Don’t Look Behind The Curtain…

On the 12th of this month, media reported that HHS was deleting twenty years of medical guidelines from its government website.

The Trump Administration is planning to eliminate a vast trove of medical guidelines that for nearly 20 years has been a critical resource for doctors, researchers and others in the medical community.

Maintained by the Agency for Healthcare Research and Quality [AHRQ], part of the Department of Health and Human Services, the database is known as the National Guideline Clearinghouse[NGC], and it’s scheduled to “go dark,” in the words of an official there, on July 16.

Medical guidelines like those compiled by AHRQ aren’t something laypeople spend much time thinking about, but experts like Valerie King, a professor in the Department of Family Medicine and Director of Research at the Center for Evidence-based Policy at Oregon Health & Science University, said the NGC is perhaps the most important repository of evidence-based research available.

Why would the administration delete this information? Experts say it was a unique repository that got 200,000 visits a month.

Medical guidelines are best thought of as cheatsheets for the medical field, compiling the latest research in an easy-to use format. When doctors want to know when they should start insulin treatments, or how best to manage an HIV patient in unstable housing — even something as mundane as when to start an older patient on a vitamin D supplement — they look for the relevant guidelines. The documents are published by a myriad of professional and other organizations, and NGC has long been considered among the most comprehensive and reliable repositories in the world.

So what was the pressing issue that forced elimination of a well-regarded, well-used, totally unpolitical resource?

AHRQ agrees that guidelines play an important role in clinical decision making, but hard decisions had to be made about how to use the resources at our disposal,” said AHRQ spokesperson Alison Hunt in an email. The operating budget for the NGC last year was $1.2 million, Hunt said, and reductions in funding forced the agency’s hand.

Not even an archived version will remain.

It’s hard to credit the notion that fiscal restraints required the deletion. After all, our “President” is spending billions on such things as repainting Air Force One and requiring a military parade a la Third-World Dictators. Toward the end of the linked report, there’s a hint:

The NGC has a screening process designed to keep weakly supported research out. It also offers summaries of research and an interactive, searchable interface.

That gatekeeping role has sometimes made AHRQ a target. The agency was nearly eliminated shortly after its establishment, in the mid-90s, when it endorsed non-surgical interventions for back pain, a position that angered the North American Spine Society, a trade group representing spine surgeons. A subsequent campaign led to significant funding losses for AHRQ, and since then, the agency as a whole has been a perennial target for Republicans who have argued that its work is duplicated at other federal agencies.

Organizations writing the guidelines for the big drug companies are paid handsomely in order to promote the companies’ products. NGC’s process provided a vetted, evidence-based resource comparatively free of that kind of influence. Gee-I wonder why it became a target for the GOP?

In 2016, when former head of HHS Tom Price was still a Congressman, one of his aides insistently protested publication of a study that was critical of a drug manufactured by one of Price’s campaign donors. According to ProPublica, Price wanted the agency to pull the critical research down.

While Americans are transfixed and distracted by the antics of our demented (and probably traitorous) accidental President, the largely unrecognized and unseen functions of competent governance are being systematically dismantled.

Even if America survives this maniac and his cabinet of disreputable and incompetent tools, it will take generations to repair the damage.

34 thoughts on “Don’t Look Behind The Curtain…

  1. Thank you for educating us to what this administration is doing to us. I am continually distressed that major and minor electronic and print media pay so little attention to the issues that directly affect our health, water, air, schools, public safety, infrastructure, and more. I’m glad you are paying attention to more than the ‘shiny objects’ and sharing this kind of information with all of us.

  2. I recently read that these idiots spent “Unused or surplus” Ryan White funds to cover some of the expenses THEY created with the Immigrant mess. These people have NO shame. None.

  3. Simply put; this is more of Trump’s deregulation of our formerly Constitutional based government. This one happens to fit nicely into his determined efforts to repeal the ACA and the loss of regulations in the EPA…another life-or-death issue which will effect all middle-Americas who struggle daily with soaring health care costs on all levels. Now; we will question the quality of health care we receive due to the lack of a knowledgeable source of information for our health care providers.

    In other words; this is simply another form of Trump’s Fascist genocidal leadership to rid this country of those he and his Brown Shirt administration deem unworthy. When Trump and Putin can finally seal the deal on the United States as a Russian satellite country; the full Holocaust will begin. Currently; the Republican dominated Congress is providing their full support for this to become reality and the Democrats appear to have brought a knife to a gunfight.

    “Even if America survives this maniac and his cabinet of disreputable and incompetent tools, it will take generations to repair the damage.”

    IF…IF…we are strong enough to bring about that hoped for “Blue Wave” in November; it will be the first step in a journey of a thousand miles.

  4. Did you mean to say “fools” rather than “tools” in the last sentence?
    Either works………

  5. Connie,

    Who are we kidding? We’re all FOOLS, we’re all complicit, one way or the other, in allowing the rise of the Three Losers: Trump, Pence, & Bannon.

  6. Hate to break the news but Republicans aren’t the only ones soaking in healthcare monies: pharma, insurance, doctor’s unions, hospitals and don’t forget about the objections of anything science by the theocrats.

    One only needs to study Indiana or any other red state to see how corrupt the regulators have become. The WHO just release a study linking air pollution to diabetes. Indiana suffers from the worst air imaginable because of our coal burning plants. I’ve been introduced to a physician in Southern Indiana who is very vocal about what’s happening to her patients…ALL children.

    Bad air and sick Americans might be good for some businesses, though. How about Eli Lilly, the Indiana maker of insulin and other diabetic drugs.

    My physician tells me that if she came out and spoke and what takes place within the healthcare industry, her license would eventually vanish to practice medicine.

    Americans are VERY SLOWLY awakening to our corrupt empire and what it will do for profits and what it will do to keep those profits.

    ‘Looking behind the curtains is the role of our free press and government regulators.’

    So what happens to this finely tuned democracy when important checks and balances don’t function properly?

    It becomes the Wild Wild West.

  7. Todd,

    “My physician tells me that if she came out and spoke and what takes place within the healthcare industry, her license would eventually vanish to practice medicine.”

    You better believe it. The same goes for any attorney who is dumb enough to speak-out, like me.

    “One only needs to study Indiana or any other red state to see how corrupt the regulators have become.”

    You hit the nail on the head with that one. Who is now regulating the regulators? It’s Public Enemy #1.

  8. I find it hard to believe that a bunch of super capitalists running a government agency would destroy a “commodity” as valuable as medical information. I see a new on-line business springing up where paying subscribers and advertisers can market all that info back to the medical professionals who produced it in the first place.

    Never underestimate the plots and plans of those who would make their money off of the suffering of others, even it they have to create more suffering to do so.

  9. Ooops! No coffee yet. That line should have read, “I see a new on-line business springing up where those who hold the information can market it back to those who produced it in the first place.”

  10. We can only hope that some forward thinking medical schools might get together and provide these resources. Are you listening Harvard, Brown, Michigan, and Stanford?

    Another note along this same line. You now have 28 days before the end of the pubic comment period for changes to the Endangered Species Act. Imagine how thrilled the little Trump boys will be to learn that they can now shoot down bald eagles?

  11. This must be what “dismantling the administrative state” looks like. The Trump administration is so much about poison, hate and Obama derangement, that the once great institutions we had that lead the world for the betterment of mankind are being dashed on the rocks of incompetence, abject corruption and the predicted horrors of un-regulated capitalism.

    I’m glad I’m old and won’t live long enough (I hope) to see the final chapters unfold, blue wave or now blue wave.

  12. Regulations – Bad for Business…..Good for the People!

    45’s supporters are very happy about the improving economy, yet they are blind to their future suffering that will occur from dismantling regulations that have protected them.

  13. While 45 destroys our country and our world power he is setting the perfect stage for China to take our place. China sees that the door is wide open and is working diligently to walk through that door to take our place. It just may happen before 34’s reign of terror ends.

  14. On the other hand, Todd Smekens,
    Aspiring medics seem to FLOOD to places like Indianapolis to ply their trade; parking is almost impossible near some medical facilities.
    The elderly are dispatched from clinic to clinic for expensive but non-curative, harmless diagnostic procedures. If the schlepping doesn’t kill them, the palliative drugs will by neglect of the undiagnosed true cause of pain. Finally, when told the test results show everything is “fine” you wonder if you should sue to get your money back.

  15. OMG 9:22; thank you! You have listed the reasons I do not report serious health issues to my primary physician. The last issue I reported was a necrotic pressure sore on a big toe; began at 10:00 a.m. in her office on the east side; sent my daughter-in-law and I to a circulatory surgeon’s office on west side in hospital complex for repeated circulatory testing done 3 months earlier. Parked in parking garage behind Methodist Hospital. Told to wait for test results, primary physician not satisfied with those answers she sent us into the Methodist ER for more repeated testing where original testing had been done 3 months earlier. This required being pushed in a wheelchair by an attendant through the physician’s building and through the hospital proper, had to go outside into the December cold and down walkway to the ER entrance. Result was diagnosis of necrotic ulcer on big toe, treated with Bacitracin and a band-aid, referral to podiatrist at 9:30 p.m. We were left on our own to reverse the route outside the ER area, back into the hospital and find our own way through darkened hospital halls and physicians building to the dark parking garage. I receive copies of all billing; total cost for one sore toe over $22,000. My co-payments were approximately $350; the balance explains why Medicare keeps raising our monthly premiums and co-pay amounts.

  16. Stories like these of the under the radar operations of President Agent Orange and the Pastor Pence Regime receive virtually no coverage by our so called News Networks. CNN and MSDNC will dedicate a whole days coverage to anything with a Russian tilt to it, Cohen, or Stormy Daniels. FOX spins everything in the opposite direction.

    CNN and MSDNC are not News Networks they are infotainment. They remind me of the shopping channels the way they pitch their product – Russia-Stormy Daniels or Cohen.

    Corporatism has long been a dominant life form in our political process, but the Regime of Agent Orange and Pastor Pence have provided it with a boost.

  17. We the people are being sliced, diced, and carved up for serving to the oligarchs. We were surprised when corporations caught up to and reached our status as people but it appears that they passed us now and we have become their servants.

    Money won.

  18. While we are busy with Trump’s latest atrocities (and they are legion), the dismantling (of which Sheila’s topic is illustrative and per Bannon) of our administrative state continues, all while right wingers decry our “socialism” and our Tariff Sheriff promises $12 billion in welfare from our till for libertarian soybean farmers, while Putin disinvites and reinvites his availability for a trip to the Oval Office (irrespective of his Crimean annexation, East Ukraine invasion, murder of political opponents and reporters), while Trump says he is open to an invitation to visit Moscow, while Putin removes $100 billion in treasuries from the Fed (which drives up yields and makes interest on our escalating debt higher) etc. etc. etc. It appears the joint efforts of the Putin-Trump duet to destroy America and her democracy are succeeding in their campaign to Make America Nearly Dead Again, as it nearly was during the early Reconstruction era following the Civil War.

    It is noteworthy that none of the NATO nations have hosted Putin (which would be a much shorter trip). Indeed NATO nations as members of G-7 have kicked Russia out of their ranks for his annexation of Crimea and invasion of East Ukraine. Given such a political environment, Trump’s invitation of Putin to visit the Oval Office amounts to approval of such total breaches of international law, conferring legitimacy to the antics of a brutal, murdering dictator. It is now time to cease asking which side Trump is on because it is clear that he is on the side of Russia (and the side of other dictators around the world whom he euphemistically calls “strong leaders,” whose governing style he would like to emulate. If he succeeds, you can kiss American democracy goodbye. It is time for him to go whatever is or is not revealed in Mueller’s report to the Congress because if he is not aiding and abetting an enemy and obstructing justice I’m not sitting here – and in broad daylight.

  19. Interesting story on CBS.
    Les Moonves: CBS chief investigated over sexual misconduct claims
    New Yorker publishes report on allegations of harassment and intimidation across the network, which CBS says it is investigating.

    The New Yorker has published a report by Ronan Farrow detailing allegations of sexual misconduct against CBS chief executive Les Moonves, after the TV network had earlier said it investigating Moonves over the allegations.

    Six women accuse Moonves of harassment and intimidation, and dozens more describe abuse at CBS, the New Yorker reported.

    Farrow’s report says four women described “forcible touching or kissing during business meetings, in what they said appeared to be a practiced routine” and also that 30 current and former CBS employees said such behaviour extended from Moonves across the corporation, including at CBS News and 60 Minutes.

    In 2013 it was reported that Moonves earned more than $65m, making him one of TV’s highest paid executives. https://www.theguardian.com/media/2018/jul/27/les-moonves-cbs-chief-sexual-misconduct-allegations
    ********************************************************
    Just so you remember:
    Back in Feb 2016 Moonves said – “It may not be good for America, but it’s damn good for CBS,” he said of the presidential race. Moonves called the campaign for president a “circus” full of “bomb throwing,” and he hopes it continues.

    “Most of the ads are not about issues. They’re sort of like the debates,” he said.

    “Man, who would have expected the ride we’re all having right now? … The money’s rolling in and this is fun,” he said.

    “I’ve never seen anything like this, and this going to be a very good year for us. Sorry. It’s a terrible thing to say. But, bring it on, Donald. Keep going,” said Moonves.

    “Donald’s place in this election is a good thing,” he said Monday at the Morgan Stanley Technology, Media & Telecom Conference in San Francisco.
    *********************************************************

    Moonves revealed what many of us know about our “Fourth Estate of Corporate News”, it is all about profits.

  20. JoAnn Green –
    At 91yo my primary, suspecting blood loss resulting in low RBC, sent me for upper and lower GI exams. After cooling my heels in the waiting room for a tolerable period, the doctor pulled up a chair, sat down, leaned forward and said ominously, and with a pained look on his brow, “Sir, we are not going to do this procedure this morning due to your medical history”. Glad for the bushy-tailed clinician but pissed about the fasting and the quarts of lavage, I have replaced my primary with one with fewser sadistic impulses. Lesson to any listeners: I must take an active role in my medical care; don’t be the doctor, but do be an active learning listener. They have a way of determining if your insurance will pay for any particular procedure so they can be free to select one or more whether indicated, contraindicated, or whatever, like a new bride at the shopping mall. It’s called “practice”.

  21. I doubt if we can even imagine the amount of money flowing from monied interests to politicians in the current DC circus.

    We needed a way to start the transition from a focus on only wealth to a sustainable focus on people and natural resource as the earth’s population bumps the red line but Agent Orange and his gang of thieves instead are feeding the monster that threatens to end us.

    All of these chickens will come home to roost probably after some of the jail time has started and it’s essential that we remember these times when that future was created because Republicans with their penchant for blame and zero accountability will be singing from the rafters that it was caused by President Obama, Hillary Clinton, Chuck Schumer and Nancy Pelosi.

  22. OMG; amazing that anyone in your medical system checked your history. They have refused to look at my records or listen to me or any family member, including former Certified Nursing Assistant and granddaughter who is an RN in their own system. I understand your anger at what you were put through unnecessarily…but how else can they make profits if they don’t invent reasons to treat or test us? It is follow the BIG money now rather than “follow the money”.

    The Indiana Johnson County childhood cancer cluster is back in the news today; a few years too late to save some of the children’s lives. But, with only 2-3 weeks before schools are back in session, 2 Franklin schools will be tested for toxins. These are not all of the Franklin schools in the known and suspected areas of hazardous waste pollution where at least 50 children were diagnosed with rare forms of blood and brain cancers, other forms of cancer were not included in the count. This rural Indiana county will be hard hit by Trump’s increasing depletion of ACA coverage (including the elimination of medical guidelines Sheila refers to today) and the hazardous waste causing the childhood cancer cluster (and adult cancers) will increase due to his elimination of EPA guidelines. We are one of the guiltiest states assisting Trump in genocide of Americans.

  23. This is part of what Thomas Frank, the author, said in a short article, yesterday, in The Guardian:

    “But understanding the perversity of rightwing populism only brought me to another mystery: the continuing failure of liberals to defeat this thing, even as its freakishness and destructiveness became apparent to everyone. My brain twirls to think that rightwing populism is still running strong in 2018 – that it’s even worse now than it was in 1988 – that the invective and the journalism and the TV shows and all the mournful books about the decline of the middle class have amounted, basically, to nothing.

    “Democrats simply have to take one of the houses of Congress this fall and commence holding Trump accountable.”

    We had the perfect opportunity to reverse course in 2008, after a deregulatory catastrophe sent the billionaires shrieking for handouts and ruined middle America as collateral damage. That was the perfect moment for liberals to reclaim their Rooseveltian heritage by governing forcefully on behalf of ordinary people, by warring against over-powerful corporations, by demonstrating the power of the state to build a just and humane society. But they didn’t do it.”

    “I know the excuses: those Republicans were so clever, they wouldn’t vote for Obama’s proposals, etc. But from the long-term perspective, what really mattered was the absence of Democratic will. Instead of doing what the moment required, Democrats chose to help the banks get back on their feet and to stand by as inequality soared; they scolded their base for wanting too much and they extended their hand instead to Silicon Valley and big pharma. The task of capturing public anger was one they regarded with distaste; they left that to Tea Party demagogues and to Donald Trump.”

    “We are going to pay for that failure for a long time. The GOP should have been ruined by the financial crisis; instead the culture wars are raging all over again, with dog whistles and fights over the flag and the persecution mania of the populist right blaring from the TV screen. We’re right back where we started. The crisis went completely to waste.”
    ______________________________________________________________________________

    “Anyone who is expecting Robert Mueller to get us out of this mess, needs to have his or her head examined.”~Marv Kramer

  24. Re: Marv’s post above.

    An Excerpt from the article ;The Guardian article w/t Thomas Frank :

    “We had the perfect opportunity to reverse course in 2008, after a deregulatory catastrophe sent the billionaires shrieking for handouts and ruined middle America as collateral damage. That was the perfect moment for liberals to reclaim their Rooseveltian heritage by governing forcefully on behalf of ordinary people, by warring against over-powerful corporations, by demonstrating the power of the state to build a just and humane society. But they didn’t do it.

    I know the excuses: those Republicans were so clever, they wouldn’t vote for Obama’s proposals, etc. But from the long-term perspective, what really mattered was the absence of Democratic will. Instead of doing what the moment required, Democrats chose to help the banks get back on their feet and to stand by as inequality soared; they scolded their base for wanting too much and they extended their hand instead to Silicon Valley and big pharma.”

  25. Marv – You rightly gave us Frank’s look at what happened and what didn’t happen with the advent of Bush’s Great Recession. Unlike Iceland (which nationalized its banks) we bailed them out but couldn’t find money to bail out those unemployed as a result of the Bush-Cheney disaster. I do not expect Mueller to get us out of this mess (the success of the right wing in keeping our attention diverted from the lies and affronts of the current administration), but I will wager many in the current administration will go to jail as a result of Mueller’s investigation, and that’s a start, all after which we follow up on the advantage Frank rightly complains we did not do last time we had an opportunity (2008). Winning elections is primary, but following up with consequences for the right wing afterwards is, as Frank notes, essential as well, so let’s first win, and then claim our prize by governing for the many and taxing the under-taxed etc.

  26. Unfortunately,with 13 weeks to go until an election,the Democratic Party refuses to acknowledge the inequality mentioned in Thomas Frank’s article. Instead, we get empty platitudes and canards. The chickens have come home to to roost in 2016 and they will continue to do so until the Democratic Party shakes off its new persona as Republican-lite. Never mind its tight embrace of Modern McCarthyism and still stuck in 2016.

    13 Weeks. 13 weeks away. They’ll screw themselves by their own volition and then summarily act surprised when the results are not what they wished. They have had almost 2 years to go beyond empty rhetoric. Instead ,the party wants to vilify voters and act as if it is an estranged,impotent and jilted lover. That’s not very attractive to anyone.

  27. To me the differences between the parties is stark. Lies vs the truth. Republicans learned decades ago the entertainment is the most effective way to lie. In fact fantasy is its fuel. There are hordes of people expert in packaging fantasy in ways that make it compelling. It’s a whole industry.

    Despite the alligiance to truth over fantasy the DNC pulled off a huge popular vote win in 2016 with the most qualified though least liked candidate in history despite the effectiveness of 30 years of GOP entertainment media fantasy that the dislike was based on.

    Why is Atilla the Hun now in the Whitehouse? More lies on entertainment media from the Trump and Putin campaigns and the stolen DNC playbook right in the nick of time and Comey’s unfortunate PR decision.

    Despite this combination of misfortune and crime I personally cannot support politics of fantasy. Truth is absolutely essential in governance and statesmanship and abandoning it just to steal power is a fool’s errand. It’s not possible to campaign one way and govern another.

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