Stressed-out workers spend $1,500 more on health care each year. Pets, yoga and sleep can change that: Former Aetna CEO Mark Bertolini

Stressed-out workers spend $1,500 more on health care each year. Pets, yoga and sleep can change that: Former Aetna CEO Mark Bertolini

https://www.cnbc.com/2019/06/19/stress-adds-1500-to-annual-worker-health-care-cost-former-aetna-ceo.html

  • Former Aetna CEO Mark Bertolini says that the most stressed-out workers at the health insurer during his tenure spent $1,500 more on health care each year.
  • He drove a cultural change that included multiple stress-management programs, from animal therapy to yoga and sleep management.
  • Bertolini says these changes contributed to a 600% stock gain and eventual sale to CVS for $69 billion.
VIDEO08:01
Watch CNBC’s full interview with former Aetna CEO Mark Bertolini

When Mark Bertolini took over as Aetna’s CEO in April 2011, shares of the health insurance company were trading just over $30. When the company was sold to CVS in 2017, the pharmacy giant paid more than $212 a share in a $69 billion acquisition.

One secret to this success: Bertolini began letting his employees take yoga and pet dogs during their lunch break.

“What we found … was that if we actually invest in people, they actually got better and health-care cost went down,” Bertolini, the former Aetna CEO and author of “Mission-Driven Leadership: My Journey as a Radical Capitalist,” said at CNBC’s Evolve event in New York City on Wednesday.

This transformation began when Bertolini noticed how far a focus on prevention rather than treating medical problems went.

We had dogs, cats, guinea pigs and rabbits that would come into our building. People would line up at lunchtime to go pet the animals to reduce stress.

An internal Aetna study found that employees in the top 20% of stress levels had $1,500 a year more in health-care costs.

To help fight this, Bertolini pitched a company yoga program. Although some upper-level management thought he was crazy, many of the employees responded positively.

“The company just went crazy from a cultural standpoint, where all the employees started coming in, ‘Can we do this? Can we do this? Can we have pet therapy?’” Bertolini said. “We had dogs, cats, guinea pigs and rabbits that would come into our building. People would line up at lunchtime to go pet the animals to reduce stress.”

Bertolini suffers from neuropathy in his arm and practices mindfulness and yoga. He has a pet, too.

“I have a dog. She is the best medicine for me every night, you know, a German Shepard, Keeva. I should have brought her. I should have brought her this morning to come along,” he said.

One of the factors Bertolini wanted to focus on most was ensuring employees got a sufficient amount of sleep every night. To encourage this, Aetna began paying $300 for employees who received 7.5 hours of sleep at night for 20 nights in a row. The company also doubled their tuition assistance program and increased their efforts to pay back student loans.

He said at the time of the CVS deal, the company was spending $120 million to $125 million a year more in employee expenses related to all those cultural changes.

While the holistic health alternatives were key, there also were serious socioeconomic factors at work in stress levels of employees, Bertolini said. Compensation, for one. Many employees were working two jobs. And most of the frontline employees were not being paid enough — 81% were single mothers, and 20% of their families were on food stamps and their children on Medicaid.

“I said, ’We have to change this.,” Bertolini recalled.

Aetna raised wages from $12 to $16 for its frontline employees.

After the crash

After the financial crash, Aetna was “was crawling out of a deep hole. … We had to rethink the way we thought about our company,” Bertolini said.

The key variable the company came up with at the time was that for every 50 basis points changed in health-care costs, there was $480 million improvement in underwriting margin, and another $480 million for the client. So it developed this model and team of people that did nothing but look for ways to improve the quality of care, to improve the quality of life, to reduce another 50 basis points.

“Every year we went after 350 basis points,” he said. “And so in 2010, we added 8% operating margin. [Wall] street said we couldn’t keep it. We actually grew it to 9.1%, and that was by literally looking for ways to improve the quality of care and improve the quality of life to individuals and reduce the costs by virtually keeping them away from the medical-industrial complex.”

“What we did was, we turned around the organization culturally and said, ’Oh, wow. We can take care of each other and it doesn’t hurt the company,” Bertolini said.

The impact of this cultural change was immediate. Health-care costs in the company went down 7.5% and engagement scores skyrocketed 1,200%.

It also created a new way to measure leadership. “That became the secret. That was the CEO metric, if you had to have a CEO metric. The CEO metric was, ‘Where do I find the next 50 basis points?’”

Bertolini credits this cultural shift for being one of the main reasons the company’s stock price soared more than 600% during his time as CEO. “The cultural energy that was created in the organization as a result was a power that you could never measure,” Bertolini said, but he added, “Our people were engaged with our customers, and we got a really high return on that.”

 

Oh-Klahoma! 8 Questions J&J Should Ask Andrew Kolodny

Oh-Klahoma! 8 Questions J&J Should Ask Andrew Kolodny

https://www.acsh.org/news/2019/06/18/oh-klahoma-8-questions-jj-should-ask-andrew-kolodny-14100

The state of Oklahoma is smelling blood in the water and it is going after blood money. State Attorney General Mike Hunter has a very big “blood donor” in his sights: Johnson and Johnson, the maker and seller of opioid drugs, has been accused of deceptive marketing that contributed to the state’s addiction problem. J&J has a whole lot of blood – a market cap of $372 billion – and Oklahoma a whopping transfusion. According to the Wall Street Journal, the state is talking about approximately $17 billion for “abatement.”

“[The company] used a deceitful, multibillion-dollar brainwashing campaign’’

Oklahoma Attorney General Mike Hunter,  May 28, 2019 (Bloomberg News)

Not surprisingly, Andrew Kolodny, a tireless self-proclaimed expert on drugs and addiction, has been chosen to testify for the state. How could it be anyone else? If you take the news at face value Kolodny is not only the expert on opioids but perhaps the only person on earth even remotely qualified to speak about them -– which is, of course, a bunch of nonsense. 

This is why I’m offering J&J’s attorneys, eight questions that I would ask Kolodny if I had the chance. 

No charge.

(Before you accuse me of being a J&J puppet or lackey, perhaps you ought to read this: “Johnson & Johnson’s Shameless Exploitation Of The Opioid Crisis“. I wrote it earlier this year.) 

1. Opioids are used almost exclusively for control of pain. Do you have any formal training in pain management? Have you ever treated pain patients?

2. “When was last time you saw a patient? When was last time you prescribed a drug to a patient? What was the drug?”

3. “You and your organization PROP have recommended a 90 morphine milligram equivalents (MME) maximum dose per patient per day. Some states have enacted legislature based on MME limits. But critics have claimed that the concept of MME itself is flawed because of significant genetic variability in opioid metabolism from patient to patient. How do you answer those critics”? (1)

4. “All drugs have risks and benefits. Focusing on only the risks will necessarily give rise to an inaccurate portrayal of a given drug. What are the risks and benefits of alternative treatments for pain, such as NSAIDS, acetaminophen, systemic anti-inflammatory steroids, spinal injections, and gabapentanoids?” 

5. “You have repeatedly referred to prescription analgesics as ‘heroin pills.’ Are you stating that Vicodin or Percocet are equivalent in analgesic potency, addiction potential, and overdose risk to heroin?”

6. “Chronic pain patients, even those who have been treated successfully for years, are being forcibly tapered off their medicines. Are you in favor of forced tapering? If so, why? You have also stated that ‘the number of doctors who are inappropriately tapering pain patients is likely very small.’ Do you have data to support this statement? 

7. You have also stated that “'[pain patients are] being effectively manipulated to controversialize the CDC guidelines.” Do you have any proof or evidence to support this statement?”

8. “Will you, anyone in your family, friends or associates benefit financially from restrictions placed on prescription opioid drugs?”

Is Kolodny a believable witness, let alone an expert? I guess that depends upon how he answers questions like these. Assuming that Johnson and Johnson’s lawyers ask them.

Prediction: I have no idea what J&J did or did not do wrong, but the company is probably doomed no matter what. J&J has a big bull$eye on its back and Judge Thad Balkman, who will decide the case, is listening to a lot of bull. 

But I could be wrong. After all, this is not an expert opinion.

At opioid trial, Johnson & Johnson moves to strike Oklahoma witness as ‘de facto member of State’s legal team’

At opioid trial, Johnson & Johnson moves to strike Oklahoma witness as ‘de facto member of State’s legal team’

https://legalnewsline.com/stories/512646956-at-opioid-trial-johnson-johnson-moves-to-strike-oklahoma-witness-as-de-facto-member-of-state-s-legal-team

NORMAN, Okla. (Legal Newsline) – Johnson & Johnson has asked the judge overseeing the first in an expected wave of trials against the opioid industry to strike the testimony of Dr. Andrew Kolodny, a psychiatrist who plays a central role in the State of Oklahoma’s case by linking narcotics marketing to opioid addiction and overdose deaths.

Calling Dr. Kolodny “a de facto member of the State’s legal team,” J&J said Oklahoma gave the Brandeis University researcher unfettered access to some 90 million internal documents obtained through discovery and used his expert testimony to “pollute the trial record with rampant hearsay, rank speculation, and the State’s own take on the evidence.”

Experts like Dr. Kolodny play a crucial role in the opioid litigation, since the plaintiffs – mostly states, cities and counties claiming to be seeking to recover opioid-related expenditures – appear to have settled on a strategy of “aggregate proof” under which they will present expert testimony, instead of specific examples, to show a connection between pharmaceutical industry practices and the increase in opioid abuse. 

Defendants like J&J therefore have a strong incentive to knock out these expert witnesses as unqualified.

Over five days on the stand, Dr. Kolodny touched on every element of Oklahoma’s case, including extensive testimony about how J&J’s ownership of a wholesale opioid ingredient business in Tasmania made it the “kingpin” of the opioid industry. Kolodny, co-director of Opioid Policy Research for the Brandeis University Heller School for Social Policy and Management in Massachusetts, also accused J&J of funding pain-treatment organizations and other groups he termed an “opioid Mafia.” 

In Dr. Kolodny’s pretrial deposition, taken two days after Oxycontin-manufacturer Purdue Pharma settled with Oklahoma, J&J says the physician for the first time discussed how the company’s Noramco and Tasmanian Alkaloids businesses “were the true cause of the opioid crisis,” instead of the widespread distribution of Oxycontin. 

The only opioid products J&J sold in Oklahoma were Duragesic, a fentanyl patch its Janssen unit introduced in 1991, and Nucynta, a pill it began selling in 2009. The company’s products represented less than 1% of Oklahoma Medicaid opioid prescriptions from 1996-2017.

Kolodny later testified in court that Purdue Pharma and its founding Sackler family “have been stealing the spotlight, but Johnson & Johnson, in some ways, has been even worse.” He also intimated, without specifically saying so, that J&J had coordinated with Purdue to produce a new strain of poppy rich in thebaine, a type of opioid, to supply expected rising demand for Oxycontin.

“This extended, free-form commentary about the State’s evidence over which the witness lacks both personal knowledge and expertise is not testimony at all, much less expert testimony,” J&J said in its filing. “It is advocacy, nothing more.”

No one from the office of Oklahoma Attorney General Mike Hunter was immediately available to comment. Kolodny testified he has been working as a paid expert for Oklahoma nearly full-time with the state for months. In testimony, he said his fee is in the mid-six figures.

Expert witnesses are intended to present opinions on complex matters to help the finder of fact, either a judge or jury, determine which party’s case is closer to the truth. Judge Thad Balkman has thus far refused most of J&J’s requests, perhaps most significantly refusing to put the case before a jury even though the state is seeking $17 billion in damages to clean up its opioid-related problems. 

Judge Balkman agreed with the State that the $17 billion isn’t money damages, which would require a jury trial if the defendant so wished, but money for “abatement” of a public nuisance. 

The state’s case is based upon a simple theory, reiterated throughout the trial by lead plaintiff lawyer Brad Beckworth, a private attorney whose firm has already reaped part of the $59 million in fees awarded in Purdue’s settlement with Oklahoma: “If you oversupply, people will die.” 

The State says opioid abuse was rare until 1996, when Purdue launched Oxycontin with the help of J&J’s wholesale opioid unit. It is calling experts like Kolodny to establish the cause-and-effect relationship, although it is not expected to call a single physician who relied on improper marketing to overprescribe opiates, or a single patient who received medically unnecessary opiates.

The state’s other expert witnesses have also displayed a thorough knowledge of their client’s case. In testimony yesterday streamed online by Courtroom View Network, Dr. Jason Beaman, chair of the psychiatry department at the Oklahoma State University Center for Health Sciences, mentioned another key legal talking point for the plaintiffs when he described the state’s “indivisible” injuries. Under Oklahoma’s rules for joint and several liability, J&J could be liable for the entire $17 billion opioid abatement tab if Judge Balkman finds its contribution to the crisis was indivisible from the activities of Purdue and other companies. 

Drug Use by State: 2019’s Problem Areas

Drug Use by State: 2019’s Problem Areas

https://wallethub.com/edu/drug-use-by-state/35150/

Drug abuse has a long and storied history in the United States, and we’ve been “at war” with it since 1971 under the Nixon administration. But no matter who is in office, the federal drug budget continues to increase. It’s moved from $23.8 billion in 2013 to over $27.7 billion in 2018.

The current administration seems to be taking a hardline approach to drug use. In addition to the issue of drugs crossing the border from Mexico, President Donald Trump has been focused especially on the opioid crisis. The Trump Administration declared the crisis a national emergency. Congress also passed legislation last year aimed at providing support for people addicted and penalties for companies that contribute to overprescribing. President Trump signed this bill into law.

Given the uncertain future and lack of significant progress to date, it’s fair to wonder where drug abuse is most pronounced and which areas are most at risk in the current political climate. This report attempts to answer those questions by comparing the 50 states and the District of Columbia across 22 key metrics, ranging from arrest and overdose rates to opioid prescriptions and employee drug testing laws. Continue reading for the complete findings, commentary from a panel of researchers and a full description of the methodology used.

 Highest Drug Use by State

Overall Rank
(1=’Biggest Problem’)
State Total Score ‘Drug Use & Addiction’ Rank ‘Law Enforcement’ Rank ‘Drug Health Issues & Rehab’ Rank
1 District of Columbia 59.95 1 34 2
2 Michigan 58.59 3 14 7
3 Missouri 57.93 18 1 17
4 West Virginia 56.62 5 3 37
5 Indiana 54.96 7 4 42
6 Arkansas 54.23 9 10 34
7 New Hampshire 53.17 16 8 28
8 Kentucky 53.00 2 11 50
9 Colorado 52.99 24 7 8
10 New Mexico 52.36 12 18 29
11 Rhode Island 50.15 6 45 6
12 Oregon 50.03 8 37 5
13 Nevada 49.19 17 44 1
14 Tennessee 48.22 10 27 32
15 Massachusetts 47.84 21 22 15
16 Maine 47.42 4 47 22
17 Delaware 46.63 15 42 9
18 Vermont 46.30 14 46 11
19 Connecticut 45.84 23 25 25
20 Pennsylvania 45.46 26 9 49
21 Ohio 45.33 11 33 43
22 Oklahoma 45.32 22 28 20
23 Louisiana 45.26 29 24 10
24 Alaska 45.18 13 50 12
25 Montana 44.56 30 30 4
26 New Jersey 44.19 35 6 39
27 Arizona 44.01 31 20 30
28 Mississippi 43.77 32 23 16
29 North Carolina 42.79 27 21 41
30 Washington 42.21 19 48 23
31 Wyoming 41.96 45 2 31
32 Illinois 41.59 34 17 46
33 Maryland 41.11 20 41 38
34 New York 40.39 38 15 33
35 Alabama 40.02 25 51 3
36 Florida 39.90 28 35 35
37 Texas 39.26 48 12 14
38 South Carolina 38.96 33 40 26
39 Georgia 38.62 36 32 13
40 Virginia 36.61 46 13 40
41 California 35.80 37 39 27
42 Iowa 35.70 41 31 19
43 Wisconsin 35.23 39 16 51
44 South Dakota 34.01 50 19 18
45 Utah 33.65 42 36 21
46 Nebraska 33.53 47 26 24
47 North Dakota 32.74 51 5 44
48 Kansas 32.64 44 29 36
49 Idaho 29.26 40 38 48
50 Hawaii 26.70 43 49 45
51 Minnesota 25.14 49 43 47

 

Red States vs. Blue States

 

Methodology

In order to determine which states have the biggest drug problems, WalletHub compared the 50 states and the District of Columbia in three overall categories: 1) Drug Use & Addiction, 2) Law Enforcement and 3) Drug Health Issues & Rehab.

Those categories include a total of 22 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the biggest drug problem.

We then determined each state and the District’s weighted average across all metrics to calculate its overall score. This total score was the basis for our final ranking. So the state ranked 1st in this study has the biggest drug problem, based on the data at hand, while the state ranked 51st has the smallest drug problem.

Drug Use & Addiction – Total Points: 50

  • Share of Teenagers Who Used Illicit Drugs in the Past Month: Double Weight (~5.88 Points)
  • Share of Teenagers Who Tried Marijuana Before Age 13: Full Weight (~2.94 Points)
  • Share of Teenagers Offered, Sold or Given an Illegal Drug on School Property in the Past Year: Full Weight (~2.94 Points)
  • Share of Adults Who Used Illicit Drugs in the Past Month: Triple Weight (~8.82 Points)
  • Share of Children Who Lived with Anyone Who Had a Problem with Alcohol or Drugs: Full Weight (~2.94 Points)
  • Number of Opioid Pain Reliever Prescriptions per 100 People: Double Weight (~5.88 Points)
  • Number of Clandestine Drug Laboratories or Dumpsites: Double Weight (~5.88 Points)
    Note: The square root of the population was used to calculate the “Number of Residents” in order to avoid overcompensating for minor differences across states.
  • Overdose Deaths per Capita: Quadruple Weight (~11.76 Points)
  • Overdose Deaths Growth (2017 vs 2016): Full Weight (~2.94 Points)

Law Enforcement – Total Points: 25

  • Drug Arrests per Capita: Half Weight (~2.78 Points)
  • Drug Arrests on College Campuses per 1,000 Students: Full Weight (~5.56 Points)
  • Prescription Drug Monitoring Laws: Full Weight (~5.56 Points)
    • 1 – States with a prescription drug monitoring law that requires doctors to consult an opioid prescription database before prescribing painkillers.
    • 0.5 – States with a prescription drug monitoring law that does not require doctors to consult an opioid database.
    • 0 – States with no prescription drug monitoring laws.
  • Maternity Drug Policy (Is Substance Abuse During Pregnancy a Crime?): Full Weight (~5.56 Points)
  • States with Employee Drug Testing Laws: Full Weight (~5.56 Points)
    • 1 – Authorized
    • 0 – Currently Not Available

Drug Health Issues & Rehab – Total Points: 25

  • Share of Adults Who Couldn’t Get Treatment for Illicit Drug Use in the Past Year: Triple Weight (~6.82 Points)
    Note: This metric measures the share of adults who needed but didn’t receive treatment for illicit drug use in the past year.
  • Substance Abuse Treatment Facilities per 100,000 People Using Illicit Drugs: Double Weight (~4.55 Points)
    Note: This metric considers people who are at least 12 years old.
  • Admissions to Substance Abuse Treatment Services per 100,000 People Using Illicit Drugs: Full Weight (~2.27 Points)
    Note: This metric considers people who are at least 12 years old.
  • Naloxone Availability without Individual Prescription: Full Weight (~2.27 Points)
    Note: Naloxone is a safe and effective antidote to opioid overdoses. This is a binary metric.

    • 1 – Naloxone is available without individual prescription
    • 0 – Naloxone is not available without individual prescription
  • Drug Treatment Programs Availability for Pregnant Women: Full Weight (~2.27 Points)
    Note: This binary metric measures the availability or absence of drug treatment programs for pregnant women in a state.
  • Share of Addiction Treatment Medication Paid by Medicaid: Full Weight (~2.27 Points)
  • Narcotics Anonymous & Alcoholics Anonymous Meetings Accessibility: Full Weight (~2.27 Points)
  • Substance Abuse & Behavioral Disorder Counsellors per Capita: Full Weight (~2.27 Points)

Sources: Data used to create this ranking were collected from U.S. Census Bureau, Bureau of Labor Statistics, Centers for Disease Control and Prevention, Federal Bureau of Investigation, Substance Abuse and Mental Health Services Administration, U.S. Drug Enforcement Administration, Child and Adolescent Health Measurement Initiative, Project Know, the Pew Charitable Trusts, Guttmacher Institute, OHS Health & Safety Services, CVS Health, IMS Institute for Healthcare Informatics and Recovery.org.

Image: Photographee.eu / Shutterstock.com

 

“I believe I am a danger to the public working for CVS.” – Anonymous CVS Pharmacist – PART TWO

“I believe I am a danger to the public working for CVS.” – Anonymous CVS Pharmacist — Part ONE

 

http://pharmacistactivist.com/2019/June_2019.shtml

They Must be Anonymous, But They Will Not be Silent!

The title for the editorial commentary in the May issue of The Pharmacist Activist is, “I believe I am a danger to the public working for CVS.” That is a quote from a letter from an anonymous (but known to me) CVS pharmacist to a board of pharmacy. I have received so many responses to this issue, the majority of which are from current or former CVS pharmacists, that I am using this June issue to include excerpts and examples from the responses. With several responses, I have made minor editing changes to prevent the identification of the pharmacists who voiced the concerns, but the importance and strength of their concerns are not changed.

I would also reiterate that there are thousands of excellent pharmacists who work in CVS stores, and the concerns identified are not a criticism of them but, rather, are to support them by increasing awareness of conditions and situations that they can’t even communicate within CVS because of their fear of being terminated. It is the CVS management-imposed metrics, working conditions, and understaffing that place consumers at risk and are the basis for this criticism.

Responses

From current CVS pharmacists:

“Subject: CVStress. All of what the anonymous pharmacist said is true, but there is more. Recently, CVS started a program where electronically sent prescriptions may be verified by another CVS store within the state. It is my feeling that eventually pharmacies will be operating without pharmacists. Everything will be done by some communications methods. I firmly believe this is what the chains want. Imagine the profits then!! This is part of the reason they are pushing to get their employees to be named to state boards of pharmacy. I’ve worked in hospitals, independents, and chains. My hours were cut and I didn’t know about it for 2 weeks until after the starting date for the change. There is no more profit sharing. No more premium pay for covering extra shifts. Our health insurance premiums have skyrocketed. Working conditions are worse than you can possibly imagine.
    While all of the above causes a financial and emotional hardship for me, the real people who suffer are the patients (customers to CVS). They are not getting the care and attention they deserve. They get bombarded by text messages and phone calls almost begging them to come in and spend their money. I have no time to do anything that I know I should be doing. I never thought I’d say this, but I can’t wait until my retirement. I truly enjoyed being a pharmacist but now I’m just a highly paid robot who feels more like a liability than an asset to my employer.
    What am I doing about it? I recently spoke with a pharmacy student with whom I work who was planning on working for CVS following graduation. I explained my experiences and feelings about working for CVS, and the student obtained another position and will be much better off. It may not be a lot, but everyone can do something. You may use any of this information you wish and I know you will respect my request for anonymity.”

“I am losing my full-time status in my store and will have to pick up a shift elsewhere to stay full-time. Cuts and closures are happening everywhere. As pharmacist cuts occur, more techs are added and the tech: pharmacist ratio is far beyond the limit allowed in my state.”

“I am aware of a pharmacist who is opening an independent pharmacy that will be near a CVS store. However, Caremark is purposely delaying the application into its provider network. Because this is a heavy Caremark provider area, a new pharmacy would have great difficulty opening without Caremark plans. Caremark is doing everything they can to delay the opening of new independent pharmacies, so that they can keep their profits in-house.”

“Another scam, or as CVS would like to say ‘patient care calls.’ Added to our duties are 10 or 15 calls per day designated as pharmacist special message calls. We are to call patients and tell them that the pneumonia shot the doctor ordered is waiting for them at the pharmacy and to come on in to get the shot.”

(Editor’s note: I contacted this pharmacist and asked whether there were doctors’ orders for the vaccine for specific patients. His response is below.)

“There are no doctor orders. We use one doc, as for all injections. CVS selects patients who are age appropriate and may be at risk. The way I have been handling this is asking them if they have any questions about meds and that this is a general call and that we appreciate them as a customer. I also tell them that we are offering pneumonia shots, and many respond that they have already had the shots.”

“We get screamed at by customers because their prescriptions are not ready when promised. We get behind and the CVS response is ‘too much red in this store today.'”

From pharmacists previously employed by CVS:

“I was let go from the company for ‘business purposes’ when district revenues were down. At least that’s what I was told. However, I and others believe that CVS and some other chains are looking for reasons to fire older pharmacists. The work environment, stress, and inability to keep up with company metrics are only a few factors which contribute to an unsafe environment. I have many stories. Even when I was let go, I had to fight for my final paycheck and stock purchase withholdings.
    Although I no longer work for CVS, I choose to remain anonymous at this time because I am concerned CVS will find a way to retaliate. However, there is a need to expose the truth. I once heard a sermon in which it was stated: ‘To sit and watch evil IS evil.’ Somehow, that thought keeps going through my mind.”

“Since the time I retired from CVS, I have stayed in touch with my friends there. CVS lost a number of pharmacists in our area in just two months. They still can’t find technicians and many who have been there for years are leaving. Customers are extremely unhappy with service and prices. There is no help.”

From a board of pharmacy member:

“I will be bringing this up at the next board meeting.”

From a former hospital pharmacist:

“What you describe in the May issue of The Pharmacist Activist is not unlike what occurs thematically in hospital pharmacies. I am SO glad that I’m out of that mess! I feel (and am) betrayed by our profession after all the work I put into it.”

From an executive of a company that works closely with pharmacists:

“I empathize with all these pharmacists. Many of these chains and supermarkets have their performance metrics. That is bad news. There is even worse news!! Many State Boards of Pharmacy are CONTROLLED by the chains and supermarkets!! They have ‘their own people’ in place to knock down any and all complaints that come in that would adversely affect anything that the chains and supermarkets are doing!! I was shocked to learn that it does no good at all to complain to the Boards of Pharmacy.”

From customers:

“I am so grateful to be back at Skippack Pharmacy! Between Express Scripts and CVS, I had enough. I was so tired of having no eye contact. Made me wonder if one of my pills fell on the floor, would they pick it up and put it in the pill bottle? Mayank (the new owner who reopened Skippack Pharmacy after CVS bought and closed it) is great and we love having him here.” (Editor’s note: Please also see the separate commentary about Skippack Pharmacy in this issue.)

(Editor’s note: I also received many other responses voicing criticisms regarding CVS, but the comments provided above are representative of the concerns communicated to me. The comment below is the single response I received that is complimentary of CVS.)

“My experience at a local independent pharmacy was unsatisfactory, and I went to a CVS that I now patronize exclusively. The pharmacists and techs all wear white uniforms. When I have new prescriptions, the pharmacist, without being asked, always presented me with the new drug and asked if he or she could explain. I have found the personnel at our local CVS to be very professional.”

From a producer of a television news program:

“Do you think the CVS pharmacist you wrote about would go on camera?”

I informed the anonymous pharmacist I quoted, as well as several other current CVS pharmacists who have voiced concerns to me, of the television producer’s question. They declined to be interviewed on camera because they anticipate CVS would terminate them and there are not other positions for pharmacists available in their areas. I then contacted pharmacists who have voiced concerns, but who no longer work for CVS. Even these pharmacists are not willing to be interviewed on camera because they are concerned that CVS would find a way to retaliate against them. I responded that I understood their concern and assured them I would not place any pharmacist at risk by disclosing their identity. Another pharmacist with whom I communicated had been a pharmacist manager with CVS for several decades before he was terminated. He sued CVS and, following an extended legal battle, was successful in receiving a large settlement from CVS. I do not know the specifics of the settlement because CVS insisted that the terms of the settlement be confidential as a condition for the agreement. Therefore, the information is not publically available and the pharmacist is restricted from disclosing any information.

I asked the television news producer if interviews could be conducted in a manner that would disguise the identity and voice of those interviewed. He did not anticipate that this would be done, but is looking into it and the outcome is pending.

I wish to express my appreciation to the pharmacists who have had the courage to communicate their concerns to me and for their trust in me to protect their identity.

Daniel A. Hussar
danandsue3@verizon.net

Oklahoma Opioid Trial: Day 14 – Testimony from Dr. Kolodny, Kristi Hoos

Dr. Andrew J Kolodny, MD – Reviews Psychiatry Brooklyn, NY

Dr. Andrew J Kolodny, MD – Reviews

Psychiatry Brooklyn, NY

https://www.vitals.com/doctors/Dr_Andrew_Kolodny/reviews

 

Johnson & Johnson profited from both sides of opioid crisis, says epidemic expert

Johnson & Johnson profited from both sides of opioid crisis, says epidemic expert

www.stateimpact.npr.org/oklahoma/2019/06/13/johnson-johnson-profited-from-both-sides-of-opioid-crisis-says-epidemic-expert/

The first case in a flood of civil litigation against opioid drug manufacturers is in its third week in Oklahoma.

Oklahoma Attorney General Mike Hunter’s suit alleges Johnson & Johnson, the nation’s largest drugmaker, helped ignite a public health crisis that has killed thousands of state residents.

Johnson & Johnson is the sole defendant in the case. Two other companies — Teva Pharmaceuticals and Purdue Pharma — both settled with the state before the trial began.

Oklahoma’s lawyers say the company did more than push its own pills. Until 2016, the state says Johnson & Johnson profited from the prescription opioid crisis by cultivating a highly potent poppy in Tasmania. The narcotic refined from the plant was sold to other companies to make opioids. One of the customers was Purdue Pharma, the maker of Oxycontin, one of the most prescribed drugs and a leading driver of the epidemic.

This case has brought to light another aspect of the company’s business. Johnson & Johnson also produced the active ingredient for opioid treatment drugs including Naloxone, which is used to reverse overdoses.

“You would be able to profit off of a drug that’s causing addiction and overdose deaths as well as profit off of drugs that are used to treat addiction and overdose deaths,” said Andrew Kolodny, a psychiatrist and opioid crisis expert who testified for the state.

He said Johnson & Johnson’s marketing of opioids, in general, was pervasive in the medical industry, beginning in the 1990s. He claims they downplayed opioids’ addiction risk, knowing that almost any opioid prescription would benefit the company’s bottom line.

“From every direction, we were hearing that if you’re an enlightened doctor in the know, that opioids are a gift from mother nature and should be used for almost any complaint of pain,” Kolodny said.

The state says those misleading sales tactics created a “public nuisance’’ which refers to actions that harm members of the public, including public health.

Sue Ogrocki / AP

Defense attorney Larry Ottaway gestures as he speaks during opening arguments Tuesday, May 28, 2019, in Norman, Okla., as the nation’s first state trial against drugmakers blamed for contributing to the opioid crisis begins in Oklahoma.

“Janssen’s conduct was not a nuisance,” said Larry Ottaway, representing Johnson & Johnson and its subsidiary Janssen Pharmaceuticals. “They provided medically necessary medications … They were lawfully subscribed by doctors in the state of Oklahoma.”

Ottaway read from a Centers for Disease Control and Prevention report in his opening statement.

“States, as regulators of healthcare practice have the responsibility and authority to monitor and correct inappropriate and illegal prescribing,” he said.

Ottaway said the company’s goal was to help patients.

“Serious, chronic pain is a soul-stealing, life-robbing thief,” he said.

In a written statement, John Sparks, Oklahoma counsel for Johnson & Johnson criticized Kolodny’s testimony.

“His comments on the production of medical-grade pharmaceutical ingredients under the regulation and authorization of the DEA and FDA are offensive, sensationalist and baseless.”

Burden of proof

Both sides agree that Oklahoma is experiencing an opioid crisis. About 6,100 Oklahomans died from overdoses from 2000 to 2017, and the state has one of the highest rates of babies born with neonatal abstinence syndrome.

But Richard Ausness, a law professor at the University of Kentucky who has been following the case, says the burden of proof is on the state.

“You gotta connect some dots. The fact that you have an opioid crisis is not necessarily caused by the promotional efforts of the drug companies, that’s, of course, the issue,” Ausness said. “If they can’t prove that, then they are going to lose.”

Initially, Hunter’s lawsuit included Purdue Pharma and Teva Pharmaceuticals. In March, Purdue Pharma settled with the state for $270 million. Soon after, Hunter dropped all but one of the civil claims, including fraud, against the remaining defendants.

Ausness says that decision could backfire and cost the state billions of dollars.

“[The state is] seeking money damages for the secondary losses that they incur by virtue of being the government, such as health and police protection and things of that sort. That’s a real stretch for public nuisance,” he said.

The bench trial — with a judge but no jury — is the first of its kind to play out in court.

Oklahoma’s case sets the stage for about 2,000 other civil lawsuits around the country trying to hold the opioid companies accountable.

Attorneys for the state still have one more week to present to Judge Thad Balkman, who will decide the case. After that, its Johnson & Johnson’s turn.

Former CDC Director Arrested And Charged With Sexual Misconduct

Former CDC Director Arrested And Charged With Sexual Misconduct

https://www.npr.org/2018/08/24/640992992/former-cdc-director-arrested-and-charged-with-sexual-misconduct

Dr. Thomas Frieden, the former director of the Centers for Disease Control and Prevention, was arrested and charged on Friday after he was accused of groping a woman, law enforcement officials said.

Detective Sophia Mason of the New York Police Department told NPR that the public health expert allegedly “grabbed a victim’s buttocks without her permission.” The incident was said to have happened last October in his home.

It was reported to police in July.

On Friday morning, Frieden, 57, turned himself in, a spokeswoman at the Brooklyn district attorney’s office told NPR.

He was charged with two misdemeanors and a violation: third-degree sexual abuse, forcible touching and harassment, the last of which carries a fine but no jail time.

Later in the day, Frieden was arraigned in Brooklyn Criminal Court and released without bail. He had to give up his passport and Judge Michael Yavinsky issued an order of protection.

“This allegation does not reflect Dr. Frieden’s public or private behavior or his values over a lifetime of service to improve health around the world,” a spokeswoman for Frieden told NPR.

He served as director of the CDC from 2009 and until 2017, leading the response to the Ebola epidemic and the H1N1 swine flu pandemic. He stepped down as President Trump took office.

Prior to joining the federal agency, he was the New York City health commissioner, where he led a ban on smoking and the elimination of trans fats from restaurant menus.

In the ’90s, he led a program to control tuberculosis in New York, lowering incidences of multiple-drug resistance. That led to work with the World Health Organization’s TB program in India.

Earlier this year, he told WHO that he got into his line of work to help people. “Hiking through the mountains with my father, he commented that I was interested in health and politics and that public health combined both. … My father, an excellent physician, had a simple philosophy of life: You’ve got to help the people. I chose a career that would give me the privilege of helping as many people as I could.”

After he left the CDC, Frieden launched a $225 million initiative called Resolve to Save Lives, part of a nonprofit global health organization called Vital Strategies.

Its president and CEO, Jose Castro, told CNN that the groping accusation came from a friend who knew him and his family for more than 30 years. “In all of my experiences with him, there have never been any concerns or reports of inappropriate conduct,” he said.

He added that Vital Strategies had conducted an investigation in which every staff member of his team was interviewed. “This assessment determined there have been no incidents of workplace harassment,” he said. “Vital Strategies greatly values the work Dr. Frieden does to advance public health and he has my full confidence.”

Frieden’s next court date is scheduled for Oct. 11.

Correction Aug. 24, 2018

A previous version of this story incorrectly said creating the Resolve to Save Lives initiative cost $225. It was $225 million.

It has been reported that Frieden and Dr AK were friends in their early careers working for the NY health dept.  Maybe this is why AK was how he got the CDC to create the opiate dosing guidelines without having legal authority.  After the FDA told AK to “take a hike” with his proposal.

Also have the CDC released those guidelines… Frieden made several public announcements that the guidelines “did not bear the weight of law”, but seemingly not many – especially the VA and the DEA was not listening nor paying attention.

After all in a few months (Jan 2017) one way or another we were going to have a new President and Frieden would most likely be out of a job and maybe this was his final “swan song” ?

 

 

Who Can Afford the Cost of Living with Chronic Pain?

Who Can Afford the Cost of Living with Chronic Pain?

www.nationalpainreport.com/who-can-afford-the-cost-of-living-with-chronic-pain-8840082.html

Most chronic pain patients do not expect their lives to be a picnic. Chronic pain inflicts psychological and physical damage that can drain the resources of the strongest and most resilient among us. What most of chronic pain patients don’t always anticipate is the additional personal pressure created by the combination of the almost inevitable loss of income and the added expenses not covered by insurance or our savings. It is difficult enough to have been living a normal life to suddenly be inflicted with chronic pain, perhaps for the rest of your life. But to add more insult to injury, the concerns as to where we are to find the financial resources needed to obtain the correct equipment, treatments, transportation, medication, etc. adds unneeded stress to a difficult life to learn to accept.

It seems particularly unfair when one is unable to have the coverage for treatments proven effective for a particular condition. This adds stress which then negatively impacts a patient’s health. Here are some examples I have to face and I am sure many of you will be able to post other circumstances you have had to face:

  • I have to have most of my medications compounded to remove the ingredients of fillers that my body can’t metabolize – but due to being compounded, insurance offers no coverage. Although I could buy that drug with the regular fillers included with coverage, yet I totally have to pay out of pocket for my medication.
  • I need to travel many times to get to the knowledgeable doctors for my condition, EDS and there is no reimbursement for travel, lodging, food, etc.
  • And heaven help us trying to turn to safe alternatives in attempts to prevent surgery. We are traveling soon to Ohio to see a jaw specialist to see if I can avoid surgery by instead using a mouth guard to keep the jaw from subluxing/dislocating. Again, there is no coverage since it doesn’t match their insurance codes for the mouth guard, but yet surgery on the jaw would be covered.
  • Co-pays sure to add up, too. Living with my medical condition, Ehlers-Danlos, manual PT is a lifeline and a way to reposition the constantly subluxing bones. But for many of us, we have a limit of money for the year for coverage so we either suffer or have to pay out of pocket to address our issues.
  • Insurance does help with some of the equipment needed, for instance, a power chair. However, co-pays can get really exorbitant. For some, it becomes too much to take on so the person suffers without the needed assistance.
  • I happen to only be able to metabolize a few medications and for pain, all I can turn to is ketamine or cannabis. I am lucky to live in the state of Rhode Island that has allowed the medical program into our state since 2006. However, as you all know, we don’t get reimbursement to buy the product or grow it. Others get to go to a pharmacy and fill their script, while we have to grow, fight mites, mold, the waiting process of growing to get our help along with no help financially.
  • Our life and house have been dedicated to trying to keep me alive. The money spent to travel to twenty-four surgeries, equipment like the hospital bed, power chair, manual chair, oxygen converter, bi-pap machine, etc. gets overwhelming and makes me feel guilty to have been the reason our retirement money is being frittered away. The dreams of traveling are pretty much shot, vacations are rare to none and we have learned to make trips to doctors and try to make them like mini vacations, but this attitude doesn’t always work!
  • Even food costs me extra. I am so restricted with food sensitivities, that I have to buy good, unprocessed, pesticide-free healthy food and that cost adds up.

I am shocked at how expensive it is to be handicapped and living with pain. I try so hard not to dwell on it, but there are times it feels overwhelming, along with unfair. I didn’t ask to have my conditions, didn’t do anything wrong to be born with them, and have had to pay the financial price. And I am a lucky one for there are times we have been able to swing the cost of things I need. But having recently downsized and still awaiting the money from selling our farm, I have had to again make those hard decisions and weigh out what can wait and what has to be down now. It is not fun to know there are things out there to help but one can’t afford to turn to them. I hope that someday the medical system will function as it should. The healthy majority should accept the responsibility for ensuring that the best care is available to all as I am sure that the vast majority of individuals and families will at some point in their lives, need costly care. Treating the chronically ill with the best comprehensive medical care may in fact save money by. For example, minimizing the anxiety from conditions such as depression and ulcers helps to provide the chance to live the best one can with what they have been inflicted with.

How Can Others Help?

  • Consider donating, when you are able, to go-fund me pages of those trying to cope with medical expenses. It is amazing how small amounts do add up and help others.
  • Consider donating to someone trying to cover the cost of a service dog. Many reached out and helped me that I didn’t even know.
  • Consider paying it forward with information of resources that one might qualify for but are not be aware of.
  • Consider donating used equipment to a program that refurbishes them or give directly to one in need. A simple post on Craig’s list can be effective. Many of us are experiencing the loss of family and friends who have had medical issues and have equipment that others could make use of.
  • Consider seeing if you can donate flying mileage points to one that needs to travel for medical needs.

May life be kind to you,

Ellen Lenox Smith