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How the opioid ‘epidemic’ was built on lies and perpetuated for politics

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How the opioid epidemic was built on lies and perpetuated for politics

I used to love “60 Minutes.” As a teenager, it was a favorite program in our house on Sunday evenings. The show featured all sorts of interesting people and places, with in-depth explorations that stimulated the imagination. Oh, how times have changed!

On February 24, 60 Minutes did a segment about a drug manufacturer who is calling out drug companies for “corrupt,” “immoral,” and “depraved” actions in marketing opioids. Supposedly the incentive for changing the labeling of opioids to allow for extended use is some sort of moral crime. David Kessler, former Commissioner of the FDA said “There are no studies on the safety or efficacy of opioids for long term use.” (8:25 in the video)

Case closed! We need to restrict opioids to two or three days at most. Anything longer than that is bad medicine and gets people killed. But… There are no polite words for the perfidious implications of Kessler’s comment. How do we know this? Let me count the ways.

First, opioids have been used for millennia. Chinese workers on the transcontinental railroad used opium on a weekly basis for years, without any notable adverse effects. American soldiers used them in Vietnam, and their performance in the field was not affected. Overdoses were unusual, since the usual heroin had well known potency. With 20% of the Army on drugs, you’d think that bad effects would be easy to find. Curiously, there was no evidence of mass addiction, either.

Why did they use drugs in their “off” time? They wanted to escape the war that none of them wanted to be part of. The Chinese laborers wanted a break from the brutal conditions on the railroad project. This is basically why urban professionals have beer at the end of a long hard week of work. Mild intoxication is therapeutic for them.

Second, while there may be no studies on extended use, those of us in medicine are painfully aware that while some patients do well without opioids, others require what Dr. Kessler would call “extended” use. This is a result of the Bell curve, or “normal distribution” of response to drugs.

Bell Curve

The person whose knee replacement requires zero opioids is on the left side of this curve, while the one who needs them for two weeks is on the right. Most of us fall somewhere in the middle. Every surgeon and every anesthesiologist lives with this curve every day. Importantly, the difference between the left and right sides of the curve isn’t two or three pain pills. The range is from zero to a hundred or more. And that leads to a key piece of information that 60 Minutes completely ignored.

Most physicians routinely use medications in “off-label” ways. To understand this, we have to point out one part of the Law of the Bureaucrat. Each FDA officer has been hired to “protect the public” from unsafe drugs. This means that people are too stupid to use drugs properly (Unfortunately, this is often all too true, even when explicit instructions are provided). And it means that doctors are too stupid to prescribe them safely, leaving the bureaucrat charged with “protecting the public” as the smartest person in the room. That then means that the bureaucrat must create iron-clad instructions for how medical personnel with more training and experience than him should prescribe the drugs. These instructions become part of “the label.”

Drug reps are only allowed to tell doctors exactly what the label says. They can’t even provide reprints of newer studies with additional information. That would be “off-label marketing,” and the FDA expressly prohibits that. Fortunately, doctors aren’t prevented from reading those journal articles. Shortly, responsible doctors start prescribing in ways that are different from what the Feds said they should do. And millions of patients get new benefits that the Feds haven’t approved.

With regard to opioids, the Feds never approved fentanyl or sufentanyl for the massive doses commonly used in heart surgery. But that never stopped me from administering literally gallons of both. The benefits were far too great to bother asking for permission I wasn’t legally required to get. And with regard to longer term use, we’ve been helping patients with cancer pain and other chronic pain with opioids for decades. These people are physiologically dependent, but you wouldn’t know it, because your co-worker with the bad back keeps coming to work. He’s able to do that because his opioid prescription keeps getting refilled.

The long term benefits of opioids have been well known for a very long time. The long term side effects are equally well known. But the key side effect that is creating the panic does not come from long term medical use. You heard me right. In spite of all the noise about “overprescribing,” that simply is not a problem. Less than 1% of the addicts on the street got their start with prescription opioids. And chronic pain patients rarely die of overdoses.

When Ed Thompson of Pharmaceutical Manufacturing Research Services tells Bill Whitaker that “the root cause of this epidemic is the FDA’s illegal approval of opioids for the treatment of chronic pain,” he’s simply wrong. This approval did create a marketing change, but for chronic pain patients, it didn’t make a lot of difference. Most pain management specialists and oncologists were already prescribing the drugs when needed for long term care. But this opened the door for unscrupulous doctors to ring the cash register in an already illegal market.

The problem in the US began in earnest when William Randolph Hearst capitalized on racist sentiments against Chinese workers in his newspaper campaign against the “coolee.” He created the myth of the “opium fiend,” who terrorized white women after smoking opium. It was a complete fabrication, but it sold the idea of opium restrictions to moralists and politicians. Who cares about facts when you can “Do something!”?

Next, when Andrew Kolodny says that “as the doses become higher [in response to drug tolerance] the drugs become more dangerous, and the risk of death goes up,” he is not telling the truth. He is pandering to a political narrative. The basic fact is that when you give opioids for an extended period, the endorphin receptors become tolerant to their presence. You do need to give more drug to achieve the same effect. But that very tolerance is what makes the drugs safer in the tolerant patient. Allow me to translate from medical to English.

If I need 10 milligrams of morphine for pain relief after surgery, and I just keep on taking 10 mg, after a while, I won’t get the relief. But my body will not need that degree of relief, so I will start spacing my doses out. This is something we saw in great detail when Patient Controlled Anesthesia (PCA) was introduced to pain management after surgery.

With the “morphine pump,” a patient was able to give himself lots of little doses of an opioid to help with pain after surgery. The PCA was rigged to prevent a repeat dose until 6 minutes after the previous dose, giving it time to work. We never saw overdoses with PCA if the patient was the only person to push the button. Never. As in “not once.” In fact, patients automatically weaned themselves off opioids. This was so safe that now the Acute Pain Service no longer exists in most hospitals. The surgeon signs a protocol sheet, and everything goes on autopilot.

The same thing happens when patients have pain pills at home after surgery. They taper off without thinking about it as the pain level subsides. But suppose they are in that 1% that stays on opioids. Their receptors get tolerant, and need higher and higher doses to get the same response. This means it also takes higher and higher doses to stop the patient from breathing, which is how ODs kill. Kolodny has his facts wrong.

So what kills addicts? Or, perhaps we should ask, why do addicts take overdoses? After all, overdoses given by someone else are rare. Even addicts don’t often try to commit suicide. It’s at this point that we have to step back from the final dose of a street drug, the proximate cause of the overdose, and look for the first step in a series of critical incidents. Like airplane crashes, it’s never just one thing that causes ODs, even if politicians like to have one problem “only they can solve.”

The first thing to note is that all opioids are, in a sense, the same drug. They all work at the same receptor, and they all have the same family of side effects. The primary differences revolve around how fast they start working (onset), how long they last (duration), and how much is required to reach a standard level of effect (potency). Of importance, the more potent a drug is, the more it binds only to the intended receptor, and the fewer side effects it will have (for example, nausea). That means that fentanyl is safer during surgery than morphine, and explains why we rarely use morphine in surgery today.

The next factor is that all the opioids are dirt cheap to manufacture. Virtually all the cost is in distribution. But even including the cost of distribution, Portugal spends about $4 a day on maintaining addicts, Canada about $11, and we should expect similar economies here if implemented. So why is it that El Chapo was worth north of $14 billion from the drug trade? It wasn’t the native cost of drugs. It came from distribution.

Why would anyone pay more than the price of aspirin for a drug that costs the same as aspirin? There’s only one reason: Prohibition. Recall that the soldiers in Vietnam used heroin and the Chinese laborers used opium for stress relief during leave time. There is a relatively fixed portion of the population that wants such intoxicants. With the change in labeling, it became “legal” for unscrupulous doctors to supply those people. But if they can’t get them “legally,” they will find a way to get them illegally.

If there’s a market for the illegal drugs, there will be a marketer. Enter El Chapo. He’ll provide your drugs, but for a price. Since he’s taking a legal risk, it will be high enough to compensate him for that risk. Economists call this a “risk premium.” Next, since you are opening your wallet, you want the good stuff. You won’t go back to the left street corner if you don’t get quality. So the guy on the right street corner figures out that if he adds fentanyl to your heroin. As the expression goes, “Aye, there’s the rub.”

We’ve described a vicious circle where higher price demands higher quality which again demands higher price. The higher price invites competition, but since the competition is in an illegal market, crime follows. And as users become addicted, they often find themselves committing crimes to pay for those high prices. Did I mention that Canada is able to maintain an addict legally for $11 per day?

Even the Drug Enforcement Agency has noted that prohibition creates massive profits for bad guys. That should raise alarms. If prohibition starts this vicious cycle, and a national experiment with decriminalization (Portugal) has basically eliminated ODs, shouldn’t we start looking in that direction? Drug-related crime in the US was essentially nonexistent until Hearst’s yellow journalism led to restrictions on heroin and other drugs. Crime accelerated as laws got stricter. In short, Congress created the drug cartels. Competition between drug cartels leads to adulteration of heroin with much more potent opioids, and this unknown potency leads people to take doses with unknown risks.

In maintenance programs, known potency drugs are given to patients with extreme safety. And over time, Portugal has seen that about half of addicts will wean themselves off their drugs.

60 Minutes wasn’t satisfied with its story until it slandered drug manufacturers and the FDA with this exchange: (13:40)

Whitaker: “(commentary)… also review new drugs, like Dsuvia, the most powerful opioid pill ever approved. (to Kessler) Just a few weeks ago the FDA approved a new opioid that is a thousand times more powerful than morphine. And this is in the middle of this opioid epidemic. How is that possible?”

Kessler: “I don’t get it. I get your question. I don’t get the agency’s action.”

Whitaker: “Isn’t the FDA supposed to be our watchdogs to protect us?”

Dsuvia is a tablet to be taken under the tongue when severe pain (chronic or cancer) “breaks through.” It is faster in onset than morphine, with a shorter duration. The 30 micrograms in Dsuvia, is equal in effect to 30 milligrams of morphine, a common dose in that situation. Whitaker’s phrasing was a slanderous lie. The FDA did not approve an opioid that was a thousand times more powerful than morphine. It was the same strength. It is a thousand times more potent, so AcelRx Pharmaceuticals created a pill carefully tailored to meet a specific need by only including a thousandth as much.

60 Minutes is complicit in the fear-mongering that is killing large numbers of Americans through poorly considered laws. The only way to eliminate the overdoses is to eliminate the laws. That will bankrupt the drug cartels. But the Overton Window for this sort of action has not yet opened. That means we will likely be seeing more and more examples of Einstein’s Maxim.

“Insanity is when you do something a second time and expect a different answer.”

 


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Conservatism

The complete fraud that is National Socialist Healthcare

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The complete fraud that is National Socialist Healthcare

The home state of Mr. ‘Medifail for All’ tried National Socialist healthcare and it didn’t work. What is the point of ever trying it again?

One would think that the operation of a socialist health care system in the home of Bernie ‘Medifail for all’ Sanders would be touted until the bovines hit the barn. Well, one would be wrong in that assumption since it never worked as advertised.

The Washington Post recently profiled the rise and spectacular fall of ‘Green Mountain Care’ from the fantastic promises at its inception to its inevitable crash as is the case with every socialist system. The Vermont rendition of single payer – a state version of National Socialist Healthcare – came onto the scene with great promise and fanfare. The problem is that states are forbidden to counterfeit [oops! ‘print’] currency, so they quickly ran out of other people’s money and the whole rotten edifice collapsed.

Why Vermont’s single-payer effort failed and what Democrats can learn from it
Three and a half years after then-Gov. Peter Shumlin of Vermont signed into law a vision for the nation’s first single-payer health system, his small team was still struggling to find a way to pay for it.

Two days later, on Dec. 17, 2014, Shumlin, a Democrat who had swept into office promising a health-care system that left no one uninsured, announced he was giving up.

The trajectory of Green Mountain Care, as Vermont’s health system was to be known — from the euphoric spring of 2011 to its crash landing in late 2014 — offers sobering lessons for the current crop of Democrats running for president, including Vermont’s own Sen. Bernie Sanders (I), most of whom embrace Medicare-for-all or other aspirations for universal insurance coverage.

[Our Emphasis]
Oddly enough, the local socialist Senator rarely mentions this when trying to sell everyone else on this statist snake oil. Those with a modicum of intelligence tend to learn from the colossal mistakes of others, implementing what works while rejecting that which does not. Then there are those on the Left who insanely insist on repeating those mistakes, hoping for a counterintuitive outcome.

This is no academic exercise, born of the Platonic dialogs from 2,400 years ago on the ‘Ideal state’. This is a deadly serious matter with millions of people’s lives at stake. Not to mention that as reported by the Associated-Press that ‘Medicare for all’ was projected to cost $32.6 trillion.

WASHINGTON (AP) — Sen. Bernie Sanders’ “Medicare for all” plan would boost government health spending by $32.6 trillion over 10 years, requiring historic tax hikes, says a study released Monday by a university-based libertarian policy center.

That’s trillion with a “T.”

Optimal conditions – and single payer still failed

One couldn’t ask for better conditions for this failed experiment in state socialist health care. The same report from the Washington post on this failed experiment noted that:

It has some of the nation’s healthiest residents, with some of the lowest rates of uninsured. It is small and homogeneous. It shares a border with Canada, putting an existing single-payer system within sight. And it has just one main insurer, the nonprofit Blue Cross Blue Shield of Vermont, repeatedly ranked the most efficient Blue Cross Blue Shield plan in the nation.

It was supposed to lower costs, insure more people while eliminating waste, fraud and abuse [Stop us if you’ve heard this joke before]. Unsurprisingly, it failed to do this. Nevertheless, the hometown senator of this communist catastrophe still touts the same ‘features’ in trying to sell his $32.6 trillion pipe dream.

Unfortunately for the purveyors of these plans presumably fueled by pixie dust and allusions to brand new ‘rights’ conjured up out of thin air the author of the piece failed to offer a solution aside from ‘controlling costs’ [read: death panels] or counterfeiting.. er.. ‘printing’ more money to endlessly throw into the bottomless pit that is the government.

It ran into all manner of problems, including what to do with people coming in over the border for all the free goodies [Stop us if you’ve also heard this one before]. Ever increasing tax rates hobbling the economy, ending with the fact that the costs of a bloated bureaucracy would mean less coverage that what the people already had.

Ironically enough, when the whole system died an inglorious death, Bernie Sanders was in Iowa testing the presidential waters, never mentioning the failure of single payer in his home state, the very idea that he incessantly touts. Why bother with facts and logic when one can just invoke counterfeit civil rights, paid for with other people’s money?

Meanwhile, the ‘objective’ media cheerleads for socialistic slavery

Still, this hasn’t stopped the ever ‘objective’ national socialist media from writing ‘News’ stories on the subject, such as this sickening saccharine piece from the Associated-Press ‘Medicare for All’s’ rich benefits ‘leapfrog’ other nations.

WASHINGTON (AP) — Generous benefits. No copays. No need for private policies. The “Medicare for All” plan advocated by leading 2020 Democrats appears more lavish than what’s offered in other advanced countries, compounding the cost but also potentially broadening its popular appeal.

Reading that infomercial for socialism, one can almost imagine the rise of a superhero in the guise of a later-day superman. The virtual embodiment of every wonderful feature of ‘Medifail for all’ vanquishing every cost overrun, taking down the ever evil private health insurance monster, providing free healthcare for all while dispensing Mocha Lattes on the side.

Faster than a speeding cost overrun. More powerful than free enterprise. Able to heap benefits to all in a single bound.

Look! Up in the sky! It’s a bird. It’s a plane It’s Single payer socialism! Here to save the day…. Until it implodes the economy.

After which, no one is helped.  How is that compassion?

Single payer can never work

Sadly, the author of the Washington post piece failed to cite how to get the bloated edifice off the ground. This is because there is no way to get it to fly.

The proper way to address this problem is to try a different direction, away from authoritarian socialism and towards economic Liberty. Conjuring up new civil rights does little to pay for all the freebies. As way experienced with a single payer experiment under ideal conditions, the end result was worse than what already existed.

There is no point in trying something that is doomed to failure, single payer [or whatever it’s called] can never work as advertised.

The Takeaway

It should be obvious that a governmental solution to the problem does not exist. Thus, it only makes sense to try a different approach. This won’t empower the Socialist-Left, but they claim to only have everyone’s best interests at heart. Let them show that is the case with a system based on economic Liberty instead of socialistic slavery.

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Healthcare

Shocking NY Times headline calls evil good and good evil

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Shocking NY Times headline calls evil good and good evil

Woe unto them that call evil good, and good evil; that put darkness for light, and light for darkness; that put bitter for sweet, and sweet for bitter! – Isaiah 5:20

There are four tactics favored by many mainstream media outlets, including the NY Times, that help them fulfill their two primary goals. Let’s start with their goals since they’re blatant: get more eyeballs for their paid subscription model and help Democrats win elections.

How do they do this? They have standard journalistic strategies that work for them well because they’ve been around for so long. They have access to people, manpower to cover stories, and resources to acquire assets necessary to make their stories popular. Those are the positive strategies they use, strategies that every news outlet strives to benefit from to various degrees. But they also use four tactics that help them with their secondary goal of pushing the left’s agenda:

  1. Shock headlines. While they rarely go as far as smaller outlets or tabloids, they are masters among the “big boys” at generating headlines to make their points.
  2. Credible experts with an agenda. One can argue that this is a technique all good outlets use to push their various agendas, but nobody is as adept at it as the New York Times. For example, if they’re pushing global warming, they get the best activists with science studies degrees to push the narrative.
  3. Manipulative statistics. Again, this is a common tactic, but the NY Times has mastered it. They have stat-finders on staff who comb the various studies of the world to find data that supports their premise. If that sounds natural, let’s not forget the idea should be the other way around. They should use statistics to form their premise.
  4. Begging the question. Contrary to the popular use of the phrase, it actually refers to a logical fallacy in which a premise becomes the basis of evidence for the premise. Similar to circular reasoning, it assumes a disputed notion to be factually correct.

In one editorial they published yesterday, they used the four tactics all at once. The title of the story is, “Pregnancy Kills. Abortion Saves Lives.”

I won’t link to it.

The article itself is an exercise in begging the question. For the statement in the headline to be remotely true, one has to assume that the preborn baby that’s aborted is not a life. If it were a life, then the statement would be (and in fact, is) ludicrous.

Of course, it obviously makes excellent use of the first tactic, the shock headline. I rarely read anything from their news outlet anymore, but it got me to click through and read it. When I did, I realized exactly what they were doing. First, they used the second tactic, a credible expert with an agenda, to not only help with the article but to actually write it. In this case, the expert is Dr. Warren M. Hern. His expertise is being a physician and epidemiologist who specializes in late-abortion “services.”

Dr. Hern proceeds to use the third tactic, manipulative statistics, to make his point that abortions are less likely to kill the mother than pregnancy or childbirth. Is it true? Absolutely. I learned this myself when my wife nearly died as our fifth child was lost in a miscarriage. Both pregnancy and childbirth are risks to mothers, much more so than abortions.

Nobody can dispute this fact. But the way this fact and others are framed, such as a statistic showing African-American women were more likely to die as a result of pregnancy than Caucasian women, were intended to be terrifying to mothers and to support his claim that pregnancy kills the mother at a higher rate than abortion.

But again, his entire argument relies on the notion that the child in the womb is not actually a life.

We are faced with a society in which a large percentage feel the same way. They have to in order to maintain their own self-perception of not doing harm to another human. Otherwise, abortion becomes murder. The only way it can’t be seen as murder is if the baby inside the mother isn’t seen as life.

This is why it’s so very important we start looking at abortion in America as more than just a political or even religious issue. It’s a cultural issue, one in which we are failing to deliver the right message. Most people can be made to appreciate the value of the life within the womb if they’re allowed to look beyond the politics. They are getting bombarded with the same two messages. Pro-abortion activists say they’re defending women’s rights. Pro-life activists say they’re defending the baby’s rights. Both arguments can have merit based on how a person perceives the baby in the womb. If it’s seen as a life, it’s hard to say that life has no right to live. If it’s seen as a parasite, clump of cells, or “potential” human, then the rights of the mother prevail.

Articles like this one in the NY Times are meant to change the way culture perceives abortion. We must fight back by continuing to push reality, that a baby in the womb is a life. We have the truth on our side. It’s time to use it.

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Culture and Religion

How Alabama’s abortion law sets President Trump up to be a pragmatist

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How Alabamas abortion law sets President Trump up to be a pragmatist

One of the favorite tactics for both major political parties is to paint opposing candidates as extremists. This is particularly true when it comes to presidential candidates; if you don’t recall, every Republican candidate since Ronald Reagan has been painted as a bigot by Democrats. But whether or not the people fall for the extremism play is usually based, at least to some degree, on reality.

That may not be the case in the 2020 election as both media and the expressions of the people seem to be favoring extremism as a reality rather than just a label. The President is a far-right bigot in the eyes of Democrats while every Democratic candidate (with the possible exception of Joe Biden) is a far-left socialist in the eyes of Republicans. Meanwhile, mainstream media is engaged in confirmation bias to appease their audiences. One need only look at coverage of the Mueller report to see how this is unmistakably true.

On the issue of abortion, the Democratic candidates have made no attempts to appeal to the middle. As each is either asked for or volunteers their perspective on abortion, invariably they are pushing no restrictions whatsoever. This is a far cry from the days when the Clintons thought abortions should be safe, legal, and rare. Today, abortions are to be embraced as far as Democrats are concerned, and any attempt to push for adoption or to fight for the rights of the child in the womb is considered bigoted. One by one, every Democratic candidate is adopting abortion extremism as their stated stance.

But President Trump did something yesterday that makes sense from a political perspective. I may disagree with his stance, but it’s a winning strategy for his reelection campaign. He said he is pro-life with exceptions for rape, incest, and the life of the mother. This stance was once considered to be an extreme position for the right, but with the Alabama abortion bill removing exceptions for rape and incest, the President has the luxury of being closer to the middle than any of his opponents (again, with the possible exception of Biden – we’ll find out soon enough).

Thankfully, the President of the United States has very little they can do when it comes to abortion other than pick pro-life judges and act as the leader of their party. Executive orders on abortion would be certainly struck down regardless of what they say, so it comes down to ideological purity. With Democrats taking on abortion-on-demand as their stated radical stance, it’s hard to argue that the President is the extremist when even he doesn’t directly support the Alabama bill. He didn’t call it out, but by stating his personal position he established that he’s not as far to the right as the Democrats are to the left.

Today, the Democrats must embrace their primary voters, many of whom are the radical progressives “shouting their abortions” and pushing for a socialistic Dystopian future for America. Meanwhile, the President has the luxury of being more pragmatic with his approach since he’s already in general election mode. He doesn’t need to appeal to his base very much because they either stand behind him out of adoration or they fear the Democrats too much to consider going against him. Even most #NeverTrumpers are having a hard time reconciling their hatred for the President with the current batch of hardline hyper-leftists vying for the Democratic nomination.

We can argue the nuances of being pro-life and having exceptions, but as long as the Democrats are all onboard for on-demand abortions, the President’s less extreme stance on abortion will help him next November.

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