Category Archives: Uncategorized

Anti-Opioid “Expert” Paid $$$’s for Testimony

J&J’s lawyers note opioids researcher being paid hundreds of thousands for testimony in Oklahoma trial By John Sammon – June 18, 2019

I just can’t resist posting more of the news coming from the trial that Kolodny is starring in.

Attorneys defending Johnson & Johnson on Monday fended off accusations their client caused an addiction crisis and shifted attention onto Purdue Pharma, while also noting a plaintiffs expert is being paid upward of $500,000 for his testimony.

He’s quite the hypocrite, accusing pain patient groups of being mere “fronts” for the pharmaceutical opioid sellers from which they accept donations. I’m delighted to see his testimony dismissed as the unhinged anti-opioid zealotry it really is.  Continue reading

J&J moves to strike Kolodny testimony

At opioid trial, Johnson & Johnson moves to strike Oklahoma witness as ‘de facto member of State’s legal team’By Dan Fisher – June 2019

I was thrilled when I saw this so I’m posting it quickly without much comment. I think we might finally be seeing the undoing of our prime tormentor, Andrew Kolodny.

Johnson & Johnson has asked the judge overseeing the first in an expected wave of trials against the opioid industry to strike the testimony of Dr. Andrew Kolodny, a psychiatrist who plays a central role in the State of Oklahoma’s case by linking narcotics marketing to opioid addiction and overdose deaths.

Calling Dr. Kolodny “a de facto member of the State’s legal team,” J&J said Oklahoma gave the Brandeis University researcher unfettered access to some 90 million internal documents obtained through discovery and used his expert testimony to

  • “pollute the trial record with rampant hearsay,
  • rank speculation, and
  • the State’s own take on the evidence.”

Continue reading

WA State condemns inappropriate treatment of pain

Finally, some good news: the State of Washington has issued an “Interpretive Statement” to officially condemn doctors unwilling to effectively treat pain, even when that includes opioid therapy, and to clarify that:

appropriate pain management is the responsibility of the treating practitioner and the inappropriate treatment of pain, including lack of treatment, is a departure from the standard of care.”

This is a complete turn-around from the stringent restrictions this state was one of the first to enact. Jane Ballantyne, MD, and Roger Chou, MD, two of the “experts” who worked on the CDC guideline, are both from the University of Washington, so I’m astonished that the same state is now backing off from their extreme anti-opioid views.

Will wonders never cease… Continue reading

Pills Costs $20 in One State and $130 in Another

This Bottle of Pills Costs $20 in One State and $130 in Another

Generic versions of the heartburn drug Nexium should be cheap all around the U.S. Numerous manufacturers sell it. A month’s worth of pills is available from wholesalers for less than $20.

But in several states, Medicaid plans that serve the poor are paying more—a lot more. Early last year in Arizona, Georgia, Kentucky, Nevada, and Ohio, that $20 bottle of generic Nexium costs Medicaid managed-care plans more than $130, according to a Bloomberg News analysis.

It’s not just heartburn pills. A Bloomberg analysis of 90 big-selling generic drugs in Medicaid managed-care plans in 31 states found wide variations in the prices of medicine from state to state. In some states, Medicaid plans appear to be getting a good deal. In others, plans pay markups of threefold or more on some treatments.

In Indiana early last year, private Medicaid plans were paying more than $8,900 for a month’s supply of imatinib, the generic version of Novartis AG’s leukemia drug Gleevec. That’s a small discount over the brand, which lists for just over $10,000 a month.

In the first quarter of 2018, managed Medicaid plans in Arizona paid more than $65 for a month’s supply of duloxetine, a popular antidepressant that was available wholesale to pharmacies for less than $7 a month.

The same plans shelled out $200 for a 30-day supply of pain-relieving lidocaine patches—more than twice what it cost drugstores to buy them.

Independent pharmacies, state lawmakers and state officials have pointed at pharmacy benefit managers, or PBMs, as one possible reason for big differences in price.

They’ve complained that PBMs, which have the contracts to run drug benefits in many state programs, operate with little transparency, making it hard to know whether health plans are getting a good deal.

Among the practices under scrutiny is “spread pricing,” a contractual arrangement that allows PBMs to pay pharmacies one price for a generic drug while charging higher prices to their health plan customers.

PBMs, including CVS Health Corp. and Cigna Corp.’s Express Scripts unit, have said that spread pricing adds stability and predictability to drug costs for their clients. Health plans freely choose the spread arrangements over other fee-based options, they say.

Outsourcing the program to private companies is meant to lower costs and provide better care for patients, including for highly complex pharmacy benefits. But the vast differences in prices that some state Medicaid plans are paying for common generic drugs raise questions about whether some state plans are getting as good a deal on drugs as they could.

Years ago, this trend to privatization started based on the myth that businesses would be better at reining in costs because they have to show a profit.

Well, we all can see how that’s going, when there are what we non-corporate folks would call thieves are at the helm of most corporations these days.

Many Medicaid drug plans are overseen by pharmacy benefit managers.

These middlemen

  • manage lists of hundreds or thousands of covered drugs,
  • negotiate with drugmakers for rebates on brand medicines, and
  • pay pharmacies that dispense drugs.

In turn, they’re paid by the Medicaid plans.

Several states have launched inquiries into PBM practices, sometimes facing opposition from the industry, after raising questions about the companies’ practices. In Ohio, CVS sued to try and block the release of one report on pricing.

Bloomberg’s analysis showed that the markups in many Medicaid managed-care plans were gradually increasing. Critics have questioned if the PBMs are using the markups as a source of excess profit—something the companies have denied

Overall in the Medicaid managed-care plans, pharmacy and supply-chain middleman markups increased to almost 32 percent in 2017, up from 24 percent in 2015, Bloomberg reported in September.

Medicaid plans in six states—including Arizona, Indiana and New Mexico—had markups of more than 40 percent on the 90 generic drugs in 2017, Bloomberg found.

Bloomberg’s broad-based analysis can’t distinguish between how much of a drug’s markup is going to drugstores and how much is retained by pharmacy benefit managers that oversee drug benefits in many private state Medicaid plans. The mix of drugs used varies from state to state, which may also affect pricing.

Express Scripts said the wide fluctuations in generic drug costs between states result from a variety of factors, including inherent differences in state reporting requirements.

PBMs tend to blame everyone else but themselves, even though they determine the prices.

So wide fluctuations are due to PbMs pushing to get as much profit as they can with varying amounts of success. To blame them on anything else is just a smoke screen.

Perhaps PBMs can see that they are about to be reined in and feel that they’d better gouge as deeply as possible before that happens. These outrageous and indefensible prices could be a “last gasp” of profiteering before this particular “golden goose” is killed.

Ohio officials told Medicaid plans to terminate spread pricing arrangements starting this month.

Here you see the golden goose is nearing the end of its life.

Spread pricing has been shrouded in secrecy, and with the new, transparent pass-through model, we intend to open the black box,” said Tom Betti, a spokesman for the Ohio Department of Medicaid.

But when this has been going on so long, why did the government wait so long to start pushing back and demanding a stop to this profiteering at taxpayers expense?

Heidi Capriotti, a spokeswoman for the Arizona Health Care Cost Containment System, said the state is reviewing the issue. Indiana and Kentucky officials said they were either monitoring or reviewing the issue. New Mexico is phasing out spread pricing in its Medicaid plans, a spokesperson for the state said.

Nevada is “working toward more transparent arrangements” with managed-care plans, said Beth Slamowitz, pharmacy program chief for the Nevada Department of Health and Human Services.

States that pay for Medicaid plans may not know the extent of spread pricing because they don’t have direct contracts with PBMs.

Here we go, with the multiple layers of money-absorbing contractors that all shift blame to the layer above or below them.

Instead, PBMs typically operate as subcontractors for the private plans states hire, allowing the PBMs to keep their operations opaque. But states and the federal government ultimately pay the bills, as their per-person payments to plans typically include a portion for drugs.

Here’s one huge problem with government outsourcing: the company that is contracted to do the actual work just turns around and subcontracts it to others, some of which also subcontract it further.

By using so many layers of “providers”, the true costs are kept well hidden while each layer creates as much profit as it can between what they are paid and what they pay their subcontractors.

It looks like these “administrative costs” will end up much higher than the cost of the goods or services provided.

The Truth About Hyperalgesia

Demystifying Opioid-Induced Hyperalgesia – By Jennifer P. Schneider, MD, PhD Feb 2019

Some insurance companies have declined to continue paying for opioid medications, citing OIH. Here’s why.

In cases like these, many insurance companies state that patients should have their doses tapered in order to decrease their pain.

Now, we’re really living in a fun-house mirror world, where taking a pain reliever increases pain and taking away opioid pain relief decreases it.

However, clinicians may find that attempts to reduce the opioid dose often result in increased pain.

Ya think?  Continue reading

Use of prescription opioids among persons with EDS

Use of prescription opioid and other drugs among a cohort of persons with Ehlers–Danlos syndrome: A retrospective study – Schubart – – American Journal of Medical Genetics Part A – Wiley Online Library – Jan 2019

The EDS specialist Clair Francomano is one of the authors of this study and gives it credibility.

Against the backdrop of increased opioid prescribing in the United States and the associated high rate of side effects, dependence, and addiction, our study examined how opioids and other medications are being used among persons with Ehlers–Danlos syndrome (EDS).   Continue reading

The Other Side of Opioids – YouTube

The Other Side of Opioids – YouTube

Here is a mainstream media outlet that’s bucking the opioid BS trend and reporting the truth about our desperate situation – which has nothing to do with the rising rates of overdose deaths from opioids or anything else people can get their hands on.

LAS VEGAS – Nightly newscasts across the country are filled with stories about the opioid epidemic — the opioid crisis. Tens of thousands of Americans who die each year are found with opioids in …

This 45 minute video is a year old and has received 175,000 downloads. It is still current and very pertinent, as the HHS Task Force on Best Practices in Pain Management draws together its recommendations to Congress.

It’s wonderful to see that our story is reaching so many people. I just hope they’re not all other pain patients, but perhaps people that might never have seen this other “painful” side of the supposed “opioid crisis”. Continue reading

How to lie, cheat, manipulate, and mislead with statistics

How to lie, cheat, manipulate, and mislead using statistics and graphical displays – by Rick Ord, rord@ucsd.edu – 2010

This is a humerous slide presentation (with Dilbert!) about the malfeasance we must endure in so much of “scientific” research lately, especially when the results must be forced to support the predetermined “idea” about the study (as explained in my recent post: Statisticians Asked to Commit Scientific Fraud).

Here’s just a quick list of some of the shenanigans he covers:

  • Mislead with poor analysis,
  • Mislead with averages,
  • Mislead with poor graphical displays
  • Mislead using chart adjustments
  • Mislead using bar charts

I highly recommend you give it a look: How to lie, cheat, manipulate, and mislead using statistics and graphical displays

 

PDMP searches by law enforcement

PDMP searches by law enforcement – Twitter thread from Health in Justice Action Lab @HiJAction

New from @ACLU_Mass & our lab: We FOIA’d @MassDPH for instances of law enforcement searching patients’ Prescription Drug Monitoring data. We found Federal, State, and Local law enforcement conducted thousands of searches of sensitive patient medical records. /1

Continue reading