African Business Ventures

Many of my clients are involved in international business ventures. This is a reminder that you don't have much time to attend. Check their website for more information and registration: www.africacncl.org.

Here is their press release:

2011 U.S. Africa Business Summit to

Showcase Huge Opportunities in Africa: Top African

and U.S. Business and Government Leaders to Participate

WASHINGTON – The African continent continues to show the world how to grow economically during one of the toughest global downturns in decades. To advance trade and investment flows globally into Africa, The Corporate Council on Africa (CCA) will convene the 8^th Biennial U.S.-African Business Summit in Washington, D.C., Oct. 5-7, 2011. The Summit is the premier event for finding and building partnerships with more than 1,200 government and business leaders from the U.S. and Africa, as well as from Europe, Canada and Japan.

A packed three-day event, the Summit will include over 32 workshops and plenaries, a trade expo and “The Vault”, a match-making program connecting projects and entrepreneurs with sources of funding. These events will highlight Africa’s most promising sectors, including agribusiness, infrastructure, energy, health, power and security.

Featured speakers include Elizabeth Littlefield, President & CEO, Overseas Private Investment Corp (OPIC); Hanna Tetteh, Minister of Trade & Industry, Ghana; Joe Oteng-Adjei, Minister of Energy, Ghana; Hage Geingob, Minister of Trade & Industry, Namibia; Bart Nnaji, Minister of Power, Nigeria; Akin Adesina, Minister of Agriculture and Rural Development, Nigeria; Erastus Mwencha, Deputy Chairperson, African Union Commission, and Susan Mboya, Group Director Eurasia & Africa, Coca Cola.

The Corporate Council on Africa is hosting on Wed., Oct. 5, a special opening gala dinner. Burkina Electric will perform their eclectic mix, and Somi will entertain with their sultry sounds. A fusion of American and African culinary classics will be served. The Summit program will be kicked off by a keynote address by one of the most senior-ranking U.S. Administration officials.

Since its inception in 1997, in Chantilly, Va., the CCA U.S.-Africa Business Summit has brought together heads of state along with other government and business leaders to engage in dialogue on U.S. and Africa trade as well as economic and political relationships.

“The nations of Africa are experiencing one of the greatest booms in business in the history of the African continent, and the Summit showcases these investment opportunities,“ said Stephen Hayes, CCA’s President and CEO. “The future of Africa is tied to the level of investment going into Africa, the last great frontier in the world for new investment and development.”

Attendees can meet potential business partners and learn more about the Obama Administration’s policy on Africa as well as details on the continent’s important position in the global economy. Participants will have the opportunity to network with key African and U.S. private sector and government representatives, identify specific growth areas and hear detailed information about projects that are ripe for investment. Additionally, they will learn about the latest financing options and meet numerous high-ranking African ministers.

CCA also offers country-sponsored Doing Business Forums, which delve into the trade and investment opportunities offered by specific countries. They begin with Kenya on the evening of Oct. 4, and continue on Oct. 5 with Nigeria, Zimbabwe, Ethiopia and Ghana.

Despite the current global economic downturn, African countries continue to experience above average growth and higher levels of investment across a diverse portfolio of industries. The International Monetary Fund estimates that gross domestic product in the 47 countries of sub-Saharan Africa rose 5 percent last year and forecasts growth of 5.5 percent in 2011. Hayes noted that global investment is beginning to pour into parts of Africa in amounts unimagined a decade ago. “The Summit connects U.S. business leaders with African business leaders, resulting in substantial new investment.”

U.S. Secretary of State Hillary Clinton noted at the 2009 Summit, “Today the question for all of us who care about the future of Africa is: What can be done to sustain and deepen the democratic and economic transformation that is now underway?”

Thirty-two major corporations and media organizations have signed on as sponsors for this monumental event. They represent the vast majority of U.S. investment in Africa and also include some of the largest African corporations and institutions.

About The Corporate Council on Africa

Established in 1993, The Corporate Council on Africa is a nonpartisan 501 (c) (3) membership organization of nearly 180 U.S. companies dedicated to strengthening the commercial relationship between the U.S. and Africa. CCA members represent nearly 85 percent of total U.S. private sector investments in Africa. The organization is dedicated to bringing together potential business partners and to showcase business opportunities on the continent.

Legal Documentary

I highly recommend Hot Coffee, a documentary that recently premiered on HBO. Hot Coffee is almost painful but if you are interested in truth it begins and ends in this film. Watching this documentary will give a complete and accurate overview of the civil side of contemporary American law. We will have to await attorney Susan Saladoff—who produced and directed Hot Coffee—to do a sequel to give an overview of the criminal justice system. But for now, Hot Coffee is the only documentary or fictionalized movie I am aware of that comes close to an accurate portrayal of the real practice of law in America today—as opposed to 30 years ago.

Beyond the "War on Drugs"

As a veteran pharmacist and attorney, I have a different perspective on how to mitigate societal problems in the United States caused by addiction and trafficking in illegal drugs such as heroin and cocaine. My readers are sophisticated and already knowledgeable regarding issues of substance abuse and the history of efforts by law enforcement to abate the problem.

I will not waste the reader’s time cataloging the well-publicized social ills attributable to drug addiction. Nor is it necessary to remind the reader of the many positive contributions that law enforcement makes to society.

President Nixon declared a “war on drugs”, created the DEA and initiated a series of long criminal sentences for illegal drug sales and use. Wars–even metaphorical ones–are extremely expensive and our country has poured billions of dollars into building more and larger prisons, hiring more DEA agents, paying off foreign governments to try to reduce drug production, covert warfare, etc. This has been an expensive failure that arguably has created more problems than it has reduced. The “war” focuses on reducing the “supply” side of the “supply and demand equation”.

Right now a large part of Mexico is embroiled in a war between rival narcotic traffickers that threatens to spread northward into the U.S. Border agents have been caught taking bribes from traffickers. This is what we know about. Our expensive prison system is overwhelmed with inmates including a large number who are there for marijuana use. Soldiers and law enforcement officers have been injured and killed, innocent bystanders have died too.

When it became obvious that the “War on Drugs” was failing, the government doubled down by adding asset forfeiture (seizure of money and property of sellers and users of illegal drugs). It seemed sensible at the time. The rationale was that drug traffickers are willing to risk long prison terms and even execution, because trafficking in illegal drugs is so lucrative. If law enforcement could seize the money, cars, boats, houses, bank accounts, etc. of drug dealers and even simple drug users, U.S. law enforcement could finally “turn the tide in the war on drugs”. This approach of asset forfeiture has not only failed to stop drug addiction and illegal drug abuse but actually has corrupted law enforcement and harmed our society. Why?

Presently, police officers observe drug dealers for sometimes years before swooping down to seize millions of dollars in assets accumulated by the drug dealer. All the while the drug dealer is operating, customers are overdosing, there is domestic violence in families and the other ills attributable to illegal drug abuse. Why wait years or even months? One could say it is to gather sufficient evidence to make an iron clad case but that might be naïve. Since law enforcement keeps 80% to 100% of the assets seized for themselves, a reasonable person might question their motivation. The reader can just Google “policing for profit”, “drug asset forfeiture abuses” and search the net and local newspapers for many stories of innocent persons being injured and killed during drug raids.

A more insidious problem with asset forfeiture is that the police have large amounts of money, a part of which is used to buy ever more lethal firearms, tanks, stun guns, grenades, flash bangs, black ninja suits and balaclava masks, helmets, helicopters and whatever else a salesman can persuade police officers is a cool thing to have in their arsenal. I submit that the very fact that police officers possess such excessive equipment makes it much more likely that police and citizens will be severely injured or killed accidentally. And just seeing the police rolling with a tank through a neighborhood with ski masks and black outfits is an affront to a civilized society.

Google this recent true story of actor Steven Seagal and publicity hound, Maricopa County Sheriff Arpaio using a tank in a residential neighborhood to knock down a garage, killing 50 chickens because they were executing a search warrant for suspected illegal chicken fighting! And yes, this was all filmed and will appear in Steven Seagal’s “Lawman” show! You can’t make up stuff this absurd. This excessive raid frightened citizens and the rumbling tanks broke home windows! The articles mention the frightened responses of neighbors living in this quiet neighborhood. Afterwards, the people in the neighborhood were shocked, outraged and ridiculed the police. Such heavy-handed tactics do not garner respect for government or law enforcement, but rather inspire fear, followed by resentment.

My approach to reducing illegal drug abuse/addiction

The smartest way to reduce drug trafficking and the societal ills caused by illegal drug abuse and addiction is to reduce demand for the product. Enlightened police officers, citizens and health professionals who work with drug addicts are uniform in recognizing that drug abuse/addiction is a medical problem that requires extensive and expensive medical treatment to rehabilitate the abuser/addict.

Prisons do not work for addicts without a real drug treatment program. Not only do people continue to use illegal drugs in the prison but turn right back to the same drugs or worse drugs when they are released. It is extremely expensive to incarcerate drug abusers. But most of you already know this, so what am I saying that is new? Read on.

Where a person’s only crime is use of marijuana, that person should not be incarcerated but should instead be directed for treatment and if punishment is required, community service and fines are more cost effective. With regard to dangerous hard drugs such as heroin, cocaine, methamphetamines, etc. then intense, effective medical treatment is mandatory.

The problem is the people who need treatment the most, do not have the money to pay for the needed treatment. My idea is to amend the existing asset forfeiture and seizure laws to take almost all of the proceeds seized to pay for real substance abuse and addiction treatment. Law enforcement should only receive the actual costs of arrests. In no event, should any individual members of law enforcement receive money or bonuses from the asset forfeiture.

Here is why my suggested amendment makes sense for society:

· The money taken from drug traffickers and users will be used to pay for medical treatment for addicts.

· Police will not have a financial incentive or motive to abuse asset forfeiture laws for their own personal or departmental financial gains.

· Law enforcement will be freed up to pursue other criminals, in particular, financial swindles that have cost the American public so dearly.

· As the number of abusers and addicts are reduced through effective medical treatment, the demand for the illegal drugs will be reduced and reduce the power and violence of narcotic traffickers.

· The number of people incarcerated and the expense to the taxpayers will be greatly reduced and there will be space for Wall Street swindlers to occupy in prison.

· Law enforcement officers and special op soldiers will have less need to put their lives in danger facing narcotic traffickers in foreign countries and at home.

· The reduction in the military style raids in neighborhoods will reduce accidental injuries and deaths to innocent bystanders as well as to repair the image of American law enforcement. No people in any country in the world has respect or loyalty to a regime where its police act violently and aggressively to its own citizens.

In summary, the law of supply and demand is primal. Since we cannot reduce the supply of illegal drugs we should try to reduce the demand.

RxNT.com Prescriptions

I never get bored with law practice. Something new always comes my way. Recently a client had an insurance company deny a certain number of prescriptions because the prescriptions were faxed to him by a company called RxNT. RxNT is probably not the only company doing this, but essentially they contract with doctors to handle their e-prescribing. The doctor apparently e-mails a prescription to RxNT and that company sends a facsimile of the prescription including controlled substances to the pharmacy. This presents a question of legality that I wanted to warn you about. While following this procedure does not present an issue with regard to non-controlled substances, it may be illegal according to DEA regulations when this facsimile is used for controlled substances. CFR Section 1311.170(f) states:

An electronic prescription must be transmitted from the practitioner to the pharmacy in its electronic form. At no time may an intermediary convert an electronic prescription to another form (e.g. facsimile) for transmission. (Emphasis added)

According to feedback, RxNT is quite active in this area and there are other companies doing this. I have contacted the DEA and reported this company’s activities so that they might investigate and hopefully have the company make changes so that pharmacists aren’t hurt. Doctors probably won’t be hurt by this practice, however, a pharmacy will be hurt because an auditing insurance company will have a justification to disallow the prescriptions for controlled substances and cause a potential for a large chargeback.

Clearly, this problem necessitates an emergency meeting with State and Federal authorities, pharmacists, and insurance companies to resolve this issue.

Think

If you think back over decisions you really regret, often the common denominator is that you acted prematurely. That is, you did not allow sufficient time to think about your decision before acting.

Often a person feels that there is no time to think and acquire more facts because someone has set an arbitrary deadline to pressure you into a hasty decision. The pressure may come from an employer, a friend, a Board, law enforcement or a scam business “opportunity”. There is always sufficient time for good advice from a lawyer who knows the subject matter.

Do not start connecting dots before you have collected enough dots to acquire the true picture.

Know who your real “friends” are. Call me before you call HPRP or decide you can talk your way out of a situation without a lawyer. If you are under emotional and time pressure, you are extremely likely to make a decision you will always regret. Asking co-workers, colleagues or friends for legal advice is a mistake. One, they are not lawyers and there is no confidentiality; second, they may or may not, be well intentioned and they usually don’t know what they are talking about.

Every week I hear a new story about a health professional following that free advice to a catastrophic ending.

I have a dollar for every time someone has said to me “I wish I had talked to you first.”

Good Press

The New York Times has a good article on the expanded role and opportunity for pharmacists to take in patients' health care. Not only is this good press for the pharmacy profession, but it can serve to inspire you to start or expand new areas in your practice. For example,

The idea of using pharmacists in this way began to gain popularity in 2006 when someMedicare plans started covering medication therapy management programs, paying $1 to $2 a minute to pharmacists to review patients’ medicines with them; this year, about one in four people covered by Medicare Part D prescription drug plans will be eligible, according to agency estimates. For example, a Medicare Part D plan covered Ms. Gelinas’s medication management session at Barney’s pharmacy.

More employers and insurers also pay for pharmacists to advise patients, a role that the new health care law encourages with potential grants for such programs. In Wisconsin, for example, community pharmacists and some health plans have banded together to create a joint program, the Wisconsin Pharmacy Quality Collaborative, to standardize medication therapy management and ensure quality care.

Meanwhile Humana, which first paid for pharmacists to work with Medicare patients, expanded its coverage a few years ago. About a third of the 62,000 pharmacies in its network offer these services, and the insurer says it is studying whether a pharmacist seeing a patient in person has more impact than a phone call.

Genetic Information Nondiscrimination Act

I will be discussing this issue in my upcoming newsletter. If you are interested in reading the entire Genetic Information Nondiscrimination Act (GINA), I link to it here.

Prescription Drug Disposal

Here is an editorial from the Bangor Daily News out of Maine. It addresses the steps that Maine has taken to try to limit drugs from being flushed or thrown out.

In 2004, the Maine Legislature passed a bill creating an unused pharmaceuticals disposal program. In 2007, the University of Maine's Center on Aging received a $150,000 grant from the U.S. Environmental Protection Agency for a prescription drug mail-back pilot program. Prepaid mailers were made available to the public through pharmacies and medical clinics. Unused drugs were to be put into the mailers, which went to the Maine Drug Enforcement Agency where pharmacists tabulated what types of drugs are being discarded. The drugs were then sent to a hazardous waste incinerator.

Painkiller Abuse

In the last 5 years, emergency rooms have seen a 111% increase in visits because of painkiller abuse.

Visits to hospital emergency departments for abuse of pain drugs more than doubled from 2004 to 2008, jumping from 144,644 to 305,885 visits annually, according to a study released last month by the CDC and the Substance Abuse and Mental Health Services Administration.

Environmental Threats

The threats to our environment never end, do they? A settlement was reached between Michigan and Birds Eye Food Inc. related to groundwater contamination because of a plant discharging contaminated water.

Numerous residents in communities where Birds Eye has sprayed say it has caused their wells to produce water that is discolored and foul-smelling, and has elevated levels of potential toxins such as arsenic and iron.

Under the agreement with the state, Birds Eye agreed to install a new $3.8 million wastewater treatment system and spray only during the growing season, the department said. At other times, the wastewater will be discharged to Fennville's municipal treatment works.

Also, the company will complete an investigation of the groundwater contamination and do what is necessary to fix it.

Birds Eye will continue providing bottled water to people whose well water doesn't meet health standards until Fennville completes an extension of its water supply network.

Where is the punishment? How much profit has Birds Eye made from this plant in all these years versus the few dollars they will have to invest to build a treatment system?

Medicare Bust

Federal authorities cracked down on Medicare fraud nationwide today across 5 states. Eleven were arrested in Michigan and 94 were indicted nationwide.

The local health care companies were located in Detroit, Livonia, Southfield and Oak Park.

From the Detroit Free Press:

McQuade and Detroit FBI chief Andrew Arena said economically distressed areas like metro Detroit are hot spots for Medicare fraud, which prompted McQuade to assign more people to prosecute such cases.

From the Detroit News:

"They prey on people desperate for drugs," said Barbara McQuade, U.S. Attorney for the Eastern District of Michigan. "Prescription drugs often are the benefit provided. They exchange stats that allow false billing."

A New Threat to Pharmacists

Britain will soon begin testing an automatic pill dispenser to be available in hospitals. However, the eventual goal is to have dispensing machines available for use by patients.

This is a dangerous and slippery slope for pharmacists. You cannot allow the profession to be seen as simply pill counters who can be replaced by machines. The video link used by the machine will connect patients with pharmacists overseas who will do your job for far less.

The machines would be able to dispense drugs at any time of the day or night. They come in two models, the paper reported, one holding 330 packs of medicine and the other 2,000.

Users insert their prescription into the machine and pick up a telephone to access a live video link to a registered pharmacist.

The pharmacist will check the prescription and ensure those who have to pay have done so before allowing the machine to dispense the drugs.

New CVS Controversy

Connecticut's Attorney General is investigating CVS' threat to drop a drug discount program because state law requires the lowest drug prices be for the state's Medicaid program.

[Attorney General Richard] Blumenthal, in cooperation with Department of Consumer Protection commissioner Jerry Farrell, Jr., has sent CVS Caremark a subpoena to explain why providing the discounts to the state Medicaid program would result in termination of its Health Savings Pass program in Connecticut and other information. The deadline for compliance is July 9.

In response to the matter, CVS Caremark said that it intends to "fully comply with all applicable legal requirements in this matter" and "will fully cooperate with the Attorney General's investigation."

Gone Fishing!

I will be out of the office until June 1. I am taking a long holiday weekend to enjoy some fly fishing at Sault Ste Marie.

As always, I can be reached in an emergency and Gina is at the office. Contact her if you have any questions.

Enjoy your holiday weekend.

CVS Caremark Editorial

Joseph Harmison, President of the National Community Pharmacists Association (NCPA), has an op-ed on The Hill website. In his piece, he praises the efforts of the Federal Trade Commission (FTC) and the many states investigating the unfair business practices of CVS Caremark.

In his piece, he names a group of bipartisan Senators and Representatives who have written letters on their constituents, both patients and pharmacists, behalf to the FTC. The Senators and Representatives include:

U.S. Senators Sherrod Brown (D-Ohio), Byron Dorgan (D-N.D.), Russ Feingold (D-Wis.), Amy Klobuchar (D-Minn.), Frank Lautenberg (D-N.J.), Mark Pryor (D-Ark.) and Roger Wicker (R-Miss.), and U.S. Representatives Michael Acuri (D-N.Y.), Robert Aderholt (R-Ala.), Marion Berry (D-Ark.), Jo Bonner (R-Ala.), John Boozman (R-Ark.), Judy Chu (D-Calif.), Lloyd Doggett (D-Texas), Jim Gerlach (R-Pa.), Walter Jones (R-N.C.), Larry Kissell (D-N.C.), Robert Latta (R-Ohio), Michael Rogers (R-Ala.), Linda Sanchez (D-Calif.), Jan Schakowsky (D-Ill.) and Anthony Weiner (D-N.Y.)

Note that this list of Senators and Representatives who have written to the FTC in support of their investigation does not include anyone from the State of Michigan. Contact your Senators and Representatives and remind them of how important it is to ensure fair business practices for everyone, not just the big corporations.

Tell them that you will watch how they act on this and take it into account when you are asked for campaign contributions or your vote.

In their letters, the Congressmen and women argued for,

“the FTC to reopen the CVS Caremark merger investigation and determine if the acquisition poses a threat of reducing competition or whether CVS is engaging in any unfair or deceptive business practices.”

Listed in Mr. Harmison's piece are these familiar problems,

This month, community pharmacists renewed the case against CVS Caremark and presented additional evidence to the enforcement agency. On one occasion, NCPA detailed CVS Caremark tactics that secretly boost the costs to health plans and profitability of its mail order pharmacy. Also brought to the FTC’s attention is how aggressive auditing is used to recoup funds from community pharmacies on minor technicalities.

Prescription Drug Use by Children

ABC News reports that prescription drug use by children has increased in the past year by 5 percent. Overall prescription drug use increased only 1.3 percent.

It is concerning that children are being treated with drugs normally used by adults, such as cholesterol fighters and Type 2 diabetes.

...they noted that more children are being treated with cholesterol fighters or powerful anti-psychotics normally used by adults.

DMC Story

Here is an article from NPR on the new DMC deal in Detroit.

A few weeks ago, officials with the Detroit Medical Center, the city's largest health system, made an announcement that was as startling as it was welcome: that they intended to sell the nonprofit to an investor-owned company. As part of the deal, Nashville-based Vanguard Health Systems promised to spend $850 million on much-needed capital improvements. If the deal goes through, hospital officials say it will be the largest single investment in Detroit ever.

CVS Caremark Lobbying Numbers

Businessweek has the numbers for CVS Caremark's lobbying.

$1.98 million in only the first quarter.

Its lobbying interests included changes to Medicare and Medicaid programs that were made as part of the health care overhaul. Those included the elimination of the "donut hole" coverage gap in the Medicare Part D drug benefit. CVS also discussed reimbursement rates for generic drugs, changes in coverage, and regulation on generic biologic drugs.

The company lobbied on antitrust legislation, along with disclosure requirements, employment, and training, and the Federal Employees Health Benefits Program.

Lansing Sues Retail Pharmacies

The City of Lansing is suing several retail pharmacies. It accuses the stores of violating a state law that covers the sale of generic drugs and overcharged city workers.

...city attorney Brig Smith alleged that Walgreens, CVS and Rite Aid violated a law that exists in three states, including Michigan, and restricts the amount of profits that retail pharmacies can collect from generic drugs.

CVS Investigation

CVS continues to run into problems. The company revealed that it is under investigation in 24 states because of its business practices. A primary focus of the investigation is whether CVS gave incentives for customers to transfer their prescriptions to CVS.

CVS Caremark Corp., the largest U.S. provider of prescription drugs, said its business practices are under investigation by 24 states.

The probe is similar to one that was started by the U.S. Federal Trade Commission last year, CVS said in a filing today. The District of Columbia and county of Los Angeles are also participating in the investigation, according to the filing. CVS said it’s cooperating with the investigations.

A multistate task force is reviewing the relationship and practices of CVS and Caremark following their 2007 merger, Connecticut Attorney General Richard Blumenthal said in March. The offices of the attorneys general of Illinois and Florida also confirmed in March that they were taking part in the investigation.

CVS also said it received a subpoena from the Office of Inspector General within the U.S. Department of Health and Human Services for information on incentives for customers to transfer their prescriptions to CVS’s pharmacies. Offers included gift cards, cash, non-prescription goods and coupons, according to the filing with the Securities and Exchange Commission.