The complexity of Death Panels

For those that don’t know, I have asthma. No biggie, I just use my medicine as I should and I’m OK. The symptoms come on, seemingly in a random fashion. In other words, I can’t (nor can doctors) predict when or why I have a flare up and have to have these medicines at hand.

Want to know why that matters to me, and will to you, eventually?

The first issue came about on obtaining the medicines. In an effort to curb the rapid rise of health care costs and to stop evil patients from abusing the Medicare/Medicaid/private insurance industry, Congress and Obama decided to put the crunch on wasteful prescribing and use of medicines.

This is the pharmaceutical side of death panels, by the way.

This is how it works. The doctor sees the patient and prescribes medications that are felt to be needed for up to the next 3 months. At the time of the doctor-patient visit, the doctor is under pressure to prescribe for the symptoms or diseases that need treatment, and in some cases, may need treatment in the next 6-12 months. As I pointed out to my doctor one year, he/we were dead wrong in our predictions on the degree the asthma would affect me that spring. I ran out of medicine, couldn’t get an appointment to see my doctor and had to resort to all manner of probably illegal methods of obtaining what I needed. I survived and we talked about this and he offered a solution.

Horde!

So my doctor’s solution to this congressional-caused chaos was to cheat the system. So I did. I insured that I had several inhalers on hand, in case the asthma symptoms returned at an inconvenient time for my doctor. But, here is a white elephant in the room. Packaged medicines don’t have an infinite shelf life. They expire. The co pay for the drug may be nothing or $75.  Now what does one do? Use the expired drug and hope it works, or at least doesn’t kill you? Or, try to replace the expired drug with an unexpired unit?

The prescribing pharmacy refused to replace the unopened, unused and expired drug.

Enterprising fellow that I am, I decided to trace down the manufacture. In the old days, whenever that was, it was common practice for the pharmacy to replace expired, unused medications. The manufacture of one particular drug that I needed was GlaxcoSmithKline of Canada. I googled (which makes it official that I’m a google doc) GSK and read their online replacement policy.

Great, “No return authorization required.”

Just send the drug(s) to the address provided.  So, I grabbed up the 4 unopened, unused units of medicine and went to the post office. That’s the United States Postal Service. The one that requires me to fill out a United States Customs Service form to declare what I was sending to this foreign country. Oops, another white elephant in the room. As of just recently, they, the USPS, will not ship prescription drugs through their service, by act of Congress. Sorry bud.

Do you know why our august Congress decided to make it illegal to ship prescription drugs?

Well, let me tell you. It’s for a variety of reasons but the last straw is the opioid crisis. Truthfully, a little more than just opioids, but drugs of abuse in general. See, one of the major avenues of illegal drugs into the US is only partly due to the absence of a wall on our southern border. Other major avenues include the USPS, UPS, FedEx and the like. The WWW, the Internet, Google. K2 (synthetic marijuana), anabolic steroids, opioids, Viagra and a host of other medications have been flowing south for years. It’s a cost issue as well as an access issue.

My expired, unused asthma medication cost me a pretty penny in co-pay ($300). It was prescribed by a US doctor, dispensed from a US based pharmacy (probably the largest in the US) that had obtained it from a Canadian based USCS approved importer of pharmaceuticals into the US and I can’t get it replaced through the company approved system because our US Congress thinks I’m importing (exporting?) illegal drugs, or at least facilitating others to do so!

Now we are down to the point of all this.  We’ve all heard the phrase, “Be careful what you ask for, you might get it and then what would you do?”  There are versions in all the major religions and folklore.  In the mid-twentieth century, Robert K Merton, an American Sociologist, coined, “The law of unintended consequences.”  Plagiarism at its best.

Another witticism.  We want to stop illegal drug abuse, illegal immigration, gun violence, rolling stops at busy intersections or whatever.  Just pass another law, that’ll fix it.

Your grumpy Uncle Dave.

Weary.

Why We Should Ban All Guns

February, 2018

Another school shooting convinces me that the anti-gun hysteria may have some basis.

We should ban guns so that the FBI can continue to not do their job and keep their job.

The FBI was informed and “investigated” Cruz before the shooting.

We should ban guns so that Law Enforcement can continue to not do their job and not loose their jobs.

Local law enforcement was called to Cruz’ home 39 times over 7 years before the shooting.

We should ban guns so that Deputy Sheriffs do not have to get in harms way to stop a maniac shooter.

So far, 3 deputy sheriffs did not enter the school to attempt to stop the shooting as it was happening. One has resigned over this.

We need to ban guns so that our perverted can use other methods of killing, like knives, clubs, bombs and other creative methods.

Jeffrey Yao stabbed a woman in a library multiple times in Massachusetts.

We need to ban guns so that stupid, liberal, helicopter parents can have mean, immoral, evil children without guilt.

Too many examples to list.

We need to ban guns so that violent crime will be free to escalate.

Several studies have shown that violent crime is inversely proportional to the availability of guns. That means that more guns means less violent crime.

We need to ban guns so that tyranny can prosper.

Hitler in Nazi Germany and Stalin in Soviet Russia.

Your grumpy Uncle/grumpy, weird and compulsive Brother Dave, just thinking.

Weary

Hunting Fentanyl

August, 2016

I saw a patient tonight that was about 40 years old. He came in for other reasons, but in the interview, he said he was on a Fentanyl patch for chronic back pain. My patient commented that he went out in the woods this morning to put up his deer stand.

Fentanyl is a synthetic form of morphine. It is a mind altering substance, meaning that it clouds judgement, alters reaction time and just plain messes with the mind. Yeah, just like alcohol.

I can see it now. Come November my patient will come in from a hunting accident;

“I fell out of my deer stand and broke my neck.” or,

“I thought he looked like a deer so I shot him. I didn’t realize that it was my Brother-in-law.”

or some other ridiculous story.

So, these Doctors (this is not an unusual occurrence) are sending him out to work as a welder and hunt while this trans-dermal patch makes sure he has sufficient narcotic in his body to relieve his pain 24/7

I’m often embarrassed by my colleagues.

Your grumpy Uncle/Brother Dave.

Weary

House of Guns

January, 2014

There was an ER doc at The Med in Memphis, Tn. and later at Emory University in Atlanta, Ga. that was nationally famous for his anti-gun stand. Athur Kellerman had published some anti-gun articles in prestigious medical publications that I (and many others) challenged and thought was basically false.

I scared them. They sent out “spies” to check me out and invited me to speak on subjects to small audiences to see what I would say. Two such instances come to mind.

I was asked to give a lecture to trauma surgery residents on ballistics and gun shot wounds in humans. You have to understand my theory of Medicine first. Doctors are assholes. Surgeons are really big assholes and trauma surgeons are really, really big arrogant assholes (there are exceptions). That said, one might understand that I wondered why they would ask a Pediatric Emergency Medicine physician to talk to a group that obviously knew more on most subjects than I.

But I persevered and researched the subject, but from a perspective they had not entertained. The audacity I showed shocked them all. I even used resources such as the NRA, the Marine and Army armorers data and gun magazines. Sources they didn’t even know existed. I started with a brief review of the types of firearms, from the blunderbuss to the M-16, rifles and pistols and then discussed bullets, powder, the flight of a lead projectile through air, ballistics “jello”, watermelons and flesh. Some of what I said contradicted what they had been taught in their training. Man was it a quiet audience.

The second encounter involved the spy issue and was much more obvious. The media staff for the Department of Pediatrics set up an interview with me to discuss the dangers of having a gun in the house if there was a child in the home. It was almost humorous, if it hadn’t been so sad. The interviewer used leading questions, Kellerman’s publications and anti-gun sources in such an obvious attempt to get me to join their hysteria. Leading questions are adroitly formed questions meant to lead the responder to a desired answer such as, “Don’t you agree, Doctor, that if there is a gun in the home, there is always the possibility a child could get it and harm himself or others?” You can’t disagree with the statement, but you can construct your answer in a way that brings its relevance to the fore front.

Well, the interviewer got distressed after the 3d or 4th question. Her questions came more rapidly, she cut off my answer before I had finished and finally snapped her notebook closed stood up and said that the interview was over. I’m sure she meant to thank me for my time, but just forgot. Anyway, my interview never made any official publication or saw the light of day anywhere.

Today I read on Fox News about ABC presenting almost the exact same data that Kellerman started way back then. ABC did what Kellerman did frequently; cherry picked statistics, falsely represented data and lied about the results.

Back in the day, we did not have Fox News or any other media avenue for our opinion to be heard.

Proudly posted by your grumpy Uncle/Brother Dave.

Steven Milloy, “Gun Control Science Misfires”, Fox News, 10/31/2002, http://www.foxnews.com/story/2002/10/31/gun-control-science-misfires.html

John R. Lott, “ABC News reports on guns mislead Americans”, Fox News, 1/07/14, http://www.foxnews.com/opinion/2014/02/07/abc-news-reports-on-guns-mislead-americans.html

Drug Deal Gone Good

2/4/2018

A guy was on a motorcycle, evading capture by the county sheriff’s deputies for suspected drug offenses.  In his hasty, not-so-reckless and excessively speedy operation of the vehicle, he wrecked the motorcycle which he had stolen and ran on foot to evade capture.  He jumped a fence, lost his footing, slid and rolled down a hill to the edge of the interstate highway.  He jumped up and tried to run across the freeway.

Yup, tried.

A car, traveling at about 70 mph and he collided.  Not a full impact.  The passenger mirror hit his elbow and left torso in a glancing blow.

As the deputy inventoried his possessions, they found brass knuckles, a loaded gun, methamphetamine and wads of cash.

This was a drug deal that didn’t go well for the guy but did go well for everyone else.

But, he does get the opportunity to add to his collection of big house tats.

From your grumpy Uncle/Brother Dave.

Weary