America Out Loud PULSE: What People Want from Their Patient-Physician Relationship

From my America Out Loud Pulse podcast with Travis Morell, MD – https://www.americaoutloud.news/what-people-want-from-their-patient-physician-relationship/

Works on the scientific and ethical practice of medicine called the Corpus Hippocraticum are attributed to Hippocrates (450 – 375 BC), considered the father of medicine. The quote “do no harm” is not in the Oath of Hippocrates, but rather in another volume, Of the Epidemics. Additionally, the writings were written in Greek and the Latin phrase primum non nocere comes from a 17th Century English physician, Thomas Syndenham. Irrespective of the authorship’s history, for centuries the medical profession adopted the Oath as a guide of professional conduct.

Patients likely don’t know the instructions in the Oath, nonetheless, patients trust doctors with their health. The Oath advises physicians, among other things, to do everything for the benefit of the sick, to keep private whatever physicians see or hear in the lives of their patients, or as some translations say, treated as “holy secrets.” These duties attached whether the patients were “free or slaves.”

Multiple surveys (here, here, here, here) have asked patients what they really want from their patient-physician relationship. Just as with any close relationship, undistracted listening tops the list. Another constant is that patient prefer the total experience with the doctor and his or her office over price. If one wish could be granted for patients it would be for more time with their doctor.

What makes are some of the other factors that make a good experience? In todays’ era of electronic medical records and computer screens, eye contact is more important than ever. If a doctor is open and honest about his knowledge base, gives truly informed consent to proposed treatments with risks and benefits, patients will develop trust. We need to have patients feel comfortable telling us everything that is going on in our lives. And doctors mustn’t be reluctant to form an emotional bond when making a connection with their patients. Patients want to know their doctor is not doing procedures for financial gain. Patients also want access to their physician. This is one of many reasons that direct primary care practices are growing increasingly popular.

Patients, like all of us want to be treated with respect. That means having their time and needs respected. Simple apology from the front desk if the doctor is running late goes a long way to letting patients know you care. Another thing patients need is clear communication, not ‘medicalese.’ Finally, patients want a partnership and giving then the opportunity to express their opinion about the proposed treatment.

My guest today is one of those physicians who is working to keep skill, compassion, and honesty in medicine – despite the roadblocks put up by current political winds and corporate takeovers.

Bio

Travis Morrell, MD, MPH, is a husband, father and physician leader. A lifelong learner to a fault, his medical training in five specialty departments gives him a broad perspective. He is a Board Certified dermatologist and dermatopathologist in private practice in Western Colorado. Dr. Morrell is also Chair of Colorado Principled Physicians, a truly grassroots organization defending non-partisan physician values such as free speech and evidence-based medicine.

Website:

Colorado Principled Physicians – https://www.coloradodocs.org

America Out Loud PULSE: Hacking Electronic Health Records, Medicare Dis-Advantage, and Measles with Twila Brase, RN, PHN

From my America Out Loud Pulse podcast with Twila Brase, RN, PHN –https://www.americaoutloud.news/hacking-electronic-health-records-medicare-disadvantages-and-measles/

Hacking into electronic databases has become child’s play. Since 2018, the Health and Human Services (HHS) Office for Civil Rights tracked a 256 percent increase in large data breaches involving hacking and a 264 percent increase in ransomware. With ransomware, the database owner must fork over a ransom in order to get cannot get access.

On February 21, 2024, United Health’s Change Healthcare was hacked. Change Healthcare processes 15 billion healthcare transactions annually and touches one in every three patient records. The outage has multiple drug stores and health systems and affected billing and physician payments, electronic medical records retrieval by insurers, verification of insurance eligibility, prior authorization requests, and prescription processing. Health systems are having difficulty billing for most hospital services. Some pharmacists are charging patients the full price because they are unable to access the co-pay information. According to an estimate from a digital health risk assurance firm, First Health Advisory, the outage is costing health care providers over $100 million daily. The American Hospital Association president and CEO said, “We cannot say this more clearly — the Change Healthcare cyberattack is the most significant and consequential incident of its kind against the U.S. healthcare system in history.”

According to a March 4, 2024 Wired magazine article, one of the partners of the hackers known as AlphV or BlackCat revealed that the hackers received 350 Bitcoins in a single transaction worth $22 million. On March 3rd, someone describing themselves as an affiliate of AlphV posted to the cybercriminal underground forum RAMP that AlphV had cheated them out of their share of the Change Healthcare ransom. Change Healthcare did not confirm or deny the ransom to Wired, commenting that “we are focused on the investigation right now.”

UnitedHealth apparently is offering paltry sums to physicians who have not been reimbursed for their services or in some cases, costly cancer medications.

There is nothing more private than our personal health information. Artificial Intelligence (AI) is erasing what little privacy we had left in the era where mot doctors’ offices use electronic health records (EHRs). This brings up another issue on the horizon is something called ambient artificial intelligence. It listens to your “private” patient-doctor conversation and processes information, then writes a clinical note summarizing the visit. More than 3,400 physicians at Kaiser Permanente Medical Group of Northern California have been using this since October 2023. Some positives include the physician being more attentive to patients since they are not writing notes. The automatic transcription lessened the up to six hours a day spent on electronic medical records. The question is obvious: who controls this information and what else will it be used for?

We’ll talk about this and so much more with my guest, a nationally recognized expert in the field of medical privacy.

Bio

Twila Brase is President and Co-founder of Citizens’ Council for Health Freedom (CCHF), a national patient-centered, privacy-focused, free-market policy organization established 25 years ago in Minnesota to support health care choices, individualized patient care, and medical and genetic privacy. Her efforts led to a national law requiring parental consent for research using newborn DNA.  Ms. Brase is author of the eight-time award-winning book Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records.

Ms. Brase’s “Health Freedom Minute” is heard weekdays by more than 5 million listeners across the United States. She provides testimony at state legislatures, meets with members of Congress and health care policymakers, and has been featured in major news outlets such as the Wall Street Journal and the Washington Post.

Citizens Council for Health Freedom website: https://www.cchfreedom.org

The Wedge of Health Freedom (independent physicians) website: https://jointhewedge.com

Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records. https://www.amazon.com/Big-Brother-Exam-Room-Electronic/dp/1592987060/ref=monarch_sidesheet

America Out Loud PULSE: Are Medical Boards Helping or Hurting Patients?

From my America Out Loud Pulse podcast with Kelly Sutton, MD – https://www.americaoutloud.news/are-medical-boards-helping-or-hurting-patients/

The patient-physician relationship is supposed to be sacred, as Hippocrates explained thousands of years ago. Medicine has entered a brave new world of third parties (insurers) telling us what to do. Various laws, particularly in California, are squelching choice for patients and free speech for physicians even with threats of loss of their licenses. Consequently, patients are losing their choice in medical treatment.

In June 2015, California passed a law, SB277 that removed the personal and religious belief exemption from mandated vaccines. Without the 15 to16 vaccines,, a child cannot not attend public schools or day care facilities. In September 2019, California went a step farther to squelch medical vaccine exemptions with SB 276. This applied to private as well as public schools.

Prior to the enactment of SB 276, state law permitted physicians to issue medical exemptions based on their independent medical judgment. Now a State Public Health Officer is the final arbiter. The state will review all medical exemptions at schools where fewer than 95 percent of students are vaccinated, from doctors who submit five or more exemptions in one year and from schools that haven’t shared vaccination rates. The state will cancel waivers written by doctors who are under investigation by the medical board.

The State has the power to revoke the exemption if it decides the exemption is “inappropriate.” Talk about inserting a third party smack dab in the middle between physicians and their patients. If the state determines a physician is “contributing to a public health risk,” it will report the physician to California’s medical board.

The laws are designed to crack down on physicians “practicing outside the accepted standard of care.” But they also target the parents who believe it is their right to make medical decisions for their children. The term “anti-vaxxer” is a pejorative description of concerned parents and physicians who question the “science.” I think Covid-19 taught us more than we want to know about the perversion of science.

Mandates rely on coercion rather than informed consent. Clearly, a parent is left in an untenable position: Vaccines or pull their child out of school. Most parents – if both are working – do not have the ability to homeschool their children. Moreover, this could only be the beginning of the erosion of individual patient rights. We have a major controversy over the appropriate treatment of minors who have decided they want to be the opposite sex. In some states schools have the right to withhold gender issues from the child’s parents. Parents have lost custody of their child over treatment choices that could have life-altering consequences. In some states, schools do not have to inform parents about an abortion of a child over 12 years old.

The silver lining? Medical tyranny has gone so far that more and more patients and physicians are becoming activists.

Bio

Kelly Sutton M.D. completed residency in Internal Medicine and some Pediatrics, and practiced family medicine for almost fifty years, using knowledge from conventional and integrative medicine. She practiced until her medical license was revoked for writing eight vaccine medical exemptions by the state of California in 2022, and by Massachusetts and New York in 2023 based only on reciprocal discipline. There were no patient complaints in any state, and no patient injury. Dr. Sutton is challenging this revocation in court.

See  www.reclaimingmed.org/drsutton for this story, its relation to other doctors’ experience with regulators, and their legal cases.

America Out Loud PULSE: Wendell Potter Is the Insurance Industry’s Worst Nightmare!

From my America Out Loud Pulse podcast with Wendell Potter – https://www.americaoutloud.news/wendell-potter-is-the-insurance-industrys-worst-nightmare/

When I was in law school, the first elective I signed up for was Insurance Law. Unfortunately for the future lawyers of America, this enlightening class had few students. The teacher began with a joke: Farmers paid a claim. The class reinforced my feeling that the insurance industry were indeed as economist Andrew Tobias called it, the Invisible Bankers.

The insurance industry is built on the fact that life is uncertain and insurance will soften the blow of life’s unexpected events. The insurance market in the United States is one of the largest in the world. In 2022, Insurance premiums amounted to $1.48 trillion. The health insurance industry alone had net earnings of $31 billion in profits in 2020. About 8 percent of Americans are uninsured, and of the insured, 65 percent have private insurance and 36 percent have government-sponsored insurance.

We have to remember that insurers are not really in the business to take care of us. They are in the business of making money. Making money is fine, but insurers should not pretend otherwise or hoodwink their customers. They have actuarial tables that project when you will die, whether you will get in an accident depending on the kind of car you have, and so on. The industry is in the business of calculating risk to maximize profits.

Artificial intelligence (AI) is the new bad boy in town. Recently, a class action lawsuit was launched against UnitedHealthcare, America’s largest health insurer. The lawsuit alleged that United used an artificial intelligence algorithm to wrongfully deny coverage under Medicare Advantage health policies. The algorithm determines the amount of rehabilitation to which a beneficiary is entitled after an injury or stroke, for example. The AI program consistently overrode the physicians’ recommendations, but case managers faced termination if they veered more than 1 percent from the AI determination. The insurer continued to use the algorithm knowing that a mere 0.2 percent of rejected patients would file an appeal – that was highly likely to end in the patient’s favor.

Nothing related to denial of medical services shocks me anymore. According to a Stat investigation, a UnitedHealth official said in a company podcast, “If people go to a nursing home, how do we get them out as soon as possible?” Was this kind words wishing for good health and a speedy recovery or kicking granny to the curb to save money?

My guest and I will discuss the health insurance industry and ways to make sure that all Americans have access to quality medical care.

Websites:

Center for Health and Democracy: https://centerforhealthanddemocracy.org

Business Leaders for Health Care Transformation: https://www.blhct.org

Newsletter: Health Care un-covered, https://wendellpotter.substack.com

Bio

Wendell Potter had a long career in corporate public relations, having served as press secretary to a Tennessee gubernatorial candidate, head of advertising and PR for a large integrated health care system in East Tennessee, a partner in an Atlanta public relations firm, and a state and federal lobbyist. In 2009, he testified before the Senate panel on health care reform about what he witnessed as a former vice-president at Cigna Healthcare, recounting how health insurers make promises they have no intention of keeping, and infuse billions into public relations campaigns to advance corporate interests at the expense of those of the patients. Wendell was an investigative journalist whose articles and commentaries have appeared in many publications including The New York Times, Los Angeles Times, Chicago Tribune, Tampa Bay Times, The Guardian, Newsweek, The Nation, Huffington Post, CNN.com, NBC.com, Democracy Journal, and healthinsurance.org. He has appeared frequently as a guest on ABC, CBS, NBC, FOX News Channel, MSNBC, PBS, and NPR. He is the author of the award winning book, Deadly Spin, An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for Me?: What Everyone Needs to Know About the Affordable Care Act.

America Out Loud PULSE: Doctors and Patients or Bureaucrats: Who’s in Charge of Our Medical Care? with Andy Schlafly, JD

From my America Out Loud Pulse podcast with Andy Schlafly, JD – https://www.americaoutloud.news/doctors-and-patients-or-bureaucrats-whos-in-charge-of-our-medical-care-2/

Political persecution through the legal system has become the new American justice. But it can work both ways – if we have the courage.

President Calvin Coolidge, a strong proponent of limited government, believed that “in order for the Constitution and self-government to survive, the people had to be vigilant in its preservation.” Covid-19 started a government and media censorship juggernaut. It is imperative that we all join to stop it in its tracks. The case currently being argued in front of the Supreme Court, Murthy v Missouri arose from – you guessed it – Covid. Missouri and other states assert that the government’s attempts to suppress so-called Covid misinformation went beyond mere public health information to suppression of speech via social media. At oral arguments, Justice Jackson seemed to feel that suppressing speech is the government’s job. To quote: “My biggest concern is that your view has the First Amendment hamstringing the government in significant ways.”  The First Amendment to the Constitution says the government cannot abridge freedom of speech. As Justice Brandeis wrote in the 1927 free speech case, Whitney v California, free speech is at the heart of a democratic society and the answer to alleged falsehoods is “more speech, not enforced silence.”

Medical freedom for doctors and patients is becoming a distant memory. Physicians are afraid to go into pain management for fear of being labelled a pill pusher. Patients with chronic pain are resorting to getting heroin on the streets rather than be put in a government database. Physicians are bullied by medical boards with the specter of losing their licenses for having valid alternative views regarding medical treatment plans.

Lawyers—who we all know can strike fear into our hearts—can be a big part of preserving our liberty. The legal fights to reign in government overreach are about more than Covid. Lawyers are here to help protect the rights of the individual citizens. They are our last defense against government oppression and corporate corruption. Lawsuits can amplify a few lone voices and let those in power get the message: Our bodies and minds belong to us, not to the government.

I love quotes. Let me give you a few of my favorites on this topic:

“Heresy is another word for freedom of thought.” Graham Greene

“Blind belief in authority is the greatest enemy of truth.”  Albert Einstein

“All progress has resulted from people who took unpopular positions.”  Adlai Stevenson

“The cure for a fallacious argument is a better argument, not the suppression of ideas.”  Carl Sagan

“When the people fear the government, there is tyranny. When the government fears the people, there is liberty.”  Thomas Jefferson

Attorney Andy Schlafly a wonderful friend of the show and general counsel to the Association of American Physicians and Surgeons is here today to discuss freedom of speech and a recent case headed to the Supreme Court.

Link to amicus brief PDF: https://aapsonline.org/judicial/aaps-amicus-murthy-v-missouri-2-7-2024.pdf

Bio

Andy Schlafly is general counsel to the Association of American Physicians and Surgeons. He received a B.S.E. in electrical engineering and certificate in engineering physics from Princeton University. After graduating from Princeton, Mr. Schlafly briefly worked as a device physicist for Intel, then became a microelectronics engineer at the Johns Hopkins University Applied Physics Laboratory. He then attended Harvard Law School along with Barack Obama. For two years Mr. Schlafly was an editor of the Harvard Law Review. After law school, Mr. Schlafly served as an adjunct professor at Seton Hall Law School and worked for a large law firm before beginning private practice. Mr. Schlafly created the wiki-based Conservapedia in November 2006 to counter the apparent liberal bias in Wikipedia.

America Out Loud PULSE: From Physician to Activist with Dr. Jane Hughes

From my America Out Loud Pulse podcast with Dr. Jane Hughes – https://www.americaoutloud.news/from-physician-to-activist-meet-jane-hughes-md/

There was a time when patients sought medical care from a physician, not a “healthcare system.” Now there’s over-priced health insurance that falls short when you actually need it; Medicare Advantage plans that trap you like a roach motel and then don’t provide care when you actually get sick.

Rather than going after flash mob thieves, the government eyeballing parents who have the audacity to actually go to PTA meetings. Schools are supporting so-called gender affirmation without parental notification or consent. Physicians are acquiescing to government, corporate, and political pressures rather than individualized patient care. What’s a person to do?

Almost 50 years ago, an iconic speech in a critically acclaimed film written by Paddy Chayesfsky expressed it better than I ever could: (Peter Finch as Howard Beale, Network, 1976.)

I don’t have to tell you things are bad. Everybody knows things are bad. It’s a depression. Everybody’s out of work or scared of losing their job. The dollar buys a nickel’s worth; banks are going bust; shopkeepers keep a gun under the counter; punks are running wild in the street, and there’s nobody anywhere who seems to know what to do, and there’s no end to it.

We know the air is unfit to breathe and our food is unfit to eat. And we sit watching our TVs while some local newscaster tells us that today we had fifteen homicides and sixty-three violent crimes, as if that’s the way it’s supposed to be!

We all know things are bad — worse than bad — they’re crazy.

It’s like everything everywhere is going crazy, so we don’t go out any more. We sit in the house, and slowly the world we’re living in is getting smaller, and all we say is, “Please, at least leave us alone in our living rooms. Let me have my toaster and my TV and my steel-belted radials, and I won’t say anything. Just leave us alone.”

Well, I’m not going to leave you alone.

I want you to get mad!

I don’t want you to protest. I don’t want you to riot. I don’t want you to write to your Congressman, because I wouldn’t know what to tell you to write. I don’t know what to do about the depression and the inflation and the Russians and the crime in the street.

All I know is that first, you’ve got to get mad.

You’ve got to say, “I’m a human being, goddammit! My life has value!”

So, I want you to get up now. I want all of you to get up out of your chairs. I want you to get up right now and go to the window, open it, and stick your head out and yell:

“I’m as mad as hell, and I’m not going to take this anymore!!”

I recently heard someone say that there are three kinds of people in this world: those who make things happen, those who watch things happen, and those who wonder what happened. We must be the people who makes things happen. No act is too small. As Sir Edmund Burke said 200 years ago, “Nobody made a greater mistake than he who did nothing because he could only do a little.”

My guest, Dr. Jane Hughes has put the act in activism and will share her thoughts about medicine, our health care “system,” and the government’s role in our lives.

Bio

Dr. Jane Hughes is the current president of the Association of American Physicians and Surgeons. She is a board-certified ophthalmologist and a fellow of the American College of Surgeons. She received her medical degree from the University of Texas Health Science Center in San Antonio where she also completed her residency. Dr. Hughes is co-founder of American Doctors for Truth and serves on Congressman Chip Roy’s Physician Advisory Council for Healthcare Policy.

America Out Loud PULSE: DEI Meets Antisemitism Meets a Lawsuit

From my America Out Loud Pulse podcast with Tammy Weitzman – https://www.americaoutloud.news/dei-and-antisemitism-meet-a-lawsuit-with-tammy-weitzman/

What strange times we live in now. We have gone from the era of Ralph Ellison’s novel, Invisible Man, brilliantly exploring what it means to be socially or racially invisible to almost every ad on television including a person of color. Segregated army barracks, motels, restaurants, clubs, entertainment venues were socially and politically acceptable even after integration became the law of the land. And as time passed, people realized that they were missing out on a whole side of life by closing the door on meeting new and interesting people. We were organically moving to a blended society where people were looking at one another just as people, judging them by their job or hobbies but not by their race. Now we have segregated college dorms, dining halls, and so-called affinity groups. What happened?

After years and years of progress we have a sick regression into separatism. Instead of “if you are white, you’re all right, if you’re black, stay back,” all white people are inherently evil deep down inside and should flagellate themselves for the sin of being born white; all black people should be forgiven for any anti-social behavior because they can’t help themselves. How racist is that supposedly progressive mindset?

This new Diversity, Equity, and Inclusion (DEI) crusade is yet another elitist movement that does nothing to help the people they movement portends to help. The DEI movement is stripping mainly blacks, but ultimately all people of their dignity. When we lose our individuality, we lose our true selves, our souls. Human nature being what it is, people do not want to be labelled as victims. But propaganda and indoctrination being what it is, anyone can be demoralized into—as the Soviets would say—ideological subversion.

Yes, racism exists. Racists exist. But the DEI cure is worse than the disease. (One of my dream conversations is asking a professed racist in kidney failure on dialysis if he would accept a kidney transplant from a black person.)

Students in as young as kindergarten are being taught to judge others by their race. In reality, most children do not focus on their differences but wonder whether their classmate likes the newest video game. How could someone think that it is acceptable to poison young minds? The same young minds were told in Brown v the Board of Education in 1954 that separate is inherently unequal. Instead of learning the necessary skills to race to the top of the ladder of success, children have the tools to win the victim triathlon. The prize: dependency on government resources. What a waste of government money. This money would be better spent on junior science fair projects or field trips to the museum of science and technology.

Schools at all levels now have institutionally supported affinity groups that are the Newspeak word for segregated groups. The DEI adherents are echoing the rhetoric of the opponents to integrated schools: people of different races learn better in separate environments where they can be their true selves. Some schools have separate times for black and LGBT students to use the swimming pool. How is this diversity and inclusion? It seems like grouping together children with the same interests, like math, science, sewing, music, or sports would be a more enriching program.

It doesn’t stop with the unsuspecting children. Corporations have devoted time and money into DEI trainings. Let’s have a re-education session and tell people they are a racist and tell them how to be an anti-racist. How? Don’t be a racist.

And of course, I wonder about the effect of DEI on medicine. There is no question that there are racial disparities in many aspects of life in the United States, including medical care. It seems that instead of doing the hard work of getting down to the root of the problems, academia has taken the easy way out by declaring that racism is the cause of health care disparities. The solutions start with racism and end with indoctrination into reverse racism.

The DEI focus on the oppressed and oppressors has fostered antisemitism as well. After all, despite the history of Jewish slavery, oppression, and genocide, they are deemed part of the oppressor class. This is a logical outgrowth of the DEI mindset that focuses on differences rather than our shared humanity.

The deafening drumbeat of race, racism, and more race is leaving its mark. The workplace has turned into a minefield. Some wokenistas cannot see that denigrating others does nothing to advance the group they purport to uplift. When reason fails, we have to turn to the law. Sometimes lawsuits are the only way we can get people to wake up.

My guest is a social worker who despite the presumed empathy and compassion of her colleagues was caught in a workplace web of wokeness gone amok and antisemitism.

Bios

Tammy Weitzman is a child of an Israeli mother and Canadian father. After her father’s death from cancer, the family lived in Israel for 3 years before returning to Toronto, Canada. She completed graduate work in social work at Yeshiva University in New York City. She spent 23 years in oncology mental health at large academic hospitals and has presented her work with oncology patients nationally and internationally.

Peter Barwick is the general counsel for the Coalition for Liberty, https://www.coalitionforliberty.com. Coalition For Liberty is a 501(c)(3) nonprofit organization whose central mission is to promote the right of all Americans to exercise their freedom of speech, expression and thought; and support the establishment of new classical model apolitical schools, while also supporting efforts to have existing schools move back to this tried-and-true model, which has been proven to obtain superior results for children.

America Out Loud PULSE: Opioid Addiction and Settlement Funds with Dr. Molly Rutherford

From my America Out Loud Pulse podcast with Dr. Molly Rutherford – https://www.americaoutloud.news/its-2024-what-is-happening-with-opioid-addiction-and-the-settlement-funds/

In 2020, 54 million U.S. adults were living with chronic pain. Management of non-cancer pain went through a slow evolution starting in 1980 to include opioids. While opioids are indicated in many types of pain, they carry potential risk of addiction and overdose. The National Institute on Drugs Abuse data in 2019 revealed that 21 to 29 percent of patients prescribed opioids for chronic pain misuse them; between 8 and 12 percent of people using an opioid for chronic pain develop an opioid use disorder.

In 1995, the pharmaceutical companies insisted that their new opioid pain relievers, particularly OxyContin, were safe and effective and not addictive. Not true. Worse yet, an April 13, 2022 congressional oversight committee report revealed that at least 22 McKinsey consultants were simultaneously working with the Food and Drug Administration (FDA) on opioid safety and advising Purdue Pharma on how to influence the regulatory decisions of the U.S. FDA, as well as how to maximize sales. The bad behavior travelled down the food chain. For example, an email in the records of distributor AmerisourceBergen revealed during a state trial last year in West Virginia described their addicted consumers as “pillbillies” and referred to OxyContin as “hillbilly heroin.” Distributors also sent massive quantities of OxyContin to small rural communities clearly disproportionate to the population.

Now many of the major players in the prescription opioid debacle are paying the piper. Several physicians have been prosecuted – some unjustifiably – for overprescribing, others were a frank embarrassment to the profession by operating pill mills.

The national opioid settlement resolved thousands of civil lawsuits by state, local, and Native American governments. The lawsuits alleged that the sometimes sketchy business practices of many firms in the chain of commerce contributed to the opioid crisis. The national opioid settlements are the second-largest public health settlement of all time, following the $246 billion tobacco master settlement of the 1990s.

The largest pharmaceutical opioid distributors, (McKesson, AmerisourceBergen, and Cardinal Health) will pony up $21 billion and one manufacturer (Johnson & Johnson) will contribute $5 billion as well as cease manufacturing prescription opioids. Teva, Walgreens, and Walmart and several other smaller companies add to the financial mix.

The creator of OxyContin, Purdue Pharma (not to be confused with Perdue, the chicken supplier) entered into a separate settlement for $6 billion as part of its bankruptcy proceedings. While 60,000 vocal victims approved of, and were awaiting the funds, the federal government decided the terms immunizing Purdue’s owners, the Sacklers, from personal liability was not consistent bankruptcy law since the Sacklers did not declare personal bankruptcy. The case is currently in front of the Supreme Court and no ruling is expected until June 2024.

Who will control the funds? Currently several states have created councils that vary in their make-up but generally include health professionals, law enforcement, and victims of addiction. Importantly, where will the money go?

These councils are deciding on where to allocate the funds and are now the objects of multiple companies pitching their products. Most agree that the biggest portion should go to treatment by building treatment facilities and increasing access to medications for opioid use disorder, including for the uninsured, and providing naloxone to reverse overdoses. Some local governments want to use the funds to purchase law enforcement tools. Despite usefulness in curbing drug trafficking, as you can imagine, many groups are unhappy with this option. Additionally, many worry that as with the tobacco settlement, monies would go to unrelated projects.

My guest will share her expertise in addiction medicine and public policy.

*Dr. Rutherford’s website: Blue Grass Family Wellness: https://bluegrassfamilywellness.com

*To find how the settlement funds will be used in your area go to:

https://www.naccho.org/uploads/downloadable-resources/OpioidSettlementsPDFFinal.pdf

Bio

Molly Rutherford, MD, MPH is the founder, medical director, and physician at Bluegrass Family Wellness—a direct primary care clinic in Kentucky. She is board certified in Family Medicine and Addiction Medicine, and employs a holistic approach to her patients’ physical health. She has more than a decade of experience treating opioid addiction.

America Out Loud PULSE: Defining Death with Dr. Heidi Klessig

From my America Out Loud Pulse podcast with Dr. Heidi Klessig – https://www.americaoutloud.news/defining-death-with-heidi-klessig-md/

Historically, people advocated for at least 24 hours between the diagnosis of death and burial in case a mistake was made in the diagnosis. For years physicians searched for a sure sign of death. Some thought putrefaction of tissues was the only sure sign. Ultimately it seemed reasonable to define death as when all spontaneous vital functions ceased permanently. Then came organ transplantation and the whole concept of the moment of death has changed— irreversibly, like death itself.

The advances in medical science have made adherence to medical ethics more essential than ever. Cardio-pulmonary resuscitation (CPR), mechanical ventilation and artificial nutrition were only the beginning. We now are experimenting with pig to human transplants and freshly obtained aborted fetal tissue is being used to create “humanized mice”. We can’t get carried away with the technology and forget the humanity. First and foremost, a patient has the right to self-determination and the physician’s duty is to respect the patient’s decisions and to do no harm to the patient. Incidents where patients were labelled DNR (Do Not Resuscitate) without their (or their family’s) consent are unacceptable.

Unfortunately, along with the innovations that can prolong life and sometimes cure, we have drifted into a utilitarian mindset when considering patient treatment alternatives. Often times, the suggested treatment—or non-treatment—pathway is at odds with the concept of the innate dignity of being a living human being. All involved persons must remember that we are far more than clumps of cells or a collection of body parts for future use.

Also disturbing is the popularity of euthanasia and physician assisted suicide, euphemistically called “medical aid in dying” (MAID). In Canada, assisted suicide has been in effect since 2016. In 2022 medically assisted deaths constituted 4.1 per cent of all deaths in Canada. This was a 30 percent increase from 2021. The patient who partakes need not be terminally ill. According to a BBC news report, social problems like poverty, lack of housing, or extreme loneliness may contribute to the patient’s willingness to request MAID, and this “prompted fears it could be used as a solution for societal challenges.” As of March 17, 2024. Now persons suffering solely from a mental illness will be eligible for MAID.

As there is more and more discussion of scarce medical resources, we have to be vigilant that as physicians we maintain our commitment to respect human life. Marilyn believes death is a separation of body and spirit, but Dr. Singleton must deal with ethics, legal definitions and guidelines.

Today my guest will discuss the past, present, and future of the concept of “brain death.”

Dr. Klessig’s website: https://www.respectforhumanlife.com

Dr. Klessig’s latest book: https://www.respectforhumanlife.com/books

Bio

Dr. Heidi Klessig attended medical school at University of Wisconsin, where she also completed her residency in anesthesiology. She received the American Board of Anesthesiology’s certificate of added qualification in pain management. She was a founding partner of the Pain Clinic of Northwestern Wisconsin and was an instructor for the International Spinal Injection Society. She recently authored The Brain Death Fallacy. Dr. Klessig and Christopher W. Bogosh, RN-BC also maintain a website called Respect for Human Life that deals with issues surrounding organ transplantation

America Out Loud PULSE: Long Term Care Solutions

From my America Out Loud Pulse podcast with Stephen Moses – https://www.americaoutloud.news/living-longer-is-great-but-we-need-reforms-to-reduce-dependency-long-term-care-solutions/

People are living longer and by 2030 about one in five Americans will be aged 65 years and older. According to a Kaiser Family Foundation survey, about 8 million people 65 and older (20 percent) reported that they had dementia or difficulty with basic daily tasks like bathing and feeding themselves. Worse yet, about 3 million of them had no assistance at all. Family or friends were their only option. But these days, family members are scattered across the country and your friends may be in as poor physical health as you are.

Kaiser Family Foundation also found that 83 percent of adults surveyed said it would be impossible or very difficult to pay $60,000 a year for an assisted living facility. The inability to afford professional help can tear families apart. As parents age, their personality may change for the worse. A professional is trained to deal with the negative psychological and physical aspects of growing old. Families may find that the only way to get help is to put their parents in a nursing home. What will they do if the parents do not want to go? Sometimes the children find that the nursing home is not too pleasant but it is the only one in the area that takes public insurance (Medicaid).

The cost of long term care can be upwards of $100,00 per year. While there can be a huge financial toll and the loss of all your savings, the emotional toll is worse. Comments in a blog from folks who are caregiving for their loved-one can be heartbreaking: “Feeling like there is no honorable way out”; “crying out of pure exhaustion and grief”; “not being able to ‘fix’ what is wrong”; “having to be close by at all times and never getting a break.” “I lost my husband [recently] and I don’t think I could handle losing her. I am here at home with her 24/7 with, as you say, no end in sight.” There has to be a better way for the elder and their family.

Many people think that Medicare will pay for long term care of your choice indefinitely. Not true. Too many people end up on Medicaid with its limited options. Planning can make it so your future is what you want it to be.

My guest will discuss the reforms to reduce dependence on Medicaid and free up private financing to fix the LTC challenge.

Bio

Steve Moses is president of the Center for Long-Term Care Reform. The center promotes universal access to top quality long-term care by encouraging private financing as an alternative to Medicaid dependency for most Americans. Previously, Mr. Moses was president of the Center for Long-Term Care Financing (1998-2005), Director of Research for LTC, Inc. (1989-98), a senior analyst for the Inspector General of the U.S. Department of Health and Human Services (1987-89), a Medicaid state representative for the Health Care Financing Administration (1978-87), an HHS departmental management intern (1975-78), and a Peace Corps volunteer in Venezuela (1968-1970). He is widely recognized as an experienced expert and innovator in the field of long term care. His recent monograph on the issue is Long-Term Care: The Problem and Long Term Care: The Solution.

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