Michigan in the Vaccination Toilet

This is a follow-up to a prior post on the anti-vaccination movement.  Recent surveys show that Michigan is now 46th in the nation in vaccinating our children and teenagers.  This is appalling.  Vaccination protects and benefits the child who is vaccinated.  It also protects and benefits the children around them — so-called herd immunity.

As a socially-conscious individual, it is your responsibility to remind parents around you to vaccinate their children.  For more information, visit visit ivaccinate.org.

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com

©2017 John B. Payne, Attorney

Repealing the Affordable Care Act

Without spin or editorializing on the issue, here are some facts from The Center for Medicare Advocacy, medicareadvocacy.org, about the program Congress plans to repeal:

  • The uninsured percentage of Americans under 65 is the currently the lowest in decades. Beginning in 2014, the rate dropped from 16.6% to 10.5%.
  • As of March 31, 2016, 11.1 million people have coverage through the ACA Marketplace.
  • As of 2015, 11 million people in 31 states and the District of Columbia had coverage through Medicaid expansion under ACA, out of a total of 81 million on Medicaid.
  • There are 19 states that did not expand Medicaid: Alabama, Florida, Georgia, Kansas, Idaho, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Texas, Tennessee, Utah, Virginia, Wisconsin and Wyoming.
  • However, the ACA resulted in 16,748,000 people becoming eligible for Medicaid as of September 2016.

Congress says it will replace the ACA with something better. Dare we hope?

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com

©2017 John B. Payne, Attorney

The Prescription You Do Not Need

Among the clues that one is no longer young can be proliferation of prescription drugs in the medicine cabinet. In this age of miracle drugs you do not even have to be “older” to be taking a regimen of four, five, or more prescriptions, daily. Aggravating this tendency for Americans to take more and more prescriptions is the fact that there is no central registry of an individual’s prescriptions, so doctors are often unaware of all the drugs a patient is taking.

Once, while volunteering as a drug crisis counselor in the ‘70s, I was called to the home of a factory worker. This was unusual because most of our calls were for overdoses of psychedelics or “downers” by students and those who tuned in, turned on and dropped out.

The man was sitting at his dining room table staring out at his back yard, catatonic. He had been seeing a large number of psychiatrists, who all gave him prescriptions for strong mood-altering drugs. His wife showed us a large toiletry bag holding dozens of psychotropic prescriptions. It was no wonder he was in the o-zone.

In 40 years there has been little progress toward protecting patients from conflicting treatment plans from different doctors or unnecessary prescriptions by scrip mills. Pill freaks can still go from doctor to doctor collecting drug prescriptions at every stop. Now they are even armed with all the brand names of the pills they probably do not need because television is polluted with Big Pharma ads, as documented today by Bloom County.

I recently learned of another aggravating factor in the drug tsunami pouring over our country – drug “protocols.” A client who takes two prescription drugs recently picked up her prescriptions and found a third in the bag, a generic for Prilosec. Surprised, she looked it up on drugs.com and learned that it is a proton pump inhibitor (PPI). She told me, “I did not know that my proton pump needed inhibition. I always thought my lack of inhibition was part of my charm.”

Reading further, she learned that PPIs are used to treat heartburn and acid reflux. She had never had a problem with her GI tract and eats highly spiced, exotic foods with gustoand no ill effects.

Prilosec was recently found to be associated with an increased risk of dementia. In addition to the dementia risk, there was a respectable catalog of dire side-effects, such as diarrhea, muscle pain or spasms, heart-rate abnormalities, and seizures. Finally, since PPIs suppress production of stomach acid, the body tries to compensate for the increased pH in the gastro-intestinal tract after a period of PPI use by producing more stomach acid. This requires ever-higher doses or a more powerful PPI.

Now both curious and alarmed, she called the office of the doctor who prescribed the PPI to ask why. The nurse checked with the doctor, who told her he prescribed the PPI because it is listed in a drug “protocol” for her condition, which had nothing to do with the GI tract. In response to her expression of concern that she was being prescribed medication for symptoms she did not have, the nurse assured her that “everyone” takes PPIs. The nurse, herself, takes Prilosec, but will be graduating soon to a more powerful medication for acid reflux because Prilosec is losing its effectiveness for her (Remember about the body’s response to prolonged use of PPIs?).

Writing a prescription based on a drug “protocol” is like prescribing for a real patient from a hypothetical medical record. This raises concerns on many fronts.

First, if the patient does not have the condition the drug is intended to treat, the doctor is introducing unnecessary interactions with other drugs. Even if the doctor knows all the prescriptions the patient is using, he or she is not with the patient on a daily basis and will not know about over-the-counter drugs and supplements the patient may be consuming or lifestyle circumstances and diet that may affect how the drug is tolerated. A real patient is likely to differ in important ways from the hypothetical patient on which the protocol is based.

Secondly, prescribing from a protocol will lead to an upward spiral in the number of prescriptions doctors write. A drug protocol created by, or with the connivance of, the pharmaceutical industry will include every possible application for every drug, but will not catalog contraindicated products. As a consequence, the list of suggested pharmaceuticals for a given diagnosis will expand over time, but never contract.

Finally, many patients will take whatever prescriptions a doctor gives them. They may not realize that a prescription is treatment for symptoms or conditions they do not have. An unnecessary drug may become a regular part of the patient’s drug regime and the side effects of that unnecessary drug may require still more prescriptions to treat those side effects. Patients in assisted living facilities and nursing homes are especially prone to take pills they do not need. They are handed their medication and take it without question.

One resident in an assisted-living facility was taking over $500.00 per month in medication and was almost totally unresponsive. When the family had a money problem and couldn’t pay for the prescriptions, they stopped giving them to her. She soon perked up and started asking about her grandchildren. She had been chemically restrained to make her more tractable.

Our consumption of pharmaceutical products is out of hand. Automatic inclusion of additional substances based on a hypothetical model of a patient’s diagnosis would be one more aggravating factor. Physicians need to prescribe treatments based solely on analysis of the specific patient’s symptoms and conditions and patients need to be more inquisitive about the prescriptions they are being given. Further, any patient who is taking more than three prescriptions should have a periodic review by an independent pharmacist or different doctor to analyze the drug interactions going on.

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com

©2016 John B. Payne, Attorney

An End to the Dreaded Plateau

On July 24, 2010, an article entitled “The Dreaded Plateau” appeared in this blog. It explained why some Medicare patients have trouble getting their full 100 days of skilled care or rehabilitation. The recent settlement of a federal class lawsuit addressed the “progress” requirement often incorrectly applied to patients in skilled care. The progress requirement is also referred to as the “improvement standard.”

Medicare covers up to 100 days of skilled care or rehabilitation. Rehabilitation or skilled nursing facilities will issue a Notice of Medicare Skilled Care Termination as soon as there is any doubt that the patient needs skilled care. Often the reason given is that the patient has reached a “plateau” in his or her progress. That requirement is not supported by Medicare law, but it was used by facilities and permitted to be used by the Centers for Medicare and Medicaid Services (CMS), the federal oversight agency for federally-supported health care programs.

The attorneys at the Center for Medicare Advocacy (CMA) are are true heroes in the battle to maintain a reliable, healthy Medicare program and in the struggle to help Medicare members get the best possible care. In conjunction with Vermont Legal Aid and other advocates, CMA achieved a landmark settlement with CMS. In Jimmo v. Sebelius, No. 11-cv-17 (D.Vt.), filed January 18, 2011, a proposed settlement was reached October 16, 2012. When the agreement is signed by the judge, CMS will revise the Medicare Benefit Policy Manual and other Medicare Manuals to correct suggestions that Medicare coverage is dependent on a beneficiary “improving.” New policy provisions will state that skilled nursing and therapy services necessary to maintain a person’s condition can be covered by Medicare. This settlement is described in detail on the CMA website.

 

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com
 
©2012 John B. Payne, Attorney
 
 

Suck a Vile Vial

Ads for 5-Hour Energy are pervasive on hulu.com. Although internet commercials are a new phenomenon, I can confidently predict that these grating snake-oil pitches will rank among the Top Ten awful ads for years and years. These execrable exercises in mendacity are wrong on so many levels that I could write for hours and hardly scratch the surface.

In the first place, the product is basically the caffeine in an ordinary cup of coffee offered in a tiny vial of slime, “enhanced” with some B-vitamins and the nutrition you might find in an ordinary cookie. Instead of this miracle potion priced at $2.00 or more, just take a No-Doz or Vivarin with an Oreo and a shot of milk. Save yourself at least 75% of the cost. In a truly bizarre twist, the product is now being offered in de-caffeinated form at the same price. That’s like offering a car minus engine at the regular price. Talk about gas-mileage!

The worst commercial for this product is the one where a flaky cowboy wannabe talks a couple of schlemiels into tossing their biggie coffees over their shoulders, littering the countryside with their styrofoam cups. What a waste of presumably decent coffee! Even worse, they are desecrating the outdoors with their trash.

A fellow WordPress blogger thoroughly trashes the commercial where a female actor tries to sell the viewer on the idea that 73% of doctors would prescribe this bilge water to their patients. In “5-Minute Calculation” the pseudo science of the ad is well and truly debunked. http://mirkwood.wordpress.com/2012/07/28/5-minute-calculation/

One point that Mirkwood did not make is the silliness of the claim that the doctors “said they would recommend a low-calorie energy supplements to their healthy patients who used energy supplements.” Why would it not be 100%? Of course a doctor would recommend a low-calorie energy supplement to healthy patients already using them. Would a doctor not recommend low-tar and low-nicotine cigarettes to patients who intend to keep smoking? That would not be a recommendation to smoke, it would be a recommendation to do something a little less stupid than smoking high-tar and high-nicotine cigarettes.

It is getting late here in the American Heartland, so I will wrap this up. Besides, I have not yet watched all the episodes of “Mongrels.” I want to see what Nelson and the gang are going to do next. For the pleasure, I will probably have to endure half a dozen revolting commercials. If repetitive advertising can truly influence behavior, at 3:00 a.m. I will probably shuffle off to the QuickeeMart to buy a 5-hour Energy decaf. Who knows? It might help me sleep.

 

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com
 
©2012 John B. Payne, Attorney
 
 

Orientation or Preference?

A major belief of those who hate or fear lesbian, gay, bi-sexual, and trans-gendered people is that sexual identity is a choice, or at least is subject to psychological influence. They are convinced that what they consider “deviant” sexual identity may be corrected through determination, prayer, therapy, a healing touch or some other instrumentality. The corollary to this principle is that the LGBT community is bent on turning “straight” people gay. The idea that sexual identity is malleable is absurd. Gay people are neither susceptible to, nor capable of, conversion.

To reach this conclusion, I only had to look inward. I have always had a strong sense of my sexual identity. There is no way that I could be persuaded, threatened, cajoled, browbeaten, or bribed into changing my sexual identity. Sexual identity is a matter of orientation, not preference. A person is AC, DC, or AC/DC because that is how the person’s brain is hard-wired. Although I never doubted that I was right about this, recent news reports have provided proof.

Chris Birch, a beer-swilling Welsh rugby player suffered a stroke. When he woke up, he found that his sexual orientation had changed from hetero- to homo-sexual. “The Telegraph,” April 17, 2012. Rugby Player Happier Gay. If a physical change in the brain can cause a change in sexual orientation, whether one is gay or straight is clearly not a matter of choice or external influence.

This case proves, “You are what you are and you ain’t what you ain’t.” A person’s sexual orientation is subject to change, but only by an accidental physical change in the brain. Religious zealots can stop trying to convert gays and homophobes can stop worrying that gays will convert them.

 

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com
 
©2012 John B. Payne, Attorney