Category Archives: Pharmaceuticals

It Ain’t Over Until The Fat Golfer Sings

Senator McConnell’s Secret Health Insurance Shop is still working, with the Lobbyists/Elves seeking a way to offer goodies acceptable to the wavering and the wanton.  Keep calling!  and if you’d like more information to substantiate your comments there are some excellent sources.

Kaiser Family Foundation:   Your one stop center for research and analysis on health insurance issues.  Definitely a “bookmark this” recommendation.  Today, KFF notes that before the implementation of the ACA individual insurance plans for health care did not cover delivery and maternity care  in 75% of the policies; 45% of the policies didn’t cover substance abuse treatment; and 38% failed to cover any mental health care services.

If terms like “risk adjustment,” “re-insurance,” and “risk corridors” seem like something written in Minoan Linear A, the KFF has an excellent summation of these technical terms in easily understood American English.

There are also some analytical pieces on the impact of Republican suggestions for health care insurance “reform” as they relate to rural health care in the following:

Human Rights Watch — Senate Health Care Bill A Swipe At Rural United States.

MSNBC/Scarborough – Rural Health Care Would Be Savaged By This Bill.

There’s a narrative going around that Democrats haven’t brought anything to the table, which depends on whether we’re taking the long or short term view.  In the short term this would be true — because the McConnell Secret Health Insurance Shop didn’t invite any Democratic participation,  for that matter there seems to have been some Republican Senators who were left in darkness.  The longer view would note some of the following:

Senator Franken’s “Rural Health Care Quality Improvement Act of 2016” (pdf) S. 3191 (114th Congress) was introduced in July 2016 and “died” in the Senate Finance Committee.  The bill would have amended two titles of the Social Security Act to improve health care in rural areas of the United States.

There is Representative Jan Shakowsky’s CHOICE Act, H.R. 635, which would establish a public option under the ACA.  See also S. 194, Senator Sheldon Whitehouse’s CHOICE Act.  There’s Rep. Gene Green’s HR 2628 to stabilize Medicaid and the Children’s Insurance program.  Rep. John Conyers introduced his form of “single payer” in his Medicare for All bill, HR 676.  On the topic of making pharmaceuticals more affordable:  Senator Sanders – Affordable and Safe Prescription Drug Importation Act S. 469.  Senator Klobuchar has a bill “… to allow for expedited approval of generic prescription drugs and temporary importation of prescription drugs in the case of noncompetitive drug markets and drug shortages.” S. 183. Rep. Kurt Schrader introduced H.R. 749 to increase competition in the pharmaceutical industry.  Senator Ron Wyden introduced S. 1347, RxCap Act of 2017.

Senator Klobuchar has also introduce a bill supporting Alzheimer’s caregivers in S.311.  Rep. Derek Kilmer’s bill, H.R. 1253, seeks to improve access to treatment for mental health and substance abuse issues.   This is by NO means an exhaustive list of what can be gleaned from Gov.Track, but it does illustrate that the Democrats are not without suggestions — negotiating drug prices for Medicare, stabilizing the current system, public options, single payer — it’s just that these bills won’t get out of Republican controlled committees and they didn’t make it into Senator McConnell’s Secret Shop.

Indulge in no victory dance, we’ve seen this movie before … don’t believe that some minor blandishment won’t be enough to lure Senator Heller from his current position …don’t think that the products of McConnell’s Secret Shop have stopped coming off their assembly line.

Senator Heller can be reached at 202-224-6224;  702-388-6605;  775-686-5770

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Filed under Health Care, health insurance, Medicaid, Medicare, nevada health, Pharmaceuticals, Politics, public health

Physicians Could Use A Bit Of Healing in Nevada: Opioid Prescription Problems

oxycontin  The Reno Gazette Journal has done a piece of highly recommended reporting – an in-depth account of opioid prescribing in Nevada.

“…a Reno Gazette-Journal analysis of DEA data showed that for certain drugs, Nevada ranks among the highest in the country.

Take oxycodone, Nevada’s most widely prescribed opioid. In 2012, nearly 1.04 million grams was distributed via retail in the state. That’s more than double what doctors prescribed in 2006. Nevada’s distribution rate is third highest in the country.

Nevada also ranks third for its hydrocodone distribution rate. In 2012, doctors prescribed more than 799,000 grams of hydrocodone — nearly three times the rate of New Jersey, which has triple Nevada’s population.”

OC pill There are some important points to take away from the article.  One of the first is that physicians, themselves, have opposed greater oversight of opioid distribution to patients, specifically in regard to SB 459.  One physician testified to the Assembly Committee on Health and Human Services that SB 459 sections 1-12 should be adopted, but the rest of the bill including reporting and medical education requirements should be dropped because it wouldn’t prevent overdoses. [AHHS pdf] Another doctor offering testimony “went there,” comparing the regulation of opioids to Nazi Germany:

“When people come to Las Vegas and need surgery or have chronic conditions and they hear that the climate here is like Nazi Germany in terms of regulations, the tightening of prescription pain medications, and the prosecution of doctors, it has a very chilling effect on these people who need those medications. […] there are folks who have chronic pain. I am an internist and I see this every single day. I sit there arguing with them about cutting their medications down and they start crying and throwing a fit because they need it.”  [AHHS pdf]

He continued:

We pull the DEA reports now and, as a private practitioner with a two- or three-man office, it creates a lot of extra work for my staff and more
documentation. It makes me pause every time I start to write a script for any controlled substance; I should not have to feel like that. At the end of the day, the doctor and the patient have the relationship, not the government in the middle. Doctors should be the ones who decide what is best for their patients. This bill has a chilling effect on that. [AHHS pdf]

The good news is that the language requiring that a doctor check the prescription drug monitoring database before writing a prescription for a narcotic to a new patient was retained in the bill.  However, the testimony presented should cause some alarm from members of the general public.

OC pill

As the article points out, a state with one third of the population of another probably shouldn’t be prescribing three times the amount of narcotic painkillers.

The argument that the state legislature shouldn’t try to do something to mitigate the problem if the proposal won’t fix the entire problem sounds altogether too analogous to the NRA’s arguments for doing absolutely nothing to prevent guns getting into the hands of felons, fugitives, and domestic batterers.  “If it doesn’t solve the whole problem, then it shouldn’t be done.”  The second piece of testimony is, itself, chilling.

Hyperbole rarely provides productive content in a civic discussion, and Godwin’s Law applies.  Bring up Hitler, and the audience moves along assuming the argument has been abandoned.  Secondly, it’s a bit more than disturbing that a licensed physician would be argued into prescribing medication he or she knows is deleterious or even dangerous for a given patient.

OC pill

No one wants the Hot Potato.  The state pharmacy board doesn’t want to use its database to flag doctors who are over-prescribing narcotics.  Their director: “Who’s to say what’s normal or what’s OK,” Pinson said. “It might be appropriate for a physician to be prescribing a ton of narcotics according to his specialty.” [RGJ]  It might be, and then again, it might very well not be. And the Board of Medical Examiners isn’t enthusiastic about clearing out their ranks either:

“It would be inappropriate, and it’s not the intent of the (prescription monitoring program), to find cases to investigate,” said Edward Cousineau, executive director of the Board of Medical Examiners, which licenses medical doctors and investigates malpractice complaints in the state.” [RGJ]

Again, we might ask: Why isn’t it appropriate to weed out physicians who are creating a situation in which Nevada is among the top five states for opioid pushing? Perhaps the next session of Nevada’s Assembled Wisdom will find the intestinal fortitude to (1) require that the Pharmacy Board use its drug monitoring database to look for BOTH doctor shopping patients and pill pushing physicians; and (2) more thoroughly investigate drug overdose deaths. 

OC pill

Kentucky, Tennessee, Texas, and Arizona have enacted such legislation. [RGJ] Nevada should join them.

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Filed under health, Health Care, nevada health, Nevada legislature, Pharmaceuticals, Politics, public health

>Coffee and the Papers: News Roundup

>

  • Somehow, somewhere, I think I’ve heard this before: “I look forward to getting my story out soon, and we’ll do that. The facts will absolutely vindicate me in this.” Nevada Lt. Governor Brian Krolicki, 12-30-08, as he pled not guilty to four felony counts related to mismanaging the Nevada College Savings Plan funds while he was State Treasurer. [LV Sun] [LVRJ] The fireworks will start ten days after the 4th of July – the trial is scheduled to begin on July 14th.

  • 2008 began with the Endoscopy Center of Nevada at the center of a Hepatitis C outbreak that potentially endangered about 40,000 Nevadans, and the year goes out with the Specialty Surgicare clinic in Las Vegas reporting lapses in disinfection procedures. [LV Sun]

  • More MD’s run to Staples and Office Depot? “No mugs? Drug makers cut out goodies for doctors” including, “We have never said and would never say that a pharmaceutical pen or notebook has influenced any prescription,” Diane Bieri, executive vice president of PHARMA. [NYT]

  • Nevada’s SAGE Commission has recommended eliminating health care subsidies for all employees who retire after July 1, and cutting subsidies to existing retirees by 50% over the next two years. [LVRJ] Approximately $8.1 billion is needed to maintain state services (accounting for population growth and inflation), and revenues are projected to be $5.8 billion. However, Governor Gibbons clings tenaciously to his No New Taxes pledge to Grover Norquist and the Neo-Hooverites. [LVRJ] The Governor is not clutching quite so tightly to his plan to appoint Kirk Montero as the director of the Nevada Commission on Tourism. [RGJ] Former Sparks, NV mayor Bruce Breslow will replace Bob Loux as the executive director of the Nevada Commission for Nuclear Projects; Loux is alleged to have increased his pay without authorization, as well as that of three employees. [RGJ]

  • Elections do have consequences? Wal-Mart has settled 63 wage and hour (time shaving) suits, some originating in Nevada, and agreed to a $54 million settlement concerning 100,000 former and current employees in Minnesota who were owed pay for “off the clock work.” Or could it be that the company discovered that 2%-8% of shoppers have had enough of the Retail Death Star’s anti-employee activities? [LV Sun] These instances aren’t the first problems Wal-Mart has experienced with wage disputes. The firm’s 2006 annual report said the company was facing 57 wage and hour disputes. A California court ordered the retail giant to pay $172 million in damages for failing to provide meal breaks to employees in 2005. Also in 2005, a Pennsylvania court approved a class action suit alleging that Wal-Mart forced workers into overtime. [WakeUpWalMart]

  • Speaking of elections: “Washoe’s longest election race still tied,” two Verdi TV District candidates are tied at 1,839 a piece after the recount. [RGJ] “Canvassing board nudges Franken’s lead up to 49” [MST] [StPPP] Senator John Cornyn (R-TX) says the GOP will try to block any efforts by Democrats to seat Franken before all legal issues in the recount are settled. Coleman is now suing to have 654 properly rejected absentee ballots reconsidered; Franken wants the focus on 1,346 absentee ballots officials say were improperly rejected.

  • Gaza Stripped: “Israel rejects proposed truce as talks continue: Assault on Gaza Strip continues for fifth day as rockets fall on southern Israel” [WaPo] “Behind Gaza operation an uneasy triumvirate” [WaPo] “Israel rejects 48 hour cease fire plan” [NYT] “Israel rejects call for truce, attacks Gaza tunnels” [LAT]

  • Ethically Challenged: “Madoff spotlight turns to role of offshore funds” [NYT] “Bank Medici manages up to $3.2 billion of assets tied to Madoff” [Blmbrg] “Developments in the case: Susan Markel, chief accountant at the SEC is leaving for a corporate investigations job” [Newsday] “Tremont sued over losses to Madoff’s Ponzi scheme” [Blmbrg] “How Madoff is burning the SEC” [BusWeek] “Madoff liquidation trustee receives $28 million for costs” [Law.Com] “Ex broker charged with conspiracy in Dreier case” [WSJ] “How Peter Kraus spent his hard earned bonus money (Merrill Lynch)” [Nymag] “Golden parachute lands Merrill exec in $37 million pad” [LAT] “Reliant says it will fight Merrill suit: energy company’s termination of $300 million credit line” [WSJ]

  • It’s the Stupid Recession: “Creative borrowing catches up with California cities” [LAT] “New jobless filings drop, but labor conditions do not improve” [LAT] “Company bond sales fall as recession drives rates up” [Blmbrg] “South Carolina unemployment fund will dry up without a deal” [AP] “Pittsburgh unemployment at 5.8%” [PPG] “Retail sales fall is worst in six years” [LAT] “Online retail sales dip 3%” [Adweek] “Stores, entire chains will close in 2009, analysts” [CST] “Mervyn’s to close its doors after 59 years” [ABC] “Retail: 73,000 stores could close in first half of 2009” [Blmbrg]

It won’t be hard to say good-bye to 2008, but 2009 may be a rough slog?

*Desert Beacon will dim down for a brief vacation – see you in a few days! In the mean time, please have a very safe and happy New Year’s celebration.

desertbeacon.blogspot.com

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Filed under Economy, Gaza, Health Care, Krolicki, Nevada, Pharmaceuticals

>Coffee and the Papers: Ethical Issues

>Ethics: The House of Representative passed the Ethics Reform package 411-8, and sent it on to the Senate wherein Sen. Ted Stevens (R-Veco) is threatening to place a hold on it. [TPMM] This, from a Senator whose home was raided by the FBI this past week in an ever widening probe into corruption in Alaskan politics. “Senate Democratic leaders nevertheless predicted victory. “This legislation will pass here in the Senate this week,” Majority Leader Harry Reid (D-Nev.) told reporters. “It’s 107 pages of change — the most significant change in the history of our country in terms of lobbying and ethics.” [Roll Call sub req] Besides Stevens, Senators Lott (R-MS), Kyl (R-AZ), DeMint (R-SC), and possibly Craig (R-ID), are opposing the measure; well short of the 33 necessary to kill the bill on procedural moves — but enough to place holds on the proposal. Senator Lott is also leading the GOP senators in the PAC money raised department, collecting $1.5 million for his New Republican Majority Fund PAC, “more than 12 times the sum raised by Minority Leader Mitch McConnell.” [The Hill] This isn’t necessarily good news for NRSC chairman John Ensign (R-NV).

“Lott said he prefers to help Republican candidates through his leadership PAC instead of making phone calls to raise large contributions for the National Republican Senatorial Committee.”…”I have a lot of money in my account and I plan to distribute it.” [The Hill] Distribution, it seems, without necessarily collaborating with Nevada’s junior Senator.

And then there are ethics: The U.S. Attorney in Virginia found his name on the “firing list,” after refusing to slow down the case against OxyContin manufacturers. “Brownlee settled the case anyway. Eight days later, his name appeared on a list compiled by Elston of prosecutors that officials had suggested be fired. Brownlee ultimately kept his job. But as Attorney General Alberto R. Gonzales confronts withering criticism over the dismissals, the episode in the OxyContin case provides fresh evidence of efforts by senior officials in the department’s headquarters to sway the work of U.S. attorneys’ offices.” [WaPo]

The investigation into the affairs of Senator Stevens (R-AK) may be examining funds he “steered to an Alaskan wildlife research center” that may have “enriched an aide.” “The SeaLife Center probe is in addition to an investigation by federal grand juries here and in Alaska into Stevens’ ties to an oil company executive convicted of bribing Alaska state legislators.” [WaPo] See also: Anchorage Daily News

This information about election officials in the U.S. isn’t all that comforting: “In recent years, top election officials in at least five states have moved from government posts directly into jobs as lobbyists for the voting machine industry, which itself grew immensely after Congress allocated billions of dollars to help states update equipment.” [NYT]

No Surprise? The Bush administration’s chief intelligence official said yesterday that President Bush authorized a series of secret surveillance activities under a single executive order in late 2001. The disclosure makes clear that a controversial National Security Agency program was part of a much broader operation than the president previously described.” [WaPo] This really isn’t helping the Bush Administration. Either, the program was narrowly focused, as the President has claimed on several occasions –and therefore Gonzales is lying –or, the program did, in fact, have both an espionage element and a data mining component, and therefore the President has been prevaricating.

The Bush Administration is also having trouble keeping the message locked down on the main source of American problems in Iraq. “Despite President Bush’s recent insistence that al Qaida in Iraq is the principal cause of this country’s violence, senior American military officers here say Shiite Muslim militias are a bigger problem, and one that will persist even if al Qaida is defeated.” [McClatchy]

Absolutely No Surprise Department: OK, tell me that the lack of exploration and refinery capacity are the crux of the problem with energy prices? Then, explain why instead of re-investing in their industries Big Oil corporations are spending billions to buy back their shares and pump up their stock prices. [LAT]

If a person were thinking that it’s taking entirely too long for generic drugs to hit the market, he or she would be right. “Although the FDA gave the go-ahead to more than 500 generic drugs last year, the agency’s backlog of pending applications grew to 1,291 last month, from 780 at the end of 2005. The median approval time for new generic applications has been stalled at more than 16 months for several years, despite a statutory requirement that generic drugs be reviewed within 180 days.” And, what’s the reason? Predictably, “…Ira Loss, a senior pharmaceutical analyst for Washington Analysis, an investment research firm, said the Bush administration and Congress have shortchanged the FDA and consumers by not providing adequate revenue for the agency to do its job. “The simple answer is the FDA is underfunded, and part of underfunding is in the generic drug area, where application numbers are increasing,” Loss said. “This has the effect of not reducing the drug prices as quickly as otherwise might be the case.” [Newhouse]
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Update: See – “Nevada election laws could use revision?” Blue Sage Views

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Filed under corruption, Ethics, Iraq, oil companies, Pharmaceuticals

>Ensign tries for extra credit

>Nevada Senator John Ensign reprised his role of “good little soldier” for the Bush Administration, and its allies in the pharmaceutical industry.

He was not included number of Senators (55) who supported a Democratic Party cloture motion [rc 132] to limit debate and vote on a bill to allow the federal government to negotiate lower prices for prescription medication. [NYT]

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>Coffee and the Papers

>Quaggas here. Quaggas there, Quaggas, Quaggas everywhere — in Nevada — at Hoover Dam, Lake Mojave, and in the Lake Havasu intake. [LVRJ] Since these invasive critters don’t walk from one waterway to another, the onus falls on irresponsible boaters who don’t clean up before relaunching — so, now we can all expect check points where vessels are hauled to California from infested waters.
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While we’re on the subject of protection on the water — the Washington Post reports that the U.S. Coast Guard’s newest cutter suffers from “significant design flaws.” Further, the “service has failed to properly supervise the contractors doing the work.” Back in December the Coast Guard had to pull 8 other cutters after finding out they weren’t seaworthy. According to Lockheed-Northrop, “There are no flaws in the design…the Coast Guard is the technical authority…if the report claims otherwise then the report is flawed.” Rep. Bernie Thompson, chair of the House Homeland Security Committee isn’t buying their explanation: “We will not tolerate the spending of $775 million of the taxpayer’s money on a boat that will not perform its intended function, will have a shortened service life and will cost another fortune to maintain.”
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Washington Secretary of State Sam Reed is proposing to make it a crime to pay initiative signature gatherers on a per-signature basis, saying the practice “creates an incentive for fraud.” [ST]
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Future Klan leader (?) or Tancredo staffer (?) Bryce Archambo of Farmington, Missouri only managed to attract about 100 people to his “Southern Heritage Night” Confederate Flag Celebration. Bryce has been suspended from Farmington HS for wearing a confederate cap to school. Other teens in Farmington reject his message: “I see the flag and know what it stands for,” said Tony (Caruthers), who was on his way to the basketball game. “To me, it’s about oppression and hate.” Senior class President Jake Goff agreed, and said he has seen kids cruising around town with Confederate flags propped on their trucks right next to Klu Klux Klan symbols. If it’s so obviously hurting others, what’s the reason for having it?” Jake asked.” [STLPD]
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Pfizer Wants You! Or, Pfizer, Inc. wants to create an “astro-turf” movement to push back against calls for negotiated drug prices and any other regulation of the pharmaceutical industry. The corporation is sending packets of information to patients who use Pfizer drugs that include pre-written letters to Senators, all the recipient has to do is fold and send. “Dr. Jerry Avorn , a Harvard Medical School professor , condemned the covert campaign as “a distortion of the democratic process.” Avorn, who tracks drug company marketing, said the industry has already “succeeded in making patients into sales reps through direct-to-consumer advertising. Now, apparently, the next step is to make patients into lobbyists.” [BG] has the details.
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The State of Pennsylvania has ordered the closure of the Buck Mountain Slope Mine in Tremont following an investigation into the fatal explosion there last October. “DEP officials say the methane explosion that killed Dale Reightler, 43, “was very similar” to a 2004 accident at the mine “and that circumstances of that accident had been misrepresented by mine management.” [Pittsburgh PG]
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Another one bites the dust. Honeywell International plans to move its Autolite Spark Plug plant to Mexico. The move will cost approximately 500 jobs in Fostoria, Ohio. [TB]
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Nevada State/Local at Blue Sage Views

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Filed under Coast Guard, Initiatives, Mine Safety, off shoring jobs, Pharmaceuticals, Quaggas