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Monday links

  • Elderly small-town doctor who accepts mostly cash patients loses her medical license because she doesn’t have a computer to report to her state’s mandatory drug-monitoring program.
  • Where oh where have we heard stories like this before? And why do politicians never see the predictable end to the tale? California plans to slap monumental taxes on legal cannabis in hopes of filling up the state’s shaky treasury.
  • The paradise papers are shaking up some otherwise comfortable people.
  • Speaking of uncomfortable, Rand Paul’s neighbor attacked the senator and severely injured him.
  • Yesterday’s horrendous church shooting wasn’t the fault of a malcontent, dishonorably discharged, court-martialed, former bible-study teacher. It was — of course! — the Republicans’ fault. No doubt by tomorrow it’ll also be the fault of the NRA, the Tea Party, and all white males, living and dead.
  • Flight logs reveal that Bill Clinton flew on Jeffrey Epstein’s Lolita Express many more times than previously known.
  • Trump urges Kevin Spacey to consider a career in politics. 🙂
  • You thought those mixed-up cats and dogs were strange the other day? Have some bird-dogs.


  1. rochester_veteran
    rochester_veteran November 6, 2017 6:47 am

    Where oh where have we heard stories like this before? And why do politicians never see the predictable end to the tale? California plans to slap monumental taxes on legal cannabis in hopes of filling up the state’s shaky treasury.

    I know folks here have heard about this from me concerning New York State’s medical marijuana program. It’s performing well below expectations due to excessive regulations, taxes and availability:

    Money woes hamper New York’s medical marijuana program

  2. R.L.Wurdack
    R.L.Wurdack November 6, 2017 6:56 am

    IIRC the WA state lotto was to ‘totally fund’ K-12.’ Then the increase in tobacco tax was ‘to make up the difference.’ Then the increase in alcohol tax . . .

    The legislature passed just last session 3 additional ‘creeping’ taxes in behalf of K-12.

  3. larryarnold
    larryarnold November 6, 2017 8:02 am

    R.L., Just a guess, but I’ma thinking it’s for the usual reasons?
    1. The money isn’t really going to K-12 and
    B. Public K-12 is insatiable?

  4. MamaLiberty
    MamaLiberty November 6, 2017 8:11 am

    Yes, Larry… the money expected isn’t coming in, they have already spent the money they expected (how many slush funds we don’t know about…), so more “borrowing” and raising more taxes will have to take place…

    All involuntary government is insatiable, but I think the government schools have it down to an art.

  5. Jim Brook
    Jim Brook November 6, 2017 8:28 am

    Regarding that doctor in New Hampshire, it appears from the link to the state website that she is required to take state-mandated online training in opioid-based pain management, not that she is required to tell the gov what she prescribes. The state does a pretty thorough job of watching pharmacies for that information. Nevertheless, it is ridiculous that there would be a specific aspect of medical practice for which doctors have to get training from the state. Training should come from non-governmental medical groups. They probably just wanted to yank her license, or they could have offered a way for her to get the 3 hours of training in some other way, like going in to the capitol. New Hampshire is pretty small, after all. I was wondering if the state would try to retire me before my patients decide to retire me. I figure on continuing to practice until I am 85, 90, maybe even 95 years old. My patients should be the only ones with the authority to retire me, by deciding that I no longer have what it takes. If the state board decides to delicense me, then I will challenge the board members to a contest of medical knowledge via exams, a pushup contest to determine physical capabilities, a shooting contest to demonstrate hand-eye coordination and steadiness, and maybe grappling jiu-jitsu style. Any board members that cannot beat me should then retire.

  6. larryarnold
    larryarnold November 6, 2017 8:54 am

    I read through a bunch of comments on the doctor’s story. (So You Don’t Have To) The debate seems to be between those who think she should be retired because she’s not keeping up with procedures, and those who think the government should help her, for instance by providing a data entry assistant. Missing were any comments about why the government should get the data in the first place.

    I note in the Paradise Papers story, The timing couldn’t be worse for Republicans. Because we all know that only Republicans are filthy rich and use tax havens. [/sarc]

    And the story about Paul ends with The senator joins a growing list of lawmakers in both parties who have been attacked or threatened with violence this year. They come up with the baseball-field story, Paul, and a representative who missed votes because she was threatened. I suppose going from two to three is “growing,” but…

  7. Jim Brook
    Jim Brook November 6, 2017 9:12 am

    Yes, Larry, I think the schools are just insatiable. The second to lowest per-pupil spending is attributed to Idaho, at about $6,900 per year. The highest is New York, at almost $20,000 per year. Here in Idaho, it is actually about $8,000 per year, but the government officials do not admit that publicly. I went to the website of the state dept of ed, and found the financial summaries that their accountants produced, which show total expenditures, divided that by the number of pupils (also from their website) and found the spending is actually $8,000 per kid in Idaho. Idaho educrats are constantly whining about being cash-strapped. The overriding question is why do they need as much as $8,000 per student anyway? Who, except for the mentally incompetent or government workers, would not be able to educate a child on that much money, or even half that amount?

  8. Comarde X
    Comarde X November 6, 2017 9:24 am

    There’s ain’t enough, cannabis, booze, carbon, etc. taxes to ever come close to cover the up coming state employees pensiongate needs!

  9. Claire
    Claire November 6, 2017 9:44 am

    Dr. Jim — Hm. Re that elderly doctor without a computer, I wonder if the state is telling the whole truth.

    The Ars Technica article says, “Specifically, Konopka is unable to access the state’s required online drug monitoring program—it mandates that prescribers tell state authorities what quantities of opioids they’re issuing,” and another article I checked (WaPo, I believe, though I can’t recall for sure) said the same thing.

    Where I live, even my veterinarian is required to report certain drug prescriptions directly to the state (though the state backed down on its original plan to require vets to open their computer systems so that the state could just pop in and scoop out the information on its own). This is why, when my late Robbie began to have mid-night panic attacks I was unable to treat him with the first-choice medicine — because it would have put me on a list of suspected drug abusers. (Furrydoc was able to come up with a combo that helped and didn’t turn me into a criminal suspect.) I don’t know what the law is in New Hampshire, but certainly such laws — with their requirements for computer reporting — are proliferating. I’ll suspect the state’s not being candid until I learn otherwise.

  10. Fred M.
    Fred M. November 6, 2017 11:25 am

    And a little overlooked in the investigation of another mass murder is the fact that the killer had been on some psychotropic drug to “correct” a problem when he was in school. And this at the request of his parents. The one common factor in all the school/church killings (other than pure terrorist killings) is that the killer(s) had been using mind altering drugs. When will we ever wake up to what Big Pharma is doing to us as individuals and as a culture.When is enough…enough!

  11. Jim Brook
    Jim Brook November 6, 2017 11:33 am

    In Idaho, I just write the prescription, and then it gets into a state database of controlled substances. That would require the pharmacy reporting it to the state. I have never heard of doctors having to submit any kind of report to the state of what they prescribe.
    The article to which you link has a link to the state website that describes their requirements. This was copied from the state website:
    Board Approved Continuing Medical Education (CME) regarding Opioid Prescribing
    Pursuant to RSA 318-B:40, all prescribers required to register with the program who possess a U.S. Drug Enforcement Administration (DEA) license number shall complete 3 contact hours of free appropriate prescriber’s regulatory board-approved online continuing education or pass an online examination, in the area of pain management and addiction disorder or a combination, as a condition for license renewal. Please see the Board Approved Continuing Medical Education (CME) regarding Opioid Prescribing below.” It says nothing about doctors reporting prescriptions, but I suppose that might be found in another regulation. I doubt it.
    My med school was in Iowa, and then residency in North Carolina, and then I practiced briefly in Colorado before moving to Idaho 13 years ago, and I never ran across or even heard of that before. The heavy DEA involvement certainly makes prescribing pain medication difficult for doctors to do adequately for patients who have real needs. Doctors fear the DEA, and for good reason. Read Dr. Feelscared from to get an idea of the problem. I supply many types of meds to my patients, and because I do not engage in certain electronic activities, such as insurance claims, I do not have to turn my records over to the government like a HIPAA-covered doctor or pharmacy would. I can therefore protect my patients’ privacy, most especially from the government. I fall into the “country doctor escape clause” that arose from a lawsuit filed by the Association of American Physicians and Surgeons. However, I do not supply any controlled substances. I also avoid chronic opioid treatment except for patients who have become established with other issues, and are trusted. There are not many for whom I do it. I fear the DEA too much to open up that issue on anything but a very limited scale. People with legitimate pain needs suffer needlessly from the heavy government oversight that endangers doctors.

  12. Jim Brook
    Jim Brook November 6, 2017 11:46 am

    Fred M.,
    Are you saying that psychiatric medications do not help some patients, because an occasional person that is on them does something horrible? Do you think that nobody is helped by them?

  13. Claire
    Claire November 6, 2017 12:07 pm

    I’m not trying to answer for Fred, but there are definitely cases in which psychoactive medications have had the opposite effect they’re supposed to have — e.g. rendering a person more anxious, more paranoid, more prone to suicidal or homicidal ideation.

  14. Jim Brook
    Jim Brook November 6, 2017 12:22 pm

    Sure, there are those cases. That is why followup is important, so changes can be made. I saw a patient a few days ago who had gotten into meth, and completely messed up her life. Lost jobs, destroyed relationships, etc. Fortunately she had not yet run afoul of the law. She fortunately had an astute counsellor who recognized that she was self-treating ADHD and sent her my way. I started her on the wrath-attracting drug adderall. She has completely changed her life around. She is in management at a hotel chain now, and has earned their trust to the point where a promotion was offered where she would go to different hotels regionally and help with their management. ADHD is certainly overdiagnosed in small children. Yet it is also a real problem in some children. It is probably underdiagnosed in adults. It leads to addictions, impulsive behaviors, and mood disorders that can destroy relationships and careers, as well as the problems with getting things accomplished. The percentage of people who are on psychiatric meds that go on shooting sprees is vanishingly small. Can we really conclude that those people would not be a problem if they were not on meds, either?

  15. Fred M.
    Fred M. November 6, 2017 12:35 pm

    Website won’t allow me to leave a response.

  16. John
    John November 6, 2017 12:36 pm

    Be nice if a doctor could look at symptom A, and prescribe drug B, because it is always the right call. But we know people react differently to the same prescription. How does a doctor know if something is working? They can pretty well verify if a broken bone is healing correctly, or if an infection has been arrested. Drug effects rely often, in part, on testimony, and that is always of somewhat uncertain reliability.

  17. fred
    fred November 6, 2017 12:39 pm

    Soooo….would you pay stupid high taxes or just buy from the black market/criminal element? This should be about putting the cartels out of business,Cali plan just keeps them in,how STUPID and greedy can the aholes get?????

    If,and or when I need medical mj,can I grow my own in Cali,anyone know? And not still be a criminal in any respects,like a federal crime?

    Im a huge proponent for pain and opioid withdrawal using mj,like to see that expand federally,recreational?not my cuppa tea,but want to see that legal too,what you ingest is your business,nobody elses IMO.

    Dr Jim,interesting info,thank you.I like your style.

  18. fred
    fred November 6, 2017 12:41 pm

    Fred M,if you cant see the post button,use the tab key,it will scroll you down to where the button to post will show.

  19. MamaLiberty
    MamaLiberty November 6, 2017 12:50 pm

    I’m sure these pills CAN help some people, in certain situations. They might be good for some to use while they pursue alternatives, changes to lifestyle, and other health issues that need to be addressed. Very few medications are the total answer to human problems, obviously.

    After 30 years in medicine, I came to the conclusion that most people want a doctor – or SOMEBODY – to give them an easy fix, solve the problem for them, absolve them of responsibility and allow them to go on abusing their body and mind however they please. Then, blame the doctor – or somebody – for the crappy results.

    And you are so right, John. The effects of any psych drug are almost purely subjective, and the doctor does not see the patient in the context of their daily lives. Self reporting the therapeutic response is only as good as the integrity of the patient, obviously. And the doctor has precious little chance of knowing what is going on with people they see once a month, or less often.

    As for spree murderers… they have an awful lot more problems than a pill or four… but I suspect it doesn’t help anything in that case either.

  20. fred
    fred November 6, 2017 12:51 pm

    Soma makes me mean.Flat out verbally mean.I have to watch my responses and engage my brain fully before I answer people when I take that med,which because of that is rarely used.When I have to relax back muscles,I take it,and only half or quarter dose.

    A lot of psych drugs can have very negative actions in people,including loss of mental control.Im SURE there are many people getting psych drugs and very poor monitoring that are cannons just waiting to get loose.

    Not all Drs are as good at watching patients’ responses as Dr Jim,be it just not such good Drs or good Drs that just dont have the time,both happen.

    Get involved with clinic style medicine and quality of care drops through the floor,high MD turnover being a big issue.I understand why people HATE VA,they havent a clue who you are as a person,just an anonymous patient.Next to zero personal care,just a diagnosis to them.

  21. Jim Brook
    Jim Brook November 6, 2017 12:58 pm

    Thanks, Fred. I too would like to see marijuana, or cannabinoid oil, or whatever a person wants, available for pain control, epilepsy, nausea control during cancer chemo, or whatever medical conditions people want. That should be up to the patient, not the government. I would not even say it should be up to the doctor. Patients should be able to treat themselves if they choose. I am a consultant, not the patient’s parent. There should not be a government permission process involved. Eliminate the FDA, the DEA, and licensure. My solution to drug abuse would be to legalize it all, and completely eliminate the welfare state (Medicaid, Medicare, Social Security, TNFA, food stamps, the whole shebang). Let people do what they want to themselves, but bear their own consequences. Then if they cannot function well enough to sustain themselves, they would have to shape up. Well, I have probably been saying too much. I have been dominating this comment session. I can be a bit opinionated at times.

  22. MamaLiberty
    MamaLiberty November 6, 2017 1:22 pm

    Please continue to comment, Doc. You sound like my kind of people. Welcome indeed!

    I worked with exactly one doctor like you in those 30 years, and the DEA drove him out. But I hear good things about some of the “gray market” medicine that is thriving in some places.

  23. fred
    fred November 6, 2017 1:46 pm

    Dr Jim,and Mama Liberty,this retired RN agree’s with you fully.ML,your comments at on this subject,and Dr Jims’ here are exactly as I see it.

    True libertarians like us here get it.

    I dont care if you want to drink battery acid,its your life,YOUR body and sure as hell none of my business.Just dont ask me to pay for it.

    Im lucky,my Dr is also a collaborator with me regarding my health care,he is 68 and I reckon will retire soon.I dont know what i will do when I lose him,all Ive seen now is medical dictators,the individual is treated as too stupid to know what they want or need.

    Excellent comments on this thread folks if I havent specifically mentioned you.

  24. Claire
    Claire November 6, 2017 1:47 pm

    “Well, I have probably been saying too much. I have been dominating this comment session. I can be a bit opinionated at times.”

    Good heavens, opine away, Dr. Jim! You’ve earned your opinions the hard way and it’s clear people (including me) are more than grateful to hear them.

    Since I know you’re here in this thead, a personal message: You asked about getting a copy of Hardyville Tales. I’ve sent messages to the two emails I have for you, but I’m not sure they’re getting through. I’ll be happy to send you one or two or three copies. I just have to FIND you first and know how you’d like the book(s) autographed.

  25. John
    John November 6, 2017 2:16 pm

    “I’ll be happy to send you one or two or three copies. I just have to FIND you first and know how you’d like the book(s) autographed.”

    I’d like to help that happen. Claire, your PayPal link keeps moving around! HA! Found it!

  26. Claire
    Claire November 6, 2017 2:47 pm

    Well, Dr. Jim, it seems that John just bought some books for you. 🙂 And made my day, too.

    Once I have autograph instructions and your preferred sending addy, copies of HT will be on their way.

  27. coloradohermit
    coloradohermit November 6, 2017 3:16 pm

    I love the bird dogs! That’s some impressive photoshopping!

  28. John
    John November 6, 2017 3:47 pm

    “I love the bird dogs! That’s some impressive photoshopping!”

    The bulldog parrot.
    I want to send a live one to two of my siblings. Fair chance they would thank me 🙂
    Can’t find them on Amazon though, dammit.

  29. Dana
    Dana November 6, 2017 4:01 pm

    FWIW, Opioids are a “thing” in NH. Second only to West Virginia, apparently. I mention that not to advocate what the state’s doing, but just to add a little more context.

  30. Jim Brook
    Jim Brook November 6, 2017 5:46 pm

    Wow, thanks, John. Claire, I don’t know why I am not getting your emails. I even checked the spam folder. My email is My address is 20 N 3167 E, Idaho Falls ID 83402. I am not anonymous here, and my address is on my website, so I don’t care if it is out there in public. I just thought I was saying a lot and did not want to be too domineering. Well, okay then. I shall opine away.

  31. John
    John November 6, 2017 6:00 pm

    ” I just thought I was saying a lot and did not want to be too domineering. Well, okay then. I shall opine away.”


  32. larryarnold
    larryarnold November 7, 2017 8:32 am

    Opine indeed, Jim. Nobody here is domineerable.

  33. Claire
    Claire November 7, 2017 8:46 am

    “Opine indeed, Jim. Nobody here is domineerable.”

    Ain’t that the truth? Can you imagine anybody hereabouts being cowed or silenced by somebody else’s opinion? Even when the somebody else has Dr. Jim’s considerable expertise and credibility.

  34. ExpatNJ
    ExpatNJ November 8, 2017 2:58 pm

    Reply to fred November 6, 2017 12:51 pm: “Soma makes me mean …”

    I suggest trying 1 of these muscle relaxants (in descending order of preference:
    – Generic Name (Brand Name)
    – Tizanidine (Zanaflex)
    – Cyclobenzaprine (Flexeril)
    – Methocarbamol (Robaxin) [narcotic-like, higher interaction with EtOH]

    Many patient friends have had very good results with Zanaflex. But, be advised all can cause dizziness and/or sleepiness, or have other negative side-effects.

    [Note: This is not – nor is it intended to be – medical advice. I am not a licensed physician, nor do I play one on TV. This information is offered in good faith based on generally-recognized and accepted Scientific practices]

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