Still healing from trauma, NYC book trip benched for cannabis country

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I’m just not there yet.

And that’s why I postponed my trip to New York City, where I was going to meet with book publishers and get some mentoring for my upcoming novel/tell-all/screenplay. Heck, it could even end up being a sci fi flick. I have no idea.

I woke up in the middle of the night last night, giggling about how I could portray the vixen if I were to give it a sci fi tint. Could be great fun.

So, who knows.

Also, while I’m not feeling so hot this past week or so about life here in the Quad-Cities, overall things have improved tremendously in terms of my outlook about that. But understand: All the money and material things in the world – even your childhood home – do not fix the pain a person feels when people you trusted violate it. People you thought were there to PROTECT you, not HARM you.

Such people are creepy.

So, I’m trying to forget. Writing a book about all of it isn’t going to help right now, when I finally feel like things are turning to a degree of normalcy.

I’ll say this as a book teaser: I truly believe the corruption problem is so bad where I live, that before it’s all over with, even if it takes three years, half a dozen politicians and public officials from this region will be in prison. And I’m not just talking about my personal experience or my knowledge garnered from years in the news business in the Quad-cities. There are LOTS of people who have had experiences like me. And we are connecting, let me tell you.

And, yes, we ARE called “victims.” Officially.

Lengthy, expensive process applying for Medical Cannabis Card

Now, where I won’t play the victim is in the truth that I have been sliding back down the alcohol slope. So that is why, today, in part, I just landed in…(drum roll, please, cue “Rainbow Tour” chorus)….DENVER!

Indeed, the mile-high city. And of course I’m going to get high. Well, not high, I’d rather say “treated.” In a very serious, controlled manner with strains specifically used to treat chronic PTSD. That diagnosis recently allowed me to apply for my Illinois Cannabis Card after consulting with my therapist, my doctor, and a physician in Chicago. I had two visits with the Chicago physician, who reviewed records provided by my therapist and doctor in the Quad-Cities.

It’s an expensive process. The card, valid for three years, was $300 in and of itself, paid to the state. There also are fingerprinting fees, and of course all the doctor’s fees.

The Chicago doctor spent quite a bit of time with me and asked several questions before qualifying me. He enjoyed hearing about my trip to the American College of Physicians conference in San Diego last month and said he went to it a few years back.

He also was glad to see I have had 100 psychotherapy sessions and continue to be in therapy, now for two years. I get professional psychotherapy for an hour twice a week at SouthPark Psychology in Moline.

While SouthPark Psychology does not take Medicare/Medicaid, I urge anyone with any sort of struggle to seek out their therapists if they have private insurance or can afford to pay out of pocket (which I did for a long time, and considered it money well spent). The place offers a level of mental health care that is just miles above the “big two” in town. I feel sorry for people who “give up” on getting better due to the poor care they receive from substandard Quad-City healthcare providers.

The dishonesty from hospital officials over the proposed Bettendorf psychiatric hospital is appalling. They are denying sick people who need immediate care, and they should be fined by a government agency.

Or, let the free market fix it — give people more choices. The local hospitals’ crafted, nonsensical explanations for opposing this hospital is not fooling one. single. person. Not one. Well, maybe their employees, who I’m told are bullied to support the propaganda.

I understand the hospitals are in a bind due to the state of Illinois not having a budget in nearly two years. That’s not the free market’s problem, nor is it the problem of people suffering from mental illness. They deserve choices in healthcare and the best healthcare they can find.

Shame on both local hospitals.

‘Marijuana maintenance’ kept me sober first year

I have been writing about medical marijuana since way back in my Healthline days. In the beginning, I was very much on board with it. For my first year of sobriety, I did do what is known as “marijuana maintenance” for 9 months after 90 days completely sober from everything but caffeine. But then I quit the marijuana, too.

At first, I feigned for it. Then I got over those feelings (because don’t kid yourself, marijuana IS addictive) and I especially enjoyed having clear lungs and a sharper mind. That said, I was getting some medical marijuana off the street during that year that did not make me the least bit high, dull my sharpness or cloud my mind. What it did do was turned my mind down to a normal level, allowed me to focus and just sort of surrounded me with quiet, if that makes any sense. I would love to find that exact strain again.

The problem with getting marijuana off the street, beyond the legality part, is that you just don’t know what you’re getting. All these different strains of marijuana are like pharma drugs, in a way. You’re not going to give an upper like Ritalin, for example, to a kid with a heart condition.

Marijuana and mental illness in general really don’t seem to go well together, research has shown. And yet most every state that has approved marijuana medicinally for PTSD, which is technically a mental illness.

I have a contact in Maine, Dr. Dustin Sulak, who is sort of “the national authority” on medicinal marijuana. I have interviewed him several times and he is very knowledgeable. He created a website called Healer that I wrote about not too long ago.

Taking a cue from fellow PTSD sufferers, addressing booze issue

Between my Facebook groups and all my recent traveling, I have met so many people with PTSD who are saying they have found relief with medicinal marijuana and are thrilled to be off the benzos.

The benzos. Yes. I’ll be thrilled to be off them, too. They’re just harsh. And sometimes I wonder if they led me back to booze, as they are alcohol in a pill, after all. PTSD and alcohol notoriously are a common, horrible mix. Like “throwing gasoline on a fire” a cop told me once.

I’ll end with a little something about my drinking. While I did get back on the wagon when I returned from Florida, I fell off it again in Savannah, Ga., and again in San Diego. And then I took the bold move of going to bars a few times in the Quad-Cities and even buying beer and Rumplemintze for at home.

We’re talking full-blown booze relapse. Who am I kidding.

And I’m done. Day 1 of sobriety began at midnight this morning. I always said I don’t believe in “turning back the clock to zero” on sobriety after a relapse – I did have almost three years of sobriety after all – but the fact is, I need to look at the booze as the ugly problem it is.

I make it no secret I’m not a fan of AA, but that’s mostly because I don’t like the meetings. There’s a lot of brilliance in the Big Book. And I always said, I NEVER had a moment’s hesitation with step one: I am powerless over alcohol.

At least once I drink it. So, I can’t.

How about some prayers that I make it all the way through my Denver trip without even taking a sip? I think it’s going to be easy in cannabis country and there should not be any excuse for it to happen even once.

I can do this. Again.

I’ll keep you posted, and I’m going to be completely honest about it.

In the end, where did hard work and determination get the Long family?

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This piece originally was written last year for Caregiver Relief as one of several point-ups to the presidential election. Reprinted here with permission. Special thanks to Diane Carbo and Rhonda Long.

By David Heitz

Rhonda Long’s story is one of a middle class, hardworking family that is getting the short end of the caregiving stick.

Rhonda and her parents do not qualify for Medicaid. Medicaid pays for long-term care for the elderly, but only once they become completely broke.

Medicaid also provides day care for the elderly, which, in theory, gives a caregiver time to work a part-time job, since so many people have to quit their full-time jobs to take care of mom and/or dad, like Rhonda. But in so many states, like the despicably fiscally irresponsible state of Illinois, even those services are being cut. The front page of my local newspaper, The Rock Island Argus, read yesterday: “InTouch Adult Day Services to Close.” The reason? The state owes it $6 million in Medicaid payments. They just can’t keep going. (Editor’s note: InTouch later was taken over by a private company from Lutheran Social Services, but I am not sure of the current status of the services it provides).

What will happen to these people? Well if their children choose to care for them, they likely will end up on welfare while trying to also get by with mom or dad’s small Social Security check. If the care ends up being more than a family caregiver can handle, and it can be under such difficult stresses and circumstances such as dementia-related illness or both parents ill at the same time, the state will intervene and place the parent in a nursing home. Once the parent is completely broke, the state will pick up the $5,000 to $8,000 monthly nursing home bill. When it’s all over, the states goes into the homes of these people and auctions off all of their belongings to make up the difference. The children are left with nothing.

Related News: Dementia-friendly America communities help elderly stay in their homes longer (Click on the link to learn more)

Rhonda long has wondered why the government can’t pay caregivers a small living wage, or at least foot the bill for respite care so they can get a part-time job elsewhere.

But with the state of Illinois at least proving unable to do that for even the poorest of the poor, one wonders how it could be accomplished for the children of people drawing Medicare. I guess lottery funds would be one idea. Of course, everyone likes that going to the schools.

Something to think about: When we care for our children, we get to see them grow up and care for themselves. When we care for our parents, they only get worse.

Not a pretty picture, but it’s reality.

Meanwhile, Rhonda has lived with her mom and dad in their house for 11 years. “They had helped me out in a time of need and in return I told them they would never see the inside of a nursing home as long as I could help it,” she told Caregiver Relief. “I honored my commitment and continue to do so.”

Rhonda’s dad passed away in June. She is pictured with him here. Through the years Rhonda’s dad had four heart attacks (Rhonda quit her job after each one) and eventually chronic kidney disease, atherosclerosis, PAD, spinal stenosis, dementia and many other ailments. After his fourth heart attack, he became bowel and bladder incontinent.

He died at home in June, under hospice care, but it was very difficult for Rhonda and her mom.

Now, mom has Alzheimer’s. Remarkably, Rhonda feels “guilty” about having a meal to herself now that dad has gone. At least mom is in good enough shape were she can leave the house a couple of hours a day.

But let’s face it. Mom won’t be that way forever. Memory care, if you dare trust any of those facilities (memory care is a social model, not a care model), costs about $5,000 per month. A nursing home? At least a thousand per month more. And remember: No help caring for your elderly parents until they are broke. Click on the link to learn more.

“In the last 11 years I have been away from this house for my own pleasure a total of 32 hours,” Rhonda told Caregiver Relief. “And I had to beg for that. I love my brother deeply, but he just doesn’t get it. I went through and beyond caregiver burnout.”

Rhonda said that in retrospect, “I think if we had the money, respite care would have been very beneficial for all of us. I would have been able to be refreshed emotionally, and I would have had some time to be a daughter and not always the caregiver.”

So in the meantime, Rhonda lives with her mom in a house that has a reverse mortgage. When her mom dies, Rhonda will be an orphan and homeless.

Rhonda’s questions for President Trump: Why can’t the government pay caregivers a small living wage, or at least foot the bill for respite care so they can get a part-time job elsewhere?

My Chat with Shawn Achor of Oprah Fame about Happiness, Gratitude and Sobriety

 

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This piece originally was published Aug. 8, 2015, on Healthline Contributors, which no longer is live. Reprinted here with permission.

By David Heitz

Oh. My. Gosh. What a terribly stressful week.

I have been so very crabby. So I’m glad I was lucky enough to land an interview recently with Shawn Achor. Shawn is nothing other than the happiness guru to O.

As in Oprah Winfrey! I’d be lying if I did not admit I enjoy speaking with celebs, and to me anyone who has appeared regularly with Oprah is a celeb.

So just as I almost had a complete and total meltdown this week, a few times, actually, including one just about an hour ago, and another a few hours before that, the tide turned once I decided to make it turn. And here I am writing about sobriety and gratitude.

 From the home office in Rock Island, Ill.

Let’s get started with a “Top Five” list. 

  1. I am grateful for getting to interview famous people like Shawn Achor and so many others, and to share what we talked about with others.
  1. I am grateful for my precious 20-year-old cat, LuLu, who is napping on the sofa in my office as I write this. (Editor’s note: Unfortunately, LuLu died last month).
  1. I am grateful for my sobriety. I’m always grateful for that.
  1. I am grateful to be living in the very house I grew up in, which brings tremendous comfort during even the most difficult of times.
  1. I am grateful for the DE-LISH ear of sweet corn I just had, smothered in butter, garlic salt and pepper.

One of Achor’s tips to staying positive, especially at times when it seems so terribly hard, is to list five things that happened in the past 24 hours that you’re thankful for.

Achor was “on the circuit” a couple of weeks back to promote Buick’s “24 Hours of Happiness Test Drive” campaign. When his people reached out to me and asked if I’d like to chat with him, I was very flattered and immediately said yes.

I asked him what tips he has for people struggling to stay sober, who find themselves without their old “friends” or their fix.

“When it comes to addiction and recovery, instead of thinking about what you’re giving up, turn that around,” Achor said. “Instead of letting your whole life become deficit thinking, things you’re not doing anymore, there is real power in seeing things you’re picking up.”

Read more: My interview with Shawn Achor for HIV Equal

For me that has meant more time to spend with my dad. (Editor’s note: My dad died in September 2015). More time to exercise. Above all, more time for my writing, which I love.

And I even am getting to the space of letting go of anger toward people who want to hurt me. I know what those people are going through. I’ve been there, and it’s not pretty.

I’m glad I no longer live in that space. (Update: I’m still angry as hell at those who tried to hurt me, especially a handful of dirty politicians who are just dripping with filth).

Hating yourself is a big downer

I really never was a very positive person before sobriety. Most people who hate themselves aren’t.

But today, even though my dad is dying a horrible death from a dementia-related illness, and even though I still struggle to make ends meet, and even though I don’t speak with hardly any of my relatives, I sometimes have to pinch myself about how good life is. (Update: My dad died well over a year ago, and his estate still is not settled, and the court battle between my brother, myself, and a third party also included in my dad’s will grows uglier and uglier by the week and by the month. I have spent about $5,000 with an attorney just to get what my dad left me in a very simply stated will. But I have a very successful career and no longer struggle to make ends meet).

Acknowledging life is better now that I am sober, even if it is much harder in some ways, really is what keeps me going.

While I’m not a fan of Alcoholics Anonymous, the first step to becoming a positive person was admitting I was powerless over alcohol.

Once I admitted that, I instantly was freed to envision a better life. My sponsor told me: “David, and I promise you, after one year, your life will be 10 times better.”

I believed him. I envisioned a better life. And today, 15 months later (update: now 30 months later), I have a better life.

I love my work. I have inner peace. I have good health.

That’s not to say I don’t get really stressed out. But with inner peace, I never blame myself for it anymore, because I know I am doing the best I can.

That’s not to say sober life has been easy. But it’s still better. And I’m grateful for that, and I know it will become less difficult over time.

How “I am an alcoholic” truly set me free

It didn’t take long after admitting I was an alcoholic before little signs of a better life began to sprout. Giving up the booze was like putting down top soil from which to sow new possibilities that come with living without drugs and booze.

I always have allowed my work to define me, for better or for worse. Many Americans are that way.

But when I was a drunk, I hardly could be proud of my work. When I was drinking, I didn’t show up for days on end. While my work always passed muster, I knew I wasn’t performing at even one-tenth of my ability.

Self-respect and good health are two things I never had when I was the town drunk. I spent each day feeling horrible about the dumb things I did the day before. So I drank to forget about it. It was an endless cycle.

In November 2010, I quit my job at the local newspaper. For three years, I tried to focus on caring full-time for my dad. But don’t kid yourself. I was drinking too.

But as I saw him decline and realized that he needed my help, I think I had purpose in life that I wasn’t getting from my job at the local newspaper.

Having purpose planted a seed for the sobriety. Suddenly life was about something bigger than myself, as they talk about in AA.

A fresh career start … so why not give up booze, too?

When dad went into a memory-care facility, I had the opportunity to start fresh in terms of my career. I lucked out when an acquaintance hooked me up with a freelance reporting gig for Healthline. Little did I know how much I would enjoy health reporting. I once again began to really feel like I was making a difference with my journalism.

I thought, “If I quit drinking, how much even better could things be?”

I was ready to quit. And after getting hammered and making an ass of myself in front of my neighbors and on social media Memorial Day 2014, I was ready to accept that booze made me do things I was ashamed of and that is was destroying my life, even as it was turning around after years of hopelessness.

So, to AA I went. A week went by without booze. Two weeks.  A month.

I worked hard to change my thinking to the positive from day one. It’s true that if you start each morning with prayer or meditation, or even list just three positive things about the past 24 hours, you can’t help but feel better about the direction your life is headed in.

The support you get from others when you become sober – friends on Facebook, professional contacts – is inspiring. After a while, though, the “attaboys” stop. And since I decided AA wasn’t for me, I don’t get any support “in the rooms,” as they say.

And my old crowd? I left them behind a few months even prior to getting sober and never looked back. Which, of course, is what everyone getting sober needs to do.

But more than a year (now 2 1/2 years) into it, I remain positive even if I operate as an island these days, at least physically. That’s because I have made friends with myself.

 

Medical establishment argues for gun control: DavidHeitz.com longform report

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Second Amendment rights advocates can finally rest assured that Hillary Clinton won’t be coming for their guns anytime soon.

But the medical establishment may be.

In a massive, unprecedented report on gun safety research, JAMA Internal Medicine this morning published some exhaustive commentary, analysis and research about gun safety. They posed questions including:

Should the medical community have a right to counsel patients about gun safety?

With access to guns a proven driver of suicide, why aren’t we doing more to stop it, and how can we get laws changed to make it easier for us to do that?

What has been the result of Florida’s “Stand Your Ground” self-defense law?

“Firearm violence in the United States has continued unabated,” JAMA writes in an editorial leading off the series.  “In June 2016, a mass shooting at the Pulse nightclub in Orlando, Fla. killed 49 people and wounded 53 others. As of October 15, 2016, Chicago had recorded more than 570 homicides this year, levels not seen since the 1990s. Shootings in which four or more people are injured or killed (including shooters) occur almost daily.”

Yet after reviewing their research, the oft-heard argument, “Guns don’t kill people, people kill people” still holds true. That’s not to say some of their findings regarding suicide prevention don’t make for solid arguments for physicians being able to counsel those at risk of hurting themselves.

“This series follows from the belief that if the United States were to implement a coordinated and sustained public health, research, and law enforcement commitment to prevent firearm violence, many lives would be saved,” JAMA writes in the editorial. “In 2014, firearm injuries were responsible for about the same number of deaths in the United States as motor vehicle crashes. Although deaths from motor vehicle crashes have substantially decreased since 2000, deaths from firearm injuries have substantially increased, mostly from suicides.”

Accounting for 33,599 U.S. gun deaths in 2014

The grisly death-by-firearm breakdown goes like this:

Suicide: 21,334

Homicide: 19,945

Unintentional: 586

Legal intervention: 464

Undetermined: 270

For a total of 33,599 gun deaths in the U.S. in 2014.

“In a research letter, Alcorn documents the reasons and consequences of the low number of studies about firearm injuries and gun violence in the United States,” the editorial argues. “From 1985 to 1999, publications increased markedly. Soon after the 1996 ban on the Centers for Disease Control and Prevention’s funding for such research, publications plateaued at about 90 articles annually through 2012. In 2013 and 2014, publications increased again after the mass shooting of school children and educators at Sandy Hook Elementary School in Newtown, Conn. In December 2012.”

Federal funding of ‘gun control advocacy’ research banned

In a systematic review of firearm laws and firearm homicides published as part of today’s JAMA report, Dr. Lois Lee and colleagues from Boston Children’s Hospital, Harvard Medical School and Harvard T.H. Chan of Public Health essentially find inconclusive data regarding whether stricter gun controls stop people from killing one another. Essentially, there is no “magic bullet” for stopping the bloodshed.

“In the aggregate, stronger gun policies were associated with decreased rates of firearm homicides, even after adjusting for demographic and sociologic factors,” the authors concluded after evaluating 34 articles published from 1970 to the present in PubMed, the nation’s medical research database. “Laws that strengthen background checks and permit-to-purchased seemed to decrease firearm homicide rates. Specific laws directed at firearm trafficking, improving child safety, or the banning of military-style assault weapons were not associated with changes in firearm homicide rates. The evidence for laws restricting guns in public places and leniency in gun carrying was mixed.”

The authors called for better research and more funding for such research, as did the accompanying JAMA editorial. “Given the 19,000 deaths from firearm homicide each year, many of which are preventable, it continues to be a national shame that the United States does not fund sufficient robust research to inform this public health imperative and establish which types of firearm laws work. Since 2012, federal law has banned all Department of Health and Human Services agencies, not just the Centers for Disease Control and Prevention (CDC) from using funds ‘in whole or in part, to advocate or promote gun control.’ This vague language continues to have a negative effect on federal funding of firearm injury and gun violence research. Some states, local governments, and private philanthropists try to fill the void.”

An analysis of Florida’s ‘Stand Your Ground’ self-defense law

In an original investigation published as part of the firearm series, researchers from University of Oxford, London School of Hygiene and Tropical Medicine, and University of Pennsylvania, Philadelphia, examined whether Florida’s “Stand Your Ground” self-defense law had an impact on homicides

I’m curious whether the study’s conclusions take into consideration that homicide is a legal term. If so, then its claim that firearm-related homicides went up by 31.6 percent monthly (homicides in general went up 24.4 percent monthly) implies that the shooters all were convicted of murder, as opposed to some of them being found not guilty under the self-defense clause. That was not immediately clear to me.

While I do not want to trivialize any loss of life, it is important to know whether self-defense was legitimately used. Only the court system decides that, and the court system was not specifically referenced in the piece.

“Throughout the United States, the application of lethal force as a means of self-defense is governed by criminal law,” the authors wrote. “Since the colonial era, it has been an individual’s ‘duty to retreat’ from perceived threats before resorting to any use of force.”

Florida’s law removed that “duty of retreat” when a threat is made on a person’s property, as almost half the states have. Florida’s law went further and removed “duty of retreat” when threats are made in public places.

“Advocates of the laws suggest that the increased threat over retaliatory violence deters would-be burglars, resulting in fewer intruder encounters,” the authors wrote. “Critics are concerned that weakening the punitive consequences of using force may serve to escalate aggressive encounters. They also argue that these laws may exacerbate racial disparities in homicide where threats motivated by racial stereotypes produce unnecessary fatalities.”

The authors admitted their study has several limitations. “Circumstances unique to Florida may have contributed to our findings, including those that we could not identify … Finally, there has been considerable debate over the potential of the Florida law to deter crime and improve public safety. Our study examined the effect of the Florida law on homicide and homicide by firearm, not on crime and public safety.”

The role of physicians in preventing firearm suicides

Perhaps the strongest arguments made in the JAMA firearm series are for finding ways to better prevent firearm owners from committing suicide. Ironically, states with some of the strictest gun control laws have created a situation whereby it is difficult to transfer ownership from a suicidal person to someone else, even temporarily.

In a “Special Communication” in the JAMA series published by Alexander D. McCourt of Johns Hopkins Center for Gun Policy and Research and Johns Hopkins Bloomberg School of Public Health and colleagues, policies in Maryland, Colorado, and California are examined. All take different approaches to firearm transfers.

“In the United States, suicides account for 63 percent of firearm deaths, and self-inflicted firearm injury is responsible for half of all suicides,” the authors write. “Firearm suicide affects nearly all age groups. In 2014, there were 929 suicides by firearm among person aged 10 to 24 years, 9,612 for those aged 25 to 54 years, and 9,277 for those aged 55 and older.”

The letter makes the case that some individuals experiencing psychological distress can be talked into giving up their guns, at least temporarily, although the public health experts admit no data is available to back up this claim.

“Reducing access to firearms and other lethal items is a recommended, evidence-based practice to prevent suicide,” claim the authors. “In the case of a firearm owner at elevated risk of self-harm, the recommendation would be to temporarily store the gun away from home or store it locked in such a way that the at-risk person does not have access at least until the mental health crisis has resolved.”

While many doctors’ organizations have encouraged their members to talk to patients about gun control when appropriate, many admit they choose not to.

“Universal background checks before firearm purchase are effective public health measures, but should be supplemented with specific protocols for temporary transfer of firearms from the home and for storage,” the authors recommend. “Protocols for temporary transfer may help to reduce the risk of other forms of firearm violence, including intimate partner violence situations where the firearm owner can be persuaded to voluntarily remove a firearm from the home.”

The authors recommend “incorporating and improving on aspects of Colorado’s exemptions to background checks” to include:

  1. “Clear statutory provisions that allow for temporary storage by federally license firearm dealers, law enforcement, officials, family members and friends.”
  2. Allow period of transfer to last at least 14 days or longer if recommended by a physician or mental health professional. Make sure children or any other unauthorized user cannot access where the firearm is being held.
  3. “Limit the liability related to these temporary transfers to instances of gross negligence or reckless behavior by the person who transfers the firearms.

“Efforts to educate physicians and the public should carefully explain these provisions to allay fears about potential liability associated with the temporary transfer of firearms from the home and to encourage transfers for suicide prevention,” the authors conclude. “Public health professionals and firearm organizations should collaborate to develop tailored and effective messaging that is acceptable to physicians, mental health professionals, and the public. Policy changes should also be evaluated to assess whether they have the intended effect of reducing firearm suicides.”

Reducing gun violence: Compromises that have worked

In yet another JAMA viewpoint in the series titled, “Reducing Suicides Through Partnerships Between Health Professionals and Gun Owner Groups – Beyond Docs vs. Glocks,” the authors from Harvard Injury Control Research Center says that in some states firearm retailers have been part of the solution.

“In New Hampshire, where over 85 percent of firearm deaths are by suicide, a group of firearm retailers, gun rights advocates, public health and mental health professionals began meeting in 2009 to examine the role gun shops might play in reducing suicide,” according to the piece. “The New Hampshire Firearm Safety Coalition’s first products were posters and brochures aimed at gun shop customers that promoted the ‘11th Commandment of Firearm Safety:’ Be alert to signs of suicide in friends and family and help keep firearms from them until they have recovered. Materials suggested options like temporarily storing guns away from home (i.e. with a friend, if local law allows, at a self-storage unit or at a gun shop), or keeping the guns at home under new lock and key that the vulnerable person has no access to until they have recovered. Unannounced visits at all 65 independent gun shops in the state found that 48 percent were displaying at least one of the materials, a good uptake for information on a topic as difficult as suicide.”

For the record, I never have been a fan of guns and I do not own one. In fact, I can’t even imagine owning one, even though I have been the victim of violent crime more than once.

But I have come to understand in recent years why people should have the right to bear them in matters of self-defense. And it is a fundamental right granted to us by our forefathers, so any attempt to restrict it in even the slightest of ways should be made with great caution, particularly in an uncertain nation    and an uncertain world.

Blame for pharma price gouging lies with politicians

Pharma prices

A special communication published online this morning in the Journal of the American Medical Association spells out just why prescription drug prices in the United States are far and away the highest in the world.

In the end, it comes down to two words: Pharma lobby. Our nation’s own laws make it easy for the pharmaceutical industry to gorge consumers, and the power of the seemingly bottomless pharma purse makes it difficult to get them changed.

“High drug prices are the result of the approach the United States has taken to granting government-protected monopolies to drug manufacturers, combined with coverage requirements imposed on government-funded drug benefits,” the authors concluded. “The most realistic short-term strategies to address high prices include enforcing more stringent requirements for the award and extension of exclusivity rights; enhancing competition by ensuring timely generic drug availability; providing greater opportunities for meaningful price negotiation by government payers; generating more evidence about comparative cost-effectiveness of therapeutic alternatives (more NIH-funded scientific research on alternative, non-pharma approaches, such as natural therapies, is sorely needed); and more effectively educating patients, prescribers, payers, and policy makers about these choices.”

The paper is an extensive review of research published in peer-reviewed academic journals from 2005 to 2016. The authors are pharmacoepidemiology and pharmacoeconomics professors from Brigham and Women’s Hospital and Harvard Medical School. The paper is one of the most compelling and easy to understand pieces I ever have read on the topic.

I became interested in pharma pricing while working as a reporter for Healthline News. While I do not have HIV or Hepatitis C, those were my primary beats. The once-a-day pill that cures Hepatitis C (Sovaldi by Gilead) came to market while I was at Healthline News at a staggering $84,000 for a 12-week supply. A second-generation pill, Harvoni, came to market shortly thereafter, and costs more than $90,000. Doctors have reported its tolerability to be far superior to even Sovaldi, which was dubbed “game changing” medication and forever changed the health landscape.

Read more: My Healthline News report when Harvoni came to market

The medications still are priced less than the cost of a liver transplant. While the drugs have a tremendous public health benefit and will result in tremendous cost savings over the course of many years, those savings won’t be realized by today’s payers.

Interestingly, Sovaldi came to market just as Baby Boomers have come of age. Hepatitis C, a disease of the liver, is most common among Baby Boomers and injection drug users. It’s common among Baby Boomers because prior to the advent of the HIV epidemic in the U.S., hospital sterilization techniques and the monitoring of the nation’s blood supply were less thorough than they are today. Many Baby Boomers obtained the disease in those settings.

Some argue that many veterans obtained Hepatitis C while in the military due to unsterile vaccination procedures.

The Prilosec problem

The authors of the JAMA paper make several interesting points:

Since the advent of the Medicare drug benefit in 2006, government entities have accounted for 40 percent of the nation’s total drug expenditure.

“Drug prices are higher in the United States than in the rest of the industrialized world because, unlike that in nearly every other advanced nation, the U.S. health care system allows manufacturers to set their own price for a given product. In contrast, in countries with national health insurance systems, a delegated body negotiates drug prices or rejects coverage of products if the price demanded by the manufacturer is excessive in light of the benefit provided: Manufacturers may then decide to offer the drug at a lower price.”

Read more: My interview with an IMAK executive about Gilead’s decision to curtail its patient assistance program for Sovaldi, Harvoni (they were playing hardball with insurers)

Drug companies receive years-long patents, and then can extend the patents for many more years – decades — through a number of loopholes and legal maneuverings.  “In an example of this strategy, the manufacturer of the proton-pump inhibitor omeprazole (Prilosec) received an additional patent on the drug’s s-isomer, despite the absence of any compelling pharmacologic difference,” the authors reported. “This lead to the creation of esomeprazole (Nexium) as a newly branded product that was sold for $4 a pill, a 600 percent markup over the over-the-counter version of omeprazole.”

Essentially, companies are able to tweak products and move patients from one to the next, “sometimes discontinuing production of older version of the drug,” the authors reported.

Backlogs at the FDA office can delay generic applications for years even when a patent does expire and generics come to market. “Some innovator companies have refused to provide the samples of their products needed for the potential generic manufacturers to conduct bioequivalence studies, slowing or blocking the process,” the authors reported.

Contact your legislators and demand change

What does the pharmaceutical industry have to say about all of this? “The pharmaceutical industry has maintained that high drug prices reflect the research and development costs a company incurred to develop the drug, are necessary to pay for future research costs to develop new drugs, or both,” according to the authors. “It is true that industry often makes expensive investments in drug development and commercialization, particularly through the late-stage clinical trials, which can be costly…. Some economic analyses favored by the pharmaceutical industry content that it costs $2.6 billion to develop a new drug that makes it to market. However, the rigor of this widely cited number has been disputed.”

What needs to be done to lower prices? For starters, patent laws need to be changed, or at least the interpretation of those laws, according to the authors. This would allow for much needed competition. “For example, changes in how the U.S. Patient and Trademark Office interprets ‘novelty’ and ‘non-obviousness’ when issuing patents could help avoid new secondary patents based on clinically irrelevant changes to active drug products.”

Read more: My Healthline News report on the cost of HIV care around the world

And existing laws need to be better enforced.

Drug promotion budgets could be limited, resulting in cost savings. The only other high-income nation in the world that allows direct to consumer advertising by pharma is New Zealand. Of course, this opens up a can of worms about our free market economy, and that’s not a discussion I care to get into. Pharma advertising makes websites such as Healthline possible, and even though I no longer write for them, I remain a big fan.

“In theory, the most effective way for a government to reduce drug prices would be for it to set them for the entire marketplace, as central governments do in countries such as Sweden, or to engage in international reference pricing and set prices at levels similar to those of other countries,” the authors wrote. “Taking such a step in the United States would have major marketplace ramifications and is not at present politically feasible, in part because of the power of the pharmaceutical lobby in Washington, D.C. Nonetheless, the U.S. government can still take steps to help control excessive drug prices by reassessing some existing unusual and overly permissive policies.”

Read more: Yes, pharma reps likely do have a say in which medications you take