HAVANA (AP) — For two years the Trump administration has been trying to stamp out one of Cuba’s signature programs __ state-employed medical workers treating patients around the globe in a show of soft power that also earns billions in badly needed hard currency.
Labeling the doctors and nurses as both exploited workers and agents of communist indoctrination, the U.S. has notched a series of victories as Brazil, Ecuador and Bolivia sent home thousands after leftist governments allied with Havana were replaced with ones friendlier to Washington.
The coronavirus pandemic has brought a reversal of fortune for Cuban medical diplomacy, as doctors have flown off on new missions to battle COVID-19 in at least 14 countries including Italy and the tiny principality of Andorra on the Spanish-French border, burnishing the island’s international image in the middle of a global crisis.
“I am aware of the position of the United States, but we are a sovereign country and we can choose the partners with which we are going to have cooperation,” Andorran Foreign Minister María Ubach said.
In the city of Crema in the hard-hit Lombardy region of northern Italy, 52 Cuban doctors and nurses set up a field hospital with 32 beds equipped with oxygen and three ICU beds.
“This is a strongly symbolic moment because the Crema hospital has been going through an extremely complicated situation from the start,” Lombardy’s top social welfare official, Giulio Gallera, said at the inauguration last week. “The number of patients who have filled and continue to fill the emergency room and departments has truly put the medical personnel to a hard test.”
The Trump administration has sought to cut off income to Havana as part of a long-term tightening of sanctions. And it continues to discourage countries from contracting Cuban medical workers despite the pandemic, arguing that their pay and conditions fall short of industry standards.
“The government of #Cuba keeps most of the salary its doctors and nurses earn while serving in its international medical missions while exposing them to egregious labor conditions,” the State Department said on Twitter last week. “Host countries seeking Cuba’s help for #COVID-19 should scrutinize agreements and end labor abuses.”
Cuba currently has about 37,000 medical workers in 67 countries, most in longstanding missions. Some doctors have been sent as part of free aid missions, but many countries pay the government directly for their services. In some other cases international health bodies have paid.
The most recent deployments of at least 593 doctors from the Henry Reeve Brigade — founded by Fidel Castro in 2005 and named after a 19th-century American volunteer who fought for Cuban independence from Spain — have also been to Suriname, Jamaica, Dominica, Belize, Saint Vincent and the Grenadines, St. Kitts and Nevis, Venezuela and Nicaragua, some of them reinforcing existing medical missions.
All have been billed as tied to the coronavirus epidemic, even though some of the countries have few confirmed cases so far. None of the agreements or financial terms have been made public.
Havana has said it receives about $6 billion a year from the export of public services, and medical services make up most of that. When Brazil expelled Cuban doctors in 2018, a few details emerged including that the country had been paying $3,100 per month for each doctor with 70% of that going into the pockets of the Cuban government.
Andorran newspaper Diari d’Andorra reported Wednesday, citing Health Minister Joan Martínez Benazet, that one of the 39 Cuban doctors in the country had tested positive for coronavirus and was quarantined in a hotel. The Cuban government did not immediately respond to a request for comment.
Infection is a serious risk for those on the front lines. In Italy alone, over 10,000 medical workers have contracted the coronavirus and more than at least 69 doctors have died.
For most people the coronavirus causes mild or moderate symptoms, such as fever and cough. But for others, especially older adults and people with existing health problems, it can cause severe, life-threatening symptoms like pneumonia.
Cuban officials have been proudly posting videos of doctors being applauded as they arrive to begin work, and blasting the Trump administration for its criticisms.
“Shame on you. Instead of attacking Cuba and its committed doctors, you should be caring about the thousands of sick Americans who are suffering due to the scandalous neglect of your government and the inability of your failed health system to care for them,” Josefina Vidal, Cuba’s ambassador to Canada, wrote on Twitter.
“It pays to sometimes open your mouth, write and complain… I spoke and wrote a letter to my Congressman, Florida A&M University Classmate and Kappa Alpha Psi Fraternity Brother Alfred Lawson of Tallahassee, Florida then forwarded to XM 127 Progressive Channel Radio Talk Show Host Dean Obeidallah, Lwayer, Comedian, Activist and this was the results”
FROM THE DAILY BEAST ARTICLE BY DEAN OBEIDALLAH
Insurance Companies to Small Businesses: Sorry, We Don’t Cover Viruses
THE FINE PRINT
Millions of small businesses pay insurance companies for “business interruption insurance.” But it does not cover virus-related closure. Isn’t that special?Dean ObeidallahUpdated Mar. 28, 2020 9:45AM ET / Published Mar. 27, 2020 5:17AM ET
“Running a business can be difficult without the right business insurance. One coverage most businesses need is business interruption insurance, also known as business income insurance. It can help replace any income your business loses if you can’t open for a time after a covered loss.”
Those words appear on a major insurance company’s website, as it, like insurers across the country, tries to entice small-business owners to plunk down anywhere from a few hundred to a few thousand dollars a month for business interruption coverage that promises to help “pay bills, replace lost income, and cover payroll when a covered event forces your business to close temporarily.”
Well, if ever we were in a situation where that’s the case, it’s now. But now that the owners finally need this coverage to keep their small businesses afloat, insurance companies are telling them they’re not covered for COVID-19 related closures.
At one time, before I saw the light, I was a lawyer in a big law firm where we represented large insurance companies. As I saw firsthand, everyone thinks they have a great insurance policy—until they make a claim. And then it becomes like the classic scene in Willie Wonka & the Chocolate Factory where Wonka tells Charlie’s grandfather that Charlie doesn’t get the promised chocolate factory because he violated a little-known term of the contract: “Under section 37B of the contract… ‘I, the undersigned, shall forfeit all rights, privileges, and licenses herein and herein contained, et cetera, et cetera…’” ending with Wonka telling them, “You lose! Good day, sir!”
“You lose! Good day, sir!” is exactly what insurance companies are now telling small-business owners based on an exclusion in the policy called—wait for it—the “Exclusion for Loss Due to Virus or Bacteria.” Yep, tucked into just about every commercial business-insurance policy since 2006 is language that states“We will not pay for loss or damage caused by or resulting from any virus, bacterium or other microorganism that induces or is capable of inducing physical distress, illness, or disease.”
In fact, as insurance lawyers have noted, this exclusion was inserted by insurance companies to prevent coverage for the very type of shutdowns we are seeing now caused by the COVID-19 outbreak. You think casinos rig the odds in their favor? You haven’t seen anything until you’ve read the list of exclusions in a commercial insurance policy.
True, everyone should read all the fine print before signing an insurance contract. But few small-business owners will, and even if they do, it’s unlikely all will understand the nuances of what is covered and what is not. And who, before now, would think of asking an insurance broker: “In the case of worldwide pandemic caused by a coronavirus outbreak, am I covered?!”
Instead, people considering insurance more likely will look at an insurance company’s website for guidance about what is not covered, such as at the bottom of one company’s page that states, “Closures caused by flood, earthquakes or broken glass typically are not covered in a business interruption policy.” (No other exclusions of coverage are noted.)ADVERTISING
But now people like Norm, a small-business owner from Florida (and a listener to my SiriusXM radio show), who forwarded me the denial of coverage letter from his insurance agent, are told no coverage “due to loss by virus or bacteria.” In Louisiana, the owner of several truck stops, who is now losing $30, 000 to $40,000 a month, is also out of luck due to that same exclusion, and the list of small-business owners denied coverage goes on and on.
This situation did get the attention of some elected officials. In the House, a bipartisan group of 18 members of Congress sent a letter last week to four of the largest insurance trade organizations urging them to provide business interruption coverage despite the “virus” exclusion. However, the response by the insurers was a resounding “no”: “Business interruption policies do not, and were not designed to, provide coverage against communicable diseases such as COVID-19.”
The stimulus bill expected to be signed into law shortly does provide billions in loans for small-business owners, but that’s far different than getting a check from your insurance company to cover a loss. Instead, now small-business owners will be required to apply to the government and comply with any terms imposed (it’s not clear yet what those will be) as they compete with hundreds of thousands of others business owners for limited resources. Plus a federal government loan has to be repaid, while proceeds from your insurer do not. “Members of Congress sent a letter last week to four insurance trade groups, but the answer came back a resounding “no.””
I discussed this issue on my show Wednesday with Rep. Mikie Sherrill (D-NJ), who explained that Congress is monitoring the issue and specific aid for business interruptions may be included in a future stimulus bill. In fact, it’s such a growing issue in the Garden State that the New Jersey State Assembly is considering a bill to compel insurers to cover small business for business interruptions caused by COVID-19. The bill was recently pulled from a full vote over concerns about the legality of rewriting an insurance policy after it has been entered into by the parties.
So what happens if you are a small-business owner and you’re denied coverage for the business interruptions caused by the virus? Simple, you can, as the insurance company hopes, just move on. Or you can hire an attorney, at your own cost—it may be pricey, given its commercial litigation—and sue the insurance company.
Last week, a Louisiana business sued its insurance company over this very issue, reportedly marking the first such lawsuit in the nation. Expect more lawsuits. A lot more. But while these cases make their way through the courts, expect insurance companies to keep doing what they’ve been doing all along: Collecting premiums and denying claims.
NORMAN J CLEMENT RPH., DDS JACK FOLSONRPH, MARTIN NDJOU RPH., RICARDO FERTIL PHARMD,NORMAN L CLEMENT JR., PHARM-TECH, JELANI ZIMBABWE CLEMENT, BS., MBA, ALEXANDER R. BLUE B.S, MS.,MBA., BRIAN OLIATUNJI, RPH, BERES MUSCHETT B.S., MILITARY PERSONNEL AND LOGISTIC CONSULTANT
The DEA has acted as an unregulated medical agency policing medical facilities and medical practices without legal standards and grounds and the DEA Administration Court System body, which operates within the Department of Justice (DOJ), as a run away unconstitutionally entity, and immune to all laws of governance to all courts within the Justice System. THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
THE HOUSE JUDICIARY COMMITTEE MUST INVESTIGATE
The DEA Court is known to those Attorneys who choose to defend their clients in these “Orders To Show Cause” proceedings as the Court of the Kangaroos. The DEA Court System, is so unique its conduct is separate from any of DOJ formal guidelines; which permits the DEA Agents to operate like un-regulated gangsters. THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
While in my attorney’s office on February 24, 2020, I over heard a call, placed, to one attorney co-counsel who had his first case representing a Pharmacy vs. Uttam Dhillion et al. acting administrator of Drug Enforcement Agency. The Attorney pointed out, he had clerked in both the Federal District Court and Federal 4th Circuit Appeals Court Systems, and never in his legal career had he ever seen such Court rules and procedures as he described as arcane, stealthy, bizarre as found in DEA Administrative Court System. THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
Currently, there is not one law in America the DEA or its Court System is bound to respect.
Federal RULES OF CIVIL PROCEDURES ARE NOT PERMITTED.
Jenks rulings or procedures are not allowed.
Gigilio rulings or protections are not allowed.
Federal rules of evidence are not allowed.
The Judge of a DEA Court works for the DEA Administrator (DRUG CZAR), and he/she has final say so in all hearing decisions.
If the DEA administrator does not agree with the Administrative Judges recommendations, the Judge is terminated.
Attorneys who practice before this Court, describe rules as arcane, stealthy, very bizarre.
Most of All cases are heard in Virginia, putting the Respondents from around the Country and their Attorneys in a logistical disadvantage and nightmare.
Until recently, the DEA Administrator has final decision on all recommendations, he/she has can sit on a recommended order as long as 3 years.
THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
THE TERM RED FLAG
The DEA has set up a system of de facto discrimination through Cognitive Dissonance which encourages Pharmacists to profiling patients by the Processes of “RED FLAGGING.” The term Red Flag has no statutory meaning in the areas of pharmacy and or within the medical profession. Those pharmacists who merely question these DEA policies risk loss of employment and/or administrative sanctions. The DEA can impose these errant actions because they possess un-checked authority and weapons the ability to intimidate by seizings property and assets. That these DEA policies are applied so arbitrarily makes them discriminatory. (see below video traumatizing those afflicting)
THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
The DEA continues and explicitly express actions that prohibit officers from targeting people based on their religion, national origin, or other characteristics. The DEA agents have substituted the legal standing of reasonable suspicion and probable cause and applied a lesser standard of cause to single out pharmaceutical facilities to obtain their organizational objectives. (see below video i’m not a criminal)
THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
The constitution protects for unwarranted government intrusions. Whereby the government DEA agents express that filled prescriptions without corresponding responsibility is the fundamental actions of a pharmacist. This assumption by the DEA is fundamentally incorrect.
DANGEROUS MIS-INTERPRETATIONS OF THE LAW
DEA agents across the country have applied what they reason as the law or searching and seizing medical facilities. This act in which the DEA agents apply is too vague to be valid. The DEA executed a show cause search warrant in August 2019 at Pronto Pharmacy LLC 1461 W Busch Blvd, Tampa, FL 33612. ( see below video Walgreens, CVS denied care treatment based on a bias)
While the purpose of the search was to obtain evidence of illegal Opioid distribution. The agents took files in the act of searching to discover items to suggest a criminal act took place or is taking place. The act of taking files, remove all electronic devices, remove scales, capsule making machines, ungunator an ointment maker.
Diversion Investigator Richard James Alpert, along with his crew, the Miami DEA Head Director, Supervisors, legal counsel, agents of the DEA who were on site participants of the August 29. 2019 raid, set out to damaged Pronto Pharmacy computer hard drives and returned the monitor with smash screens 60 days later.
Thus the goal and purpose of this raid was to inflict such physical destruction to put Pronto Pharmacy out of business. See below video, as computer tech Erlin Daniel Clement, the 3rd., points out the effects on what DEA attack had done. It is further clear here, DEA wanted to send their calling card message to Pronto Pharmacy or to any other Pharmacy they feel that gets out of line. (See below video DEA Agent destroyed Pronto Pharmacy monitors screens and computers)
THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
The Search team, dismantle camera systems, removed and destroyed a private camcorder. This is not implied within the warrant and the act of looking to find a criminal act is not supported by probable cause. The DEA agents retuned the electronic device; two computer screens were crackled; the computers were nonoperational. Agents should be charged with a common-law misconduct in office1 as well as larceny in a building. (see below video two DEA Agents work to dismantle and disable Pronto Pharmacy security cameras)
PHOTOS OF COMPUTER MONITORS SCREEN RETURNED DESTROYED BY DEA OCTOBER 30, 2019
The search conducted was not specific in nature, whereby the agents confiscated a black three-ring binder that was located on top of a desk. Therefore, the removal of such documents and listed items serve the purpose of developing a case beyond the scope and statues of the search warrant, when the ordering and dispensing ‘Approved Medicinal Drug Products’ is viewed as a criminal act and thus created tacit reasons to search. THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
Whereas DEA selectively enforces their arbitrary Red Flag rule of suspicious against the small mom and pop Pharmacy, stating small pharmacies must take 89% insurances and 11% cash (debt. credit card, cash), while large chain drug store companies can freely select-out which insurances they choose to take and not worry about DEA’s interference. The following videos shows a patient, and Ellen Corcorhan is describing her experience when she presents her insurance card at a Walgreens Pharmacy. THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
Most notably, the chain pharmacies (CVS, Walgreens) are now owners of the drug insurance companies. So, these large chain pharmacies now own the market, the pricing and which pharmacies plays and which pharmacies are excluded. The problem is so extensive, Walmart had to lay-off 40% of its pharmacy staff around the country in part because of a dispute with CVS CAREMARK over reimbursements. THE CONGRESS MUST INVESTIGATE DEA
DEA’S CORRESPONDING RESPONSIBILITY VIOLATES PRACTITIONER PATIENT RELATIONSHIP AND THEIR RIGHT TO MEDICAL CARE.
Whereby, 1306.04 Purpose of issue of prescription
(a) A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment, or legitimate and authorized research is not a prescription within the meaning and intent of section 309 of the Act (21 U.S.C. 829) and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances.
(b) A prescription may not be issued in order for an individual practitioner to obtain controlled substances for supplying the individual practitioner for the purpose of general dispensing to patients. THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
The DEA follows code 1306.04 with states, “the corresponding responsibility rests with the pharmacist who fills the prescription.” This policy is in the absence of medical logic unless a pharmacist has equal access to the patients’ entire medical/dental records, including treatment plans, radiographs, study models. Further, a pharmacist would require equal knowledge or equal training to the standards of a physician, dentist, or any prescribing practitioner and be capable of conducting a physical examination leading to a diagnosis.
It is more than clear that a pharmacist is incapable of offering a second opinion, altering treatment to the patients or further suggesting changing the dosage to a lesser or greater amount from behind a dispensing counter. Such opinions, would be considered a second opinion and comes dangerously close to practicing medicine without the proper credentials. More importantly, we would need to request a signature from the patient to gain his or her medical record from the prescribing practitioner. (See below Video Patient didn’t know he was classified as a criminal)
More further, 1306.04 fails to be gender-neutral as it further implies all prescribing practitioner to be male. Whereby the Florida standard of medical and medicine depending is based and practiced by license pharmacists. Thus, in the actions of the DEA, the agency is acting upon the citizens based on an unreasonable standard in absences of Reasonable and/or Probable Cause. THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
The warrant issued identified Items that are evidence of violations of 21 U.S.C. §§ 841(a)(1) possession with the intent to distribute and distribution of oxycodone and hydromorphone. (see below video I give my permission)
The intent of this law implies that it shall be unlawful for any person knowingly or intentionally— to manufacture, distribute, or dispense, or possess with intent to manufacture, distribute, or dispense, a controlled substance; or to create, distribute, or dispense, or possess with intent to distribute or dispense, a counterfeit substance.
The DEA applied their reinterpretation of the law to identify licensed, Pharmacist, as a person that illegally distribute, or dispense, a controlled substance. The DEA has failed to understand or has deliberately used to law to their advantage to attack African American Pharmacists. THE CONGRESS MUST INVESTIGATE DEA.
In the case of Pronto Pharmacy LLC, Tampa Florida, owner Norman J. Clement was acting in the capacity of a licensed pharmacist. Whereby a registered Pharmacist is a person who is professionally qualified to prepare and dispense the medicinal drug. This definition and is a statue within the Florida Administrative Code & Florida Administrative Register. The officer acted upon an oath to enter the premises to secure evidence of violations of 21 U.S.C. §§ 841(a)(1) (possession with the intent to distribute and distribution of oxycodone and hydromorphone.
The issue in the case is whether the record as a whole establishes by a preponderance of the evidence that Pronto Pharmacy’s DEA Certificate of Registration Number FP2302076 should be revoked and whether any pending applications for renewal or modification of such registration and applications for any other pending DEA registrations should be denied pursuant to 21 U.S.C. 824(a) (4) and 21 U.S.C. 823(f). THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
The DEA agents removed files with the intent of searching to discover items to suggest a criminal act took place or is taking place. This is not implied within the warrant, and the act of looking to find a criminal act is not supported by probable cause. Such act to search to find without stated cause for the search is an investigative function that violates the premise of a search warrant and violates the basis of Probable Cause and elements of Reasonable Suspicion. The search conducted was not specific in nature, whereby the agents confiscated items not specific to the warrant.
The removal of such documents and items serves no purpose of criminal activity but only to developing a case beyond the scope and statues of the search. The intent that a person and not a sold medication and criminalizing the job of a licensed Pharmacist. THE CONGRESS MUST INVESTIGATE DEA.
The Fourth Amendment
The Fourth Amendment was intended to create a constitutional buffer between U.S. citizens and the intimidating power of law enforcement. The officers failed to indicate within their search warrant the components of what was to be seized. Therefore, the officers exercised undue discretion when they choose to search and seize. Therefore, the interest of the defendant was violated when the search and seizures became “unreasonable” and not authorized by the warrant based upon probable cause, to remove personal artifacts such as documents of academic research. This binder contained copyrighted academic research. THE CONGRESS MUST INVESTIGATE DEA.
The officers apparently did not know that a pharmacist is not just a person but a license individual to compound, distribute, or dispense, or possess control substance. The act to remove all electronic devices is an act to suspend the income and eliminate the practice of filling legal prescriptions.
DEFECTIVE SEARCH WARRANT DESIGN TO BE DECEPTIVE: 21 U.S.C. 841(a)( 1)
The officers should have known Pronto Pharmacy is a license pharmaceutical medical facility whereby Class 2 narcotic analgesics are stored and sold. The officers made a deliberate choice to reclassify, without legally redefining or understanding the different between a license’s pharmaceutical facility and a street corner drug operation. By their actions, the DEA agents ignored the laws in that they identified the pharmacist as a person. THE CONGRESS MUST INVESTIGATE DEA.
This allowed them to deceive the courts to cause a signature to support their deception of probable cause that a person, not a pharmacist was compounding and or manufacturing drugs. Items that are evidence of violations of 21 U.S.C. 841(a)( 1) (possession with the intent to distribute and distribution of oxycodone and hydromorphone substances) and 846 (conspiracy to do the same) and 843 (fraud/deception regarding the same), including the following: Distributing, ordering, purchasing, or the loss or disposal of oxycodone and hydromorphone. These items can be found in a licensed Pharmacy such as was in Pronto Pharmacy LLC on August 29, 2020.
On this statement, the agents fully knew and understood that these medical narcotic analgesics will be found. They further knew and failed to understand the distinct difference and the lack of cognitive distinctive analytical differential association. Whereby they could not differentiate between a licensed pharmaceutical facility and an illegal non licensed drug house. The police acted far outside of their scope of training when they wrote “Information to Be Searched and Items to Be Seized” All capsules and powder, including capsules containing suspected controlled substances.
This warrant plainly violates the due processes clause of the Constitution 1st, 4th 8th and 14th amendments. Whereby, capsules and powder, including capsules containing suspected controlled (see below videos “why Small Pharmacies are fee for Service)
substances. Will be naturally found in a licensed facility pharmacy (Pronto Pharmacy) and to list such as suspected controlled items is a clear and deliberate to operate under illusion that a crime is afoot. THE CONGRESS MUST INVESTIGATE DEA.
Moreover, If the prescriptions were fraudulent than how did law enforcement obtained the records of each prescription transactions? If the records were obtained from Pronto’s computer and subsequently transmitted to the PDMP (the DEA computer systems). Via the PDMP computer system, the DEA has full knowledge of each medical Class 2 prescription that was filled. The DEA agents should have known from the ARCOS system what prescriptions were filled. THE CONGRESS MUST INVESTIGATE DEA.(see below videos “why Small Pharmacies are fee for Service)
Therefore, the criminalization of medical practices was a clear intent to undermined a legitimate pharmaceutical operation and to personalize a templet to initiating a warrant and raid must be questioned. Did the DEA agents inquire if the individual has medical insurance? Most insurance do not cover oxycodone, and a business has to right to deny taking insurance because many insurances do not pay. THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
COMPOUNDING CONTROL MEDICATIONS
During January 28, 2020, Drug Enforcement Administration Hearing, Agent Richard James Albert Jr., Diversion Investigator for the Drug Enforcement Administration. Agent Albert stated that he “became involved after receiving a phone call from the Department of Health about a pharmacy compounding Hydromorphone and Oxycodone.” THE CONGRESS MUST INVESTIGATE DEA AND FDA.
There is a conflict in order whereby Norman Clement, is licensed to compounding Hydromorphone and Oxycodone under license number PS37644. The agent displayed and lack of knowledge of the law whereby a phone call does not give an officer probable cause and the right to search on mere suspicion. THE CONGRESS MUST INVESTIGATE DEA, THIS AGENT MUST BE TERMINATED FOR VIOLATIONS OF THE LAW.
The initial contact shows a lack of significant knowledge and training whereby the act of compounding was a legal act, and anything based on this assumption fall under “The Fruit of The Poisonous Tree.” THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
64B16-27.700 Definition of Compounding
“Compounding” is the professional act by a pharmacist or other practitioner authorized by law, employing the science or art of any branch of the profession of pharmacy, incorporating ingredients to create a finished product for dispensing to a patient or for administration by a practitioner or the practitioner’s agent; and shall specifically include the professional act of preparing a unique finished product containing any ingredient or device defined by Sections 465.003(7) and (8), F.S.
The term also includes the preparation of nuclear pharmaceuticals and diagnostic kits incident to use of such nuclear pharmacies. The term “commercially available products,” as used in this section, means any medicinal product as defined by Sections 465.003(7) and (8), F.S., that are legally distributed in the State of Florida by a drug manufacturer or wholesaler.
(1) Compounding includes:
(a) The preparation of drugs or devices in anticipation of prescriptions based on routine regularly observed prescribing patterns.
(b) The preparation pursuant to a prescription of drugs or devices which are not commercially available.
(c) The preparation of commercially available products from bulk when the prescribing practitioner has prescribed the compounded product on a per prescription basis, and the patient has been made aware that the pharmacist will prepare the compounded product.
The reconstitution of commercially available products pursuant to the manufacturer’s guidelines is permissible without notice to the practitioner.
If the officers were asked the difference between compounding and manufacturing, they must know what they are being asked. A reasonable officer could not support or testify to the facts of any item or file that was within the seized computer or secondary storage systems.
Based on the initial phone from a unknowlegable Department of Health Inspector Cheryl Eschear of the Tampa office call to say Pronto Pharmacy was compounding control medication which was legal, the DEA stigmatize the disease immediately jumped to criminalize treatment, payment and therefore, they (see below videos “why Small Pharmacies are fee for Service)
Had the agents studied pharmacology, they would have known the chemical composition and the treatment rate of various medications. These agents should have known the multifaced functions of pharmaceutical procedures of chronic pain therapeutic plans. Therefore, what law enforcement saw from their lack of knowledge of pharmacology was the perception that a criminal act was taken place. THE CONGRESS MUST INVESTIGATE DEA, AND BOTH HEALTH DEPARTMENT INSPECTORS AND DEA ALL DEA PERSONNEL MUST BE TERMINATE
The police are not trained or knowledgeable of medical treatment plans. This process is similar to Tylenol, and Motrin asks the police are the difference between these two medications. With adequate knowledge in pharmacology, the police certainly would have known the difference in drug interactions.
Therefore, the search through the computer was and after facts search for the discovery information to support the Law Enforcement accusation of what was perceived by them as a fraud.
DEA TARGETING AND PROFILING OF PRONTO PHARMACY WENT ON FOR YEARS
According to the DEA Certificate of Registration Number FP230207621, U.S.C. § 824(d), “because Pronto Pharmacy’s continued registration constitutes an imminent danger to the public health or safety.” During the period of DEA operation upon Pronto’s Pharmacy, there were nine pharmaceutical facilities within a six-mile radius of Pronto Pharmacy, operating and sell opioids. Moreover, two months before the federal raid, Pronto Pharmacy was inspected by the Florida Board of Pharmacy. Pronto pharmacy passed the inspection.
During the same time, the DEA’s raided Ponto’s Pharmacy. Several white males owned pharmacies filling opioid prescriptions and are permitted to operate to this day. Of the nine pharmaceutical facilities currently operating each pharmacy, they are filling more prescriptions for Opioids than Pronto Pharmacy. The acts and actions of the DEA, has made it clear that federal agents have targeted Pronto Pharmacy. THIS IS CLANDESTINE DIABOLICAL RACISMO!!!
The DEA targeting tactics have identified and Pronto Pharmacy with false claims. The DEA has ignored their data and caused to blame the owner-operator of Pronto Pharmacy for placing the public in imminent danger under U.S.C. § 824(d). THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
Examining two of the nine pharmacies located in Hillsborough County along with Pronto Pharmacy:
PMSI Pharmacy, 4502 WOODLAND CORPORATE BLVD SUITE 105 TAMPA FL 33614
Twenty-six million two hundred fifty-three thousand eight hundred pills were shipped to this pharmacy between 2006 and 2012.
About enough for 44 pills per year for each of the 83,874 people who live within five miles of Pronto Pharmacy.
OMNICARE PHARMACY OF FL, LP8603 FLORIDA MINING BOULEVARD TAMPA FL 33634
Thirteen million eight hundred sixteen thousand nine hundred pills were shipped to this pharmacy between 2006 and 2012.
About enough for 22 pills per year for each of the 86,780 people who live within five miles of this Pronto Pharmacy.
It becomes clear that individually each of these two pharmaceuticals received and produces more opioids sales to the streets than Pronto Pharmacy. THIS IS CLASSIC RACIAL PROFILING!
Whereas with Pronto Pharmacy, had
Three hundred forty-eight thousand pills shipped to Pronto pharmacy between 2006 and 2012.
About enough for less than one pill per year for each of the 104,932 people who live within five miles of this pharmacy. THIS IS CLASSIC RACIAL PROFILING!!
After examining the DEA database, it becomes apparent their data points are inaccurate. Each of these pharmacies is within 6 miles of each other. These data points would seem, therefore, to overlap multiple pharmacies within the data areas. If the DEA included the entire area, it would be plain to see that Pronto Pharmacy would produce less than one pill per year for each of the 104,932 people who live within five miles of this pharmacy. The actual number would most likely be .5 pill per year of each. THIS IS CLASSIC RACIAL PROFILING!!!
The DEA used an arbitrary level of calculation to single out Norman Clement, an African American male, owner-operator of Pronto’s Pharmacy. These calculations are applied to support the efforts to convince judges to sign warrants to raid and destroy businesses. Although Pronto pharmacy fills the least amount of opioids among competing pharmacies, with in the area. Using the DEA PDMP system is clear to see that no other pharmacy within the area is being forced to stop business operations. The DEA has claimed that Pronto’s Pharmacy presents an imitate danger to the community. THIS IS CLASSIC RACIAL PROFILING!!!!
If it could be the reason that an African American Male single handily contributed to the growth of the opiate crises. How then is PMSI Pharmacy be allowed to operate when they are filing 25,905,800 92% more opioids within the same time frame and geographical location as Pronto Pharmacy. This PMSI Pharmacy is still operating. Yet, an African American male filling fewer pills that are sounding counterparts is prevented from conducting business in Tampa, Florida, Hillsborough County. Why?
The federal Drug Enforcement Agents assigned to opioid enforcement operating in Tampa, Florida, in August 2019, acted more liken to criminal intervention team’ assigned mostly to investigate, and that focuses on African Americans to justify drug enforcement. ESTE E’ RACISMO DIABO’LICO CLANDESTINO!!!!!
The removal of files is an act of searching to discover items to suggest a criminal act took place or is taking place. The searching and removal and destruction are not implied within the warrant, and the act of looking to find a criminal act or function is not supported by probable cause. Such act to see is an investigative function that violates the premise of a search warrant. The aspect of a search is the basis of reasonable suspicion. THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.
TRIBUTE TO QUILOMBO dos PALMARES, GREENWOOD, TULSA, AND ROSEWOOD AND BLACK BOTTOM DETROIT
African American Pharmacist at Risk of Elimination
Ability to past on generational wealth is effectively thwarted by the Department of Justice in 2 distinct ways, wealth and education. Despite the levels of training and knowledge of the African American Pharmacists, or for that manner, any pharmacists receive the DEA continues to profile these persons and facilities as a place of criminal activity; we are deemed as both upidity and arrogant, yet we are but role models and invisible menall in the same day.
In the United States, Brazil Quilombo dos Palmares 1699, Cuba 1912, China African Town 2003 the challenges of African business to develop and sustainment had been fraught with unusual challenges. In 1921, the Tulsa Race Riot (or the Greenwood Massacre) mobs of white residents attacked black residents and businesses. In 1923, the Rosewood Massacre in Florida several black American citizens considerably propertied businesses owners alone with the African American citizenry were killed, and the property destroyed. We are not seen as humans beings with a God given brain to reason or be analytical and the manifestation of which XM Radio host Joseph Madison Says ” is to be underestimated, under-valued and marginalized.”
We would like to express my sincere gratitude to the African American entrepreneurs for their continuous efforts to open and operate licenses pharmacies. Despite the historical threat to their survival. These pioneers attended universities to gain knowledge and college degrees in pharmacy, Ph.D.’s in pharmacy, dentistry and many other academic fields. My support for their academics and entrepreneurial efforts is unending.
They know the United States Government, DEA, cannot and will not tolerate an African American pharmaceutical Business to survive. While conducting this research, I could not have imagined having a better mentor for academic and entrepreneurial teachings than the African American medical practitioners throughout the United States.
Their patience, motivation, and immense knowledge of the dangers from government intrusions are a factor for all Africans who were knowledgeable/entrepreneurial by owning a pharmaceutical business is a danger to their health, life, and economic stability.
THE CONGRESS MUST INVESTIGATE DEA AND THEIR COURT SYSTEM.THE CONGRESS MUST INVESTIGATE DEA.
“A TRIBUTE TO THE GREAT MADIBA IN HIS QUEST FOR FREEDOM THIS 30th ANNIVERSARY OF HIS RELEASE FROM VICTOR VERSTER PRISON IN THE WESTERN CAPE“
WALTER R. CLEMENT B.S, MS.,MBA., NORMAN J CLEMENT RPH., DDS JACK FOLSONRPH, MARTIN NDJOU RPH., RICARDO FERTIL PHARMD,NORMAN L CLEMENT JR., PHARM-TECH, JELANI ZIMBABWE CLEMENT, BS., MBA, BRIAN OLIATUNJI, RPH, BERES MUSCHETT B.S., MILITARY PERSONNEL AND LOGISTIC CONSULTANT
Black Pharmacy Owners, AT Cost Pharmacy, Ft. Myers Fl., Aaron Howard PharmD owner, Gulf Med Pharmacy Cape Coral Fl., Ricardo Fertil PharmD owner, Pronto Pharmacy LLC, Tampa Fl, Norman J Clement RPh., DDS, owner, Oak Hill Hometown Pharmacy owner Martin Ndjou, Top Line Pharmacy, owner Brian Olatunji, have joined together in exposing the Drug Enforcement Agency (DEA) for harassment, and malicious targeting and return of properties unjustifiably seized.
THE RED FLAG – Distance
In the exploring role and purpose of the DEA that acts as an unregulated medical agency policing the medical profession without legal standards and grounds. The DEA Diversion Investigator claims in arbitrary reasoning; their actions are based factors applied that “traveling long distances to fill prescriptions can be a red flag of abuse and diversion if a patient travels a significant distance to a particular pharmacy.
The DEA has developed criminal elements of free commerce by criminalizing distance travel as elements of criminal conduct. Whereby a pharmacist is a licensed practitioner who has advanced knowledge of the chemical-physical properties of medications, mechanism of actions, their dosage forms design, will likely not refer to GOOGLE MAPS as an element of patient treatments. More dangerously, as a result of the DEA’s aggressive policing of community pharmacies many are reluctant to fill any legitimate narcotic analgesic medication prescriptions for non-acute pain patients.
Some patients are known to spend days on end looking for a pharmacy to fill their prescriptions to no avail. This has caused massive concerns in the chronic pain disease medical/dental community, where one of the most important goals of any therapy is continuing staple treatment without disruptions.
It is well understood amongst medical/dental practitioners when disruptions in therapy occur, many of the deleterious effects are likely to happen. For example, patients diagnosed with Sickle Cell Anemia are many times profiled as addicts, rather than as persons with a chronic disease condition needing treatment for pain.
Other examples include persons who have survived traumatic accidents such as automobile accidents, gunshot wounds (civilian and military), notwithstanding leukemia and other cancers.
Indeed, pain management becomes even much more difficult when anxiety and diminished mobility complicates the treatment plans.
Further, it is well understood, when both medical/dental practitioners and patients can locate a Pharmacy that will fill pain control prescriptions with dignity and respect, both parties will often share that information with others.
DEA’s RED FLAGS OF OLD JIM CROW
Throughout this entire presentation, it becomes nearly impossible to ignore the racial disparities, and dehumanization without taken into the historical connotation of society as the whole. It is a giant elephant walking in front of us.
However, the difficulty becomes how RACISMO will often deflect from the diverse issue that touches every individual of this nation and beyond versus a bunch of guys who happen to be black pharmacists, who present a matter of human disparities which effects the foundation of our existence. (see below video elephants walking)
DEA’s Pharmacy expert, Don Sullivan, interviewed no physicians/dentist, no patient receiving prescriptions, nor reviewed any prescriptions of any patients from Pronto PHARMACY. Further DEA, expert Don Sullivan reviewed no radiographs, performed no physical examinations on patient of Pronto Pharmacy to impeach the primary physician initial diagnosis.
What DEA expert Don Sullivan a Pharmacy Clinical Professor at The Ohio State University College of Pharmacy, do is profiling each patient forming an opinion base on bias by cleverly eviscerating the physician-patient relationship. Then erroneously supports his conclusion of bias with tools such as GOOGLE MAPS were he claims he can effectively conclude the distance patient travels to fills a concluding prescription establish they are illegitimate medical purposes. (SEE VIDEO BELOW “IT SOUNDS LIKE PROFILING)
Ironically Professor Don Sullivan, works in the vicinity of the James Cancer Hospital Solve Research Institute at The Ohio State University (right next to the College of Pharmacy at The Ohio State University). Patients travel great distances from all over the world to receive services and have their prescriptions filled, utilizing their hospital pharmacy and neighboring pharmacies. Yet, there is no judgement by the mile marker or suggestions of unresolvable “red flags being opined by Professor Don Sullivan pertaining to prescriptions being written at the James Cancer Hospital. These pharmacies are far exceeding the 30 mile limitation of many these patients being treated at the James Cancer Center; as Professor Sullivan testified to as being RED FLAGGS in DEA’s Order To Show Cause Hearing in Tampa Florida January 28-29, 2020.
What further serves to undermines the credibility of both Don Sullivan and DEA Diversion Investigator Richard Alpert are the 11 patients they identified as unresolvable ‘RED FLAGGS,” are still being treated today, by the same doctor for the same amounts at non- black own Pharmacies. Most importantly, prescriptions filled at these other pharmacies and the physicians are no longer classified RED FLAGGS. Both DEA Diversion Investigator Richard Albert and Pharmacy Expert Don Sullivan could have easily verified this by using the PDMP. So what happened to the RED FLAG?????
These patients continue to contact Pronto Pharmacy to inquire when are we resuming services. They are concerned under this current hostile environment aboutthe increase cost they are now paying for their medications at other Pharmacies.
THE DEA’S JUDGEMENT BY THE MILE MARKER
Currently, the DEA has no statistical guidelines or law to support or establish boundary levels, which are indicative of criminal acts when filling any Control prescription written for patients by a physician who has performed a thorough physical examination, diagnoses supported by medical/dental radiographs and treatment plan. The DEA guidelines are tactic acts that specifically target American pharmacist.
In the case of AARRIC Pharmacy, Ft. Myers, Fl., the DEA reasoned that the pharmacist regularly filled controlled substance prescriptions for individuals who traveled an unusual distance. The DEA further stated that “Obtain or fill a controlled substance is indicative of diversion and/or abuse, and
that such behavior is a red flag that must be addressed prior to dispensing.” The DEA reasoned that traveling 78 miles round trip and over 53 miles round trip is a red flag that must be addressed prior to dispensing. The DEA also claimed that traveling 45 miles round trip and or 44 miles round trip is a red flag that must be addressed prior to dispensing.
THE DEA AND GOOGLE MAPS
The DEA in their Order to Show Cause on Pronto Pharmarcy, LLC, applied the distance rule using GOOGLE MAPS. Using GOOGLE MAPS, the DEA cited several filled orders. One was stated as approximately 140 miles from the patient to Pronto Pharmacy, LLC (Respondent’s registered address); another was “located approximately 130 miles; the third patient lived “approximately 145 miles, and yet the fourth patient lived approximately 160 miles from Pronto Pharmacy, LLC.( see below video I’m not the right Criteria, my teeth are too shiny)
It must be noted the DEA agents applied a higher mileage factor in different warrants to obtain a sense of urgency to support their cause. We observe in the case of AARRIC pharmacy, the DEA said that traveling 78 miles round trip, and over 53 miles round trip is a red flag that must be addressed prior to dispensing.
Once again, in the Pronto Pharmacy case, the DEA using GOOGLE MAP stated, a patient was “located approximately 130 miles from Respondent’s registered address, and another lived “approximately 145 miles yet another lived approximately 160 miles.
If the distance of traveling to obtain a prescription is a factor, these rules should apply to mail-order pharmacies, to citizens driving to Canada and to other pharmacies that fill prescriptions to individuals. Moreover, these Class 2 medications are delivered from manufactures via UPS and other delivery services and all retail stores that sell goods and services. if mishandled can cause harm to the public.
THE DEA MUST BE DISBAND OR REFORM
CONGRESS MUST INVESTIGATE
By the DEA standards, the manufacturers are operating a criminal drug enterprise, and the delivery service operated as drug carriers. Therefore, the entire pharmaceutical industry is at risk when the DEA applies its unabashed rules. Such actions of a government agency are to be feared. And such actions violated the 1st, 4th, 8th and 14th amendments.
The DEA’s expert opined that “traveling long distances can be a red flag of abuse and diversion if a patient travels a significant distance to a specific pharmacy, especially if the patient also travels significant distance to a particular prescriber”. The facts to support the probable cause cannot be justified by mere suspicion. “DEA’s expert opined that it can be a red flag of abuse” this cannot support an express intent that a crime is or was afoot. Thus, it cannot establish probable cause. In fact, the DEA statements that ‘long distances using GOOGLE MAPS “can be” a red flag of abuse and diversion,’ is a clear application that fails to supports Responsible Suspicion.
THE US HOUSE OF REPRESENTATIVES CONGRESS MUST INVESTIGATE
The DEA has no supportive measures to apply further or support their claim that a crime was committed. Their tacit applications can be applied to any and all retail outlets. Whereby the acts and application and their idea of enforcement are so vague, that its strikes at the core values of our law. This agency can no longer be entrusted to protect and serve the citizenry. Their conduct throughout the nation strikes fears in that a law enforcement agency can act at will to claim that a citizen violated the law by merely stating that a specific law was violated. With no supporting facts and or articulations of how the citizen violated the law, this agency acts at will. With little and no restraints.
DEA’S MATTERS OF ENFORCEMENT ARE BASELESS THE U.S. CONGRESS MUST INVESTIGATE
This lack of knowledge violates the 4th amendment rights. It becomes apparent the DEA agents lacked sufficient training that their actions violated the constitutional rights under Harris vs. Canton when the failure to train your officers amounts to a policy of no training.
The actions and acts of performance displayed that the DEA agents show the inadequacy of training in that the DEA Agents failed to adequately understand the scientific methodologies of pharmacology. Yet, they chose to enforce rules and regulations without adequate pharmacology schooling. The agents relied on mere Here Say and applied what was heard to medical doctoral professionals.
Their failure of medical knowledge and training serves as the basis for liability only where the failure to train in relevant respect amounts to deliberate indifference to the constitutional rights of persons with whom the DEA Agents came into contact. The elements of the DEA agents’ during the
search displayed a lack of significant training. Whereby in on instant it can be seen that agents disabled and removed the camera system before they searched the facility.
CONGRESS MUST INVESTIGATE
Therefore, the acts and actions of the DEA’s application fall under the “Fruit of the Poisonous Tree.” Therefore, these matters of enforcement are baseless, and all items removed must be immediately returned, and all losses of wages and profits must be restored.
Norman J Clement RPh., DDS, Jack Folson RPh., RPh, Ricardo Fertil PharmD., Walter R. Clement, Bs., MS.,MBA., Norman L. Clement, Pharm Tech., Martin NdJou, RPh, Jelani Z. Clement BS., MBA., Pharm Tech, Brian Olatunji, RPh.
“Beyond race, it is The Drug Enforcement Agency’s stupidity, and its incompetence which troubles us more.”
Mural found in Cape Town South Africa International Airport
“WE MUST GO PUBLIC AND CONGRESS MUST INVESTIGATE”
THE DEA CAMPAIGN OF STUPIDITY
Over the years, the DEA has cleverly captured the ability to mis-classify, eviscerate patient practitioner relationships, and willfully redefine medical, pharmaceutical, and dental procedures to the detriment of the greater society. DEA’s policies are often in conflict with modern Public Health Medicine, which recognizes addiction, mental health, substance abuse, acute and chronic pain as diseases. (see video by Norman and Jelani Clement of US Surgeon General Jerome M. Adams MD., statement on Mental Health and Substance Abuse) “Congress Must Investigate.”
We reported in earlier articles of a disturbing trend within DEA whereby medical practitioners are being targeted.( i.) (see video below)
A campaign of false information has been generated and disseminated to sway the public into believing that these medications are on par with street drugs, dangerous drugs that contribute to abuse and trafficking and the so-called ‘Opioid crisis’ in America. The Agency has raided and arrested medical personnel for dispensing prescription ordered medications, particularly control medications, to the community.”
CONGRESS MUST INVESTIGATE THESE ILLEGAL ACTIVITIES OF THE DRUG ENFORCEMENT AGENCY (DEA)”
Washington , District of Columbia, United States April 25, 2018 10:24 am, United States Surgeon General Jerome M. Adams, MD, MPH speaks at Behavioral and Opioid Conference on his brother Philip serving 10 years imprisonment, near D.C.,(video 1) and removing stigma of mental and drug addiction(thru partnering) to medical and Public Health treatment. Attended by Jelani Z Clement Pharm Tech., Pronto Pharmacy and Norman J Clement Rph., DDS., Conference Office of Minority Health on Opioid Overdose and Mental Health Disparities, Hubert Humphrey Bldg.
While it is easier to divert our attention on racismo, this is only an anodyne, masking how the DEA has become the sole heinous government agency whose tactics have increased costs of medications and healthcare all across America. They’ve accomplished this by misinterpreting the purpose and roles of medications needed to treat acute, chronic, neuropathic and psychological pain.
“Congress Must Investigate.” (see my skin is too dark)
These authors, have found that the DEA has unfortunately lost sight of their true mission and now effectively uses bullying, threats and intimidation tactics such as;
1. Raids and Arrests,
3. Prison Time
“CONGRESS MUST INVESTIGATE THESE ILLEGAL ACTIVITIES OF THE DEA.”
DEA agents lack knowledge and understanding of Opioid Pain receptors, but armed with badges, guns and profound stupidity, are imposing their new misguided mission onto the medical profession; (nurses, pharmacists, physicians, dentists, drug wholesalers, and their patients)
“Congress Must Investigate.”
According to The New York Times article called Federal Agency That Fuels The Opioid Crisis written September 17, 2018, “The Drug Enforcement Administration (DEA) has proved itself incompetent for decades.” Most notably it was reported; (see video below ” I’m not the right criteria” and my teeth are too shiny”)
“CONGRESS MUST INVESTIGATE THESE ILLEGAL ACTIVITIES OF THE DRUG ENFORCEMENT AGENCY (DEA)”
Authors Professor Leo Beletsky and Jeremiah Goulka further reported:
1. “ The Drug Enforcement Administration, the agency that most directly oversees access to opioids, deserves much of the blame for these deaths. Because of its incompetence, the opioid crisis has gone from bad to worse. The solution: overhauling the agency, or even getting rid of it entirely.”
2. “The problem begins with poor design. A brainchild of Richard Nixon’s “war on drugs,” the agency sought to cut off supplies of drugs on the black market, here and abroad. But in passing the Controlled Substances Act of 1970, Congress also gave the agency broad authority over how prescription opioids and other controlled substances were classified, produced and distributed.”
3. “The agency was supposed to curb problematic drug use, but failed to do so because its tactics were never informed by public health or addiction science.(iii.) Despite the investment of hundreds of billions of taxpayer dollars and the earnest efforts of thousands of employees, the D.E.A.’s track record is abysmal.” “Congress Must Investigate.”
4. “The agency has been unable to balance legitimate access to and control of prescription drugs. The widespread over-reliance on opioids, along with benzodiazepines, amphetamines and other scheduled medications, has created a booming black market.”“Congress Must Investigate.”
THE DEA’s RED FLAGS PILL MILLS, COCKTAILS AND HOLY GRAILS (TRINITY) vs THE PATHOPHYSIOLOGY OF PAIN, ANXIETY AND SLEEP DISORDERS
Pain Management is a very complex issue. More often than not in chronic (non-acute) pain which is considered a disease, comorbidities need to be addressed.(iv.) We further must have a basic understanding of pain patho-physiology and neuroscience and the basic structures and function of the nervous system which is a complex structure that coordinates voluntary and involuntary actions by transmitting signals to and from different parts of the body.(v.) (see video below “then I was Red Flagged”)
Pain is a complex and subjective experience initiated by an unpleasant (or noxious) stimulus associated with actual or potential tissue damage. Pain is a primitive response that motivates us to withdraw from the source that is causing the pain and protect the body from further damage. The unpleasant feeling associated with pain is also stored in our memory so that we can avoid similar situations in future.(vi.) While the pain complex may seemingly be intimidating, its basic understanding is not all that difficult.
According to LP-3 network, Publication PAIN: PATHO-PHYISIOLGY AND NEUROSCIENCE; (see I have an artificial from tractor injury)
5. “The nervous system is divided into two main parts: the Central Nervous System (CNS) and the Peripheral Nervous System (PNS). The CNS consists of the brain and spinal cord, while the PNS consists of all the nerves that branch out of the spinal cord into the body.”
6. “The PNS is divided into the somatic, autonomic, and enteric nervous system. The somatic nervous system is responsible for transmitting information from motor and sensory neurons to the CNS.
7. “The autonomic nervous system is largely responsible for regulating autonomic functions, such as digestion, respiratory and heart rate, pupillary response, and certain reflexes (e.g., coughing, sneezing, swallowing, and vomiting) activities that occurs in response to a perceived harmful event, attack, or threat to survival i.e. fight-or-flight response.
According to LP3 Network, Pain: Patho-Physiology and Neuroscience, “it is important to remember that pain is a multidimensional sensory experience. Pain may vary in intensity (mild, moderate, or severe), quality (sharp, burning, or dull), duration (transient, intermitent, or persistent), and dermatomal or referred (from somatic or visceral structures). “
LP3 Network, Pain; Patho-Physiology, points out, “Pain can be classified in terms of its duration, etiology, and physiology, namely as acute or chronic pain.” (see “video not being judged by the mile marker in Durbanville, South Africa)
“Acute pain, usually follows a physical injury, is transient and resolves with healing. Conversely, Chronic pain, is often defined as any pain lasting more than 12 weeks, which usually has unclear etiology or multiple causes, persisting even after healing. Acute pain usually serves a protective function, whereas chronic pain usually performs no adaptive function.”(v.)
More importantly, LP3 Network defines, “An example of acute pain is touching a very hot object. The brief exposure to this hot object will cause a rapid but brief pain sensation and initiate a withdrawal reflex to prevent and/or minimize tissue injury. In so doing, this type of pain also serves a protective (or adaptive) function because it protects the individual from further injury.”(v)
Kalbaka, Trikala, Greece
“Hence, acute pain is often categorized as adaptive pain. In contrast, chronic pain is often categorized as maladaptive pain as it serves no protective function, but instead results from abnormal functioning or damage to the nervous system.” “Maladaptive pain is not associated with noxious stimuli but to abnormal sensory processing. In addition to these categories, pain can be separated into the following different types of pain: nociceptive, inflammatory, neuropathic, and functional. “
Nociceptive pain, according to LP3-Network Pain; Patho-Physiology, “results from noxious stimuli that are either mechanical, thermal, or chemical, and that elicit tissue damage and activate nociceptors. This type of pain can further be divided into somatic pain, which affects somatic structures; visceral pain, which affects visceral structures; and inflammatory pain, which results from the release of inflammatory substances in the periphery by cells in the affected area. “(v)
Pain; Patho-Physiology, states, “Nociceptive pain usually results from tissue damage following injury (e.g., surgery, trauma, or wounds). At times nociceptive pain can persist after healing and cause chronic pain (e.g., after surgery). “
Archea Olympia, Elis, Greece
Therefore, it is very important to treat acute pain to prevent it from becoming chronic pain. “The treatment of nociceptive pain usually involves analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and Na+ channel blockers.”
“Opioid medications (narcotic analgesics) can also be used in the treatment of pain because peripheral opioid receptors are increased after an inflammatory response,” as clearly define in the Pain; Patho-Physiology.(vi)
“Neurogenic pain is a direct consequence of diseases that affect the somatosensory system. Neurogenic pain can further be divided into neuropathic and functional pain. Neuropathic pain often results from lesions to the PNS and CNS. For example, neuropathic pain that occurs from CNS lesions includes diabetic neuropathy or acquired immune deficiency syndrome (AIDS) polyneuropathy, post-herpetic neuralgia, or lumbar radiculopathy.”
Pain; Patho-Physiology by LP3 Network states, “Neuropathic pain that results from lesions to the nervous system include spinal cord injury, multiple sclerosis, or a stroke. Functional pain is different from neuropathic pain in that it occurs in the absence of a defined anatomic lesion within the nervous system.”
LP3-Network Pain; Path-Physiology further states and reports, “Instead, functional pain results from an abnormal responsiveness or function of the nervous system. In other words, functional pain occurs from the dysfunction of pain modulation mechanisms, such as the activation of endogenous excitatory systems that amplify nociceptive signals or the dysfunction of inhibitory mechanisms.”(vii.)
“Thalamic pain syndrome, which usually occurs after a thalamic stroke or lesion to the thalamic nuclei, is an example of functional pain. The thalamus contains many inhibitory interneurons that can modulate transmissions to the brain.”
Therefore, “a lesion to the thalamic nuclei can often cause hyperactivity of the thalamic neurons, which are normally inhibited by a complex network of interneurons, to cause an intense pain covering a large part of the body. “
“Other examples of functional pain include fibromyalgia, irritable bowel syndrome, and some forms of noncardiac chest pains. The treatment of neurogenic pain often involves using pharmacologic approaches that reverse or reduce the hyperactivity of nociceptive neurons or activation of endogenous inhibition. For example, opioids, anticonvulsants, antidepressants, and cannabinoids are used to treat neurogenic pain. “(viii)
Therefore, when a practitioner finds a combination of medications that successfully treats chronic pain, they are reluctant to stray from that protocol. It’s akin to other protocols that are used in medicine that address chronic conditions such as cancer protocols, ALS protocols, hypertension step-care therapy, anti-coagulation protocols and others. “CONGRESS MUST INVESTIGATE THE DRUG ENFORCEMENT AGENCY (DEA)”(see video “Walgreens says I’m a dope addict”)
Typically, there is inflammation and therefore non-steroidal anti-inflammatories are used. Patients often experience anxiety so anti-anxiety agents such as benzodiazepines or tricyclics are used. In nociceptive pain, Gabapentin is often the first drug of choice. In lower back pain, whose underlying causes can be quite different from each other the presentation of muscle spasm or hypersensitivity, muscle relaxers such as cyclobenzaprine, metaxolone, baclofen, carisoprodol or others represent standard therapy.
It is unreasonable to expect a Diversion Investigator to have a complete understanding of these complex issues. Notwithstanding the basic foundation of patho-physiology is not in their 12-week course as compared to Physicians and Pharmacists requiring years of training to make adequate choices in this arena. “CONGRESS MUST INVESTIGATE”
ENOUGH IS ENOUGH
According to Professor Leo Beletsky and Jeremiah Goulka, (ii.) Director of Northeastern University’s Health in Justice Action Lab, where Jeremiah Goulka is a senior fellow in their September 17, 2018 New York Times article; “Congress Must Investigate.”
9.“Overdose deaths soared since so many people were prescribed opioids and many mixed them with alcohol and other sedative drugs. The D.E.A. could have marshaled a calibrated response, expanding evidence-based treatment and reducing the prescription of especially risky drug combinations.”“The Congress Must Investigate.”
12. “A decade into the crisis, more and more prescription drug users turned to the black market. Even though the D.E.A. had tried to “eradicate” illicit drugs for nearly 50 years, users could easily buy stolen and counterfeit pills, along with a cheaper option, heroin.”(ii.)
THE CONGRESS MUST REFORM OR DISBAND THE DRUG ENFORCEMENT AGENCY (DEA)
Today hundreds of medical practitioners sit in prison, their lives destroyed, property seized and stolen, families disrupted, due to of 40 years of the incompetence of this single heinous agency. The September 17, 2018 article concludes: “CONGRESS MUST INVESTIGATE THESE ILLEGAL ACTIVITIES OF THE DRUG ENFORCEMENT AGENCY (DEA)”
According to Professor Leo Beletsky and Jeremiah Goulka,
“ We ought to reinvent the Drug Enforcement Administration. Considering its lack of public health and health care orientation, the agency’s regulatory authority over the pharmaceutical supply could be transferred to a strengthened and independent Food and Drug Administration, while the regulation of medical and pharmacy practice can be ceded to the states.” “CONGRESS MUST INVESTIGATE THE DRUG ENFORCEMENT AGENCY (DEA)”
We have seen the culture of song and dance. Its power is always captured within a movement, while having traveled the passage from Barbados, Panama, Cuba Haiti, United States, Brazil, South Africa:(see video)
According to Professor Leo Beletsky and Jeremiah Goulka,
“Parts of the D.E.A.’s law enforcement mandate should be transferred to the F.B.I., delegated back to the local or state, or eliminated. A significant portion of the D.E.A.’s budget should be reinvested in lifesaving measures like access to high-quality treatment.” AND WE CONCUR
AND WE CONCUR
According to Professor Leo Beletsky and Jeremiah Goulka, and Norman J Clement, Jack Folson et al.
” It is more than clear Congress must take actions to reform or disband The Drug Enforcement Administration (DEA). We concur, DEA has had over 40 years to win the war on drugs. Instead its tactics have fueled the opioid crisis. To finally make a dent in this national emergency, we need to rethink the agency from the bottom up.”
My soul is liberated, from the Anthem of the “Good Death” “Festiva De Boa Morte,” the Good Death of Slavery, Cachoeria, Brazil. “Da me liberdante”(see video)
v.,vi., vii., viii., Pain: PATHOPHYSIOLOGY AND NEUROSCIENCE, Editors
Daphnee Lalonde, BSc, MSc. Radia Johnson, BSc, PhD, Miguel de la Garza, MD, DABA, DAPM, Kenneth Latta, BS Pharm, RPh, FIACP, FACA
LP3 Network CE Coordinator Disclosure – Medisca Consultant
Senior Associate, Gates Healthcare Associates
Disclosure – Health System Consulting Group LLC Consultant; Gates Healthcare Associates Consultant; Accreditation Commission for Health Care (ACHC); North Carolina Board of Pharmacy; Visante UK; Visante Inc.; and Medisca Consultant
Ken Speidel, BS Pharm, PharmD, RPh, FIACP, FACA
Senior Associate, Gates Healthcare Associates Disclosure – Accreditation Commission for Health Care (ACHC) Surveyor; Gates Healthcare Associates Consultant; Medisca Consultant
Oral Health in Relation to Pancreatic Cancer Risk in African American Women (see attached full text)
Hanna Gerlovin, Dominique S. Michaud, Yvette C. Cozier, and Julie R. Palmer DOI: 10.1158/1055-9965.EPI-18-1053 Published April 2019
Background: Incidence of pancreatic cancer is higher in African Americans than in U.S. whites. We hypothesized that poor oral health, disproportionately common in African Americans and associated with increased risk of pancreatic cancer in several studies of predominantly white populations, may play a role in this disparity.
Methods: We examined the relation of self-reported measures of oral health (periodontal disease and adult tooth loss) in relation to pancreatic cancer incidence in the prospective Black Women’s Health Study (BWHS). Cox proportional hazard analyses were used to calculate HRs of pancreatic cancer for women with periodontal disease, tooth loss, or both, relative to women who reported neither. Multivariable models adjusted for age, cigarette smoking, body mass index (BMI), type 2 diabetes, and alcohol consumption.
Results: Participants aged 33 to 81 were followed for an average of 9.85 years from 2007 through 2016, with occurrence of 78 incidence cases of pancreatic cancer. Multivariable HRs for pancreatic cancer incidence were 1.77 [95% confidence interval (CI) 0.57–5.49] for periodontal disease with no tooth loss, 2.05 (95% CI, 1.08–3.88) for tooth loss without report of periodontal disease, and 1.58 (95% CI, 0.70–3.57) for both tooth loss and periodontal disease. The HR for loss of at least five teeth, regardless of whether periodontal disease was reported, was 2.20 (95% CI, 1.11–4.33).
Conclusions: The poor oral health experienced by many African Americans may contribute to their higher incidence of pancreatic cancer.
Impact: Future research will assess associations between the oral microbiome and pancreatic cancer risk in this population.