Unsafe Meds from India

Good news: the FDA is increasing its oversight of “…safety lapses, falsified drug trial results and selling (sic) fake medications,” according to a New York Times article by Gardiner Harris in the Raleigh News & Observer, February 17, 2014.
Bad news: the FDA has only been required by Federal law to increase its scrutiny of foreign drug manufacturers since 2012.
Good news: financing for the increased inspections by the FDA comes from fees from generic drug makers of roughly $300 million.
Bad news: Ranbaxy, one of India’s largest drug manufacturers paid a $500 million fine last year after pleading guilty to felony charges.
Bad news: India exports $15 billion in drugs annually, but the World Health Organization estimates 1 in 5 drugs from India are FAKES!
There are more news flashes in the Harris article; e.g., the FDA recently banned “…exports of adulterated generic versions of popular medicines, such as…” Accutane, Neurontin, and Cipro.
Have to wonder: will the FDA require labeling to identify where drugs are manufactured? When? In the meantime, do we have to check with our pharmacists, research the medicines we are taking, have our medicines independently tested……what else?
And why, pray tell, is this not HUGE NEWS? (I almost missed the one-column article on page 10A.)


Front Page “News?”

Saturday headlines on page 1 of the Raleigh News & Observer: “3 shrubs trigger lengthy court fight” and “McCrory: N.C. learned from storm.” On the front page….
A lengthy court fight about 3 shrubs? No wonder the courts are still clogged. This “case” went to the N.C. Court of Appeals. Good grief.
And what did N.C. learn from the storm? “Give drivers clearer information about what happens to abandoned cars and trucks, Cancel school sports events when appropriate, Do not put state employees at risk by pressuring them to travel to work, and Make sure there are enough resources in areas that typically receive lots of snow.”
First, snow doesn’t typically go to certain spots, with the possible exception of the entire states of Minnesota, Montana, North Dakota – you get the idea.
Second, are we just learing about those other things? Good grief.
Third, and I humbly submit more useful informaton: stay home, don’t drive in storms, and wait for the sun to come out a day or two later.
Finally, my standard procedure when I manage a state court system and large D.C. law firm when people asked me whether they could leave early was to say yes, as long as they didn’t stop by a day or two later to tell me how long it took them to get home, how their vehicles were towed, etc. Good grief.

Misleading if not false advertising on health care

Karen McGrew of Raleigh, NC, wrote to the Raleigh News & Observer about a misleading ad the Koch brothers sponsored.
You’ve probably seen it. Seems like it runs every a couple of times an hour.
The ad features a woman “…who suffers from lupus and lost her health insurance because of Obamacare.” Ms. McGrew writes that the woman’s lost health insurance was a Tennessee program with “a $25,000 maximum cap,” and that Tennessee, like North Carolina, did not take advantage of the Medicaid expansion under Obamacare that would have taken care of the woman’s problem.
Health insurance with a $25,000 maximum cap? Might as well not have insurance. A colonscopy and an MRI will probably bust that budget.
Ms. McGrew offers a reason the Koch brothers are willing to part with millions to run those ads: “…large corporations do not want to pay for health insurance plans required by ACA. It has been far cheaper to pay minimum wage with no benefits and have the rest of us foot the medical bills for their employees who have to use the emergency rooms for regular health care.”
Michael Connelly’s fictional Los Angeles detective Harry Bosch has it right: “Either everybody counts or nobody counts.” Seems clear to me that opposition to universal health care is equivalent to making sure there are some people who don’t count.

Health care: more things to check – facility and lab charges

Went for the ever-popular colonoscopy last fall.  Made sure the doctor was in-network, but the procedure was handled at the doctor’s office operating room.  Medicare Advantage handled the doctor, but now I have bills from an anesthesiologist I didn’t know so couldn’t have checked on, and a “facilities charge” of nearly $400.  Oh boy.

Had the annual blood tests by my in-network primary care doctor.  Exam covered, but now I have an additional bill from the lab that did the blood work.  Oh boy.

And here I thought things might get easier as I piled on the years.

The More Things Change……

The conservative Chicago Tribune: “an incompetent.”

The Los Angeles Times: “the most complete fumbler and blunderer this nation has seen in high office in a long time.”

Harold Ickes, Franklin Roosevelt’s faithful advisor: “You have the choice of retiring voluntarily and with dignity, or of being driven out of office by a disillusioned and indignant citizenry.”

Probably gave away the answer with the last one, but the person those three quotes were about or addressed to was President Harry Truman, just before the nominating convention of 1948.  Truman went on to an upset victory over New York Governor Thomas Dewey.  Today Truman is admired by many as one of our most effective presidents of all time.

French novelist Alphonse Karr (1808-90) came up with the proverb: The more things change, the more they stay the same.  As I read my book club’s February selection, The Presidents Club, Inside the World’s Most Exclusive Fraternity, by Nancy Gibbs and Michael Duffy, I am struck once again by the truth of that French proverb and by how much the present relentlessly imitates the past.

Which brings to mind another proverb, from George Santayana: “Those who cannot remember the past are doomed to repeat it,” from his book Reason In Common Sense, the first volume of his The Life of Reason.

I’m All for Progress, But I’m Against Change

Several of my friends have told me I should write about my years in Lansing, Michigan, 1972-81, spent working as the administrator for the state court system, a job created in the Michigan Constitution.  The title of the job was state court administrator and my immediate boss was the Chief Justice of the Michigan Supreme Court.  The entire Court was in essence my “Board of Directors.” 

At the time, there were approximately five hundred judges and several thousand court employees handling criminal and civil matters throughout the state. 

When I began the work, then Chief Justice Thomas M. Kavanagh and Associate Justice and former Governor G. Mennen (“Soapy”) Williams summoned me to the Chief’s office to talk about how they wanted to modernize court management.   Before appointment to the job in Lansing, I had been working with Justice Williams in the Detroit office on several projects involving the use of computer systems to streamline case flow, reduce or eliminate paperwork, and generally improve court management by putting reliable information systems in place.

In Justice Williams’ words: “We need to change how the business of the state courts is managed.  We need to modernize our court system.” 

Chief Justice Kavanagh added that he wanted a more specific set of definitions and policies regarding the Court’s constitutional supervisory authority, and that he expected the state court administrator to develop recommendations and projects that would achieve those results. 

As I agreed with those words I remember thinking: Wait a minute.  That’s me!  The full import of the job started sinking in and all of a sudden I thought I may have taken on too big and too important a job.

Despite my initial panic, during the decade of the 1970’s, we did make some changes that carried out Chief Justice Kavanagh and Justice Williams’ expectations.  Please don’t think I’ve lapsed into the “royal we.”  All that was accomplished in my Lansing years depended on the expertise and help of dozens of excellent judges and court staff, and my only intent is to include them with my use of “we.”  Just to name just a few of the judges whose help was greatly appreciated: Bill Peterson, Horace Giulmore, Al Horrigan, Mike Cavanaugh, Joe Sullivan, John Murphy, James Ryan, Blair Moody, Jim Lincoln, and dozens more.  In the state administrative office: Herb Levitt, John Mayer, Doris Jarrell, Norm Paelke, and Don Riggs, Dolores O’Brien, Jack Crandall, Art Chettle, Don Sherburne, Dennis Catlin, Terry Nafisi, Bill Rye, Judy Bartell, Dick Wilhelm, and Bruce White, and many others.  My everlasting thanks to all.

In retrospect I believe the most important change was the Court’s adoption of the Chief Judge Rule we proposed, which created the job of chief judge in the trial courts and set out the authority and responsibility of the job.

In typical fashion, when we started developing a proposal for the new rule, we gathered a representative group of judges, court staff, and others to help us in the state office develop a proposed rule.

As the process progressed, it became apparent that having a strong chief judge was going to be a rude awakening for many of the trial courts.  When one of the judges advising us objected to some of the authority we want to give chief judges, I did my best to defend the whole idea by loosely quoting Warren Berger, then Chief Justice of the U.S. Supreme Court: “It is as useless to believe the courts can function effectively if everybody just does his job, without having someone in charge, as it is to believe an aircraft carrier can function effectively with no skipper as long as everybody does his job.  Courts are complex social and government institutions that need skilled persons in charge of their management.”

One of our judges, whom I will always think of as an able and decent man, responded by telling me that: “I’m all for progress, but I’m against change,” a good-natured and universally true human sentiment that always makes me smile.

It took a long time and many drafts, but the Supreme Court adopted the Chief Judge Rule – I think it was in 1978.

Yet to be described: information systems, working with the legislature and the executive budget office, regional support offices, Michigan Judicial Institute, sentencing guidelines, court reporter certification, consulting services for trial courts, public information materials, court facilities study, and more.