The Anti-Aging Myth

Attached a link to an interesting article published in today's Miami Herald highlighting the proliferation of so-called anti-aging clinics in South Florida whose unscrupulous operators are peddling steroids and growth hormones. I also recommend reading the excellent commentary by Fred Grimm. I hope that my fellow colleagues will join me in the effort to curtail the (ab)use of steroids and growth hormone products which can have serious and detrimental health effects. We should point out those so-called "doctors" who are profiting from promoting the use of steroids for muscle-building and human growth hormone (hGH). We should make it clear to those "doctors" that federal law prohibits the use of such substances except for rare circumstances such as growth retardation. Instead, those "doctors" are promoting the use of human growth hormone therapy to treat patients suffering from low energy, increased fat or a slowing sex drive. Now is time to act and to speak up. Yours Bernd

Gun Safety

Attached a link to an article titled " The Pediatricians vs. the NRA" published on slate.com. We need to continue pushing for the implementation of common-sense gun safety measures and doctors play an important role to communicate this issue with their patients. Yours Bernd VISIT MY NEW WEB SITE AT www.bwollschlaeger.com

Guns,NRA and the Affordable Care Act

The tragedy of the horrific shooting in Newtown Connecticut gradually faded from the daily news. Sadly, this shooting will be followed by another one and we will continue to seek answers to why it happened and what we could have done to prevent another massacre. In my opinion we have to recognize that the National Rifle Association (NRA) tentacles of influence have penetrated all aspects of our lives. An article published in the Washington Post highlighted that the National Rifle Association successfully lobbied for the national health care law signed by President Obama in 2010 to include provisions restricting the ability of doctors and health plans to collect patient information about gun ownership.The language, pushed by the National Rifle Association in the final weeks of the 2010 debate over health care was discovered only in recent weeks by some lawmakers and medical groups and is drawing fierce criticism. The provision says that “wellness and prevention” portions of the health-care law “may not require the disclosure or collection of any information” relating to the “presence or storage of a lawfully possessed firearm or ammunition in the residence or on the property.” Further, the measure says the law cannot be used to “maintain records of individual ownership or possession of a firearm or ammunition.” It adds that the price of health coverage may not be affected by the ownership, possession or use of guns. The deal to add gun language to the health-care bill was struck so quietly that several top officials in the Obama administration and in Congress had no idea the passages had been added until approached by The Washington Post last week. Its important to understand that this questionable legislative compromise erected an almost insurmountable barrier to the type of research required to address gun safety and gun control issues vital for addressing the issues involved in the post-Newtown policy debate. Again, the NRA has skillfully implemented a gag rule into the health care law preventing physicians to contribute to the data collection of ANY gun related issue. As parents, responsible citizens and physicians we need to continue and intensify our struggle against the metastasizing influence of the NRA in our government and lives. Yours Bernd ADDENDUM: Attached the original wording contained in Sec. 1001\2717 PHSA t: PROTECTION OF SECOND AMENDMENT GUN RIGHTS.- "(1) WELLNESS AND PREVENTION PROGRAMS.-A wellness and health promotion activity implemented under subsection (a)(l)(D) may not require the disclosure or collection of any information relating to- "(A) the presence or storage of a lawfully-possessed firearm or ammunition in the residence or on the property of an individual; or "(B) the lawful use, possession, or storage of a firearm or ammunition by an individual. "(2) LIMITATION ON DATA COLLECTION.-None of the authorities provided to the Secretary under the Patient Protection and Affordable Care Act or an amendment made by that Act shall be construed to authorize or may be used for the collection of any information relating to- "(A) the lawful ownership or possession of a firearm or ammunition; "(B) the lawful use of a firearm or ammunition; or "(C) the lawful storage of a firearm or ammunition. "(3) LIMITATION ON DATABASES OR DATA BANKS.-None of the authorities provided to the Secretary under the Patient Protection and Affordable Care Act or an amendment made by that Act shall be construed to authorize or may be used to maintain records of individual ownership or possession of a firearm or ammunition. "(4) LIMITATION ON DETERMINATION OF PREMIUM RATES OR ELIGIBILITY FOR HEALTH INSURANCE.-A premium rate may not be increased, health insurance coverage may not be denied, and a discount, rebate, or reward offered for participation in a wellness program may not be reduced or withheld under any health benefit plan issued pursuant to or in accordance with the Patient Protection and Affordable Care Act or an amendment made by that Act on the basis of, or on reliance upon- "(A) the lawful ownership or possession of a firearm or ammunition; or "(B) the lawful use or storage of a firearm or ammunition. '(5) LIMITATION ON DATA COLLECTION REQUIREMENTS FOR INDIVIDUALs.-No individual shall he required to disclose any information under any data collection activity authorized under the Patient Protection and Affordable Care Act or an amendment made by that Act relating to- "(A) the lawful ownership or possession of a firearm or ammunition; or "(B) the lawful use, possession, or storage of a firearm or ammunition.

Drug Facts: High School and Youth Trends

Attached a link to an article posted onthe NIDA web site titled "DrugFacts: High School and Youth Trends" It contains a mixed bag of good and bad news including: Illicit drug use among teenagers has continued at high rates, largely due to the popularity of marijuana. Marijuana use by adolescents declined from the late 1990s until the mid-to-late 2000s, but has been on the increase since then. In 2012, 6.5 percent of 8th graders, 17.0 percent of 10th graders, and 22.9 percent of 12th graders used marijuana in the past month—an increase among 10th and 12th graders from 14.2 percent, and 18.8 percent in 2007. Daily use has also increased; 6.5 percent of 12th graders now use marijuana every day, compared to 5.1 percent in the 2007. Comment: The marijuana legalization efforts will further contribute to the acceptance of this drug as a "harmless" mood altering substance with "no" addictive potential. Synthetic marijuana is a new and major concern. Also known as Spice or K2, synthetic marijuana refers to herbal mixtures laced with synthetic cannabinoids, chemicals that act in the brain similarly to THC, the main active ingredient in marijuana. These mixtures could be obtained legally until recently and are still wrongly perceived as a safe alternative to marijuana. Synthetic marijuana was added to the MTF survey in 2011. In that year, 11.4 percent of 12th graders—one in nine—reported using it in the past year. This year 4.4 percent of 8th graders, 8.8 percent of 10th graders, and 11.3 percent of 12th graders reported past-year use. Nonmedical use of prescription and over-the-counter medicines remains a significant part of the teen drug problem. In 2012, 14.8 percent of high-school seniors used a prescription drug nonmedically in the past year. Data for specific drugs show that the most commonly abused prescription drugs by teens are the stimulant Adderall and the pain reliever Vicodin. Positive trends in the past several years include reduced use of inhalants and less use of cocaine. Inhalant use is at its lowest levels in the history of the survey. Past-year inhalant use by younger teens dropped significantly between 2007 and 2012, from 8.3 percent of 8th graders and 6.6 percent of 10th graders to 6.2 percent and 4.1 percent, respectively. Past-year use of cocaine by 12th graders dropped from 5.2 percent to 2.7 percent from 2007 to 2012. Other drugs, such as heroin, methamphetamine, and hallucinogens, are holding fairly steady. Ecstasy (MDMA) is seeing a significant drop among teens. Past-year use of ecstasy by 12th graders decreased from 5.3 percent in 2011 to 3.8 percent in 2012. Among 10th and 8th graders it dropped from 4.5 to 3.0 percent and from 1.7 to 1.1 percent, respectively. Yours Bernd

Opioid Treatment in the News

The content of the WSJ article titled "Painkiller Advocate Thinks Twice" neither shocks nor surprises me. Its a fact that in the US opioids are being prescribed by medical practitioners with little or no training in their clinical indication, application, dosing and length of treatment. As an international medical graduate from Germany and Israel I can attest to the fact that the use of prescription narcotics is far more restricted and controlled in other countries than in the US. It appears that in the US doctors are practicing on another planet, where the laws and rules of medicine do not apply: no tolerance to drugs, no drug induced hyperalgesia , no addiction. In South Florida ( another planet by itself) I routinely see patients for opiod dependence treatment who are being prescribed ungodly amounts of Oxycontin,Percocet or Lorcet for unspecified chronic pain syndromes related to "old" injuries, migraine or back pain with no, or little, documentation. Most of them I safely took off opioids and they are doing much better. The article clearly points out that the proponents of long-term opioid treatment provided little evidence for their efficacy or safety. Furthermore, the article also highlights how pharmaceutical companies such as Purdue Pharma, influenced and manipulated key decision makers and regulators including the Federation of State Medical Boards. Regarding Dr. Portenoy: after years of opioid treatment "education" and hundreds of thousands of dollars worth of paychecks by the pharmaceutical industry he still seems to struggle with the reality that opioid dependence can be induced by prescription narcotics and can be treated successfully. This article serves as an attempt by Dr. Portenoy to emulate Pilate in Matthew 27:24 in which he washes his hands in public to proclaim his own innocence. I definitely do not believe him and neither should any of the readers of this article. Happy Holidays. Yours

A Common Sense Approach

Attached a link to an article titled "UM offers community service program for students facing minor pot charges" describing a University Law Enforcement Assisted Diversion Program (U-LEAD), a first in Florida, which offers young first-time offenders facing misdemeanor marijuana possession charges an opportunity to avoid criminal charges. Personally, I fully support the decriminalization of marijuana possession which differs from legalization of marijuana as a drug. Its about time that we start focusing on addiction treatment and stop warehousing non-violent offenders in already overcrowded jails. Yours Bernd

Success in Florida

Miami, October 25th, 2012: Attached an article published in yesterday's Sun Sentinel highlighting the significant decrease in prescription narcotics overdose deaths as a result of the crackdown on pain clinics and the availability of the Prescription Drug Monitoring Program. Deaths related to oxycodone, the widely abused prescription painkiller, dropped by 17.7 percent in 2011. Overall, prescription drug overdoses fell by slightly more than 6 percent. But despite the decline in deaths due to painkillers, overall drug-related deaths increased by 134 last year, to 9,135.The increase was largely due to more fatalities linked to cocaine, alcohol and benzodiazepines, normally prescribed for anxiety or insomnia. Florida Attorney General Bondi said that she was "shocked" at how quickly the reforms had reduced oxycodone deaths. The new laws were in effect for only about six months last year. And the state prescription drug monitoring database was operational for only about three months. Finally, we are making progress and I thank all of you who work so hard to make our great State of Florida a safer place to live for us and our children. Yours Bernd =============================================================================================== Prescription drug overdoses fall in Florida October 24, 2012|By Kathleen Haughney, Tallahassee Bureau TALLAHASSEE -- Deaths related to oxycodone, the widely abused prescription painkiller, dropped by 17.7 percent in 2011, state officials announced today. The drop, they say, is a direct result of the state's battle to root out pain clinics and crack down on pill pushers. Overall, prescription drug overdoses fell by slightly more than 6 percent. "This is a milestone," said Attorney General Pam Bondi. "We know we have a long way to go. We have so far to go in this fight against drugs, but these numbers to us in such a short time are truly remarkable." Still, Wednesday's report by the Florida Department of Law Enforcement was a jarring reminder of the severity of Florida's overdose problem. It showed that, despite the decline in deaths due to painkillers, overall drug-related deaths increased by 134 last year, to 9,135. The increase was largely due to more fatalities linked to cocaine, alcohol and benzodiazepines, normally prescribed for anxiety or insomnia. FDLE Commissioner Guy Bailey acknowledged that the state's effort to target oxycodone and other painkillers sold through "pill mills" may have had the effect of diverting addicts to other drugs. "I will tell you there is speculation that it is a supply and demand issue, that some of the addicts, if you will, that we've blocked from the oxycodone have turned to these other drugs in the place, but we don't know that," he said. "At this point, it's speculation." In March 2011, Bondi and Gov. Rick Scott created strike force teams, partly funded by a federal grant, to target prescription-drug dealers in "pill mills," amid reports that Florida doctors prescribed more oxycodone than any other state. That spring, lawmakers also passed a comprehensive measure to crack down on pain clinics and the following fall, pharmacists began logging prescriptions for most controlled substances in a state database. Bondi said that she was "shocked" at how quickly the reforms had reduced oxycodone deaths. The new laws were in effect for only about six months last year. And the state prescription drug monitoring database was operational for only about three months. However, the oft-repeated statistic that seven people per day are dying of prescription-drug overdoses still holds true, Bailey said. Though there has been a decrease, it hasn't been quite enough to get the number down by even one person. "There was a very slight downtick," he said. "It's a little less than seven." Added Dr. Jan Garavaglia, the medical examiner for Orange and Osceola Counties: "To me, [the report] just shows there's still a lot of deaths from prescription drugs." The report showed that benzodiazapenes, like Xanax, were found to have at least contributed to the death of 1,879 people, and were the principal cause of death of 39 of them. Easier to obtain than oxycodone, the medications are increasingly showing up mixed in a cocktail with other drugs. Bailey said the state hasn't been "flag flying" on benzodiazapenes the way agents have been highlighting oxycodone abuse. Bondi said that she is hopeful that next year, when the laws have been in place longer, the numbers will go down even further. She said that her office, combined with law enforcement, is also working on more prevention programs.