AAPS News June 2018 – Transparency

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Volume 74, no. 6  June 2018

In about 2000, the number of publications indexed under “transparency in healthcare” started an exponential rise, reaching about 400 per year in the past few years. Politicians have also become very fond of the word. To AAPS, it should mean honest price signals and “government in the sunshine.” Support or opposition by various entities, such as government and its private partners, seems to depend on whether it is their data or your data.

Secret Science

In 1999, an add-on to the giant Omnibus Spending Bill sponsored by Sen. Richard Shelby of Alabama required that data obtained in federally funded research be released under the Freedom of Information Act (FOIA). One motivation for the provision was the Environmental Protection Agency’s (EPA) refusal to allow outside analysis of controversial data used as the basis for draconian rules on particulate matter (AAPS News, May 1999).

“There is strong evidence that this relationship [between  fine particulates—PM2.5—and premature death] has been falsified by EPA…for more than 20 years,” writes James Enstrom, Ph.D., in the spring issue of our Journal (tinyurl.com/y9yzv2pd).

An appellate court declared the law unenforceable in 2003, and secret science continued (Steve Milloy, WSJ 3/27/18).

Other issues on which physicians sought data release included the use of high-dose steroids in spinal cord injuries, safety studies on the use of antidepressant drugs in children, psychological questionnaires administered in school-based clinics, and the finding of smaller brains (a drug effect?) in children diagnosed with attention deficit disorder (AAPS News, January 2007).

Vaccine-related data allegedly have been suppressed by the Centers for Disease Control and Prevention (CDC). For example, CDC has stone-walled AAPS and other FOIA requests for data supporting the safety of hepatitis b vaccine in newborns.

The PM2.5 controversy went dormant until 2011, when Congress took exception to EPA rules that were bankrupting the coal industry. EPA Administrator Gina McCarthy defied a congressional subpoena to release data on small particulates. EPA Administrator Scott Pruitt recently published a new rule, Strengthening Transparency in Regulatory Science (STRS), which would codify the Honest and Open New EPA Science Treatment Act of 2017 (HONEST Act), which passed the House but never came up for vote in the  Senate (https://tinyurl.com/ycmdadr2).

Democrats and radical environmentalists strongly oppose the rule, claiming concerns about privacy and proprietary data, despite the rule’s provisions to protect confidentiality. They assert that discussions about the “irreproducibility crisis of modern science”—the basis for new policies at major scientific journals— are being exploited for political ends. Science, Nature, and others oppose the rule. “Like tobacco lobbyists and climate-change deniers, the [EPA] is co-opting scientific trappings to sow doubt, writes Naomi Oreskes (https://tinyurl.com/y7rl2vvc).

The peer review process of “reputable” journals should purportedly be adequate to discredit doubters of certain orthodoxies.

Secret Government

Despite “government in the sunshine” laws, a FOIA request is frequently not enough to get information; litigation is required. AAPS had to sue to gain access to the documents of the Clinton Task Force on National Health Care Reform.

Judicial Watch (www.judicialwatch.org) has filed dozens of lawsuits seeking information about “Deep State” corruption, cover-ups, and abuses of power. Even when released, documents are often so heavily redacted as to be meaningless; “national security” considerations are frequently cited.

Individual Americans facing administrative or criminal proceedings may be unable to access information needed to defend themselves. The Louisiana House heard testimony on May 2 by a physician whose career had been ruined by the Louisiana State Board of Medical Examiners (LSBME). During years of proceedings, he was denied a complete copy of his file (https://tinyurl.com/y8cos4l2). But a doctor’s failure to disclose even a seemingly trivial matter on an application can end his career.

Secretive processes that keep physicians in the dark about accusations, evidence, and even the existence of  an investigation are trademarks of sham peer review exposed by Lawrence Huntoon, M.D., Ph.D., in many issues of our Journal.

Two books reviewed by John Dale Dunn, M.D., J.D., in our journal (https://tinyurl.com/yc6hmwgq), Licensed to Lie and Three Felonies a Day, detail prosecutorial abuses such as withholding exculpatory evidence, mishandling or destroying evidence,  and witness intimidation. The perpetrators include Robert Mueller and some members of his special counsel team.

No Secrets for Patients or Doctors

“Value-based medicine,” in which the goal is management by outcomes, is increasingly like Jeremy Bentham’s Panopticon (AAPS News, September 2003, December 2004). Data in the electronic health record, combined with data from other sources, is being bought and sold, sliced, diced, and scored (see pp 2,4), including our risk factors, compliance, and attitudes, for the convenience of the technocratic state. Are we to be like “Number 6” in the surreal 1967-1968 British television series The Prisoner, where the evil balloon is constantly seeking “information”?

Once Untrustworthy, Always Restricted

In early 2017, more than 6 million Chinese citizens had been banned from taking flights because of “social misdeeds.” New rules in China’s social-credit system went into effect May 1. The score is developed by a secret process, using data from a ubiquitous surveillance system, and there is no due process. The Sesame Scoring System, allegedly the brainchild of China’s wealthiest man, whose conglomerate includes Verizon and Yahoo, monitors reading choices and the credit scores of friends and acquaintances (https://tinyurl.com/yanejrxm). Those with too low a score can’t buy property, send a child to private school, or get a loan.

China also deploys “brain-reading” sensors to monitor factory and transport workers, and the military. Detecting fatigue and attention loss is said to have prevented a large number of errors.

“Pilots may need to sacrifice some of their privacy for public safety” (South China Morning Post 4/29/18, tinyurl.com/y9g4xsuc).

Try. Fail. Repeat.

For those who think Communism is dead, and it can’t happen here (https://tinyurl.com/y7a2g8jl):

Bill de Blasio, just re-elected to a second term as mayor of New York City, complained that “private property rights” are limiting his ability to plan for New York.

Data Mining and Tracking in the U.S.

  • Google’s Selfish Ledger: In a leaked internal video (https://tinyurl.com/y83lg2d4), which Google claims is a mere “thought experiment,” Google explores how all the personal data gleaned from a person’s electronic devices could be used as a tool to enable total social engineering.
  • Facebook Accused of Conducting Mass Surveillance: In a lawsuit filed by Six4Three, Facebook has been accused of using its apps to track users’ location, to read and collect text messages, and to record calls. It also collects information sent by nonsubscribers, who could not have consented, to FB users (Guardian 5/24/18, https://tinyurl.com/y796nrn4).
  • Spy Devices Track Cellphones in D.C.: While driving around the District of Columbia area, the News4 I Team detected dozens of spy devices capable of tracking cellphones and intercepting calls. The device, sometimes called a StingRay, can mimic a cell tower and trick a cellphone into connecting with it. About half the devices are probably government’s (tinyurl.com/y9s3wzy8).
  • Student Data Mining: Facebook, Google, Apple, Microsoft, Pearson, and other tech giants are partnering with the U.S. Dept. of Education to cash in on data collected under the recently passed Every Student Succeeds Act—on attitudes, values, beliefs, and dispositions. Available data burgeoned after adoption of tech-industry supported Common Core. Obama-era loopholes allow release of data to third parties. Google admits to scanning and cataloging student email messages. There are endless avenues to “align” student learning with characteristics desired by corporations, writes Michelle Malkin (https://tinyurl.com/yace8bp3).

 

“Thou shalt not be a victim…. Thou shalt not be a perpetrator…. Above all, thou shalt not be a bystander.”

Holocaust Museum, Washington, D.C.

 

How Bad Is the Government’s Science?

Half the results published in peer-reviewed scientific journals are probably wrong, stated John Ioannidis, now a professor of medicine at Stanford, in 2005. But what about the science that the government has been using to justify policy for decades, without ever confirming its validity? Peter Wood and David Randall write: “The social psychology that informs education policy could be entirely irreproducible. The whole discipline of climate science is a farrago of unreliable statistics, arbitrary research techniques and politicized groupthink” (WSJ 4/17/18).

Medical Price Transparency Worsens

Most states require hospitals to report price information, and in 2012 there were at least 60 state healthcare price transparency websites.  However, researchers posing as a patient’s family member trying to get a bundled price for a hip replacement could get a full or partial price in less than half the 120 hospitals contacted. Between 2011 and 2016, the number of hospitals that could provide complete price information dropped from 48% to 21%, and the number unable to provide any price information increased from 14% to 44% (https://tinyurl.com/y8r27lnb).

Price Falsification

“The heart of the Fed’s monetary central planning regime is the falsification of financial asset prices,” writes David Stockman (Contra Corner 3/1/18). The modus operandi of Keynesian central banking is to replace free-market prices on bonds, loans, and other financial assets (including equities) with administratively set prices designed to stimulate increased levels of real activity in targeted sectors. The powerful yield suppression—falsification of term debt prices—during the quantitative easing binge drove real-interest costs for 10-year loans to 80% below historical levels, resulting in a speculative bubble.

Drug Company Rachets Up Political Activity

With pressure mounting over its soaring insulin prices, including a lawsuit and investigations by at least five states, Novo Nordisk’s campaign contributions nearly doubled from $207,880 in 2015 to $405,000 in 2017. It also spent $3.2 million lobbying Congress and federal agencies in 2017. The company claims that discounts and rebates substantially lower the list price. Including discounts, the company’s net profit margin for 2017 was 34%, twice as high as in 2007 (https://tinyurl.com/ybwv7846).

 AAPS Calendar

July 21. Missouri state chapter meeting
Oct. 3-6. 75th annual meeting, Indianapolis, IN.
Sep 18-21, 2019. 76th Annual Meeting, Torrance, CA

Drug Enforcement Alert

The Maine Board of Licensure in Medicine distributed a Special Notification regarding an extortion scam targeting Drug Enforcement Administration registrants. Scammers use a disguised telephone number that appears on registrant’s caller ID as the DEA’s 800 registrant support number. The impersonators then make their demands with threats to suspend DEA registrations.
The BOLIM states that a DEA employee would not contact a registrant and demand money, threaten to suspend a registration, tell of an investigation, or threaten arrest. Report such calls using the DEA’s online extortion scam report form available at www.deadiversion.usdoj.gov.

Swift, Secret Justice in Britain

Within hours of his arrest by seven police officers, “Tommy Robinson” (real name Stephen Yaxley-Lennon) had a “four-minute” trial in which he was convicted for contempt of court and sentenced to 13 months, according to Mark Steyn. At the time of Robinson’s arrest, he had been livestreaming, from his cell phone, outside the Leeds Crown Court, where the trial of a “Grooming Gang” was proceeding (tinyurl.com/ycn2fwd2).

“Grooming,” Steyn writes, is “the useless euphemism for industrial-scale child gang rape and sex slavery by large numbers of Muslim men with the active connivance…of every organ of the state: social workers, police, politicians. Oh, and also the media.”

An immediate media blackout was ordered, lest the outcome of other rape trials somehow be influenced by news of Robinson’s arrest for reading published news items to Facebook followers and trying to photograph defendants. Robinson was under a suspended sentence for his reporting on a previous “Grooming Gang of the Week” case. And he had a prior conviction in 2014, resulting in an 18-month sentence for—a misrepresentation on a mortgage application, discovered in zealous combing through his personal affairs (https://tinyurl.com/yb6qxuyp).

Robinson was immediately hauled off to prison. The judge was aware that during his previous incarceration he was almost killed by Muslim inmates. The judge reportedly stated that freedom of speech comes with consequences.

Fighting “Islamophobia” is the official priority, Steyn notes, contrasting officialdom’s alacrity in dealing with Robinson with its failure to protect thousands of young British girls from rape.

 

==>Tip of the Month: Risks in voice-activated virtual assistants: About one-fourth of physicians’ offices use virtual assistants for drug dosing questions, appointments, and diagnostic information searches. If patient-specific information is overheard, the physician may be guilty of a HIPAA violation. Queries are stored and might be accessed by third parties. As part of the Internet of Things, these applications are easily exploited by cybercriminals. They can be re-programmed or used to transmit malware. Information from internet searches may be incorrect. The rate of correct answers to 782 standardized questions was 52% for the Siri HomePod, 57% for Microsoft’s Cortana, and 81% for Google Home. A device can turn on in response to a word that resembles the one that activates it; Alexa might be recording you without your knowledge. Past queries are discoverable in malpractice litigation (Medical Practice Compliance Alert, April 2018).

 

Is Free Speech Dead in Britain?

Upon receiving an invitation to a “Freedom Festival” in Bournemouth, England, David Skinner called to ask whether there were any issues that could not be discussed, as he didn’t want to waste £72 if there were. The brochure claims: “TFA [The Freedom Alliance] believes in the freedom of the individual in all aspects of life to as great an extent as possible. As such, we seek to challenge any erosion of civil liberties, and campaign in support of individual liberty and freedom of expression [emphasis added].”

However, just asking that question got him banned from attending.  Mr. Skinner has a history of objecting to school curricula that force pro-homosexuality and transgender views on 4-year-old children. Parents who uphold traditional family values in Britain may be publicly humiliated with a the Bigot of the Year Award.  People fearful of the consequences of expressing unpopular views stay silent (https://tinyurl.com/ybvnmynk).

Pain Doctor Paroled after 8.5 Years

After serving 8.5 years of an 8.5-20 year prison sentence, anesthesiologist William Mangino II, M.D., has been paroled in Philadelphia. According to his own account, he was convicted for continuing to prescribe opioids to five patients who had been receiving them from other doctors for years before they had been referred to Dr. Mangino for injections, which did not relieve their pain. He says that he turned down a plea bargain for 6 to 11 months of imprisonment with work release on condition that he would testify against two other doctors. Also he felt it would be unfair to claim that his patients were drug addicts who did not have pain. Dr. Mangino states that the prosecution withheld exculpatory evidence and never proved the main element of the alleged crime—deliberately prescribing for patients he did not believe to be in pain. Excessive dosing was not alleged. His patients report being “blacklisted” by other doctors. He is continuing to appeal his conviction (https://tinyurl.com/y82eon5n).

Innocence Is Irrelevant

Plea bargains are now used to resolve 94% of felony convictions at the state level and 97% at the federal. The “trial penalty” is so severe that many innocent persons feel they have no option but to plead. There are few rules or protections, and little written trace. The indelible stigma of a guilty plea in today’s zero-tolerance, zero-risk society leaves millions of Americans with little chance of leading an ordinary life (Atlantic, September 2017).

Flashback: the Reign of Terror

Robespierre and his allies on the Committee of Public Safety developed the Law of Suspects, a template still followed by the Left. Suspects included those who, by their conduct, associations, comments, or writings had shown themselves to be enemies of the Revolution; those who were unable to justify their means of existence and the performance of their civic duties in the prescribed manner; and those to whom certificates of patriotism had been refused. Surveillance Committees drew up warrants for their arrest and placed their papers under seal. The slightest indiscretion  could mean a death sentence  (https://tinyurl.com/ybnhfoxp).

Correspondence

 Physician-Assisted Suicide Proposed in NY. The Medical Society for the State of New York (MSSNY) has taken a strong stand against a proposed bill to legalize physician-assisted suicide, a.k.a. medical aid in dying. MSSNY president Thomas Madejski, M.D., writes that we need to create an environment that eliminates the desire of patients to end their life for fear of inadequate care (https://tinyurl.com/ycdpyfhg).
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY

Progressivism Is Neo-Communism. The totalitarian communism that allegedly died in Eastern Europe in 1989 went underground and re-emerged with a new image as a softer and gentler form of government tyranny. The agenda is unrestrained globalism. There is no plan to starve and gulag 100 million people like in the old communist system—just a desire to reduce the planet’s population by a few billion because overpopulation is supposedly destroying the planet. Today most people do not oppose neo-communism/progressivism for fear of losing their jobs, their businesses, lucrative contracts, social standing, etc. They are like the Roman soldier of old, who cared only about the pebble in his shoe, not the fate of the far-flung empire.
Ileana Johnson,  https://tinyurl.com/ybkrr8oe

What If Kickbacks Were Illegal? I recently presented insulin pricing information to a large group of African-American leaders. The Executive Summary: Three manufacturers control 97% of the market. Nine are locked out. Of the cost of $406 per month, 75% is kickbacks. Patients who have a high copay/deductible are funding the kickbacks out of pocket. If kickbacks were made illegal again, monthly insulin costs would go from about $400 to $100 per month. If 12 manufacturers were allowed to compete without exclusionary sole-source kickback payments,  the reintroduction of competition would take the cost down to less than $40 per month—a 90% savings.
Robert Campbell, M.D., Physicians Against Drug Shortages

A Balanced Budget. Rep. Mark Walker (R-N.C.) has proposed a Balanced Budget Amendment. What would happen in the unlikely event that it was enacted? It would require his party to do an about-face on their previous pattern. Republicans would have to fight with the socialists, on principle, to drastically cut spending and shrink government, and finally try to win. Their default mode has been surrender and betrayal. Under present circumstances, this amendment is a sure-fire recipe for massive tax increases.
Joseph Guarino, M.D., Reidsville, NC

Digital Caste System. Pharmacy benefits managers (PBMs) were supposed to work with insurance companies to help control costs, but now they are not much more than complex algorithmic human scoring machines that deny or allow access to drugs to create big corporate profits. There’s still some drug pricing involved, but it’s more about what the market will bear than affordability. PBMs mine  and score and sell your data—as to Big Pharma (you get a medication adherence score) and to FICO, a data analytics company focused on credit scoring.
Barbara Duck, https://tinyurl.com/y9e43df9

CMS Inverts Meaning. The proposed Medicare Direct Provider Contracting (DPC) model is the antithesis of the current model embodied in the term DPC—direct primary care or direct patient care. CMS asks how the model could be designed to attract a wide variety of practices, including small, independent ones. Once the government gets involved with a practice it will no longer be independent in the true or practical meaning of the word. The CMS Innovation Center needs to do a 180-degree turn away from the managed-care premises in this proposal. What we need is to restore direct contracting (direct pay) between patients and physicians.
Twila Brase, R.N., https://tinyurl.com/y9yqkjox

Safe Harbors. I believe that the safe harbors for group purchasing organizations (GPOs) and pharmacy benefits managers (PBMs) are tied into nearly everything that obstructs us as physicians. PBM Optum collects our MIPS (Merit-based Incentive Payment System) data, GPO Premier collects MOC (Maintenance of Certification) data, hospital administration collects GPO sharebacks, insurers consort with PBMs in attempts at merging for the purpose of having no-physician minute clinics, and on and on.
Marion Mass, M.D.,  Sellersville, PA

Price Transparency. Sen. Bill Cassidy, M.D., (R-La.) claims he is going to mandate price transparency in healthcare. Surely he realizes that doing so will negate virtually all managed-care contracts.
Kevin Wacasey, M.D., Haltom City, TX

CMS Decides Limits of Professional Practice. In a Final Rule for Medicare Advantage Plans issued on Apr 2, CMS plans to save $295 million by implementing the Comprehensive Addiction and Recovery Act of 2016 (CARA). The Rule in effect separates pain patients into two groups, those with active cancer or terminal illnesses, and others. CMS will define “at risk” groups of patients (e.g. those who “use multiple pharmacies”), who “should not” be treated with “frequently abused drugs” such as opioids.
William Mangino II, M.D., Philadelphia, PA

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