilitating pain they experience.

Intractable pain and forced isolation often leads to depression and other mental health crises as well. Unfortunately, some patients have turned to the street to find unsafe alternatives (including dangerous counterfeit pills) in a desperate effort to relieve their untreated pain, while others have succumbed to suicide as a final escape.

CIAAG offers lawmakers and other decision-makers fact-based research on prescription opioid use from qualified physicians, as well as policy white papers, testimonials and other resources to aid in crafting sensible policies around opiate use.

 Learn more about CIAAG at https://ciaag.net/

The CIAAG dossier, “Violation of A Nation” can be found at http://uploads.documents.cimpress.io/v1/uploads/c7c18e1c-2c3d-4ffd-b251-2ddba53a2d8b~110/original?tenant=vbu-digital

You can donate and contact CIAAG at https://ciaag.net/donate-and-contact

The National Pain Strategy referenced in this episode can be found at https://www.iprcc.nih.gov/sites/default/files/HHSNational_Pain_Strategy_508C.pdf

Be sure and check us out The Rapp Report Chronic Pain Crusade group on Facebook:

https://www.facebook.com/groups/247276683163131

And follow us on Twitter:

https://twitter.com/rapp_report

Thank you for listening! Please share this episode!

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