Costco Exposes Seattle’s Sugary Drink Tax With the Perfect Sign

www.digitalpoliticsdaily.com/2018/01/07/costco-exposes-seattles-sugary-drink-tax-perfect-sign/

On January 1, Seattle’s new ‘Sugary Drink Tax’ went into effect. Why? Seattle leftists want to dictate behavior and stop people from drinking soda because it can be unhealthy. So by taxing the soda, they are hoping to deter people from drinking it. But now, thanks to Costco, customers know exactly how much the city is soaking them for with the tax.

Costco in Seattle put up signs delineating exactly how the tax would cost people and Costco invited people to shop at its warehouse centers outside the city.

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http://www.sfgate.com/opinion/chopra/article/How-to-Be-Your-Own-Medical-Advocate-12480937.php

When the average person goes to the doctor, shows up at the ER, or enters the hospital, the possibility of controlling what happens next is minimal. We put ourselves in the hands of the medical machine, which in reality rests upon individual people—doctors, nurses, physician’s assistants, and so on. Human behavior involves lapses and mistakes, and these get magnified in medical care, where misreading a patient’s chart or failing to notice a specific symptom can be a matter of life and death. The riskiness of high-tech medicine like gene therapy and toxic cancer treatments is dramatically increased because there is a wider range of mistakes the more complex any treatment is. To be fair, doctors do their utmost to save patients who would have been left to die a generation ago, but they are successful only a percentage of the time.

Risk and mistakes go together, but the general public has limited knowledge of the disturbing facts:

• Medical errors are estimated to cause up to 440,000 deaths per year in U.S. hospitals alone. It is widely believed that this figure could be grossly inaccurate, because countless mistakes go unreported—death reports offer only the immediate cause, and many doctors band together to protect the reputation of their profession.

• The total direct expense of “adverse events,” as medical mistakes are known, is estimated at hundreds of billions of dollars annually.

• Indirect expenses such as lost economic productivity from premature death and unnecessary illness exceeds $1 trillion per year.

Statistics barely touch upon the fear involved when any patient thinks about being at the wrong end of a medical mistake. What the patient is all too aware of is the doctor visit that goes by in the blink of an eye. A 2007 analysis of optimal primary-care visits found that they last 16 minutes on average. From 1 to 5 minutes is spent discussing each topic that’s raised. This figure is at the high end of estimates, given that according to other studies, the actual face-to-face time spent with a doctor or other health-care provider comes down to 7 minutes on average. Doctors place the primary blame on increasing demands for them to fill out medical reports and detailed insurance claims. Patients tend to believe that doctors want to cram in as many paying customers as they can, or simply that the patient as a person doesn’t matter very much.

As a result there’s a new movement afoot to provide a personal advocate who stays in the doctor’s office with the patient. The advocate is basically someone who represents the patient’s best interests in any medical situation. The person might be a well-meaning relative who helps an older patient understand what’s going on, or who steps in to do attendant tasks like picking up prescriptions and organizing medical bills. But more and more one sees the need for an advocate who is professionally trained to buffer the mounting risks in a health-care system in which less and less time is spent between doctor and patient.

It would be up to an advocate to find out, and needless to say, this has created hostility from some doctors. Used to ruling their domain with absolute authority, few doctors want an overseer in the room asking questions, inserting their own opinions, and potentially finding fault. At worst, the specter of a malpractice suit looms. The movement for professional advocates, which is quite young, insists that looking out for a patient’s best interests is benign. The medical profession has its doubts.

The upshot, for now at least, is that patients who want an advocate must play the role themselves. At the heart of the problem is passivity. When we surrender to medical care, whether at the doctor’s office, the ER, or the hospital, we shouldn’t surrender everything. Poking and prodding is intrusive. Undergoing various tests can be stressful. The minute we walk in the door, we become largely anonymous—a walking set of symptoms replaces the person. There are doctors and nurses who take these negative effects seriously and who go out of their way to offer a personal touch. They should be saluted for their humane compassion in a system that focuses more on impersonal efficiency.

You may like your doctor and feel that he cares, but this doesn’t rule out being your own advocate. Quite the opposite—the inherent stress in medical treatment is what you want to counter. First comes the stress of worry and anticipation, what is commonly known as white-coat syndrome. We all remember how afraid we became as children thinking about getting a shot from the school nurse or how scary it was sitting in the dentist’s chair even before the drill was turned on. Studies have verified that anticipating a stressful situation can cause as great a stress response as actually undergoing the stress. In one study subjects were divided into two groups, one of which gave a public speech while the other was told that they were going to give a speech but actually didn’t. Both groups became stressed out, but the researchers wanted to measure how well they recovered from the stress

Knowing that you are going to be in a stressful situation, there are a number of ways to feel more in control:

• Be informed about your illness. Don’t relinquish your opportunity to find out exactly what is wrong with you. This doesn’t mean you should challenge your doctor. If you feel the need to inform your doctor about something you saw online, you aren’t being confrontational, and most doctors are now used to well-informed patients.
• If the illness isn’t temporary and minor, contact someone else who is going through the same diagnosis and treatment as you. This may involve a support group, of which many exist online, or simply talking to another patient in the waiting room or hospital.
• If you are facing a protracted illness, become part of a support group, either locally or online.
• Keep a journal of your health challenge and the progress you are making toward being healed.
• Seek emotional support from a friend or confidant who is empathic and who wants to help (in other words, don’t lean upon someone who is merely putting up with you).
• Establish a personal bond with someone who is part of your care—nurses and physician’s assistants are typically more accessible and have more time than doctors. Ideally, this bond should be based on something the two of you share—family children, hobbies, outside interests—not simply your illness.
• Resist the temptation to suffer in silence and to go it alone. Isolation brings a false sense of control. What actually works is to maintain a normal life and social contacts as much as possible.

Following these steps will go a long way to achieving the goal of patient advocacy, which is to serve the patient’s best interests at all times. But there remains a difficult unknown, the possibility of a medical error.

Seeing the doctor involves personal interaction, and it’s important to reduce any possible friction. Here are a few pointers:

Do

Be involved in your own care.

Inform the doctor and nurses that you like to be involved.

Ask for extra information when you need it.

Ask for a questionable event, like a pill you aren’t sure is the right one, to be checked with the doctor.

Tell somebody if you have gone out of your comfort zone.

Remain polite in all of the above.

Praise the doctor and nurses when it’s called for. A show of gratitude doesn’t go amiss

Don’t

Don’t act hostile, suspicious, or demanding.

Don’t challenge the competency of doctors and nurses.

Don’t nag or whine, no matter how anxious you are. Reserve these feelings for someone in your family, a friend, or a member of a support group.

Don’t pretend you know as much (or more) than the people who are treating you.

Don’t, when hospitalized, repeatedly press the call button or run to the nurses’ station. Trust their routine. Realize that the main reason patients call a nurse is more out of anxiety than out of real need.

Don’t play the part of a victim. Show your caregivers that you are maintaining a normal sense of security, control, and good cheer even under trying circumstances.

Probably the most important finding about medical mistakes is that they are frequently caused by lack of communication.

In our new book The Healing Self we delve into patient advocacy in more detail as well as covering the expanding role of self-healing, which is going to only become more important in the coming decades.

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www.drphil.com/videos/how-opioids-and-heroin-affect-the-brain/

It is estimated that 2 million Americans 12 or older are addicted to prescription pain relievers. According to the CDC, deaths from prescription pain killers have more than quadrupled since 1999, with 91 Americans dying every day from an opioid overdose.

“People sometimes think that an addiction is psychological. But we’re not talking about a psychological addiction here. We’re talking about an addiction that affects a number of structures [in the brain],” Dr. Phil says.

He is joined by Dr. Charles Sophy, who is board certified in adult, child and adolescent psychiatry, and family practice, and is the medical director for DCFS in Los Angeles, to explain how using opioids and heroin affect the brain.

“Any drug that you’re putting in your body is changing the chemistry of your brain, which will affect parts of your brain,” Dr. Sophy says. “Frontal lobe is the part that does executive functioning, judgment, insight, impulse control.”

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A couple of days ago I posted this blog 

#Walgreens: pharmacist told me he can no longer fill it (opiate) because I do not have cancer

“Hello Steve do you know who I contact to complain about filling my prescription? For the last 2 years I have been filling my prescription at Walgreens and the pharmacist told me he can no longer fill it because I do not have cancer. I am 60 yrs old have had 2 back operations my prescription is oxycodone 30 mg two times a day it’s crazy what he told me. Thanks”

On comment by a person whose ID’d  suggested that they have a PharmD degree … got me thinking… of the “excuses” Pharmacists are using to support their “medical decisions”

“Wow. As a pharmacist, I can assure you there is A LOT MORE to that story. It’s far more likely that the MD who wrote the RX is under DEA investigation or the MD is practicing outside of the scope of his/her practice (family practice MD who’s trying to function as a pain specialist, etc). And you are correct – there’s nothing you can do to force the Pharmacist to fill a script. Just the same way that a MD cannot be forced to write you a prescription, a pharmacist cannot be forced (or coerced) into filling a script.”

‘the MD who wrote the RX is under DEA investigation“… last thing that I knew about our legal system is that any us citizen is “innocent until proven guilty” I know one physician that has been “under investigation” for abt FOUR YEARS… this physician still has a license in good standing and still has a DEA license in good standing.  But this physician to is having trouble with some local pharmacists refusing to fill the controls this prescriber writes… to the best of my knowledge .. these same pharmacists do not have a problem with filling this prescriber’s prescriptions that are written for NON-CONTROLLED medications.

“MD is practicing outside of the scope of his/her practice (family practice MD who’s trying to function as a pain specialist, etc)“….

I wonder if these same Pharmacist challenge a GP/FP’s prescribing within their scope of practice for treating any pt with any number of health issues where there is a specialist that deals with a specific disease state… some particular examples.

If a pt is diagnosed with diabetes, should the pt then be referred out to a endocrinologist ?

If a pt is diagnosed with asthma or emphysema should be referred to a Pulmonologist ?

This list can go on and on ad nauseam

Some years ago I got a call from a Dentist who specialized in treating TMZ, myofascial trigger point pain and the like, he was also an associate professor at a large west coast dental school, but his prescriptions for non-controlled medications for the appropriate treatment of the disease issues that he was treating was being challenged by some local pharmacist for him prescribing “outside his scope of practice”… when in reality these Pharmacists only saw the initials behind his name indicating that he had a DENTAL DEGREE and JUMPED TO THE CONCLUSION… based on that slim amount of information that he was “outside his scope of practice”

And I agree with this poster that THERE IS A LOT MORE TO THIS STORY…  if what this pt said in the email to me is true.. that the pt had filled the same prescription at the same Walgreens for TWO YEARS from the same doctor… and this Pharmacist ignored this fact that what he was dealing with was a opiate dependent pt…  The dose was within the CDC’s guidelines as upper limit of MME’s  Pharmacists will require pts to wait until there is only 2 to 0 days of medication left from the previous prescription… so this pt being denied his routine opiate (Oxycodone) prescription could end up in a full blown COLD TURKEY WITHDRAWAL within a few hours not to mention UNTREATED ELEVATED CHRONIC PAIN.

All healthcare professionals have a “scope of practice” … who is in charge of making sure that Pharmacists do not exceed their scope of practice?

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The steady stream of celebrity stories about prescription drug abuse makes Americans keenly aware of the dangers of overdosing on medications like OxyContin and Vicodin. And from President Obama’s Drug Czar to California Attorney General Jerry Brown, politicians are calling for greater power to monitor doctor-patient relationships in order to fight the “epidemic” of prescription drug overdosing. But maybe the real epidemic is underdosing. Countless Americans suffer with severe chronic pain because doctors are afraid to treat them properly. Michael Jackson’s death unleashed a flurry of media stories about all aspects of the pop star’s life, including his alleged prescription drug abuse. On the same day countless millions watched Jackson’s star-studded memorial service, reason.tv interviewed another musician. Seán Clarke-Redmond, a man who enjoyed an active live before the neurodegenerative disease ALS, often referred to as Lou Gerig’s disease, rendered him nearly immobile—he can no longer even play the piano. The disease also left him in almost constant pain. Redmond is prescribed some medication, but not nearly enough to keep his pain under control. Dr. Frank Fisher says Redmond’s case is an appallingly common one. “Chronic pain in America is an enormously under treated disease,” says Fisher, a Harvard-trained physician. “It’s a public health disaster.” Pain specialists like Fisher and patients’ groups like the Pain Relief Network battle law enforcement officials who are forever on the lookout for “pill mills” and patients who misuse pain medicine. Fisher notes that the same medications so often associated with celebrity addiction are the same medications that combat pain most effectively. Fisher has treated his patients with high doses of opioids-that is, until a swat team raided his clinic and threw him behind bars. “They were trying to give me 256 years to life,” says Fisher who argues that fear of prosecution often prevents doctors from treating chronic pain patients effectively. What allows doctors’ medical decisions to be overruled by police? “What we’re dealing with is a mass insanity,” says Fisher. “We call it the war on drugs.” “When Cops Play Doctor” is written and produced by Ted Balaker and hosted by Nick Gillespie. Director of Photography is Alex Manning, Associate Producers are Hawk Jensen and Paul Detrick.

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https://www.heraldandnews.com/news/medications-malpractice-holding-doctors-accountable-can-prove-difficult-for-patients/article_4b4841af-552f-56c7-8c26-b74431036aa4.html

Lori Lester never dreamed that her husband of 15 years — and someone she had known for 40 — would take his own life.

“He was a very happy man, everyone said that about him,” the Klamath Falls realtor told the Herald and News this past week. “If you were down, he would lift you up, no matter how bad a day he had. He was always upbeat.”

Yet, at age 59, John Lester shot himself in their ranch-style home off Old Midland Road on Jan. 8, 2014.

John’s close friend, Bub Haigh, and Lori had made plans the night before to take John to Bend to seek medical attention. On the morning of the 8th, Haigh was en route and Lori was rushing out of the house to feed the horses so she could travel with Bub and John to Bend.

“After I fed the horses, we were just about to leave when I found him in the bedroom,” she said.

Up until Christmas 2013, everything seemed to be going in the right direction for the Lester family. They were finally getting clear of debt incurred while operating long-haul trucks and a gravel-hauling business, Lester’s Dump Trucks. Lori, now 59, had purchased a Klamath Falls real estate business (Apodaca-Pierce and Associates) and the family was busy planning outings for the coming year.

“He told me that 2014 was going to be more for me [her year],” Lori said. “We had finally made it over the hump, we owned our equipment outright. John was planning on remodeling our home that year, which had been built in the 1950s. He had bought new appliances and had worked on replacing the countertops. He was just so upbeat.”

Anxiety attacks

It was about five years ago that the anxiety surfaced.

John had been taking medications for “travel anxiety” that could be traced to an incident early in his career.

“He was unloading a truck in Bakersfield, Calif., when the engine in the back of the truck exploded. He received serious burns on his arms, back and face and was hospitalized for three months,” Lori said.

“At one point we were going to Bend to see the children when he said we needed to turn around. I had never seen him like that. We had to head home. It was tough to plan a trip anywhere. That’s when we sought medical attention,” she said.

By the end of December 2013, however, John Lester was on a downward spiral. For five years, 2009-2013, he received insomnia and anti-anxiety prescriptions from a Klamath Falls clinic.

In December of 2013, doctors at the clinic cut off his prescriptions, warning they were highly addictive.

John ran out of his prescriptions for sleep and anxiety just before Christmas. He returned to the clinic with worsening symptoms, more than once, asking for refills for the medications he had been given since 2009.

“He was so surprised they had cut him off, rather than lowering the dosage or finding something else he could use. I didn’t know what to do. He wouldn’t let me call 911 to get him help.”

It was four years ago Monday.

The clinic where he was refused more medications was Basin Immediate Care, owned by TLP Inc. and operated by physicians Thomas Koch, Laura Moore, Kathie Lang and J. Eric Brunswick. They were the subject of a medical malpractice lawsuit brought by Lori Lester in October 2015.

In March 2016, the case was dismissed from trial with “no awards to either party,” the court order obtained by the H&N read. However, H&N would later learn the case went to confidential negotiations for settlement instead of trial. (For details of the suit, see the sidebar online).

The clinic’s doctors were contacted through their office manager to comment on this story, but they declined. The physicians and Lori Lester cannot talk about the settlement as they are all bound by a non-disclosure agreement.

“I would not wish this on anyone. I came home to a dark house every day after John was gone, there wasn’t even a noise.” Lori reminisced, “We had made plans for the rest of our lives.”

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https://www.doximity.com/doc_news/v2/entries/10680265

On a recent trip to urgent care for my child, I began to more clearly see how the changes in medicine are affecting our patients and who is benefiting from the bottom line of what is occurring in the US healthcare system.

A minor injury to my 2-year-old son had me waiting patiently to be seen at a local urgent care center. Eventually, a nurse practitioner evaluated, correctly diagnosed, and successfully treated my son. (I make it a habit not to treat my own children, as I feel it more appropriate to be “mom” instead of “Dr. Jones” to my children in these types of situations). I appreciate nurse practitioners and feel they provide a great service and are filling in gaps in areas of need, especially in this time of physician shortage.

My concern arose as I considered how this medical care visit was truly playing out financially. I paid a copay with my insurance; no big deal; it was $30. My insurance would be covering the majority of the visit. However, ultimately the company running the urgent care facility would be charging the same rate to my insurance and same copay to me for my son’s care regardless of whether I saw a physician or a nurse practitioner. I went as far as calling a billing specialist in membership services at my insurance company to ask if this was the case. She confirmed that there is indeed not a separate charge for urgent care visits depending on the level of provider seen.

My question to anyone who has seen a nurse practitioner or other qualified individual is, “Is your co-pay lower for the service? Do you receive a discount for not seeing the higher paid/more trained physician?” In my situation, there was no reduction of copay. So, if they are collecting the same amount for the service provided despite a disparity in income level of the provider, who benefits from this profit?

The company running the urgent care center reaps all of the benefits of employing a healthcare provider with a lower salary than that of a physician. Their smaller salary likely means more profit for the company.

Again, I am in no way against using mid-level providers, nurse practitioners, midwives, etc. They are here to stay and play an important role in healthcare moving forward. However, my argument is that if a company is benefiting financially from hiring “cheaper” people to provide care to their patients, they should at least be passing the savings on to the patients who are receiving the care. Often, these companies are looking for the financial bottom line and what they can get away with to reap the most profit. It is a primary responsibility of top administrators to make money for the company, and we can hardly blame them for successfully completing the role they were hired to fulfill.

Transparency is required in these situations. The patient must know they are not seeing a physician — when they could be — for the same cost to themselves and their insurance company. They should have the ability to demand physician care if desired.

A prime example how this business scenario is becoming the future of medicine can be seen in the recent proposed merger of CVS and Aetna. The companies involved are in a massive media campaign to make patients think this is to their benefit. Please remember, these are businesses at the end of the day, and their ultimate goal is to increase financial return to investors. The basic facts are still at play: a drug store is buying an insurance company.

On Wall Street, the widely held belief behind this merger is that by teaming up, CVS and Aetna can have a fighting chance against the behemoth that is “Amazon”, as this online giant attempts to get into prescription drug sales.

Often, the patient is the one to suffer in situations such as this merger, as they will actually pay more and receive less choice. It’s a monopoly, and if your insurance is owned by a drug store company, guess which prescription you will likely receive? The one on formulary at CVS of course! So, if the prescription chosen to treat your condition is on formulary at CVS, there most certainly is less overall cost in the healthcare transaction. So, does the patient pay less since their prescription costs less or a lower copay for seeing a mid-level provider in a “clinic” in CVS stores?

You guessed it, the company will profit each time a prescription is written for a drug under their formulary instead of one that isn’t. The company will also profit each time a mid-level provider sees a patient instead of a physician. Again, is this in the best interest of the patient?

One last piece of information to consider, the Aetna CEO will walk away with $500 million in cash and stock if this deal goes through. This executive, who is not a physician, has much to gain from this merger. I don’t begrudge anyone good fortune, but I also don’t believe the media should portray that the patients are the primary ones to benefit in a deal such as this.

Patients and physicians are no longer accepting the status quo and what everyone outside of healthcare is telling us is “in our best interest”. We see and understand what is going on. We are speaking up and demanding better.

Dr. Valerie A. Jones is a board certified OB/GYN and ACOG Fellow. She is currently a Doximity Fellow and physician/patient advocate. She can be reached on her website: ObDoctorMom.com.

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Hello Steve do you know who I contact to complain about filling my prescription? For the last 2 years I have been filling my prescription at Walgreens and the pharmacist told me he can no longer fill it because I do not have cancer. I am 60 yrs old have had 2 back operations my prescription is oxycodone 30 mg two times a day it’s crazy what he told me. Thanks

I can tell you who to complain to …but… NO ONE CARES… and WILL NOT DO A THING…

Let’s start with Walgreen’s corporate… their Rx sales are up 7%+ and they just picked up 2000 former Rite Aid stores.. they are good for the next year or two with the stock market looking for them to increase sales/profits…  We have a serious – and growing – pharmacist surplus… and if they were unhappy about their pharmacists running customers off – especially those having controlled Rxs filled – they would replace those pharmacists… but.. they are not… you  can call them and they will tell you that they can’t force a pharmacist to fill a prescription – and they are right… but don’t have to keep those who do employed…

You can file a complaint with the pharmacy board… but most of those boards are stacked with non-practicing corporate pharmacists and they are not about to do anything against those who sign their paycheck.. and they will also tell you that they can’t make a pharmacist to fill a prescription.. although they could investigate a pharmacist for denial of care for failing to fill a legit/on time/medically necessary Rx and fine, suspend and/or charge them with unprofessional conduct … but… they won’t

You can file a complaint with your insurance company because Walgreen is listed as one of their preferred pharmacies network… and they will tell you that they can’t make a pharmacist fill a Rx… and they could threaten to toss Walgreens out of their network … but… they won’t… because they continue to get monthly premiums to provide you with necessary medical services and if they don’t have to pay for your Oxy… they end up making more money… and after all … they are a FOR PROFIT business …

Walgreens is discriminating against someone who is disabled and it is a civil right violation under the Americans with Disability Act and you can file a complaint at the federal level but it is under the Dept of Justice … just like the DEA… so hell will probably freeze over before one federal agency takes on another federal agency violating laws… especially since they are under the same Cabinet position.

IMO.. your only option is to find a independent pharmacy where you will be dealing with the Pharmacist owner and unlike the Walgreen’s – or any other chain pharmacist – doesn’t get paid by running customer off…

Here is a website to help you find one by zipcode   http://www.ncpanet.org/home/find-your-local-pharmacy

Transfer all your prescription to one.. .Walgreens doesn’t deserve your patronage and you should not have to beg someone to let you give them your money.

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