Are Drugs Past Expiration Date OK?

Pharmaceutical drugs, both prescription and over-the-counter come with an expiration date. This manufacturer expiration date applies to unopened containers and many patients think they should discard expired meds or that it will be dangerous to take them. But do they really need to toss the "old" one and buy something new?  Is there a problem with safety? What about the efficacy...will it still be potent?

The Medical Letter on Drugs and Therapeutic, a well-respected and non-biased publication, looked at shelf life extension and the stability of expired medications. They showed that all drugs they tested were stable for a year past the expiration date, and most drugs stored in unopened original containers were fine for 66 months. (that's 5 years!) One drug, theophylline retained 90% of its potency 30 years past its expiration date. 

Solutions and suspensions are less stable than solid medications. Epi-Pen auto-injectors may lose potency after the expiration date so that is one that should be replaced if expired.

So the answer to the above questions about using expired medications are here:

1.  Is there a problem with safety?  No. There are no reports of toxicity.

2.  Will it still be potent?  If the medication is in a cool, dry place in the original container, it is probably 90-100% potent and good for at least a year after expiration and maybe even up to 5 years later. Exceptions would be Epi-Pen, liquid antibiotics, and insulin.

What Is Neurodiversity? - Child Mind Institute

What You'll Learn

• What does the term neurodiversity mean?
• How does the neurodiversity movement, launched in the 1990s, help kids with autism, ADHD, or learning disorders?
• Neurodiversity also helps children cultivate self-esteem, viewing their differences not as impediments but simply as expressions of their uniqueness. As these attitudes are cultivated in children, they become better prepared to handle their neurodivergence in college, in the workplace and throughout their adult lives.Why are teenagers and young adults adopting neurodiversity as an identity?

Lately, neurodiversity has also become an identity sometimes adopted by teenagers who are struggling socially. The concept gives them a brain-based explanation for their difficulties: “I'm like this because my brain works this way.” And it can help them feel connected to others who identify as neurodivergent.

A central premise of the neurodiversity movement is that variations in neurological development and functioning across humans are a natural and valuable part of human variation and therefore not necessarily pathological (e.g., Jaarsma and Welin, 2012; Kapp, 2020)

Neurodiversity is a term that seems to be everywhere these days. And increasingly, kids and young adults are using it to describe themselves. But what does it mean to be neurodiverse, and where does the term come from?

In short, it means that there are many differences in the way people’s brains work. There’s no “correct” or “incorrect” way. Instead, there is a wide range of ways that people perceive and respond to the world, and these differences should be embraced.

The term neurodiversity was coined in the 1990s to fight stigma and promote acceptance of people with autism. But it also includes other conditions that involve neurological differences, such as ADHD and learning disorders like dyslexia and dyscalculia.

Autistic Self-Advocacy and the Neurodiversity Movement: Implications for Autism Early Intervention Research and Practice

The growth of autistic self-advocacy and the neurodiversity movement has brought about new ethical, theoretical, and ideological debates within autism theory, research, and practice.  The last two decades have brought about huge socio-political shifts within the world of autism theory, research, and practice. In the mid-1990s, the emergence of the internet provided a more accessible text-based means of communication and empowered a growing number of autistic people to connect and share ideas with one another (Dekker, 2020)1. Out of the early autistic social groups of the 1990s emerged autistic culture, the autistic self-advocacy movement, and the assertion that autism is a valid way of being. This environment also gave rise to the neurodiversity movement (Singer, 1998). Through the 2000s, the neurodiversity movement has been galvanized in a large part due to the voices, advocacy, and protest of the autistic community, facilitated through developments in online communication and networks (Kras, 2009) and is increasingly influencing academic, clinical, and lay understanding of autism and other forms of neurological difference

A central premise of the neurodiversity movement is that variations in neurological development and functioning across humans are a natural and valuable part of human variation and therefore not necessarily pathological (e.g., Jaarsma and Welin, 2012; Kapp, 2020). Neurodiversity as a social justice and civil rights movement intersects with the wider disability rights movement (Hughes, 2016). The most significant premise of both is that disability is not simply a defect in the individual, but arises from the interaction between a non-standard individual and an unaccommodating environment (the social model of disability; Oliver, 1990). Consistent with this stance, many neurodiversity proponents do view autism as a disability. From this theoretical underpinning, the neurodiversity movement makes several demands, including the recognition and acceptance of the value of cognitive variation as a form of biodiversity and hence its positive contribution to groups, communities and societies (the social-ecological perspective; Chapman, 2020) and equal rights leading to an end to discriminatory policies and practices (Runswick-Cole, 2014).

What Is Neurodiversity? - Child Mind Institute

The impact of using digital mental health apps.

The COVID-19 crisis has uncovered an enduring mental health epidemic globally.

New ethical questions about the safety, efficacy, equity, and sustainability of digital mental healthcare – online and through apps – are being raised around the world, and businesses are being held to account over their creation and endorsement of services.

Over 10,000 mental health apps are currently on the market, yet regulations do not fully protect against the sharing of sensitive consumer data or ensure a standard quality of, for example, chatbot psychologists. Telehealth has contributed to solving the paucity of mental health providers.  This was even more apparent during the COVID pandemic. The pandemic fueled a large uptake in the use of telehealth during the necessity of social distancing. 

Not only is telehealth used for telemedicine there are also numerous mental health apps available for patients.

Best overall: Moodkit

Best for therapy: Talkspace

Best for meditation: Headspace

Best for suicide awareness: Better Stop Suicide

Best for stress: iBreathe

Best for anxiety: MindShift CBT

Best for addiction: Quit That!

Best for boosting your mood: Happify

Best for eating disorders: Recovery Record

Best for OCD: NOCD

Best for sleep: Calm

Best for drinking less alcohol: Reframe

Best for quitting alcohol: I Am Sober

Mental Health the Trillion Dollar Challenge (Spotify)

What’s the challenge?

Between a quarter and half of the global population is affected by a mental disorder at some point in their life. Between 2011 and 2030, the cumulative economic output loss associated with mental disorders is projected to be $16.3 trillion worldwide.

Disruptive technologies – such as artificial intelligence and machine learning, digital reality, blockchain, and the cloud – are ushering in a new era for consumers, industries, and organizations. There are more than 10,000 mental health apps in the Apple App Store and the Google Play Store alone. Many of these 10,000 apps are not currently evidence-based, placing users at significant risk in some cases. Deloitte analyzed 190 global high-traction use cases for the toolkit, revealing 89% of the apps are not clinically validated.

Web 3.0, Virtual Reality, and the Metaverse will also contribute to new online therapies.

Online platforms have the potential to engage patients in a patient-centric manner.

Meditation Virtual Reality

Try Healium

The uptick in VR meditation parallels an avalanche of smartphone apps for mental health, which total about 20,000. VR is more immersive than smartphones and, some say, can enable feelings of awe, relaxation, mindfulness, and connection with fellow meditators— or their avatars, at least

Protecting users of digital mental health apps | World Economic Forum

COVID FACTS. VAERS Summary for COVID-19 Vaccines

VAERS Summary for COVID-19 Vaccines through 12/16/2022

VAERS Summary for COVID-19 Vaccines through 12/23/2022

What will 2023 bring ?

Are we on the verge of another pandemic year ? There are many factors now developing for the United States. Anthony Fauci M.D. has retired from the NIH. His parting advice.......wear a mask

1. China has lifted its strict Zero Covid policy

2. The United States has opened travel from China to the U.S. with certain provisions

Covid vaccination statistics for the U.S.

Are we well prepared for 2023 ?

Dr. Fauci’s Legacy--IT'S EASY TO THROW ROCKS

Dr. Marty Makary writes on the public health risk of putting America’s fate in the hands of one doctor. Dr. Markery himself is no slouch, Dr. Makary is the chief of Islet Transplant Surgery at Johns Hopkins and is the recipient of the Nobility in Science Award from the National Pancreas Foundation. He has been a visiting professor at over 25 medical schools, has published over 250 peer-reviewed scientific articles, and has been elected to the National Academy of Medicine.  A graduate of Bucknell, Thomas Jefferson, and Harvard Universities, he completed his surgical residency at Georgetown University and his specialty training at Johns Hopkins Hospital. is in a position to analyze the Covid 19 debacle. However, I disagree entirely with Dr. Makary's opinion.  

Anthony Fauci was brought into the spotlight by then President Donald Trump in 2020 at the beginning of the COVID pandemic. At times it was obvious he did not agree with Mr Trump's opinions and edicts.

Fauci became the ground zero  for controversy and suffered from overexposure by the media, who were desperate to headline breaking news.  For several years COVID disrupted normal life in America, fueled not so much by Fauci, but by news media.

Video Interview of Anthony Fauci MD

Here, on the last day of 2023 some are casting stones at Anthony Fauci, who today ends a long life of dedication to advising many Presidents, Republican and Democratic..

Perhaps  he should have retired at age 65.  The National Institute of Health does not have a mandatory retirement age. Many scientists have worked their entire lives and are brilliant investigators.  Not only do they research, they also teach and act as mentors to fellows, and medical students, advising others. The NIH has many divisions including Fauci's (the National Institute of Allergy and Infectious Diseases. Most of them only receive an appointment to NIH as gifted scholars after a very competitive application process. Many of them come from prestigious research universities, such as UCLA, Harvard, MIT, They have all demonstrated proficiency in publishing peer reviewed articles while they were. undergraduates, either in college and/or medical school.  Many are combined MD/PhD candidates. Most are still very productive and creative. They mentor younger minds and guide their scientific journey at NIH.

Anthony Fauci's origins at his parents Pharmacy in Bensonhurst, N.Y.

Fauci ascended to a leadership position at NAID over many years. His earliest contributions to science number 336 according to PubMed, the NIH catalog of peer reviewed medical science library.

Dr. Fauci’s Legacy: Dr. Marty Makary on the public health risk of putting America’s fate in the hands of one doctor.

Illegal Fentanyl is the scourge of overdoses by opioids

Contrary to media sources prescriptions for opioids (codeine, hydrocodone) is not the main cause of overdoses in the United States.

Illegal sources of fentanyl (DEA). 

Currently, China remains the primary source of fentanyl and fentanyl-related substances trafficked through international mail and express consignment operations environment, as well as the main source for all fentanyl-related substances trafficked into the United States. Seizures of fentanyl sourced from China average less than one kilogram in weight, and often test above 90 percent concentration of pure fentanyl.

This is how Fentanyl is causing so many deaths.  

Fifty times stronger than heroin, one hundred times stronger than morphine, fentanyl is very dangerous, a quantity like 2 grains of salt can be lethal.

A Tavares, Florida police officer has her coworkers to thank for taking decisive, lifesaving action when she overdosed ...from inhaling fentanyl powder accidentally when doing a traffic stop.

 It was a windy day and even though the officer wore protective gloves when handling the plastic containers of fentanyl powder, it is thought that she inhaled some of the fentanyl powder when the wind blew it into the air.  Fortunately her fellow officers had Narcan (a powerful antidote) readily available. Narcan is administered as a nasal spray.

Public health measures such as:

Establishing a leave behind program enables first responders to leave naloxone kits with the family, friends, or bystanders at the scene of a non-fatal overdose. Survivors are at high risk for repeated overdoses, providing naloxone to these individuals and their loved ones is especially important.

VIDEO: Bodycam Shows Officer Overdosing After Fentanyl Exposure, Fellow Officers Saving Her Life With NARCAN: 

A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians' Patterns of Practice and Quality of Care in Health Centers - PubMed

Who was that person in the white coat that saw me today in the clinic? Should I have called them 'Doctor'??

For the last several decades what we are calling mid-level practitioners. have been present in a variety of settings.  Various titles have been assigned to them dependent upon which route they took to become mid-level practitioners.  Nurse practitioner, physician assistant.  It is not so straight forward to telling you how advanced their training has been.

M.D.s and D.O.s normally have three or four years of undergraduate degrees leading to a bachelor's degree, followed by four years of medical school and then postgraduate training in a general or specialty area.  Over time this training has evolved and become longer.  Mid-level health personnel may have previously been R.N.s or taken a route to become a physician assistant in special programs. Some P.A.s may also become 'specialty PAs' serving as assistants to surgeons as extenders.

It becomes obvious a long white coat is no longer a beacon called 'doctor'.

This phenomenon has become more prominent due to organizations such as the. Veterans Administration Health System, the Department of Defense and some managed care institutions.  The initial impetus was to increase accessibiliy when physicians are in short supply and/or over worked.  A secondary gain has been some cost savings.  

In all instances the mid level practtiner reports to a licensed physician. They do not practice independently.

: Under the Affordable Care Act, the number and capacity of community health centers (HCs) is growing. Although the majority of HC care is provided by primary care physicians (PCMDs), a growing proportion is delivered by nurse practitioners (NPs) and physician assistants (PAs); yet, little is known about how these clinicians' care compares in this setting.  

 Primary analyses included 23,704 patient visits to 1139 practitioners-a sample representing approximately 30 million patient visits to HCs in the United States.

Measures: We examined 9 patient-level outcomes: 3 quality indicators, 4 service utilization measures, and 2 referral pattern measures.

Results: On 7 of the 9 outcomes studied, no statistically significant differences were detected in NP or PA care compared with PCMD care. On the remaining outcomes, visits to NPs were more likely to receive recommended smoking cessation counseling and more health education/counseling services than visits to PCMDs (P≤0.05). Visits to PAs also received more health education/counseling services than visits to PCMDs (P≤0.01; design-based model only).

Conclusions: Across the outcomes studied, results suggest that NP and PA care were largely comparable to PCMD care in HCs.

A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians' Patterns of Practice and Quality of Care in Health Centers - PubMed

Practice Environment and Workforce Outcomes of Nurse Practitioners in Community Health Centers

A survey of implicit bias training in physician assistant and nurse practitioner postgraduate fellowship/residency programs

The development of a visual dashboard report to assess physician assistant and nurse practitioner financial and clinical productivity

Factors associated with federally qualified health center financial performance

This study. is highly biased as it only surveys in FQHMCs. (Community Health Centers).  The cohort of patients is almost 100% Medicaid, a statewide payer through a variety of managed care programs such as the Inland Empire Health Plan and Molina Care.

Both of these entities are not for profit plans, paid for entirely by state and federal medicare funds.  These plans reimburse providers and hospitals amounts far below the usual and customary fees.  Hospitals and providers are paid barely their cost to provide services.  They could not exist without indirect subsidies by private payers.

The statistical results as to quality of care may be biased since the study is done by the entities themselves, to justify the use of mid level practitioners.

Nearly 90% of those living with long COVID have not returned to full health

The study of 988 participants conducted by APC Microbiome Ireland, an SFI research center based at University College Cork (UCC), in conjunction with Cork University Hospital (CUH) and long COVID Advocacy Ireland, provides greater insight into impact of long COVID on quality of life, mental health and physical health of people in Ireland. The study is published in HRB Open Research.

More than 2 out of 3 participants continue to experience fatigue, post-exertional malaise, palpitations, chest pain, stomach upset/nausea, memory problems, muscle pain or joint pain. The median number of long COVID symptoms reported was 8 for each person, highlighting the substantial burden of this disease. The median reported time since the initial COVID-19 infection was 12 months

Six out of every ten missed workdays

A high proportion of long COVID patients reported that they still have a moderate to severe limitation in their ability to carry out their usual daily activities. Nearly 4 of 10 people were severely limited in their ability to work and 6 of every 10 have missed workdays (at some stage) due to their long COVID symptoms. 16% of respondents were unable to work at the time of the survey due to long COVID and were receiving social welfare supports.

The survey was produced in a researcher-clinician-patient partnership involving Professor Liam O'Mahony, APC Principal Investigator and UCC Professor of Immunology, Dr. Corinna Sadlier, Consultant in Infectious Diseases at CUH, and Ms. Tanja Buwalda, long COVID sufferer and representative of "Long COVID Advocacy Ireland."

This working group included patient engagement to ensure the survey would impact patients in a targeted and meaningful way, and ultimately help inform care pathways in the treatment of long COVID.

SARS-CoV-2 infection not only impacts the lungs

Professor O'Mahony said, "This survey highlights that SARS-CoV-2 infection not only impacts the lungs but can have significant long-term effects on multiple organ systems following clearance of the acute SARS-CoV-2 infection in many Irish people who were otherwise healthy previously. The reasons why some people develop long COVID, and others do not, are still unclear. While many different biological mechanisms have been proposed, we are focusing on the role of the immune system and the microbiome in these complicated disease processes.

Dr. Corinna Sadlier said, "The study demonstrates the significant and wide-ranging impacts long COVID is having not only on physical health, but also on ability to carry out usual daily activities, return to employment and overall quality of life.Fatigue is the single most frequent symptom reported," Professor O'Mahony continued.  

Ref:

 Liam O' Mahony et al, Impact of Long COVID on health and quality of life, HRB Open Research (2022). DOI: 10.12688/hrbopenres.13516.1

Nearly 90% of those living with long COVID have not returned to full health: 

This Couple Died by Suicide After the DEA Shut Down Their Pain Doctor

“There are millions of chronic pain patients suffering just like me," Danny Elliott wrote before ending his life. "Nobody cares."

DEA, FDA, CDC often overstep their missions.  This is all to common a problem.

Many physicians should push back and be aggressive if confronted by their state medical boards, or other regulatory bodies.  Organized medicine must do more to protect patient rights to access treatment. A referral to a pain specialist may not be adequate protection.  One would think an ethical and properly trained pain medicine physician would escape algorithm care.  Then again there are other means to alleviate pain.  Suicide should not be an option.

It was a Tuesday in early November when federal agents from the Drug Enforcement Administration paid a visit to the office of Dr. David Bockoff, a chronic pain specialist in Beverly Hills. It wasn’t a Hollywood-style raid—there were no shots fired or flash-bang grenades deployed—but the agents left behind a slip of paper that, according to those close to the doctor’s patients, had consequences just as deadly as any shootout.   

On Nov. 1, the DEA suspended Bockoff’s ability to prescribe controlled substances, including powerful opioids such as fentanyl. While illicit fentanyl smuggled across the border by Mexican cartels has fueled a record surge in overdoses in recent years, doctors still use the pharmaceutical version during surgeries and for soothing the most severe types of pain. But amid efforts to shut down so-called “pill mills” and other illegal operations, advocates for pain patients say the DEA has gone too far, overcorrecting to the point that people with legitimate needs are blocked from obtaining the medication they need to live without suffering. 

Starting around 2016, a backlash to prescribing opioids began to spread across the U.S. healthcare system, sparked in part by guidance from the Centers for Disease Control and Prevention (CDC) that prompted scrutiny of patients on doses equivalent to over 90 milligrams of morphine per day. The National Committee for Quality Assurance, which develops quality metrics for the healthcare industry, has implemented its own 90 milligram threshold, and patients over that baseline count as receiving “poor care,” regardless of their dose history. In practice that means doctors have strong incentives to reduce the dosage, even for someone like Elliott, who had been taking the same prescription for years, and even if it’s not necessarily in the best interests of the patient. Since 2018, the CDC has developed an initiative called the Opioid Rapid Response Program, which is supposed to assist when doctors lose the ability to prescribe pain medication. Stephanie Rubel, a health scientist in CDC’s Injury Center who leads the program, said when the DEA visited Bockoff’s office, “a healthcare professional was onsite in case any patients arrived for their appointments.”

One of Bockoff’s patients who relied on fentanyl was Danny Elliott, a 61-year-old native of Warner Robins, Georgia.

This Couple Died by Suicide After the DEA Shut Down Their Pain Doctor

The Vaccine Confidence Project

Throughout the world confidence in the Covid vaccine varies

State of Vaccine Confidence in the EU (2022)

State of Vaccine Confidence in the EU (2022) by Country

              Download pdf

Vaccine confidence among the public and healthcare professionals is high across most populations, with some exceptions and caveats. Between 2018 and 2020, there was a large increase in public perception towards vaccines across the EU, particularly towards the seasonal influenza vaccine. Many of these 2020 gains have since been reversed. Perceptions towards the importance, safety, and effectiveness of vaccines have declined across the EU between 2020 and 2022. Across the EU, the view that vaccines are safe remains higher than 2018 levels. Yet, EU-wide changes in public perceptions towards the importance and safety of vaccines shows that strong vaccine-dependence and variability in vaccine confidence exist between countries and within sociodemographic characteristics. 

An evaluation into the differences in public confidence between over 65-year-olds and 18-34-year-olds reveals key insights into an increasing ‘vaccine confidence gap’, which needs to be addressed. The difference in vaccine confidence between 65-year-olds and 18-34-year-olds appears to be widening over time across many EU member states, with 18-34-year-olds becoming less confident between 2018 and 2022.

Vaccine confidence among healthcare professionals remains high in 2022 Above 90% of HCPs surveyed in all EU member states agree that vaccines are important. 

Above 90% of HCPs surveyed in all EU member states agree that vaccines are safe, except for France, Greece, and Austria. 

Healthcare professionals across the EU are highly likely to recommend the MMR, seasonal 

influenza, and COVID-19 vaccines to patients, though likelihood to recommend the HPV vaccine shows high variability between countries.

HCPs likelihood to recommend seasonal influenza and COVID-19 vaccines to pregnant women are generally lower than their likelihood to recommend these vaccines to other patients 

Variability in vaccine confidence exists between countries, among vaccination types, and within sociodemographic characteristics.

The age “gap” in confidence is widening between younger and older age groups   

Between 2018 and 2022, there is increasing polarisation between older and younger age groups in terms of perceptions of vaccines with over 65s becoming more confident and 18-34- year-olds growing less confident.

The seasonal influenza vaccine is the only vaccination where an inverse of this trend can be seen, where the gap between older and younger age groups is narrowing.

Research Feed — The Vaccine Confidence Project

Surprise billing ban implementation

Health insurers have limitations on what providers you as the patient can see. Most of us are familiar with network providers and out-of-network providers, and the differential in payments.

Patients are careful to select in patient providers as outpatients, and they have a choice. However when hospitalized and seen by a number of providers the patient loses the option of selecting a provider.

Case in point. A patient is admitted by his PCP (in network), then requires a specialty  provider which is usually selected by the PCP.Most of the time the PCP and specialty provider belong to the same network or have an agreed common MSA, HMO or PPO.  In those instances the correct billing is automatic.  However in  cases where a network provider is not available the patient has no choice. This can happen if a patient needs surgery and the anesthesiologist is not in network, or if a patient requires X-rays, or  a critical care consultation in an intensive care unit.

Hospitals are careful to accept and join networks in which  their physicians are members.

Disputes often arise and a means to adjudicate the billing are important.

A federal judge poked at the government’s defense of a rule that is designed to help third parties resolve payment disputes between healthcare providers and insurers

Federal Judge Jeremy Kernodle heard arguments Tuesday in a case challenging the implementation of a federal law that protects consumers from surprise medical bills.  Congress in its infinite wisdom created this law to protect patients.

The No Surprises Act was a win for consumers who found themselves stuck with hefty medical bills after being caught between provider and payer pricing disputes. Patients were sometimes stuck with the remaining balance of a medical bill from an out-of-network provider with insurers paying only some — or none — of the bill. Patients were sometimes surprised by these bills after going to an in-network facility and unknowingly treated by an out-of-network clinician. 

With patients shielded from surprise bills, it places the burden on payers and providers to resolve payment disputes when an out-of-network claim arises. If they can’t come to an agreement on reimbursement, payers and providers can opt to engage in an independent dispute resolution process and turn to a third-party arbiter. Each side submits a payment amount, leaving it up to the arbiter to pick one.

Patients are usually confused and poorly prepared to chose a plan which can cover most of their health needs

Judge questions surprise billing ban implementation during court hearing | Healthcare Dive

What Happens When Doctors Can't Tell the Truth?

By Katie Herzog (with insertions by this author Gary M. Levin M.D.)

Whole areas of research are off-limits. Top physicians treat patients based on their race. An ideological 'purge' is underway in American medicine

That’s one of the lessons I have learned over the past few years as the institutions that have upheld the liberal order — our publishing houses, our universities, our schools, our non-profits, our tech companies — have embraced a Manichean ideology that divides people by identity and punishes anyone that doesn’t adhere to every aspect of that orthodoxy.  This duality creates bias and inaccuracy in scientific studies.  

I always thought that if you lived through a revolution it would be obvious to everyone. As it turns out, that’s not true. Revolutions can be bloodless, incremental and subtle. And they don’t require a strongman. They just require a sufficient number of well-positioned true believers and cowards, like those sitting in the C-suite of nearly every major institution in American life.

You see C-suite  members rarely know what is going on in the basements of their corporations, tending to observe from 50,000 feet what is happening at sea level. The higher the level, the less granular is the data.  Whether intentional deceitful or accidental the outcome can be misinformation and dangerous.

That’s one of the lessons learned over the past few years as the institutions that have upheld the liberal order — our publishing houses, our universities, our schools, our non-profits, our tech companies — have embraced a Manichean ideology that divides people by identity and punishes anyone that doesn’t adhere to every aspect of that orthodoxy.

This is wrong when it happens at a company Apple or Condé Nast. But there are sectors where the stakes of the ideological takeover are higher. Like K-12 education.The rapid explosion of communication via the internet and the digital age presents certain new challenges.

But if any area is more urgent, it is the world of medicine, where the ability to speak truthfully is quite literally a matter of life and death. Without being able to discuss reality and take intellectual risks, it’s impossible to get to the truth. No truth, no medical progress.

Doctors who are alarmed at what they are witnessing in some of the top medical schools and hospitals in the country. It was clear that this is a story that deserves to be told.  In my time (that dates me) scientific research was a secretive secretive industry. There were fewer journals and it was common policy to be secretive about one's research.  Believe it or not I was told by a senior scientist to not discuss our work for fear it would give advantage to our 'competitors'.

There is significant competition for grants, awards, the number of articles one had published and the Nobel Prize.  It took considerable time to do research, write the results and get it published in a reputable peer reviewed journal.  At times this can consume several years and require resubmission. At times the research scientist will not resubmit his article due to the effort. He/She may decide to submit to a lesser known journal as an alternative.

Benefits of Peer-Reviewed Literature

Peer-review process ensures that the quality of the research and validity of the findings are high.

Information on highly-detailed subject matter and complex analyses  

Easy to search through millions of articles with online databases.

Limitations of Peer-Reviewed Literature

Highly-detailed and complex analyses may be irrelevant for users who are simply searching for descriptive statistics and basic measures of public health

May require a subscription to journals or databases to access articles (can be costly for individuals, although many universities and other organizations provide access to students and faculty)

In 2022, this literature is easily accessed in Pubmed, Medline, or Google Scholar. Previously, non-scientists were not aware of Pubmed or Medline, both of which are hosted by the National Institute of Health and its subsidiary National Library of Medicine.

The categories of literature range from basic sciences (such as chemistry, physics, organic chemistry to clinical articles organized by medical or organ specificity.  There are also review articles which summarize advances in each category. These articles are not about original articles and are written by experts in each category.

Articles published in media such as news sites, new media and social media are often not researched adequately.

The review committee for each journal is the GATEKEEPER. (According to Urban Dictionary, gatekeeping is defined as, "when someone takes it upon themselves to decide who does or does not have access or rights to a community or identity". Essentially, gatekeeping is an ongoing practice that a hierarchy of power within the community and further excludes others.One cannot overemphasize the importance of the editorial advisory board.) (more about this later)

In this age of accelerated knowledge gain, communication and a control mechanisms which were overloaded by the COVID pandemic an atmosphere of anxiety and fear was rampant among the public.  Social media added to the chaos because anyone can publish fake news or misinformation.  Most posts do not include references.  

It is the social media author's responsibility to provide this in their post. A failure to do so is akin to. yelling "FIRE" in a crowded theater.  

Transparency and informed patient consent have become a  foundational part of healthcare.

Some journals publish article on the internet, which are open access.

PLOS Medicine   is a nonprofit, Open Access publisher empowering researchers to accelerate progress in science and medicine by leading a transformation in research communication.

https://www.thefp.com/p/what-happens-when-doctors-cant-speak

California has plenty of anti-COVID drugs, but few prescriptions -

“Why are doctors still so afraid to [prescribe] Paxlovid,” tweeted Dr. Purvi Parikh, an infectious disease expert and clinical assistant professor at New York University Grossman School of Medicine.

Public health sites, newspapers, social media are all espousing the lack of enthusiasm of providers to recommend  drugs which include pills such as Paxlovid

What these sources are not telling you are the possible serious complications which can occur with Paxlovid or Molnupiravir.  It has been shown these molecular agents can cause mutagenesis creating unknown variants which may be cardiotoxic, causing heart dysfunction, and even death.  Public health studies and statistics are misleading as the risk factors are only probabilities, and not absolutes.  There is no predictability of adverse occurrences

Although all these sources emphasize the drugs are free and widely available,  officials say some doctors are not prescribing them as much as they should. Paxlovid and another oral medication known as molnupiravir.

Public health sites argue, “Many of our hospitals across the state are reaching capacity — if they aren’t there already — and one of the ways we can reduce admissions is by treating individuals who have COVID-19,” Dr. Tomás Aragón, the California public health director and health officer, said in a statement. “Unlike previous years, people now have safe and effective treatment options that can prevent serious disease, reduce hospitalization and may also lower the risk of long COVID-19 symptoms.”

Rate of bivalent boosters in population over 65 yrs

Much of the online reporting is duplicated verbatim from the CDC and/or WHO posts.  They basically are parroting (plagiarising information from National sources.

Physicians usually do not accept isolated studies and prefer to source peer reviewed articles from physician scientists in reputable journals, such as the Lancet, New England Journal of Medicine or Infectious Disease Journals. Much of what is published by conventional media are not adequately resourced by authors in a rush to be the first to publish  news worthy information even if it is not correct.

Should Physicians prescribe Paxlovid ?  There is no absolute answer, because it depends upon the severity, the age, presence of other chronic conditions, such as chronic kidney disease and the presence of immunocompromise.   

mRNA vaccines and treatments should not be used lightly or without a careful history and severity of the illness.

Data snapshot: Covid-19 bivalent booster uptake winners and losers among seniors. Comments from Jeremy Faust MD

Consult with your physician, before going to a CVS, RiteAid, of Walmart.

California has plenty of anti-COVID drugs, but few prescriptions - Los Angeles Times