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Archive for the ‘Healthcare’ Category

Will the VA Let Doctors Recommend Medical Marijuana to Veterans?

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Philip Smith reports in Drug War Chronicles:

On Wednesday, a group of 21 US senators and representatives sent a letter to the Department of Veterans Affairs calling on it to allow VA doctors to discuss and recommend marijuana as medicine in states where it is legal.

The bipartisan effort was led by Sens. Kirsten Gillibrand (D-NY), Steve Daines (R-MT), and Jeff Merkley (D-OR) and Reps. Earl Blumenauer (D-OR), Dina Titus (D-NY), and Dana Rohrabacher (R-CA). All represent medical marijuana states.

Under current VA policy, embodied in VHA Directive 2011-004, which expires Sunday, VA doctors are prohibited recommending marijuana as a treatment option even in legal states. This discourages patients and doctors from being honest with each other.

“According to the current directive, VA providers are prohibited from completing forms seeking recommendations or opinions regarding a veteran’s participation in a state-sanctioned marijuana program. This policy disincentivizes doctors and patients from being honest with each other,” the solons wrote. “Congress has taken initial steps to alleviate this conflict in law and we will continue to work toward this goal. However, you are in a position to make this change when the current VHA directive expires at the end of this month. We ask that you act to ensure that our veterans’ access to care is not compromised and that doctors and patients are allowed to have honest discussions about treatment options.”

If patients can’t get a recommendation from their VA docs and thus can’t access dispensaries, they would be tempted to go elsewhere for recommendations, to doctors “likely far less familiar with their symptoms and medical history,” the solons wrote.

Noting that there has been a “sea change” in the legal framework around marijuana since the directive was issued in 2011, they asked that “upon the directive’s expiration, any new directive remove barriers that would interfere with the doctor-patient relationship in states that have chosen to legalize marijuana for medical purposes.”

But without a new directive, even though the old one is expiring, it will be the status quo at the VA, said Michael Krawitz, a US Air Force veteran and executive director of Veterans for Medical Cannabis Access. Krawitz participated in the process that led to the production and distribution of the directive.

“VA Directives remain in effect with full force even after expiration unless they are officially replaced or rescinded,” he said. “Although I can understand that patients might not know that and might get uneasy about the expiring directive, but in practicality there should be no change in clinical practices caused by the expiration.”

While VA patients could be spooked by the expiration, the status quo is unacceptable, said Dr. Sue Sisley, MD, in clinical psychiatry and internal medicine, who has two decades of experience treating veterans and who is set to do apilot study on medical marijuana and PTSD for veterans.

“I’ve worked with veterans all over the country who are dealing with severe and chronic, debilitating medical problems,” she said. “They just want the treatment that is going to help them the most, with the least side effects. I have seen firsthand the dramatic improvement so many veterans have had while taking cannabis. Not only have they experienced relief from problems such as PTSD, chronic pain, and migraines, but many of them have also been able to break their addiction to more dangerous drugs, such as opioids and benzodiazepines.”

VA staff physician Deborah Gilman, MD, said current VA policy forces physicians to ignore the science if it conflicts with policy.

“Unlike private practice physicians, VA physicians are under a gag order regarding discussing marijuana with patients,” she said. “In other settings, doctors can be honest about their medical opinions regarding treatment options, based on science. In the VA, an administrator can write policy that you can’t disagree with without losing your job. Veterans are fearful of losing either their medical benefits or their access to health care if they acknowledge using marijuana. This causes a VA doctor to give you a medical opinion based on the VA regulation, not on the science. I knew many VA doctors whose professional opinion was that cannabis might help some of their patients, but they could never say so in their office or in public.” . . .

Continue reading.

President Obama is in charge. Isn’t he? Doesn’t the buck stop there?

Written by LeisureGuy

5 February 2016 at 11:03 am

Shkreli Was Right: Everyone’s Hiking Drug Prices

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I don’t think that “They’re doing it, too” is much of a defense for a wrongful act, but the fact that Shkreli is correct in pointing out that other companies are also profiteering by jacking up prices of drugs people must buy is an argument that government regulation is required. The free market will not fix a problem created by the free market.

UPDATE: Read this Atlantic report about Shkreli’s appearance before the House committee.

Robert Langrath and Rebecca Spalding report in Bloomberg Business:

After Martin Shkreli raised the price of anti-parasitic drug Daraprim more than 50-foldto $750 a pill last year, he said he wasn’t alone in taking big price hikes.

As it turns out, the former drug executive was right. A survey of about 3,000 brand-name prescription drugs found that prices more than doubled for 60 and at least quadrupled for 20 since December 2014.

Among the biggest increases was Alcortin A, a combination steroid and antibiotic gel to treat eczema and skin infections: The price soared 1,860 percent, or almost 20-fold, during the period. And a vial of Aloprim, a Mylan NV drug for cancer complications, more than doubled, according to the survey by DRX, a provider of price-comparison software to health plans.

Skyrocketing prices are getting increased scrutiny ahead of a U.S. congressional hearing this week: Democratic Representative Elijah Cummings, ranking member on a committee that is probing drug pricing, said Tuesday that pricing “tactics are not limited to a few ‘bad apples,’ but are prominent throughout the industry.”

Big price hikes

Even after soaring prices became an issue in the U.S. presidential campaign, the cost of many drugs has continued to rise at annual rates of more than 10 percent. Drugmakers raised the prices of products as wide-ranging as erectile dysfunction drug Viagra, heart treatments, dermatology medicine and even brands that long have lost their patents. While specialty companies have had the steepest hikes, giants such as Pfizer Inc. and GlaxoSmithKline Plc kept pushing through smaller rises.

“The data shows that price increases are an integral part of the business plan,” said Jim Yocum, executive vice president at DRX.

Pharmaceutical companies often boost prices around the end and the start of the year, and the scale of recent increases was higher than what Yocum has seen in the past few years. About 400 formulations of brand-name drugs went up at least 9.9 percent since early December, according to DRX. . . .

Continue reading.

Written by LeisureGuy

4 February 2016 at 12:54 pm

Guinea Worm Is Set to Be the Second Disease We’ve Ever Managed to Eradicate

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Jimmy Carter has reason to be proud of this great accomplishment. Nell Frizzell reports at Motherboard:

The image of a serpent twisting around a staff is probably medicine’s most enduring icon; we wear it on medical alert bracelets, hang it in doctors’ surgeries, and print it on healthcare documents. But the story behind the so-called fiery serpent is, at least according to former US President Jimmy Carter, almost over.

Since 1986, incidences of Guinea worm disease have reduced from 3.5 million to just 22. Read that again—just twenty-two. It’s a drop so enormous that medical experts believe Guinea worm disease is on the brink of becoming the second ever human disease to be completely eradicated through human endeavour, the first being smallpox in 1980.

This week, The UK’s Department for International Development announced a £4.5 million partnership ($6.6 million) to support the Carter Center’s Guinea Worm Eradication Programme. Following the announcement, Carter took to the stage in the gloriously camp, gilt-edged Queen’s Robing Room at the House of Lords on Wednesday evening to speak about his 30 years spent battling the disease.

For centuries, the only treatment for Guinea worm has been to wait for the parasite, which breeds unseen in stagnant water, to burrow out of human skin, then wrap it around a stick and slowly wind it out of the body like a blistering cotton reel over 20 days. This is one theory of where we get the snake around a staff symbol from—a worm and a stick. The process of extracting Guinea worm is not only as unpleasant as it sounds (the worms grow up to a metre long and can break out anywhere on the body, sometimes with as many as 81 emerging from a single person, according to one representative of the Carter Center) but the lesions can often lead to secondary bacterial infections. In short, getting Guinea worms out of your body is every David Kronenberg nightmare made flesh.

The eradication of Guinea worm disease is, in his own words, former President Jimmy Carter’s “most satisfying achievement.” In 1988, just a few years after leaving the White House, Carter travelled to Ghana where he saw a woman holding what he thought was a baby in her arms. As he moved closer, he realised that what this woman was holding was in fact her right breast; a Guinea worm was emerging from her body through her nipple, creating a searing blister and untold tissue damage. As there is no known cure for Guinea worm disease, the focus had to instead be on prevention; educating what Carter described in his lecture last night as “the poorest of all people, but who are as intelligent, ambitious and as hard-working as we are.”

The science behind the programme is so simple that it can be communicated in a cartoon. A special water filtration system—which looks like little more than a large fine-weave hair net fitted over a bucket—cleans water of the copepods or “water fleas” that carry the Guinea worm larvae. In Nigeria, which had 656,000 cases back in 1988 at the beginning of the programme and now has none, 6 million square metres of a special fibre were created to filter people’s drinking water without rotting in the damp, tropical conditions. In countries like South Sudan, where people frequently move around to access water, the Carter Center gives out special straws, worn around your neck like a pendant, to filter water as you drink it.

Back in 1986, there was no YouTube, no television, and little radio to be found in the countries worst affected by Guinea worm disease. So the medical experts involved in the programme turned to cartoons—posters and picture books showing how Guinea worm disease is contracted and how to filter your drinking water. These pictures have now become so widespread that they can even be found printed on the cloth that people use to sew t-shirts, dresses and shirts—literally a walking advertisement for the public health programme. . .

Continue reading.

Gruesome photo of a guinea-worm extraction from someone’s foot is shown at the link.

Written by LeisureGuy

4 February 2016 at 12:24 pm

Judgment calls in evaluating Bernie’s healthcare plan: single-payer

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Kevin Drum gets down into the nitty-gritty of evaluating costs of proposed plans. And it’s quite interesting, showing how two people looking at the same plan can differ greatly in their estimation of costs—and thus in answering two key questions, “Is it worth it? and is it fiscally sustainable?”

Written by LeisureGuy

3 February 2016 at 6:15 pm

Paul Krugman Unironically Anoints Himself Arbiter of “Seriousness”: Only Clinton Supporters Eligible

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Glenn Greenwald points out an interesting turnabout by Paul Krugman:

For years, New York Times columnist Paul Krugman has repeatedly complained about the DC orthodoxy-enforcing tactic of labelling only those who subscribe to Washington pieties as “Very Serious People,” or “VSPs.” It’s a term Krugman borrowed (with credit) from the liberal blogger Atrios, who first coined it to illustrate how Iraq War opponents were instantly marginalized in establishment discourse and only war advocates are deemed to be Serious. Krugman mockingly uses it so often that The New York Times created a special tag for the term. The primary purpose of the “VSP” tactic is to malign anyone who dissents from DC establishment pieties as non-Serious or un-Serious, thus demeaning them as someone who can (and should) be ignored as residing on the fringe, unworthy of engagement or a real platform regardless of the merits of their position.

Yesterday, one of the purest and most noxious examples of this tactic was invoked — by Paul Krugman. The long-time Clinton defender announced that all Serious policy experts “lean Hillary”; he even used the term “serious” unironically to advance his claim:

Meanwhile, the Sanders skepticism of the wonks continues: Paul Starr lays out the case. As far as I can tell, every serious progressive policy expert on either health care or financial reform who has weighed in on the primary seems to lean Hillary.

Let’s repeat that: “every serious progressive policy expert on either health care or financial reform who has weighed in on the primary seems to lean Hillary.”

The economist Dean Baker – previously cited as a financial reform and economic policy expert by Krugman but who now most assuredly does not “lean Hillary” – quickly reacted to his formal exclusion by Krugman from the Club of Seriousness:

Paul Krugman Revokes Credentials of Those Who Don’t Support Clinton . . .

Oh well, so much for those of us backing or leaning towards Sanders. I guess we just have to turn to that old Washington saying, “better right than expert.” In other words, it’s better to rely on people who have a track record of being right than the people who have the best credentials.

As so often happens, those who fancy themselves dissident gate-crashers (which apparently can include someone who is a Nobel-Prize-winning tenured economics professor (at Princeton until somewhat recently), an advisory board member of the nation’s largest corporations, and effectively a life-tenured New York Times columnist) quickly assume the role of vigilantly guarding the gate once they realize they were admitted all along. So congratulations to Paul Krugman on his power of decreeing who is a Serious Expert and announcing that the label applies only to those who want Hillary Clinton be the next President, but not Bernie Sanders.

To any of you Sanders supporters who previously believed that you possessed serious policy expertise, such as Dean Baker; or former Clinton Labor Secretary and Professor of Economic Policy Robert Reich (who yesterday wrote that “Bernie Sanders is the most qualified candidate to create the political system we should have”); or the 170 policy experts who signed a letter endorsing Sanders’ financial reform plan over Clinton’s:  sorry, but you must now know that you are not Serious at all. The Very Serious Columnist has spoken. He has a Seriousness Club, and you’re not in it. If you want to be eligible, you need to support the presidential candidate of the Serious establishment, led by Paul Krugman. . .

Continue reading.

Written by LeisureGuy

28 January 2016 at 10:38 am

Why the GOP never reveals its alternative to Obamacare

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Because there isn’t one. Paul Krugman explains in his blog:

Lucy just snatched the football away, again. Republicans assured us that this year they really would, seriously, roll out their alternative to Obamacare. Or, maybe, not.

But I have the sense that some political analysts still don’t understand why the GOP keeps sheering away from proposing an alternative. It’s not because Republican leaders are cowards. It’s not because there are sharp divisions within the party about the shape of their plan. The reason Republicans haven’t offered an alternative is because there is no alternative.

Specifically, if you want to propose some other, less-intrusive system that won’t cause 10 or 15 or 20 million people to lose health insurance, it can’t be done. The Affordable Care Act looks the way it does because it has to.

My sense is that even reformocons, who imagine themselves more open-minded than the party’s base, still don’t get that. But the logic has been clear from the beginning.

Start with a goal almost everyone at least pretends to support: making coverage available to people with preexisting conditions. How can you do that? Well, unless you simply want to provide government insurance, you have to prohibit discrimination based on medical history by private insurers: guaranteed issue and community rating.

But just doing that isn’t enough, because community rating on its own means that people don’t sign up until they get sick, and you have a very poor risk pool. So you have to include an individual mandate, requiring that everyone get coverage. Note, by the way, that the individual mandate is essential in a way the employer mandate isn’t.

Yet you can’t have an individual mandate without some way of making insurance affordable for lower-income families. So the mandate has to be backed by means-tested subsidies.

And there you are: community rating, individual mandate, subsidies — ObamaRomneycare! Everything else is details.

True, single-payer would be an alternative, and I’d be for it if I thought it had any chance of happening. But that’s an alternative to the left; there is no alternative to the right.

That’s why Obamacare opponents really had to stop it before it happened. As long as it was just a plan, they could insist that it was unworkable — that it would not, in fact, cover the uninsured, that costs would soar, that it would cripple the economy. And the official GOP position is indeed that the law has failed; who you gonna believe, us or your lying eyes? But none of the bad things that were supposed to happen, did. And the repeal-and-replace crowd cannot come up with an alternative, because there isn’t one.

Written by LeisureGuy

16 January 2016 at 10:52 am

Posted in GOP, Government, Healthcare

The attacks on Bernie Sanders’s healthcare policy seem to be funded by health-insurance companies

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Bernie wants a single-payer system and, needless to say, health-insurance companies do NOT want that because they make a lot of money from providing health insurance and infuriatingly poor service. Hillary Clinton, who has received millions from the industry (more information in Zaid Jilani’s article in The InterceptHillary Clinton’s Single-Payer Pivot Greased By Millions in Industry Speech Fees“). Not to put too fine a point on it, Hillary’s positions are up for sale to the highest bidder—not what I want in a president:

Hillary Clinton’s sudden attack on Bernie Sanders’ single-payer health care plan is a dramatic break with Democratic Party doctrine that the problem with single-payer is that it is politically implausible — not that it is a bad idea.

Single-payer, the Canadian-style system in which the government pays for universal health care, takes the health insurance industry out of the picture, saving huge amounts of money. But the health insurance industry has become so rich and powerful that it would never let it happen.

That was certainly Clinton’s position back in the early 1990s, when she was developing her doomed universal coverage proposal for her husband, Bill.

But in the ensuing years, both Clintons have taken millions of dollars in speaking fees from the health care industry. According to public disclosures, Hillary Clinton alone, from 2013 to 2015,  made $2,847,000 from 13 paid speeches to the industry.

This means that Clinton brought in almost as much in speech fees from the health care industry as she did from the banking industry. As a matter of perspective, recall that most Americans don’t earn $2.8 million over their lifetimes.

Hillary purchase

Hillary Clinton’s record on single-payer dates back to 1993, when she was tasked to help formulate White House policy. According to the notes of former Clinton confidante Diane Blair, Clinton told her husband during a dinner in February 1993 that “managed competition” — a private health insurance market — was “a crock, single payer necessary; maybe add to Medicare.” . . .

Continue reading.

And now Howard Dean has joined the attack, as Lee Fang notes in another article in The Intercept, “Howard Dean, Now Employed by Health Care Lobby Firm, Opposes Bernie Sanders on Single-Payer.”

Howard Dean is the latest in a string of Hillary Clinton supporters to charge that Bernie Sanders is wrong to support a single-payer health care plan. The former chairman of the Democratic National Committee claimed on MSNBC last night that Sanders’ reform might result in “chaos” because “trying to implement it would in fact undo people’s health care.” Dean added, “That is something people should be concerned about.”

Dean, a longtime supporter of single-payer, seemed to be changing his tune, a point made by host Chris Hayes during the segment.

This evolution of Dean, known within many circles for his spirited critique of the Iraq War during the 2004 Democratic primary, comes as he has settled into a corporate lobbying career.

Dean, though he rarely discloses the title during his media appearances, now serves as senior advisor to the law firm Dentons, where he works with the firm’s Public Policy and Regulation practice, a euphemism for Dentons’ lobbying team. Dean is not a lawyer, but neither is Newt Gingrich, who is among the growing list of former government officials and politicians that work in the Public Policy and Regulation practice of Dentons.

The Dentons Public Policy and Regulation practice lobbies on behalf of a variety of corporate health care interests, including the Pharmaceutical Research and Manufacturers of America, a powerful trade group for drugmakers like Pfizer and Merck.

In 2009, Dean praised single-payer while speaking on Democracy Now, calling the idea “by far the most economically efficient system.” That’s because, as Dean noted at the time, a Medicare-for-all style single-payer system would cut down on bureaucratic overhead and do a better job at controlling prices. An analysis by University of Massachusetts at Amherst professor Gerald Friedman found that the single-payer plan introduced into the last Congress, for instance, would save $592 billion, while expanding coverage to all uninsured Americans, regardless of ability to pay. Over 95 percent of households would see higher after-tax income because of the cost controls and elimination of insurance premiums.

Incumbent health care interests, particularly drug companies and insurers, have long viewed single-payer as a threat to their business model. Health insurance lobbyist strategy memos that were leaked from a source to veteran journalist Bill Moyers reveal a sophisticated effort to undermine public support for single-payer policies and to discredit Michael Moore’s Sicko, a movie that sharply criticizes the inequities and price-gouging of the American health care system. One slide discusses the need to use town halls and special forums to shape the Democratic primary debates in 2008 and peel away support for the reforms proposed in Sicko, while another calls for pundits to appear on television and denounce Moore as harmful to the Democratic Party. . .

Read the whole thing. And there’s a video at the link.

The attacks on Sanders are paid for by the industry. And you may recall Hillary saying “Democrats should not attack Democrats on healthcare.” Apparently that opinion has now be purchased and remodeled to favor the industry, as noted in a Mother Jones post by Tim Murphy, who points out:

Hillary Clinton is going after Bernie Sanders on health care reform. On Monday, she warned that his proposal for universal single-payer health care was a “risky deal” that would tear apart the Affordable Care Act and “start over.” On Tuesday, her daughter, Chelsea Clinton, followed suit. It’s an abrupt shift one month before the Iowa caucuses, but perhaps an inevitable one given Sanders’ rising poll numbers.

It’s also reverses the tactic her campaign embraced eight years ago. In the 2008 Democratic primary, it was Clinton who found herself on the defensive after then-Sen. Barack Obama’s campaign sent mailers to Ohio voters warning that her plan would force every citizen to buy health insurance. In a now-famous moment, Clinton held a press conference to trash the mailer and tell her opponent, “Shame on you”:

The Obama mailer was “not only wrong, but it is undermining core Democratic principles,” Clinton said at the time. “Since when do Democrats attack one another on universal health care? I thought we were trying to realize Harry Truman’s dream. I thought this campaign finally gave us an opportunity to put together a coalition to achieve universal health care.”

“This is wrong and every Democratic should be outraged because this is the kind of attack that not only undermines core Democratic values, but gives aid and comfort to the very special interests and their allies in the Republican Party who are against doing what we want to do for America,” she continued. “So shame on you, Barack Obama. It is time you ran a campaign consistent with your messages in public. That’s what I expect from you. Meet me in Ohio. Let’s have a debate about your tactics and your behavior in this campaign.” . . .

Continue reading.

Hillary reverses her positions for money. Bernie does not. What more do you need to know?

Written by LeisureGuy

14 January 2016 at 11:41 am


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