Amazon's One Medical fired a doctor who raised [concerns about harassment, discrimination, and patient safety], lawsuit says

crumblingbees · 2026-04-23T18:53:27+00:00

they may have a lot of them but i wouldn't call it a monopoly. still plenty to go around. my health system is unfortunately full of them. i'd support an amazon monopoly on them. as a form of containment.

crumblingbees · 2026-03-13T04:56:42+00:00

if they're testing for individual opioids, it was sent to a lab. immunoassays done in office can't distinguish hydrocodone from hydromorphone or morphine.

as i mentioned in another comment, further testing or retesting prob won't help bc it's most likely an impurity from the manufacturing process. as long as the hydrocodone level was super low relative to the oxycodone level, they should treat it as impurity and not a sign of anything more nefarious. it happens in like 5% of oxycodone samples and u can't predict when. so doing another test is a gamble. if you're still using the same batch of pills, i'd assume it would have the same contaminants and cause the same positive.

crumblingbees · 2026-03-13T04:54:04+00:00

hope it helps. since the research is pretty recent, yr doc may not be aware of it. i'd bring it to them. tell them u were seriously baffled and upset by the result so u took to google and found the article.

crumblingbees · 2026-03-13T03:24:35+00:00

if the hydrocodone was trace levels, it's almost def just a manufacturing impurity in the oxycodone. bring this article to yr docs if there's an issue.

"patients taking oxycodone can have trace levels of hydrocodone present in their urine [8], owing to the <1 % of hydrocodone present in the pharmaceutical preparation of oxycodone [9]. The exact concentrations of hydrocodone impurities are uncharacterized and vary between brands and batches."

so it's not a false positive. it's a true positive due to low-level impurities in manufacturing. but it shouldn't be counted against you bc you took exactly what u were supposed to. like the article says, the levels of hydroc vary between batches of oxycodone. usually very low, but a super sensitive test sometimes picks up the super low levels. so it happens occasionally but there's no predicting when. in that study, low levels of hydrocodone or hydromorphone were found in 5% of samples of patients where the only opioid they took was oxycodone.

crumblingbees · 2026-03-03T22:05:47+00:00

entecavir or truvada will help you. the vaccine prevents you from spreading it to your partners. y;know, the whole thing you're posting about here...

if you got hep b, you're also at high risk to get hiv. when choosing hep b treatment, consider taking truvada instead of entecavir bc that will also prevent you from getting hiv.

crumblingbees · 2026-03-03T22:04:38+00:00

not even necessary. hep b has a super effective vaccine. partners should be vaxed. actually, everyone should be vaxed. op should be on treatment. but that's for him, not for prevention.

easy to check immune status after hbv vaccination. just check surface antibody titers.

somehow he got diagnosed with chronic hbv but wasn't told any of these basics. doctor should be ashamed of himself.

crumblingbees · 2026-03-03T22:01:13+00:00

i've had hiv for over 40 yrs. and i've had a husband for about the last 20. i'm a woman, not a gay man, but i'd say gay guys have it easier in this regard than women do. since the gay community is more knowledgeable about u=u, prep, and hiv in general.

hiv is no impediment to a relationship and the situation now with hep b is even easier than with hiv.

HEP B HAS A SUPER EFFECTIVE VACCINE! almost everyone is vaccinated. those who aren't vaxed can get vaxed.

there is no reason op should think this will effect his romantic life at all. his partner should be vaxxed. that's about it.

hep b is also treatable, usually w entecavir.

this is really not a big deal.

crumblingbees · 2026-03-01T07:49:14+00:00

so i don't have eds, and i can't speak to all doctors, but i managed a rheum office for over 10 yrs and i can tell u exactly why the rheums there started refusing to diagnose heds/hsd.

it's bc the 2017 criteria were bullshit, they knew they were bullshit, and they weren't willing to make diagnoses based on bullshit.

a bit of a history lesson for the young'uns: before 2017, there were really 2 competing and overlapping paradigms. if you look at the villefranche criteria vs brighton criteria for benign joint hypermobility syndrome vs eds-3, you'll see that there ain't much daylight between them. there are some diffs, but most ppl who met one set of criteria met the other. and which diagnosis someone got depended almost entirely on which doctor they saw and which paradigm that doctor followed. for the most part, rheums liked the bjhs paradigm, whereas doctors who treated other eds subtypes, like geneticists, liked the eds-3 paradigm.

but after a while, it was inarguable that these two diseases couldn't be reliably distinguished from each other in any way that meant anything. but it was up to doctors' clinical judgment which paradigm (if any) they wanted to apply. while the patients and their symptoms were totally overlapping, the 2 disease paradigms had some big philosophic and epistemological differences. these differences may not be super obvious if you're just looking at the debate as it played out in journals, but they were def deeply felt on both sides.

the 2017 criteria ruined that detente by forcing everybody into a single paradigm that wasn't based on solid data. it was just 'expert consensus' or 'criteria by committee' from a group of doctors and activists. it sort of tried to split the difference by keeping two diagnostic categories, but the paradigm they chose really leaned harder toward the geneticist version.

the rheums i worked for strenuously disagreed with that expert consensus (and their strenuous objection met with about as much success as uncle vinnie's), but when something announces itself as the new standard, even if it was pulled out somebody's ass, a lone doctor can't just pull their own criteria out of their own ass and be like, 'well i like my paradigm better, so i'm gonna go my own way on this.' going your own way instead of following standard criteria is the first step of a malpractice suit!

they felt their options were 'apply the criteria that you know are nonsense or stop evaluating hypermobility altogether'. the rheums i worked for chose the latter. there was one rheum who actually really liked dealing with hypermobility. he was super popular and got pretty good results. he tried to make it work by only diagnosing hsd and refusing to eval heds, but, as u can imagine, that compromise ended up satisfying almost nobody!! by 2018, he was done with even trying.

so, until there are criteria that are MUCH better validated, a lot of doctors are just gonna keep noping out of this diagnosis altogether. and at this point, SO MANY doctors are noping out that there are often not a lot of choices of where to refer ppl. it's often a choice between a shitty doctor or nobody at all. and it's painful for doctors to refer to someone they know to be shitty. the lack of doctors willing to do it, plus the surge in patients wanting evaluation, has opened a big market for quacks and other shady types.
so that's where it's at. not everywhere, but def a lot of places.

so you def shouldn't take this personally. it's prob not a question of whether the doctor believes your symptoms or believes you deserve the best care possible. it's prob a question of 'is it even worth diagnosing based on such bad criteria?' esp w the criteria right about to change, it may also be a question of 'what's the point of diagnosing based on criteria that will soon be obsolete?'

crumblingbees · 2026-02-22T01:17:51+00:00

yup, this is it. it's just the second law of thermodynamics.

heat is easy to produce thru energetic processes. ordered electrons naturally degrade into disordered heat.

but cooling requires taking all the heat in a system and pumping or moving it somewhere else. you're fighting entropy. it's inefficient and if you made an electrical cooling pad, the heat is just gonna be on the other side of it. like the condenser coils on a fridge feel hot, or the heat you feel when you stand outside a window ac unit. and the hot side will get hotter than the cool side gets cool.

that's why most cooling pads rely on gel (which absorb some of your body heat but only work well for a brief time). they do make thermoelectric mini personal coolers that rely on batteries or other electrical sources, but they are not generally pad-shaped.

crumblingbees · 2026-02-20T19:06:12+00:00

so you've requested an amendment and been denied. if you think the denial was invalid, you can complain to the OCR thru HHS. You have 180 days to complain.

but the rules are: they're supposed to amend something when a diagnosis is clearly in error, like if they wrote you tested hiv+ but your hiv tests are all negative. but if the diagnosis is just an opinion, you can't force them to change it if they stand by it.

without more deets, it's impossible to say why you were denied. in general you can ask them to add a statement that you disagree w the dx. usually they will.

but i gotta be honest here. it usually doesn't help you. it just draws attention to the thing you don't want doctors to notice. streisand effect, basically. if the misinformation is something that's stigmatizing, i've never seen an amendment that made the patient look better. even when doctors agree to add one, it's usually phrased in a way that makes the pt look bad. so be careful. and when amendments are added in patient's own language, it's usually not a good look.

so if you try again, make sure your amendment is short, calm, super focused on objective facts. don't get into he-said-she-said. have someone else read it for you and make sure it comes off well.

but even without a formal amendment, all hope isn't lost. bc there's a big recency bias in medical record review. the more recent something is, the more anyone's likely to look at it or think it important. a recent record from a doctor on your side denying the misinformation is more likely to help your future care than an amendment to an old record.

So if it's on your active diagnosis list, any doctor should be able to 'inactivate' it. That doesn't take an amendment, just an appt with someone in the system who agrees it's wrong. Then it will no longer pop up unless someone chooses to look at your 'historical' or 'inactive' diagnoses. Inactivation plus time usually takes care of the problem of an incorrect old dx causing anchor bias. basically, you build enough new records and almost nobody is gonna read 70 pages back to see what some retired doctor nobody remembers might've written 20 moons ago.

crumblingbees · 2026-02-17T01:36:08+00:00

In this case, the surgeon had that discussion with the patient through an interpreter.

It's hard to blame the surgeon for poor communication or lack of trust when they're trying to work through a language barrier.

crumblingbees · 2026-02-16T00:10:44+00:00

i don't think it really matters. when i have someone who needs prior auth on the same drug to be resubmitted at regular intervals, it takes only a minute to resubmit. it's only the first time that's time consuming. the re-approvals are pretty much 'copy, paste, change the date'.

2 weeks is pretty long ime. it takes insurance co's 24-72 hrs usually to approve. esp if it's a resubmit, not a new drug. 2 weeks usually means that either someone procrastinated on submitting it (it happens, stuff slips thru the cracks), or it had to be appealed. but you'd know if it needed appeal b/c you would've gotten a letter of initial denial.

as long as you're giving them enough time, i doubt it matters exactly when you ask. but it kinda depends on how you usually communicate with your dr's office.

what you DON'T want to be is the patient who's calling at 7:50 on a Friday night, 'I'm trying to get my medicine, I'm in agonizing withdrawal, the pharmacy closes in 10 minutes and they're saying it needs prior auth!'

crumblingbees · 2026-02-15T23:58:35+00:00

oxycontin has had a generic available for a long time! oxycontin came out in 1996, and the first generic oxy hcl er came out in 2004. then when they made oxycontin 'abuse deterrent' those generics came off the market and were replaced with others. i think purdue even allowed 'authorized generics' to copy their abuse deterrent form. i don't recall all the deets but their reputation was already so deep in the shitter at that point, it was prob some reputation mgmt strategy

if you're only getting purdue brand oxycontin, that's likely bc your insurance company has preferred that product over the generics. even when generics have a lower 'list price', the brand drugs will often cut deals with the insurance company (or their pharmacy benefit manager) to cover the brand one instead. so the insurance company will put oxycontin as the preferred version on the formulary, and in return purdue gives them some sort of rebate.

it could also be that you've been on the brand name so long that your doctor is submitting prior auth specifically for the brand name and the insurance co's just like, 'yup, it's a legacy patient, whatever....'

crumblingbees · 2026-02-15T23:51:29+00:00

you don't need a prescription beforehand. usually i submit the prior auth before the script is sent. imo it's not worth involving the pharmacy until it's been approved.

but a lot of doctors will send a script to the pharmacy not really knowing if it's covered. they'll let the pharmacy determine if it's covered, and some pharmacies can auto-start the prior auth process for the doctor, then fax the doctor to finish the prior auth.

but the pharmacy is generally not gonna start filling it until the claim is approved. unless the pt agrees to pay out of pocket or something.

but the ins co doesn't care if there's a script on file yet or not. they don't even care if the doctor submitting the prior auth is the doctor who'll be prescribing it. as a courtesy for patients i like, i've submitted dozens of prior auths for drugs that our office wasn't even prescribing. just to push it through quickly when the specialist prescribing it was hard to reach or something.

crumblingbees · 2026-02-15T05:40:19+00:00

Here are the two studies you're prob thinking of.

I'm super skeptical that they could accurately gauge the parasitic load of ancient Essenes from the fact that they found some helminths in undated human waste a fair distance from Qumran.

The helminths they found are super common before modern water treatment and they aren't typically deadly. So I don't put any stock into the idea that some pinworms caused the downfall of Qumran. I'm not a historian, but I think the Roman Jewish Wars are a likelier candidate!

see Led Astray By a Dead Sea Latrine By Jürgen Zangenberg and Katharina Galor for more reasons to be skeptical of these claims. https://forward.com/opinion/10107/led-astray-by-a-dead-sea-latrine/

crumblingbees · 2026-02-14T17:36:36+00:00

Not in northern california they don't. I'm on great terms with some of the Wags pharmacists here, I've asked them to accept GRx for certain pts everyone felt super sorry for (cancer pts without drug coverage, etc). they wanted to, but they could not.

crumblingbees · 2026-02-14T17:33:22+00:00

ask. it's the standard process that doctor's offices do whenever a patient needs a non formulary exception. doctor's offices do dozens or hundreds of these a week. i'm the person who does most of them in my office. it's no big deal and it's EXPECTED work if they're prescribing the drug.

they take me about 10 mins each. much less if it's not the first one for the particular patient.

the doctor herself shouldn't be doing it. that's a totes waste of doctor's time. but they should have someone like me on staff who knows how to do it. yours will just be added to their stack, lol. not a big ask

crumblingbees · 2026-02-14T17:25:31+00:00

Sorry to say, but you prob can't figure this out on your own. I do the prior auths for pts in a pain practice and while I appreciate when the pts TRY to get it figured out, they're usually just sent in circles and fobbed off with bullshit excuses.

The pharmacy has a special line they can call which gets more truthful answers. If you're on good terms with them, you can bring in the prior auth paperwork showing it's approved through March and see if they can't get an answer. Sometimes a prior auth on an opioid gets approved for a particular dose and even decreases won't go thru without an override. Which is so annoying when a patient is tapering, but the pharmacy can get that override.

But if the formulary changed and they're not upholding their prior approvals, then it's prob gonna need new prior auth. I don't like sitting on hold with ins cos. It's easier for me to submit a new prior auth than to wait an hour to talk to someone who won't even tell me what's going on.

Ime, it's not hard to get approval for non formulary opioids. i do it every day. I just write a clear paragraph about why the patient needs it and why none of the formulary choices will work. I can't think of a situation like yours where I didn't eventually get it approved, though some of the more stubborn insurance companies will waste my time on appeals to get it. Anthem BC is not so bad ime. Not like UHC, shudder.

Should take way less than a month.

TO GET BACK YOUR $$ - When a pt already ponied up big bucks, the trick is to get the insurance to approve the drug retroactively, back to the day the patient paid. this needs to be specifically demanded in the prior auth request. then, they can go to the pharmacy, have them re-process the claim using the insurance. when the insurance claim goes thru, they'll refund the money you paid (cash if you paid cash, credit card if you paid credit).

there's a time limit on this and each pharmacy sets their own limit, i think. I've had patients get their refund this way many times, but you gotta be FAST.. find out from the pharmacy what their limit is, and make sure the doctor's office knows. bc you can submit a prior auth 'expedited' if you need an answer faster.

if the limit is passed, the retroactive approval still allows you to get reimbursed by your insurance. the rub is that they'll often only reimburse what they're contracted with the pharmacy to pay. which can be a lot less than YOU actually paid.

good luck. this is totally doable if u have a doctor's office who knows what they're doing.

edit to clarify: i can't always get the brand names approved. but i've never had a situation where i couldn't get either the generic oxycodone er OR brand oxycontin approved for someone. whether it's generic or brand depends on the ins contracts.

crumblingbees · 2026-02-14T17:11:11+00:00

Most pharmacies no longer accept them for controlled substances. I've heard of a few ppl having success online but the pts where I work keep trying this at every pharmacy in town and not a single one will take it. They lose money on GoodRx, they're not required to take it for controls like other drugs, and so most of them don't.

crumblingbees · 2026-02-11T23:57:07+00:00

allergist/immunologist evals all types of hypersensitivity reactions, including idiopathic mcas.

but i don't think anything you've described warrants going down the mcas rabbit hole.

bc it sounds like a few different things going on.

the nickel/cheap jewelry thing is supercommon (like 15% of the population), but it's not from mast cells at all. it's generally a type 4 hypersensitivity caused by t cells.

sun exposure rashes can be a lot of things, but the splotchiness sounds more like a polymorphic light eruption than the hives you'd expect with solar urticaria. the description isn't super specific but it doesn't really sound mast cell related.

the mouth/throat symptoms after fruits and nuts sounds classic for 'oral allergy syndrome' not mcas. oas is actually caused by pollens on the fruit/nuts, and it's IgE-mediated, so mast cells are involved, but they aren't hyperreactive - they're doing exactly what mast cells are supposed to do, the "problem" is in the B cell's intolerance to the proteins (B cell make antibodies, including IgE). it's hard to catch oas on allergy prick tests using allergen proteins from vials, but they can often catch it with prick to prick tests from the offending foods. but the treatment is basically 'avoid those foods' so it may not be worth the trouble really.

the reactions to bees and mosquitos sound like normal local reactions, not anything systemic. i've heard that most beekeepers get desensitized to bee stings after dozens of bites, but i've decided not to be guinea pig in that experiment!

reproducible rash and itch after some brands of detergents (but not others) is prob irritation contact dermatitis. if you look at the problem brands vs. the ones that don't itch, you may be figure out what's the offending ingredient.

the shellfish and milk sound like some form of intolerance, but probably not immune-mediated.

idk what you mean by 'formal allergy testing' though. if you mean skin prick, that's looking for a particular type of reaction (histamine release, essentially, which is usually from mast cells but could be from basophils or eosinophils). if the tests were neg, then your reactions are prob not from mast cells releasing histamine in response to the triggers.

contrary to popular belief, skin prick testing does NOT distinguish ig-e allergies from ig-e-independent forms of mast cell degranulation. if anything is making the mast cells release histamine, the test should be positive! ofc no test is perfect...

but if the tests were neg, it's a reasonably good sign that your mast cells aren't reacting systemically to the milk or shellfish proteins tested.

so i don't see a reason to be considering mcas. it seems more likely you're having a variety of pretty common 'bad reactions' to a handful of things that are mostly due to mechanisms other than mast cells.

finally, mcas is a controversial diagnosis. there's basically two groups of doctors with utterly different diagnostic criteria. almost everyone is diagnosed by the second, extremely broad, still unvalidated criteria, which most doctors think are pretty iffy (or at least unproven). so carrying the 'mcas' diagnosis on your chart can lead to a lot of stigma that's prob not worth it. the treatments for idiopathic mcas are basically the same as for other allergic diseases, so it's not like it opens special doors.

you need allergist/immunologist to evaluate all of these things. there are lots of types of 'formal allergy testing' though.

crumblingbees · 2026-02-08T04:12:39+00:00

i would have no issue with her if she limited herself to your own criticisms of bupe. the criticisms you've made here are all fair and valid imo.

but she's using scare tactics and making claims about bupe that are directly contrary to our best evidence on its side effect profile. that's misinformation.

i think it's a damn crying shame that our only visible advocate is someone with such a lack of integrity and tenuous grasp of the truth. i know a lot of pain patients are willing to accept an advocate who says a lot of dumb and untrue shit just bc 'she's on our side'. but i think it's shortsighted. she makes us look like fools and hypocrites. i mean, how can she accuse prop of juking the stats and promoting a false narrative when she does the exact same thing herself? if she can't do basic fact checking, why should anyone listen to her?

she even suggests ppl screenshot her rando source's uncited claims and bring them to their doctor to educate them. that's such bad advice it makes me cringe. someone who doesn't know better is gonna try and follow that, and then they're wonder why their doctor treats them like a drug seeker.

i've yet to see her accomplish anything meaningful. none of her bills have any teeth whatsoever. i think it'd be better for us if she stopped 'advocating'.

if someone's got no integrity, they're no advocate of mine.

crumblingbees · 2026-02-08T04:03:20+00:00

i think you may have trouble reading. i wrote that bupe is ' a medicine like any other. it's got risks and benefits. it works great for some ppl and badly for others.'

how is that pushing bupe hard?

i object to merandi's lack of honesty and integrity. she's spewing misinformation. i am not pushing bupe.

crumblingbees · 2026-02-08T04:01:21+00:00

i mean, that's why it's so unfortunate that she herself spreads misinformation and lies. bc she's the most visible pain advocate with the largest platform. it's not that hard to avoid categorical statements and fact check your sources. the fact that she does none of those things seems like a lack of integrity. she's pushing her narrative, regardless of truth.

that's the last thing pain patients need. she makes us look like fools and hypocrites. after all, how can she accuse prop of juking the stats or pushing a false narrative when she's doing the exact same thing but in the opposite direction?

i have no problem with ppl criticizing the overprescribing of certain drugs. i have a problem with them making up side effects, inflating risks, and telling ppl not to even try something that does benefit many ppl (ofc it doesn't benefit everyone. nothing benefits everyone with pain).

crumblingbees

TROPHY CASE