The 1974 Research Act was created in entirety from the Belmont report, and put into place to prevent the Government, it agencies or representatives, military and private companies, from violating an individual's freedom: by forcing, tricking or coercing persons for research, testing and administration of unknown injections/materials, and experimental procedures. This law was enacted after a century long track record of precedence including, and not limited to, the following:
Demonstrated lack of Respect for Persons and their protections in violation of 1974 law. 1- Autonomous agents, individuals capable of deliberation about personal goals and of acting under the direction of such deliberation. The Government and companies have to give weight to autonomous persons' considered opinions and choices, and cannot obstruct their actions and judgments, nor deny individual freedom to act on considered judgments, and cannot withhold information necessary to make a considered judgment. Necessary information includes - but not limited to - all medical opinions by established, industry experts, health status, the necessary assessments, labs, with close monitoring of physical lab and test follow ups of each and every autonomous persons as part of clinical research and testing, along with full documentation of testing, efficacy, use of chimera for research and testing, any and all conceivable side effects, and interactions of conditions.
 2- persons with diminished autonomy are entitled to added protections. Violators to the law have been marketing to the most vulnerable, including the immature and the incapacitated who were in need of extra, added protections, even to the point of excluding them from any injections or procedures which may harm them; violating added safety precautions for children, elderly, or those with diminished capacity. Informed consent - must include full disclosure of ALL contents to be injected, any and ALL possible side effects (which can be several pages long), how those persons are individually to be closely monitored, safety guidelines, and above all the right to say no before or at any time, and full reporting of all individuals regarding their safety monitoring/labs/assessments, and any and all side effects. By promoting COVID shots all still under clinical trial/research, and coercing with careers/jobs, inability to travel, etc. in order to take the shots, this law is being violated through: lack of informed consent, lack of protections of autonomous persons, and/or illegally acting as IRB safety board members marketing to those not autonomous and capable of self-determination, with higher standards of protection to be invoked, and assuming the role for their safety. The maxim "do no harm" has long been a fundamental principle of medical ethics. Claude Bernard extended it to the realm of research, saying that one should not injure one person regardless of the benefits that might come to others. An agreement to participate in research constitutes a valid consent only if voluntarily given. This element of informed consent requires conditions free of coercion and undue influence. Undue influence also includes offers of an excessive, unwarranted, inappropriate or improper reward or other overture in order to obtain compliance. Also, inducements that would ordinarily be acceptable may become undue influences if the subject is especially vulnerable as in the case of targeting children, persons with limited capacity, and elderly with elements of mental defect, or instilling fear. Short term morbidity and mortality cases from the shots are well reported and known, such as death, myocarditis along with spontaneous cardiac arrest with no warning, debilitating neurological conditions, etc. And, there is no means yet to determine mid and long term effects because Phase I trials have not been competed, let alone Phase II and III - which is vital information in order to determine informed consent. Injustice has been performed with companies and government representatives, by involving vulnerable subjects, including the young, those unable to fully comprehend with all necessary information, and scaring parents with compromised capacity for free consent. In addition to lack of individual, tightly scheduled, continual monitoring and follow ups, autopsies of all persons involved in this trial participation should be conducted for reporting by the pharmaceuticals companies for any and all persons who received the shots, as well as labs determining efficacy and detriments (as examples, antigen creation, D-dimer, Pulse Cardiac and Troponin Tests) for all those who were coerced or unduly influenced to participate in research. This law was created to protect people from government abuse through experimentation. The government cannot arbitrarily dismiss components, create resolutions or stipulations to supersede the law, as to invalidate its protection of individuals from them, including, but not limited to Health and Human Services (HHS) Center for Disease Control (CDC), Food and Drug Administration (FDA), National Institute for Health (NIH), etc. and pharmaceutical companies, etc. Persons have been illegally acting as members of, or bypassing, IRB safety review and monitoring of each and every person receiving injections, with open undue influence and coercion, to participate in Covid injections. Coercion has been especially directed to the diminished autonomous, children and elderly, through TV ads, library recordings, verbal encouragement, schools or other public venues acting as government agents, and/or clinical researcher recruiting participants, and/or illegally as untrained IRB member who is not following up to ensure safety of the people they recruited, coerced or used undue influence. Overall lack of informed consent has become too often common practice across the healthcare industry, including people being given consent forms hours or minutes prior to surgery; no alternative treatments or lifestyle-nutrition changes prior to medications begin prescribed, and undue influence to intubate or perform surgery on patients in lieu of alternative treatments.
Lawsuits for unconstitutional violation of laws regarding shotsPosted by Brian Ward on Twitter Guess what? Defendants in our lawsuits no longer argue that they had a right to mandate EUA drugs due to their state's at-will employment doctrine. That the EUA drugs can be mandated. That they had the authority to even issue the mandate. Why? Read the 127 pages, and then you'll understand that it was a legal lie from the beginning, but due to the novelty of the laws, no one knew of them. As courts have stated, "sometimes laws take naps," and these laws never showed up for work until now. https://coloradomedicalfreedom.com/wp-content/uploads/2023/08/Stamped-Final-Complaint.pdf full document https://coloradomedicalfreedom.com/wp-content/uploads/2023/08/Stamped-Final-Complaint.pdf page 127 C. the Secretary has no “authority to require any person to carry out any activity that becomes lawful pursuant to an authorization under this section…” 549. In 2005 Congress passed the PREP Act94 which provided the following regarding preemption of state law: (8) During the effective period of a declaration under subsection (b)…no State or political subdivision of a State may establish, enforce, or continue in effect with respect to a covered countermeasure any provision of law or legal requirement that— (A) is different from, or is in conflict with, any requirement applicable under this section; and (B) relates to the…administration…of the covered countermeasure, or to any matter included in a requirement applicable to the covered countermeasure under this section or any other provision of this chapter, or under the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 301 et seq.]. 550. Therefore, via the PREP Act and 21 U.S.C. §360bbb-3, Congress expressly prohibits Defendants from: A. interfering with the authority of the Secretary, B. establishing a condition not authorized by the Secretary, C. establish conditions contrary to the Secretary and the congressional statute under 21 U.S.C. §360bbb-3, D. mandate participation in any 21 U.S.C. §360bbb-3 product or PREP Act activity, E. interfere with an individual considering participation in a 21 U.S.C. §360bbb-3 product or PREP Act activity, F. penalize a person refusing to participate in a PREP Act product or activity or 21 U.S.C. §360bbb-3 product. 551. The executive branch of the United States Government purchased all COVID-19 licensed and EUA drugs using federal funds. Congress expressly prohibits the federal government Brian Ward @GodsRiddles Nov 1, 2023 Breaking…Gov Gavin Newsom and Kaiser have been sued in federal court for requiring healthcare workers to inject an experimental drug into their bodies as a condition to sell their labors in the marketplace. The requirement violated the workers’ Equal Protection of Laws and Due Process rights. Moreover, Kaiser signed a contract with the CDC promising not to mandate participation but did so anyway. Kaiser and Newsom fraudulently concealed the fact that nurses would be required to forfeit litigation rights if they incurred an injury from the use of the experimental drug. The California Nurses union stood by and refused to stop Newsom’s tyranny, leaving members without representation. Governor Newsom perpetuated the greatest assault on the US Constitution in the state’s history and the CA AG did nothing to prevent it. Worse yet, is that CA and Kaiser already had an agreement with HHS promising to never place an individual under a sanction for refusing to inject federally funded experimental drugs into the body. Legal Fact: medical providers have dual roles in relation to their employees. An employee can be a patient and an employee. Should a hospital mandate the use of a drug under the PREP Act as a condition of employment and the patient is injured then the patient would find it difficult to sue the medical provider for that injury. However, the employee has the right to seek compensation irrespective of the PREP Act because it’s an on the job injury. Of course this opinion does not account for the laws of all 50 states but demonstrates why one should seek legal advice immediately upon sustaining an injury. This is not my opinion but the chief judge of the 11th circuit who wrote a slip opinion when he was AL AG denoting the company is liable for vaccine injuries because the company believes the vaccine would benefit the company. Last edited10:55 AM · Nov 10, 2023
 Brian Ward - Twitter Oct 25, 2023 Legal Fact: Any state that penalized citizens or denied unemployment benefits to an individual terminated for the sole reason of refusing to inject an unlicensed investigational drug into their body violated the individual's Fourteenth Amendment Equal Protection and Due Process rights. The U.S. Congress conferred legal authority onto an individual to either accept or refuse an EUA product. Both options were enacted by a valid act of Congress and must be equally protected. Moreover, the Supremacy Clause of the Constitution denied that state authority from interfering in the chosen option. The state established what courts call an Unconstitutional Condition. SCOTUS said: "But the power of the state in that respect is not unlimited; and one of the limitations is that it may not impose conditions which require the relinquishment of constitutional rights. If the state may compel the surrender of one constitutional right as a condition of its favor, it may, in like manner, compel a surrender of all. It is inconceivable that guaranties embedded in the Constitution of the United States may thus be manipulated out of existence." Governors and state agency directors violated their oath of office & the Constitution the moment they required COVID-19 EUA participation and or penalized an individual's federally protected option. They deprived citizens of their interest in liberty and property and, unfortunately for some, their very lives, all without due process. They did so by applying the law unequally demoting those who refused to that of a second-class citizen. Legal Fact: 21 U.S.C. §360bbb-3 and the PREP Act expressly restrict public and private employers from conditioning access to employment and other benefits upon a person injecting an FDA-classified experimental drug (Pfizer-BioNTech COVID-19 Vaccine) into their body. The CDC stated, "Coverage under the Public Readiness and Emergency Preparedness (PREP) Act extends to Organization if it complies with the PREP Act and the PREP Act Declaration of the Secretary of Health and Human Services." "IF IT COMPLIES" is the key phrase here. When a governor issued a proclamation that directly violated the federal statute, the governor did not comply and fraudulently amended the federal law in violation of the Supremacy Clause. The PREP Act and 21 U.S.C. §360bbb-3 provide a legal right to individuals considering participation in the product/activity. That legal right is the option to accept or refuse. Therefore, the immunities provided to persons participating in activities under the PREP Act extend only so far as they do not force persons to participate in the product/activity. Governors, employers, hospitals, all FORCED (under threat of a penalty) individuals to participate in violation of federal law. Force does not have to mean physical force. It can be the force of law, rule, or other means having the same negative effect as physical force. The courts have said that force means to prevent a person or cause a person to participate in an activity outside of their free will and voluntary consent. Significant lawsuits inbound! 12:45 PM · Aug 29, 2023 Brian Ward Aug 2022 BREAKING: LA Superior Court requiring LAPD to reinstate an officer terminated for refusing the vax mandate. Full back pay too! This is under a Writ of Mandamus, which is rare. Legal Fact: "Nothing in this section (EUA Law) provides the [HHS ] Secretary any authority to require any person to carry out any activity that becomes lawful pursuant to an authorization under this section, and no person is required to inform the Secretary that the person will not be carrying out such activity." - The Secretary may grant access to an unlicensed drug (Pfizer-BioNTech COVID-19 Vaccine) during an emergency but he can not mandate that anyone manufacture, distribute, store, administer, or receive the product. His authority is non-transferable, nor may he delegate it to another person. Therefore, by what authority are universities and private employers mandating that which Congress prohibits? EUA drugs are "controlled" drugs by Congress, and no person may participate in them outside of the conditions established by Congress. Moreover, Congress expressly prohibits private employers from interfering with your choice of accepting or refusing participation in the product. It was illegal - It is illegal - and it is being remedied in court. We will not allow this September to be a repeat of years past. 2:18 PM · Aug 21, 2023 Legal Fact: 100% of all hospitals and nearly all universities signed a FEDERAL agreement to abide by the ethical principles of the Belmont Report, though few know it, ANYTIME they involve a human with an investigational medical product such as any available COVID-19 drug. The report is only 10 pages long, but it holds in part: (1) Respect for persons incorporates at least two ethical convictions: first, that individuals should be treated as autonomous agents, and second, that persons with diminished autonomy are entitled to protection. The principle of respect for persons thus divides into two separate moral requirements: the requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy, (2) To show lack of respect for an autonomous agent is to repudiate that person's considered judgments, to deny an individual the freedom to act on those considered judgments, or to withhold information necessary to make a considered judgment, (3) Respect for persons requires that subjects, to the degree that they are capable, be given the opportunity to choose what shall or shall not happen to them. BONUS ROUND - All US States and Territories signed this agreement pre-pandemic too. Yup, no one knows this either, including state attorneys general. Lastly, unlike the Nuremberg Code, the Belmont Report has the force of law via federal statute and contract. Last edited9:28 PM · Aug 2, 2023 Brian Ward via Twitter The VERY first EUA issued was in 2005 for the Anthrax investigational drug for service members and civilian employees of the DoD. The EUA stated: A. Individuals (service members and civilians) who refuse anthrax vaccination will not be punished. (Emphasis added) B. Refusal may not be grounds for any disciplinary action under the Uniform Code of Military Justice. C. Refusal may not be grounds for any adverse personnel action. Nor would either military or civilian personnel be considered non-deployable or processed for separation based on refusal of anthrax vaccination. D. There may be no penalty or loss of entitlement for refusing anthrax vaccination, E. This information shall read in the trifold brochure provided to potential vaccine recipients as follows: You may refuse anthrax vaccination under the EUA, and you will not be punished. No disciplinary action or adverse personnel action will be taken. You will not be processed for separation, and you will still be deployable. There will be no penalty or loss of entitlement for refusing anthrax vaccination. Nothing in law has changed to negate the authority of DoD members to refuse EUA COVID-19 drugs except the 6 civilian appointees engaged in willful misconduct against our Armed Forces. 11:51 PM · Sep 3, 2023 
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Videos to listen toAmerican Biological Threat Consultant at the European Parliament in Strasbourg, France on September 13/2023 https://rumble.com/v3sahot-dr-david-e-martin-who.html Coronavirus Gain-of-Function Research at the Covid Summit in Brussels, Belgium May 2023 https://rumble.com/v2mwrgm--dr.-david-martin-documenting-coronavirus-gain-of-function-research-at-the-.html Dr. Martin is impressive with his work, and how he articulates things https://twitter.com/i/status/1615707500946546689 Martin was the first to stipulate Pharma with DoD, CIA 7-12 minutes great breakdown of science that it is not about virus, protein fragment! 13 minutes Insert mRNA fragment, so cell makes S1Spiked Protein. 17 minutes Acts of Terror 18 minutes AntiTrust laws violated, conspiracy 20 minutes Interlocking Directorates, Sherman Act 22 minutes Civil law, used by Trade Commission - cannot do deceptive marketing 27 minutes unlawful lack of informed consent Institutional Review Board never created, even in the case of emergency Code 21CFR section 50.24   by Rose M. RohloffProviding informative snippets from 100,000s of primary source documents. None of this gain-of-function work meets the legal definition of a vaccine. Link document (A) with document (C) regarding active substance; injected with GOF. Chimera used for creation, efficacy testing (human+animal); Humanized mice from injected aborted fetus cells, to create LUCIFERase encoded modRNA: active substance is SPIKED PROTEIN.
 (C) Page 1 of report from Marine who left DARPA - sent to DoD IG office. Release from Project Veritas
World Counsel For Health - Detox Protocol https://worldcouncilforhealth.org/resources/spike-protein-detox-guide/
Flu shots  
read blog entry 9/24/23 |
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| AARON SIRI GIVES TESTIMONY - ARIZONA STATE SENATE |  |
Listen with this link https://thehighwire.com/ark-videos/aaron-siri-gives-testimony-on-the-floor-of-arizona-state-senate/
FDA working in support of pharma - no clinical trial testing of vaccines with "circular approval."
by Rose Rohloff
The baby boomer generation is now the growing population of elderly with more care needs in home health. As the current generation is being faced with the care responsibilities, many are still unaware concerning various facets of caring for others: advanced directives and living wills; stimulation and diets for mental sharpness, questions to ask and quality of care considerations with becoming power of attorneys - the core of healthcare awareness. One area is focused heavily within hospitals and other care delivery environments, but yet over looked in private homes – surface areas and cleanliness.
A popular trend in houses is the use of marble and granite as counter tops. A leading surface expert, Linda Lybert President of Healthcare Surface Consulting stated, “Granite and Marble are like large sponges you cannot wring out.” The photo displayed shows the build up of E. coli bacteria in the pores of stone. According to Ms. Lybert, even when sealed, the porousness is reduced, but not eliminated. And, bleach is not able to eliminate once they reside in the crevices.
A popular trend in houses is the use of marble and granite as counter tops. A leading surface expert, Linda Lybert President of Healthcare Surface Consulting stated, “Granite and Marble are like large sponges you cannot wring out.” The photo displayed shows the build up of E. coli bacteria in the pores of stone. According to Ms. Lybert, even when sealed, the porousness is reduced, but not eliminated. And, bleach is not able to eliminate once they reside in the crevices.
All surfaces in the home, counter tops, floors including laminates, tile and grout need diligent daily cleaning and disinfection. However, Ms. Lybert brings awareness that regarding "stone surfaces, including granite/marble, there is no effective means to disinfect these surfaces." Consider, "granite is an underground aquifer for our water filtering out all kinds of things. Given the right kind of environment, heat and moisture, bacteria will grow."
As the elderly begin to lose their mobility and agility, it is important to maintain clean surfaces in bathrooms and bedrooms, along with the most important surface being the skin. Diligent hand washing and bathing is important throughout the day to avoid cross contamination from the loved one you are caring for, as well as to them. The other surface area to be conscientious of is bedding. When excrement accidents occur, it is important to wash bedding with very hot water to not only clean them, but also kill the microbes.
Clostridium difficile (commonly known as C-diff) "is in the community and found in outpatient settings. There are significant risk factors in patients who are immunosuppressant, individuals who have been on antibiotic therapy, and the elderly population." C-diff is a secondary, very dangerous and potentially deadly infection after antibiotic use. [read article] It is important to those in the community to have appropriate antibiotic prescriptions and use, especially avoiding unnecessary broad spectrum antibiotic use which targets the "good" bacteria you need internally (and not on external surfaces) to kill off C-diff.
As the elderly begin to lose their mobility and agility, it is important to maintain clean surfaces in bathrooms and bedrooms, along with the most important surface being the skin. Diligent hand washing and bathing is important throughout the day to avoid cross contamination from the loved one you are caring for, as well as to them. The other surface area to be conscientious of is bedding. When excrement accidents occur, it is important to wash bedding with very hot water to not only clean them, but also kill the microbes.
Clostridium difficile (commonly known as C-diff) "is in the community and found in outpatient settings. There are significant risk factors in patients who are immunosuppressant, individuals who have been on antibiotic therapy, and the elderly population." C-diff is a secondary, very dangerous and potentially deadly infection after antibiotic use. [read article] It is important to those in the community to have appropriate antibiotic prescriptions and use, especially avoiding unnecessary broad spectrum antibiotic use which targets the "good" bacteria you need internally (and not on external surfaces) to kill off C-diff.
PART 1 of 4: THE A, B, C of U.S. GOVERNANCE
by Rose M. Rohloff
Across the country I have asked various parents, teachers, grade school and high school students an elementary question: "What form of government is the United States?"
Being the most basic of query, the universal response of “A Democracy” took me by surprise. The next request was for each person to quote the Pledge of Allegiance. Some did not know it clearly, while others did recite ... United States of America, and to the Republic for which it stands ... followed by, "Oh, so what."; "It is a democratic republic which is the same as a democracy." One male in his twenties from Chicago (who stated he attended the best high school in the city) responded, "Well, we need a combination democracy, socialist, communist government because people are too stupid to think for themselves." My final statement to this person was to point out that these are three opposing ideologies that cannot exist together.
The question begs to be asked, "How can voters function as responsible citizens and make reasoned, insightful judgment when voting, if they do not know or understand what form of government exists in the United States?"
It is interesting to compare the intelligence of writing for grade school children from the 1800s with the readings of today. Children in the 1800s were educated in civics starting at young ages, because parents and grandparents fought to obtain and secure for them the new form of government - a Republic governed by a national Constitution.
Being the most basic of query, the universal response of “A Democracy” took me by surprise. The next request was for each person to quote the Pledge of Allegiance. Some did not know it clearly, while others did recite ... United States of America, and to the Republic for which it stands ... followed by, "Oh, so what."; "It is a democratic republic which is the same as a democracy." One male in his twenties from Chicago (who stated he attended the best high school in the city) responded, "Well, we need a combination democracy, socialist, communist government because people are too stupid to think for themselves." My final statement to this person was to point out that these are three opposing ideologies that cannot exist together.
The question begs to be asked, "How can voters function as responsible citizens and make reasoned, insightful judgment when voting, if they do not know or understand what form of government exists in the United States?"
It is interesting to compare the intelligence of writing for grade school children from the 1800s with the readings of today. Children in the 1800s were educated in civics starting at young ages, because parents and grandparents fought to obtain and secure for them the new form of government - a Republic governed by a national Constitution.
| Arthur J. Stansbury created the Catechism on the Constitution (the “Catechism”, Boston 1828) that was used to teach schoolchildren. | Today, Magruder's American Government is “hailed as a stellar educational resource for nearly a century, updated annually to meet the changing needs of today's high school students and teachers. The program's engaging narrative is enhanced with numerous primary sources, political cartoons, charts, graphs, and photos …” [Amazon] |
The Catechism, written for grade school aged children, does not contain pictures or cartoons, and has elegant writing in the form of Question followed by Answer. A few of the profound sentences by Stansbury summarizing poignant points for me include:
- "That a people living under a free government which they have themselves originated should be well acquainted with the instrument which contains it ... this would be no good reason why pains should not be taken to understand and to imprint (the Constitution) upon the mind ... its brevity surpassing all example, it is certainly a most reprehensible negligence to remain in ignorance of it." (Preface)
- "Let every American learn, from his earliest years, to love, cherish and obey the Constitution. Without this he can neither be a great or a good citizen." (Page 10)
- Question: "But if even the Congress itself should make a law which is contrary to the Constitution, must the people obey it? Answer: No." (Page 11)
In contrast, today’s American Government book by Magruder's teaches:
Figure 1: www.slader.com/textbook/9780133240825-magruders-american-government/18/
- U.S. Government is taught as being a Representative Democracy versus specifically a Republic (which is not discussed), and describes the various forms in rudimentary text, without addressing the ideologies in depth.
- Communism is not discussed especially in relation to China, the Chinese Communist Party (CCP). The various forms of Government in detailed ideology should be Democracy, Republic, Socialism, Communism, Dictatorship, Monarchy, Tribal.
- Specific ideologies variations are not defined well and the writers are focused on side-by-side listing of dictatorships to democracy, with lack of detailed distinctions.
The comparison of "new" (incorrect) teaching is important, because Democracy intentionally does not appear anywhere in the Declaration of Independence or the Constitution. [Cato Institute: On Democracy Versus Liberty, By Steve H. Hanke, Feb 2011] The founders studied history in depth with types of governments, and specifically did not create a democracy to avoid mob rule.
The public today is often bombarded with reports, news (non-news) - an overabundance of opinions regarding important issues. Without the basic understanding of the U.S. Republic, individuals have been conditioned to react with and vote based on emotion, as opposed to thoughtful reasoning; the breaking down of issues with intelligent discourse based on Constitutional understanding.
Authors have broken down a differentiation of a democracy in the simplest term as a majority dictating issues. When a majority of persons are swayed with emotion, it is ‘mob rule’. This distinction is important, as more and more voters are craving socialism, with groups such as ANTIFA and #xyzMOVEMENTS continuing to form. The Founding Fathers researched all the various forms of governments thoroughly before specifically establishing a Republic instead of a Democracy (as reviewed in the link video, discussing the rule of law versus the majority).
James Madison reviews the downfalls of a large democracy in the Federalist Paper, No. 10: The Utility of the Union as a Safeguard Against Domestic Faction and Insurrection.
The public today is often bombarded with reports, news (non-news) - an overabundance of opinions regarding important issues. Without the basic understanding of the U.S. Republic, individuals have been conditioned to react with and vote based on emotion, as opposed to thoughtful reasoning; the breaking down of issues with intelligent discourse based on Constitutional understanding.
Authors have broken down a differentiation of a democracy in the simplest term as a majority dictating issues. When a majority of persons are swayed with emotion, it is ‘mob rule’. This distinction is important, as more and more voters are craving socialism, with groups such as ANTIFA and #xyzMOVEMENTS continuing to form. The Founding Fathers researched all the various forms of governments thoroughly before specifically establishing a Republic instead of a Democracy (as reviewed in the link video, discussing the rule of law versus the majority).
James Madison reviews the downfalls of a large democracy in the Federalist Paper, No. 10: The Utility of the Union as a Safeguard Against Domestic Faction and Insurrection.
"The second expedient is as impracticable as the first would be unwise. As long as the reason of man continues fallible, and he is at liberty to exercise it, different opinions will be formed. As long as the connection subsists between his reason and his self-love, his opinions and his passions will have a reciprocal influence on each other; and the former will be objects to which the latter will attach themselves. The diversity in the faculties of men, from which the rights of property originate, is not less an insuperable obstacle to a uniformity of interests. The protection of these faculties is the first object of government. From the protection of different and unequal faculties of acquiring property, the possession of different degrees and kinds of property immediately results; and from the influence of these on the sentiments and views of the respective proprietors, ensues a division of the society into different interests and parties.
The latent causes of faction are thus sown in the nature of man."
The latent causes of faction are thus sown in the nature of man."
A great deal of emphasis has been placed on the importance of the 2018 mid-term elections, and the tide of ‘Red’ versus ‘Blue’ control at State and Federal levels. In Arizona, two candidates posted the following in the election overview of candidates:
Taking the importance to the Nth degree for properly educating and understanding the foundations and ideologies of a Republic versus a Democracy: A democracy may vote in socialism; the U.S. Republic cannot, because representatives must abide by the guaranteed protections within the Constitution, especially our Rights.
- Steve Gaynor (Republican) for AZ Secretary of State: “… bedrock of our democracy …”
- Katie Hobbs (Democrat) for State Senator: “… foundation of our democracy …”
Taking the importance to the Nth degree for properly educating and understanding the foundations and ideologies of a Republic versus a Democracy: A democracy may vote in socialism; the U.S. Republic cannot, because representatives must abide by the guaranteed protections within the Constitution, especially our Rights.
PART 2 of 4: What is a Right? Why Healthcare is Not a Right.
As previously written in Part I: The A, B, C of U.S. Governance, unless voters understand elementary basics of governance, they will be unable to have reasoned, intelligent decision making when reviewing issues and voting. Educating the public that the majority rules, a Democracy, fosters politicians swaying large groups of a divided population with emotion – known as mob rule - versus lawful thought and discourse in a Republic governed by the Constitution.
| Question 1: "What is the Constitution?" The most basic, succinct answer is that it’s the document protecting our Rights from the government, Rights it cannot take away. The Founding Fathers Alexander Hamilton, John Jay, and James Madison wrote about the rationale behind the establishment of the Constitution, with the general insights:
| Question 2: "What is a Right?" The first Rights established in the Declaration of Independence in 1776: “All men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness — That to secure these rights, Governments are instituted among Men … Therefore, when groups use the current statement healthcare is a Right (or a human Right); there is a general lack of understanding regarding the term. The Bill of Rights is the continuation of all Rights naturally afforded to citizens that the government cannot take away; not Rights to be supplied by the government. Rights are Inalienable from God, fundamental rights not transferable or impossible to take away. These rights include the life, liberty, and the pursuit of happiness, the right of privacy, to travel, and have possessions. |
Veterans are the citizens who have the Right to free healthcare through the Veterans Affairs (VA), for wounds or illnesses sustained in the protection of the country. The inefficiency of the VA system as a government run entity has sadly been well documented over the last two decades, and requires separate coverage of its own.
The concept of a Right given by the government is an oxymoron, being the very essence of Unconstitutional. Rights define our freedom from the government. When Rights are given to, allowed control by the government, it is socialism. And, Socialism is defined in Merriam-Webster as:
economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods (and services); there is no private property; a system which the means of production are owned and controlled by the state; a stage of society in Marxist theory transitional between capitalism and communism.
There is currently a growing trend calling for a single healthcare payer: That single payer is the government. Giving full, nonmilitary healthcare control over to the government is contrary to having Rights, often called socialized medicine, which is in actuality what I term healthcare socialism.
The concept of a Right given by the government is an oxymoron, being the very essence of Unconstitutional. Rights define our freedom from the government. When Rights are given to, allowed control by the government, it is socialism. And, Socialism is defined in Merriam-Webster as:
economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods (and services); there is no private property; a system which the means of production are owned and controlled by the state; a stage of society in Marxist theory transitional between capitalism and communism.
There is currently a growing trend calling for a single healthcare payer: That single payer is the government. Giving full, nonmilitary healthcare control over to the government is contrary to having Rights, often called socialized medicine, which is in actuality what I term healthcare socialism.
PART 3 of 4: Single Payer = Government, Healthcare Socialism
The American system has been based upon freedom, the free market, at its very core. Healthcare is included with the exception of the Veterans Affairs (VA) system, and the formation of Medicare, and now the expansion of Medicaid. A growing trend in the country is a call for a single payer healthcare system.
Recent articles have cited a high percent (up to 40%) of medical students wanting a single payer. This year, Medical students bring the AMA into the single payer dialogue AMA House of Delegates 2018 Annual Meeting, June 9-13, 2018
Well, who is that payer? The answer is the government. What would be the single payer system - VA, Medicare, Medicaid? I suggest we not use the term single payer system, and instead delineate the true description, what I refer to as healthcare socialism.
As discussed in Part I of this series, the Federal Government was designed for protection of the Constitution, and to be effective with limited power, operating with efficiency. Government run healthcare has proven to not have limited power, to be costly with decreased quality, and to be inefficient.
Recent articles have cited a high percent (up to 40%) of medical students wanting a single payer. This year, Medical students bring the AMA into the single payer dialogue AMA House of Delegates 2018 Annual Meeting, June 9-13, 2018
Well, who is that payer? The answer is the government. What would be the single payer system - VA, Medicare, Medicaid? I suggest we not use the term single payer system, and instead delineate the true description, what I refer to as healthcare socialism.
As discussed in Part I of this series, the Federal Government was designed for protection of the Constitution, and to be effective with limited power, operating with efficiency. Government run healthcare has proven to not have limited power, to be costly with decreased quality, and to be inefficient.
The following cases are only a few of the major healthcare fraud cases over the last few years:
Healthcare socialism includes physicians as employees of the hospitals, ergo employees of the government. Under the current government payer system, Hospital-employed physicians drain Medicare By Alex Kacik|November 14, 2017
1 National Health Care Fraud Takedown Results in Charges against 301 Individuals for Approximately $900 Million in False Billing, Department of Justice, June 22, 2016, https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-charges-against-301-individuals-approximately-900
2 Justice Department charges three in $1 billion Medicare fraud scheme, The Wall Street Journal, July 22, 2016, http://www.foxnews.com/politics/2016/07/22/justice-department-charges-three-in-1-billion-medicare-fraud-scheme.html
3 U.S. Charges 412, Including Doctors, in $1.3 Billion Health Fraud, The New York Times, July 13, 2017, https://www.nytimes.com/2017/07/13/us/politics/health-care-fraud.html
4 Beverly Woman Defrauded State Of $1 Million From Medicaid: Prosecutors, DNAinfo, October 14, 2017, https://www.dnainfo.com/chicago/20171018/beverly/santila-terry-speech-therapy-clinic-theft-charges-docbarbie-hair-boutique/
- 301 National take down in healthcare fraud results in approximately $900 million in false billing1
- Three charged in $1B Medicare fraud scheme2
- 412, including doctors, in $1.3 Billion Health Fraud3
- Woman defrauds Medicaid of $1 Million4
Healthcare socialism includes physicians as employees of the hospitals, ergo employees of the government. Under the current government payer system, Hospital-employed physicians drain Medicare By Alex Kacik|November 14, 2017
1 National Health Care Fraud Takedown Results in Charges against 301 Individuals for Approximately $900 Million in False Billing, Department of Justice, June 22, 2016, https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-charges-against-301-individuals-approximately-900
2 Justice Department charges three in $1 billion Medicare fraud scheme, The Wall Street Journal, July 22, 2016, http://www.foxnews.com/politics/2016/07/22/justice-department-charges-three-in-1-billion-medicare-fraud-scheme.html
3 U.S. Charges 412, Including Doctors, in $1.3 Billion Health Fraud, The New York Times, July 13, 2017, https://www.nytimes.com/2017/07/13/us/politics/health-care-fraud.html
4 Beverly Woman Defrauded State Of $1 Million From Medicaid: Prosecutors, DNAinfo, October 14, 2017, https://www.dnainfo.com/chicago/20171018/beverly/santila-terry-speech-therapy-clinic-theft-charges-docbarbie-hair-boutique/
- A 49% increase in hospital-employed physicians between 2012 and 2015 led to a $3.1 billion increase in Medicare costs related to four specific procedures in cardiology, orthopedics and gastroenterology, according to analysis from consulting firm Avalere Health.
- Medicare paid $2.7 billion more for diagnostic cardiac catheterizations, echocardiograms, arthrocentesis and colonoscopies delivered in hospital outpatient settings than it would for treatment in independent facilities, while beneficiaries footed a $411 million higher bill.
- Hospital-employed physicians performed more services in costlier hospital outpatient settings, resulting in up to 27% higher costs for Medicare and 21% for patients.
How would it be funded initially as there is no long term sustainability.
The existing Federal Total revenue as of 2018 is only $3.654 trillion (T)
| The current US Debt Clock as of August 2018 reads:
|  |
Right now, the country cannot fund social security or existing Medicare (and Medicaid which is not included or considered). The Forbes July 9, 2018 article reviewed the additional cost projections of a single payer system:
- An independent analysis of Sanders's plan conducted by the left-leaning Urban Institute estimated that it would cost $32 trillion over 10 years.
- And those are just the financial costs. Socialized medicine's human costs are even greater. Single-payer systems, the world over, ration care and force patients to wait for treatment.
- The United States can barely afford its existing healthcare obligations. In 2017, the federal government spent more than $700 billion on Medicare -- a 65 percent increase over just 10 years.
It is important to read all three sections of this series to appreciate under Healthcare Socialism, the individual gives up their Rights because the government dictates: what is to be done, the services to be given, lack of financial responsibility with a non-sustainable system, and who is to do what job where and when – which is covered in the next section.
PART 4 of 4: Under Healthcare Socialism
A major factor that is never discussed in healthcare socialism (since it is referred to as ‘single payer’) is the education of clinician staff - the doctors, nurses, etc. which is not covered regarding cost and decreased quality.
New York University (NYU) just announced they now have a tuition free medical school. In response, Elisabeth Rosenthal, MD, editor-in-chief of Kaiser Health News, explains why NYU got it wrong.
In an op-ed for The New York Times, Dr. Rosenthal, a former emergency room physician, cites research that shows medical school debt often discourages students from pursuing lower-paying specialties or from practicing in areas where the majority of patients are on Medicaid.
Instead, students are more likely to pursue more highly paid specialties, like neurosurgery or orthopedic surgery.
By eliminating tuition … She claims most physicians who enter higher-paying specialties are able to quickly pay off their student loans; the physicians that have trouble doing so are those who opt to take lower salaries as primary care physicians …"Instead of making medical school free for everyone, NYU — and all medical schools — should waive tuition only for those students who commit to work where they are needed most," she wrote. (See Title V of the ACA tax law passed under Obama.)
New York University (NYU) just announced they now have a tuition free medical school. In response, Elisabeth Rosenthal, MD, editor-in-chief of Kaiser Health News, explains why NYU got it wrong.
In an op-ed for The New York Times, Dr. Rosenthal, a former emergency room physician, cites research that shows medical school debt often discourages students from pursuing lower-paying specialties or from practicing in areas where the majority of patients are on Medicaid.
Instead, students are more likely to pursue more highly paid specialties, like neurosurgery or orthopedic surgery.
By eliminating tuition … She claims most physicians who enter higher-paying specialties are able to quickly pay off their student loans; the physicians that have trouble doing so are those who opt to take lower salaries as primary care physicians …"Instead of making medical school free for everyone, NYU — and all medical schools — should waive tuition only for those students who commit to work where they are needed most," she wrote. (See Title V of the ACA tax law passed under Obama.)
The ACA Tax Law (we need to stop calling it Obamacare, it is a tax law) has a lack of understanding, or misrepresentation, because it is not even read in entirety for the ability to even debate, and needs for repeal,
ACA, Page 1309, Title V SEC. 5207. FUNDING FOR NATIONAL HEALTH SERVICE
… authorized to be appropriated, out of any funds in the Treasury not otherwise appropriated, the following:
‘‘(1) For fiscal year 2010, $320,461,632.
‘‘(2) For fiscal year 2011, $414,095,394.
‘‘(3) For fiscal year 2012, $535,087,442.
‘‘(4) For fiscal year 2013, $691,431,432.
‘‘(5) For fiscal year 2014, $893,456,433.
‘‘(6) For fiscal year 2015, $1,154,510,336.
‘‘(7) For fiscal year 2016, and each subsequent fiscal year, the amount appropriated for the pre-ceding fiscal year adjusted by the product of ‘‘(A) one plus the average percentage increase in the costs of health professions education during the prior fiscal year; and ‘‘(B) one plus the average percentage change in the number of individuals residing in health professions shortage areas designated under section 333 during the prior fiscal year, relative to the number of individuals residing in such areas during the previous fiscal year.”
In summary, $BBs funneling out without oversight or budgeting and funding of bodies through schools without quality education, and then dictating who must work where and when.
The ACA is predominately discussed in regards to healthcare coverage for uninsured, some $17M people, because people choose to not make the time to actually read the whole Tax Law. As Title V reflects, monies being spent have nothing to do with coverage, and is shows spending with no accountability, and we are seeing negative outcomes with the reduced training and preparedness as clinicians – clinical time and sciences replaced with diversity, global health issues, nursing theory. Last year, I was interviewed by a university with a ‘leading nursing college’, asking me if people who would make good nurses are prevented from becoming nurses because they cannot pass basic sciences, so we just need to reduce more of the sciences as “they don’t use that knowledge anyways, right?”
… authorized to be appropriated, out of any funds in the Treasury not otherwise appropriated, the following:
‘‘(1) For fiscal year 2010, $320,461,632.
‘‘(2) For fiscal year 2011, $414,095,394.
‘‘(3) For fiscal year 2012, $535,087,442.
‘‘(4) For fiscal year 2013, $691,431,432.
‘‘(5) For fiscal year 2014, $893,456,433.
‘‘(6) For fiscal year 2015, $1,154,510,336.
‘‘(7) For fiscal year 2016, and each subsequent fiscal year, the amount appropriated for the pre-ceding fiscal year adjusted by the product of ‘‘(A) one plus the average percentage increase in the costs of health professions education during the prior fiscal year; and ‘‘(B) one plus the average percentage change in the number of individuals residing in health professions shortage areas designated under section 333 during the prior fiscal year, relative to the number of individuals residing in such areas during the previous fiscal year.”
In summary, $BBs funneling out without oversight or budgeting and funding of bodies through schools without quality education, and then dictating who must work where and when.
The ACA is predominately discussed in regards to healthcare coverage for uninsured, some $17M people, because people choose to not make the time to actually read the whole Tax Law. As Title V reflects, monies being spent have nothing to do with coverage, and is shows spending with no accountability, and we are seeing negative outcomes with the reduced training and preparedness as clinicians – clinical time and sciences replaced with diversity, global health issues, nursing theory. Last year, I was interviewed by a university with a ‘leading nursing college’, asking me if people who would make good nurses are prevented from becoming nurses because they cannot pass basic sciences, so we just need to reduce more of the sciences as “they don’t use that knowledge anyways, right?”
Accountable and responsible citizens are again required to maintain a well run and responsible Republic – beginning with every Representative reading in full all Bills, with the ability to discuss well thought out long and short term ramifications of ALL components. And, if Representatives feel that “We need to pass it in order to find out what is in it;” then it is up to Citizens to actually read, vote out all persons not representing their best interests – with the ACA Tax Law (we should not refer to as Obamacare) as the preeminent example of why. The U. S. Constitutional Republic does not have the means, nor want Healthcare Socialism. To understand in detail why not, perhaps we need to bring back Arthur J. Stansbury’s Catechism on the Constitution (Boston 1828) as required reading for all grade school children – and members of Congress.
by Rose Rohloff
A Memorial Day quote yesterday regarding veterans also exemplifies much of what has happened in healthcare over the last 10 years, regarding the focus on Population Health, meaningful use reporting, value based analysis, big data analytics-claims data, and mergers of health systems with large EMRs, with focus on reporting.
“We are arguing over a statistical analysis. This is the challenge that we face in society today ,,, we are quantifying numbers because it’s easy to look at a number, and it’s not easy to look at the value of a human life. I would say to you today that (losing) one a day, one a year is too many.”
Kyle Reyes, CEO, The Silent Partner Marketing
Kyle Reyes, CEO, The Silent Partner Marketing
When the primary focus is on data (the multiple of numbers/records-statistics), singular records and numbers or outliers are not worth the time and effort of analysts and executives. And yet, they should be as each record is a real patient, a friend, a loved one.
The solution is bringing analysis down to the most base level of management with front line analysis, to coincide with first-hand observation, the voice of the patient & their caregivers/champions, and reducing the ever growing administrative overhead. Bigger is not better for addressing health and care of populations, when the focus is shifted upward with large systems where individuals are lost: Especially when the individual issues are indicative of the core problems that need to be addressed for quality care delivery.
The need for P&P Reviews
The solution is bringing analysis down to the most base level of management with front line analysis, to coincide with first-hand observation, the voice of the patient & their caregivers/champions, and reducing the ever growing administrative overhead. Bigger is not better for addressing health and care of populations, when the focus is shifted upward with large systems where individuals are lost: Especially when the individual issues are indicative of the core problems that need to be addressed for quality care delivery.
The need for P&P Reviews
| by Rose Rohloff  | HealthLeaders published an article Proper Sharps Management in Senior Living Helps Reduce Risk for Needle Stick Injuries Feb. 9, 2018, addressing the need for proper containers to safely dispose of used needles. Sadly, stories have been relayed regarding used syringes being left in the beds of patients in hospitals and rehabilitation facilities. As trained clinicians, this circumstance should never happen. The issue of needle-syringe safety, however, transcends all environments, including the increasing use in homes. Safety guidelines for syringe use |
- Have designated, well marked containers for immediate disposal (reference the Healthleaders article above)
- Use the one touch rule: after injecting medication, do not set the needle down; immediately drop into the designated, marked container.
- Do not recap the needle unless necessary. To avoid sticking oneself, drop the syringe directly into the container without recapping after used. If the needle requires coverage for immediate safety, keep the cap on a flat surface (such as a table) while inserting the needle. Then, lift the syringe with the cap on to firmly secure it against the table; avoiding needles accidentally being pushed through a cap, or missing the cap opening and puncturing your finger.
- Properly dispose of needle containers. See CDC recommended guidelines.
Photo: Gabrielle Lurie, Special To The Chronicle: Dirty needles at UN Plaza in San Francisco, CA
Numerous reports of discarded, used syringes in the streets of major cities, such as San Francisco, also necessitate being aware of 'sharp safety' in the community. Whether a street, park or playground, it is good to have knowledge of what to do, and teach your children, regarding needle-syringe safety. The following are just a couple example guidelines:
by Rose Rohloff
Naloxone is an emergency medication; it is temporary and doesn't stop or eliminate opioid abuse, addiction.
This week, reports were released in the media that US homes need Narcan to aid in opioid overdose epidemic, surgeon general advises
This week, reports were released in the media that US homes need Narcan to aid in opioid overdose epidemic, surgeon general advises
Dr. Delos Marshall "Toby" Cosgrove, the previous CEO of Cleveland Clinic, spoke to a room of healthcare leaders from across the country about the Opioid Crisis in April 2017. The discussion centered around the abuse of taking prescribed medications - legally and illegally - with the current trend of NARC Parties. He explained that NARC Parties entail the supply of Naloxone (the common brand name is Narcan, used by hospital-emergency personnel as the medication to temporarily counteract a narcotic or heroine overdose.) He continued that having Naloxone allowed people to overdose, the person(s) were then given Narcan in order to continue partying.
The general public needs to be aware: Naloxone has been reported to foster increased abuse of drugs by allowing revival of overdosing for continuing to take more drugs. Naloxone is the generic of Narcan. Just as EpiPen is only the delivery system and not the generic drug Epinephrine, It is important to know the difference between the brand name versus the generic drug name.
The general public needs to be aware: Naloxone has been reported to foster increased abuse of drugs by allowing revival of overdosing for continuing to take more drugs. Naloxone is the generic of Narcan. Just as EpiPen is only the delivery system and not the generic drug Epinephrine, It is important to know the difference between the brand name versus the generic drug name.
The danger of advising the untrained public to distribute emergency medicine
"A serious problem is many doctors and many more nurses are unaware of the different mode of metabolism of Fentanyl and Methadone. With various dosages of Fentanyl and Heroin or combinations of other opioids, the efficacy of Naloxone or Naltrexone is compromised. The general public (let alone many new doctors and nurses) do not have a working understanding of the differences in these competitive antagonists." "There may not be any impact for at least 30 minutes with a basic spray." 45 year RN, BSN, NP, MSN, Committee Member Opioid Crisis, Board of Directors Health Facility
Many clinicians, let alone the general public, are not specifically trained in the proper dosage and treatment with Naloxone for the various forms and dosages of opioids and heroin.
FDA Advisory Committee on the Most Appropriate Dose or Doses of Naloxone to Reverse the Effects of Life-threatening Opioid Overdose ... Sept 2016
"The effectiveness of naloxone, and thus the exposure required, will depend on the opioid dose, the potency of the opioid in binding receptors, the lipophilicity of the opioid in crossing into the CNS system and the elimination half-life of the opioid, together with patient factors (7, 26). Appendix [2] and [2a] includes further information on naloxone pharmacology. The complex pharmacology of appropriate dosing is further compounded as often the fentanyl involved is illicitly manufactured without normal procedures or controls and may be introduced surreptitiously into heroin or prescription painkillers. Reports from the field confirm the need for additional naloxone doses to reverse opioid overdoses including those involving more potent fast onset synthetic opioids."
Many clinicians, let alone the general public, are not specifically trained in the proper dosage and treatment with Naloxone for the various forms and dosages of opioids and heroin.
FDA Advisory Committee on the Most Appropriate Dose or Doses of Naloxone to Reverse the Effects of Life-threatening Opioid Overdose ... Sept 2016
"The effectiveness of naloxone, and thus the exposure required, will depend on the opioid dose, the potency of the opioid in binding receptors, the lipophilicity of the opioid in crossing into the CNS system and the elimination half-life of the opioid, together with patient factors (7, 26). Appendix [2] and [2a] includes further information on naloxone pharmacology. The complex pharmacology of appropriate dosing is further compounded as often the fentanyl involved is illicitly manufactured without normal procedures or controls and may be introduced surreptitiously into heroin or prescription painkillers. Reports from the field confirm the need for additional naloxone doses to reverse opioid overdoses including those involving more potent fast onset synthetic opioids."
Narcan (Naloxone HCL) Use in Opiod Overdose: A Perspective
4/10/2018
An important point for the general public who is not used to or trained in emergency medicine, this “rescue” drug is only the first step in the opioid crisis ... not the end all and be all of treatment. I would like to respond to this “advisory report” from the Surgeon General as a pharmacist, an Emeritus Professor, Pharmacy Practice from a College of Pharmacy, former President/Chair of the Michigan Pharmacist Association (MPA) and Fellow of this Association; and lastly as a chronic pain patient.
I have used opioids now for chronic pain management after a car accident almost twenty-years ago. I will admit, I was taken aback by my family physician about a month ago being given a prescription for Narcan (generic name Naloxone) as a “precautionary measure” for my chronic opioid use. The form I was prescribed is a nasal formulation vs. the oral/injection form. When I took it to a pharmacy to be filled, I had to undergo “special counseling” by a pharmacist (even with my credentials) which consisted of a video on proper use and a warning that after use, 911 had to be called and I was to be taken to the emergency room for follow-up. This is the proper follow-up when someone is prescribed any rescue medication for a drug reaction. The Naloxone is only to be given when a known opioid (i.e. codeine and it’s derivatives; Fentanyl, Meperidine, etc...) is given or taken in life-threatening incidences. I was instructed, "Were you aware that Naloxone has two elimination half-lives because this drug has an active metabolite; and, were you aware that Naloxone and Naltrexone are different agents, but are easily confused."
I believe giving someone this agent for overdose situations is giving a false sense of security that nothing else needs to be done. Nasal Naloxone is like putting a bandage on a cut artery. You may stop the blood flow at the moment, but the wound will continue to bleed if the wound isn’t sutured properly. Without appropriate emergency room follow up of an opioid overdose the person may die from that overdose.
Many opioids vary in dose, strength, predictability and most of all drug half-life. Knowing the half-life of drugs is essential to know how long the drug is going to last in your body. Drug half-life’s, drug absorption, distribution and elimination is well covered in Colleges of Pharmacy in courses such as pharmacology, pharmacokinetics and pharmacotherapeutics. Pharmacists do not know the pharmacokinetics on every drug substance out there by memory, and we are called the drug experts. Physicians do not have nearly as much education on medications as pharmacists, yet they are the first line of treating drug overdoses in emergency situations along with the nurses, Physician Assistants and Nurse Practitioners.
The general public is being provided a false sense of security by the media to carry this drug in their homes to address the opioid crisis. The public needs to be AWARE there is more to treating an opioid overdose than just squirting this agent up their nose.
Joan M. Rider-Becker, BS, PharmD, FMPA
Retired, Emeritus Professor, Pharmacy Practice Ferris State University College of Pharmacy
Education/Training
B.S. Pharmacy-Ferris State University College of Pharmacy-1987
Pharmacy Practice Residency-Bronson Hospital Kalamazoo, MI-1987-1988
Doctor of Pharmacy (PharmD), University of Michigan-College of Pharmacy Ann Arbor, MI 1990
An important point for the general public who is not used to or trained in emergency medicine, this “rescue” drug is only the first step in the opioid crisis ... not the end all and be all of treatment. I would like to respond to this “advisory report” from the Surgeon General as a pharmacist, an Emeritus Professor, Pharmacy Practice from a College of Pharmacy, former President/Chair of the Michigan Pharmacist Association (MPA) and Fellow of this Association; and lastly as a chronic pain patient.
I have used opioids now for chronic pain management after a car accident almost twenty-years ago. I will admit, I was taken aback by my family physician about a month ago being given a prescription for Narcan (generic name Naloxone) as a “precautionary measure” for my chronic opioid use. The form I was prescribed is a nasal formulation vs. the oral/injection form. When I took it to a pharmacy to be filled, I had to undergo “special counseling” by a pharmacist (even with my credentials) which consisted of a video on proper use and a warning that after use, 911 had to be called and I was to be taken to the emergency room for follow-up. This is the proper follow-up when someone is prescribed any rescue medication for a drug reaction. The Naloxone is only to be given when a known opioid (i.e. codeine and it’s derivatives; Fentanyl, Meperidine, etc...) is given or taken in life-threatening incidences. I was instructed, "Were you aware that Naloxone has two elimination half-lives because this drug has an active metabolite; and, were you aware that Naloxone and Naltrexone are different agents, but are easily confused."
I believe giving someone this agent for overdose situations is giving a false sense of security that nothing else needs to be done. Nasal Naloxone is like putting a bandage on a cut artery. You may stop the blood flow at the moment, but the wound will continue to bleed if the wound isn’t sutured properly. Without appropriate emergency room follow up of an opioid overdose the person may die from that overdose.
Many opioids vary in dose, strength, predictability and most of all drug half-life. Knowing the half-life of drugs is essential to know how long the drug is going to last in your body. Drug half-life’s, drug absorption, distribution and elimination is well covered in Colleges of Pharmacy in courses such as pharmacology, pharmacokinetics and pharmacotherapeutics. Pharmacists do not know the pharmacokinetics on every drug substance out there by memory, and we are called the drug experts. Physicians do not have nearly as much education on medications as pharmacists, yet they are the first line of treating drug overdoses in emergency situations along with the nurses, Physician Assistants and Nurse Practitioners.
The general public is being provided a false sense of security by the media to carry this drug in their homes to address the opioid crisis. The public needs to be AWARE there is more to treating an opioid overdose than just squirting this agent up their nose.
Joan M. Rider-Becker, BS, PharmD, FMPA
Retired, Emeritus Professor, Pharmacy Practice Ferris State University College of Pharmacy
Education/Training
B.S. Pharmacy-Ferris State University College of Pharmacy-1987
Pharmacy Practice Residency-Bronson Hospital Kalamazoo, MI-1987-1988
Doctor of Pharmacy (PharmD), University of Michigan-College of Pharmacy Ann Arbor, MI 1990
| by Rose Rohloff  | Another common practice over the past decade is the prescription of broad spectrum antibiotics for non-life threatening conditions. Broad spectrum antibiotics are for use in life threatening conditions/sepsis when there is no time to wait for a culture, or the inability to do a culture. Broad spectrum antibiotics target the necessary bacteria needed in the adult intestinal tracts; and so, the standard practice has become the second prescribing for probiotics; the requiring of multiple medications to be taken. Additionally, numerous reports over the last 10 years have shown the continued misuse of antibiotics (e.g. CDC Grand Rounds) causing antibiotic resistance, with the need for more and more antibiotics to be created and used. |
What has caused the layering of medications
The country is currently facing increased antibiotic resistance, opioid crisis, etc. due to our culture being conditioned in the taking of medications versus alternative treatments, or prescriptions of medications without diagnosis. A mother of a small child was recently told by a doctor as part of her son's care, "It is very important for you to teach your child how to swallow pills. Start with candy sprinkles, then swallow mini M&Ms, and then have him swallow large M&Ms so he can take multiple pills at the same time." This instruction was given to the mother without a diagnosis for her son, no plan to achieve understanding of what was causing his pain to then create a plan of care - which may or may not have needed to include medication.
Consumer engagement is needed with all medications being prescribed to be fully empowered, to understand: 1) the need for prescriptions, why and when appropriate, 2) the side effects of medications to determine alternatives versus adding on more medications, and 3) to eliminate the misuse of medications without the continued layering of additional drugs. Antibiotics should only be used when the body, given time, cannot fight a severe bacterial infection. And, antibiotics should only be given out after a culture is performed to eliminate a virus as the cause, or to target the specific bacteria. Broad spectrum antibiotics should only be used with life threatening-septic issues while waiting for a culture, or there is not the ability to perform a culture.
Consumer engagement is needed with all medications being prescribed to be fully empowered, to understand: 1) the need for prescriptions, why and when appropriate, 2) the side effects of medications to determine alternatives versus adding on more medications, and 3) to eliminate the misuse of medications without the continued layering of additional drugs. Antibiotics should only be used when the body, given time, cannot fight a severe bacterial infection. And, antibiotics should only be given out after a culture is performed to eliminate a virus as the cause, or to target the specific bacteria. Broad spectrum antibiotics should only be used with life threatening-septic issues while waiting for a culture, or there is not the ability to perform a culture.
by Rose Rohloff
Last week, Jeff Bezos, Warren Buffett and Jamie Dimon (I reference as the BBD solution) announced their focus for healthcare. Here are thoughts from an industry insight perspective to think about. The industry needs major shakeup for transformation to occur. BBD are technology giants focused on technology and employer offered care. This expansion will likely be predominantly that of Telemedicine, Amazon electronic medical record (EMR), and investment in technology companies. Our current system is the push for capitation (covered lives/socialized medicine, Medicaid expansion) with the focus of technology as the solution. BBD is moving this model under companies, and will impact costs. However, technology without personal and personnel intelligence with sound processes is the continued automation of bad practices and "garbage in - garbage out" data, with the potential for expanding the 'fast food healthcare' of symptom=prescription, unless we start addressing the true underlying issues impacting quality, the needed personal and personnel intelligence with mutual accountability on consumers & providers. We currently have the increasing issue of people causing accidents and walking into walls with the advancement of cell phone technology, with more and more technology trying to replace basic awareness and personal intelligence. We need to avoid the same mistake with healthcare delivery with more and more expensive technology driving up costs, without first addressing basic sense solutions.
February 14, 2018 Telemedicine is a tool that can be very effective depending upon how it is used. Top 5 Ways Telehealth Will Change Under the New Federal Funding Bill, "The new federal Bipartisan Budget Act of 2018, signed into law by the President on February 9, 2018."
by Rose Rohloff
Learned lessons from the devaluation and closing of Theranos labs and blood testing centers include the lack of transparency, the need for thoroughly vetting new innovation, the requirement to understand the market, the need to support vision with qualified proof of concept, as well as deficient oversight and due diligence, to name a few. One lesson of success, however, has been overlooked – the model that was established. [read more]
| |
The healthcare industry has used perioperative morbidity and mortality reviews (M&Ms) for blunt evaluations, to continuously improve the understanding of and performance in surgical intervention. Since the industry touts Population Health and Patient Engagement as top initiatives, health systems can use the successful process of M&Ms to perform Population Health and Patient Engagement reviews (P&Ps) of individual cases, for ensuring quality care processes. [read more]
"Those in healthcare are there for the patients, the patients are not there for them. If we stopped for a moment to view the actual words 'patient,' 'health' and 'care,' there is no 'I' in either 'health' or 'care,' only in the word 'patient.'" Those in the healthcare industry tout the idea of prioritizing patients by using phrases such as "patient-centric" and "patient engagement," and yet current data trends suggest the contrary is happening. Instead, motivation based on self-interest continues to permeate care delivery. Here are three trends in the healthcare industry that work against patient-centered care. [read more]
| One important step healthcare leaders have not done - ask the consumer, those individuals who make up the population - what is the public’s understanding or desire for Population Health. Therefore, I went out to the public to ask, and listen to them. [read more] |  |
