YouTube Link coming sooner or later!

This edition of Doctor's Housecall aired live on KMOG radio FM103.3 and AM1420 in Payson, AZ between 5pm and 6pm MST (Arizona Time) on February 22, 2022. Dr. Weyrich offers a free 15 minute consultation at Call +1 (888) 391-0414 +1 (888) 391-0414 to discuss any comments or questions you might have about this broadcast (subject to schedule availability).

Topics

In this YouTube podcast edition, Dr. Orville Weyrich, Jr NMD PhD and host Mike Farrell discuss topics including:

  1. Dr. Gear Status [0:58]
  2. Your Spine: The Benefits of Traction Therapy [2:45]
  3. Dr. Weyrich also does Internal Medicine [20:16]
  4. CDC Changes Opioid Guidelines [21:24]
  5. Dr. Weyrich's Background [30:49]
  6. What is Truth: False Dichotomy [40:00]
  7. What is Ethical: Kant's Categorical Imperative [51:40]

Relevant Links to Related Topics

What is New: CDC Changes Opioid Guidelines (Again)

In 2016 the CDC published "guidelines" for prescribing opioids for chronic pain. In the introduction to the guidelines it stated that "the recommendations in the guideline are voluntary, rather than prescriptive standards" [CDC2016].

Nonetheless, state licensing boards widely began enforcing their understanding of the guidelines as prescriptive standards, which resulted in many doctors being prosecuted and many other doctors voluntarily refusing to prescribe opiates. This had the predictable side effect of many compliant pain management patients being cut off, often cold turkey, and turning to various street drugs. This had the unfortunate side effect of actually increasing opioid overdose deaths, since street drugs are inherently unpredictable in their actual potency, and drug pushers are uninterested in promoting their client's wellbeing.

This situation caused the CDC to issue additional guidance in 2019, which included the following points [CDC2019]:

  • Some policies, practices attributed to the Guideline are inconsistent with its recommendations.
  • Misapplication of the Guideline's dosage recommendation that results in hard limits or "cutting-off" opioids. The Guideline states, "When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should ... avoid increasing dosage to [more than] 90 MME/day [milligrams morphine equivalents per day] or [emphasis added] carefully justify a decision to titrate dosage to [more than] 90 MME/day."
  • The recommendation statement does not suggest discontinuation of opioids already prescribed at higher dosages.
  • The Guideline does not support abrupt tapering or sudden discontinuation of opioids. These practices can result in severe opioid withdrawal symptoms including pain and psychological distress, and some patients might seek other sources of opioids [i.e. street drugs].
  • In addition, policies that mandate hard limits conflict with the Guideline's emphasis on individualized assessment of the benefits and risks of opioids given the specific circumstances and unique needs of each patient.
  • The Guideline includes guidance on management of opioids in patients already receiving them long-term at high dosages, including advice to providers to:
    • maximize non-opioid treatment
    • empathetically review risks associated with continuing high-dose opioids
    • collaborate with patients who agree to taper their dose
    • if tapering, taper slowly enough to minimize withdrawal symptoms
    • individualize the pace of tapering
    • Patients may encounter challenges with availability and reimbursement for non-opioid treatments, including nonpharmacologic therapies (e.g., physical therapy [or Chiropractic or Naturopathic therapies]). Efforts to improve use of opioids will be more effective and successful over time as effective non-opioid treatments are more widely used and supported by payers [including the government].

    Dr. Weyrich notes that today, in 2022, neither Medicare nor AHCCCS [the Arizona Medicaid program] will pay for Naturopathic non-opioid treatments, and that AHCCCS will not pay for Chiropractic or Naturopathic non-opioid treatments.

    However both programs continue to pay for opioid treatments if the patient can find a prescriber.

    And the opioid overdose death rate continues to rise, fueled by social despair due to COVID-19 lockdown isolation, and lax border control that allows massive amounts of fentanyl produced primarily in China to cross our southern border.

    Recently, in 2022, the CDC is again updating their guidelines [NYT2022], Their current draft proposal, which is currently available for public comment, includes the following points:

    • Remove previous recommended ceilings on doses ... and instead encourage doctors to use their best judgment.
    • Doctors should first turn to non-opioid therapies for both chronic and acute pain, including prescription medications like gabapentin and over-the-counter ones like ibuprofen, as well as physical therapy, massage and acupuncture [what about Chiropractic and Naturopathic treatments?].
    • "It's a total change in the culture from the 2016 guidelines," characterizing the earlier edition as ordering doctors to "just cut down on opioids - period."
    • The new proposal "has a much more caring voice than a policing one, and it's left room to preserve the physician-patient relationship"
    • "We went from one side of the pendulum, with overly liberal prescribing of opioids [prior to 2016], and that did harm, to just looking at gross drops in prescribing without looking at individual needs. And that did harm ... This is closer to a Goldilocks solution where chronic pain is not a monolith."
    • The 2016 guidelines generated anger and fear in many chronic pain patients, many of whom rely on doses far higher than the recommended ceiling of 90 morphine milligram equivalents daily. Hundreds of pain medicine specialists protested as well.
    • Though the dosing ceilings were merely a recommendation, dozens of states codified them. Fearing criminal and civil penalties, many doctors misapplied them as rigid standards, tapering chronic pain patients too abruptly and even tossing some from their practices.
    • Studies show that the number of opioid prescriptions overall has been dropping since 2012 [before the 2016 guidelines were issued, so arguably the 2016 guidelines were directed at a problem that was solving itself].
    • The new proposed recommendations step back from the notion of one-size dosing fits all and instead builds in "flexibility to recognize that pain care needs to be individualized."
    • In another indication that the CDC sees these new guidelines as a course-correction to the earlier ones, the agency now suggests that when patients test positive for illicit substances, doctors should offer counseling, treatment and, when necessary, careful tapering. Because doctors [and medical examiner boards] had interpreted the 2016 dosing limits narrowly, some had worked up one-strike policies and were summarily ejecting such patients.

    It is past time for the "powers-that-be" to not only change the narrative, but to also apologize to patients and doctors harmed by "the powers that be's" previous misunderstandings and fiat actions, and to also revisit their previous persecution of doctors that, under current guidelines from the CDC (2019, 2022), "did the right thing" despite "the powers-that-be's" previous incorrect understanding of advice from the CDC that is currently being recognized as incorrect.

What is Truth: False Dichotomy

Vaccination Example

According to Go to etymonline.cometymonline.com "dichotomy" is derived from the Greek, and has the meaning "a cutting in two, division into two classes."

That is all well and good if the topic under discussion can be divided into two categories, such as vaccinated versus unvaccinated.

But most topics cannot be neatly divided into to two categories. For example, we now know that there is a third significant category relevant to discussions of COVID-19: natural immunity (people who had COVID-19 and recovered), whom the CDC recently announced had a better immune response to COVID-19 than people who are vaccinated.

Therefore, when we are discussing the merits of vaccination, there should be at least categories of people:

  1. People who have been vaccinated and therefore are presumed to have a protective immune response.
  2. People who have recovered from having [the virus] and therefore are presumed to have a protective immune response (natural or acquired immunity).
  3. People who have never been vaccinated and have never recovered from [the virus] and therefore are presumed to be at higher risk of contracting [the virus].

All of the above statements have been scientifically shown to be true in general for a wide variety of different viruses and vaccines, and by analogy can be hypothesized to be true of COVID-19 as well, subject to further scientific study.

In the scientific method, each of the above assertions should be considered true but unverified (i.e. null hypotheses) until proven by scientific evidence to be false. Dr. Weyrich discusses the scientific method further in his podcast "The Scientific Method" broadcast September 17, 2019.

We could also add finer distinctions, such as people who have both recovered from COVID-19 and been vaccinated, people who have had vaccine boosters, etc. But no legitimate scientific discussion of COVID-19 should have fewer than the three categories listed above.

I raise this point because I recently heard a news broadcast that can be summarized as follows: "People who have not been vaccinated have a xx% increased risk of hospitalization of death due to COVID-19."

This "fake-news" blurb is invalid because it implies the false dichotomy that the world consists only of people who are either vaccinated or not vaccinated, and ignores the third possibility that people may have natural immunity.

In other words, they combine "People who have recovered" and "People who have never been vaccinated" into a single category, and declare that they all have a xx% increased risk of hospitalization of death due to COVID-19. In truth, according to the CDC, people who have recovered (have natural immunity) are better protected than people who are vaccinated.

I will leave it to the listener to decide whether this logically invalid news blub is due to ignorance of science on the part of the reporting news media, political bias, or malice.

Gender Example

That is all well and good if the topic under discussion can be divided into two categories, such as XX (female) versus XY (male) genetics.

But most topics cannot be neatly divided into to two categories. For example, we now know that there are rare cases such as Klinefelter Syndrome [a male who is XXY] and Turner Syndrome [a female who has only one X].

It is an open question whether medical discussions of gender should include these scientifically verifiable alternative variations from the common dichotomy of of XX versus XY.

The "Universe of Discussion" includes all relevant possibilities that are included in the current discussion, discourse, or argument. Dr. Weyrich has previously discussed this point in his "What is Truth?" segment for his "Understanding Logic" podcast, which was broadcast on January 25, 2022, in which he gave examples of the debate over ivermectin and "the mother will be happy."

For a logical discussion, all assertions of fact should be consistent with the whole universe of discussion.

In this example of genetics and gender, it is an open question whether the "Universe of Discussion" should include XX, XY, XXY, X, and maybe other variations.

It depends on the context, which I will not further comment on that in this venue, other than to acknowledge that there are indeed people who were born "that way" as neither XX or XY, and who therefore are entitled to empathy from the medical community and society in general.

By the way, there is a simple blood test called a "karyotype" that can identify persons who are neither XX or XY, and is firmly based in science.

Immigration Example

Another common false dichotomy is found in discussions of immigration policy, where two very different populations are "conflated," which means "combined, blended, or confused."

In particular, arguments are often made that Americans are racist because they do not like immigrants.

But this is a false dichotomy - the universe of discourse is not really only Americans and immigrants.

The media and certain politicians conflate the very different ideas of legal immigrants and illegal immigrants, and therefore fabricate false logic that suggests that Americans dislike ALL immigrants, where in fact Americans are generally quite friendly to legal immigrants, many of whom are actually naturalized citizens (like Enes Kanter Freedom, a Turkish immigrant).

Further clarity on the distinction between illegal and legal immigration can be found in the political activities of Cesar Chavez, a Latino of Mexican decent, who fought vigorously against illegal immigration from Mexico for economic and political reasons that clearly had nothing to do with race.

Furthermore, it appears that even the classification of Latino immigrants is an inappropriate conflation, based on their country of origin. We recall that Cuban refugees fleeing communism are the only migrants Biden refuses to welcome. Evidently, immigrants from Cuba are in a different category than immigrants from Mexico and South America. What is the principle that governs this distinction? They are both Hispanic. But Cubans tend to vote Republican. This smells like politics, not racism.

What is Ethical: Kant's Categorical Imperative

From a logical point of view, Kant's "categorical imperative," which can be stated as "Act only on that maxim whereby thou canst at the same time will that it should become a universal law."

Or in more common language, don't make a rule unless you expect that EVERYONE will follow it (including you!)

For example, suppose I justify lying to a lender when applying for a loan, knowing full well that I cannot repay the loan and that the lender has no recourse against me. What if everyone did that? Then nobody would make any loans, and Society would suffer from that. That violated Kant's Categorical Imperative.

In other words, a double standard ("rules for me but not for thee") invalidates a rule or principle and renders it neither moral nor logically valid.

As another example, consider that "Obamacare" was passed by a Democratic majority without allowing the public to read the bill before voting. One disturbing aspect of that bill was that Congress excluded itself from participating in Obamacare, because they had a better health care plan than Obamacare.

Using the above examples, if January 6 [2021] is called an insurrection, then so must be the Summer of Rage [2020], since in both cases Federal facilities were attacked. Similarly, if the Summer of Rage was a "mostly peaceful protest," so must be January 6.

In any event, according to Kant's categorical imperative, any outrage or punishment should be proportional to the amount of violence committed, and consistently applied in both cases [it has not been].

Informed consent, which we have previously discussed, also includes consent of the governed, as addressed in the Declaration of Independence.

Public discourse becomes fraudulent when the original meaning of words is twisted, like the dialog between Alice and Humpty Dumpty. For example:

  • "When I use a word,' Humpty Dumpty said in rather a scornful tone, 'it means just what I choose it to mean - neither more nor less.' 'The question is,' said Alice, 'whether you can make words mean so many different things. 'The question is,' said Humpty Dumpty, 'which is to be master - that's all.' [Lewis Caroll.]
  • Consider the abuse of words like "racism" (as Caryn Whoopi Goldberg recently did when denying that the Holocaust was about race [because both Nazis and Jews were White and neither were Black]).
  • Or consider the abuse of the words "protest" and "insurrection." During the 8 months of the "Summer of Rage" in 2020, which was described as "mostly peaceful protests by the news media," and supported and encouraged by many politicians on the leftist end of the political spectrum, numerous civilians and police were murdered, the CHAZ/CHOP "autonomous zone" was created by violent force, and Federal facilities were attacked. For one of many examples, on July 20, 2020, the Go to Department of Homeland SecurityDepartment of Homeland Security reported that Portland rioters attacked the Hatfield Federal Courthouse. (Sounds like an insurrection to me).
  • But during the one-day "January 6 so-called insurrection," only one unarmed civilian was killed by a police officer and two other unarmed persons died of apparent heart attack or gas inhalation. According to autopsy reports, NO police officers or other government officials died as a result of the January 6 protests. It doesn't sound like an armed insurrection to me.
  • The one civilian shot by a police person was an unarmed White female veteran named Ashli Babbitt, who was shot by a Black male police officer named Michael Byrd. There was not any public outrage or court proceedings like that which resulted from the death of George Floyd. This violates Kant's Categorical Imperative and is thus illogical and unjust.
  • The First Amendment says in part: Congress shall make no law ... abridging ... the right of the people peaceably to assemble, and to petition the Government for a redress of grievances."
  • By any reasonable interpretation of the meanings of the words, clearly "The 2020 Summer of Rage" far better meets the definition of "insurrection" and "January 6" better meets the definition of "peaceful protest" based on the amount of government property damage and death count.
  • None of the above justifies initiation of force either in the Summer of Rage or on January 6, but the disparate reaction from main-stream media and the ruling elite class in this country clearly justifies distrust on the part of the American people of both the mainstream media and the ruling elites [currently the Democratic Party].

And as I have previously discussed, a deliberate failure to disclose the "whole truth" is fraud.

A willful "half truth" is tantamount to a "deliberate lie."

Such fraudulent use of language tears at the fabric of the foundation of this country, which is "consent of the governed." Informed consent is only possible in the absence of fraud.

References for CDC Changes Opioid Guidelines; False Dichotomy; Kant's Categorical Imperative