Less Price Relief From the Haven of Generic Drugs

High costs, in point of fact the highest cost of pharmaceuticals, have been a given for the resident of the United States. Citizen/health care consumers of these drug prices have pretty much accepted this state of affairs since the late 1980’s when under the Reagan administration, in anthromorphorzing view of the human-like actions of the big drug companies, upped their periscopes from the national headquarters bunkers, looked around at the regulatory landscapes, and saw the lack of regulation creating a manna from Heaven business opportunity for their business model and industry. And that was the realization that they could jack up prices even more and not get their knuckles rapped by the feds, or any of its past oversight, regulatory agencies.

And so, in my ‘industry, “healthcare,” [a term I and most providers hate unless they are more business types and less health care devotees in practice to make a decent living but mostly to serve their patients and ‘do good,]  became ‘business-ized at the upper, larger, company levels. Hospitals started buying up medical, surgical, and specialty practices at huge rates for the last 20 years. Providers found themselves being squeezed, pressured and commanded to evolve into a factory-like production model of seeing as many patients in as short an individual time as possible. Seeing patients does not lend itself easily to the Henry Ford conveyer belt mass production manufacturing model that has been the basis of modern production and business model that has dominated the industrial revolution since the early 1900’s. But the medicine behemoths have tried. And now they have reached the limits of that as patients and providers have typically 15 minutes or less for histories, physicals, treatment planning, execution and referral and whatever else is called from. Solo practices have disappeared as the economics of a single revenue generator cannot pay the overhead anymore, e.g., purchasing and maintaining a high-end mandated health information and record keeping system that is also used to monitor the quality of care issues and determine level of reimbursement for that poor shcmuch doctor living and practicing in the past. Groups have had to expand greatly, buy out other practices mirroring the wave of mergers in all industries who have had to adopt the same strategy to stay competitive for decades.

Now with limits of squeezing out more and more revenue of a system that cannot increase production beyond a certain limit, unless unscrupulous money making practices such as ordering procedures for larger numbers of patients that are not needed, medicine is turning to big data as its saviour to somehow point to population-wide ventures based on disease management through data that tells the data trend sifters and analysts what could need new attention and new ways of inventing new health care measure and generating reimbursements for preventive services to the ‘still well.’ Wellness program, weight loss programs, stop smoking campaigns, yoga classes, preventive back injury exercise programs (do you know any furniture movers or long distance truck drivers who need those, actually taking and paying for them? No, I didn’t think so.

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Left Wing Radicalism Again, Though Different, Still All Bad

I will make my apologies at the outset for this post, as it may be controversial to some readers but I feel it is well indicated given our growing trend of extremism on all sides of the political spectra.

I have kept this kind of controversy out of my posts but I feel the need to comment from my own in the middle, moderate perspective, that at times, seems endangered nowadays.

The controversy is about facing up to the evils and poisonous dangers of extremism on both ends of the ‘political’ landscape. Left-wing extremism has long been known since the 1960’s Memories of the Weathermen, SNCC,  SDS and other groups come easily to mind for students of contemporary American history. I can remember doing the student thing of attending meetings and learning somewhat from the inside, and hearing such figures speak and hold forth such as Rennie Davis, Tom Hayden latter of Jane Fonda and California state assembly renown when he ‘grew up’ and changed. Also, I heard Stokely Carmichael and lesser known figures such as Eric Chester expound their views of radical change that went nowhere and were clearly misguided but borne out of the frustration in the years of Nixon and the Vietnam War divisiveness in this country. I recall talking all this over with my conservative WWII viewpoint’ed father, reassuring him that I was not being “radicalized,” and hearing his stabilizing observations that helped me maintain an independent perspective. Radicalization of course nowadays is a political phenomenon that is once again puzzling and alarming everyone but is not at all new in this country as some more alarmist commentators would have us believe.

A difference is that one check and balance working against the radicals movements of the sixties and seventies is that they were disorganized and very naive–fortunately. Only a few heinous acts of violence came out of those years and movements, notably the  bombing of the  physics lab at the University of Wisconsin at Madison by the Harrises, a radical husband and wife team who were on the run and living under false identities for over three decades until they surfaced and were discovered several years ago. Also the left wing radicalism never really caught on in much of an organized way.

Radicalism nowadays, whether of Muslim extremism or right wing militias, are more organized than the ‘student radicals’ ever were. Additionally, as Michael Douglas’ prophetic movie, Falling Down of 1993, foretold over two decades ago, we have moved into the era of the lone wolf extremist. The Shoe Bomber and Timothy McVeigh, although from diametrically different world views, were essentially more alike than different. They were loners, disaffected, politically warped individuals, who fell prey over a period of time to equally disaffected political extremist philosophies. This long wolf path is far more dangerous to detect and prevent or reach ideationally in order to help them out of the traps of extremist philosophies.

One mantra that I have never forgotten says ominously, “Violence is the last refuge of the hopeless.” This has become and will continue to be an important motivator for the disenfranchised and for those who feel cast aside by large social forces such as decline of past bedrock industries such as manufacturing, coal mining and other economic sectors that have been eroded to a shadow of their former power and reliable vast sources of employment in this country.

It appears that the baseball park shooter in Arlington Virginia who shot and targeted Republican Congressional members was likely such a disaffected loner person. The very recent report late this week (June 15th week, 2017) that he may have had a list of Republican targets is unfortunately not surprising. Those who feel totally disenfranchised will blame and direct their frustrations that evolve into a rage that robs them of the ability to see their adopting murderous extremism as terribly wrong by any moral or ethical yardstick.

It seems to have been lost the awareness that ‘words do matter,’ and set the tone for public discourse in the social and political arenas.Caution in this regard has been lost by all quarters. This has very great import when we forget that the less mature, less controlled, less reasoned, and more vulnerable members of us, can be greatly motivated in bizarre and disturbing ways by acrimonious climates of discourse.

The current social trends cause me to appreciate how important Dr. Martin Luther King’s and Gandhi’s emphasis on nonviolence in their protest movements for equality and enfranchisement in all the important political and social realms. I continue to be amazed there was not more rageful violence on the part of blacks in this country. Nelson Mandela as has been recognized for decades and again recently by honest commentators led his peoples to not wage race war as many whites feared when apartheid was abolished and the black majority finally assumed political power in South Africa. He forgave and instituted the national truth and reconciliation commission that identified political atrocities and crimes against humanity without permitting descent into the kinds of horrific, senseless butchering of the French Revolution and its emblematic guillotine slaughter.

The disenfranchised tend to target the party in power. They see them as the architects of their misery and target them accordingly. I have worried for months, given my long term interest and understanding of radical movements derived from my witnessing them in my student days in one of the radical centers, Ann Arbor, in this country in the late sixties and early seventies, that we might witness the development of such disturbed actions as the vitriol of the past 20 years, has reached recently in the national political campaign of 2016 and the rhetoric of all parties but perhaps more noticeably to the disturbed of the Republicans. I hope I am wrong but I fear we shall see perhaps more loner acts from the disenfranchised toward the party in power. This will not help any of us at all and may be a social phenomenon we have to weather and learn to correct the level of our political discourse. But I take heart that if the IRA and the Northern Ireland establishment could move to deal with each other reasonably and more and more without mindless radical violence, then we can also.

 

Psychopathy and Its Growing Understanding

I have long been stumped, frightened and intrigued by psychopathic persons since encountering them in adolescence in my sheltered growing up years. Then in college, I began to see them in action in observing some arch manipulators and charismatic leaders in the circles of campus radicalism around me in the late 19060’s and early 1970’s. I attended a large university that was one of the national hotbeds of student radicalism. I was fortunately naive and protected by this in a sense though I did not realize this at the time. What I did realize was the ideas advocated by most student radical leaders, both local and national, were in my view “just plain nuts.” Then I began to realize their effect on surrounding students, some of whom I knew. The followers were almost ‘converted’ by the charisma of these charlatans. One speaker/leader I particularly remember was an acclaimed author of one of the Bibles of those years, but he had a very checkered personal and legal background that everyone who endorsed his ideas, ignored. He was actually instated by the university as a writer in residence for a semester, holding seminars and colloquia. He as incredibly smart, clearly of superior, genuine intellect, and many of his student attendees ate up what he had to say. However, I am happy to be able to say that many of us had a totally different take on him as a showman, manipulator, a ‘false prophet’ as the Christian or Jewish community might term him, and intellectually dangerous. Fortunately, the program that he was operating under as a guest temporary faculty, permitted open separate discussions by students who were exposed to him. It was in a sense reassuring that many of us saw through his entire view of the world and realized he was in his own way dangerous. But he was really good at carrying off his “schtick” as some in the entertainment industry would call it. So good that he was famous on the basis of his one book he had produced that had charmed millions I would expect and was a best seller for years, and still is standard fare for the college student for the last forty years.

As a medical student, I was exposed to psychopaths a few years after mulling over my attendance at the above-described author’s seminars. These persons continued to stump me. I recall interviewing once a copycat killer who emulated Ted Bundy (still alive at the time, but imprisoned and very famous). This man was designated a “criminal psychopath” under that state’s forensic laws and serving an “indeterminate sentence,” a sentencing category that largely does not exist because of unconstitutional issues. I recall this man had applied for admittance to the nearby state university’s law school. Of course, he was turned down as unfit, but that did not stop him. He sued the law school briefly on the grounds that since he felt then President Nixon was a “psychopath,” and was a lawyer himself, this man could also become one. My encounter with him and his absurd lawsuit occurred during that later stages of the Watergate hearings and President Nixon’s downfall. But the grandiosity and anti-social conviction and self-justification of this man astounded me and further added to my almost locked in interest in this subject.

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Leftist Radicalism Ignores Free Speech As Readily as Right Wing Does

In this morning’s Education section of the Washington Post, an article appeared, “Ann Coulter a no-show at raucous but peaceful Berkeley rally,” which gave me a very sad case of Yogi Berra’s famous saying to the effect that ‘It’s deju vue all over again.”

Over the last few weeks, there has been a shameful display of political intolerance, ignoring of the fundamental right of free speech that this country tries to maintain, sustain, uphold and protect for the good all. But it has been roundly trashed in Berkeley CA on the campus of UC Berkely the few weeks. The controversial right-wing political commentator Ann Coulter who has become I suppose in the last several years the left wing-nuts vision of Joe McCarthy, Rasputin and The Wicked Witch of the West for that Far Left. Ignore that she is in her own right, very bright and in my opinion DOES speak for a very sizeable segment of the American populace unhappy with the decline of the middle class, wage freeze, resentment of the growing power of the Federal Government etc. She has useful things to say and a number of them need attention and to be welcomed into the world of political discourse in this country. They do represent a “sizeable portion” of our citizenry’s heartfelt ideas.

I am a centrist which means I catch it sometimes from all sides it seems. Personally I find Ann Coulter astonishingly fascist in some of her remarks but I have to give her credit for raising issues that the liberal elites in this country ignore, pooh-pooh as beneath them or as the by product of inferior minds or the less educated. And therein lies the dead giveaway that those who denigrate Ms. Coulter, who dismiss her observations and points out of hand, are just as prejudiced and “fascist” as those they label as such.

I am personally glad to hear that the ACLU whom some quarters loathe and still see as the fount of communism, radicalism, or some other evil “ism,” is coming to Ms. Coulter’s defense. Ms. Coulter was not only extremely shabbily treated by Berkeley but her freedom of speech was trampled on just as if she had been stampeded over by a herd of my maternal grandfather’s vast cowherds of New Mexico of the 1930’s.

I went to college in one of the hotbeds of student left wing radicalism of decades ago and remember the exact same issue transpiring. A very conservative well-known figure’s announced appearance at an upcoming educational colloquium at the university was reviled days and weeks ahead of time and would have cancel or be subjected to embarrassingly shameful treatment, being interrupted by horrendous offensive heckling to the extent they could not speak and so on. I feel cheated as I was a big naive student sponge back then and wanted to hear what everybody had to say unfettered so that I could digest their ideas, mull them over and decide what I thought was legitimate and useful no matter what end of the political spectrum it came from. I saw the exact same kinds of brutish, intolerant, shouting down of reasonable advocated for the exchange of ideas played out semester after semester. I came to conclude that the wing-nuts from bosideside of the political  spectrum were more similar, more “fascist,” equally intolerant, and equally dangerous to rational reasonable discourse and debate as whatever dictator was in power and in power in some other part of the world back them. And if I voiced my sentiments as I did a few times at student colloquia when I was an upperclassman and more sure of myself on a stage with a microphone in my hand, I was shouted down until I had to give up and leave the stage.

I foresee right wing backlash this time as being more likely than it was 40 years ago when I was a student. Fortunately back then the local state legislative leaders looked upon those “student antics,” as not so dangerous and were peacefully paternalistic about it all with some sort of “students will be students,” mantra and trusting that most of them would “grow out of it.”

Not now. I fear that after decades of this kind of dumb behavior, right-leaning legislators are going to realize that they have legislative power over their state-funded universities and could easily come to the ideas of retaliatory financial punishments as consequences. The older generation in power could easily economical severely spank the upstart pesky intolerant students. Loyalty oaths for faculty efforts could follow. And we would be off to the races of more polarization which would no do any good at all and only “harden their hearts,” on both sides, and make their “necks stiff”-er than ever. And there would go trying to find common ground and be moving toward the unifying middle and the needed art of tolerance of another’s differing point of view, so necessary for a democracy such as ours has been for so long out the window sucking all dieas out into the void of dead intellectual “space,” which would be a great loss for all of us.

 

Fentanyl Overdose Deaths Surge in North Carolina in 2016

As Ms. Hoban very accurately wrote fentanyl is incredibly more potent that ‘your average narcotic,’ in that it is “as much as 100 times stronger than morphine.” Further in her article what I consider one of the more malignant aspects of this epidemic. That circumstance is that once again like unto the LSD age of the late 1960’s and the early 1970’s, the “chemists” are coming out of the woodwork and generation analogues, biochemical close cousins of the fentanyl faster than legislatures can identify, classify and outlaw them.

Amd it is now well known that most of the sources of the “fentanyls” as one almost has to speak of them in the plural, are coming from outside the country, much of the on the street supply coming from Mexico. Economic incentive to manufacture, smuggle in, cut and distribute and then finally sell on the street is massive motivating. While a kilo of heroin is worth at least a thousand dollars on the street, a kilo of fentanyl is worth a million dollars!

One of the subtle but constant and ‘reliable’ characteristics of fentanyl is that it is rapid acting, fast in its time from ingestion to onset of effect. Simply put, this means that this drug gives the ingestee very little time to signal for help if they detect that the dose they have guesstimated for themselves is too large, they have almost no time to get life saving treatment.

Several years ago, the NC Medical Society did a brave thing and started providing free, no questions asked, EpiPen-injectors of naloxone, the narcotic antagonist or “reverser” drug. One county that had a rising and alarming amount of opiate related deaths was selected. The injector pens were given to families with opiate addicts in clinics, medical offices in a nonjudgmental manner in that no law enforcement figures were called, no recipients were arrested. It became clear over time that the program was saving lives in unprecedented numbers.Use of opiate-reversal drug naloxone has become more accepted over the past decade as law enforcement agencies, social service agencies and even the state health director have promoted its use as a harm reduction agent nationwide now.

As the authors of this article pithily phrased the lesson learned: “Dead people can’t find recovery,” demonstrating the all too obvious circumstance that if a drug abuser is save from death, recover can start and have a change of turning a life around.

Still use of naloxone to give to an unresponsive fentanyl often requires many times the doses of the same drug naloxone when dealing with a heroin overdose. Counties in many many locales are finding that their budgets are ballooning almost out of control posing another perhaps partially unforeseen problems.