Today was another full day--thank goodness tomorrow will be slower. I'm at the annual Oklahoma Association of Broadcasters Convention in Tulsa. It's been an extremely busy day--and full of challenges! My stress level was super high as I tried to get everything done I needed to complete before heading this way. It was crazy.
I handled my food very well. Tonight's dinner selection was full of sauces with refined sugar. I asked for what I needed and received it without issue. I was the only one in the room eating something different, but I didn't mind. My commitment to maintaining abstinence from refined sugar is 701 days strong. I take it very seriously. I'd rather pass and eat something later, if that's what I need to do. I'll not starve--that's for sure. The staff was happy to accommodate my request and all was well.
I was out of eggs this morning. That's how insanely busy yesterday was--so much, I didn't make sure I had what I needed! I had plenty of calories tonight, so I did get some eggs with a veggie and mozzarella omelet.
The OAB Poker tournament (with play chips) was a big deal this evening. The final table included Bill--the man who owns the broadcasting company where I work. He and I became the last two players, head to head--and he took just a few hands to finish me second.
The day will be a little slower tomorrow. Much slower, actually. And that's a very good thing!
I really enjoyed Live Tweeting the day.
MyFitnessPal said I'm on track to be under 200 pounds within five weeks. That's not my plan. We'll see how this goes.
I'll let the Tweets take it the rest of the way...
My Tweets Today:
2 cups water & 20 push-ups due before l get my hands on the coffee mug of "wake up juice." Aaaannnnddd DONE. ?? pic.twitter.com/K0AVDIsFhK
The fifth annual national summit on prescription drug abuse, started by U.S. Rep. Hal Rogers of Kentucky, was the largest, broadest and highest-profile yet.
A non-prescription drug was added to the title of the four-day event, making it the National Rx Drug Abuse and Heroin Summit. It drew more than 1,900 to Atlanta, including President Barack Obama, who joined an hour-long panel to talk about new ways to deal with a growing opioid and heroin epidemic.
U.S. Rep. Hal Rogers
"The rapid growth of this summit is truly a testament to the power of unity. Everyone here has one common goal - to save lives from the dark clenches of drug abuse," Rogers, a Republican from Somerset, said in a news release.
The summit was hosted by Operation UNITE, a Kentucky non-profit created by Rogers that leads education, treatment and law enforcement initiatives in 32 counties in Southern and Eastern Kentucky. The acronym stands for Unlawful Narcotics Investigations, Treatment and Education.
According to the federal Centers for Disease Control and Prevention, in the U.S. someone dies every 20 minutes from an opioid overdose and Kentucky has one of the nation's highest rates, with more than 1,000 deaths a year from it.
(On Monday, April 4, KET's "Kentucky Tonight" will have a report on the summit and a look back at the network's coverage of drug addiction issues. For a preview from host Bill Goodman, click here.)
The University of Kentucky and UK HealthCare, which helped sponsor the summit, sent a delegation of executive, clinical and research leaders, including President Eli Capilouto as one of the keynote presenters, according to a UK news release.
�Too many Kentucky families are too often confronted by the dark and painful scourge of prescription drug abuse and opioid addiction," Capilouto said. "It�s an epidemic that penetrates communities across the nation, both urban and rural, but has especially intractable roots in Appalachia and the regions served by the University of Kentucky.�
Obama opened his remarks on the panel by thanking Rogers,who is also co-chair of the Congressional Caucus on Prescription Drug Abuse, and UNITE, "the organization that has been carrying the laboring oar on this issue for many years now. We are very grateful to them."
Obama focused some of his comments on broadening access to medication-assisted treatments for addiction, most successfully with counseling and behavior therapy.
"What we do know is that there are steps that can be taken that will help people battle through addiction and get onto the other side, and right now that's under-resourced," the president said.
Obama's administration recently proposed doubling the number of patients a health-care provider can treat with buprenorphine, one of the drugs used to fight addiction, to 200 from 100.
He said the opioid and heroin epidemic is a public-health issue and not just a criminal-justice problem, which is the only way to reduce demand. "In this global economy of ours that the most important thing we can do is to reduce demand for drugs," he said.
Because the opioid and heroin epidemic is touching everybody and not just poor people and minorities, there is now more emphasis on treatment over incarceration, Obama said: "This is not something that's just restricted to a small set of communities. This is affecting everybody -- young, old, men, women, children, rural, urban, suburban."
The president also noted that there has been a significantly increase in opioid abuse in rural areas, which often suffer from an under-resourcing of treatment facilities and mental health services.
"And that's why, for all the good work that Congress is doing, it's not enough just to provide the architecture and the structure for more treatment. There has to be actual funding for the treatment," he said.
The president has proposed $1.1 billion in his upcoming fiscal year 2017 budget request to fund drug-treatment programs in counties all across the country.
Agriculture Secretary Tom Vilsack announced two rural initiatives at the summit: town hall meetings in rural areas hit hardest by drug abuse, including Appalachia, "to raise awareness of the issue and discuss possible solutions," and an extension of the Rural Health and Safety Education competitive grant program to include $1.4 million in grants that will now be available to rural communities to fight heroin and painkiller abuse, according to a press release.
The president also announced several other new initiatives: establishing a Mental Health and Substance Disorder Parity Task Force; implementing mental health and substance use disorder parity in Medicaid; releasing $11 million for the purchase and distribution of the opioid-overdose reversal drug, naloxone; expanding an initiative that improves local partnerships between law enforcement and public health; a $7 million investment for community policing to address heroin; and providing guidelines for the use of federal funds to implement or expand needle-exchange programs.
The Kenton County Fiscal Court unanimously approved a mobile needle exchange program March 29, which moves the City of Covington's needle exchange program one step closer to fruition, Terry DeMio reports for the Cincinnati Enquirer. The Fiscal Court's approval was one of several conditions required by the City of Covington to allow its exchange to move forward. Covington's plan also requires two other counties in the Northern Kentucky Health District to adopt exchanges (only Grant County has); limits access to only resident's of the district's four counties; and would move the exchange to St. Elizabeth Healthcare hospital.
In addition, it requires a one-for-one needle exchange and a mandate that all participants must be tested for hepatitis C, hepatitis B, HIV, and, where applicable, pregnancy. This condition is likely not legal and is being investigated by the Northern Kentucky's Health Board's legal counsel, DeMio reports.
Kenton County's plan differs from Covington's in that it mandates only the offering of these tests, DeMio reports.
Both plans will require the Kenton County Board of Health's approval.
Needle-exchange programs were authorized by the state anti-heroin law passed in 2015, and require both local approval and funding. They are meant to slow the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. Northern Kentucky has been hit the hardest in the state by heroin and its hepatitis C rates have been reported at 19 times the national rate.
The needle exchange would be funded by $250,000 from the R.C. Durr Foundation, and the health department would use its staff and already available testing to further pay for the exchange, DeMio reports.
The Fiscal Court also approved exploring the idea of building a community-wide addiction treatment center on the county jail grounds; putting $25,000 toward a heroin helpline; and approved a resolution to encourage the Northern Kentucky Board of Health to create a high-quality prevention and education program for the community.
The Northern Kentucky Area Development District has already put out proposals for the heroin helpline, DeMio notes. And County Judge-Executive Kris Knochelmann told him that Boone and Campbell counties were willing to consider putting $25,000 each toward it, and that St. Elizabeth had promised $75,000 toward its operation.
The other needle exchanges in the state that are either operating or have been approved are in Louisville and Lexington and in the counties of Pendleton, Carter, Elliott, Franklin, Grant and Jessamine.
Nine years ago, three top executives of Purdue Pharma pleaded guilty to criminal charges of "misbranding" Oxycontin. The case appeared to be a landmark. In previous years, top executives of large health care corporations rarely faced legal consequences when their companies misbehaved. Yet in the Purdue Pharma/ Oxycontin case, things were not what they seemed. Maybe that is why this case never did yield a new era of accountability for top corporate health care leaders.
Background - the Oxycontin Guilty Pleas
In 2007, we posted about the executives' guilty pleas. Relying on the New York Times coverage, we noted that the Department of Justice charged that the company used aggressive, deceptive marketing, including claims that Oxycontin had little potential for addiction, even though they then knew otherwise. Unlike many other settlements, the executives and the company admitted their dishonesty, although they were not apparently charged with fraud.
In a statement, the company said: 'Nearly six years and longer ago, some employees made, or told other employees to make, certain statements about OxyContin to some health care professionals that were inconsistent with the F.D.A.-approved prescribing information for OxyContin and the express warnings it contained about risks associated with the medicine. The statements also violated written company policies requiring adherence to the prescribing information.'
'We accept responsibility for those past misstatements and regret that they were made,' the statement said.
While no executives went to jail, the three who pleaded guilty,
Michael Friedman, the company�s president, who agreed to pay $19 million in fines; Howard R. Udell, its top lawyer, who agreed to pay $8 million; and Dr. Paul D. Goldenheim, its former medical director, who agreed to pay $7.5 million.
appeared to be the top leaders of the company. So, at the time I concluded,
At least in the Purdue Pharma/ Oxycontin case top company leaders were prosecuted, pleaded guilty, and will personally have to pay substantial financial penalties. Maybe this will convince the leaders of health care organizations that deceptive marketing practices may not be in their long term interests. Up to now, it may have been too easy to be swayed by the enormous profits deceptive marketing can bring, and regard fines paid by the company as just a cost of doing business.
No Lasting Effects
I was much too optimistic. Alas, we have since documented numerous legal settlements, and other cases of at least alleged bribery, kickbacks, or fraud, in which the top organizational leaders who authorized or directed the questionable conduct never suffered any consequences for their actions. That is, they demonstrated impunity.
Meanwhile, Purdue Pharma has been in the news since 2007, and not in a good way. In particular, we noted that the company seemed to keep up manipulative, if not deceptive marketing efforts on behalf of its narcotic product. In 2010, Canadian medical students protested that their "education" about narcotics and pain management was influenced by Purdue marketing (look here). In 2012, we noted that a leading "key opinion leader" who had a key role promoting the liberalized, if not reckless use of narcotics to treat all sorts of chronic pain, and had financial relationships with numerous narcotic pharmaceutical manufacturers, including Purdue Phrama, later admitted that it was all "misinformation." Yet this aggressive promotion of narcotics was likely a major factor in the ongoing narcotic epidemic which has killed thousands in the US. And in January, 2016 we described how opposition to new CDC guidelines that suggested much more conservative use of narcotics seemed to be funded, if not orchestrated by narcotic pharmaceutical manufacturers, notably including Purdue Pharma. Finally, there have been many other stories about Purdue Pharma about which we failed to post.
One would think, however, that a company that admitted to a crime, and whose three top executives lost their jobs and also pleaded guilty to crimes, would at least change its ways, even if these guilty pleas and admissions did not inspire more attempts to hold top corporate health care leaders accountable.
An Assumption about Unaccountable Hired Mangers
But it turns out that some obvious assumptions that I and probably many other people made about the Purdue Pharma cases of 2007 were wrong. I implicitly assumed when I wrote my 2007 post that the three Purdue Pharma executives who pleaded guilty were the top leaders of the company.
Furthermore, as we have discussed elsewhere, the top executives of large, for-profit publicly held corporations, like most pharmaceutical companies, have become largely unaccountable. They may seem to exist in a bubble, in which they are hailed as visionaries, and paid exceedingly well no matter how their organizations perform. (Look here). However, many top hired corporate managers have mainly become "value extractors."
These executives are nominally accountable to their corporate boards of directors, which are supposed to represent the owners of the companies. However, most large pharmaceutical companies have numerous stockholders, who have no easy avenue to organize. Many of their stockholders, in turn, are mutual funds, retirement funds, etc whose shares in turn are owned by thousands more. These numerous, dispersed "owners" have little influence on corporate boards, who often functionally are dominated by cronies of the top management.
So when the three top Purdue executives pleaded guilty, at least it looked like in this case the unaccountable hired executives had been made accountable, if not to their boards of directors, at least to the courts.
But Who Owned Purdue?
But what you see is not always what you get. There was a hint buried in the NY Times article,
Between 1995 and 2001, OxyContin brought in $2.8 billion in revenue for Purdue Pharma, a closely held company based in Stamford, Conn. At one point, the drug accounted for 90 percent of the company�s sales.
As part of the plea agreement, Purdue Frederick, a holding company for Purdue Pharma that is also closely held, pleaded guilty to a felony charge of misbranding OxyContin.
The article did not further discuss the meaning and implications of the twice used phrase, "closely held." I confess I missed it entirely. However, it seems to have meant that rather than being a public corporation with numerous, dispersed stockholders, the owners of Purdue Pharma and its parent were a smaller group, perhaps a group who should have been accountable for the actions of their executives. However, the NY Times did not further describe this group. Neither did reports in other outlets, such as the Wall Street Journal, CBS, or Time. Nor did a variety of other news stories that mentioned Purdue Pharma through 2010.
The Oxycontin Billionaires
There were a fewother clues available in 2007, but would have not been easily found at that time. After the case's resolution was disclosed, an article appeared in the Corporate Crime Reporter (but was presumably only available at that time by subscription.)
Purdue is a privately held, very secretive company based in Stamford, Connecticut.
It�s controlled by the Arthur Sackler family. Arthur Sackler is the guy who, before he delivered OxyContin, brought to you the marketing for Librium and Valium. Walk on the mall in Washington and you walk by the Freer Gallery of Art and Arthur Sackler Gallery.
Art brought to you by Oxy.
New York Times correspondent Barry Meier is probably the most plugged in journalist on the topic. A couple of years ago, he wrote a book detailing the problem titled Pain Killer: A 'Wonder' Drug�s Trail of Addiction and Death (Rodale Books, 2004.)
So apparently Purdue Pharma and Purdue Frederick were privately held, the Sackler family held a controlling interest, and the Sackler family were rich enough to have their name attached to an art museum.
The relationship between the Sackler family and Purdue got no other attention I could find until 2010. In March of that year, another member of the family, Dr Mortimer D Sackler died, and his NY Times obituary led off with evidence of his wealth, and philanthropy,
Mortimer D. Sackler, a psychiatrist who was a co-owner of the pharmaceutical company Purdue Pharma, makers of the controversial painkiller OxyContin, and whose lavish gifts to the Guggenheim Museum, the Metropolitan Museum of Art and Columbia University made him one of New York City�s most prominent benefactors, died March 24 in Gstaad, Switzerland. He was 93 and had homes in London, Gstaad and Antibes, France.
The obituary also provided evidence of a direct relationship among the Sacklers, Purdue, and the development of Oxycontin.
The Sackler brothers were all doctors, and all businessmen as well. In 1952, while the three were working at the Creedmoor state psychiatric hospital, Arthur financed the purchase of a small drug manufacturer based in Greenwich Village, the Purdue Frederick Company, which Mortimer and Raymond Sackler ran as co-chairmen and which later became Purdue Pharma, now based in Stamford, Conn.
Then,
by the mid-1990s Purdue Pharma was still a small drug company. But with a new product, OxyContin, a powerful, long-acting, narcotic painkiller, the company hoped to join the ranks of industry giants. Indeed, by 2001 sales of the drug had reached nearly $3 billion and accounted for 80 percent of Purdue Pharma�s revenue.
The lavish scale of Sackler's generosity was indicated in The Sunday Times's "Rich List" for 2008, which noted that while he and his family owned a �500 million stake in the pharmaceutical business, Purdue Pharma, huge charitable contributions had cut their wealth to �300 million. Yet few knew much about the Sacklers apart from their association with the cultural institutions that bear their name.
However, I could find no echos of this story beyond these obituaries, and certainly none that prominently made their way into the health care world. In late 2011, about ten percent of a long piece by Fortune on Purdue made the Sackler's ownership and wealth clear, but did not discuss the implications.
The story only began to echo a little in 2014. That year, the prospect of a trial of a civil lawsuit against Purdue filed in the state of Kentucky, one of the most hard hit by the narcotic epidemic, promised to shake things up. A long Bloomberg story on the lawsuit was the first to suggest that the very wealthy Sackler family might bear some responsibility for how Purdue marketed Oxycontin, and the results on patients' and the public's health.
Kentucky lawyers plan another first for Purdue: They want to elicit testimony from the company�s board, which is dominated by members of the Sackler family, the wealthy philanthropists who own the company and have until now remained largely untouched by the controversy tied to the blockbuster drug that netted their business billions of dollars.
It underlined the tightness of the ties between the Sackler's and Purdue. The family does not merely own a controlling interest, but dominates the company's governance.
Purdue today is owned through holding companies and family trusts for the benefit of Mortimer and Raymond Sackler�s families, according to Raul Damas, a company spokesman. In all, nine members of the Sackler family are Purdue directors. In January, Raymond Sackler announced the appointment of Chief Executive Officer Mark Timney. None of the Sacklers has been named in the Kentucky suit.
Raymond, who remains on the board, and his children have been the most involved in the family business. His son, Richard, a physician, worked at Purdue for three decades before being named president in 1999. Now retired, he remains a director. A grandson, David Sackler, sits on the board and runs a family investment fund, Summer Road LLC, in New York. Raymond�s other son, Jonathan, is a director, too.
By the way, the Bloomberg article also detailed another point (which had been mentioned in the obituaries and the CNN article). One member of the Sackler family was behind the aggressive, deceptive marketing campaign that sparked so many sales of Oxycontin. In fact, this Sackler brother could be viewed as the father of modern aggressive, deceptive pharmaceutical/ biotechnology/ device corporate marketing.
Raymond and Mortimer ran the company together. Arthur, the oldest, appears to have been primarily an investor and adviser.
Considered the father of modern pharmaceutical marketing, Arthur Sackler created the first medical-journal advertising insert to promote a drug and pushed for hiring sales reps long before they became as common in physicians� waiting rooms as out-of-date magazines. Purdue used many of Arthur Sackler�s tactics when it introduced OxyContin, a time-released dose of the opioid oxycodone, in 1995.
CNN had gone into a bit more detail on Arthur Sackler's previous work:
Arthur, joined a small advertising agency that specialized in marketing pharmaceuticals. (He also funded his brothers� purchase of Purdue, according to a 2003 book by New York Times reporter Barry Meier called Pain Killer: A Wonder Drug�s Trail of Addiction and Death.) Arthur was so successful that in 1997 he was one of the first people named to the Medical Advertising Hall of Fame, whose website credits him with helping 'shape pharmaceutical promotion as we know it today.' As early as the 1950s he was experimenting with TV marketing, and according to the entry, Arthur�s scientific knowledge and ability to expand the uses for Valium helped turn it into the first $100 million drug ever. Arthur�s philosophy was to sell drugs by lavishing doctors with fancy junkets, expensive dinners, and lucrative speaking fees, an approach so effective that the entire industry adopted it.
So at least this article credits Dr Arthur Sackler, of Purdue Pharma, with being one of the creators of the web of conflicts of interest that has ensnared many medical professionals in the last decades. Who knew?
Just to ice this cake, in later 2015, it became apparent that the Sacklers did not merely become wealthy from Purdue profits and Oxycontin sales. They became fabulously wealthy. Forbes listed the Sackler family that year as one of the 20 richest US families, estimating their combined wealth as $14 billion.
The Sackler family, which owns Stamford, Conn.-based Purdue Pharma, flew under the radar when Forbes launched its initial list of wealthiest families in July 2014, but this year they crack the top-20, edging out storied families like the Busches, Mellons and Rockefellers.
How did the Sacklers build the 16th-largest fortune in the country? The short answer: making the most popular and controversial opioid of the 21st century � OxyContin.
Purdue, 100% owned by the Sacklers, has generated estimated sales of more than $35 billion since releasing its time-released, supposedly addiction-proof version of the painkiller oxycodone back in 1995.Its annual revenues are about $3 billion, still mostly from OxyContin. The Sacklers also own separate drug companies that sell to Asia, Latin America, Canada and Europe, together generating similar total sales as Purdue�s operation in the United States.
Forbes estimates that the combined value of the drug operations, as well as accumulated dividends over the years, puts the Sackler family�s net worth at a conservative $14 billion.
Perhaps if the Kentucky lawsuit had gone to trial, these echos would have gotten even louder.
However, in December, 2015, Purdue settled the suit for $24 million, admitting no liability, and keeping the Sackler name out of the limited press coverage (although see this in STAT by Ed Silverman.)
I, for one, only found out about the Sackler / Purdue linkage when STAT published a followup in March, 2015. It turns out that in the run up to the Kentucky trial, a member of the Sackler family was actually deposed. This may have been the only direct discussion of the Oxycontin case by a member of the family.
The settlement required the attorney general to 'completely destroy' or return to Purdue all documents it received from the company or from any other party through a subpoena. The attorney general was given 60 days from the Dec. 18 agreement to comply. The agreement also prohibits the attorney general from sharing the documents with any other entity investigating or litigating against Purdue.
The attorney general�s office destroyed millions of pages of documents within the 60-day period, according to spokesman Terry Sebastian.
While the attorney general destroyed the records in its possession, copies of some of those records remain under seal in the Pike County courthouse, including the Sackler deposition.
The STAT article noted that millions of pages of records from other Oxycontin litigation were destroyed or returned to the company as stipulated by previous settlements. This time,
STAT is making a motion to intervene in the settled Kentucky lawsuit. The motion was sent to the Pike Circuit Court Monday via overnight courier.
The motion argues that STAT and the public have a constitutional right to the records that trumps Purdue�s interest in keeping them secret. The motion also states there is a substantial public interest in the case, citing the epidemic of drug addiction and related crime stemming from the abuse of OxyContin in Kentucky and other states. STAT is requesting the court make the documents available immediately.
We will see how this attempt to shine a little light on the long running Oxycontin story goes. I am not optimistic, since this long-running case has vividly shown how those who have the biggest vested interests in keeping our commercialized, overutilizing, over-marketed health care system going can use money and influence to keep it all so anechoic.
Summary
So now we see, dimly, reasons why the penalties handed out to "top" Purdue Pharma executives for the deceptive "misbranding" of a dangerous narcotic failed to end the impunity of top health care leaders. Those supposed "top men" were not really the top.
Just like in "Raiders of the Lost Ark,"
They were hired managers with fancy titles who worked for a secretive family which owned Purdue Pharma, which was apparently directly involved in the engineering of the aggressive, deceptive, "misbranding" sales campaign which sold so much Oxycontin, which became fabulously wealthy from the ownership of the company, and which managed to conceal their relationship to the company from nearly all prying eyes. So far, the family seems to either have befuddled or intimidated law enforcement sufficiently to prevent any direct consequences from befalling them.
This case vividly demonstrates, first, how those who have personally gained the most from our current dysfunctional health care system have often brilliantly covered up what they were doing (part of what we have called the anechoic effect). As long as we do not know where the money goes, and how it is made, we do not know what needs to be done to make things better. True health care reform requires bright sunlight to be shown on how the health care sausage is made, who makes it, and how they profit from it. As long as we the people let ourselves stay in the dark, we will continue to endure our woefully overpriced, inaccessible, mediocre quality, and all too often frankly corrupt health care system.
A piece this long and heavy deserves a musical interlude. Here is a live performance by the Dramatics of "What You See Is What You Get," (if only that were the case here).
This day has been non-stop since 4:30am. I can't keep up this pace, that's for sure. The plan for a refresher nap before a trip to Tulsa and back this evening (duties involving the big broadcasters convention I'll be headed back to tomorrow) didn't happen, thanks to the weather. Part of my job is on-air weather coverage--and the storms moving through this afternoon were just enough to preempt some needed rest.
Let's get right to it--since it's after midnight--I've been home about twenty minutes--All I can say is, thank goodness for good coffee.
Thanks to my phone, I was able to maintain excellent support connections via text messages throughout this rather challenging schedule.
If you read last night's edition, you know I was preparing my brain for a gain simply based on the number of missed workouts of late. Well, after this morning's maintenance weigh-in, I officially give up trying to guess what the scale will say. Obviously, my food plan and maintaining its integrity each day, is working for me in amazing ways. This morning's bi-weekly weigh-in represents a 4.8 pound loss over last time's 211.6. I'm absolutely perplexed. I'm blessed--and VERY grateful, absolutely--but I didn't expect this, at all. I feel great! I'm not worried about this in the slightest. It is sparking some changes, though.
I always communicate with Gerri before and after each weigh-in--just in case I need some perspective. She suggested a monthly weigh-in. And I agree!
I'm keeping my food plan the same for at least the next month. I'll weigh again in four weeks instead of two and we'll see where I am. Maintenance is working. I'm so glad.
I'm off to bed. My radio show starts at 6am--and I'm schedule to leave for Tulsa, again--at 10:30am in order to be ready for convention activities starting just after 1pm. I'll likely have a late afternoon opportunity for a nap in between afternoon breakout sessions and the evening's schedule of events.
I'll be staying overnight and coming home late Friday after the awards banquet. Plenty of challenges await me over the next two days. From getting this blog posted tomorrow night to food planning--to choices in restaurants and banquet rooms. I will maintain the integrity of my plan--it's not a question--it's non-negotiable. The only questions will be, how challenging will it become and how will I overcome? I plan to succeed.
My Tweets Today:
Who's idea was...Oh- never mind, it was me. 2.5 cup water bottle & 20 push-ups before I get the coffee! ?? Uhg! ;) pic.twitter.com/gtiPUROEor
For a second day, the region�s second-largest health care system deals with a crippling computer virus. MedStar Health says it is making progress, but WJZ is learning some patients are still feeling the effects.
... Despite the challenges affecting MedStar Health�s IT systems, the quality and safety of our patients remains our highest priority, which has not waned throughout this experience. Fortunately, the core ways in which we deliver patient care cannot be altered, manipulated or harmed by malicious attempts to disruptthe services we provide[that is, by taking down the EHRs -ed.],� Stephen R.T. Evans, MD, executive vice president, Medical Affairs and chief medical officer, MedStar Health. �Our ability to serve our patients and their families depends first and foremost on our caregivers, and their expert knowledge and compassion focused on each patient.�
He likely does not realize just how correct his spin actually is.
-- SS
3/30/2016 Addendum:
This is not the first time for EHR outages at MedStar.
MEDSTAR EHR GOES DARK FOR DAYS: MedStar�s outpatient clinics in the D.C. and Baltimore area lost access to their EHRs Monday and Tuesday when the GE Centricity EHR system crashed. The system went offline for scheduled maintenance on Friday and had come back on Monday when it suffered a �severe� malfunction, according to an email from Medstar management that was shared with Morning eHealth.
�All of a sudden the screens lit up with a giant text warning telling us to log off immediately,� a doctor said. �They kept saying it would be back up in an hour, but when I left work Tuesday night it was still down.�
This doctor told us that the outage was �disruptive and liberating at the same time. I wrote prescriptions on a pad for two days instead of clicking 13 times to send an e-script. And I got to talk to my patients much more than I usually do.
But of course we didn�t have access to any notes or medication history, and that was problematic.� MedStar notified clinicians in the email that any information entered in the EHR after Friday was lost.
The last couple of days have been two of the most challenging I've experienced in a very long time. I kept up very well last week, and it too was a busy one, but wow--the last two days have had it all; Lots of extra responsibilities at work, busy schedule at home and an unexpected circumstance or two thrown in to keep me on my toes.
I really should have leaned on my support team a little better, last night. I made it through. And all things considered, I have consistently utilized excellent support connections 95% of the time--and it makes a powerful positive impact. So really, I'm proud of this.
I'm not proud to report that this will be my third day in a row without making it to the gym. I've done my very small morning push-up routine--and that's it. I had every intention of the workout last night and tonight. Both night's, the plan had to be modified midstream. Tonight it was work projects I underestimated, that took an hour and a half longer than planned.
Okay--I'm going to declare right here and now, I'm not beating myself up over this. It's something of a thing--and things change. It's certainly not the end of the world. But it is important for the balance in my maintenance plan. All I can do is pick up and move forward. After all, this trek has never been about perfection.
It's about progress--not perfection. It's about consistency instead of intensity. It's about keeping it simple and sustainable not complicated and nearly impossible to maintain.
I'm okay.
Tomorrow is weigh day. The only reassurance I have is the certainty found in maintaining the integrity of my food plan. The last two weigh days, I've spent the night before adding up how many workouts I didn't complete--and then worrying how that lack of activity will affect my weight the next day. My maintenance calorie budget is 2300. That's a bunch to me. And that kind of a budget relies on a consistent workout schedule in order to balance well. At least, that's my perception--and it seems to be confirmed by my maintenance track record thus far. We'll see together, tomorrow.
Bad Health IT ("BHIT") is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, is difficult and/or prohibitively expensive to customize to the needs of different medical specialists and subspecialists, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or evidentiary fitness, or otherwise demonstrates suboptimal design and/or implementation. (http://cci.drexel.edu/faculty/ssilverstein/cases/)
I observed bad health IT leading to HIT compromise, hospital chaos and paying of a ransom demand at my Feb. 18, 2016 post "Hollywood Presbyterian Medical Center: Negligent hospital IT leaders allow hacker invasion that cripples EHRs, disrupts clinicians ... but patient safety and confidentiality not compromised" at http://hcrenewal.blogspot.com/2016/02/hollywood-presbyterian-medical-center.html.
It's happened again, at least with regard to publicly-disclosed stories (there is no requirement for hospital disclosure, more on that below).
WASHINGTON (AP) � Hackers crippled computer systems Monday at a major hospital chain, MedStar Health Inc., forcing records systems offline for thousands of patients and doctors. The FBI said it was investigating whether the unknown hackers demanded a ransom to restore systems.
A computer virus paralyzed some operations at Washington-area hospitals and doctors� offices, leaving patients unable to book appointments and staff locked out of their email accounts. Some employees were required to turn off all computers since Monday morning.
A law enforcement official said the FBI was assessing whether the virus was so-called ransomware, in which hackers extort money in exchange for returning a victim�s systems to normal. The official spoke on condition of anonymity because the person was not authorized to discuss publicly details about the ongoing criminal investigation.
Not discussed is corporate accountability for deficient IT security.
�We can�t do anything at all. There�s only one system we use, and now it�s just paper,� said one MedStar employee who, like others, spoke on condition of anonymity because this person was not authorized to speak to reporters.
I note that if the cybernetic pundits were listened to, patients would now be considered at deadly risk due to paper records being used - not due to critical IT infrastructure being hacked and disabled. Yet it's impossible to disable paper charts en masse.
MedStar said in a statement that the virus prevented some employees from logging into systems. It said all of its clinics remain open and functioning and there was no immediate evidence that patient information had been stolen.
Company spokeswoman Ann Nickels said she couldn�t say whether it was a ransomware attack. She said patient care was not affected and the hospitals were using a paper backup system.
The absurdity of this claim is that if patient care is not affected by returning to paper, then why did the hospital invest hundreds of millions on EHRs?
When asked whether hackers demanded payment, Nickels said: �I don�t have an answer to that,� and referred to the company�s statement.
Dr. Richard Alcorta, medical director for Maryland�s emergency medical services network, said he suspects it was a ransomware attack. He said his suspicion was based on multiple earlier ransomware attempts on individual hospitals in the state. Alcorta said he was unaware of any ransoms paid by Maryland hospitals or health care systems.
The rather calmly-stated "multiple earlier ransomware attempts on individual hospitals in the state" suggests that
Hospitals are being targeted in an organized fashion, and
Costs to implement proper security will draw even more capital and resources from direct patient care and from real brick and mortar facilities, such as entire new hospital wings that would cost less than an EHR, to cybernetics of increasingly dubious value. (Past projected cost benefits are certainly being proven even more naive.)
Terrorism or just plain old crime, the medical driector asks...
�People view this, I think, as a form of terrorism and are attempting to extort money by attempting to infect them with this type of virus,� he said.
God help us if true terrorists get in the act of cybernetically paralyzing hospitals.
Alcorta said his agency first learned of MedStar�s problems about 10:30 a.m., when the company�s Good Samaritan Hospital in Baltimore called in a request to divert emergency medical services traffic from that facility. He said that was followed by a similar request from Union Memorial, another MedStar hospital in Baltimore. The diversions were lifted as the hospitals� backup systems started operating, he said.
It used to be that patient diversions were due to doctors and nurses having too many sick patients they are caring for. Here it seems due to doctors having to many sick computers to deliver proper patient care.
MedStar operates 10 hospitals in Maryland and Washington, including the MedStar Georgetown University Hospital, along with other facilities. It employs 30,000 staff and has 6,000 affiliated physicians.
That's a lot of paralysis.
Monday�s hacking at MedStar came one month after a Los Angeles hospital paid hackers $17,000 to regain control of its computer system, which hackers had seized with ransomware using an infected email attachment.
Hollywood Presbyterian Medical Center, which is owned by CHA Medical Center of South Korea, paid 40 bitcoins � or about $420 per coin of the digital currency � to restore normal operations and disclosed the attack publicly. That hack was first noticed Feb. 5 and operations didn�t fully recover until 10 days later.
Hospitals are considered critical infrastructure, but unless patient data is impacted there is no requirement to disclose such hackings even if operations are disrupted.
I won't even comment on why a US hospital is owned by a Korean medical center. The statement "unless patient data is impacted there is no requirement to disclose such hackings even if operations are disrupted" implies yet another blind spot in the unregulated health IT industry. Add that to the blindness towards close-calls and actual harms, and you have a field being pushed on the population under penalty by those somewhat deaf, dumb and blind to the downsides.
Computer security of the hospital industry is generally regarded as poor, and the federal Health and Human Services Department regularly publishes a list of health care providers that have been hacked with patient information stolen. The agency said Monday it was aware of the MedStar incident.
All I can hear is "ka-ching! ka-ching!" as the costs to fix the poor computer security in the hospital industry accrues.
How much will patient care suffer as a result of the diversion of yet more resources to cybernetics?
As I've written before, stories like this support a serious rethinking of the entire healthcare IT hyper-enthusiast movement to whom the considerable downsides (even patient death) are just an unfortunate "bump in the road" (http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html), or perhaps more accurately, the healthcare IT hyper-enthusiast religion.
-- SS
[1] I've written that paper for many clinical settings, including highly specialized forms as I implemented highly successfully in invasive cardiology (http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story), needs reconsideration, relieving clinicians of clerical work and employing data entry clerks to enter the data. This would be supplemented by far less expensive document imaging systems for 24/7 availability, and computerized lab results retrieval - the latter with appropriate humans on the receiving end to prevent the "silent silo" syndrome of lab results returned to a computer silo but missed by clinicians due to being very busy and due to unreliable/fatiguing cybernetic alerting. A lot of workers can be paid for by saving $50 or $100 million on software.
3/30/2016 Addendum:
This is not the first time for EHR outages at MedStar.
MEDSTAR EHR GOES DARK FOR DAYS: MedStar�s outpatient clinics in the D.C. and Baltimore area lost access to their EHRs Monday and Tuesday when the GE Centricity EHR system crashed. The system went offline for scheduled maintenance on Friday and had come back on Monday when it suffered a �severe� malfunction, according to an email from Medstar management that was shared with Morning eHealth.
�All of a sudden the screens lit up with a giant text warning telling us to log off immediately,� a doctor said. �They kept saying it would be back up in an hour, but when I left work Tuesday night it was still down.�
This doctor told us that the outage was �disruptive and liberating at the same time. I wrote prescriptions on a pad for two days instead of clicking 13 times to send an e-script. And I got to talk to my patients much more than I usually do.
But of course we didn�t have access to any notes or medication history, and that was problematic.� MedStar notified clinicians in the email that any information entered in the EHR after Friday was lost.
Health officials in Kentucky, especially in the eastern part of the state, hope to increase lung-cancer screenings by following a successful colon-cancer screening initiative, Jackie Judd reports for PBS NewsHour. (Centers for Disease Control and Prevention graphic: Colon-cancer screenings are up)
In rural Eastern Kentucky, smoking and lung cancer rates are double the national average, while the state is second in adult smoking rates and leads the nation in lung cancer and rates of death from it. That is "fueled by a toxic combination of poverty, medical illiteracy, limited access to care, lifestyle choices like smoking, and a fatalism that says knowing you have cancer won�t save you."
Another challenge is that local bans of smoking in public places have left two-thirds of residents living in areas with no such bans, and a statewide ban seems unlikely because it failed to pass the state House this year after narrowly passing last year. New Republican Gov. Matt Bevin opposes a statewide ban.
Fifteen years ago Kentucky led the nation in "both the highest incidence and mortality rates for colorectal cancer," Allison Perry reports for University of Kentucky News. Rural residents didn't seek care, partly because of a lack of facilities and partly because of a refusal to schedule an appointment. If local residents wouldn't seek care, health officials decided to bring care to local residents.
"In the seven years following this new focus on colorectal cancer, the screenings rates nearly doubled, from 34.7 percent of the age-eligible population receiving screenings to 63.7 percent," Perry writes. "This raised Kentucky�s rank from 49th in the country to 23rd compared to other states. No other state has had such a dramatic increase in colorectal screenings in such a short period of time. As a result, the lives of many Kentuckians have been saved: the incidence rate for colorectal cancer is down nearly 25 percent, and the mortality rate has dropped 30 percent. Through colorectal screenings, doctors can find precancerous lesions and remove them before they become cancer. Screenings also allow physicians to find these cancers at an earlier stages, when they are more likely to respond to treatment."
The number of cancer screenings jumped in 2014 and 2015, as the state expanded eligibility for the Medicaid program under federal health reform, making many more people eligible for free screenings. Bevin is seeking change the state's program in ways that could require co-payments, premiums and deductibles.
In Kentucky "the challenge is to not only encourage certain lifelong smokers to get screened, but to get them to quit, and for others to never start," especially because of the addictive nature of smoking, Judd reports. "It will be even more difficult than changing the profile of colon cancer, because smoking involves addiction. The hope of public health officials is that the model used to bring down colon cancer deaths can be used to the same effect, not only for lung cancer, but for other diseases plaguing this depressed swath of America."
This was a wonderful Easter. Except for getting home over an hour later than expected, it was just perfect. I maintained the integrity of my calorie budget, continued my abstinence from refined sugar, exceeded my water goal by four cups, engaged in spot support communications via text and phone and spent the majority of the day in company of loved ones--and really, that's such a precious gift.
There was a topic I wanted to elaborate on--but this is clearly not the time. I must drop in bed. I'll save it for another night. Instead--I'll tell the rest of today's story with pictures and captions--and the Live-Tweets of the day as it unfolded.
This was Noah's first official Easter egg hunt. Courtney, unfortunately, had to work today and couldn't be there, so Irene, Allen, Amber, KL and I accompanied Noah to his age group and waited for the huge firetruck to start the egg hunting frenzy with a blow of its extremely loud horn. When the time came, it slightly startled our little man!
He has grown beyond the 'frightened of people in costumes' phase--and straight into the, 'this is cool,' phase.
We all gathered at the restaurant prior to the big hunt.
Noah and I made the trip to see mom this evening. We enjoyed a late dinner out and a great Easter evening visit before heading back home--and taking little man to his Nana's (Irene's) house for a sleepover.
I rarely have a day that includes two restaurant meals. Today was the exception. I feel like I navigated well. It helped that both places were really easy for me to navigate. Instead of tacos at lunch--I made it a salad, knowing I'd have tacos later. Beef for lunch--chicken for dinner. I enjoyed some variety--including an unusual breakfast. Mainly, I enjoyed the time spent with everyone--and Noah, oh my, that little guy owns my heart.
It feels so good to be at a healthy weight, enabling me to keep up with him--and not just the physical part of that equation--it's also about not being in a constant food fog. It's hard to express gratitude and appreciate important things and others, when under the influence of the food fog. Before I elaborate any further--turning this into a big exploration of thoughts and experiences, I better go to bed! Another time...
