Happy BD America!

Tony Soprano Dies!!

Tony Soprano, aka James Gandolfini, has died at the age of 51.

He died of a heart attack while on vacation in Italy.

Sad:(

Upgrading to iOS 6.1.2--DON'T DO IT!

If you are an iPad or iPhone user and happen to be blogging on google's "blogger", don't upgrade to the iOS 6.1.2.

If you do, some of you will not be able to post comments or see comments on "blogger", and you can't revert to the old operating system to fix this problem.

I just finished talking to the so called "AppleCare" and it became clear to me that they "don't care", as this is, as the 16 year old tech explained to me, a Google problem and not an Apple problem.

Assuming that the Apple techs have really looked into this, in the 25 minutes that they had me on the phone, I would submit that this is "our problem", the consumers, but neither Google nor Apple seems to care that we are being left in the lurch.

Apple executives should re-read Steve Jobs interview with Forbes from 2012 titled:

 "Steve Jobs Warns Apple: Don't Get Greedy" 

(http://www.forbes.com/sites/richkarlgaard/2012/12/10/steve-jobs-warns-apple-dont-be-greedy)

So while we wait for Apple and Google to control their post Steve Jobs era "greed" and cooperate for the sake of us, don't upgrade to the iOS 6.1.2.

Photo source: mystifiedbysocialmedia.com 

Happy Thanksgiving!

Obama for president

“Only Pres Obama could prevent a depression, end a war, get bin Laden, bring unemployment below 8 percent, then be told he can’t run on his record."

Chris Rock

Assertive china promoting ultra-nationalism, to what end?!

The Chinese one party government, having taken religious freedoms and freedom of speech, has promoted ultra-nationalism for the masses as an alternative, to keep the masses occupied and in check. The nationalistic indoctrination of the nation is made possible by state controlled message in schools, including hong kong schools in the near future, and state controlled media. The consequence of this highly controlled propaganda has been an inflated sense of superiority, and is bringing the region closer to war. Keeping in mind that most wars are instigated by ultra-nationalist, or ultra-religious, as the easiest ways to rally the masses.

The Chinese military is edging closer to the leavers of political power, and as the economy slows down their eyes would be on the outside world to distract the Chinese people and keep them a step away from revolting against their own government.

The close economic ties, and the global recession, will likely prevent imminent war between china and Japan, but if the trend continues, it's almost impossible to imagine china and japan not testing their military muscle against each other. The united states,  with its defense treaty with Japan, will face hard choices if that were to happen.

The silver lining is that given the current American military superiority, it's almost better to have the conflicts and skirmishes now, instead of later, to humble the Chinese masses and show them that their leaders have inflated their military capabilities.

The Japanese may feel that in order to deter nuclear china, they may need a military buildup of their own, and minimize their dependence on the united states for defense.

The Obama administration was right in prioritizing the far east in its defense budget, as the next war, or mini-wars, are most likely to occur over there.

Look for my posts on Uskowi on Iran

www.uskowioniran.com

Health watch USA

For healthcare related blogs also see
Health watch USA

http://www.blogger.com/blogger.g?blogID=8021635107577023872#overview/src=dashboard

Lessons for Iranians in the Libyan Revolution

Iranian revolutionaries have tried and failed in the past two years to make significant progress in their ambition to overturn the regime in Iran. For those revolutionaries, and anyone supporting them, there is a lesson to be learned from events in Libya, as the Libyan and Iranian regime share many features in common.

Both countries have a weak Army, intentionally replaced by paramilitary forces, whose loyalty was cultivated over decades of dictatorship. The Iranian Basij and revolutionary Guard has its counterpart in Libya in the form of citizen militias and Gaddafi security brigades.

Libya, just like Iran, limits foreign media, and so the events on the ground don’t make it to the average Libyan homes. While Aljazeera is broadcasting in libya, they are jammed in the capital and have no reporters on the ground, except now in liberated eastern parts of Libya.

In Iran, the persian language BBC is broadcasting in Iran but has few reporters on the ground. and those reporters are banned from reporting on any demonstrations, or be on location in hot spots. The BBC is also being jammed at the peak of street unrest. Moreover, the BBC doesn't have the budget of Aljazeera, nor are they willing to defy government restrictions and risk arrest of their reporters.

The Libyan leader and his hardcore supporters appear immune to political or street pressure and are creating a situation on the ground that leaves very little way out of the crisis short of the forceful removal of Gaddafi. Gaddafi had no problem using the air-force, artillery, and mercenaries to quell the libyan revolt; There is footage in the media showing the aftermath of mass execution of security and military personal who refused to follow orders to shoot at the protestors. They are gearing up in Libya for a military battle for control of the capital and Gaddafi bunker compound within Tripoli, the same compound bombed by the USA during the Reagan years.

The Libyans are going to succeed at the end of the day but we will likely see thousands more killed and injured before they get to Gaddafi’s. The United States should, and likely will, impose a “no fly zone” in Libya to prevent the use of Libyan air-force to bomb the demonstrators. If we don’t we lose a chance to show support to the people of Libya in their hour of need, and in the process risk damaging our future relation with that nation of Libya and its future representative government.

In case of Iran, the regime has made it clear that they think that the Shah of Iran lost in 1979 because he wasn’t ruthless enough and stopped short of using “sufficient violence” to quell the Iranian revolution then. This guiding principle for the government strategy in Iran has meant that the violence against opposition protests is organized and unrelenting, designed to shock and ow the demonstrators. Just like in Libya, It is hard to imagine how 100% peaceful protest alone will dislodge this government. There will likely be an element of violence to combat the hardcore government forces that will fight till the end to preserve the regime, this will have to come from defecting military units towards the end of the revolt.

The Iranians have failed in the past two years in their revolution, mostly because of the government success in keeping them isolated from the world and the general population with total news blackout. They have experienced total internet shut down and cellular phone network restrictions which made it impossible for demonstrators to get their footage to the BBC, and when they did, it came a day or two after the events casing them to lose momentum every time they pushed to the streets. To complicate maters the BBC persian TV had limited coverage and broadcast ability due to government jamming in Iran. In short, the world knew what goes on in Iran in the days of demonstration but most Iranians at home didn't.

The Iranians don’t need military support or billions of dollars to be spend on destabilizing the government in Iran. Their needs are more practical and simple, they include:

-Free and uninterrupted satellite internet access to send out their footage of demonstrations.

-Professional cameras with or without reporters filming in the streets of Tehran and overcoming the government restrictions.

-Blanket 24/7 coverage by the BBC persian TV when the demonstration erupt again and be able to broadcast current events so that more Iranians can be moved into joining the revolution. The United States should consider financing the BBC for this coverage as the BBC has no budget for such extended coverage; The BBC had major budget cuts this year. I suspect that most Iranians would appreciate such moral and media support from the US and the west, and would not consider it interference in their internal affairs. Incidentally, voice of America broadcast, financed by the USA, is not as respected as the BBC as a credible source of news in Iran.

-The BBC and western countries should use all available technical option to limit the Iranian government future jamming of the BBC broadcast.

The Iranians have no hope of success minus all these elements and every time they go out to demonstrate they risk dying or being arrested without the benefit of media documenting their scarifies and conveying their cry for help to their own people. There is safety in numbers and media coverage, and so I hope they get both this year and 2011 will be the year of freedom for Iran too.

Revolution in the Middle East

For those of us not distracted by the news of Charlie Sheen’s 911 call or other exciting news, it is apparent that the entire middle east is changing in front of our own eyes.

Understanding the particulars of the events in the various middle eastern countries is essential for us as the citizens of the only remaining world superpower, a country that is spending over half a trillion dollars a year to police the world and to shape or influence world events to preserve our national interests.

Regardless of outcome on the grounds, there goal for the US should be that american interests in the middle east be preserved for the long run. To that end, we can expect our government to be proactive and not be on the losing side at the end of the day.

The united states diplomacy has a difficult task as the our traditional allies, with the exception of Israel, consist of the governments, not the people.

As the people revolt against their dictatorships, the united states is left chasing its tail trying to decide when to come out in support of people power and against its “friends”, the dictators. With the situation so fluid, the only certainty is that at the end of the day the united states’ most immediate goal is not to be on the losing side, regardless of who wins the ongoing philosophical arguments.

With about a hundred billion dollar a year spent on wars designed, in part, to introduce democracy to the middle east, you would think that, in principle, we should welcome the intrinsic democratic revolutions by the people of so many middle eastern countries at no cost to us. The obvious reasons why thats not the case is that, minus the dictators, we cant really guarantee the actions of middle eastern governments in the future when it comes to oil exports, or supporting US peace initiatives, or having normal trade and political relations with the USA.

During the Egyptian revolution there was an argument made by many that the US shouldn’t support that revolution because if the regime of dictator Mubarak falls, it would be replaced by an Islamic regime hostile to Israel and the USA. The US administration came very close to choosing the losing side because of that argument. President Obama eventually realized that the Egyptian youth revolting on the street of Cairo didn’t care less if the USA was convinced of their cause, they were determined to overthrow the regime regardless. Ironically, in the demonstrators’ darkest days, one could see commentary in arab media calling for the big bad USA to intervene and be the savior in from the regime’s brutal force. At the end of the day, the US was widely credited with protecting journalists (by intervening when Aljazeera reports were arrested) and by encouraging the army not to fire on the people. It was a close call but at least we’re not the enemy of the people, at least not yet.

However we want to analyze the middle eastern revolutions, we can not start by arguing that “democracy” is unpredictable and thus “dangerous” when it comes to the middle east. The United States must believe in what it’s selling. The pendulum of democracy works in egypt just like it does here, all we have to do is make sure that the free change of governments from right to left and vis versa is not impeded by dictators. Even If we assume that the islamists end up governing Egypt, which is very unlikely, its better that they are in a democratic framework, like the case of Turkey, a US ally.

The other big issue is protecting the existing peace treaties between Arab nations and Israel. I can only think that any peace that requires the subjugation of so many countries under never ending dictatorships is not a real or lasting peace. Best chance at peace in the region is when democratically elected governments, representing their people, can reach a middle ground. Such peace won;t as fragile as they one we have now.

Revolutions in the middle east are not new; nations revolted against colonial powers and previous kings many times, only to be pushed back into dictatorships, after a few months of democracy. The United State’s role in the immediate future lies in it using its remaining influence to ensure that democratic principles are protected in the post revolution states in the middle east.

In Tunisia, all appears to be going as planned, but if we look carefully we see that the interim prime minister was given emergency powers and he issued a decree dissolving the ruling governing party. This maybe in line with the mood on the streets, but didn't the previous dictatorship start by outlawing the unpopular or unwanted political parties?

In egypt the military is now in charge, but it refuses to abolish the 30 year old emergency law that allows the government to arrest anyone. anytime, without due process or giving them the right to challenge their arrest in court. The military says that they will abolish the law as soon as the crisis is over. In other words we, they want to preserve the right to illegally crackdown on descent during the transitional period, if they so chose. Mrs. Clinton, in addressing this issue seemed to somehow say that we don’t like it but that it’s up to the “Egyptians” on this matter; one of the demonstrators main demands was to to free them from this law.

I would argue that this is one of the few risk free stances that would give the US credibility and allow the US to be the guardian of democracy. What better image for the USA in the middle east than a superpower that uses its influence to protect democratic values. I say lets take our 1.3 billion dollar yearly check to the egyptian army for a spin and secure true democracy for the Egyptian, and shamelessly take credit for it. Egyptians won’t help but be grateful.

In Libya, the west happen to promise Mr. Gaddafi to stop pushing for regime change in return for canceling his nuclear program and ceasing assistance to terrorist groups around the world (he even supported the IRA in its heyday). Its wonderful to keep one’s promise but this regime is using live ammunition against its people for the past week resulting in over 200 people dead and hundreds of injuries. It’s time for us to say, that we support, at least morally, the Libyan people in their hour of need. It is clear that the Libyans won’t stop until this regime falls and they will remember who stood with them and who didn’t. In fact I predict that this paragraph will become obsolete with hours of me writing it. It won’t kill us to be clear in our condemnation of the regime given it’s use of extraordinarily brutal tactics against peaceful demonstrators, but it is crucial if we are interested in preserving US interest in the future Libya.

In Bahrain, there happens to be sectarian ting to their revolution. Bahrain is similar to Sadam Hussein’s Iraq in that a sunni minority rules a Shiia majority and because of the small population of the country, about the size of population of Maine, they bring in sunnis from outside the country and employ in the security forces and the army. One other little complication for us under these circumstances is that the American navy fifth fleet has its base in Bahrain. The Shiia population, if successful in their revolution despite our objection, will likely cancel that base contract with the USA and be closer to Iran given the religious links.

One other issue is that Saudi Arabia has a Shiia population in the Saudi areas closest to Bahrain, and they have the potential of rising against the Saudi King, due to long standing grievances. There is actually a great danger that the Saudis may in fact decide to militarily intervene in Bahrain if it feels that the government of Bahrain is about to fall. They have a mutual defense pact to cover such intervention.

Back to the basic argument, if it looks like the people have momentum and will not stop until the government is down, then we should consider supporting the people, the winning side, in order to protect our interests, including the naval base. In fact of the US sides will the people of Bahrain in the near future, there is no way we would lose the naval base or our other interests.

In Yamen, the president of Yemen had united north and south Yemen after years of civil war then decided to stay on as president for 3 decades. The demonstrations in Aden (south) are not just calling for regime change, but some are calling for separation from the north. The southern part of Yemen also happen to be were Alqada is most active. In the North (capital Sana) the people are calling for regime change. Watching the events day to day, in local media, it looks like the number of deaths and demonstrations is rising everyday. With most people in Yemen armed, there is potential that the currently peaceful demonstration, might turn violent and result in full blown civil war. US diplomacy has the hardest choices in Yemen, compared to the other ongoing revolutions, nonetheless, the US can ill afford to be passive and take no stance allowing an totally anti-american regime to emerge, that would provide safe-haven to Alqada. I would argue that in the case of Yemen, with more than 50% illiteracy, the USA needs to be more decisive early in order to make an impression on the poorly educated people and their future democratic government, not to mention, being able to advocate for the post revolution territorial integrity of the country.

In case of Iran, a non-arab country, with a theocratic dictatorship, the events in the rest of the middle east is sparking a new wave of protests there. Unlike, the arab countries, Aljazeera is not very active in Iran, leaving the BBC persian as one of the few TV services that provide the people of Iran with real news. The government propaganda is in full gear and the events on the street are not know to the people until days later as protestors cant sent their clips to the BBC via the internet. This is robing the demonstrators from the support of the millions of sympathizers who might at any moment decide to join them if they see in real time the events on the ground.

The USA has no leverage over the government in Iran so the daily condemnations are not what they Iranian people are looking for. Instead, what the Iranian demonstrators on the street need is access to Satellite based internet, thats not subject to government control.

The other caveat in Iran is that the visible opposition leaders are not calling for regime change, yet. The “green movement” is a reform movement that is in the process of evolving into a revolutionary movement, with or without it’s own original leaders. My feeling is that the Iranian opposition leaders will be like Gorbachev in the soviet era, very eager to reform but stop short of abandoning the regime entirely.

Lets hope that the Iranians revolutionaries continue their momentum and save themselves from 30 years of dictatorship. Needless to say, that that would be great for the USA, not to mention myself. If they succeed, will get to visit my country of birth for the first time in 20 years, without any fear of arrest and arbitrary execution.

The point of no return in Iran

http://www.youtube.com/watch?v=E_yBgd88f50

For the past 7 months the Iranian regime seemed to think that by exercising extreme violence on the street they can avert a new revolution in Iran. They base this strategy on the false belief that the fall of the shah's regime in 1979 was a result of faint heartedness on his part when it came to the crackdown on demonstrators. The events on the ground today are proving them wrong as their heavy handed strategy has left the demonstrators with no choice but to fight back and defend themselves by use of force.

The demonstrators in Tehran today (Dec 27) responded to the sever beatings by the security forces by organizing and attacking those forces. They managed to overwhelm the security forces in some areas, a site that is likely to repeat itself in the days to come.

Just like in the 1979 revolution, the next stages are sure to come, public strikes and the defection of security officers to join the masses. History is more likely to repeat itself than not.

If I were an Iranian official I'd be packing my bags and sending some $ to switzerland.

Government inflexibility and Healthcare reform

At the peak of the national debate on healthcare reform a central fear of ordinary people and healthcare providers remain unaddressed and rarely discussed. Would bigger government role in healthcare make our government even more inflexible in correcting system failures that impact patient care?

I submit that the government’s past conduct in fixing existing issues is the barometer for things to come. Issues like the VA’s prior authorization for PCP visits in nursing homes (In some nursing home contracts the VA mandates that they pre-approve most, if not all, visits by the patients’ own PCP before they happen) that practically make veterans second class patients.

Another current unresolved issue is the DEA requirement that nursing home patients not receive medications ordered by doctors unless there is a hard script given to the nursing home, a process that has caused delays in patient care since its enforcement almost a year ago. All efforts by healthcare organizations such as the AMA and AMDA have been fruitless on this issue as no one in government wants to be the one responsible for changing the rules, even if it makes sense to do so.

We should pause and consider the root causes for this apparent trend of government inability to respond to concerns or to correct rules that are proven to endanger the well-being of patients.

Letters to government, including our representatives, are responded to with generic responses, and the big government systems remain unimpressed by the professionals' protest of government rules that hamper their effort to provide basic care for their patients.

Nursing home care is out of site and out of mind for most in healthcare and in government, but there is a growing movement to get attention to a variety of concerns that are the creation of the government's own, often obsolete, rules.

Going back to basics in trying to get the attention of our giant, unyielding, government, a petition was published 3 weeks and is so far signed by hundreds of doctors and other healthcare professionals protesting a specific government action in nursing homes. This petition was sent to many government officials in the executive and legislative branches and we await their response.

Link: http://www.gopetition.com/online/32305.html

Online Petition: Stop the DEA From Criminalizing Routine Geriatric Care in Nursing Homes

Go here to sign http://www.gopetition.com/online/32305.html

Background (Preamble):

The DEA in accordance with the controlled substance act (CSA), amendments to the CSA, and the DEA’s own internal interpretations of the act, regulate the prescription and dispensing of scheduled (controlled) drugs with the purpose of limiting abuse of these drugs. The intention of the CSA was geared toward limiting abuse in outpatient settings; the CSA itself does not mention nursing homes or hospitals.

When these DEA rules, which are originally designed for outpatient/office setting, are applied to inpatient settings, like nursing homes and hospitals, they create a logistical barrier to care and make the timely dispensing of medications prescribed by medical providers very difficult.

The DEA in 2009 initiated a strict enforcement of controlled substances rules in nursing home and have taken action against some nursing home pharmacies for what they deemed to be non-compliant practices. This “non-compliance” is not associated with any abuse issues but rather the nursing homes are being caught not following outpatient procedures set by the DEA.

This is a complicated issue but below are a few of the ways this DEA action is impacting nursing home providers’ practices and the care of nursing home patients:

1. If a new order for a narcotic drug is written in the nursing home chart, the provider has to write a hard script to go with that order.

2. If the medical provider writes an order to change a pre-existing order for narcotics, the provider has to repeat the same process and write a new script for the new change in dose or interval. This creates a disincentive to making appropriate order changes in patients with uncontrolled pain.

3. If the provider is not in the nursing home facility and gives a verbal order for a narcotic, he or she would have to fax a script to the nursing home before the pharmacy can dispense what he or she ordered. If a faxed script is not possible then a separate call is required to the pharmacist to authorize an emergency dispense. Hard scripts would then have to be written for the emergency authorization as well as the original order and be faxed to the pharmacy within 7 days. Of note, some pharmacies, like Waltz pharmacy in Maine, would not even take an emergency authorization unless the patient in the nursing home is having an “actual emergency” aside from the fact that they have a doctor’s order that shouldn’t wait till the next business day to be carried out. Ironically, CMS (Centers for Medicare and Medicaid) would consider such delay in care a violation in any federal or state survey of a nursing home. CMS expect nursing homes to carry out doctors orders without delay.

4. If the nursing home pharmacy can not deliver the ordered medicine in a timely fashion the staff at the nursing home are accustomed to using the “Emergency box” (E-box) in their facility to dispense the ordered medicine, while waiting for the pharmacy to deliver. The DEA’s position now is that the nursing staff can not use the E-box without a separate prescription (in addition to the original order and script), otherwise they are considered in violation of DEA regulations. Emergency script for each “Emergency box” use in this impatient setting is what the DEA is now mandating. With this DEA interpretation, some nursing home patients may be deprived of an important stop gap measure traditionally used by nursing staff to ensure the timely dispensing of medications legitimately ordered by licensed providers.

5. In addition to writing the orders for narcotics and providing hard scripts, nursing home providers are now expected to ask for a specific number of pills even though their patients are in an inpatient setting. This means that most providers would write for larger number of pills to avoid having to repeat this process over an over again. Larger scripts means more drug wasting in the nursing homes.

6. If the strict interpretation of the DEA regulations are applied then the above issues with schedule II narcotics would also be applicable to other scheduled drugs (III-V). In fact some nursing home pharmacies are already taking this strict stance as standard of practice.

7. Last but not least, assisted living facilities are in a worse shape than nursing homes as a result of the new DEA enforcement practices. Despite having a contracted pharmacy, like nursing homes, and having more or less the same checks and balances as nursing homes, these assisted livings facilities are now required to mail hard scripts (not fax) to the pharmacy for all narcotic orders. Some assisted living facilities are reverting back to using regular outpatient office practices for their patients rather than utilizing onsite geriatric medical services because it makes it logistically easier to meet the DEA requirements.

8. At no point does the DEA allow nursing home nurses to act as the agents of the providers in prescription matters. This is contrary to the realities of geriatric work in nursing homes where the medical team is made up of providers and nurses. Nursing home nurses have traditionally been the eyes and ears and the right hand of the providers in every nursing home in the nation.

The argument against the DEA actions:

1. Doctor’s authorization in nursing homes equals doctors orders in the chart. Mandating a hard script is simply a duplication of the providers’ orders in another format and serves no purpose whatsoever.

2. Nursing homes are inpatient facilities and patients residing there are inpatients. Nursing home residents should not be treated as community dwelling outpatients who get their prescripts during outpatient office visits and have minimal changes in medications between visits. Modern Geriatric standards mean more frequent intervention and orders to meet the needs of the nursing home population. This includes frequent, sometimes daily, nursing calls to providers to address changes in patients’ status that often require new orders. The DEA requirement that these frequent orders be coupled with prescriptions is bringing this dynamic system of care to a halt.

3. Nursing homes maintain contracts with house pharmacies that follow the same checks and balances as hospital pharmacies. These checks and balances already account for the appropriate use of the nursing home “Emergency box”. As it is, two nurses are required to sign off on each access of the “Emergency box”, in addition to having a doctor’s order in the chart. These pharmacy services, and protocols are already mandatory for all nursing homes in the United States and have been proven very effective.

4. Nursing homes and hospitals follow the same protocols and have similar checks and balances, yet the DEA doesn’t apply the scheduled drugs rules to hospitals but does so in nursing homes. The explanation is that the hospitals are inpatient; We say so are the nursing homes.

5. The DEA, by applying rules designed for outpatient setting to nursing homes, are creating problems without solving any. It is widely accepted that the only major DEA related problem in nursing home is “drug diversion” by staff, not “drug abuse” by nursing home patients. The documentation and checks and balances in nursing homes, just like in hospitals, are geared to dealing with the issue of drug diversion and preventing it. The DEA’s current actions divert attention from this very real DEA related problem and focuses attention on a self created issue of paperwork compliance that does nothing to prevent drug diversion.

6. The DEA is creating unnecessary hardship for nursing home patients and providers alike in a field of Medicine where there is a real shortage of qualified medical providers. Geriatric recruitment and retention is already suffering as the unnecessary paperwork mounts. The DEA actions are exacerbating a chronic geriatric recruitment issue in nursing homes.

7. Drug wasting in nursing homes can be expected to increase as the DEA is providing an incentive for providers to write larger scripts to minimize their paperwork. When there is a change in orders, the pharmacy is not allowed to take back the unused drugs, so they are routinely wasted at a huge cost to the system.

8. The increased bureaucracy increases the chances of medication errors as the potential for providers giving slightly different instructions multiplies when orders and scripts are done in separate steps and in duplication.

9. The DEA is creating a new potential abuse issue in nursing homes that never existed before, as the new mandates are resulting in increasing number of hard prescription that the providers give to facilities only to sit in charts after being faxed to pharmacies. These signed hard scripts can be sold or used illicitly to get narcotics from outpatient community pharmacies. Most providers are genuinely concerned that the hard scripts they provide to nursing homes serve no purpose and are a liability for them and their practices.

10. CMS (Centers for Medicare and Medicaid) has long been pressing nursing homes to improve pain management for their residents. This new DEA action is a barrier to meeting that goal, and it can potentially disrupt the quality of care related to pain management.

Petition:

We petition our government to instruct the DEA and CMS to take the following actions:

1. The DEA should use the same standards for all inpatient facilities, including nursing homes. Nursing homes (NF and skilled facilities) and assisted living facilities should be treated the same as hospitals and inpatient rehabilitation facilities, provided they maintain the same pharmacy checks and balances as hospitals. This should include the ability of nursing home nurses to use the “Emergency box” to fill doctors orders until the pharmacy can deliver the ordered medications.

2. Allow nursing home nurses to act as the agents of medical providers to implement and carry out doctors’ orders in their facilities. This should apply to the DEA as well as Medicare Part-D issues i.e. assist with prior authorization issues and conveying doctors’ orders to pharmacies.

3. Allow nursing home pharmacies to act as the agents of medical providers in processing prior authorizations with Medicare part-D plans for nursing home patients when providers order drugs not covered by Part-D formularies.

4. Allow nursing homes to have a less restrictive system for partial fills for PRN (as needed) as well as scheduled narcotics to decrease drug wasting and associated cost.

Go here to sign http://www.gopetition.com/online/32305.html

It's the economy stupid, Even in Iran

Many following Iranian politics are waiting and hoping for some sort of major political event that would push the Green revolution over the hump and lead to the collapse of the Iranian regime.

The main problem this Iranian revolution has had is that the educated elite are the only ones revolting, while the majority of other Iranians are still on the sidelines.

There is one event that might motivate the other socioeconomic classes to join the green revolution and it happens to be the brainchild of the government itself. Facing a budget deficit and impending sanctions, the Iranian government just approved a measure to take away subsidies on some basic commodities, like gasoline.

The gas prices in Iran are about to increase by at least 350%. Imagine if Gas prices in the US went from $2.7 to $9.45 overnight. The amazing thing is that if the Iranian government is doing this at a time when the political future of the regime is in jeopardy. They think their plan to pay qualified families a stipend will lessen the devastating psychological impact of such a jump in inflation.

Like other dictatorships in history, the dictators are the last to realize that their time is up. East Germans had a military parade a month before the Berlin wall fell, and in similar fashion the Iranians are increasing the cost of commodities for the poor during a major political turmoil. This political suicide will be put into action within the next 12 months; I can't wait!

The greatest thing about the dictators of Iran is that they seem to be more arrogant than they are stupid, which suits me just fine.

Iranians are posting info on individual Riot police officers

Facing an increasingly brutal crackdown, and with no way to fight back, Iranian revolutionaries are fighting back by taking the battle to the individual riot police. The Green movement is posting photographs of the riot police officers as they beat up young demonstrators, most of whom are girls. What really caught my attention was that they also included the individual officers' name, rank, unit, as well as their home address and phone number.

This is their way of trying to hold their oppressors accountable. Some of the riot police officers can no longer go home and forget about their rough day at work anymore. Sooner or later they will have to answer for their actions to their families, neighbors, friends, and most likely future courts, if and when the regime is overthrown.

This revolution is evolving in many ways:

-When the government refused to grant permits for public gathering, the greens used government events to make their voice heard. The latest example was Nov.4 when they went to a government sanctioned anti-American demonstration, commemorating the hostage taking of American diplomats, to chant slogans asking the American president Obama to support them in their struggle against the anti-American Iranian regime. They walked over the picture of the supreme leader instead of walking over the american flag, as is customary in such events.

-When the government started using the online video footage to track down demonstrators, the Greens started taking clips showing the backs of people rather than filming while facing the demonstrators, many of whom now waring masking for good measure.

-When there was no opportunity to express dessent on state television, some brave soles confronted the leadership, including the supreme leader, in the government's own TV covered events and the government to task publicly. They held the regime accountable for its actions and oppression on state media, even if it was only for a moment to be censored later.

The future is now more unpredictable than ever but with the government squashing peaceful demonstrators it's a matter of time before some of these demonstrators decide to arm themselves and exercise whatever version of self defense they deem appropriate. We will then have a full blown civil war that will only end after much loss of life.

Lets hope this regime expires before this stage of the revolution.

Iran and President Obama, time to take a stand

Iranian demonstrators in Tehran are chanting "Obama, Obama, either with them (the government) or with us". I wonder if he is aware of the gravity of this sentiment on the streets of Iran. What if the people of Iran conclude that the united states would rather play it safe and be content to watch as the Iranian regime tries to crush them. What if they won despite the lack of moral support from the US and it's president?Isn't that a political risk for Mr. Obama?

It is hard to imagine how Mr. Obama can avoid taking a chance and stand with the Iranian people despite what some overcautious politicians think. I hope his advisers are pointing out the fact that it is politically wise for the united states to abandon talks with a government at this time considering that the current regime will never be a true friend to America, in favor of cultivating a better relationship with Iran as a country down the line.

Even if the government of Iran doesn't change the US can pick up were it left off months or years later when the political atmosphere is different and the US won't appear to be appeasing a brutal regime.

The continuation of overtures towards Iran despite the savage crackdown against the defenseless civilians is undermining the future relationship between the two countries. The risk of siding with the demonstrators is much less than the risk of appearing obtuse about the cause of freedom and the wants of the Iranian people.

The current government of Iran blames the US for all ills whether they support the democratic movements or not so why not show some initiative and go all out in support of the peaceful demonstrators.

President Obama is not immune from missing a historical opportunity to do good, just as president Hoover, with his strong financial background, was an unlikely president to miss a historical chance to confront the great depression.

The president is facing a choice and he should know that he can't have it both ways, either stand with the Iranian people in their fight with the regime or pursue an illusive reconciliation with an untrustworthy regime that still celebrates taking American diplomats hostage after 30 years of that shameless act.

I hope he throws caution to the wind and do the right thing. Mr. Obama and The united states shouldn't be on the wrong side of history in this crucial time for Iranians.

Khamenei's mistake could end his Regime

Khamenei did not need to antagonize all the grand Ayatollahs in Iran and Iraq, for no reason what so ever, but yet he did.

Khamenei issued a decree, on Sat the 19th of september, "ordering" all Iranians to stop fasting and celebrate the Eid on Sunday, rather than Monday, contrary to the decrees of all the other Ayatollahs.

In Shiite Islam individuals are required to select a senior clergyman, an Ayatollah, to be their spiritual guide in religious matters, such as when to start and end the fasting month of Ramadan. Ayatollah Khamenei, like the other Ayatollahs, has his own religious followers, inside and outside the country. He is also the only Ayatollah who is the head of state for all Iranians. This political title does not change the fact that most Iranians, regardless of their political allegiance, look to Ayatollahs other than Khamenei for spiritual guidance when it comes to religious matters.

As a religious leader Khamenei is expected to exercise his purgative in issuing edicts for his own religious followers on issues such as what day to start and end of the fasting month of Ramadan. Such religious edicts are expected to be directed at his religious followers and not be forced on others.

The aforementioned command is a major leap even for a supreme leader and effects all Iranians and not only Khamenei's own religious followers--It is an intolerable mixing of politics and religion even in a theocracy. This blatant action is tantamount to countermanding the religious advice of all other Shiite Ayatollahs in Iran and Iraq, including the grand Ayatollah Sistani in Najaf, who has the greatest religious following among Shiites around the world.

By this action Khamenei is forcing all Shiite Iranians to ignore their own spiritual guides and follow his religious instructions as the political head of state instead. Most people would see this as a step too far and an abuse of power by the supreme leader--needlessly interfering in the most basic of religious matters. The Grand Ayatollahs in Qom and Najaf are likely to see this as a direct challenge to their authority over their flock, and may do the unthinkable and consider the Iranian theocracy a threat to the Shiite religious establishment.

With the exception of the student organizations, the religious establishment in Iran is the only non government entity with grass roots that could be tapped into to organize the opposition movement and give it a reasonable chance of success. If all the Ayatollahs brake their silence and put their weight behind the Green revolution then this regime is history.

Khamenei may believe himself to be the new Khalif or Shah of Iran with power over all people, in both religious and political maters, or he could be simply inadvertently over reaching, either way he may have just made his biggest mistake yet.

Iranian women ministers, yeah right

Mr. Ahmadijejad may think that the women of Iran who are eager to depose him will be satisfied with the gesture of selecting two women to be the first women ministers in the Islamic republic. Never mind the fact that the proposed minister of health is a hardliner who once called for the segregation of women into separate hospitals. Never mind that the proposed minister of welfare is a staunch defender of polygamy and is a two time Parliament member in the hardliners' block.

Mr. Ahmadijenad is either arrogant, stupid, or both, for believing that the brave girls and women who walk in front of their men in the street demonstrations would be that gullible. It doesn't seem likely for these women to risk arrest, torture, and rape only to fall for such empty gestures.

Radical women in ministerial positions does not advance the cause of women's rights, rather it is likely to serve as a cover for more limitations on women.

Some blacks may have once thought that the selection of the black Judge Clarance Thomas to the united states supreme court would mean more support for minority rights, but he proved that a person's beliefs are more important than gender or ethnicity.

Iran will one day be free and so will its women and minorities; the only way Mr. Ahmadinejad is going help in this process is by fueling the flames of the green revolution by being the stupidly arrogant sun of a bitch that he is.

Mr. Ahmadinejad does not realize this but he is like a frog enjoying the slowly boiling water that is the Iranian green revolution. He will one day be tried for his actions and the judge might well be one of the women that he subjected to imprisonment and rape.

Mousavi needs to act

Brave people deserve brave leadership, and so the besieged people of Tehran deserve to have their leaders share in their risks and sacrifices.
I know that Mr. Mousavi is under house arrest but if the few thousand people manage to get through the armed militias and police maybe he can try harder to join them.
Such a brave act would force the government's hand into arresting him, which would add another spark to this revolution.
Mr. Mousavi may turn out to be like Mr. Gorbachev, a catalyst for change but not destined to be the leader in the new age. Either way he needs to act and leave the rest up to the Iranian people. I hope he gets it that this is no longer about a desputed election--it's about regime change.

Iranians should be proud, Persian or Not

Most in Iran know that not all Iranians are Persians but most Iranians abroad insist they are. Perhaps it is because people might like them a little better if they associated them not with Iran but with ancient Persia.

Even as Iranians from all ethnic backgrounds fight and die on the streets of Tehran and other cities, some supporters insist on over emphasizing the persianhood of the people of Iran. This old inferiority complex was exaggerated by the bad reputation brought on by 30 years of the Islamic republic. In this day and age such thinking, regardless of its root causes, is at worst racist and at best narrow minded.

After the sacrifices and the extraordinary bravery of the Iranian men and women in the past few week it should be easier for most Iranians to use the word "Iran" without being ashamed anymore. Let us stop insisting on reminding everyone of our Persian heritage in order to entice them to respect us despite us being Iranaian.

Again, We are all Iranian but not all Persian. Afterall Mr. Moussavi himself is an Azeri Turk, and the young student who took a bullet to the head on the 20th of June was an Arab Iranian from Ahwaz; sadly he also happens to be my sister's brother in law.

Lets be proud of being Iranian again and stop pushing the "Persian" phrase all the time. Lets just pray that our brave country men and women in the front lines will keep on fighting for all of us, Persians and non-Persians.

Did I also mention how we need to distribute some DVDs to the masses and inform ordinary Iranians about our struggle?

DVDs maybe the key to Iran's Green Revolution

There is no doubt that the students and the facebook members of Iran are predominantly behind the fledgling green revolution. What is in doubt is the awareness and support of the millions of poorer Iranians with no access to alternate media. It is not clear if they are aware of the extent of oppression and killings by the government security forces on the streets. If the Media black out in Iran holds, the revolutionaries may remain cut off from the majority of the poor Iranians. Without those masses in southern Tehran and the provinces the revolution can not succeed.

In 1979 ayatollah khomeini, faced with a simillar Iranian media black out, spread his message from France through smuggled cassette tapes. The hope of the new Green revolution may lye in DVDs and CDs as even the poor with no facebook accounts have access to DVD players. Lets burn some DVDs and get the word out. There is security in numbers and this might help bring more people out to support the thousands of brave Iranians already on the street.

I was touched last night as I watched a clip of young demonstrators being charged by the police. As the crowd saw tear gas and smoke rising ahead of them they chanted "be brave, we're all together". With no one to help them and surrounded by so many security forces they are indeed brave as they only have each other.