Archive for the Dr. Joseph Harris on Politics and Medical Category

Death Planet Hep C!

Posted in Dr. Joseph Harris on Politics and Medical on July 30, 2017 by playthell

 

“Cure ‘em, then Cut ‘em Loose!”

Dr. Joseph Harris, MD

 

I’d seen jaundice, “serum or infectious?” the old heroin addicts use to ask.

I remembered Mr. Fitzpatrick, the conductor on my father’s train. Jovial older Irishman, hard drinker, his grey hair turned increasingly “Blonde”. “Drinks too much” my father shrugged.

I’d see a sad cat with ashen skin  waiting on line in the welfare office, “Public Assistance’ Elderly Boriken women murmured “Brujo” and “Diablo “. His eyes were ‘icteric’, lemon yellow, nearly florescent.

A Typical Case

I remembered an old man sitting on a Paterson Houses bench. I’d cut through the Projects on my way to clinic. A Buddha smile, his lean frame and dark skin reminded me of my grandfather, except for his huge Buddha abdomen. He looked pregnant, 9th months. The cat was my age. Me and him could have shared the same $1 works, 60’s or 70’s era shooting gallery. The difference between him and me was someone had cut my heroin with “pure D” luck as my addict uncle used to say.

Would  hepatitis C hand me a similar fate? It gnawed in my belly each day. The Summers morning heat began waning, the bench became empty and peaceful like an ancient Mosque or Temple. The old brothers spirit seemed to linger in the cool shadows like a kindly sentinel.   I never saw him again.

Swollen Stomach from Hep-C

The USA prison system is currently undertaking a grand, historic,  yet unofficial experiment.  The “US Prison study of Untreated Hepatitis C in the Incarcerated Male and Female ” as I’ve christened it, involves over 700,000 patients.  The “Tuskegee study of Untreated Syphilis in the Negro Male” involved over 600 patients.  The Tuskegee Study was largely secret, the Prison study is public.  Both were guided by the same Med-Crime against Humanity: DENIAL OF AN AVAILABLE CURE TO AN AFFLICTED OPPRESSED POPULATION FOR NON-MEDICAL REASONS.

Black Men Infected with Syphilis at Tuskegee Alabama
 
Human Ginuea Pigs Circa 1932

At the onset Tuskegee program had a ethical and moral basis, observation of a barely treatable condition-“Syphilis” or “Bad Blood” for a limited period wherein disease progression would be observed, after which informed patients would be treated with the Pre- Penicillin medications. Patients weren’t informed of the diagnosis nor treated until 4 decades later when a worker finally exposed it.

In the “US Prison study” patients sit in cells, recreation halls, exercise yards, solitary confinement, even death rows as their livers and lives smolder away with deadly, unrelenting, inflammation fire. Torture. Like walking under a Viral Sword of Damocles, 24/7. “When will my liver flip to Cirrhosis?” 5 years? 10 years? One year like Mumia?” How many inmates have anxiety intensified by the conditions of confinement? Victims of the reality that life in American Jails and Prisons ain’t worth a nickel or as was stated under oath, by DOC’s expert “Doctor” Jay Cowan, “$90,000”?

The “US Penitentiary Hepatitis C experiment” includes subjects from all community groups including African-Americans, Latin Americans, Undocumented workers, gay, straight, lesbian, transgender, Euro-Americans, political prisoners.  Planet Hep C is truly post-racial. Mumia Abu-Jamal has reported Trump-supporting Alt-Right, and White Supremacist inmate types thanking him because his fight saved them. He spoke of amusement as some pepper him with questions and how it opens up deeper discussions on class and race. Many of the patients reported being told by snarling white guards “Now we got to treat you. All because of Mumia”. The jailers are lamenting the high cost of cure that could result in layoffs instead of death.

“The number of US residents who have been infected with hepatitis C is unknown but is probably at least 4.6 million (range 3.4 million-6.0 million, and if these at least 3.5 million (range 2.5 million-4.7 million) are currently infected; additional sources of potential underestimation suggest that the true prevalence could well be higher.” (Edlin Br, Eckhardt et al-Hepatology, 2015 Nov;(5) emphasis added). Many patients aren’t aware of their diagnosis and many patients declined testing especially prior to 2011 when Hepatitis cure rates were generally dismal ranging from 15%-80% depending on the virus genotype, genetic predisposition to cure (IL28B allele etc). Social stigma played a role as well especially prior to the availability of new effective medications. “Why get tested when you can’t cure it?”

Comorbidities (HIV/Hep B) and life style (ethanol intake), exposure to hepato-toxic are important factors in disease progression, as well as with drug or medication use.

“In the United States HCC is the fastest growing cause of cancer-related death. The incidence of HCC in the United States has increased in recent years, largely attributable to a significant rise in hepatitis C related HCC… it is estimated that in 2013 there will be 30,640  new cases diagnosed hepatitis C –related HCC (Hepatocellular Carcinoma) and 21,670  deaths due to hepatitis c-related HCC.’(Hepatitis C Online-http://www.hepatitisc.uw.edu)

170 million patients worldwide have hep c. It hits poorer countries hardest especially India and Egypt. Egypt’s rate is 14.7%-26% and approx 11.5 million afflicted. (Ahmed Elgharably, Asmaa, Gomma-j. Gen Med. 2017;10: 1-6.). It resulted from vast anti-Shistosomisis campaigns of the 50-60’s when unsterile syringes were used. Similarly mass vaccination of US ‘Baby Boomers’ was the major contributing factor to the US epidemic. Other Risk factors include exchange of body fluids, transfusions, IVDU with needle sharing, increased numbers of sexual partners. Despite the markedly lower cost of the medications ($68 is the current lowest price reported for a complete 84 day course) it still remains out of reach for masses of Egyptian and Indian patients.

“The burden of hepatitis C is much higher in Corrections compared to the general community. In the late 90’s the…CDC – Center for Desease Comtrol – estimated that 16% to 40% of prison inmates were seropositive for  hepatitis C…Seroprevalence data only account for the numbers of individuals incarcerated on any given day and do not account for the movement in and out of correctional facilities. Approximately 30% of individuals with hepatitis C infection in the United States pass through the correctional system in a given year.” (Hepatitis C Online-Http:www.hepatitisc.uw.edu/go/special-populations-situations/treatment-corrections/core-concept/all. Emphasis added)

The high numbers reported are unreliable. ‘Reluctance to systematically perform hepatitis C testing …newly highly effective, well tolerated, short-course all oral regimens will markedly increase the number of inmates eligible for hepatitis C treatment. Unfortunately the extremely high cost of new all-oral regimes will make it increasingly difficult to garner the financial resources to actually treat the much broader number of inmates eligible for hepatitis C treatment. This changing landscape means that cost of therapy for hepatitis C in corrections will become an even greater barrier in the coming years” (Hepatitis C Online, op-cit emphasis added)

Prison medical protocols are deliberately designed mainly to deny cure as many stricken inmate as possible. Typical is the case of Mr. Abu-Jamal who despite being a “baby boomer” wasn’t tested until 2012 with  confirmatory Viral load was at last performed over 3 years later, only after conditions related to his hepatitis C resulted in his waking from a coma shackled to an ICU bed after falling into a coma.

In 2013 an 18% Hepatitis C antibody prevalance in 100,000 inmates was reported for the Penn. DOC Yet only 6,000 reportedly had chronic disease, half of the expected number 12,000 (.8 x 18,000). Most inmates (by design: see below) never get confirmatory viral load confirmation. This is a generalized finding in Correctional Healthcare Systems. This study alone excluded over 30,000 inmates due to missing date of birth, etc.

In Abu Jamal Vs Kerestes,  the district judge, the Honorable Robert Mariani, ruled that denial of cure for Hepatitis C, regardless of the patients’ clinical status, violated 8th amendment protection against cruel and unusual punishment. Like “Brown vs. Topeka” outlawed Jim Crow, Abu-Jamal Vs Kerestes and its consequences may indeed represent the end of Prison medicine as we now know it.

Medical malpractice, wrongful medical death and injury litigation will challenge (in paradoxical ways) the domination of American healthcare by Big Pharma and the unsustainable and inhumane combined systems of medicine and incarceration for private profit. It’s emblematic that in the midst of a major national debate on the system of health care in the US the implications of these rulings don’t seem to have been appreciated by either the bourgeois press or the legislative bodies themselves.

(Already Federal Judge N. Laughrey extensively cited Judge Mariani’s in her ruling for inmates in Postawko v. Missouri Department of Correction-5-11-2017).

The Hepatitis C crisis in the prisons and in the general population is a like precision drone strike on the central contradictions of medical care and incarceration in capitalist America.

 

Big Pharmaceutical profit vs. Human Life:

For the first time in modern Medical history a infectious, eradicable disease is being left untreated due to the ‘fiscal constraint’ dictated by the open drive of private capital for private profit .  It has resulted in significant numbers of tragically avoidable mortalities:

“Even though they acknowledged that thousands of patients might have to go without the treatments…The company assumed that fewer patients would be served would be served as the price rose but overall revenue would keep rising until price reached above $96,000”. (Gilead harmed patients by overpricing it’s drugs, but did it miscalculate?-M. Hiltiis-LA times 12-01-2015).

“Thousands” or “fewer” patients in the Penn DOC who likely were horribly sacrificed for the higher good of Gilead’s “overall revenue,” whose “miscalculation” resulted a price rise yet higher to $96,000. Hepatitis C previously known as “Non A-Non B” prognosis remained unclear until late 90’s. As anti-retroviral medications dramatically improved survival of HIV/HEP C confected patients, Non-opportunistic mortality rates exploded as HIV patients began dying from complications of their hepatitis C, cirrhosis HCC-hepato-cellular carcinoma and other non-hepatic conditions.

Hepatitis C has 6 genotypes (1-6) as well as sub-types.  Genotype 1, prevalent in the USA, had a poor cure rate, particularly among African-Americans whose genetic predominant variations (IL28B allele, etc) made cure markedly more difficult. Cure rates ranged from 15-50 percent depending on patient genetic variation and co-morbidities esp. HIV and hepatitis B. Other genotypes such as 2 and 3and had a cure rate closer to 80% especially for European-Americans.

Alpha-Interferon, the first  treatment available, generally required 3 weekly injections for 48 weeks . Side effects and duration made treatment, especially patient compliance daunting. A new formulation, once weekly injected Pegalated Interferon with Ribavirin doubled cure rates to the 15-20% range for African-Americans and over 50% for Euro-Americans. Later NS4A, NS3/4A protease inhibitors (Telaprevir and Bocifivir TDK)) were complicated (one hepatologist called them “Talmudic”), costly, with many side effects and were taken generally for one year. It must be noted that in general, treatment with or without- SVR (Sustained Virologic Response or cure)- slowed progression to AdvLD. (Cirrhosis, decompensated cirrhosis, Hepato-Cellular Carcinoma, etc). (Teleprevir was discontinued in 10/2014).

Complex algorithms, side effects, cure prognosis, estimated inflammation score and disease staging were central for an effective treatment plan. A Shakespearian quandary, “To treat or not to treat” was for years debated in educational conferences, research papers and Medical Journals articles whether to “Treat now or wait for new medications”. There were no clear cut answers.

Between late 2013 through 2014 a new series of medications DAA’s- direct acting anti-virals- were approved. Cure rates for most categories including patients who had failed previous courses skyrocketed to over 90% and in most categories nearly 100%. It was the most gratifying experience in my medical career. The 4-week lab results of my first patient receiving the 2-pill regime of Solvaldi and Olysio: Undetectable.

I rushed out of my office and shared the results to my staff. Everyone became elated, festive even. Most of the workers came from the South Bronx community and had firsthand experience with the infection from family and friends. We’d actually cured something!  Not stabilized, relieved, improved, or controlled.

Cured

I began a crash program; educating my patients on the new DAA’s and strongly encouraged them to all start the lab work and the prescription for the medications. An initial challenge was getting the for-profit HMO’s to ante up.

Elation was quickly tempered with the bitterness of betrayal. I was played; all US physicians were.  Big Pharma could have taught Iceberg Slim himself a trick or two in the way it “turned-out” the most powerful ‘guild’ in America, transforming its members into shameless whores for the Pharmaceutical industry.  For years I told anxious patients that good prospects for new medication, relatively intact liver functioning without apparent significant damage, made ‘active surveillance” or close monitoring likely the best course. The Big Pharma bosses turned medical doctors into a band of sniveling snake oil venders – myself included. The Eden of Hepatitis C cure was in sight when a Seraphim’s flaming Capitalist sword of profit bared the way forever (for some).

I wasn’t trained for this. My “King James” Bible of Internal Medicine was Harrisons, not a dividend book. Until several years post-residency I didn’t even know the prices of the medications I prescribed. With the exception of extremely expensive drugs like Vancomysin. The quality of the medications and clinical experience, judgement and training alone determined my diagnosis and treatment. That soon changed. The patient’s insurance provider, her or his HMO, now was the supervising physician.  The benevolent stethoscope, white jacketed MD was vanquished with the pock marked face of privatization, profit and doom.

Capitalist medicine: “Your money or your life” or better still, “No Money? No Problem! Die of cirrhosis, cancer, or bleed to death motherfucker. Or if credit rating permits get a drug “Mortgage”. (Buying costly Drugs on The Installment Plan: Could it work? 03/28/16-NPR-Michelle Andrews)  Denial of Hepatitis C cure for ‘fiscal’ reasons of private profit, isn’t similar to the denial of a ‘cosmetic or an ‘elective procedure’. Mass denial of cure is responsible for at the minimal several deaths daily in the US prison system and America as a whole.

“Even the Guilty Deserve Justice”

Cirrhosis death is ghastly. Pain, disfiguring abdominal swelling, yellow skin-Jaundice-irreversible renal failure (Hepato-Renal syndrome) are its hallmarks. Pruritis-itching-unremitting is maddening to the point of suicidal ideation. There’s also hepatic encephalopathy, where unprocessed neurotoxic metabolites and ammonium accumulate in the central nervous system, leading to obtundation, confusion and death.

Epidemiology of Death

In place of a cure, prison medical systems throughout the country have continued using protocols based on outdated treatment modalities. Previous to the availability of the DAA’s treatment “Priorization” were based on low cure rates, degree of liver scarring, virus genotype, genetic character of the patient etc. A patient with a relatively intact liver, yet was concerned over his diagnosis, understood the side effects and wanted to be treated, they were generally treated at least for 12 weeks when a check of the viral load determined if a full course was justified. In my clinical experience I can’t recall patients being refused only on the basis of an overly healthy liver. No “prioritization” schemas existed at all for genotype 2 or 3 patients.

The new “Prioritization” protocols are only Rationing

 “Sick people are dying in this country because of these markups, then this company doesn’t pay its taxes…(they’re) booked in Ireland…. Veterans who are dying are being turned away from the VA and other places because they say they can’t afford this…” (Jeffry Sachs- Morning Joe 10/11/16)

“The problem with Sofosbuvir is that Gilead is currently leaving millions to die both in the US and abroad…(Gilead’s) actual production cost is $100 or $1 per pill…   “… Around 170,000 people have been treated with Solvadi, this is about 1 per 1,000 of HCV-infected individual patients worldwide. In short, Gilead is making a fortune through astronomical pricing of Sofosbuvir…” (The Cure for Gilead”- Jeffery Sachs-Huffpost Blog 08/03/2016)

Hepatitis C + Prison + Capitalism = Death

In America, 700,000 incarcerated patients have Hepatitis C. An unreliable figure as to date no national epidemiologic evaluation exists. State and Federal Prison policies rang from generalized testing, ‘op-out’ testing, (right of refusal) to no consistent testing policy at all. Viral loads to determine chronicity are typically done years later if at all. Of the 80% of patients with chronic disease 5-6% yearly will annually develop AdvLV (advanced liver disease-cirrhosis, decompensated, cirrhosis, (HCC ).  Therefore, even with the unlikely assumption that no patients had Cirrhosis at the onset of the study, approximately 600-720 (12,000 x .05 and .06) annually go on to AvdLD. “The median survival of compensated cirrhotics has been reported to be 9 to 12 years” (Karla Thornton, MD, PHD-Hepatitis C online).

Annual progression to decompensated Cirrhosis is 3-6%, to HCC it’s 1-5%. (Journal of Hepatology Volume 6-, Issue 1-‘Natural history of hepatitis C’ Westbrook et al). Therefore, in the between 2004 and 2012, between (TDK) patients (.03 and .06 x 12,000) annually advanced to decompensated cirrhosis for a calculated total of 144-345 for the 8 year period. As the DOC has approved no liver transplants in the above period, the calculated mortality depending on the existence of bleeding esophageal varices and ascites approaches 50% annually.

So statistically up to (TDK) patients have un-necessarily perished in the 8 year period 2004-2012. (A Mortality report issued by the DOC reported a total of 37 deaths between 2015-2016. Thus aprox 19 annually deaths which would approximate the statistical prediction above (.5 x 18-44) between 9 and 22 deaths from decompensated cirrhosis alone. As above a DOC mortality report of at least 10 mortalities in 10 weeks in 2015 giving an annual rate of approx 50 yearly which in broad agreement with the calculated mortality above.

*******************

Most alarming are the implications of mortality rates. With US annual death rates close to 20-30,000 and with the estimated percentage of prisoners in the US being 30% as above the calculated death rate should be between 7-10, thousand. Thus weekly 140-200 US inmates perish from an infectious easily curable affliction. 20-30 men and women daily die miserable unnecessary deaths.  Already this year Federal court judges in Missouri and Pennsylvania ruled it cruel and unusual punishment. An idea of the numbers of incarcerated patients dying is given with the Penn DOC’s Death records from Jan-March 2015. In 10 weeks 10 patients died from liver disease and its complications. It is reasonable to assume that the majority if not all were secondary to hepatitis c infection.

A typical example of this sleaze is the Pennsylvania Department of Correction protocol. At a recent federal hearing the DOC’s leading Physician admitted that no patients had been treated in over 2 years, as they were in the process of developing a “protocol” for the newly released DAA medication. This Protocol was so shameful DOC lawyers citing other pending legal challenges franticly demanded Judge Mariani order it sealed.

One article reported approx 100,000 inmates tested (With 30,000 patients excluded due to missing data such as birthdates, etc.) 18,000 were determined to be hep C positive. However only approx. 6,000 had chronic Hep C. (Epidemiology of Hepatitis C virus in Penn. State Prisons-2004-2012, Larney, Mahowald et al AM/ J Public Health 2014-June) This number is nearly 7,000 patients lower than expected by statistical projection, -14,400. (.80 x 18,000).

Likely many Viral load confirmations were missing due to openly expressed aim of “limiting” patients in demanding a cure. In Abu-Jamal Vs Kerestes, the patient had a positive HEP C anti-body as early as 2012 but confirmatory Viral load was ordered 3 years later and patient got cure only 5 years later after Mr. Abu-Jamal had advanced from a mild or mod fibrosis or scarring to stage F4 cirrhosis or severe scarring. This is indefensible from a Medical-Legal point of view and in case of litigation would likely be settled out of court.

Mumia And Dr. Harris

Rescued From an agonizing Death by Cirrosis

The Penn DOC in the face of Mr. Abu-Jamal’s cure is typical of the ongoing response made by most Correctional Facilities. Lies and falsehoods.  DOC spokeswoman Anne Worden inaccurately reported that Mr. Abu-Jamal had met DOC Criteria for treatment and that 250 patients annually would be cured.  (Observers in the facility question whether treatment is actually being carried out). For over a decade the DOC performed voluntary testing or “Op-Out.”  Ms. Worden reported that the number and identities of patients who opted out were never recorded. Thus, the Penn DOC has no accurate count of the number of infected inmates.

Due to the massive increase of incarcerated elders and rates of disease progression it can be reasonably estimated that between 15-20% are cirrhotic. For the Penn. DOC number of pre-existing cirrhotic should approximate 2,888, (.2 x 14,440). With the estimated progression to AdvLD (advanced liver disease) overall at approx. 5% for annual increase of approx. 700. (14,000 x .05 ) . So, in the two years the DOC treated no patients from 2013-2015 (Dr. Noel court testimony) nearly 700 additional patients have advanced to decompensated cirrhosis which would entail transplantation or death.

Even calculated for the lower reported prevalence of the of approx. 5-6 ,000 progression .05 x o6,000. For example, in one study in the NEJM, the progression to AdvLD (Advanced Liver Disease) ranged from 1.6% (<45 year olds) to 4.4 and 5.2% (45-64 and 65+year old patients respectively). In the progression from cirrhosis to Decompensate was 5.1%, 11.5%, and 8.8% in the <45, 45-65 and 65+ year cohorts, respectively. Curing 250 patients yearly it would take over 20 years only to cure 6,000 inmates and factoring disease advance and new infections the DOC will only slow down but never stop the increasing number of inmates with the disease. This is without calculating those groups needing immediate treatment regardless of the degree of liver scarring-HIV and Hep B co-infections.

In another study chronic hepatitis c progressed to AdvLD (compensated and decompensated cirrhosis, Hepatocellular ca) at an annual rate of 6.5%. Thus in just the 2 years alone the lowest number of patients, (assuming that no patients had pre-existing advanced liver disease at the onset) nearly 360 patients (.06 x 6000) yearly would have significant disease progression. Thus the DOC’s promised annual cure of 250 inmates will never achieve eradication even assuming an nearly impossible “best case” of no pre-existing cirrhosis patients.

Therefore as all US prison systems are rationing cure due to “fiscal considerations” dictated  by private profit, the numbers above indicate the  astronomical costs of new infections and care for the 6.5% of patient advancing to AdvLD.  Transplantation (over $250,000-$1,000,000 each) dwarfs the current medication price. (In the Penn DOC no patients have reportedly been evaluated for a possible liver transplant, despite DOC mortality reports indicating numerous cases of death due to AdvLD). As inmates and families of deceased inmates, initiate litigation the legal costs alone for these potentially prolonged legal/political battles would bankrupt many State Correctional Facilities and HMO’s. A Tsunami of wrongful death and malpractice suits looms and like many other crisis’ of decaying capitalism is being willfully ignored in the current congressional debate on American health care.

The US prisons have been transformed into openly cruel and inhuman Death Camps. The calculations above indicate strongly that rates of death will increase yearly.  Two of the Medical officers Dr Jay Cowan and Dr Peter Noel involved in the Abu-Jamal vs. Kerestes expressed this in emails worthy of the T-4 “Life not worthy of life” outfit of the Third Reich.

 

‘We should also take into account the quality of life of the patients as a factor in treatment…” (Emphasis added). Wrote Dr Cowan devilishly devising yet more obstacles for patients to overcome for cure.  To ‘life expectancy’ the only factor considered in the accepted treatment guidelines he introduced a sinister new quantity, “Survival Benefit” was introduced as a major factor in the decision to cure adding certain diagnosis and co-morbidities as justifications for denial of  cure. Thereby rejecting the recommendations of all governing organizations for hep C (AASLD, CDC, BOP, Pennsylvania Medicaid) who have held that the only condition under which cure would be denies is life expectancy of less than one year due to non-hepatitis co-morbidities.

Dr. Cowan created new obstacles for inmate eligibility. in addition to increasing life expectancy from 12 to 18 months as criteria for treatment. Under oath he maintained that “Survival Benefit” was only “Life Expectancy” contradicting several email communications laying out the treatment recommendations mentioned above. This is perhaps unsurprising for a Medical Director at Rikers under whose callous watch over a dozen inmates perished of medical neglect. Other patients needing immediate treatment, yet denied include patients with HIV or Hep B co-infection. These patients weren’t listed as ‘high priority,’ nor even acknowledged all, in the DOC’s protocol.

 

Currently the ruling class response has varied only in its degree of cruelty and medical incompetence. As with Hep C testing, a spectrum of treatment protocols and cure exists for the 100’s of thousands of currently infected inmates. The Federal Bureau of Prisons and New York State Department of Corrections have been slightly more appropriate, while other states are refusing all inmates. Some states have added a moderate number of inmates to its Medicaid rolls thereby using federal funds.

This systematic denial has produced a skyrocketing number of individual and Class action suits for treatment and damages.  Abu-Jamal vs. Kerestes. Is being called the “Brown vs. Topeka” case for Hepatitis C. Judge Mariani unequivocally called for cure of all infected patients under 8th amendment rights. However, the Pennsylvania Department of Corrections has continued their appeal to maintain their death dealing protocol. Proclaiming falsely that Mr. Abu-Jamal had now become eligible due to his F4 cirrhosis prior to examination for varicies with EGD (esophageal endoscopy).

For nearly all prison health systems it’s been a stalling operation treating small numbers of severely ill inmates or none at all and ‘rope-a-dope’ for the rest. Using outdated recommendations and guidelines, inadequate testing patients to avoid diagnosis’, denial of cure on the basis of outdated and unethical recommendation, withholding treatment indefinitely for inmates incurring prison violations such as Cannabis, illicit drug use, tattoos, “behavioral problems” regardless of levels of liver inflammation or scarring.

Thus penalty for cannabis use for the incarcerated men and women (Whose prevalence is nearly 2x that of men) is ongoing suffering and probable death. This cruelty is unprecedented in Modern Medicine with the possible exception of the Medical Services of the Third Reich.  How many patients have experienced painful, disfiguring, humiliating deaths for the demands of Big Pharma. and private profit? Gilead. whose price of production actually runs about .02 to 2.00? (See Jeffrey Sachs above). Nearly all of the research was gov’t subsidized and entailed significant tax refunds for the Pharma. companies involved like Gilead. Who as Jeffrey Sachs reported above is not paying tax anyway.

Hopefully the Big Pharm bosses themselves will pay for the miserable deaths and suffering they’re inflicting on thousands. Justice would entail 100% expropriation and long penitentiary sentences. Suspended death sentences as well? Perhaps those investors in private prisons will be consoled with the fact that they might be profiting from their own incarceration as an acceptable ‘conflict of interest’? When the right to cure for all is won and the Big Pharma bosses will hopefully receive the humane care they denied so many others. Not ending up like a black elder smiling and dying on a Bronx Project bench.

Then Death Planet C will become Planet Cure.

End of Part One

**********************

 

Joseph Harris MD

07/30/2017

Harlem, New York