Dr. Steve Miller, You Suck

I had no idea that so many pain medications also came in topical form, including Gabapentin and Tramadol. And I can’t believe how much they’re charging for them:

http://www.cbsnews.com/news/investigation-insurance-billed-18000-for-unwanted-pain-meds/

“$18,000 for one-month supply, three creams, that’s about right,” said Wurtz…

Western Medical pitched the creams as a “free benefit” paid by insurance. If a patient said “yes” Western Medical told their doctor: “One of your patients has expressed interest in a non-invasive topical cream to help alleviate pain.” It also sent over pre-written prescriptions for the doctor to sign…

Sources linked to Western Medical tell CBS News the company collected up to 200 prescriptions a day, billing them to Medicare and private insurance for more than $1 million a week…

“This is really abuse in the marketplace,” said Dr. Steve Miller.

Dr. Miller is the chief medical officer at Express Scripts, the nation’s largest pharmacy benefit manager. They paid for John Picard’s creams, but recently stopped covering many of them because, Dr. Miller said, there’s no research proving they work.

“If you talk to almost any pain expert, they’ll tell you these things are working strictly through a placebo response and not through a physiological response through the pain receptors,” said Dr. Miller…

How many pain “experts” would declare that topicals don’t work? That topicals only provide a placebo response? (Is your pain doctor a paid consultant for Express Scripts? A paid consultant for pain medications that aren’t topicals?)

I’m not a big fan of topicals, but I’ve read plenty of comments from pain patients who say that they help. I’ve used Lidocaine patches and I’ve tried a compounded topical with Soma. I have to agree with Dr. Miller about the placebo effect, but I don’t think every patient who gets relief from topicals is experiencing a placebo effect. And for a doctor to discount the relief that can be obtained from a placebo effect is very short-sighted.

For Dr. Miller, this is about money. And I guess Express Scripts is not willing to pay for drugs which can provide the benefits of a placebo effect. Even though the percentage of patients who benefit from a placebo effect are fairly small, they’re not inconsequential. Express Scripts is saving a lot of money by denying the benefits of placebos, as well as denying that topical pain medications can and do work.

Dr. Miller, you suck. How can you call yourself a doctor?

Under comments:

THIS NAME USED? February 26, 2015 7:7AM
This report only scratches the surface of the fraud and laws being broken around the compounding pharmacy industry. I happen to work for a compounding pharmacy and understand the business. There are good, ethical compounding pharmacies out there that follow all the rules. Then there are those that solicit physician “investment” and compensate those physicians handsomely for using their pharmacy exclusively. Medimix and RXpress are prime examples…

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Because Bread

I had a gluten party yesterday. Can you smell the yeast?

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I put garlic salt and fresh parsley on top of the gluten.

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Nothing like the taste of bread and butter.

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The internet shares my love of bread.

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For some reason, people think bread and cats are funny.

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But I don’t think the cats are having any fun. Dear internet: Please stop torturing your cats with bread heads just so you can make a meme.

Can your DNA be used against you?

http://www.knowable.com/a/18-black-people-reveal-the-most-overtly-racist-thing-theyve-ever-experienced/p-2

4. Riding in a car with my cousin, some cops pull us over and wants to search the car. We were young and just assumed they could do that…

http://www.propublica.org/article/dna-dragnet-in-some-cities-police-go-from-stop-and-frisk-to-stop-and-spit

Valutsky told them there had been a string of car break-ins recently in the area. Then, after questioning them some more, he made an unexpected demand: He asked which one of them wanted to give him a DNA sample.

After a long pause, Adam, a slight 15-year-old with curly hair and braces, said, “Okay, I guess I’ll do it.” Valutsky showed Adam how to rub a long cotton swab around the inside of his cheek, then gave him a consent form to sign and took his thumbprint. He sealed Adam’s swab in an envelope. Then he let the boys go.

Telling the story later, Adam would say of the officer’s request, “I thought it meant we had to.” …

Private DNA databases have multiplied as testing technology has become more sophisticated and sensitive, enabling labs to generate profiles from so-called “touch” or “trace” DNA consisting of as little as a few skin cells. Automated “Rapid DNA” machines allow police to analyze DNA right at the station in a mere 90 minutes. Some states allow “familial searching” of databases, which can identify people with samples from family members. New software can even create composite mugshots of suspects using DNA to guess at skin and eye color.

Strict rules govern which DNA samples are added to the FBI’s national database, but they don’t apply to the police departments’ private databases, which are subject to no state or federal regulation or oversight…

In 2012, New York became the first state to require DNA collection from those convicted of any crime, not just violent ones, and at least 29 states now authorize collection from anyone arrested for certain crimes…

Blackledge said building a private database also allowed the city to collect more DNA from juveniles…

Since 2007, the District Attorney’s office in Orange County, California, has offered certain non-violent offenders the chance to have their charges dismissed in exchange for contributing cheek swabs to a special separate DNA database — a “spit and acquit” program, as the local media nicknamed it. As of mid-August, according to the DA’s office, over 145,000 people had voluntarily donated their DNA to this database…

Police in Branford, Connecticut, draw a different line in collecting DNA. They’re instructed to request DNA from people they merely observe acting inexplicably or strangely…

West Melbourne police say they’ve collected “abandoned DNA” from chewing gum or cigarette butts left by people who refused to sign consent forms…

Under comments:

bdaly • 3 days ago
Has anyone considered how much medical info your DNA has? Imagine the damage that could be done to you if that info were to fall into the hands of insurance companies or potential employers. It’s not like these databases are unhackable.

http://www.genome.gov/10002328/genetic-discrimination-fact-sheet/

Genetic discrimination occurs if people are treated unfairly because of differences in their DNA that increase their chances of getting a certain disease. For example, a health insurer might refuse to give coverage to a woman who has a DNA difference that raises her odds of getting breast cancer. Employers also could use DNA information to decide whether to hire or fire workers.

The Genetic Information Nondiscrimination Act of 2008, also referred to as GINA, is a new federal law that protects Americans from being treated unfairly because of differences in their DNA that may affect their health. The new law prevents discrimination from health insurers and employers. The President signed the act into federal law on May 21, 2008. The parts of the law relating to health insurers will take effect by May 2009, and those relating to employers will take effect by November 2009.

The law protects people from discrimination by health insurers and employers on the basis of DNA information. The law does not cover life insurance, disability insurance and long-term care insurance.

http://www.yahoo.com/news/pot-breathalyzer-hits-street-115944220.html

American police have for the first time used a marijuana breathalyzer to evaluate impaired drivers, the company behind the pioneering device declared Tuesday, saying it separately confirmed its breath test can detect recent consumption of marijuana-infused food. The two apparent firsts allow Hound Labs to move forward with plans to widely distribute its technology to law enforcement in the first half of next year, says CEO Mike Lynn…

Though breathalyzers are familiar roadside tools, there are other options for officers looking to rapidly test a person for marijuana or other drugs, including increasingly accepted roadside oral fluid tests or — potentially early next year — a futuristic fingerprint-sweat test.

Dr. Paul Yates, a forensic scientist and business development director at U.K.-based Intelligent Fingerprinting, says the sweat-test devices — which can be calibrated to specific thresholds for marijuana and other types of drugs including cocaine and opiates — can indicate drug use in near-term windows…

Duffy Nabors, vice president for sales and marketing at Smartox, says the company has received inquiries from law enforcement departments in California, Colorado and Texas interested in roadside use of the metabolite test, and he expects law enforcement will be among the first American buyers…

The DrugTest 5000 — one of a handful of similar products — indicates if marijuana or other types of drugs are present in a suspect’s saliva. The company counts the New York Police Department, the Nevada Highway Patrol and Oklahoma tribal police among its customers.

Shaffer says the test detects THC in a user’s saliva for roughly 2-6 hours after they consumed the drug, though a heavy user once tested positive 24 hours later. The test only indicates the presence of THC and does not quantify the amount, though like the Intelligent Fingerprinting technology can be calibrated to a specific threshold…

https://painkills2.wordpress.com/2015/05/18/patients-wrongfully-labeled-by-ameritox-drug-tests/

Now, if you’ve read all of the above information, how do you feel about this:

https://www.yahoo.com/news/u-justice-dept-push-prosecutors-opioid-crisis-usa-134410768.html

WASHINGTON (Reuters) – The U.S. Justice Department will enlist federal prosecutors to help fight the nation’s opioid crisis by sharing information on overprescribing doctors and coordinating with public health officials to address addiction, USA Today reported on Friday…

Lynch said sharing information about physicians tied to prescription drug abuse could help authorities better identify drug traffickers and the routes they use, the report said, adding that working with local health officials will help give equal attention to prevention and treatment efforts…

She said the department would issue the new plan next week in a memo to its 94 U.S. attorney offices…

Tell me, how are federal attorneys going to “work” with local health officials in regards to prevention and treatment efforts? What do attorneys and the justice system have to do with addiction and health care? Are the attorneys going to give patients free legal advice?

To me, this little tidbit of information from Attorney General Loretta Lynch has to do with the PDMPs. There’s been a push to connect all state databases into a federal database that’s accessible across state lines. Like the FBI has a national database for DNA. “Coordinating with public health officials” might mean that U.S. attorneys are going to require states (doctors, government employees, pharmacists) to input the information into the PDMPs, making their use mandatory.

What does this mean for chronic and intractable pain patients? Looks like the federal government has taken the criminalization of opioids to the next level. Perhaps the U.S. Attorney’s Office is getting tired of waiting for the DEA to make a difference.

If you have a DNA test, make sure you read the release forms. Don’t sign a form that says the lab can share or sell your DNA information, and make sure you see HIPAA language. I’m not saying these things will protect you, but that’s all we’ve got.

http://www.nationalpainreport.com/genetic-testing-may-provide-faster-path-to-the-right-fibromyalgia-medication-8831433.html

Someday in the not-so-distant future, before your health care provider decides which medication to prescribe for your fibromyalgia symptoms, they might first swab your cheek for a few cells and send them off for genetic tests. The genetic data hidden in those cells might reveal which medications you are likely to get benefit from, and which to avoid due to higher chance of side effects.

It sounds futuristic, but in fact this technology is available now, though it has not been widely adopted by medical providers. Testing for a person’s gene-drug interactions is called “pharmacogenetics,” and is a rapidly expanding field with multiple companies now offering panels of tests targeted to different illnesses…