You Can’t Handle the Truth!: Spies and Damn Lies

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I suppose that most everyone recalls Col. Jessup’s (Jack Nicholson) impassioned defense of a “Code Red” in the film A Few Good Men:¬† “You can’t handle the truth!

For Col. Jessup and many others, the “truth” is an absolute certainty. Every time I hear some “talking head” or “politician” state that “the American public deserves to know,” I can’t help but recall Col. Jessup’s staunch defense of his own “personal” truth or value system.

Many are beginning to realize that discovering the “truth” is – at best – a personal quest. Just when you think you have found that elusive kernel of “truth,” new revelations create additional uncertainties.

For reasons that are not entirely clear (personally, I think it may be intellectual laziness), many of our citizens have created a very simple coping mechanism which I call “tribal politics”. Instead of wearing tribal colors or a tattoo, we simply register for one political party or the other and then cheer loudly to see which party can humiliate members of the other party more viciously.

Civil discourse is now little more than a shouting match, with party supporters cheering on their political gladiators in much the same way that “the mob” cheered on the lions at the Colosseum some 2,000 years ago.

Sadly, our search for the “truth” (even if it could be found) has given way to a whole host of silly slogans and tribal chants that prematurely end any reasonable quest for something close to the truth¬†before it has started. Col. Jessup was probably correct in his assertion that we “can’t handle the truth.”

House of Straw: U.S. Election Meddling and Russia

I understand that people get rattled when they think that Russia meddled in the U.S. election.¬† While politicians and the media have been beating the “meddling” war drums loudly, I am entirely at ease with the thought that Kremlin spooks, lobbyists and hackers have been seeking to tamper with our election.¬† Gosh, I would be even more surprised if Russia hadn’t been doing everything possible to gain a political and military advantage over the U.S.

Why?¬† Well, U.S. clandestine agencies do exactly the same thing in other countries (friends and foes alike).¬† It is not unreasonable to expect that the U.S. would try to influence or manipulate results in other countries for our geo-political advantage.¬† I certainly hope that U.S. spies, hackers and “influencers” have been as active as Putin’s shady cast of characters.¬†¬† In fact, anyone who has played the very popular Online game Sid Meier’s Civilization¬†would attest to the value of spying to gain a competitive advantage over your competitors on the world stage.

It is just plain hypocrisy or stupidity to play the role of a “blushing” democracy when our spy agencies are doing exactly the same thing as Russian spies (or spies of most any other nationality).¬†¬†

While Congressional Hearings are surely a “big thing,” you simply must laugh if you expect spies to tell the truth.¬† Spies are trained to lie and the best ones do a very good job of it.¬† In my estimation, Congress and the Senate and the “American People,” will not be any wiser after this silly political charade plays out in D.C.

Tribal Behavior

When politicians lack the courage to rise above their tribe’s silly rituals, representative democracy suffers.¬† With tribal behavior lurking behind the sanctimonious sound bites of most politicians, it is the American public that suffers.

It is impossible to determine how the “Special Counsel” charade will play for the electorate, but those who place their lives on the line every day to defend our freedoms must be genuinely disillusioned by politicians who argue that they will get to “the truth” for the benefit of the American people.¬† ¬†If you buy into this silly argument, there is a bridge in Brooklyn that many of these politicians will sell you.

While tribal leaders of both parties continue to posture with meaningless soundbites, real issues like the reform of the Department of Veterans Affairs and opioid abuse (among many serious issues) will continue to be pushed into the background as politicians position themselves at taxpayer expense for the next election.

Maybe Col. Jessup is right, “We can’t handle the truth!”

The views expressed here are those of the author and NOT necessarily those of the members of SFTT.

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Opioid Crisis: Contributors to the Current Crisis

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The opioid crisis is real.  It is hard to believe that people dying from drug overdoses each year now exceed the total number of brave warriors who lost their lives in Vietnam.

Homeless Veteran

Regardless of one’s political affiliation, this drug epidemic must be faced with determination to eradicate this awful plague.¬† Yet, in looking at The President’s Final Report on Fighting Drug Addiction and Opioid Abuse, I find myself wondering how we got to this sad state of affairs in the first place.

Despite having only 5% of the world population, the US consumes 80% of the world’s global opioid supply.¬† More to the point, these are not disreputable drug barons south of the border peddling addictive drugs, but licensed members of the medical profession encouraging the use of lethal and addictive prescription drugs.

There have been pharmaceutical companies like the Sackler’s firm of Purdue Pharma that used their considerable marketing skills to hype the benefits and hide the risks of opioids, but the most obvious revelation is that the very institutions that should have protected our backs may have been complicit in enabling them:¬† the Healthcare System.

Specifically, the President’s Final Report (pages 20 – 23 with just a few summarized below) argues “that the modern opioid crisis originated within the healthcare system and have been influenced by several factors:”

Unsubstantiated claims: High quality evidence demonstrating that opioids can be used safely for chronic non-terminal pain did not exist at that time. These reports eroded the historical evidence of iatrogenic addiction and aversion to opioids, with the poor-quality evidence that was unfortunately accepted by federal agencies and other oversight organizations.

Pain patient advocacy: Advocacy for pain management and/or the use of opioids by pain patients was promoted, not only by patients, but also by some physicians. One notable physician stated: ‚Äúmake pain ‚Äėvisible‚Äô‚Ķ ensure patients a place in the communications loop‚Ķ assess patient satisfaction; and work with narcotics control authorities to encourage therapeutic opiate use‚Ķ therapeutic use of opiate analgesics rarely results in addiction.

The opioid pharmaceutical manufacturing and supply chain industry:   To this day, the opioid pharmaceutical industry influences the nation’s response to the crisis. For example, during the comment phase of the guideline developed by the Centers for Disease Control and Prevention (CDC) for pain management, opposition to the guideline was more common among organizations with funding from opioid manufacturers than those without funding from the life sciences industry.

Rogue pharmacies and unethical physician prescribing: The key contributors of the large number of diverted opioids were unrestrained distributors, rogue pharmacies, unethical physicians, and patients whose opioid medications were diverted, or other patients who sold and profited from legitimately prescribed opioids.

Inadequate oversight by the Food and Drug Administration (FDA):  The FDA provided inadequate regulatory oversight. Even when overdose deaths mounted and when evidence for safe use in chronic care was substantially lacking, prior to 2001, the FDA accepted claims that newly formulated opioids were not addictive, did not impose clinical trials of sufficient duration to detect addiction, or rigorous post-approval surveillance of adverse events, such as addiction. 

Reimbursement for prescription opioids by health care insurers: Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, largely paid for by insurance carriers. It is estimated that 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings.

Lack of foresight of unintended consequences: As prescription drugs came under tighter scrutiny and access became more limited (via abuse-deterrent formulations and more cautious prescribing), market forces responded by providing less expensive and more accessible illicit opioids.

Public demand evolves into reimbursement and physician quality ratings pegged to patient satisfaction scores:  Prior to this year, poor patient satisfaction with pain care could lead to reduced hospital reimbursement by Medicare through Value-Based Purchasing (VBP). There are often higher costs or no specific reimbursements for alternative pain management strategies, alternative pain intervention strategies, or spending time to educate patients about the risks of opioids.

Given the scope of the problem, there is no question that urgent action needs to be taken to address this epidemic.  Nevertheless, one must question why we should entrust leadership  of that initiative to the same institutions that enabled the epidemic in the first place.

As reported earlier by SFTT in Opioids:  Bipartisan Incompetence in DC and vividly documented in the joint Washington Post and 60 Minutes Report, there are entrenched political and business interests at play.    I find it highly unlikely that they will release their grip on the brass ring with so much money at stake.

To date, there is no price tag on resolving the drug overdose crisis.¬† Isn’t it ironic that the same cast of characters that profited from addicting our nation, now get a chance to monetize the painful withdrawal process?¬† In the corporate world, we refer to this as “double-dipping,” but in politics it is simply “business as usual.”

If you honestly believe that “big government” will get us out of the drug addiction and opioid abuse crisis the government and healthcare system colluded to create, P. T. Barnum has a bridge to sell you.

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